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I live in N.Ireland and have been through all available treatments here. The only medication that gave me any hope was Nardil but when on it my BP dangerously low. I found out about various treatments by using the internet but the doctors here are unwilling to try them. At the minute I am waiting to go to a hospital in London which specialises in treating refractory depression. As I have no one to discuss things with here I would like to hear from anyone with experience of combination medications and also psychosurgery. I seem to know more about these treatments than the doctors here, and that makes me feel as if I am on my own.
Answer:
Some psychiatrists (at least in North America) are willing to break 'from the herd' and will use a small amount of d-amphetamine in conjunction with Nardil (or other stimulant-MAOI combo). This is usually reserved for only after everything else has been tried, but your's sounds like just such a case. The reason why this comes to my mind in reading your situation (e.g. Nardil producing problematic low blood-pressure...) is that the amount of d-amphetamine (which, as a side effect, usually produces a _rise_ in blood-pressure) to use in this combo is sometimes determined in accordance with the two drugs' net effect on the patient's blood-pressure. For example, my own doc considered trying a d-amphetamine-Nardil combo on me (although, for unrelated reasons, later changing his mind) and at that time explained to me that since the two drugs have opposite effects on blood-pressure, he would decide what dosage of d-amphetamine to use by closely monitoring my blood-pressure while introducing, and then cautiously increasing the dosage of, the d-amphetamine until my blood-pressure became increased back to its normal (prior to treatment with Nardil) level. Mixing d amphetamine is an unnecessary risk for treatment resistent depression. The best choice of medications for treatment of recalcitrant depression is OPIODS. THEY ARE VERY MUCH SUPERIOR TO MIXING AMPHETAMINE WITH MAOIS. If you can find a decent doctor and document to him the number of meds you have gone through, the list of opiods to try is a long list. You could conceivably start with a weak opiod agonist and change to more potent ones as you attenuate. It would be important to find a progressive doctor. It would be even more important to provide your doctor with enough information so that he will not get in trouble for doing this. He may fall under scrutiny from FDA. They thing about opiods is that they almost never fail to treat depression. Prozac is 6 for 10. Morphine is 999 for 1000.
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