QUESTION:
Dear Dr. Heller,
Dr. Heller, I am a 22-year-old college student who has been diagnosed with chronic major depression (the depression first came on about 3 years ago). My symptoms include chronic fatigue, extreme difficulty with concentration and organization, despondency, mood reactivity, and hypersomnia (have been sleeping 10-11 hrs. a day). I have undergone trials of Zoloft, Paxil, Remeron, and Wellbutrin with little success. The SSRI-class antidepressants have been the most effective, but have done little to resolve the fatigue, sleepiness, and concentration problems.
Recently, I did some research at the medical library at my school and discovered that one treatment option for refractory depression is the use of stimulant meds to augment SSRI's. It seemed from what I read that this strategy is extremely effective for treatment-resistant depression, and especially so for those who show symptom patterns similar to my own. However, my doctor, and then my psychiatrist, were both adamantly opposed to this treatment strategy because of risks of tolerance, abuse, psychoses, etc.
My question to you is this: How do you feel about this treatment strategy and the associated risks? Might it be a viable treatment option for someone like me who cannot find relief from anything else?
Any advice would be greatly appreciated.
ANSWER:
I usually reserve the use of psychostimulants for depression to the elderly and those
adults who are having a very difficult time with their depression. Almost all of my adult
patients who respond to stimulants like Ritalin also have attention deficit disorder.
While potential problems from the stimulants exist, they are a relatively low risk option.
I'd recommend you do the
screening test I use for my
patients, since treating all the diagnoses usually makes the depression go away.
