Treatment resistant depression?

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Hi!
I'm new here and this is my first post. If someone has any advice I would be very thankful.

I'm 32 years old and have had depressive symptoms and a lot of anxiety since I started school. I sought help maybe six years ago. First I was diagnosed with depression but my therapist believed there was something more to it and did an assessment. I was diagnosed with Aspergers after that and then with borderline personality disorder maybe two years ago.

The depression is rated severe. I have had several suicide attempts in the past and those thoughts are always present. I have anxiety on and off, enough to make every day stuff difficult. I have self harmed a lot to deal with everything, but I don't do that as often anymore.

I have periods when I'm more upbeat, have more energy, make a lot of plans, spend a lot of money and such things but they are short and few, but it does make me wonder if there can be some sort of bipolar issues going on?

I have had cbt, dbt and ect. I've learnt a lot by being in therapy but the depression is still there. Ect gave me pretty bad side effects memory-wise. I've tried pretty much every group of medications there is, so my psychiatrist have sort of given up, he can't do any more. I only have some benzo I can take if it gets too difficult.
I have been inpatient a lot for suicide-watch basicly, most of the time against my will.
I worked full time until maybe five years ago, now I don't work at all.
I know about, and try to follow, all the basic stuff, exercise, sleep and all that. I struggle with the food part, because I don't like cooking and and have a lot of phobias regarding food.

I don't know what to do next. Does anyone have any idea of something I could try?
Thanks for taking the time to read!

The primary issue is stress and the ability to shed stress. I would recommend a type of therapy called Somatic Experiencing. You might begin by reading a book called "In An Unspoken Voice" by Peter A. Levine.

All the therapies you mentioned are behavioral. But it is common to female Aspies to be masking to the extent that you don't recognize your own emotions and then, when those emotions get messed up, you have no tools to deal with them.
What helped me was quite a deep therapy starting with childhood memories and dreams and slowly uncovering my real emotions. It hurts, I'm facing all of my demons but it lets me see clearly and discover I actually do have a healthy intuition. Recognizing my own emotional patterns, the great toil of my sensory issues and how "normal" social interactions drain me... and that my "loving" family was actually quite dysfunctional – when I can see these demons, I am also able to protect myself from them.
But you need a really good therapist for that, finding one is kind of hard.

Lots of energy and spending much money indeed fits bipolar. I've heard lithium helps. You can try.

Do they have medical ketamine infusions in sweeden(popular in the US for severe depression and there are some in Canada)? Or medical cannabis? Maybe psilocybin too?, there are studies showing it can help treatment resistant depression.

When I asked the former counselor Jeanne Courtney, what treatment refractory depression was, she l, as usual, had the nerve to squeak "what?"



Masters in psychology. 60 years old. Not only does she not know how to "help", all that stupid b***h know how to do, is annoy

The first time I had depression I was 13. Diagnosed 21

What is so bad about depression?

Is mania any better?

You mentioned you tried lots of meds but you didn't say if you tried marijuana. It helps some members here with depression & anxiety. Might be worth a try depending on where you live. I'm wondering if you tried the med Buspar. It's specially for anxiety but not a benzo. You have to take it regularly thou. It's in a different class than antidepressants(one other approved med in it's class & the other med is only approved in Japan & China) so maybe that's why lots of docs & psychs overlook it, at least in my experience they do. I never even heard of it till I started doing research for anxiety meds that weren't antidepressants or benzos. It can be taken with most other psych meds including benzos. It helps my anxiety lot.

Thank you so much for your replies!

jimmy m, I'll look into that book.

magz, what you describe is very much what I've experienced earlier in my life. I've had a great deal of luck regarding therapists, and these past three years they've helped me label what emotion I'm feeling and basic understanding in why we even have emotions and a lot of other stuff. I still struggle with accepting emotions, I don't want to feel them and I don't trust my emotions or impulses at all.
I'm glad to hear that you managed to work through therapy, and even though it hurt, it was helpful for you.
I've tried lithium, it made my mood shift in a very different pattern that I've not experienced before but it didn't have any real good effect overall.

Noca, there are trials here with ketamine right now, but otherwise not legal. Cannabis and psilocybin is also illegal.

nick007, marijuana is illegal where I live, and aside from being illegal I have too much social anxiety to have any way of getting hold of that. I'll look into Buspar. I have a vague memory of the name but I don't remember if I ever took it or if it was only mentioned as an option.

I wish there were some way to battle this without medications though. Really, I only wish the bad downs just went away, and that I could have some sort of stability.

Have you tried Tianeptine? I know its available in some European countries but not over here. It works through a different mechanism than other antidepressants, might be worth a try. Also what about Kratom? is Kratom legal in Sweeden? It is an herb that can help treat depression and you can find it online.

Have you tried MAOIs such as Parnate or Nardil? In my experience when a doctor says they tried everything they are usually full of baloney and there are options they are aware of but can't be bothered to volunteer simply because the doctor themselves has given up. The doctor should never be the first one to give up.

Noca, thank you very much for all your suggestions, I'm researching them the best I can to se if there is some of those available here in sweden so that I can try them. Thank you so much for your help!

I'm a bit dissapointed in my doc atm so I'm considering switching to someone else, since he no longer seems interested in trying to find something that works.

This is my understanding of bipolar:

Bipolar Disorder, formally called Maniac Depressive Disorder (MAD), is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). When your mood shifts to mania or hypomania (less extreme than mania), you may feel euphoric, full of energy or unusually irritable. When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. These mood swings can affect sleep, energy, activity, judgment, behavior and the ability to think clearly.

Individuals can relive past traumatic events. The unused excess stress energy is stored within the muscles and nervous system. When the stored energy reaches the body’s capacity, it can trigger a massive uncontrolled release producing the mania or hypomania condition. And one of the reasons is that when you do these kinds of relivings or flashbacks, there's a tremendous release of adrenaline. There's also a release of endorphins, which is the brain's internal opiate system. In animals, these endorphins allow the prey to go into a state of shock-analgesia and not feel the pain of being torn apart. When people relive the trauma, they recreate a similar neurochemical system that occurred at the time of the original trauma, the release of adrenaline and endorphins. Now, adrenaline is addictive, it is like getting a speed high. And they get addicted not only to the adrenaline but to the endorphins; it's like having a drug cocktail of amphetamines and morphine. And after the stored stress energy is depleted, their body crashes into depressed state. The effects of coming down from a speed high are: feeling restless, irritable and anxious, aggression that may lead to violence, tension, radical mood swings, depression, paranoia, lethargy, and total exhaustion.

I think treatment-resistant depression is more responsive to medications than other therapies, but, of course, them can help very well. Some psychiatrists ate encouraging prescribing mood stabilizers, nmda-antagonists and stimulants too, because depression is a very complex thing, and in some, serotonergic drugs don't work well. They have been focusing in other neurotransmitters which play a role, such glutamate and dopamine, and habits/life changing. Although not as well, but psychotherapy always help a bit. I have trying some "supplements"-like stuff, like N-Acetylcysteine and Phenibut, which can help sometimes, acutely.

Personally, I've been depressed at least since I was eight. Never found a cure. But I can't leave it alone. I think its a contributing factor to some of my executive functioning deficits.

Symptomatically, it seems to be tied to issues of self-esteem, motivation, and socialising.

So I'll probably work on tackling those weaknesses, maybe quit gluten too.

Took drugs about 25 years ago for depression. Didn't help much. Don't want to go down that path again.

It reminds me of my experience with bipolar 2.

For me hypomania felt like having increased energy and capacity to do multiple tasks and chores in a day. Elevated mood, but less self control, spending more money that I should. I also needed very little sleep, about 3 hours. Sometimes I would also get very irritable, especially if things didn't move fast enough.

In my case, it was easy to treat.