instruction: hello doctor my 19 year old son is suffering from major depression and has been on at least four different medications eat and ketamine treatments eat and the ketamine seem to show the best results so far but are short lived and I hate to keep shocking his brain if this is not going to work he has completed 10 sessions now all I have been doing is research on how to help him because I know his doctor has only one hour with him every two or three weeks where I am with him every day for hours I ran across an article about using tramadol to treat depression and I was wondering if taking this every day would produce the same or near same effects that the ketamine treatments do but over a longer time right now he is on cymbalta 90 my rexulti 5 my wellbutrin 150 my hydroxyzine 50 my as needed clonazepam 5 my as needed
output: hello resistant or long standing depression needs treatment with a mood stabilizer that has not been given the list on ongoing medicines I would recommend that you add a mood stabilizer like divalproex sodium or lithium carbonate it will help hold the mood in place once it has been elevated by antidepressants also cymbalta is not a very good antidepressant it is the least potent among sari serotonin norepinephrine reuptake inhibitor class of drugs normally after this you can try using a tea tricyclic antidepressants class of antidepressant and if that does not help then a combination of venlafaxine and mirtazapine is highly effective it is also been evidenced by star trials the largest clinical trials for resistant depression this is also my clinical experience in addition to the primary antidepressant sari or sari or tea and the mood stabilizer also an atypical low dose antipsychotic will augment the efficacy of the antidepressant such as 50 to 100 my of amisulpride or my of aripiprazole etc so there are a lot of options available which have not been tried and I would request you to consider these first in addition to the ongoing therapies and finally do not use tramadol daily that would lead to an opioid type of dependence and ultimately worsen his depression