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Treatment for Imipramine-Resistant Depression

Imipramine (Tofranil) is a tricyclic antidepressant prescribed to treat major depression, attention-deficit disorder and other mental conditions. While effective for many people, imipramine may not work for every type of depression. Fortunately, there are many treatment options for imipramine-resistant depression, a few of which include SSRI and SNRI medications, stimulants and herbal remedies like St. John's wort.

  1. Common Antidepressants

    • Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed class of antidepressants. According to JoinTogether.com, one in 10 U.S. women takes an SSRI like Zoloft or Prozac. Drugs in this class work by preventing the reuptake of serotonin--a neurotransmitter that affects mood, appetite and other functions. SSRIs are considered the first line of treatment for depression, because they are least likely to cause side effects.

      SNRIs are similar to SSRIs in that they affect levels of serotonin in the brain. In addition, they selectively target norepinephrine, a neurotransmitter implicated in mood disorders like depression. Drugs in this class include Effexor, Cymbalta and Pristiq. Atypical antidepressants like Wellbutrin and Remeron may be effective when SSRIs and SNRIs have failed. Though their mechanism of action is not well understood, they appear to provide relief from depression for some patients.

      Medications from the MAOI, tricyclic antidepressant or antipsychotic classes may also be prescribed to treat imipramine-resistant depression.

    Unconventional Treatments

    • In addition to serotonin and norepinephrine, the neurotransmitter dopamine is thought to play a role in some forms of depression. According to Biopsychiatry.com, stimulants increase dopamine levels and may be helpful in treating depression when it is caused by dopamine insufficiency or dysfunction. Because they can cause addiction, stimulants are generally considered a last resort for the treatment of depression.

      Tramadol is another option for treatment-resistant depression. It has both opiate and SNRI properties, making it doubly effective in treating some forms of depression. While this two-tiered approach can work well for some people, tramadol is not frequently prescribed for treating depression due to the risks of addiction and abuse.

    Herbal Remedies

    • St. John's wort is among the most popular herbal remedies for depression. According to NewHope.com, it is as effective as SSRI medications at treating mild to moderate depression, often with fewer side effects. Because it is not regulated by the FDA, procuring a consistently high-quality source of the herb can be challenging. When buying St. John's wort, choose products standardized to contain a specific amount of the active alkaloid hypericin.

      5-HTP (5-Hydroxytryptophan) is another natural option for treating depression. Derived from the Griffonia simplicifolia plant, 5-HTP is a serotonin precursor thought to work by increasing production of the neurotransmitter in the brain. While the evidence for 5-HTP isn't as strong as for St. John's wort, it remains a top-selling herbal remedy for depression, weight loss and other serotonin-related conditions.

      Other herbal remedies popular for their potential mood-brightening effects include SAM-e, DHEA and Korean ginseng.

    Warning

    • Supplements can change the way certain medications affect the body. To avoid unwanted interactions, talk to your doctor before trying an herbal remedy for depression. If your depression symptoms become severe or you have thoughts of suicide or self-harm, seek medical attention immediately.

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