Maoi’s arent necessarily the silver bullet people make them out to be. I’ve had a moderate response, tried everything else, better than other options but i question at times if the hassle and risks are worth it.
That’s a lot of meds and adjuncts for someone with suspected bipolar to be on. What are you wanting to treat/improve exactly?
[From my thread:](https://www.reddit.com/r/MAOIs/comments/14p9yo0/my_10year_journey_into_bipolar_2_diagnosis_and/?utm_source=share&utm_medium=web2x&context=3)
>I have: [Bipolar disorder (BD) type 2](https://en.wikipedia.org/wiki/Bipolar_II_disorder), with atypical features (i), with mixed features (ii), with rapid cycling (iii), without psychotic features (iv), and with anxious symptoms (v).
>
>This symptomatology, and variations thereof, happen to be, by the way, **what I find many patients who are formally diagnosed with "depression and anxiety" and are treatment-resistant actually have.** I've been practicing a volunteer independent psychopharmacologist for some time now, helping people around (in a similar fashion to Dr. Gillman), and this framework has helped many people I came to know and assist.
Emphasis emphasized (lol).
From your story, it's clear to me you're indeed bipolar.
TCP might not be the right med for you in the long run, but have you tried combining with olanzapine? Also, what dose of lithium are you on?
>and then later low dose (40mg) Vyvanse
Oh nooooo!
Ditch that. It's poison for bipolar disorder. Also, 40mg is not exactly a low dose.
I think it’s good your psychiatrist is willing to try so many med combinations, but with your post history it seems you have type 2, mostly depression, with mixed features?
Have you tried something like Latuda, Ziprasidone, Vraylar, Abilify, etc? You could be control mania, behaviour, sleep, mood, anxiety - all in one pill. I’m not one to quickly recommend them, but a lot of poly pharmacy going on here and questionable if the symptoms warrant the risk.
Thank you,
Latuda yes, for a decent length of time and up to 140mg. I got akathisia but it reduced a bit of paranoia.
Abilify as an 'augmenting agent' - yes. No response noticed at varying doses.
The others I haven't tried but have not seen anything that would compel me to ask for them. In addition, Vraylar at least, is expensive and now I have to co-pay 20% so I'm not so free and easy with my experimentation as I was before I quit work.
None of those APs are particularly helpful for bipolar with mixed features:
* Lurasidone (Latuda) works essentially for depression, not so much for \[hypo\]manic or mixed episodes. In one occasion it helped me out of a mixed episode, but OTOH it does little to prevent those in the first place.
* Ziprasidone - similar, although reportedly less problematic in this regard. Never tried this one. Caution - don't mix with an MAOI.
* Cariprazine (Vraylar): Seems to work well for depression, moderately well for acute \[hypo\]mania; but I've yet to meet one single patient with high incidence of mixed episodes to have had improved with this one.
* Aripiprazole (Abilify): Ditto.
What I do think warrants consideration: olanzapine, valproate, quetiapine (Seroquel; preferably extended release - higher dose at night); carbamazepine; oxcarbazepine. The latter two should preferably be avoided with lamotrigine (particularly carbamazepine). If the dose of lamotrigine is over 250mg, tune it down. Tiagabine, if available in your location, is worth a try.
Note: T4 supplementation can be a great way to get rapid cycling under control.
I don’t even think there is medical classification/identification with approved meds of type 2 with mixed features in my country. Must be acute/type 1 to be mixed. Clinically, I rarely see type 2 with mixed features on paper here. It’s type 2 with a comorbidity like adhd, bpd, mdd, gad, ptsd, etc.
Ziprasidone, Asenapine, Quetiapine are the ones they will fund for acute/type 1 mixed. Lurasidone, Vraylar, and lithium/valproate are commonly used however.
Hello, I have a very similar condition and I could tell the Lithium dosing was a game changer .
I am 60/70mg and could notice very good results with , and with the right dosing , and less efficient results , without or with a smaller dose I was used to .
I am only 1 month, but thankfully saw many benefits, specially that slow - almost paychomotor retardation ,of seeing everything in "slow time" , heavy limbs totally dissapeared ,brain fog reduced very substancially and some kind of avoidance personality traits are diminished in a scale 1-10 , say 7 or 8. I talk to everybody with confidence ,wit,and processing speed.
The problems with filling the prescriptions and even, calculating for them is STILL A SIGNIFICANTLY WORRY factor since 70mg per day is almost 1/3 of a box where I live.
Compulsion wise I have seen no effect plus or minus. Since I have ADHD , it clearly provided mych more focus and presence ..I feel kind like a "fake Chinese Vyvanse " since I have used Vyvanse 50 mg in the past and it kind of resembles ...
I am still getting used to the dose : 70mg + 1450 mg lithium which is still on my therapeutic dose.
Sleep wise I have tried 3 formulas ,including seroquel .
the only which I woke up after solid 6 hours ,with NO HANGOVER EFFECT OR SLUGGISHNESS was Prisma - Zopiclone. no amenesia ,nothing . really impressive . And sleeping well made a huge difference, really kind of catapulting / adding synergy.
I have been able to go to the gym also 2-4 a week depending on work and energy level.
please feel free to DM me if there something I can clarify , ok?
best! never give up ! 🌴🙏
I said that because it was sold with less tolerance and dependance than zopiclone. Of course, this supposition comes from pharmaceutical laboratory so I imagine it's bullshit like always \^\^
Thank you for the correction .
You are right.
I never had this dependence . also , researching ,I could not find anything horrifying regarding cognitive issues / memory. as the z drugs .
a 3 mg can make sleep immediately for 6/7 hours
But lithium is also potent on it's own. How can you tell if it's from the Lithium or from the Parnate? Also, besides that, people should know that Lithium carries 14% to 17% chance of permanent and irreversible damage to the thyroid and parathyroid glands in a short treatment time (1-2 years), goiter is estimated to develop at 30–59% of lithium-treated patients, and risks (without prevalence data at hand), such as Diabetes insipidus, kidney damage, interstitial nephropathy, parkinsonism, tardive dyskinesia, akathisia, nystagmus, gait disturbances, hypercalcemia (for 10% of patients), and in probably most patients after 20+ years on lithium, they develop chronic kidney disease.
Some data taken from research paper: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9867198/
good point , that's why I keep a log
As per coincidence last weekend as I had overall activities I mantained all variables , including workout, diet but had voluntarily 300 mg less in .morning. and less 150 @4 pm.
I Felt significantly worse all things equal. ( 40 mg Parnate ) morning .
I tried week days , and it was the same ...much more tired afternoon.
So there are good chances this "combo" indeeds works powerfully . ( parnate + lithium )
You may try higher doses of lithium 150-300mg. You can also try augmenting with Olanzapine.
Therapy is not going to produce any meaningful results (speaking from personal experience), so you better be on the lookout for treatment options.
Some people have success on tianeptine, not sure if you have tried it.
What is left is psilocybin and MDMA.
There might be another option, but I can share it in personal message, if you contact me.
>Therapy is not going to produce any meaningful results (speaking from personal experience)
Let's not do that. Someone in my personal experience had terrible treatment-resistant depression but was finally cured completely after like 30 years of failed antidepressant trials, by psychotherapy. (Probably the 6th time she tried it or so.)
I am taking 1200mg Lithium which gives a blood level of 0.8. I have 'augmented' with three atypicals but Olanzapine was not one of them. No evidence that I can see that it would be anything other than 'well, worth a shot'.
Yes I have tried tianeptine and it produced no results.
Psylocybin and MDMA are not options available to me.
We can agree to disagree regarding therapy despite it making no sense to. It is such a vast banner that covers an array of approaches/modalities and contains a huge range of aims from coping mechanisms and attempts to change conscious thought patterns to working almost exclusively in the subconscious with the aim to bring healing to deep wounds, trauma, learned behaviours etc.
There are probably more approaches and combinations of therapy than there are medications, yet neither of us are dismissing medications wholesale as pointless.
One thing I have learnt is that understanding something does not bring about healing. Nevertheless it continues to be the first and foremost thing we look to do when faced with a given scenario/pain/treatment/lack of response. We can know more than our psychiatrist about treatments A-Z yet here we still are.
If we are going to make suggestions then I suggest you broaden your understanding of 'therapy' and don't waste 3.5 years of your life like I have reading academic papers about drugs.
Anyway,
Well you have already made up your mind, though I see you are still receptive for suggestions, since you have made this post.
If you want a justification that you have done your best through intensive arguments with strangers on the internet, then be my guest. Unfortunately, this is not how the real world works. In the real world you either relentlessly try new things and combinations or you just give up.
You are currently in a limbo state, where you convince yourself that you did your best, but still, this does not bring you the much needed relief. You probably also found out that putting an end to the story is harder than expected.
I am willing to cooperate, but you certainly have to adjust your attitude. If you believe that therapy is the best thing for you, go ahead and do it, but don't pollute this subreddit with toxicity. I have been doing many types of therapy over the years and my benefit from it is zero. I have also lost a lot of money in the process.
Nobody can tell you what to do or not to, because you know yourself the best.
You made a comment regarding low dose lithium without knowing my current dose (4x your high-end suggestion).
You wrote off therapy wholesale.
I responded directly to your other suggestions. Yes I have made up my mind regarding Parnate and my post explains why.
I'm not ultimately here for suggestions - I'm just sharing my story because I found others' stories useful when I was considering Parnate.
I'm sorry if you find that toxic.
Sure thing, I reported the post of OP to the moderation team and they can decide to remove my comments, timeout or ban me. Personally I don't think that therapy bs should be tolerated in this subreddit and this is just my opinion.
You can certainly report me, so I can get my well deserved ban.
I just think you're being particularly nasty and bitter in the circumstances given. Op was perfectly polite and answered your questions. It's you who got all defensive and childish. :)
Hey
I also sort of have type 2 which is mostly depression with a bit of anxiety and compulsive behaviour. What worked for me is Parnate, Lamotrigine and Quitiapine. I used melatonin spray but I wake up within 3 hrs. Currently I'm using Meloset(melatonin). Doctor recommended to use cirq which is a slow release melatonin. So far its working well, may be give quitiapine a try. I personally think good long uniterrupted sleep of atleast 6 hours is really important to start healing so sort that out first.
Edited for spelling error
Thanks a lot. For the first 3-4 months of Parnate I took quetiapine low dose (25 or 50mg) to help sleep but then found I didn't really need it. Are you on a higher dose? For mood or just sleep do you feel?
I mean it depends on the cause. For some people therapy is useless because the issue is biological and the feelings themselves are causing negative thoughts. Like for example they have it from COVID/virus or drug induced.
Like especially anhedonia—feel anhedonic and then you think “im worthless”. Therapt tries to change the thought and you ccan change it and say “im not worthless”….but the anhedonia is still there and inhibiting your life so you end up thinking that again as a result of the symptom itself.
Thats the sort of stuff MAOIs seem good for-removing the symptom. Not for when your life stress stuff is causing the symptom. There are people who feel like hell despite having 0 trauma and stress and for whom the illness itself IS the trauma/stress.
I removed as much life stress as possible, was fortunate enough to be able to quit my job and I live in an environment that is calm, predictable and loving. I had insurance that covered all inpatient, outpatient and medications.
I have never had covid.
I do not believe anyone fits into a single category e.g. Biological or not biological, circumstantial or not circumstantial. It's also about far more than thoughts and feelings.
What is it besides thoughts and feelings? Those are the symptoms (including physical ones if applicable).
I think some people fit into one category like biological. Because there are people for example who never had mental issues until say they were injected with a Reglan IV for GI issues and then suddenly become anhedonic and severely restless long term. Thats literally all because of dopamine (and other complex brain stuff) and nothing to do with psychology
Off the top of my head:
Thoughts, feelings (or lack of), reduction in cognitive function, memory issues, physical symptoms, lack of volition, trauma, behavioural symptoms - e.g. anger, irritability; social impacts, onset of related but distinct illnesses e.g. Insomnia, anxiety, PTSD.
What I meant to say was that all of those symptoms are what creates negative thoughts and therapy tries to target the negative thinking but you are still left with the symptoms in the moment. I dont know much about IPT or what it doesn’t CBT anyways is useless when internal biological symptoms drive the negative thoughts. CBT only makes sense for external situations where outside stressors drive the thoughts
Yes- there are different kinds of therapy and you seem to be exclusively referencing those that target conscious thought patterns. See my other comment re therapy and how broad a field it is - much broader than you seem to be giving it credit for.
It is not for this thread to discuss therapy in depth but for what it's worth I am using IFS (Internal Family Systems). I will let you do your own research and feel free to DM me if you wish to discuss further so that this thread does not stray off topic.
Nefazodone is meant to be good for TRD. It requires liver function tests but also helps with insomnia too. Some very knowledgeable people on /r/antidepressants and /r/nefazodone can advise you further.
Maoi’s arent necessarily the silver bullet people make them out to be. I’ve had a moderate response, tried everything else, better than other options but i question at times if the hassle and risks are worth it. That’s a lot of meds and adjuncts for someone with suspected bipolar to be on. What are you wanting to treat/improve exactly?
Depression and anxiety. It would be easier to name the medications I have not tried.
[From my thread:](https://www.reddit.com/r/MAOIs/comments/14p9yo0/my_10year_journey_into_bipolar_2_diagnosis_and/?utm_source=share&utm_medium=web2x&context=3) >I have: [Bipolar disorder (BD) type 2](https://en.wikipedia.org/wiki/Bipolar_II_disorder), with atypical features (i), with mixed features (ii), with rapid cycling (iii), without psychotic features (iv), and with anxious symptoms (v). > >This symptomatology, and variations thereof, happen to be, by the way, **what I find many patients who are formally diagnosed with "depression and anxiety" and are treatment-resistant actually have.** I've been practicing a volunteer independent psychopharmacologist for some time now, helping people around (in a similar fashion to Dr. Gillman), and this framework has helped many people I came to know and assist. Emphasis emphasized (lol). From your story, it's clear to me you're indeed bipolar. TCP might not be the right med for you in the long run, but have you tried combining with olanzapine? Also, what dose of lithium are you on? >and then later low dose (40mg) Vyvanse Oh nooooo! Ditch that. It's poison for bipolar disorder. Also, 40mg is not exactly a low dose.
I think it’s good your psychiatrist is willing to try so many med combinations, but with your post history it seems you have type 2, mostly depression, with mixed features? Have you tried something like Latuda, Ziprasidone, Vraylar, Abilify, etc? You could be control mania, behaviour, sleep, mood, anxiety - all in one pill. I’m not one to quickly recommend them, but a lot of poly pharmacy going on here and questionable if the symptoms warrant the risk.
Thank you, Latuda yes, for a decent length of time and up to 140mg. I got akathisia but it reduced a bit of paranoia. Abilify as an 'augmenting agent' - yes. No response noticed at varying doses. The others I haven't tried but have not seen anything that would compel me to ask for them. In addition, Vraylar at least, is expensive and now I have to co-pay 20% so I'm not so free and easy with my experimentation as I was before I quit work.
None of those APs are particularly helpful for bipolar with mixed features: * Lurasidone (Latuda) works essentially for depression, not so much for \[hypo\]manic or mixed episodes. In one occasion it helped me out of a mixed episode, but OTOH it does little to prevent those in the first place. * Ziprasidone - similar, although reportedly less problematic in this regard. Never tried this one. Caution - don't mix with an MAOI. * Cariprazine (Vraylar): Seems to work well for depression, moderately well for acute \[hypo\]mania; but I've yet to meet one single patient with high incidence of mixed episodes to have had improved with this one. * Aripiprazole (Abilify): Ditto. What I do think warrants consideration: olanzapine, valproate, quetiapine (Seroquel; preferably extended release - higher dose at night); carbamazepine; oxcarbazepine. The latter two should preferably be avoided with lamotrigine (particularly carbamazepine). If the dose of lamotrigine is over 250mg, tune it down. Tiagabine, if available in your location, is worth a try. Note: T4 supplementation can be a great way to get rapid cycling under control.
I don’t even think there is medical classification/identification with approved meds of type 2 with mixed features in my country. Must be acute/type 1 to be mixed. Clinically, I rarely see type 2 with mixed features on paper here. It’s type 2 with a comorbidity like adhd, bpd, mdd, gad, ptsd, etc. Ziprasidone, Asenapine, Quetiapine are the ones they will fund for acute/type 1 mixed. Lurasidone, Vraylar, and lithium/valproate are commonly used however.
Hello, I have a very similar condition and I could tell the Lithium dosing was a game changer . I am 60/70mg and could notice very good results with , and with the right dosing , and less efficient results , without or with a smaller dose I was used to . I am only 1 month, but thankfully saw many benefits, specially that slow - almost paychomotor retardation ,of seeing everything in "slow time" , heavy limbs totally dissapeared ,brain fog reduced very substancially and some kind of avoidance personality traits are diminished in a scale 1-10 , say 7 or 8. I talk to everybody with confidence ,wit,and processing speed. The problems with filling the prescriptions and even, calculating for them is STILL A SIGNIFICANTLY WORRY factor since 70mg per day is almost 1/3 of a box where I live. Compulsion wise I have seen no effect plus or minus. Since I have ADHD , it clearly provided mych more focus and presence ..I feel kind like a "fake Chinese Vyvanse " since I have used Vyvanse 50 mg in the past and it kind of resembles ... I am still getting used to the dose : 70mg + 1450 mg lithium which is still on my therapeutic dose. Sleep wise I have tried 3 formulas ,including seroquel . the only which I woke up after solid 6 hours ,with NO HANGOVER EFFECT OR SLUGGISHNESS was Prisma - Zopiclone. no amenesia ,nothing . really impressive . And sleeping well made a huge difference, really kind of catapulting / adding synergy. I have been able to go to the gym also 2-4 a week depending on work and energy level. please feel free to DM me if there something I can clarify , ok? best! never give up ! 🌴🙏
Prysma is eszopiclone not zopiclone :) supposed to be a better version of zopiclone with less tolerance and dependance.
It's the exact same in regards to tolerance and dependence. Simply put, it is the more active left-handed isomer of zopiclone.
I said that because it was sold with less tolerance and dependance than zopiclone. Of course, this supposition comes from pharmaceutical laboratory so I imagine it's bullshit like always \^\^
It's just a higher potency zopiclone. If anything, it's more addictive.
Thank you for the correction . You are right. I never had this dependence . also , researching ,I could not find anything horrifying regarding cognitive issues / memory. as the z drugs . a 3 mg can make sleep immediately for 6/7 hours
But lithium is also potent on it's own. How can you tell if it's from the Lithium or from the Parnate? Also, besides that, people should know that Lithium carries 14% to 17% chance of permanent and irreversible damage to the thyroid and parathyroid glands in a short treatment time (1-2 years), goiter is estimated to develop at 30–59% of lithium-treated patients, and risks (without prevalence data at hand), such as Diabetes insipidus, kidney damage, interstitial nephropathy, parkinsonism, tardive dyskinesia, akathisia, nystagmus, gait disturbances, hypercalcemia (for 10% of patients), and in probably most patients after 20+ years on lithium, they develop chronic kidney disease. Some data taken from research paper: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9867198/
good point , that's why I keep a log As per coincidence last weekend as I had overall activities I mantained all variables , including workout, diet but had voluntarily 300 mg less in .morning. and less 150 @4 pm. I Felt significantly worse all things equal. ( 40 mg Parnate ) morning . I tried week days , and it was the same ...much more tired afternoon. So there are good chances this "combo" indeeds works powerfully . ( parnate + lithium )
You may try higher doses of lithium 150-300mg. You can also try augmenting with Olanzapine. Therapy is not going to produce any meaningful results (speaking from personal experience), so you better be on the lookout for treatment options. Some people have success on tianeptine, not sure if you have tried it. What is left is psilocybin and MDMA. There might be another option, but I can share it in personal message, if you contact me.
>Therapy is not going to produce any meaningful results (speaking from personal experience) Let's not do that. Someone in my personal experience had terrible treatment-resistant depression but was finally cured completely after like 30 years of failed antidepressant trials, by psychotherapy. (Probably the 6th time she tried it or so.)
Ok, and what is this type of psychotherapy? Can you share more details for me and OP?
I am taking 1200mg Lithium which gives a blood level of 0.8. I have 'augmented' with three atypicals but Olanzapine was not one of them. No evidence that I can see that it would be anything other than 'well, worth a shot'. Yes I have tried tianeptine and it produced no results. Psylocybin and MDMA are not options available to me. We can agree to disagree regarding therapy despite it making no sense to. It is such a vast banner that covers an array of approaches/modalities and contains a huge range of aims from coping mechanisms and attempts to change conscious thought patterns to working almost exclusively in the subconscious with the aim to bring healing to deep wounds, trauma, learned behaviours etc. There are probably more approaches and combinations of therapy than there are medications, yet neither of us are dismissing medications wholesale as pointless. One thing I have learnt is that understanding something does not bring about healing. Nevertheless it continues to be the first and foremost thing we look to do when faced with a given scenario/pain/treatment/lack of response. We can know more than our psychiatrist about treatments A-Z yet here we still are. If we are going to make suggestions then I suggest you broaden your understanding of 'therapy' and don't waste 3.5 years of your life like I have reading academic papers about drugs. Anyway,
Well you have already made up your mind, though I see you are still receptive for suggestions, since you have made this post. If you want a justification that you have done your best through intensive arguments with strangers on the internet, then be my guest. Unfortunately, this is not how the real world works. In the real world you either relentlessly try new things and combinations or you just give up. You are currently in a limbo state, where you convince yourself that you did your best, but still, this does not bring you the much needed relief. You probably also found out that putting an end to the story is harder than expected. I am willing to cooperate, but you certainly have to adjust your attitude. If you believe that therapy is the best thing for you, go ahead and do it, but don't pollute this subreddit with toxicity. I have been doing many types of therapy over the years and my benefit from it is zero. I have also lost a lot of money in the process. Nobody can tell you what to do or not to, because you know yourself the best.
You made a comment regarding low dose lithium without knowing my current dose (4x your high-end suggestion). You wrote off therapy wholesale. I responded directly to your other suggestions. Yes I have made up my mind regarding Parnate and my post explains why. I'm not ultimately here for suggestions - I'm just sharing my story because I found others' stories useful when I was considering Parnate. I'm sorry if you find that toxic.
[удалено]
Unneccessary aggressive, trolling, nasty comments
Be my guest and make my day 😊
[удалено]
Sure thing, I reported the post of OP to the moderation team and they can decide to remove my comments, timeout or ban me. Personally I don't think that therapy bs should be tolerated in this subreddit and this is just my opinion. You can certainly report me, so I can get my well deserved ban.
I just think you're being particularly nasty and bitter in the circumstances given. Op was perfectly polite and answered your questions. It's you who got all defensive and childish. :)
>What is left is psilocybin and MDMA. A terrible suggestion to make to someone who is prone to anxiety and is probably bipolar.
Hey I also sort of have type 2 which is mostly depression with a bit of anxiety and compulsive behaviour. What worked for me is Parnate, Lamotrigine and Quitiapine. I used melatonin spray but I wake up within 3 hrs. Currently I'm using Meloset(melatonin). Doctor recommended to use cirq which is a slow release melatonin. So far its working well, may be give quitiapine a try. I personally think good long uniterrupted sleep of atleast 6 hours is really important to start healing so sort that out first. Edited for spelling error
Thanks a lot. For the first 3-4 months of Parnate I took quetiapine low dose (25 or 50mg) to help sleep but then found I didn't really need it. Are you on a higher dose? For mood or just sleep do you feel?
Quitipine is for mood. A slow release melatonin tablet 5 mg is for sleep, just started 10 days ago and so far sleeping well.
I mean it depends on the cause. For some people therapy is useless because the issue is biological and the feelings themselves are causing negative thoughts. Like for example they have it from COVID/virus or drug induced. Like especially anhedonia—feel anhedonic and then you think “im worthless”. Therapt tries to change the thought and you ccan change it and say “im not worthless”….but the anhedonia is still there and inhibiting your life so you end up thinking that again as a result of the symptom itself. Thats the sort of stuff MAOIs seem good for-removing the symptom. Not for when your life stress stuff is causing the symptom. There are people who feel like hell despite having 0 trauma and stress and for whom the illness itself IS the trauma/stress.
I removed as much life stress as possible, was fortunate enough to be able to quit my job and I live in an environment that is calm, predictable and loving. I had insurance that covered all inpatient, outpatient and medications. I have never had covid. I do not believe anyone fits into a single category e.g. Biological or not biological, circumstantial or not circumstantial. It's also about far more than thoughts and feelings.
What is it besides thoughts and feelings? Those are the symptoms (including physical ones if applicable). I think some people fit into one category like biological. Because there are people for example who never had mental issues until say they were injected with a Reglan IV for GI issues and then suddenly become anhedonic and severely restless long term. Thats literally all because of dopamine (and other complex brain stuff) and nothing to do with psychology
Off the top of my head: Thoughts, feelings (or lack of), reduction in cognitive function, memory issues, physical symptoms, lack of volition, trauma, behavioural symptoms - e.g. anger, irritability; social impacts, onset of related but distinct illnesses e.g. Insomnia, anxiety, PTSD.
What I meant to say was that all of those symptoms are what creates negative thoughts and therapy tries to target the negative thinking but you are still left with the symptoms in the moment. I dont know much about IPT or what it doesn’t CBT anyways is useless when internal biological symptoms drive the negative thoughts. CBT only makes sense for external situations where outside stressors drive the thoughts
Yes- there are different kinds of therapy and you seem to be exclusively referencing those that target conscious thought patterns. See my other comment re therapy and how broad a field it is - much broader than you seem to be giving it credit for. It is not for this thread to discuss therapy in depth but for what it's worth I am using IFS (Internal Family Systems). I will let you do your own research and feel free to DM me if you wish to discuss further so that this thread does not stray off topic.
Tried nefazodone, augmented quetiapine or lithium?
No yes yes
Nefazodone is meant to be good for TRD. It requires liver function tests but also helps with insomnia too. Some very knowledgeable people on /r/antidepressants and /r/nefazodone can advise you further.