For anyone who wants to try a pharma solution, a "novel" antidepressant came out just recently named Auvelity. It works on a completely different mechanism than any other oral anti-depressant out there. It works on the same system as ketamine, it just needs to be dosed every day rather than once a month, and you just take it as a pill, and not as an infusion or a nose spray. It is also rapid acting, typically a significant change will be seen within 14 days.
I don't actually recommend anyone take the brand name, it's a total rip-off. You can do the exact same thing with generic bupropion and OTC dextromethorphan IR typically labeled as Dextromethorphan HBr usually listed as 8 hours dosing. You DO NOT want the extended release dextromethorphan, commonly labeled at Dextromethorphan Polistirex, that is labeled for 12 hours dosing. Make sure to get just dextromethorphan HBr, and avoid Guaifenesin. It can be harder to find, but you don't really want to take Guaifenesin if you don't need to.
Following the formulation of the brand name medication it would be 100 mg of bupropion SR (this is the sustained release formulation, not the IR [Immediate Release] type, and not the XL [Extended Release] type) with 45 mg of dextromethorphan every 12 hours (so twice a day).
If you have trouble falling asleep you can try knocking the second dose of the dextromethorphan down to 30 mg, so it would be 100 mg of bupropion SR with 45 mg of dextromethorphan in the AM and 100 mg of bupropion SR with 30 mg of dextromethorphan 12 hours later. If you still have trouble with sleep you can drop the second dose of dextromethorphan to 15 mg, so it would be 100 mg of bupropion SR with 45 mg of dextromethorphan in the AM and 100 mg of bupropion SR with 15 mg of dextromethorphan 12 hours later.
If you find the dosage is generally too high, you can switch to 30 mg of dextromethorphan, so it would be 100 mg of bupropion SR with 30 mg of dextromethorphan in the AM and 100 mg of bupropion SR with 30 mg of dextromethorphan
There is also an alternative dosing approach which may work for you. That is 300 mg of bupropion xl with 45 mg of dextromethorphan in the AM and 45 mg of dextromethorphan by itself 12 hours later. If you still have trouble with sleep you can drop the second dose of dextromethorphan to 30 mg, so that would be 300 mg of bupropion xl with 45 mg of dextromethorphan in the AM and just 30 mg of dextromethorphan by itself 12 hours later, so that would be 300 mg of bupropion xl with 45 mg of dextromethorphan in the AM and just 15 mg of dextromethorphan by itself 12 hours later.
If you find the dosage is generally too high, you can switch to 30 mg of dextromethorphan, so the dosing would be 300 mg of bupropion xl with 30 mg of dextromethorphan in the AM and just 30 mg of dextromethorphan by itself 12 hours later.
How can you tell if the dosage is too high? You will find you have trouble with recall. Things that normally you would easily be able to pull from your memory stay right on the tip of your tongue and they will come to you, but it could take a good 20-30 seconds. Another way to tell the dosage is too high is that you have problem with executive function. This will manifest as you have to remember a short alphanumeric string (such as a phone number, for example) for a short period of time and you will find when you go to transfer that information (write it down, for example) that it is just gone when you have never had this trouble before. These are both good signs that the dosage is too high. You don't need to adjust the bupropion, but you do need to adjust the dosage of the dextromethorphan.
While this antidepressant can work for anyone, there is a subgroup it works particularly well for. If you're the type of depressive where you have constant thoughts involving all the depressing shit in your life and you can't not think about it, especially when trying to sleep, this antidepressant has a chance to work really well for you because of its mechanism of action (which is through the glutamatergic system/NMDA modulation).
The brand name, as I mentioned is a rip-off. Without insurance it is ~$1200 a month. Using generic bupropion, without insurance it is $15.00, and OTC dextromethorphan, $24.00. So, ~$40 a month. Not bad if you haven't been able to get your depression under control any other way.