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Talk to me about SSRI medication, please

(108 Posts)
Cairngorms Thu 21-Mar-13 13:40:31

I've had phases of depression for many years, but not ever taken medication. Over the past year, I've had major anxiety too associated with some very major life changes we are dealing with.

In the summer, I so desperate that I was prescribed an SSRI which I took. The side effects when I started were horrible, really horrible, my husband disapproved in general, and longer term it reduced my desire to have sex, which caused issues with my husband. I am not brilliant about remembering to take it, and during the autumn something came up where DH disagreed with me doing something because I was on medication, so I stopped taking it altogether.

I am now really unstable again - anxious, depressed, unhappy. I would like to try taking the SSRI again, BUT
- I am worried about the short-term side effects;
- I am worried about reduced libido again;
- I am worried about facing the GP who told me NOT to stop taking it.

How do I face the GP, face the DH's disapproval, find an SSRI with reduced starting side effects and also without the reduced libido effect?

Please help! I am finding this overwhelmingly hard.

NanaNina Fri 22-Mar-13 22:34:36

CG it sounds like you have decided to go with your DH's preference, that you start next Thursday, so that's not that long away. Did you tell the GP about the anxiety. ADs are meant to cope with depression and anxiety, but if you told the GP he may have prescribed Prozac as they may have more of a sedative effect.

Re you present anxiety. I'm not too good on this as depression has always been far worse for me than anxiety but I do experience it in maybe a lesser form. I take the diazepam 2mg but I'm not sure it does any good. It's probably unlikely your GP would prescribe diazepam because of all the problems that I wrote about in the last post. Mine was prescribed by a psychiatrist.

I think you should try some breathing exercises for your anxiety. Lie on the bed and put your hands on your top tummy and breathe in through your nose to a count of 7 and then breathe slowly out to a count of ll. Feel your tummy rise and fall as you breathe. It doesn't matter about the numbers, just do what feels right for you. It just might help a bit.

What you are doing is catastrophising in thinking of all the things that can go wrong, and this has taken you over, which is very understandable. I don't know if you've ever heard of CBT (cognitive behaviour therapy) but it might just help a bit. The theory is quite basic and acknowledges that when we are anxious we have ANTS (automatic negative thoughts) that pop up, and then your thoughts spiral down and down until your ANTS have taken over which is what is I think what is happening with you at the moment. The thing is you have to try to replace your negative thoughts with more balanced ones. My CPN (community psychiatric nurse) introduced me to this therapy and said that when my ANTs were getting out of control I had to write them down - all of them and then write a more balanced view of the ANTs. When you have written the ANTs you have to ask yourself "is this accurate" and it is usually NO and is it helpful and again the answer is NO. SO you are then meant to try to keep the more balanced thoughts in your head. MUCH easier said than done I know. I always found this CBT helpful when I am ok but not somuch when I am having crap days.

Sorry CG you can google CBT and get the info - much better than what I have been telling you. You need to cut yourself some slack and you can't expect to follow your usual chores washing/cooking etc and not exercising etc - you are ill - mentally ill. YOu wouldn't be expecting to carry on your usual routine if you had pneumonia would you.

Am feeling really sorry that you are having to cope with this awful anxiety but you will cope - the human mind and body are programmed to make us cope - you will feel shite but you will still be here tomorrow and the next day and keep going..........Am happy to hold your hand through the weekend and next week. I am going to Ireland on Sat next week though I shall be anxious next week as I always am before we go to Ireland in case I get a bout of bad days, as I cry a lot, very loud and long and worry like hell, as I am paranoid about anyone seeing me in a state, only my DP and close friends. SO I will be doing deep breathing..........

All for now Love NNx

Cairngorms Sat 23-Mar-13 08:50:55

I am too tired at the moment to add much now, but I wanted to say thank you so much and that I will be back.
I am definitely catastrophising - mostly focused on regret about a recent decision where I feel we made the wrong choice. I have done quite a but of CBT focused on a number of areas, but not explicitly this sort of anxiety / regret. As I said in the OP, we've had a lot of life changes / stresses / decisions this year.
The usual chores still need to happen, though I am cutting corners where possible.

Queenofknickers Sat 23-Mar-13 12:56:00

Just to say thinking of you xxx

I have diazepam too but again from a psychiatrist. A weekend out of hours GP might give you a limited supply to take until you start your ADs if desperate.

Breathing exercises from Nana are excellent idea also tips on www.nomorepanic.com.

Talk to yourself kindly, in terms of regrets I have found it helpful to repeat "I did the best I could at the time"

If you get chance then I can't recommend enough anything by Dr Claire Weeks - especially her audiobook - I will see if I can dig out my copy and summarise her guide to dealing with anxiety.

Much love to you x

NanaNina Sat 23-Mar-13 13:44:27

Me too thinking of you CG and glad to hear you are cutting corners. Something tells me you might be a perfectionist, when everything has to be done and done well......sorry if I'm wrong - I'm not a mind reader!

Don't worry about posting or not - just do what feels right - we will still be here for you x

Cairngorms Sat 23-Mar-13 19:37:20

Thank you so much for ongoing good wishes. I've had a pleasant, lazy day, have eaten, slept ok-ish and am feeling more relaxed than for a long time. Just having the meds in the drawer is calming, as an action in the right direction. I'm anxious about side-effects and will wait till the holidays. I am really hung up on the decision I'm regretting, and that's the focus of a lot of my anxiety and depression. I shall look out those Claire Weeks books, the breathing exercises and try the CBT for the ANTS - that is a very good reminder!
I treasure the goodwill of people out there. x

NanaNina Sun 24-Mar-13 00:22:19

Oh sooo glad things are easing a little for you CG but there will probably be fluctuations - it's the nature of the beast. Another thing that you could look into is mindfulness with is at it's most basic about "staying in the moment" not thinking of the past or future. I have a friend who swears by it for depression, and she has suffered a fair bit over the years. She is also learning meditation and is finding that really beneficial. You can google mindfulness and get lots of info and I know there are courses that you can attend, and an internet programme. I keep thinking I should look into this but when I'm feeling crap I haven't the motivation and when I'm okI don't think about it!

In a way I think it's good that you know the origin of your depression and anxiety, though you did say in your OP that you had bouts of depression and anxiety over the years but had not taken meds. Do you think it might help to discuss this issue that is beating down on you so badly, with a therapist. As I'm sure you know there are no magic bullets (if only) but it just might help you. ADs can alleviate symptoms but can't of course deal with the underlying cause of the depression.

I think the GP can refer you to a CBT therapist and you usually get 6 sessions on the NHS but there is often a waiting list. As you probably know CBT is about the "here and now" and that may be just what you need. However if CBT is not the right therapy for you, the GP might be able to refer you to a therapist on the NHS who has different orientations other than CBT. I had 20 sessions with a psycho-dynamic therapist on the NHS but I think that was because I had been an inpatient. Worth asking though.

Don't know if you can afford to go private - they are usually around £50 per hour dependent on where you live. IF you think this is for you, make sure you look on the BACP (British Assoc of Counsellors & Therapists) website as they are all registered therapists and counsellors.

Ah well 15 mins past midnight so better be thinking about bed. I'm a bit of an owl and hate the mornings.

Finally have you tried writing things down that are swirling around your head - I have always found it useful to get things out of my head and onto paper and I keep a journal and record (and score) every day and it makes me feel a bit more in control, and it's very useful to look back and see how I coped with the bad days. This may not feel right for you, as we are all different, but it might be worth a try.

This is really finally, the more I think about it the more I think maybe therapy is the way forward as you know what is at the route of your illness and many of us don't. Whatever this thing is that you regret so much needs to see the light of day and even by bringing it into the open with someone you trust and with whom you feel safe, will reduce the power it has over you at present, and is dragging you down into depression. Have a think about it CG sorry I have gone on so long.

Take care and sending good wishes x

Cairngorms Sun 24-Mar-13 09:13:10

NN I've just finished a seven week set of CBT sessions on the NHS, focussing on self-esteem (based on my negative 'core beleifs'), which was really helpful. It was towards the end of these sessions that I made the poor decision, and so I didn't explore it with the therapist. I don't think I have access to more NHS therapy and I'm not sure we can pay for private therapy.
While I know what I'm fretting / ruminating / anxious about, I think I'm displacing a lot of anxiety (we have a log going on, and have had a horrible year) onto one thing, and it's the thing that's taking my focus rather than an actual problem.

I have had quite a bunch of therapy through the years, and have benefitted from it. I think you are right that I should address this specific issue, either with a therapist or using the techniques myself. I am (irrationally?) afraid if I do so that I will feel worse about it.

I just want to feel happy and stable. I'm not sure I've ever managed that, but the techniques from CBT a few years ago and the self-esteem stuff more recently have helped me think that it might be possible.

You are right - I naturally have perfectionist tendencies - but I've overcome that after a year in which we barely managed to keep out heads above water. I suspect there are areas where I am being perfectionist and don't recognise it, but not much of our day to day life.

I have years (20+) of depression, and know I'm not through it completely yet, though it has been worse.
Thank you so much for your support, and my best wishes to you. Xx

Cairngorms Sun 24-Mar-13 09:16:57

I also wanted to add, I'm still concerned about libido reduction, which I see another thread here focussing on. DH might be in the wrong, but regular sex is a really big deal for him, and he will become quite grouchy otherwise.

Cairngorms Sun 24-Mar-13 11:48:21

It's being a bad day, emotionally / mentally, and I'm not sure how to deal with that. I am full of regret and anxiety.

Cairngorms Sun 24-Mar-13 12:50:47

I've been back through this thread, and am trying to summarise the advice I've been given.

Get and take SSRI meds (fluffyanimal and others) but possibly try a different SSRI (various).
(orangesandlemons suggested a tricyclic, due to reduced start-up side effects and reduced libido impact, but ?? suggested they have greater dependancy impact and possibly greater long-term side effects).

DH should be kind and put up with the reduced sex-drive (fluffyanimal and others). I could try a FPA or sexual health clinic to see if there's availability for a sexual health councillor (*evansthebread*) which is a really interesting and hopefully useful idea.

Counselling (Lucyellensmama95, NanaNina and others).
- I should apply the CBT techniques I've been taught to deal with the ANTS.
- I've exhausted the NHS CBT offering, but should consider private counselling (find via BACP).
- QueenofKnickers suggested a couple of free online CBT websites, thank you.
- NanaNina recommended breathing exercises to deal with anxiety / panic, and mindfulness, QoK recommended www.nomorepanic.com and an audiobook by Dr Claire Weeks, and elsewhere I've been suggested hypnotherapy book / CD.
- NanaNina recommended writing things down.

I think that summarises all your advice. There's a lot of ideas here, and I need to work out what's right for me, what's possible and what to do.

Most of all, I'm stunned by all the kindness and care, it's an honour - thank you all!

Lucyellensmum95 Sun 24-Mar-13 14:05:04

A thought re the labido - i am finding a reduced ability to orgasm (sorry TMI) on citalopram, and maybe reduced sensation but i can't say the desire is less. I think there is nothing worse than anxiety actually to reduce labido so for me i don't really notice a difference. I do think that regular sex is important for BOTH partners though, why do you say that it is an issue for DH and not you? I find that im grumpier when we haven't had sex - DP, i dont know but it did make a comment to me about "oh thats our sex life out the window again" when i went back on the medication - i shut him up with "what do you want, me dead or horny?"

NanaNina Sun 24-Mar-13 15:00:33

Hello CG the sentence that stood out for me in your recent post was "while I know what I'm fretting/ruminating/anxious about I think I am displacing a lot of anxiety (we have a lot going on and have had a horrible year) onto one thing and it's the thing that is taking my focus, rather than an actual problem."

I keep re-reading this sentence but can't really fathom what you mean. Would you be able to explain a little more.

There is certainly nothing wrong with your organisational skills or concentration, as you have summarised all the advice you have been given.

When you say you have had depression for 20 yrs + and when people say this I am always puzzled - do you mean on and off for 20 years, episodes of depression, or low lying chronic depression. I think you said you'd never taken ADs - is that right.

Sorry you are having a crap day, but I really think you nust talk to someone about this "thing" that seems to be at the front of your mind all the time and maybe your depression is due to a culmination of bad things happening, but you have for some reason displaced everything on to this one thing. AH is that what you meant by your sentence that puzzled me.

Do you have anyone in RL in whom you can confide? Best choice is a therapist though as it needs to be someone outside of your situation - I think there might be some voluntary charities like Relate and Cruise that just ask for a small financial contribution. Not sure but you could google.

Still here for you and yes MN has ot me through many a dark hour I can tell you - I think the milk of human kindness flows free on the MH threads! x

Cairngorms Sun 24-Mar-13 15:14:56

Hi NanaNina
We have had a year with a lot of major changes and decisions, some of which are not yet resolved and some of which are not in our control. There is amongst all these things ONE decision that is standing out to me as the one that is causing me a lot of worry. I don't think it's the most significant and either option (let's call them outcomes A and B) is fine, though one outcome might be better than the other (don't know which though!). A month ago we solidified this decision as A (having previously tried out option B), and since then it has been causing me a lot of distress. I don't know whether I'm really distressed at that specific decision, or overwhelmed with all the changes and dumping all those feelings onto that one decision.

I have struggled with organisation and concentration for most of the past six or more months, but now I've slept for three days, and am much, much clearer than I have been for months, hence I could write the summary post. The feeling of relief when I can think compared to the muddle headed overwhelmed feeling is huge. I feel that had I been rested and clear when we finalised the worrying decision I'd have seen some other issues and made the other choice.

I've had low level depression since a teenager, with worse phases (I've been prescribed ADs four times before but not taken them till last summer, and had several sets of CBT and other therapy) and better phases where things have been reasonably ok.

Lucyellensmum95 If I don't want to have sex (while on ADs) I don't miss it, but DH does, which is why it's a problem for him. His grumpiness is then a problem for me.

Thank you for that milk of human kindness!

Cairngorms Sun 24-Mar-13 16:21:28

Unrelated: Peeled myself out of bed to begin to sort through a pile of their clutter my parents have passed on to me. 50 mins and you can't really tell I even started, though half of it is now in piles and some of it in a bin bag. I'm calling it an achievement.

Cairngorms Mon 25-Mar-13 12:28:36

Have taken it (DH said he wouldn't travel this week, and I need to concentrate on getting well).
Am worried about side effects.
Am sad.

Lucyellensmum95 Mon 25-Mar-13 12:44:10

This is good news - can you keep busy? I am two weeks in now and I am starting to feel better, more like i can manage the world. I have noticed a bit of difficulty acheiving orgasm but i only have an orgasm when i do it myself anyway blush don't tell my dp that though! wink I still feel like having sex because i find i need the intimacy. Sometimes i have sex with DP even if i don't feel especially horny, this sort of sex tends to be over quickly anyway, and not altogether unpleasant, i enjoy it but just don't get off - if that makes sense. As for other side effects, the only time i have felt anything really was when combining with diazepam and then i felt very disconnected from things. I didn't like that. I was worried if i was doing the right thing, so was my DP - i now realise I have so done the right thing by taking the pills. They don't work miracles, my life is still a crock of shit just now - but i now am STARTING to feel like I can make the changes i need. I didn't get any of the light headed sicky feeing i got last time so that was good, saying that, that only lasted a few days.

Do keep posting, we are all here to help.

Good that your DH has taken week to be at home - Im looking forward to the holidays and you will be side effect free by then, so you can enjoy them too xx

Queenofknickers Mon 25-Mar-13 13:05:14

That is good news - and sounds like DP might be being more supportive? X

NanaNina Mon 25-Mar-13 17:40:31

Hi CG these options A and B you say either would be fine - yes? But you don't know which is the better option, but you have tried Option B and presumably that wasn't right, so you are now with Option A but that is worrying you - have I got that right now? It's horrible to have things hanging over you about which you have no control - very anxiety making.

I'm assuming that some of these changes are things that are quite high up on the list of "life Crises" - a bereavement, divorce, moving house, financial problems, redundancy, new job etc etc. It just sounds like you have had a really tough time and it still isn't all sorted and that is the root of this depression. Can I ask why you never took ADs before?

Oh YES amost forgot, well done for starting on the meds. Don't expect much to happen initially - they can take 2/3 weeks to "kick in" and I think you said you have a review appt booked.

Ah, you're last sentence "I am sad" touched me. Are you sad as in being depressed, or because you are taking meds, or just sad at all the shite you are going through, or maybe you're sad because you're sad!

Cairngorms Mon 25-Mar-13 18:21:47

We tried Option B, I thought Option A would be better, we went for Option A and now I regret that. It's a biggie.

We have several (not quite all) on the list of "Life Crises", together with some long-term stressful issues. Yes, we've had a really tough time - even tougher than we usually deal with. No, it's not all sorted, and somethings - like the Options A / B above - have ended up different to how I would choose if I could have a do-over.

I've always felt that ADs are not the solution for me - typically depression for me has been unfocused (for no clear reason) and I've used various therapy, exercise, and time to get through it. This time we have so many changes and decisions, and no time to get things right. I know it'll take a while for the ADs to kick in, but I've had about 6 weeks of being confused and upset, and I felt I needed to lift out of it in order to move on.

"I am sad" for all the reasons you gave. I'm not as "grey" as I have been when previously depressed, but I am completely torn apart by this faulty decision and exhausted by the rest of our circumstances.

Thank you for talking me through this all.

Yes, DH is being much more supportive. I'm agonising over the decision with him saying how stupid I am, and he's saying "no - you're not being stupid - you're being ill and we need to help you get better." smile

Cairngorms Mon 25-Mar-13 18:32:59

Actually, mostly I am sad with regret at the option A/B situation. sad

NanaNina Tue 26-Mar-13 01:31:19

Do you want to talk about these options - not prying at all but just wondered. Happy for you to PM me if you like and will not take offence at all if you want to keep these things off MN. I don't usually write posts like this, but I'm getting confused with the A/B and just thought it might help. I'm sure anyone else on the thread would be happy for you to PM them.

Cairngorms Tue 26-Mar-13 07:55:18

Disrupted night's sleep and feeling nauseous.
I might PM you later, NN, it's a done thing now and I have to settle down with the choice we made. Thank you for hand-holding. My CBT therapist was suggesting ADs to reduce the emotional affect of all the challenges we are dealing with. I avoided an avoided, but this latest decision has tipped me over the edge.

Queenofknickers Tue 26-Mar-13 12:25:57

Hi Cairngorms
Just popping in to offer a virtual hug xx

It's interesting what you said about not wanting to take ADs before because there didn't feel like there was an actual reason - I'd say two things, firstly depression is an illness that convinces us not to take help ( it's sneaky like that!), secondly lots of people need ADs because their brain chemistry not because of an event.

It's great that you can identify your feelings, even if they are painful ones, you sound like you have really good self-awareness.

Glad DP being more supportive - you are doing really, really well and I hope some part of you can feel that
Big hugs xxxx

NanaNina Tue 26-Mar-13 13:00:58

Hi CG - the nausea is probably a side effect of the meds, or it can be because of anxiety. Sleep problems are also a sympton of depression. Hope you are still taking the meds. You can't hope for any kind of benefit yet,it's way too early. Thing is the ADs hopefully will cope with the symptoms of depression so that you can maybe get some help with the underlying stuff. However I know you have had lots of therapy before but do you think there is any point in going down that route again. I think the big difference this time is that you are taking ADs and are going to continue taking them, and if they are not helping, another AD might help. I hope you will stay on this track.

QofK
I totally agree that depression is a sneaky even deceitful illnesses, and convinces us that nothing can help. In my case (and I think this is very common in depressive illness) I felt ashamed and guilty when the symptoms began and convinced that there should be something I should do to be able to get better. We don't feel like this with a physical illness. I think depression makes us think all sorts of things about ourselves that aren't true e.g. that people will be better off without us (when we are really crap - I have felt that so many times)

Re the chemical imbalance in the brain, I think this is a chicken and egg situation, because medics and psychologists are divided about this. Does an event trigger the chemical imbalance or is it the other way round? I have struggled to understand this but I don't think there is a definite answer.

All I am sure about is the depression and anxiety (in their severe form) are a torment, a total torment.

Cairngorms Tue 26-Mar-13 13:45:02

QoK thank you for popping by.
depression is an illness that convinces us not to take help ( it's sneaky like that!)
This is suck a good thought, thank you. I am utterly unconvinced that I can ever feel better and sure that I have ruined everything for ever. I am also sure that nothing can help and that I should be better without help. I also still feel that I don't know what to do about it. Onwards ....

NN thank you - the sleeplessness is an ongoing symptom, the nausea is a side-effect. I'm also eating very little at the moment, am very lethargic / finding it hard to do anything, and have ongoing trembles (symptoms - though maybe I'm just cold?). I'm trying to listen to people who say "keep taking the ADs" even though I really don't want to.
I did send you a PM, but I can't see it in my sent folder. Did you get it? I've not PMed on MN for a long, long time and may have messed it up.

I don't mind so much being tormented for my own sake, but I mind messing up my children's lives with my dodgy decision-making processes (<- catastrophising, I trust).

I shall be back when I've made myself take my tablet for today, and had some food ...

thank you xx

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