depression, anxiety, right diagnosis and taking the right medication

[infinitestars]

I have been suffering from depression for a long time and never seeked any help nor thought anything of it. I have found it hard to make sense of it all and thought i'd share my situation on here to see if anyone can help.

I always felt the depression was normal but abnormal at the same time and that I could just handle it. I later developed anxiety which now i find is even harder to live with.
Following a spree of large "life changing happenings" (such as death of father, cousin (who suffered terrribly with bipolar) and other depressing head whacking experiences that never seem to end), I have found myself STUCK.
I feel my head is always churning, thoughts race from one another that i space out even when driving and cannot focus. Thoughts could be absolutely pointless or random thoughts on fixing things. i am always confused, cannot make decisions (even a choice of food on a menu), have lost interest in hobbies and people in general (dont seem to like anyone or stay away from friends and family now). I dont know what i want to do with my life anymore and feel theres nothing worthwhile. Biggest issue is I may start something and suddenly decide not to do it, or lose complete interest in it.
I have bad days/ weeks and suddenly have a good day where i feel i can take on the world and have bursts of energy to do tasks but it slowly trickles down back to that feeling of nothing.
I tend to sit quietly a lot and not really leave home anymore (from being a very sociable person). My thoughts add up to nothing by the end of the day and i feel i have not stepped forward in anyway.
I have been having many episodes of extreme anger where i throw a massive tantrum triggered by even the slightest of things and end up having a panic attack and causing damage. I have had these episodes more and more over the last three months.
The anxiety can be around for the entire day from waking to sleeping or for a few hours, and suddenly i feel silly for being so anxious but soon realised i cant even control it.
I have terrible nightmares and wake up feeling awful - this has increased in frequency over the last few months to now where it is every night).

There is much more, but i will stop there as i feel i am rambling and dont quite understand what i am saying anymore and seem to be confusing myself like i mentioned.

I would like to ask about medication.

I went to see a doctor a while ago and he prescribed me DULANE at a dose of 40 mg. I saw no changes and in fact my episodes and the way i felt everyday just got worse. I went last week to a new doctor and he has prescribed me MIRTAZ at an initial dose of 15mg with the intention of increasing it in addition to cognitive behavioural therapy. It sounds promising and from what i've read and learnt from having studied some psychology, seems my best option.

The mirtaz knocks me out as soon as i take it (which is intended for regulating my sleep as I cant sleep some nights or just for a few hours/ sleep for hours and hours on end). Is mirtaz a good option? Is something like prozac a better option? what are the differences and why do doctors prescribe so many different tablets for similar issues? (aware that different medicines work for different people).
At this point id really like to focus on changing how i feel and would like to carefully take these steps as i know the damage even the littlist of things can cause.

[NanaNina]

I am not a medic but there are one or two things in your post infinite that just make me wonder if you have the right diagnosis. You mention "racing thoughts, and feeling spaced out" (incidentally it doesn't sound like it's safe for you to drive just now) "starting something and suddenly deciding not to do it" and "having a good day when you feel you can take on the world and have burst of energy" and I wonder if you mentioned these things to the GP. Look I really dislike anyone trying to "diagnose" on the internet, but the things you have mentioned could though not necessarily are symptoms of bipolar disorder. And of course that does mean that you can have very long periods of depression which seems to be the case with you.

I also wonder about these "many episodes of extreme anger where you throw a massive tantrum" - I think when we are depressed it's easy for something seemingly trivial can tip us over into anger (certainly the case for me) but you mention these bouts of extreme anger are getting gradually worse. Again did you tell the GP about this. You say there is "much more" and I wonder if you told the GP what these other things were.

Re: meds - I haven't heard of DULANE - but can I ask did you just stop taking it as it made you feel worse. How long did you take it for because you might not have given it long enough to "kick in" - ADs can take up to 4 weeks for us to feel the benefit. I take Mirtazapine 45mg (but am reducing to 30mg) but as an addition to an SSRI (Sertraline) Mirtazapine causes weight gain in more than 1 in 10 people (and I've put on 1.5 stones in 2 years) that I can ill afford which is why I want to come off it but gradually. I never felt it had much of a beneficial effect anyway.

You ask if Mirtazapine is a good option or would Prozac be better but that is something that can't be answered because as you say they work differently on different people. I don't know what the differences are, the old fashioned ADs are tryclics and the more recent ones are SSRIs and I know they work on brain chemistry - raising serotonin levels but that's as much as I know. In fact doctors and psychiatrists don't know how they work either and they know it's all "trial and error" with prescribing these meds, and so they try different ones to see what works. I think the NICE guidelines are to try as first choices SSRIs usually citalopram or sertraline. I don't know if there is any logic to what GPs prescribe. If you are prescribed more than one AD this has to be done by a psychiatrist. To be honest I don't think GPs know a great deal about mental health.

SO unless you have told your GP all of your symptoms I think it would be wise to show him/her your post, or better still write down your symptoms in a list, as that's easier to read.

Hope you get the support you need. Mental illness is an absolute torment and has certainly ruined the past 5 years of my life.

[idlevice]

I also think it would be advisable for you to see a mental health specialist, rather than just the GP. They are much more thorough & a good psychiatrist will have an excellent knowledge of drugs that can help if appropriate & other therapies. You shouldn't have to suffer with this much longer - although there are no quick fixes of course, but at least working towards feeling better should help you feel more positive in itself.