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Talk to me about different anti-depressants(14 Posts)
Citalapram seems to be what gps are keenest on. Personally I take fluoxetine which, after a couple of weeks of side effects, has been good. There is a newer version of citalapram called Ecitalopram - I have no knowledge but someone might come along who does. They might try you on sertraline. Unfortunately it can be trial and error to find the right one or even combination. Good luck - this too shall pass xxxx
I used to take fluoxetine and I thought it helped at the time but looling back it had more negatives that positives. I felt numb inside, it kept me awake at night and it put me off eating for a while. I only stopped taking it because I used to feel dizzy and felt like I did before I had a fit ( I had epilepsy when I was younger) turns out I should never have been taking them to start with.
Im now on cymbalta and feel loads better, I sleep better my moods improved and that dizzy feeling has gone. The only downside is weaning off them. I noticed a big change if I stop taking them I feel so agitated and moody for the slightest reason.
I hope one day I wont need to take anything.
I think the big problem with ADs is that they act differently on individuals and there is no way of knowing which one will suit you without the "trial and error" way. GPs or psychiatrists don't know any better than we do about what's best to prescribe, though they will know which ones are safe for women breast feeding or things like that. I was on imipramine (an old fashioned tryclic) for many years and was fine but gradually reduced them over 10 months and relapsed 4 months after coming off them. I went back on them but had a lot of fluctuations. I'm now on Sertraline 150mg (max dose is 200mg) and they are very effective for me, though I still get bad days here and there.
The NICE guidelines (I think) are to prescribe citalopram, although I notice on the MH boards, Sertraline does seem to be prescribed in a lot of cases. Your GP will almost certainly look at prescribing an SSRI as they are thought to have fewer side effects but I think the real reason is because they aren't fatal in overdose as the tryclics can be. I am in secondary care (so have a CPN and oversight by a consultant paediatrician) and he prescribed an additional AD (Mirtazapine) which wasn't really effective and has caused me to gain 1.5 stones (slows down metabolism) and I am intending to come off it now that the Sertraline is more effective. Of course I won't know whether it is the combination of the Sertraline and Mirtazapine that has made the improvement until I stop taking the Mirtazapine. It's all so damn confusing as if severe depression wasn't an absolute torment in itself.
SO I don't honestly think it's possible for you to "know what you need" and the GP won't know any better - it is all "trial and error" I'm afraid. Hope you find something that helps.
That's very unusual I think for a GP practice to only prescribe AD short term. They are very cheap drugs so there's no funding issue and in my experience they leave you on them as long as you want, and let the patient decide when they want to try coming off them, which is the right thing to do. There's no evidence of any long term risk to health so I think you should question this policy at your GP practice.
I believe citalopram is first choice as it's the cheapest. Of course it's all about saving as much money as possible in the NHS <cynical>. Although my GP actually suggested fluoxetine first but I said no because I'd tried it in the past and it didn't make any difference. I wasn't given citalopram as I was prescribed amitriptyline to help me sleep and you can't take them together apparently.
I guess sertraline would be the next one your GP will suggest as it's an SSRI and it has reasonably good rates of success. Sertraline was great for me on the higher dosage but I had to come off due to side effects (but it was a rare one so I'm sure won't be a problem for you). If you have any issues with sleep, they might suggest mirtazapine either on its own or alongside an SSRI. I'm just on mirtazapine now, 4 and a half weeks in and it's done nothing so far. If anything I feel worse but I've felt worse on all the ADs I've been on at the start so I guess that's just how I react to them.
I think it's a very good thing you're going in well informed. When I was first on fluoxetine years ago and I felt worse nobody said to me that could happen so I just assumed they weren't working and stopped taking them. Nobody questioned it, which I think is pretty bad actually. I feel much happier taking ADs now I know more about the effects and how they work. But as Nina said, it's all trial and error. I'd be inclined to give sertraline a go in your shoes, I'd mention it if your GP doesn't.
Defo citalopram is first call, as it's the cheapest as said!
Also each of us are individual, so what suits one may not suit another and may also not get the same side effects.
I'm was in secondary care(psycharist and care co-ordinator) I was on escitalapram(cipramil) but it stopped working for me and I had a really bad bout of depression/anxiety I was put on venlafaxine then.
This literally took nearly 3 mths before I saw much change in myself, so I say give it a really good go.
I've never heard GP only prescribing AD short term, as I said it can take a few good weeks to get into your system.
They only give out diazepam short term to help with start up symtoms and some won't at all, thankfully mine did.
My psych told me on my last visit before being discharged, that when I've felt well without ANY symptoms (anxiety/depressed etc) only then could I think of coming off them if I wanted to but she was perfectly happy for me to stay on them forever how long I wanted.
There's a good MH site called No More Panic, which help me a lot and there People on there exactly feeling some of the symptoms you have with MH issues
I was on fluoxetine for about six months due to anxiety, I didn't feel anxious but the problem was I didn't feel anything at all. I wanted to sleep all the time. I don't remember laughing or feeling anything in that whole time. They got me over my bad patch but I'm hoping I never have to go on them again.
I've tried plenty of medications and I have yet to find one that helps significantly. I dislike many of the SSRI and newer drugs because they didn't work and had intolerable side effects. But if I had to recommend one it would be Sertraline. I think Sertraline had the least side effects and was most tolerable in general, it was also not so difficult to taper off.
But given that you have already tried two SSRI I wonder if your doctor should not be considering an alternative class of medication anyway. Especially as SSRI are not good for sleep, some other medications can help sleep and depression at the same time.
I also don't understand this idea that anti-depressants will only be given for a short time. I thought the standard treatment was at least 6 months and for people with severe or recurring depression 2 years, or even continuously.
I have been on mirtazipine and it worked well for me. Good luck.
I'm on mirtazapine and have been for the past month so I'll be interested to see how you get on. It has increased my appetite so I've put on a bit of weight (nearly half a stone) so just keep an eye on it. I had some very weird dreams when I first started but they've tailed off now. I actually struggled sleeping on 15mgs even though it's more sedating at a lower dose, or it's supposed to be. I've just gone up to 30mgs and I've been sleeping better the past few days. I haven't seen any improvement in my mood yet but it's still early days. What dose are you on?
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