..to not try another antidepressant ?

[Robotpaper]

Not posted in mental health as I want to know if IABU or not.

I started taking citalopram for anxiety a couple of years ago, it helped with the anxiety but caused me to go through highs and lows quite often (I’ve experienced highs/lows since around 15). This ended up in me being arrested due to my behaviour during an extremely “high” time during which I suffered some hallucinations . I went straight to my GP who took me off that medication and put me on Mirtazapine which I had to come off after a week due to it causing horrific hallucinations and body sensations. GP referred me for assessment due to suspected bi-polar.
So, I’ve been waiting since October for an appointment, in the mean time my anxiety is becoming quite extreme so I went to see the gp. Was a new gp I saw, my usual one is away, and this gp wants me to try sertraline.

Sorry that’s long but AIBU to not try it? I do need something ing to help but I’m terrified of the reaction I might have to it. I cannot do with hallucinations/ crazy behaviour that results in arrest again. This gp seemed no not take any notice of my concerns at all so I’m not feeling reassured .

I don't think you're being unreasonable for not wanting to try the sertraline given your experience with citalopram and mirtazipine. I've never taken sertraline, (I've only had citalopram and mirtazipine) but as I understand it, it is also an SSRI so your concern that it could end up having the same effect on you as the citalopram is not an unreasonable one.

How long is your usual GP away for? Could you cope with your anxiety until they are back and speak to them about their opinion on the sertraline given your particular history?

Thanks for the reply. I’m not sure when my usual gp will be back, he’s been away quite a while now. The SSRI thing is my concern and was the concern of my usual gp too. He gave me a small prescription ( 10)
of low dose diazepam to take when need untill my referral came through but I’ve run out and the new gp I saw won’t give any more, seems to think I’m going to abuse them.

There must be something other than either of those I can try though? I’m about to lose my job due to absence and struggling to care for my child.

I’ve been waiting since October for an appointment, expected to be another 3 months untill I’m seen.

If you’re bipolar then an antidepressant is likely going to make you very ill.

Can you afford to see a psychiatrist privately?

If not, can you request an urgent referral from your GP? You may have to really push for this but waiting 6 months for an appointment when you’ve been so unwell is not on.

I’m not sure how you should move it forward, but I second the need to see a psychiatrist. GPs are great, but they aren’t specialists, so won’t have the experience in helping you find the right medication.
This is even more important if you might have bipolar disorder.
On the other hand, anti-depressants can trigger mania, which does not mean you have bipolar. It does mean you need to be very careful about taking anti-D’s.
Talk to the GP about how quickly you can see a psychiatrist - if they’re on your side, they’ll want to help you get this sorted ASAP. If not, get another GP!

Unfortunately we cannot afford to go private at the moment due to me not really working much.
My normal gp has tried to push the referral forward twice already and this new one said she has done the same but when I phoned up the service they said it would still be another 3 month wait. I really have bugged them as much as I can.

I know I may not have bi-polar but I do seem to fit almost all the symptoms so am more than happy to see a psychiatrist to get to the bottom of whatever it is, if anything, I do have.

I’m just a bit stuck atm. Seems my only option untill I’m assessed is to try sertraline but I don’t think I can risk it.

When I told the new gp of my concerns she did say that perhaps it’s a personality disorder instead which might be why she wants me to try sertraline. But I don’t seem to have the symptoms of any personality disorder that I’ve read up about , they don’t describe me at all.

Not convinced another antidepressant would be a good idea at all, particularly if there’s a chance of it sending you hypomanic.

Something like quetiapine might be worth asking about.

Glad the consensus seems to be that not being unreasonable (first time for everything! ).

I don’t know what that medication is paddy, is it something a gp can prescribe?

I don't think you're being unreasonable, however I would say that I know lots of people (myself included) who tolerated one SSRI better than others - for me sertraline was a lifesaver and citalopram was the worst thing I ever took! So don't rule it out, but you may also be limiting yourself because it could be the one for you.

What were your bad side effects jelly? If you don’t mind saying.

I second Jelly's point that one SSRI can be utterly different than another, and I certainly wouldn't rule them out. It's just that you need a lot of support and monitoring if you've had such extreme reactions to others.
If this new GP would be ok with you having two or three appointments a week to make sure you're doing alright (even if only phone appointments), and you're confident she's taking your concerns seriously, it might be worth a try.
If you don't have confidence in the support you'll get, it's much harder.

How long does each period of high or low last for?

Quetiapine is an antipsychotic, and can also be used as a mood stabiliser. Sometimes it is used as an add-on for treating depression. It’s a good drug, which acts on serotonin receptors as well as dopamine.

It’s up to a GP if they feel comfortable prescribing it or not. They may not want to, as they may feel it’s something a psychiatrist should do. Which is fair enough really. But worth asking anyway.

An antipsychotic? That’s sounds a bit extreme. I’m not sure I would feel comfortable being prescribed that by a gp.

Highs last a couple to a few months, it’s difficult to remember exactly. The lows can last longer though, but then for some periods of time im fine apart from anxiety.

When I say I’m feeling high I don’t mean just very joyful btw, I go a bit further than that.

@Robot - the side effects of citalopram? Nausea, insomnia, suicidal thoughts to name a few! Sertraline was so different.

I have exactly the same problem with Citalopram as you. Hallucinations mostly. Freaky aren't they? Sertraline was not my friend either as I ended up retaining urine but I have had success with Paroxetine. Took over a month after coming off Citalopram for my visual disturbances to completely go though. I have also gotten along well with Tricyclic antidepressants. They aren't the drug of choice anymore, considered a bit old fashioned and more potential for side effects but I've been alright with them in the past.

Hi OP.

SSRIs are a complete no go for me with bipolar. However my friend takes them with a mood stabiliser with no issues.

I’m currently on Venlafaxine (SNRI) in the mornings, Propanolol (beta blockers, for anxiety) through the day and small dose of Amytriptylene (a TCA) at night to help me sleep and to counter the slight mania the SNRI causes.

The doses and combos have varied wildly over the decade since my diagnosis, depending on external stressors (having children, divorce, Uni stress, work etc.) Have been the most stable on this particular combo.

I’ve had antipsychotics in the past; when I was at my absolute worst at the start and when I’ve slipped a few times since. I get that they sound scary but they do work.

Hopefully your psych appointment will come through fast and you can get some answers and some medications. What works for one won’t work for another unfortunately.

Re the anxiety; there’s no evidence of beta blockers causing mania etc in bipolar patients so they may be with exploring with your GP to tide you over.

Thanks for all your he replies, I shall perhaps go back to the gp, need to think some lore about it.