Help please choosing next anti-depressant

[Chocattack]

Hi, I'm a reluctant pill taker (they rarely agree with me, don't work or stop working after a while) who's just agreed with gp to give ads another try. I've got a few weeks to decide which but I know definitely not citalopram or venlafaxine.

I know everyone is different but does anyone have any experience of taking more than one or two different types? I've also tried Prozac, Mirtazapine (spelling incorrect?) and sertraline but have very little recollection of taking them. It's mainly for depression but I suffer with anxiety and self-harm issues but these are secondary to the depression. I'm looking to start some kind of therapy too but have been warned I may have to wait a few months - so just need something to help prevent me from getting any worse.

Details of successful or disastrous experiences is much appreciated. How many different sorts did you have to try? Is it better to try something I've not had before? Thanks.

I've taken Dosulepin twice for two episodes of PND and anxiety. I'm still on a really low dose two years on from the second episode. I find they reduce the anxiety therefore help me sleep better therefore help me feel less depressed. But that's the order my depression seemed to go in both times (general anxiety for weeks, then insomnia for months then full on debilitating depression for months) so perhaps they work for that kind of issue. If you suffer from insomnia I find they're great as they don't work from a 'knocking you out' perspective but they seem to tackle the route cause ie the anxiety.

Maybe worth considering as an option to discuss with your GP?

Good luck with it. I'm sure you'll find the right one soon.

Thanks for the reply countrylover. I could discuss it with my gp though pretty sure she won't agree as easy to fatally overdose on these.

Hi, I have had prozac, citalopram, venlaflaxine (on now), sertraline, lofepramine (an old style one) ... always guided by Gp and now Psychiatrist.
Venlaflaxine not recommended for pregnancy or breastfeeding and I have struggled coming off it - with side effects but also the serotonin disorder I got purely as side effect of being on it for so long - hence it is usually supervised by a psychiatrist.

All I know of mirtazipine is it is a sedating AD. Could you ask the dr how you would be on the 4 you have tried before but can't remember... if you weren't on them very long do you know why, or why they were changed so much?

Do you want a first line AD or a 2nd line one (2nd line ones are mirtazapine and venlaflaxine - to use after tried a few 1st line ones generally). There are other ones out there too. Hope your talking therapy works.

Hi I take dosulepin like countrylover and find it works very well and I don't suffer with any nasty side effects. I was given citalapram and mirtazapine before and they didn't work for me so it's definitely worth trying different ones.

Thanks Keiza, your questions have really made me think! Neither pregnancy nor breast feeding are an issue for me so in theory venlafaxine should be ok. My gp has said that I was on this for more than 2 years and has actually suggested it again this time. But I do recall asking to come off it (partly because I'd spooked myself out by reading some bad things about it and also because I felt it wasn't working as well as it should for the side effects I was experiencing) and being given mirtazapine. My memory goes a bit hazy after that and I can't remember how long I took this for but the sedating effect was very welcomed! I know I also took sertraline for around 2 years but I think these are what I tried to OD on so they possibly weren't working for me particularly well by that time either. I started with the venlafaxine not long after so I guess a 2nd line ad would be a better option.

I guess the long and short of it is that I need to ask some more questions of my gp. I'm just worried that it will all be a bit of rush in the appt so I'm trying to give it a bit more thought beforehand. Thanks for focusing my mind!

Thanks also Orangeflutie. As I mentioned before I think dosulepin will be a no go for me. But I'm interested in how long you took the citalopram and mirtazapine for? I mean how long should I be taking something before deciding it doesn't work?

Sounds like either venlaflaxine or mirtazapine helped you then - and I guess if you have a choice it depends whether you would like the sedating effect of mirtazapine or not.

Hope you have a useful appointment.

Chocattack I was on citalapram for six weeks. I felt I had to stick it out as often it takes a while to work. I had to go to my doctor in the end as I was getting too many side effects. I felt jittery all the time, couldn't eat ( I lost over half a stone in weight) and I didn't really need to, kept yawning in the day but couldn't sleep much at night.

After this I was put on mirtazapine and had a bad reaction to the first dose. It caused my heart rate to slow too much and my blood pressure plummeted. I ended up in hospital on a drip! I'm sure this is a very unlikely reaction (it was listed on the packet as rare), but it did scare me.

I'm really pleased I'm now on an AD that works. Don't give up. There will be one out there that suits you:)

Kezia, thanks. Yes I probably do have a choice. And I think I'm (reluctantly) choosing mirtazepine (even though there seems to be fewer people on MN to compare side effects etc with!).

Orangeflutie I appreciate you sharing your experiences. Wow 6 weeks is a long time. I lasted just under 3 weeks but within 3 days I knew something wasn't right but my gp kept assuring me things would subside. I gave it 2 weeks then decided no more. I'm so scared that something like that will happen again.

Glad you've both found something that works. I hope I can find something too I've got a long wait for therapy .

If you have had trouble in the past with tablets/finding something that suits you, could you ask your GP for a referral to see a specialist (i.e. a psychiatrist) for a second opinion? This could just be a one off appt to review your medication.
Imo it may help you more if you could discuss the pros and cons with someone more experienced rather than trying to decide yourself? An experienced psychiatrist may well be more confident than a GP in terms of starting a combination if this is felt necessary/appropriate.
Hope you find something that suits you.

OP - I have had a recent positive experience with Agomelatin. I did not get on with Citalopram at all (ditto jitteriness and loss of appetite) but am on a low dose (25mg) and it is helping with sleep, anxiety and (albeit very mild in the first place) self-harm. It is quite new to market (licensed for Europe in 2008 I think) and has been prescribed for me by a private psychiatrist (my GP surgery were not aware of it but have been happy to continue prescribing it after initial Psych. consultation and recommendation). Do a google for it and reviews and see what you think? It works in a different way to traditional SSRIs so may be the change/alternative that works for you.

Onepiece, interesting advice thanks. Certainly an avenue to explore. I have had trouble with meds in the past but I guess I'm reluctant to be referred to a psychiatrist. I was prescribed venlafaxine by a psychiatrist about 6 years ago and never felt listened to about how I was feeling. I was certain that my problems were related to the drug yet my psychiatrist disagreed and argued it was my illness and the answer being to keep taking more and more. The thing is I've been living with depression now for 15+ years and I worry about taking meds that will actually make me worse! Nobody wants that.

TheyKnow - I haven't heard of Agomelatin. Will go google. Thanks.