Please help... Am on the edge

[Sharpkat]

Have previously posted but never been this bad. Until recently I had private medical care so coped but am now at the bottom of the pile as far as my GP is concerned. I returned to work in August after 4 months off but found it too stressful - was collapsing every day and vomiting and unable to eat, lost a stone in 3 weeks so after 3 months I quit as my health is more important.

Until then I had private medical insurance so have not relied on the NHS for 7 years. I had to register with a practice for NHS services.

I spent 5 weeks as an inpatient and 5 weeks as a day patient 2 years ago at at a psychiatric unit but cannot afford it now as it is 5k per week.

I have been to my gp x 6 and seen numerous doctors but they will only give me the minimum strength of ads and sleepers. I need more. After 3 years of very high doses (225mg) 25mg is not going to cut it.

Am now on day 4 of no sleep and feel like a zombie but just hallucinate if I try and sleep.

Is there anywhere free/cheap I can go for a few days like the previous hospital just to getu meds sorted out. GP has been useless and have tried everyone at the practice. Am
not working so money is tight but would pay or help.

Am in se London

So sorry for long post but the nhs cannot/will not give me the dose I have proved I need and I am beside myself.

Just wanted to bump this up for you.
I am sorry things are so very difficult for you atm :(
I really have no advice apart from I think A&E have mental health workers if you are feeling suicidal or unable to function.
It sucks that you are unable to get the correct dose of medication to keep yourself well.
How are you feeling this morning?

Like ElfandSafety says, A&E is an option (as would be out of hours gp).

Have you specifically asked your gp for a chmt referral/what you should do if you feel worse/said the drugs aren't working? (I know you probably have).

hi sharpkat

I haven't used these services (only outpatient services myself) - sure someone will be along shortly who can better help from this perspective -but I do work in the NHS and understand how the services should work.

Has your GP referred you to any of the community mental health support teams? They're the halfway house between having no support (which it sounds like you have) and being a day case/inpatient? I used to live SE London (only moved 2 months ago) and there are Southwark community mental health services which are part of SOuth London and the Maudsley NHS Trust who provide community and day/inpatient mental health services.

A&E do have mental health support if you get really stuck. They'll treat you as an emergency but can also refer you in to crisis teams etc if needed.

It sounds as if your GP has given you medication and done no more? That can't be right. Would you consider community or outpatient support? WHat type of support do you think you need beyond medication?

It sounds like you are addicted to sleeping tablets and maybe other meds too (not ADs as they are not generally addictive). Also, sorry for saying this, you say you've tried everyone at the practice, it sounds like you are only willing to accept advice and treatment that falls in with your own ideas or what you have previously been given, whether or not that was good for you. Sorry to sound so harsh but it seems that the meds you were on are a significant part of the problem. Maybe go back to one of the GPs at the practice and ask for help with managing your addiction.

ouch Madmouse - I know you are always straight talking and knowyou may sound harsh, but you're right - you do!

I think OP you have had some helpful posts, especially ItrytobeZen. It is going to be difficult for you to change from private care to NHS and no I don't think there is any mental health provision free/cheap where you could "book yourself in" as it were. The thing that occurs to me is why the private psychiatrist who prescribed a high dose of AD canot write to your GP and recommend that this is the dosage that you need.

A friend of mine has just had a terrible experience with her daughter (finally diagnosed with severe depression with psychotic episode) and was totally misdiagnosed by the medics who sent her off with a relaxation tape! My friend was at her wits end as her daughter was "climbing the walls" and she paid for a session with a private conslt psychiatrist who diagnosed her and prescribed all the meds she needed, and wrote to her GP and they have followed all of his recommendations. I think the one thing that conslt psych can do is diagnose and treat, and I don't think some GPs have great expertise in mental health.

It does sound though that you have been panicking if you have seen ever GP in the practice and are finding it hard after private care. Can you contact the private psych who put you on 225mg AD and ask him/her to write to a GP at the practice and you may then get the meds that you need. My GP prescribed 25 mg of AD which was fair enough at the time, as I was only moderately depressed and she wanted to build them up slowly. However I took a nose dive after a few days and had to be admitted to psych ward (NHS) and I was immediately put on 150mg and am now on 200mg per day.

I think you should explore with your GP the things that Itrytobezen suggests. I had a lovely CPN who was very very helpful after I was discharged. Re the sleeping tablets - is it zopiclone that you take? As you probably know you can become dependent on them quite quickly and this is why GPs will only prescribe for a short time.

Could you start over with the NHS GPs and maybe try to be a little more tolerant of the services that they offer.

If you were on the meds when you were working and still feeling like that (what was it you did?) Then I'd say the high dose anti-d's were not working for you anyway?
When you had inpatient was it just assesing? It feels to me from what you have posted that you need to start getting to the roots of your problems rather that just relying on medication to 'fix' things.

I know nothing of the OP's situation obviously, but I think you need to know frid that sometimes depression strikes without anything specific as in "getting to the roots of your problems" it used to be called endogenous depression (without cause) but I think that is an outdated term. Sometimes you need ADs to "get you off the floor" before you can make good use of therapy. I don't thing either frid that you are in a position to comment on the beneficial effect or not of ADs. I know you have added a ? mark but you sound rather definite.

Is it just me or are these posts to the OP sounding rather harsh/dismissive, which is unusual on the MH threads.

Can you come back OP and let us know if anything has helped you onthe thread/or give us a bit more detail so we can best offer suggestions that may be helpful.

NanaNina I am responding to the post as I read it, as I always do. I'm not setting out to be harsh, that's why I'm not usually harsh. Based on what I read in the OP the writer needs a wake up call, like I have needed a few in my life too. The OP can take or leave my post as she seems fit, it's not gospel.

Oh and personally it is my belief that there is usually a reason why someone is depressed. I speak both personally and professionally to many people with depression and have yet to come across someone for whom there was not a cause of sorts. Depressive episodes can come on without a direct trigger but that is something else.

I work in mental health and am just wondering if the ad prescribed now at 25mg is the same as the one prescribed at 225mg as many do not have such a large prescription range.

One drug may be prescribed at 20mg and be very effective but lethal at 200mg so it depends not only on the strength but the drug itself. Other drugs are prescribed at 200mg+ and are effective but have no therapeutic value at 20mg.

It is also important to remember that drugs for mental health conditions are developing all the time and NHS GP's are required to prescribe at NICE recommended guidelines which usually incorporates that most evidenced based medications. Private psychiatrists are more able to prescribe a range of drugs as it is the medical insurance that picks up the bill not the taxpayer.

No two people are the same so it can take a while to get the right does type so do go back to the GP if your not happy but remember they will not normally change anything for 1 month as that is how long most meds to to have an effect, this would not be any different in a hospital setting.

Try and hold in there and don't give up hope.

NanaNina having suffered from long term depression, I think I can talk about it with some knowledge. And really in the long run it is better to work on how you think, why you think like that and how you can try and change that ALONGSIDE medication.

I think you post is very helpful Suzic84 and it is good to have an experienced MH professional on the site. My friend who paid for her daughter to have a private consultation with a conslt psych did not have medical insurance. The conslt psych wrote to her GP with the diagnosis she had made, and a recommendation of the drugs that she should be on, and the GP seems happy to follow the recommendations, so the the bill is not being picked up by medical insurance. Infact the GP surgery wrote a letter apologising for not diagnosing correctly, and for the distress that this had caused my friend's daughter.

This also happened with my sister. She was suffering so much with her knee and ankle and kept getting fobbed off by the GPs, saying it was arthritis, and not even looking at it. I paid for her to see a knee specialist and he wrote a very detailed letter to her GP, saying that she should have an urgent appt with an orthaepedic surgeon. When my sister went to the GP he said he couldn't really understand some of the things in the letter but he would definitely refer her as a matter of urgency, which he did. She then had a knee operation on the NHS, so this is another example of the way paying for a private medic can lead to treatment on the NHS.

I know you are straightforward madmouse and I usually agree with you - I just thought this was a bit harsh, and yes I often see your posts, giving people a wake up call with which I am in agreement. You are probably right that there is generally a cause for depression, which I think is almost always about loss of some sort. However it also has to be remembered that after 1 major episode of severe depression, there is a 50% chance of a 2nd one, and after a 2nd one there is an 80% chance of a third one. Not sure what happens after that. Frankly I hope I die of natural causes before I get a 2nd major episode. And yes of course posters can take or leave anything anyone says - one of the positives of MN I think.

Frid - I don't think we should get competetive about who has had the longest, more acute episodes of depression. I think everyone on the MH threads posts from personal experience, apart from the HCPs who are always helpful, but I think we have to be careful about our posts and yours sounded rather definite and somewhat dismissive. Apologies if that is not what you meant.

sharpkat - how are you and have any of the posts been helpful?

. Im one of the people who has been diagnosed with endogenous depression (with a hormonal factor.)

This was after seeing a number of different GP's, 3 psychiatrists and a very experienced counsellor.

I was very keen to find out a 'cause' and to work on the reason behind why this had happened but they all agreed that there wasnt actually one other than chemical/hormonal shifts.

However even though this was the case - I have still found CBT helpful because it has helped to cope with the depression/anxiety symptoms and to not make them even worse by catastrophizing etc.

OP - I dont know if this any use to you but I have always tried to think of my treatment as a range of different things rather than just one (medication). So medication plus CBT, relaxation, gentle exercise, good diet etc etc

Hope you start to feel better soon.

kizzie, NanaNina and others didn't mean to be dismissive to anyone who feels or knows that their depression has no cause - sorry if this is what happened.

I dont feel 'dismissed' madmouse