Talk to me about SSRI medication, please

[Cairngorms]

I've had phases of depression for many years, but not ever taken medication. Over the past year, I've had major anxiety too associated with some very major life changes we are dealing with.

In the summer, I so desperate that I was prescribed an SSRI which I took. The side effects when I started were horrible, really horrible, my husband disapproved in general, and longer term it reduced my desire to have sex, which caused issues with my husband. I am not brilliant about remembering to take it, and during the autumn something came up where DH disagreed with me doing something because I was on medication, so I stopped taking it altogether.

I am now really unstable again - anxious, depressed, unhappy. I would like to try taking the SSRI again, BUT

• I am worried about the short-term side effects;
  
• I am worried about reduced libido again;
  
• I am worried about facing the GP who told me NOT to stop taking it.
  

How do I face the GP, face the DH's disapproval, find an SSRI with reduced starting side effects and also without the reduced libido effect?

Please help! I am finding this overwhelmingly hard.

[TheSilveryPussycat]

When does the prescription say to take them? - should be on the bottle.

It is some while since I started on mine, but was told morning, and that some food helps nausea. Just remembered another side effect was initial difficulty in getting to sleep, this too passed quickly, but had an idea this was why I was supposed to take them in the morning...

[lazymum99]

Has it occurred to your DH that a depressed anxious wife is not going to be wanting sex frequently. If you suffered from bad headaches he wouldn't say don't take paracetamol just snap out of it and get on the bed. He is putting extra pressure on you which you don't need while feeling unwell.

[Queenofknickers]

Firstly well done for taking that step and going back to GP. I have been on Prozac for 15 years and remember main starting symptoms were nausea but not debilitating ( much less than morning sickness) but really made worth while by the feeling two weeks later that someone had switched the colour on in a previously black and white world.

I'm glad you felt CBT helped - there is free online NHS CBT but v few people seem to know about it, even GPs. Will look up link for you and post. Remember soon you feel be feeling better

[orangeandlemons]

Your dh sounds very selfish to me, and I think you need to pull him up on this. I know you don't feel up to it at the moment, but where is the support for you? He needs sex, so you comply despite feeling crap. You are ill, and he tells you you don't need medication, what does he do to actually help you? Where is what you need in this? Perhaps this is the reason you feel so crap?

[Queenofknickers]

Free online CBT at www.livinglifetothefull.com and www.MoodGym.anu.edu.au. Both have great reviews and are now being used by most NHS areas in UK.

Ps if you want some bossy handholding ill be on here every day as I'm on bed rest for weeks....

[NanaNina]

Hi CG - we...ll you could wait till the Easter holidays I suppose which is 1 week away - is your DH a teacher so will be around in term time. How old are your children btw?I think 20 mg is a very low dose and you might not feel a great deal better but I'm glad you have a review booked.

However you could start them tonight. Does it say when you have to take them or "just 1 per day" on the box. If so I would definitely take 1 before bedtime. Don't read the list of side effects (although you have probably already done that!) drug companies have to cover themselves by providing an a comprehensive list of side effects.

I think whether you start them tonight or in the Easter holiday is to some extent dependent upon the age of your children and if they are pre schoolers it may well be best to wait for the Easter holiday, but if they are old enough to get to and from school themselves, then you could start now.

Whenever you start the main thing is you must find the emotional strength from somewhere to stand up to your DH and not give in to him trying to make you stop. Yes he is a selfish sod and all the things people are saying, but he is as he is and you aren't going to change him anytime soon. The thing to concentrate on is YOU.

SO we have option 1 - take 1st one tonight before bed
OPtion 2 - wait till Easter holiday.

And a firm pledge that you are NOT going to STOP taking them this time. Yes?

I am more than happy to hold your hand and be a little directive (sounds better than bossy) and you also have that offer from QueenofKnickers, so between us we should be able to keep you afloat. Have you any RL support.
I am going to Ireland to see family over the Easter holiday (away for 5 days) otherwise I am here.

SO have a think about the 2 options and come back and let us know, and a bit more info about the ages and stages of your children. How did DH react when you had to take to your bed for 2 weeks last time you started them. He must have some good points - presumably he cared for the children.

Over and out at 4.50
Will check again in an hour or so. NNx

[orangeandlemons]

I have taken 4 different Ssri's, only one made me feel sick. So there's no saying that you will feel sick with prozac

[Cairngorms]

Easter holidays start on Friday; DH is not a teacher, but has the two weeks booked off anyway. My children are primary school age, need support with getting to / from their two schools, and one has complex SN. It is easier in many ways for me to care for them at home in the holidays than deal with schools.

DH was sort-of supportive last time (he took a few days off work) and also cross, but I also had a major physical infection and he considered all my unwellness to be due to physical health rather than mental health. Last time my parents, PILs and a random classmate's mum cared for me and the children. (I KNOW that the physical infection quite probably made me feel worse and some of the side effects may have been the infection or drugs I was taking for that, but that doesn't stop me feeling anxious about taking them again.)

I took them for three months last time, and quit mainly due to wanting his approval to apply for a job. I know he's a selfish sod, but as NanaNina says, I'm not going to change that immediately. He's trying hard, but we are under enormous stress for other reasons. I intend to keep going for longer this time.

The instructions just say "once a day", not when. I went for around 7pm last time, kids bedtime. I'm ... still not sure whether tonight's the night or next Thursday.

I have a few hand-holders in RL, though most are not local to me. So many, many thanks to all of you, especially NN and QoK for your offers of support.

[orangeandlemons]

Can you cut them in half and start on a low dose? I never had any side effects with Prozac. Tonnes with all the others though

[KobayashiMaru]

I always find side effects are reduced a lot when I take right before bed, its like you sleep through it.
You really need to take them for at least 6 months, and don't stop suddenly, its bad for you.

[TheSilveryPussycat]

Please don't cut them in half. 20 mg is a v low dose. It's my maintenance dose of paroxatine, and was effective when I was suffering from depression.

[KobayashiMaru]

20mg is standard for prozac, different drugs have very different doses, you can't compare them.

[NanaNina]

Thanks for more info CG and NO don't cut them in half, because you are probably on a very low dose anyway and it's important to follow GPs advice. You may need the meds to be increased later, but they usually start you off on a low dose.

Glad to hear you have some RL support.

It's your call when you start, and there are pros and cons I know. However I think you should make a decision about that asap, as the ruminating about when will I think increase your anxiety, as depression and anxiety usually go hand in hand.

Have you told your DH yet and if so what was his response (just to get a measure of how much emotional strength you are going to need to stick to your meds) I know that emotional strength is very very low when depressed but you will have to find some from your "reserve tank." It's difficult when we don't know the dynamics of your r/ship with DH, but just wondering how his disapproval manifests itself. Does he say his piece and that's it or is it more prolonged.

Incidentally how are you feeling at the present time in terms of symptoms. Depression I think is different for everyone and I sometimes think we all have our own unique experience of the torment of this illness.

I have intermittent depression following a severe episode 2 years ago, and haven't made a full recovery so have periods of time when I am totally crap and can't function and others when I'm fine. I have no warning or trigger so I don't feel in control of my life really.

SO - does dh know and next time you post tell us when you are taking the meds, tonight or next Friday night.

Sending warm wishes your way.

[NanaNina]

Lucyellensmum you posted that tryclic ADs are more addictive than SSRIs and this isn't the case. None of the ADs are addictive (which means you clamour for more and more - like an addiction for heroin or smoking or alcohol etc) It is true that you can become dependent upon ADs which is different because you don't need more and more (ok your dose gets increased but that is overseen by medics and is to hopefully provide you with greater benefits)

Having said that I think the dependency on ADs is manifested when trying to come off them and you get withdrawal symptoms, which is why it is so important to come off them gradually. To be honest I don't think many GPs know much about mental health and even less about reducing ADs. I tried 3 times to come off the tryclic I was on for 14 years and each time i tried I had withdrawal symptoms and GPs just told me to go back on them and not "mess about" with the dose anymore. None of them mentioned withdrawal symptoms, they just said the depression had returned because the dose was being reduced.

I finally saw a psychologist who knew how to get me off them safely - it took 10 months and I was free of ADs for the first time for 14 years...........BUT 4 months later I had a 2nd severe episode of depression (and again inpatient on psych ward for 3 months) the consensus was that I had relapsed due to stopping the ADs after so many years. I wish a thousand times I had never come off them - I had no side effects (only an occasional dry mouth) and held down a responsible job for all those years, and now here I am with intermittent severe depression.

Sorry I am telling you stuff you may not not want to know but it might be helpful to you CG to know my back story.

[Lucyellensmum95]

Ah, ok Nana - to be fair, i suppose that was an assumption on my part. I do wonder if ADs are chosen depending on what the pharma companies are trying to sell at the time. I have only taken citalopram and recently diazepam (2mg is it worth it???) I too wonder if i just need to be on ADs permanently, however my DP is very anti - not becaue of the labido thing but just becaue i lose my spark. Id sooner lose my spark than throw myself under a train though.

[Cairngorms]

I was pretty much psyched up to take them tonight, when DH asked about them. He said, rather crossly, that he was being supportive, and could I take them next week when it's holidays (I'd start Thursday evening). If he's happier with that, I'll run with that too.

Symptoms: It's the anxiety that's killing me at the moment, I think. I'm trembling pretty much all the time, can't think about anything other than all the things that could go wrong, and am finding it almost impossible to do my usual chores (the cooking / laundry etc) or my hobbies/exercise (because my brain gets stuck on the things I'm fretting about) or think (brain full of cotton wool and fog) or be organised. I'm not eating properly (which for me is a VERY worrying sign) and earlier this month had problems sleeping, but that's got better (sleep disrupted by children, but not by myself).

[evansthebread]

My nephew played holy hell with my BIL for being on ADs. As a result he stopped taking them suddenly and became very ill.

No one knows how truly bad it can feel to suffer with depression unless they've been there. A holier-than-thou attitude from others is downright harmful. I should know as until I was attacked and suffered with PTSD which triggered anxiety and depression, I belonged to the "pull yourself together" brigade, too.

Without a doubt I would not be here without chemical help. You'd need a painkiller if you broke a bone, so if you can take a pill that helps with what's inside, why not take it. I know it's not ideal, especially over the long term, but please don't suffer when you don't need to.

Maybe you could try to explain that to DH?

As for the sex issue, many sexual health clinics have a counsellor. I believe they primarily help people who have found out they have HIV, but I was rec'd an absolutely wonderful lady after attending the family planning session at the local "clap clinic".

I'm nearly 50, have spoken to a private counsellor weekly for 4 years and had many CBT sessions from my local MH team. None of them have been as wonderful as the sexual health counsellor. She recognised that I have issues stemming back to my childhood and has drawn me out more in half a dozen sessions and helped me deal with the problems I've been having with my sex life than 15 years of "normal" counselling has.

I would highly recommend you pay a visit to your FPA or sex health clinic to see if you could have some sessions to help you deal with your libido problems. I hope you can open your husband's eyes to the potential damage he may be causing with his attitude, too.

Good luck.

[orangeandlemons]

I only meant start them on a low dose to minimise side effects. After a week or so put them up to a full dose. I have had to do this with Ssri's to start them off. The full dose at once is too much for me.

[Lucyellensmum95]

Please take the tablets, they will take a few weeks to work and you really want to be side effect free by the time you have the holidays to deal with. I guess your DH is frustrated that he can't help you, but it doesn't matter how supportive he is, you are ill - unless he is a doctor or a drug he can't help you. Would he tell you not to take your insulin until next week if you were diabetic? of course he wouldn't - I am quite happy to talk to him by pm if he wants a perspective. Your anxiety sound severe and the drugs will help you - it is madness not to take them. Your DH can still help, he can still support you, in fact it is vital that he does so, but he cannot be your knight in shining armour and make this go away, he needs to drop the arrogance and accept medical help.

[evansthebread]

PS Yeah, the anxiety has been pretty bad for me, too. It was there before I started taking Prozac, though, but I coped. I think it's just a case of you can be strong until a certain point and then - BANG -either the depression or anxiety will kick in.

I was given benzos to help with the anxiety (the only things that did). They also helped with sleep issues and we all know that a lack of sleep makes everything worse! I've had them withdrawn, though (and given hypnotics instead - equally as addictive so why not just leave me on stuff that actually worked!).

If you can tell yourself that the anxiety is a side effect that will dissipate as time goes on and you settle on ADs, I think that might help you. I lost weight and appetite with anxiety, too - previously unknown as depression had always made me eat fast, unhealthy food that sort of comforted me (I remember stuffing a half-defrosted pasty into my mouth whilst tears ran down my face. I wasn't hungry, I just needed "something").

Again, good luck.

[Cairngorms]

I want the ADs to deal with the anxiety, not that the anxiety is a side effect of the ADs. I cannot, really cannot, become MORE anxious. I can cope with depression. I cannot cope with the ongoing anxiety.

[Lucyellensmum95]

I have been given diazepam alongside the citalopram to counter the side effects. To be honest though i can't say that they increase my anxiety and i didnt have any extra meds last time, just the citalopram. I found they made me agitated rather than anxious, so i find that my feet get fidgety etc. I was prescribed them for anxiety alone the first time.

Also, get some bach's rescue remedy, this really helped me and i had forgotten about it, am going to buy some tomorrow. Its herbal drops and perfectly ok to take with SSRIs, however do NOT take St Johns wort as this interacts with SSRIs and increases the affects and you mustn't take them together.

[TheSilveryPussycat]

I agree that you should start taking them as soon as possible. You have been advised so to do by your GP, who you consulted about your mental health. Even if we are depressed, it is up to us to manage our own mental health, albeit with the support of others.

[NanaNina]

Lucyellensmum the NICE guidelines are for GPs to prescribe citalopram or another SSRI. I don't think it's to do with money (unusually) as I think ADs are relatively cheap. SSRIs are thought to have fewer side effects and are not fatal in overdose so I think that's the reason they are prescribed. I was "written up" for diazepam too (2mg) x 3 per day, by the conslt psych when in hospital. Like you I don't know if they are any use. I take them on bad days, and I think the one I take at night helps me to sleep. 2mg is a very low dose.

Some years ago there was a big huhaa about GPs dishing out major tranqs (diazepam - trade name Valium) mainly to women and the tranqs made them less anxious but I think that is evidence of addiction in that they craved more and more, and GPs were just doubling and trebling doses and women were becoming "zombies" - the GPs had to stop prescribing major tranqs and some patients sued the NHS for "stolen years" when they were like zombies.

I am wondering if you are fully recovered as you have lost your spark, and it may be that your meds need "tweaking" - but I quite agree , loss of spark (whatever that means) is better than loss of you!

[NanaNina]

CG it sounds like you have decided to go with your DH's preference, that you start next Thursday, so that's not that long away. Did you tell the GP about the anxiety. ADs are meant to cope with depression and anxiety, but if you told the GP he may have prescribed Prozac as they may have more of a sedative effect.

Re you present anxiety. I'm not too good on this as depression has always been far worse for me than anxiety but I do experience it in maybe a lesser form. I take the diazepam 2mg but I'm not sure it does any good. It's probably unlikely your GP would prescribe diazepam because of all the problems that I wrote about in the last post. Mine was prescribed by a psychiatrist.

I think you should try some breathing exercises for your anxiety. Lie on the bed and put your hands on your top tummy and breathe in through your nose to a count of 7 and then breathe slowly out to a count of ll. Feel your tummy rise and fall as you breathe. It doesn't matter about the numbers, just do what feels right for you. It just might help a bit.

What you are doing is catastrophising in thinking of all the things that can go wrong, and this has taken you over, which is very understandable. I don't know if you've ever heard of CBT (cognitive behaviour therapy) but it might just help a bit. The theory is quite basic and acknowledges that when we are anxious we have ANTS (automatic negative thoughts) that pop up, and then your thoughts spiral down and down until your ANTS have taken over which is what is I think what is happening with you at the moment. The thing is you have to try to replace your negative thoughts with more balanced ones. My CPN (community psychiatric nurse) introduced me to this therapy and said that when my ANTs were getting out of control I had to write them down - all of them and then write a more balanced view of the ANTs. When you have written the ANTs you have to ask yourself "is this accurate" and it is usually NO and is it helpful and again the answer is NO. SO you are then meant to try to keep the more balanced thoughts in your head. MUCH easier said than done I know. I always found this CBT helpful when I am ok but not somuch when I am having crap days.

Sorry CG you can google CBT and get the info - much better than what I have been telling you. You need to cut yourself some slack and you can't expect to follow your usual chores washing/cooking etc and not exercising etc - you are ill - mentally ill. YOu wouldn't be expecting to carry on your usual routine if you had pneumonia would you.

Am feeling really sorry that you are having to cope with this awful anxiety but you will cope - the human mind and body are programmed to make us cope - you will feel shite but you will still be here tomorrow and the next day and keep going..........Am happy to hold your hand through the weekend and next week. I am going to Ireland on Sat next week though I shall be anxious next week as I always am before we go to Ireland in case I get a bout of bad days, as I cry a lot, very loud and long and worry like hell, as I am paranoid about anyone seeing me in a state, only my DP and close friends. SO I will be doing deep breathing..........

All for now Love NNx