suggestions for other antidepressants to try?

[madmomma]

I know this is one for the gp really, but I was hoping to get some suggestions to put to him.

I'm on an antidepressant indefinitely due to lots of relapses, but mine is a bog-standard depression with no other features. I've been on fluoxitine, citalopram and sertraline and so far have had some success with all of them, but I think it's time for a change as I'm getting a lot of morbid thoughts (not self-harm, just death-related)

Anyone know what might be worth a try next? I briefly tried venlafaxine, but didn't get along with it. TIA

I think that you may be referred to a psychiatrist because you've been on several ADs and you haven't had a satisfactory response from them. That's the reason I was referred to one. They're much more knowledgable about them than gps are.

I could be wrong, but all the ones you've tried (apart from venlafaxine) are SSRIs so switching to a different group might be an idea. Maybe mention that to your gp? When you say that you didn't get on with venlafaxine, what do you mean? Bad side effects? It's not a nice drug, I know. I had to stop taking that one too, due to nausea and sleeping problems.

Thanks bisleyboy Yeah they're all ssris apart from venlafaxine (made me extremely panicky and swollen tongue).I want to try another drug from that group though, in case I get a better response.

Don't be afraid to try some of the old school tricyclics, amitriptyline, lofepramine etc, these can be prescribed by gps. I've never got on well with SSRIsor SNRIs but have found the tricyclics to have more tolerable side effects, at worst a bit of constipation, and itchiness for first few days (but everyone is different). then if that fails get a referral to a psychiatrist be considered for MAOIs or lithium, both of which can be used for resistant depression (not a medical Dr but am under treatment).

I've struggled for years with depression and tried lots of different meds so understand how frustrating it is. hopefully the next one you try will be one that works for you. good luck

I second Butterchunks thoughts. Tricyclics might be the next road to go down but not all GPs will be comfortable prescribing them due to the perceived dangers of overdose (though venlafaxine is pretty bad on OD too).

amitriptyline and clomipramine are supposed to be potent antidepressants. clomipramine is supposed to be good for OCD and if you are getting intrusive morbid thoughts that wont go away that is a kind of obsession really? lofepramine is OK,a GP might go for that because it is safest tricyclic.

You might benefit from specialist input if you have had this treatment resistant depression for a long time. The problem is getting to see a psychiatrist isn't always easy. But if you can they will assess and diagnose you and then they want to medicate or refer for talking therapy.

There is a bit of a trend in psychiatry for using low dose antipsychotics like Quetiapine. That can help some people with treatment resistant depression, especially if anxiety and poor sleep are an issue.

Have you tried paroxetine? It is now s out of favour because some patients have problems coming off it but I have find it far more effective than either sertraline or citalopram. I haven my ever had any withdrawal issues either.

I think the trouble is that all these ADs react differently on individuals, so it's all so hit and miss. I've been on a tryclic AD, and now on Sertraline and was on Mirtazapine also but wanted to come off that because of weight gain, but wish I hadn't as I'm so much worse now. The psych said I either had to go back on Mirtazapine or try another AD, so I said I'd try something new. She prescribed Venlafaxine (think because it's an SSNI) - only been taking it for a week at very low dose but really messed with my sleep, and I've had some horrible days.

To be honest I think I've lost faith in the drugs - I think it's all a bit of a lottery in finding the right one, or a combination of two (which seems to be what they do these days) if you are in secondary care.

Thankyou so much everyone, for taking the time to reply. Interesting about the tricyclics. Paroxetine sounds good, withdrawl wouldn't be a problem cos I won't be coming off the buggers if they work!! I'd be scared shitless of a lithium type thing to be honest. I don't get anxious and sleep very well (although always bloody tired!) I've had every kind of talking therapy known to man so I don't think I need anymore really. I have friends who I can talk deeply to, which is a big help. The OCD angle is really interesting.I'd not thought of the morbid thoughts as obsessive, but actually they are so stubborn that maybe it would be helpful to frame them that way.

It's definitely worth trying to get a referral to a psychiatrist as they can prescribe things gps can't. One of my ADs is agomelatine which is quite new and has been very good but gps don't seem to be familiar with it.

just googled agomelatine - sounds promising!

That's interesting, queen, I'm on agomelatine too. Do you find it helps? I haven't had much change on it yet in terms of depression, but I does wonders for my sleep and I'm not nearly as anxious as I was.

Cross posted madmomma

Also, queen, you say agomelatine is one of the ADs you take. Can I ask what else you take? My psych is thinking of combining/augmenting with another drug, but he's a bit nervous about it as agomelatine is very new and not much research has been done on it in combination with other drugs yet.

What ever you do, please stay away from venlafaxine....it's horrendously addictive and when i withdrew from it I honestly wasn't safe to look after my children alone, and felt like I was dying. And thats a common reaction to ti.

What ever you do, please stay away from venlafaxine....it's horrendously addictive and when i withdrew from it I honestly wasn't safe to look after my children alone, and felt like I was dying. And thats a common reaction to ti.

Yeah I took one venlafaxine tablet and felt like I was choking on my own tongue all night, rigid with fear. That is one strong drug!! Although a friend is having a good response from it.

Hi Bisley - I combine agomelatine with fluoxetine and lithium with no problems. The lithium is to boost the others and did work well. Agomelatine is in the body for just a short time compared to other ADs that I don't think much reacts with it. I've had general anaesthetics, drugs for nerve pain etc and all have been fine. It does tend to worry Drs though because it's so relatively new.

queen tell me to piss off if I'm being too nosy, but is that combo for a 'regular' depression or something a bit more complex? I only ask because the psychiatrists I've seen are certain that mine is a straightforward depression IYSWIM?

That's useful to know queen, thank you. Do you get any side effects from the combination of drugs that you are on? My psych has mentioned lithium, but the thought of it makes me nervous. He also loves quetiapine and keeps trying to put me in that too, but again I'm not keen.

keeps try to put me on* that, sorry!

Drat!! Bold fail

My diagnosis is severe depression with anxiety, nothing complicated like PD etc. I did have side effects when I started the lithium - mainly dizziness but they passed. The best thing I have found about the lithium is that as well as boosting the other ADs it also gets rid of suicidal thoughts. Apparently it's well known for it. I've never had quetiapine but I have heard it makes you gain weight and having been on mirtazapine and put on 3 stone I've been a bit "hmmm" when it's been suggested to me. However I've heard of other people who think it's great.

Thanks queen I didn't know lithium boosted other antids. Does it not make your hair fall out?

No! Not that I've noticed! I did feel dizzy at first and I do feel v tired a lot but I've got other medical problems eg thyroid which might be causing it. The lithium is my "turbo charger"!

I've tried sertraline (didn't help enough) venlafaxine (unbearable side effects) and paroxetine (same). I'm now on escitalopram and quetiapine and it seems to be good for me.