What to expect? Medication related

[threelittledinosaurs]

Hi everyone,

I have suffered with depression since 2010 (I honestly can't believe it's been 8 years!). I have never been on medication for it, and have only had one round of online CBT (which helped to a certain extent). I'm back to feeling overwhelmingly awful, and completely withdrawn from my family and life. You know that place you get to when you feel you're on the verge of a breakdown.

I've finally accepted that I need to take medication. I also suffer from anxiety, so it's been a battle of worrying from the anxiety about taking medication for the depression! I'm sure I'm not the only one who's been in this position, and I'm hoping the anxiety wouldn't change my mind again.

I'm curious to hear about your initial GP appointment when you were prescribed medication. I have an appointment on Wednesday AM, and I just want to know what to ask, or talk about. Any heads up on what to expect will be great. I've spoke to a GP before about the depression and anxiety, and they prescribed me an antidepressant beginning with S .. Sero.. something. I didn't take the medication, and instead did the CBT.

Problem being is that I also have an under active thyroid (treated), and sadly I still have most symptoms from that. The hormonal imbalance has caused sexual dysfunction, and I'm reluctant to take anymore medication that will further affect this. I believe my thyroid medication also causes problems with sex drive too. Any one take levothyroxine with antidepressants? What's your experiences? Is there a certain kind I need to avoid due to taking levothyroxine?

I understand that the antidepressants are there to help me feel better, but if I were to take a type of antidepressant that improves your sex drive, then it would help massively. GP doesn't seem to care that I have no sex drive at all.

Also I can't take beta blockers due to asthma.

Sorry for the long, and question full post. And thank you in advance.

Any anti-depressant prescribed by your GP will initially be from a type knows as SSRIs which increase the serotonin levels in your brain. Depending on what other symptoms you have may change which one they try first, however it is highly likely to be either Citalopram, Fluoxetince or Sertraline as these have the highest success vs minimum risks or side effects ratio (and are cheap).

Sadly, SSRIs are well know to cause sexual dysfunction in both libido and or ability to achieve orgasm. Everybody reacts differently and these side effects (amongst others) are not a certainly, however they are fairly common.

The only anti-depressant available from your GP as part of initial primary care that is well regarded not to cause sexual dysfunction is Mirtazapine, however it has a highly sedating effect and can cause significant weight gain due to increasing appetie.

There is an anti-depressant available in the USA that can decrease appetite and improve libido/sensitivity called Bupropion, made by GSK under the trade name of Wellbutrin which targets Dopamine, however it is not prescribed in the UK for depression, only as an aide to quit smoking (called Zyban), mainly due to it's high cost. It can be prescribed in the UK off label to treat depression, but only under secondary care following a psychiatric referral should at least two typical anti-depressants fail to yield an improvement in your symptoms.

Your GP will go through a fairly standard assessment to see whether an anti-depressant drug is likely to assist with your symptoms, a copy of which is in the link below.

patient.info/doctor/patient-health-questionnaire-phq-9

Most ant-depressants can take several weeks to take effect and most don't have a 'lights on' impact, more of a slow improvement in mood from about 4-6 weeks onwards.

Hope that helps.

Thank you willworkforfood, that information is really helpful. I'm still happy to go ahead with starting medication, so I think it's for sure my time. It's been a long time coming. Thanks again.

It can be a big step to hold your hands in the air and ask for help - took me 20 years....