What drugs under secondary care?

[WillWorkForFood]

I've been referred by my GP to secondary care as the current crop of ADs are not working and/or are having intolerable side effects - tried all the usual SSRIs, Mirtazapine etc...

For those who have had a secondary care referral for depression (not anxiety), what drugs were prescribed by the psychiatrist, and did they work where others had failed?

Just curious as to what's out there that GPs aren't permitted to prescribe under primary care and whether they are effective?

Thanks in advance.

I’ve been under secondary care, it was about 6/7 years ago though
your really lucky to get that now!
It’s all about non urgent care now, there’s no such thing as urgent care you have to be psychotic or proven to be suicidal.

Mine was for anxiety which turned into depression, prob because it took that long to go.

She first tried me on quetiapine, only took one and I fainted.
Then promzine, that gave me massive headaches and tight jaw.
Then tried venlafaxine, starting at 37.5mg and slowly increasing upto 150mg.

Don’t think it was that Gp couldn’t prescribe, more maybe at a loss as what to do. Plus your open to more help, we’ll was back then
Don’t know about now

I’m talking Manchester area.

Venlafaxine and mirtazapine together - shit side effects but saving my life one day at a time. Actually got this from a locum psych when my regular one was on sick leave - his plan had been to head for lithium as the next stop, together with the Venlafaxine.

I have 300 of Venlafaxine and 15 of mirtazapine, which is apparently more effective in lower doses for depression. Gained five stone in a month after misunderstanding what I was told about mirtazapine and hunger, though - but as I was fat anyway, was a more palatable alternative than being dead

Good luck: there is hope

I have tried many antidepressants and it secondary care has provided the more exotic ones. Also combining them with antipsychotics or mood stabilisers. Interestingly sertraline has been one that works for me.

I was on citalopram when I referred to secondary care back in 2009. The psychiatrist kept me on it for the time being, but then changed it to venlafaxine later on. I think the GP would have been able to do that.
I think referral to secondary care is as Haribogirl says; it's not necessarily about drugs but about what else they might be able to offer (specialist therapies for example).

Thanks all.

So far I have tired Fluoxetine, Sertraline, Citalopram, Velafaxine,
& Mirtazapine.

I've had all the side effects from them (Venlafaxine was the worst, never again) but none of the benefits, even giving them months and upping the doses.

Just flat out miserable, no energy, can't cope with anything, can't think straight, no enthusiasm for anything or hope for the future. Been getting worse and worse over the years and is now just awful and very much 'what's the point'. I can function, but there's just no joy in anything.

In my frustrations and torment, I've researched lots of drugs and it's the SSRIs that don't seem to help me at all - I believe (uneducated but researched) that a drug that enhances dopamine might be of benefit, hence I'm going to ask for / suggest I try Bupropion, (Wellbutrin/Zyban, off label) but will keep an open mind.

Have you had Venlafaxine together with Mirtazapine? (The side effects of both settle down after about six weeks in- NHS rocket fuel ) Or Escitalopram instead of Citalopram? (GPs tend to say they are the same, but some people break them down differently)

I haven't found NHS psychiatrists to be receptive to suggestions about medication, but you might have more luck in your area. There's a thread on mh that gets resurrected every so often, of posters asking for the name of a private psych who will prescribe Wellbutrin, so don't get too invested in that as an option, as it seems it's not easy to access in this country.

I wanted some Xanax for long haul flights a while ago- it's used like sweeties in the US and Ireland. Had to have a private prescription as they aren't allowed to give you an NHS one for it or something (the computer wouldn't allow it to go on a prescription black)- but then I couldn't find a pharmacy anywhere in two major UK cities (not London) that was able even to order it in for me

Good luck, anyway - and hopefully, they'll be able to find something that will help you soon

I've not tried Venlafaxine and Mirtazapine together and have no intention of doing so - the reaction to Vellafaxine was so bad, I will never take it again.

I nearly called an ambulance I was that bad on just one pill.

I woke up at 3 am in a pool of sweat, my entire body shaking. I could feel every heart beat through every blood vessel in by body. With each heart beat, if felt like a conveyor of millions of tiny insects crawling through my veins. My lips felt like they were going to burst and my toe nails felt like one more heart beat would make them explode off my toes etc.

My heat rate was at about 140-150 bpm continuously and I was gasping for air uncontrollably like I was drowning.

I laugh about it now, but my DP tells me that I couldn't speak fast enough, my brain not able to keep up with the speed my mouth was moving, trying to verbalise what I was thinking - like listening to a tape recorder on fast forward. I developed blotchy rashes all over my body and was itching everywhere like crazy.

I was shaking and panicking but my DP managed to keep me stable and just about in control until I was able to be escorted to the GP surgery who took one look at me and jumped the queue immediately to a Dr who (as informed by my DP who was with me, I can't remember anything about it) that I'd had some kind of noradrenaline allergic reaction which was rare, but not impossible and said not to take anymore Venlafaxine.

Never again, under any circumstance. Ever.

The only effect I've had from the Mirtazapine is flu like symptoms, a two week long head ache and aching joints with no positive effect whatsoever.

I'm starting to feel I'm resistant to front line treatments.

Psychiatrists will have more experience with a wider range of medications.

Also as others have mentioned may use a combination of antidepressants together, or augment an antidepressant with another type of medication like lithium, quetiapine or one of many others. Most GPs wouldn't I think, unless they had a special interest in mental health. GPs have to know a lot about many things; psychiatrists need to know about a smaller range of things but in greater depth.

GPs know a lot about treating depression, but psychiatrists are familiar with using a wider range of treatments.

Some medications are "specialist initiation only".

And yes, if someone does have treatment resistant depression, then being seen by a psychiatrist sounds like a good idea.