antidepressants if the standard ones haven't worked...?

[letsgooutstiiiiiiide]

Can anyone suggest antidepressants that might work if the following hasn't worked?

I am fearsomely tired and on the edge of depression. I'm a SAHM with a 2.4yo DS who is being assessed for ASD, does not yet go to nursery without me (goes to playgroup), and still sleeps like a newborn; and a DH with a massive workload who has to be fit to drive and work so can't help at night, and no other support (both sides of family all live overseas and aren't interested). I am also perimenopausal so have absolutely horrific periods from hell where I lose 250-500 ml blood (yes those numbers are correct) so I feel exhausted and dizzy a lot of the time anyway, despite apparently not being anaemic.

I was depressed from about 2002-2015, partly down to me, partly down to hating my chosen career, partly probably because I was on Cerazette 2002-2015.
I was on antidepressants ca. 2007-2009, fluoxetine, citalopram and venlafaxine. Fluoxetine and citalopram made me feel numb and foggy. Venlafaxine had to be ramped up to a very high dose and made me constantly nauseous and anxious, but made me feel better briefly. I stopped it cold turkey when supply ran out and I was going to have to wait 3 weeks for some (not a good move). I tried it again in 2015 and it instantly threw me into such crippling, massive anxiety and restlessness that I got off it very quickly - it felt like psychosis. I tried Cerazette a couple of times since DS was born, both times it made me instantly irritable, restless, depressed, almost suicidal, within the first 12 hours. I don't dare try it again, despite the fact it would probably be good for controlling the perimenopausal symptoms.

Anyone got any suggestions of drugs?
GP suggestions so far in the last 2 years are fluoxetine, citalopram, venlafaxine, talking therapy, diet & exercise, give up breastfeeding, get more sleep, ask your mother to come over a few times a week to help with your child... the GPs in the practice tend to respond best if you go in with a copy of the guidelines on prescribing, list which steps you've already tried and why, then say "and thus, I want XYZ drug" - i.e. if i do their job for them.

I'm no expert, however in my experience you need to give ads 2-4 if not 6 weeks for you to get used to them, sometimes they can make you feel worse before you start to feel better.
If you have read up so much and think cerazette would be best for your symptoms, you need to give it more chance to work than a day or two.good luck.

Sertraline is probably the other standard antidepressant that GPs will normally prescribe that you haven’t tried. It worked well for me for a long time when paroxetine, fluoxetine, citalopram and venlafaxine had all failed.

Later I had another major episode whilst on sertraline and was then put on vortioxetine, which is a new class of antidepressant recently approved on NHS for refractory major depression under NICE guidelines. Sadly I couldn’t tolerate it (caused vomiting in me). But I’d still say worth talking to GP about, or asking for a referral to psychiatric assessment service to discuss with a specialist.

Tried Sertraline? They like you to go the SSRI and SNRI route before resorting to Tricyclic Antidepressants.

Mirtazapine? Doesn't have the same nasty start-up anxiety as the SSRIs. It's very good for sleep as well. Only thing is it can cause major weight gain for many people.

thanks everyone.

Haven't tried sertraline, or mirtazapine. The ones I tried I gave months each (3+ for the ones that made me numb, > 1 year for Venlafaxine). More recent attempts have had such strong start-up side effects that I got off because I wasn't sure I would survive long enough to get through any hypothetical start-up period.

Minor point: I don't necessarily want something "good for sleep" as I have no choice but to wake up a zillion times a night - the sleep deprivation is not of my making! Though it sounds nice as a long term goal.

If only there were a hormonal option that would just smooth things out a bit - I actually feel fine (other than tired) the last few days - I think the depressive feelings of last week were PMT. But given this is perimenopause-related too, period started on Saturday (with all the usual associated symptoms), then stopped. Then started again about an hour ago with none of the usual associated symptoms.

Will talk it through with GP...

I'm on Mirtazapine, 30mg at night, I've lost 2 stone since I started taking it a year ago.

I've had mirtazapine for 4 weeks and it really didn't work for me - needed sleep for +14hrs a day plus the appetite increase put loads of weight on .
Everyone is different and responds differently but you have to give them chance first.
Citalopram worked for me for ages, but then I was on max dose (didn't know that) and certain triggers have caused a 'nervous breakdown ' (I'm not keen on the term but it's the truth.
Sometimes you have to try different meds before you find the one that works for you - I wish you well xx

You could try asking for Agomelatine (brand name Valdoxan) - it's one of the only ADs which doesn't affect Serotonin levels.

There's a receptor in your brain called 5HT2C, which is at least partly responsible for anxiety & depression - it's triggered by Serotonin, which is why increasing serotonin - for some people - is a bad thing.

Other options which stop the 5HT2C receptor working include Mirtzapine & Amitriptyline (though both of these also increase serotonin too).

Wellbutrin is the only other AD which doesn't affect Serotonin.

Mirtazapine has been a game changer for me. The sleep side effects are incredible after a year of surviving on maybe an hour or two a night. My anxiety is now at a manageable level and the depression has lifted. I've been on it since last July and take 30mg on a night.

It can have some side effects such as weight gain but I'm following ww plan and have actually started losing weight whilst on it.

I find I can’t get on with SSRI’s, sertraline makes me unbearably anxious, Prozac - paranoid and wired, can’t sleep.
I take a Tricyclics (imipramine) it has worked for me for years and my doctor is happy for me to take it for life.

Can you get something like tranexamic for the periods? And take iron anyway if you feel anemic

It’s tough I’m sorry you’re feeling this way

I tried citalopram, venlafaxine, mirtazapibe, sertealibe, lithium, l-tryptophan, olanzapi e, aripripazole, quetiapune, risperadone and fluoxetine - didn't feel any better but I've been on duloxetine a while now and I'm not so bad

I forgot to say I've been told I have refractory depression

I'd love to try Wellbutrin as it's also good for weight loss but as far as I know it's only licensed for quitting smoking in the uk

Im currently on duloxetine, have tried literally all the others already mentioned. It has been working for me until I decided I'd wean myself off them, now I'm a wreck! Mine is for major depressive disorder, suicidal ideation and ptsd, so am unsure if it would be prescribed for you as your symptoms sound pretty different.
It make me lose weight, which was good for me, but just something to note. After a while on it you do start to gain again though.

Hi
I hope nobody minds me joining the chat. I have been on 10mg citalopram for aniexty for nearly 8 weeks now still not myself doctor suggested I increase to 20mg as anybody else done this ?