Please tell me about various antidepressants

[Aheraldangel]

I'm struggling again with depression. I've taken a few different antidepressants over the past 18 years, but find the side effects counteract the benefits.

Sertraline gave me terrible restless legs. Duloxetine took away all libido - as did sertraline tbh - and made sleeping difficult, but helped with pain. Mirtazapine caused weight gain. Fluoxetine gave me shocking headaches. Duloxetine was also very scary to come off, I don't want to take it again. I have health anxiety, so any side effects make me extremely anxious.

I'm considering asking to go back on mirtazapine, as apart from weight gain it seems to have the least side effects.

I've no motivation, barely leave the house and wish I'd just not wake up in the morning, I've had enough. Everything is difficult and I accomplish nothing. I can't relax, am permanently worrying about something and stressed.

The menopause isn't helping. I have hrt patches and sleep is better and the sweating stopped, but otherwise feel awful.

I eat junk, can't be bothered to cook most of the time, vape constantly, can't concentrate on anything, tv or reading or other hobbies. I don't shower or wash my hair or clean my teeth or even get dressed most of the time. I'm worried I'm just basically lazy.

I don't want to waste my gp's time and know that in ten minutes he can't do much. I've a mental health assessment coming up in February, maybe I should wait til then, but I'm not sure I can.

I'm having online CBT but struggling to commit to doing anything in between sessions due to lethargy. I've not admitted to anyone that I stopped taking my antidepressants in the summer as they'll accuse me of self sabotage.

I'm just fed up of the side effects, I felt a bit numb and wanted to feel like myself again, also hoped I would be able to enjoy a sexual relationship again, but it hasn't helped my libido. My partner's trying to be understanding, but unless you're in that situation you can't understand how it feels, can you? So I go through the motions, but that makes me feel rubbish.

Thanks for reading this far

I'm having online CBT but struggling to commit to doing anything in between sessions due to lethargy.

Sorry to read the whole post and pick out one tiny thing to address but this stood out to me. We're often advised to do things - exercise! See a friend! Take up a hobby! Clean the house! Paint the house! Go somewhere new! Cook a healthy meal! - when we're feeling low. And those things make us feel better. Except when we're too tired and low to do them. Then the list of undone things makes us feel worse.

What is on the list of things you're struggling to complete within sessions? It may help (a lot) to make those tasks smaller. If you've got something like "go out for half an hour walk each day" then maybe chop it down to "go out for five minutes each day", for example. It is better to plan and achieve one five minute task than to plan five hour-long tasks that aren't very realistic. You describe a really debilitating set of symptoms; be kind to yourself.

Thanks for your reply.

It's simple things like write down what you were thinking, what you were doing, how you behaved ... but what am I supposed to write when i don't do anything, don't go anywhere? Nothing much happens that I can write about. Then i feel stupid at the next session.

It's not a big ask and I can't do it.

Also every week he asks me if there's something I want to talk about and I can't think of anything. I feel stupid.

Ah right, OK.

Are the sessions 30 mins with a PWP, by any chance?

Those kinds of homeworks are more about helping you and the therapist find out what your thoughts are. It doesn't need to be anything remotely "impressive". It isn't your job to entertain the therapist.

So you could have

Situation: lying in bed, 3 pm
Thoughts: I'm useless, I'm tired, I should get up but I can't
Feelings: Numb, useless, bored, tired
Action: stayed in bed until DP made me get up to eat, went back to bed.

That would be fine.

Or:

Situation: 11 a.m., at home, trying to complete this homework
Thoughts: don't know what to write, therapy is wasted on me, what's the point,
Feelings: stupid, useless, hopeless
Actions: gave up, played minesweeper for 3 hours

A lot of people shy away from telling therapists when the therapy isn't working brilliantly for them. It's understandable, especially when feeling low already, to want to avoid conflict or to worry about making someone else feel bad. However, if the homework itself is making you feel bad the therapist needs to be told so they can try something different.

I think these sorts of homeworks are quite a big ask, btw. Disclosing private thoughts to someone we don't know well is rarely easy, even when feeling well. When we aren't feeling well, those thoughts are not just private, they can be very painful to think about and to write down. It's OK to find it hard. Lots of people do.

Thank you.

It's an hour long online cbt session.

I find it extremely hard. I understand the r negative thought process but that doesn't help when you can't do anything and everything just seems difficult.

Yeah, CBT is the most effective therapy we have (in terms of number of people who recover and stay that way for a year or so) but if people are really unwell it can be just a bit too demanding. The best recovery rates happen when people are taking meds and doing talking therapy at the same time (the meds lift them enough to enable the talking therapy to work, is often the thinking). Which brings us right back to your original question, re: antidepressants.

I would suggest that you book a double appointment to see your GP, and talk it through with them. You don't mention having tried citalopram in your OP, which is often a first-line med, although maybe it's contraindicated for other reasons. There are other antidepressants beyond the ones you've mentioned so far.

Please don't think it would be a waste of your GP's time. It's quite common for people who are feeling low to think that they don't deserve help, but depression is an illness, not an attitude problem. It wouldn't be a waste of your GP's time to treat you for, say, shingles or diabetes. Depression is a horrible illness that they can help with.

I've re-read your OP and seen the thing about libido. Yes, meds can crush it. So does depression, of course. Please stop forcing yourself to go through the motions because you think that's what your partner wants. I've been there and it made me feel so much worse. If your partner loves you they won't want you to go through that. Sex should always be enjoyable.

If you aren't taking a multivitamin, please consider starting. Vitamin deficiencies can really contribute to low mood and anxiety, and if cooking meals is difficult right now, it could help a bit.

Thank you. I've made an appointment online - I struggle with phone calls - no double ones available.
I've taken citalopram before, can't remember what happened, but i didn't get on well with it and was put on mirtazapine .. Maybe it was bad headaches, not sure.

I've had counselling before, it didn't help really, I end up thinking what they said makes sense, tell them it's all fine, and a couple of weeks after the end of the counselling i feel the same.

I'm so tired of it all. It's been going on for 21 years really, on and off.

It's good to have made the appointment.

Do you know who the mental health assessment in February will be with?

All of those are SSRIs or SNRIs. Has your GP not suggested a different class of antidepressant?

Would be worth trying a Tricyclic like Amitriptyline or Imipramine. They will probably be a bit reluctant as tricyclics are a bit old fashioned and known for having side effects and are less widely tolerated than SSRIs but personally I get on much better with them. Mild dizziness for the first couple of weeks and a bit of a dry mouth but other than that I've been fine. They don't zap your sex drive and they make you sleep like the dead but for me that's a plus! I think definitely ask about trying them. I didn't get on with the newer ones either and these have been good for me.

They are absolutely lethal in overdose though so keep well away from children, up high or locked up.

Thanks. They've never mentioned them. Are they very effective?

No children here anymore so that's not a worry.

I don't fancy feeling dizzy, but could probably cope if it was temporary. Sleeping soundly would be great!

If I ask for them is my gp likely to say yes?

I have used citralopram for about 3 years now; it's been a complete game changer for me.

Ask your GP about Amitriptyline, it’s rarely prescribed for depression anymore but often used for nerve pain, it can work well for those that can’t take other antidepressants. I can’t get on with antidepressants, the wait gain made me more depressed, I was already on Amitriptyline for nerve pain so GP upped my dose for a short time. I also found exercise to be great, like you I had no motivation to do anything but I joined the gym, the thought of paying for a gym membership and not using it was enough to make me go, I now go 4/5 times a week, just gentle exercise and it really helps keep my mental health in check and I no longer take any medication.

Thanks. I really can't afford gym membership, but I try to go for a walk when I can get out. But I've had a gym membership in the past and couldn't make myself go.

I'll look into amitriptyline before I go to see my gp.

I asked my doctor for bupropion which is dynamite here in the Uk and used off label for depression. It is brilliant stuff I just needed a small dose (37.5 mg)

I asked my doctor for bupropion which is ZYBAN here in the Uk and used off label for depression. It is brilliant stuff I just needed a small dose (37.5 mg)

The dizziness is very mild and doesn't last long. Normally just a few seconds when going outdoors or coming in, I think it's the change in light. Disappears in a week or so.

They are very very effective if given a chance. I had them for about 3 months before I really got the best of them but was noticing improvement after about 6 weeks. GP will generally prescribe if asked for them as long as you aren't actively suicidal and don't have any other meds that they interact with but might cap you at 75mg. Any higher generally needs a psychiatrist to approve them but whether that's just my GP or a national thing I don't know. Do not go straight onto any dose higher than 25mg though, no matter what the GP says. Start low and build up over a few weeks or it will hit you like a fucking train. The sleep is great though. Out like a light until something wakes you. My record I think is about 19 hours straight. I was knackered to start with though.

10 years ago I was diagnosed with depression and given Fluoxetine which made me suicidal. Then I switched to Citalopram which worked really well. At the same time I was given Amitriptyline which made me so ill. I slept so well my DC couldn't wake me up when they needed me and I felt permanently like I was tripping on drugs (at least how I imagine that would feel)

This time around (diagnosed with depression, anxiety and PTSD in Feb) I started on Sertraline but 9 months later was on maximum dose and felt no better.
I'm now on mirtazapene which is working and helping me sleep. I am gaining weight though which isnt good. Especially as I'm already obese. I'm also taking propranolol for migraines and anxiety.

I did ask the gp for citalopram again but she gave me mirtazapene instead.

Thanks everyone.

After reading up on amitriptyline I daren't risk it, as a common side eject is constipation and I have huge problems with that anyway and in a lot of pain due to years of it, I just about have it under control these days and can't risk it getting worse.

Mirtazapine seems to have the least side effects.

What if my depression doesn't react to antidepressants though? Is that possible?

It's possible to have treatment resistant depression but the most common treatment for it is Tricyclic antidepressants. I don't have any response to SSRIs or SNRIs myself which is why I'm on them. Other than that it's talking therapy really unless your life is so badly affected by it that you might resort to ECT but you'd be under a psychiatrist by that point.

Sorry you’re feeling so knackered OP. It’s a horrible feeling.

Don’t let constipation put you off meds if those ones may help? You said you eat crap, as most of us do when tired. Can you just increase your veg per day to combat the constipation if you need meds that bung you up? A big bag of carrot battons or something could perhaps help and they fill you up too meaning you dont reach for the crisps as much, win win

Yes agree with @nothingcanhurtmewithmyeyesshut. Ibe had no response to SSRI's so I'm now on lofepramine which is a tricyclic. Like you OP I've been on many different types of anti depressant, none of which have really worked. The next step is to go on a mood stabiliser I've been told and I have an appointment next month with a psychiatrist who will prescribe me one to take alongside the lofepramine.

Thanks. I'm scared it'll cause me problems and make me even more miserable.

What is a mood stabilizer?

If it helps, I'm on 100mg of it and I still get the anxious shits. Sometimes I wish it would bung me up but alas...

Oh no That doesn't happen to me often, quite the opposite

I'm scared if I ask my gp he's just going to suggest fluoxetine or citalopram, purely because they're the most popular ones.