Anyone tried old style tricyclic meds?

[Sunnyscot80]

Hi all,

After a very long battle with postnatal depression which manifests as severe anxiety, including derealization, nocturnal panic attacks, nightmare, insomnia and horrific morning anxiety, my psych has now recommended I try a tricyclic med.

Ive tried pretty much all the ssri's (setraline, mirtazapine and lexapro) which just make the aggitation worse, or make me very sick. I also tried venlafaxine which was OK but I felt off my face (in an illegal drug kind of way!).

I'm desperate and feel theres not much left for me. I hate this anxiety. And the nocturnal panic attacks / waves of adrenaline are just the worst.

I was wondering if anyone has had similar symptoms and had any luck with tricyclics? I'd maybe try venlafaxine again (reluctantly) to see if the 'off my chops' feeling passed.

There was also talk of valdoxan but its hard to get here in Scotland on the NHS. Any advice appreciated 🙏❤️

Yes, in almost exactly your circumstances. After my second dc was born (and he’s now a teenager) I had horrific anxiety, ocd, and developed anorexia too. I was a ball of fear tbh. I tried the usual antidepressants but never got past the ‘you’ll feel worse before you feel better’ stage as tbh I couldn’t afford to feel worse. Trazodone honestly saved my life. I’ll warn you, my first dose had me practically collapse in the middle of the day. It was incredibly sedating for me at first. So I switched to taking it at night and it was wonderful for me. No problems coming off it either. Combined with CBT spread over about a year of weekly or fortnightly sessions (which I’m aware is very unlikely on the NHS now) I got my life back. The newer SSRIs just don’t seem to work for me, I’ve had a couple of incidences in the last 15 years where I’ve tried them, and have always ended up on a short course of Trazodone instead. Doctors seem reluctant to prescribe it, wether that’s because it IS considered old fashioned, or perhaps the cost, I’m not sure. It’s worth trying it, especially if it’s been suggested to you. I wish you all the luck. You WILL feel better soon, I promise x

@YouHaveNoAuthorityHereJackieThank you so much for your reply. I'll ask about Trazadone. Did it leave you very groggy the next day? I was on mirtazapine for ages and it left me very hungover. Did you experience any of the panic feelings in your sleep? Before the meds.
I so want to feel 'normal' again. I'm better than I was a year ago, but still just don't feel relaxed. The sleep thing is hell. And I find it hard to feel emotions. I'm quite numb. Cant have a cup of tea, just feel energised all the time! Heart races. Haven't been to a dentist for such a long time now incase I have a massive panic attack. Its grim. So very glad you got better xx

Should say I don't go to many appointments on my own, incase I have a panic attack.. Ive not got a thing about dentists! Just the constant fight or flight I'm in, my mind tells me to run.

Yeah I’ve been on Amitryptiline, Chlomipramine and Prothiaden. No terrible start up effects.

Chlomipramine was by far and away the best one I’ve ever been on ( I’ve been on about 13!). It was like having a pink rosey light switched in in your brain. But l couldn’t stop eating on it.

They’re fine. I think Amitryptiline is the gold standard, and Chlomipramine is the one for anxiety and ocd. God l loved that drug😍

Don’t be scared of them. I found them much more benign than SSRI’s.

I felt on edge all the time. I found it worse if I stayed in my house, I had a real fear that someone was coming for me. Which was totally irrational. But because of it I was out pretty much all day every day, with baby ds while dc1 was at school. Coming home was hell. I felt constant adrenaline. I was a single parent at that time so everything was on me, and the panic I felt was never ending. As for feeling groggy, no not that I remember. With all the medications I tried I remember having a dry mouth for about a week to two. I remember describing how I felt on the medication, it’s like the panic was still there but it has no power over me, it just couldn’t rise up. It felt miraculous. And it didn’t suppress my other emotions either. I just felt able to function again without this constant fear in my chest.

Mirtazapine (zispin) would probably help you as it is very sedating. However you could not be responsible for a baby (please please don't try) after taking one and it can be severely awful to get off. Like, incredibly hard. That said, it depends how desperate you are now.

Oh you've tried zispin, sorry.

@YouHaveNoAuthorityHereJackie that must have been pure hell on your own. You are so strong for getting through it.
My official diagnosis from the perinatal phychiatrist was an aggitsted form of Pnd. Ironically all the meds she gave me made the aggitation so much worse.
I'm with adult mental health now and I have a lovely lady doctor. She's older and seems quite in to the older style meds 🙏 that something works for me.
I still find the world just seems to sharp if that makes sense. Things look too bright. Noises to loud. Everything makes me startle. And that horrible feeling of dread 😭

@ArseInTheCoOpWindow you've been so kind replying to my desperate posts about meds! I wish venlafaxine could have worked for me. But I felt high as a kite. Frustratingly as if didn't push me over the edge like the ssri's did. That may have passed. I know you loved it.

The psych has mentioned Lofepramine, I think that was it anyway. Are all tryclics likely to pile on the weight?

Lofepramine won’t pile on the weight. It’s not sedating though x

I think some are worse than others for weight x but they don’t affect everyone that way. Agomelatine won’t pile on weight and helps with sleep x

Yes, I have Amitriptyline 100mg. Had no luck with any of the SSRIs and piled on so much weight with Mirtazepine which I never have managed to lose.

Amitriptyline is fine. Bit of a dry mouth but no other side effects except a few brief dizzy spells when I first started it but they stopped within days.

It helps too, I feel a lot better on it.

If you have agitation you need a sedating one.

Amitryptiline (great for sleep) or Chlomipramine are the sedating ones.

@ArseInTheCoOpWindow was going to ask, have you tried valdoxan? I'm pushing for it here, but it's not widely available on nhs Scotland x

@Notanotherwindow so glad you are feeling better.
I hated everything about mirtazapine. Made anxiety so so much worse. And I piled on the weight too.

Doctors seem reluctant to prescribe it, wether that’s because it IS considered old fashioned, or perhaps the cost, I’m not sure

It’s because they have very serious consequences in overdose. The modern Ssri’s etc are much safer, and have a much bigger margin for dosing error.

Something that’s easy to harm yourself with, intended or not, is not something you want to prescribe someone who is depressed, possibly suicidal.

Having said that, they are still a very effective drug, with tolerable side effects.

I would definitely give them a go o/p if you’ve tried the ssri’s.

Yes, Valdoxan is Agomelatine. I tried it, but it made me more anxious. Which is a pain as l slept like a baby on it.

Sunnyscot80

Did they try you on Paroxetine? It’s an SSRI but a sedating one. It’s the only one l could get on with.

@ArseInTheCoOpWindow that's a shame valdoxan made you worse. I've heard mixed reviews.

Paroxetine hasn't been suggested. Do you take that one at night? I didn't think it was prescribed much these days as its really hard to withdraw from?

Ssri's I've tried are setraline - 8 weeks made anxiety a thousand times worse. I couldn't move with the fear. Bad stomach and vomitting on it too.

Lexapro very briefly - took me to a very dark place quickly and I was also sick.

Mirtazapine - was just hell for 10 months. Made me more aggitated, couldn't sit still. Suicidal thoughts and crashes of crying, constantly. Didnt have gastro side effects though (I know it's not an ssri)

Venlafaxine - I was rushing like I'd taken something dodgy. Clamped jaw. Didn't give it long.

Ive never tried prozac but I believe thats very activating?

Feel like a lost cause.

Sertraline made me worse
I didn’t get on with Mirtazapine
Citalootam alsk took me to a dark place.

If you are agitated you need a sedating anti depressants not an activating one like sertraline.

I was on Paroxetine. I had no trouble withdrawing from it. If you ask a pysch Paroxetine and Chlomipramine are the ones for agitation/ anxiety.

Failing that you can try Lithium but it needs a ys b to prescribe.

Pysch to prescribe.

@Afterallsbeensaidanddone thanks for your reply. Ironically i was put on mirtazapine by a perinatal phychiatrist who told me I'd be fine getting up with the baby! I wasn't. And the drug made me so much more depressed. And you're right, so hard to come off. But glad I did.

Mirtazapine was horrible. It made me so bad tempered.

@ArseInTheCoOpWindow same here.
Is Chlomipramine still available in the UK? Googling it and lots saying its been discontinued.

Yes, it is. It’s not available in the USA.

Op, you need to look up agitated depression. Many anti depressants make it worse, in fact that is one way it can be identified. The older drugs do have a better record with helping I believe, at least some of them.

Have you thought of mood stabilisers or anti psychotics that can be used as a sedative off label.