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 🙏❤️

@BeyondPurpleTulips
day 1 and I feel like hell. Took the lofepramine last night. Woke up super early. Feeling heavy but aggitsted. Stayed in bed crying for hours. Husbands looking after the kids. Psych says to persevere. Is this normal? Feel a thousand times worse. Anyone else had this reaction to begin with? I suffer from a very aggitsted depression and can't actually face feeling any more aggitated! 😭 Really bad thoughts today.

I have Amitriptyline for nerve pain, low dose but I have found its definitely chilled me out and made me less anxious.

Gosh you've had a time of it haven't you.

I've taken lofepramine for 23 years, for phobic anxiety - I recall side effects being dizziness and a heavy sensation in my body/limbs which took about a week to wear off. But other than that, I can't get through day to day life without it - I was certainly sitting around crying (3 hours under a running shower once) before I was prescribed it.

I really wish you well, try to stick with it. And don't worry about weight gain, I'm fat but that's because I'm a greedy bastard that loves chocolate.

Thank you @EleanorDeCleaner
Yeah yesterday I was getting by with my usual levels of depression and anxiety. Which isn't grea. But Today I'm stuck in bed crying my eyes out.
I definitely have the heavy sensation in my limbs. But the increase in anxiety and extreme low mood is awful.. How long do I give it feeling like this? Xx

Give it a while, lots of meds take a while to settle down into your system. Maybe speak to a pharmacist? They're so good in my experience.

I can't imagine having another day as bad as this. The aggitation is off the charts. Can't settle or stop crying.

You poor thing,I think you need to speak to someone. Perhaps you should work your way up to full dose slowly rather than taking it all in one go. What about a quarter dose tomorrow and see how it goes?

I am NOT medical but have done this with tablets myself.

This is why they're old. People give up on them too quickly because they can't tolerate the initial side effects so they've been relegated to the last resort AD.

When my GP put me on Amitriptyline she referred to it as the sledgehammer approach. They work but the adjustment period is brutal. As it turned out I was fine. Bit dizzy for a week or two but then fine apart from a dry mouth.

It shouldn't last more than 2 weeks and it won't be this bad the whole time. Give them a chance to get into your system. Your brain is basically in shock atm so give yourself a chance to recover from it and adjust.

Have you tried Escitalopram? I had very similar PMD symptoms and it helped me enormously. I did feel a bit 'off my face' for a week or two, but not in a terrible way, then it settled and smoothed a very difficult period. I took it for about a year and then gradually tapered off.

Mirtazapine was horrific and made me feel like a zombie, citalopram I havent tried but was told its not as effective as Escitalopram. I take amitriptyline now for peri menopause symptoms which its great for, but it would not have worked for my PMD.

Oh that's so tough OP.
I did have similar when starting ADs - this may be completely frowned upon now but I was given a small dose of diazepam just while the increased anxiety settled.
Be really gentle with yourself

@Ohsugarhoneyicetea did it make you feel like you were on something illegal? Like a bit high / rushy? Body tensed up? I felt like that on venlafaxine so I didn't carry on with it. Now I wish i had as thst was far more preferable to this. I've cried the entire day. I just don't think I'm made for any antidepressants. Which is a worry as what's the alternative!

@Notanotherwindow brutal as in emotionally brutal?! Today has definitely been brutal. I could not take another one. I've not been able to look after my kids today. I feel like such a failure when it comes to meds.

Brutal as in nervous breakdown with a side of am I having an aneurysm?

It passes within a few days. Fresh air helps and forcing yourself to focus on something. It was when I tried Imipramine. I didn't get it with Amitriptyline. That I was fine with although some people say its awful.

Yes, a low key E feeling for a few days, dry mouth & slight gurning, but it only lasted about 3 days and then it significantly improved my PND. I went from crying all the time, having visions of harm happening to baby, terrible self talk, to a peaceful calm. Felt a little like wrapped in cotton wool, emotions dulled, but that was what I needed for a while. I tapered them off after about a year, but very grateful I had it when I needed it.

@Notanotherwindow

Brutal as in nervous breakdown with a side of am I having an aneurysm?

It passes within a few days. Fresh air helps and forcing yourself to focus on something. It was when I tried Imipramine. I didn't get it with Amitriptyline. That I was fine with although some people say its awful.

Definitely agree with the benefits of fresh air, drag yourself out tomorrow even if only for 10 mins.

@Notanotherwindow that is the best description. That was me yesterday. I felt like my body was also just electrified if that makes sense. Suppose that's the aggitation getting much worse.

I hope today is a bit better x

Think of them like antibiotics. or a bomb

They don't just wipe out the bacteria you want them to, they fry everything within reach. This makes you feel shite because your whole system feels the impact. They upset the equilibrium.

It's not a case of take them and your serotonin level goes up and everything else remains in beautiful harmony. They affect the whole chemical balance in your brain.

Which actually is fine because that balance isn't so great to start with or you wouldn't be depressed and anxious.

But everything takes the hit. So now your brain is like wtf is this? Everything else has to adjust to the higher levels of serotonin and other chemicals that ADs affect.

But you will adjust and hopefully feel much better.

Just try and distract yourself in the meantime.

Force yourself to get washed, dressed and outside every day. It really does help to stay as close to normal behaviour as possible or you get caught in a vicious circle. Exercise is even better. Nothing strenuous, just a walk into town would help

@Notanotherwindow

Think of them like antibiotics. or a bomb

They don't just wipe out the bacteria you want them to, they fry everything within reach. This makes you feel shite because your whole system feels the impact. They upset the equilibrium.

It's not a case of take them and your serotonin level goes up and everything else remains in beautiful harmony. They affect the whole chemical balance in your brain.

Which actually is fine because that balance isn't so great to start with or you wouldn't be depressed and anxious.

But everything takes the hit. So now your brain is like wtf is this? Everything else has to adjust to the higher levels of serotonin and other chemicals that ADs affect.

But you will adjust and hopefully feel much better.

Just try and distract yourself in the meantime.

Force yourself to get washed, dressed and outside every day. It really does help to stay as close to normal behaviour as possible or you get caught in a vicious circle. Exercise is even better. Nothing strenuous, just a walk into town would help

That's really sensible advice.

@Notanotherwindow you've got a great way with words! Thank you.
I've had to put off trying that particular med because yesterday I was an absolute state. I really couldn't have walked anywhere outside. I couldn't look after my kids. I was a mess. It's Easter holidays here and I don't have much childcare so I just can't do that right now.
I tried venlafaxine recently but I felt off my chops like id taken something illegal. I was having rushes and gurnijng. So I didn't continue (yet again) but in comparison that was much better than the crying aggitsted state I was in yesterday. So I might have to return to that. The psych is calling me today to discuss. I just don't know how people get through that level of despair and aggitation with small kids in tow! My doc says I have a very aggitatrd form of Pnd so when that is increased its basically unbearable.

Really worth asking about taking a lower dose and increasing slowly.

Do you have a garden? Try and sit outside for 10 mins if you can't manage a walk.

@MrsPelligrinoPetrichor I do have a garden. That's a good idea. More achievable.
Unfortunately lofepramine doesn't come in a lower dose and the pill can't be split. It's quite a large/coated round tablet, bit like an ibuprofen don't think the coating can be cut through.

When I've tried new meds in the past the doctors gave me 3 or 4 days of diazapan (I'm not sure how how to spell it) to help me get through the early anxiety symptoms. Your phsyc might be a be able to do that.

@Spottybutterfly thanks. Yep I have diazapam which wasn't even touching the sides yesterday. The psychiatrist has said to try a low dose venlafaxine instead as I really couldn't tolerate what I experienced yesterday.

Don't piss about with the dose. The coating is gastro-resistant, it's designed to break down slowly for controlled release. If you cut it, you get too much too quickly and then a period without enough. Take it as instructed.

I also wouldn't keep stop starting things. Again, you are upsetting the chemical balance in your brain by keep changing things.

You're only going to make the adjustment period worse and longer by messing about with it. Its one of those things where you have to either commit to trying something and give it a chance, or not.