When SSRIs and CBT don't work

[Socktopuss]

I've tried various SSRIs over the past 20 years - citalopram, mirtazapine, fluoxetine and did a short CBT course about 10 years ago. I'm functional in that I get up and go to work and for the most part largely keep on top of the essential stuff like showering, washing clothes. Although self care things I think I can get away with not doing like going to the hairdressers, dentists etc I avoid.

I feel like I basically spend all my mental energy forcing myself to do the basic day to day survival stuff and have nothing left to think about socialising or planning nice things like holidays. I guess the things lots of people would say make life living. Basically day to day things most people take in their stride like commuting to work, talking to work colleagues cause a constant low level anxiety that's just exhausting. I don't ever remember a time when I didn't feel this way. I know the CBT techniques for acknowledging intrusive thoughts and stopping the pattern of ruminating on them. It's somewhat effective most of the time in the moment, but then subconsciously the feelings of anxiety hit me when I'm trying to sleep.

I don't remember the last time I slept for more than 5 hours (well over a decade by this point). At various points when I've been so exhausted I can barely move, I've dragged myself to the doctors and they've prescribed zopiclone for a few nights, but again this didn't have any effect on the length of time I was sleeping or the quality of my sleep.

I just can't imagine another 40 years of this. I basically seem to have reached the limits of what the NHS can offer - SSRIs and CBT. Has anyone had any success with private mental health care in England? I'm open to trying it but unsure how to access it as a lot of websites suggest you need an NHS referral?

CBT-check
ACT therapy-check
Medication-check.

I’ve no clue what the answer is but I did see an interesting video on TT the other day that said CBT therapy doesn’t work long term because, whilst it gives you coping mechanisms, it doesn’t deal with the underlying cause. Makes sense I suppose.

I do know someone (an ex HCP) who after years of depression, anxiety and all sorts of counselling & medication has finally found success with psychotherapy. Sadly it’s not something I can afford and is incredibly difficult to access on the NHS.

there are psychotherapist (& other types of therapists) listed here that you contact directly with no need for referral.
www.psychologytoday.com/gb/counselling/wales?gclid=Cj0KCQjwqoibBhDUARIsAH2OpWhBdJaeZdVNhzMkt88EvqNtOzQb0fNALA6a_nQqtjjtY7iCAJCrgfMaAl3MEALw_wcB

Do you know what the root cause of your issue is?

You mention ruminating and intrusive thoughts. What sort of thoughts do you have? What is the anxiety about?

Is ketamine offered to treat depression in the UK?

Ketamine for Depression: What to Know

Highly recommend schema therapy. You won’t need a referral for a private psychotherapist

You could look into EMDR therapy.

You could try old school meds they work for some people

My DH has had good results with pregabalin (but I think there is possibly a move away from prescribing) and excellent results with vaping CBD. His childhood/parents are the underlying cause so he is low contact.

There are more meds that GPs can give other than SSRIs.

• SNRI
• TCA
• MAOI
• Some antipsychotics for severe depression (Quetiapine for example)

It only tends to Psychs that prescribe controlled drugs like Pregabalin, especially as that one is prescribed off label.

Your GP is shit.

Longer term psychotherapy that addresses the root causes can be very helpful. Look for someone psychodynamic or psychoanalytic, it will be very different from CBT. You can go private - look for someone local through the directories on BACP, UKCP or BPC websites or depending on your location, there are some referral services through training colleges and professional bodies that will match you with a suitable therapist.

Proper, long term therapy with the aim of building the relationship between you and the therapist. This isn’t the goal in CBT etc.

Use counselling directory and look for people with UKCP accreditation or membership. Contact them and ask if they offer a reduced fee. Don’t settle for anyone, find the right person for you.

Try ECT. It is pretty effective for treatment resistant depression

I got refused for CBT and talking space as they said they could no longer help me ,I’ve tried everything you mentioned,and more besides .
I’ve had everything the nhs can offer therapy wise ,and still nothing,I’m often awake at night with my mind racing and I’m chronically depressed

Your post struck a chord with me - the “forcing yourself to do day to day survival stuff” especially. It’s been a revelation to realize I’m neurodiverse (on long slow path to getting diagnosed). Sleep issues, anxiety, self care problems can all be signs, especially if you’ve experienced this all your life. I also don’t like the hairdresser experience, commuting, talking to colleagues etc… but I thought I couldn’t be autistic as I have high levels of empathy and mask adequately in social situations (then burn out afterwards). Might be worth looking at ADHD and autism to see if you identify with any of the traits. Very underdiagnosed in women and many therapists don’t spot the signs (especially if you’re masking all the time). The ND board on here is a good place to start if you’re interested. Things like CBT aren’t going to cut it if you’re ND - might be worth having a chat with a private therapist who works with the ND community or is ND themselves. Hope this helps and feel free to disregard if it doesn’t 😀

Do you know what the root cause of your issue is?

[Trigger warning]

I think it stems back to childhood. My parents hated each other but stayed together in a miserable relationship until my Dad died when I was 25. I can't recall a single time I saw them hug or be affectionate together, all I remember is constant arguing. My oldest brother picked up on a lot of the hostility and was basically a massive bully to myself and our other brother. Any small thing would set off his temper (eg if he thought I looked at him the wrong way). He would break or burn my things or spit at me and pin me to the floor, screaming in my face that he's bigger than me and can do whatever he likes to me and there's nothing I can do about it. My parent's didn't acknowledge any real issue with his behaviour, so for many years I believed this was all just standard family life.

My earliest memories from when I first started school is that everything was so overwhelming and I just wanted to be invisible. I remember lying in bed barely being able to breathe, having what I now recognise were panic attacks. When I tried to speak to my Mum about how I was feeling, she would tell me I wasn't to tell anyone else or I'd be told off by the headteacher or taken into care. It progressed to pretty much constantly thinking about ways I could end my life when I was in year 5/6. In secondary school I was fixated on the idea that when I turned 16 I would do it.

My Mum has obvious undiagnosed depression and anxiety that she's never admitted to or sought any medical help with to my knowledge. I'm sure part of her motivation for having kids was so she could stay at home and not have to work. On paper we were well cared for physically, and academically high achievers, but I feel like my mind never developed properly emotionally if that makes sense. I'm naturally very anxious when people interact with me. I've learnt to mask and force myself to smile, so I don't completely alienate everyone in my life. A lot of the time I feel like a robot. It gets exhausting and I feel like people can sense I'm not really ok, if that makes sense.

Thanks for the suggestions for other therapies I can look into. I'm going to have a good read through and look into whether there's anything local to me. I'd be open to trying other drugs that may help. I'm just not sure I'll get anywhere with GPs as I must have tried at least 6 different ones over the years and just keep getting offered the same SSRIs. CBD may be worth a go. I did use to self medicate with weed when I was in my 20s, it certainly helped me sleep better. What CBD would people recommend?

ecigarettesworld.ie/e-liquids/1740-300mg-cannabidiol-natural-cbd.html

That's what dh was using first though I think he started with a weaker one. He chose that as he didnt want something with additives or flavourings and so on. He now buys from a French website le petit vapoteur but they seem to have hundreds of options so I dont know what exactly he buys except it will be the same idea except cheaper because that's why he changed. There's some basic info on the french site. I just read bioavailability is 20% through inhaling as opposed to 8% from ingesting. Though they are selling a product.

I'm not sure DH is able for counselling or therapy as he is mainly just trying to hold things together day to day and I think delving into his childhood is very painful for him.

I’m currently waiting for assessment for autism ,with nhs.sent forms of 18 months ago ,so only another years wait now .
not sure if autism is the cause of my depression.my kids are diagnosed though.
i usually suggest people look at autism
Samantha craft .autism in women..is a good article on internet

Please have a look at my AMA on hypnosis. There's a lot of defence mechanisms in your subconscious that did a great job when you were young but don't know they are now hurting you.

Re CBD recommendations: I historically found the Healthspan maximum strength good! They sell it at larger Boots stores (and online) and they used to stock it on Amazon

90% of that is exactly me. I’m watching the thread for suggestions.

I was only ever offered SSRIs and CBT (group sessions) too. I hated CBT, I’m sure it made me worse as it added resentment and frustration into the mix!

When you feel this bad it’s really hard to get anywhere. I find it incredibly hard to make appointments for anything, and even harder to leave the house and go to them. Quite often I don’t make it to appointments and that brings a whole load of extra problems.

SSRIs are imho bullshit, not much better than placebo when they work and worse when they don't because of all the horrible side effects.

Psychoanalysis etc might work but it's very expensive and long-winded and it wouldn't have helped me when I was suffering from essentially biochemical depression. (I did two years of it in graduate school when not depressed and found it useful and sort of formative, but when depressed I wouldn't have engaged properly or even been bothered to go.)

I would ask for a referral to an NHS psychiatrist. Exaggerate your symptoms if necessary. Any suggestion of mania or psychosis will do it. Then speak to someone with a much deeper knowledge of the available medications about how crappy you actually feel. The MAOIs are brilliant anti-depressants and don't have as many dietary restrictions or risks as you might think.

Basic theory is the underlying issue hasn't been dealt with so I'd be looking more towards EMDR or psychotherapy. If you feel it's the medication then Maybe look to switch to SNRI like venlafaxine.

Could be worth asking about trying some antipyschotics. I've never felt that antidepressants made much difference to me but antipsychotics made a huge difference to severe depression (had obsessive thoughts but never any psychosis). May also help with sleep, most of them have a sedative effect.

Is what you wrote going to be helped by meds or CBT though?
I read it as someone who was incredibly mistreated and misunderstood and was provided with basic care but that's where it stops.
Psychotherapy would be way more effective as you can sort through your emotions and set things straight.