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When SSRIs and CBT don't work

27 replies

Socktopuss · 02/11/2022 10:44

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?

OP posts:
Weatherwax13 · 03/11/2022 02:29

For a start you need a psychiatrist. GP hasn't been able to help and you deserve more appropriate care as the more simple fixes haven't worked.
I'm always banging the drum for it on here but I'd seriously suggest reading up on EMDR.
I imagine you have trauma still affecting you.
Please do seek a psychiatric referral. They should be able to link you in with a proper psychologist - not a counsellor - who is trained in trauma therapy and all the resulting depression etc.
I can empathise with everything you've written and you honestly can get better treatment.

daretodenim · 03/11/2022 06:07

OP, the good news is that you know what the problem is: you were physically abused by your brother, emotionally neglected and gaslit by your parents and grew up with a mother who was depressed.

That may come as a hard shock to read, and is a short form version, but you've been suffering for a long time and it's not fair to think that there's something wrong with you. There's not: some really bad things happened and your parents didn't protect you. You reacted to that (abnormal treatment) in a way that is completely normal.

Look up ACEs (adverse childhood experiences). They're best seen not as a diagnostic tool, but an indicator. Might be interesting to you.

As for CBT and the medications (do NOT stop the medications), imagine you have a wound on your leg. It hurts and won't go away. I give you some painkillers and show you how to sit so it doesn't put too much pressure on it. That's like medication and CBT in your case, they're not able to heal the wound. That's of course simplified, but gives you an idea.

EMDR and schema therapy have been mentioned and they're two good routes to try. EMDR is referred to as a relatively quick fix and it's important to understand that in the context of, for example, doing it after a car crash. In your situation, the issues are not stemming from one incident that happened 6 weeks ago, so it can be longer, per issue. I'm trying to get your hopes up, but not unrealistically and reading about EMDR generally focuses on single issue problems.

What is very important is that you are with someone properly qualified. I'd be looking for someone who is a counselling psychologist or clinical psychologist (both doctorate level qualifications) or a psychiatrist.

I don't know your financial situation and very sadly that can have an impact on things. If you can afford private those are the qualifications you should be seeking out. In the order I've listed them, but they're all good to start with. And note: counselling psychologist is not the same as counsellor, or someone who offers counselling, or a psychotherapist. It's much more highly trained.

It was mentioned that SSRIs can cause side effects and can actually be unhelpful. This is true. However, it's dangerous to just stop taking them, so please, if you want to do that, don't do it without proper medical supervision.

As you're looking at reading, then a good place to start would be Bessel van der Kolk The Body Keeps the Score. I would really recommend it.

I can recommend other books too but need to get up. Let me know.

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