Seriously what next?

[Ihaveaquestionn]

Background - I’ve had anxiety/depression since 2016 related to chronic pain which has never been properly resolved but was coping okay

Had a baby in 2021 - things were going okay until he was 8 months old when I woke up suddenly panicky. This escalated to intrusive thoughts, constant fear, suicidal feelings. All related to myself, my past failures (why have I never been able to resolve my chronic pain, did I marry the right man and other random things I’d done as a child or teenager that were embarrassing/immoral)

Admitted to mother and baby unit and had a horrendous experience. Was essentially discharged without a care plan and left to carry on. I improved over time, went back to work etc. Was on sertraline and Quetiapine.

This level of functioning continued for around a year. Looking back I was not okay I was simply pushing myself through the day and avoiding any time alone, unable to relax etc.

In November my husband convinced me to stop taking my medication as I was still complaining of some anxiety and chronic pain… I’m sure you all know what’s coming.

Life stressors, massive relapse. Back on meds but no change. Swapped to fluoxetine, no change. Had a horrendous reaction to venlafaxine and now on mirtazapine which is making me extremely tired and angry but doing nothing for depression/anxiety.

I have been under the crisis team three times since January and keep being discharged back into the community on a new drug that ends up not working.

I am extremely suicidal and get through the day by simply holding on to the tiny slither of will to live I have because of my child. I can’t be alone, can’t drive, go out alone.

being around my son is unbearable because I can’t cope with him at all.

The next medication being suggested is Duloxetine. I have no hope left in medication but will try it anyway.

I’ve got to the end of this and realise I don’t even know what I’m asking. I just can’t live like this anymore it’s been this bad since January.

Cant have therapy at the moment as literally cannot process anything people are saying. It’s like nothing makes sense. Can’t focus on a book or tv. Can just about do a crossword with my heart racing and constant intrusive thoughts.

Am I literally fucked or does anyone have any words of advice

my past failures (why have I never been able to resolve my chronic pain, did I marry the right man and other random things I’d done as a child or teenager that were embarrassing/immoral)

Interesting that you fee that you've 'failed' in terms of resolving your chronic pain - how did you come to the conclusion that you should have been able to do that? It is possible to turn off the mind's response to pain but it's not something you'd know instinctively.

Is your marriage happy in general? Was there another man you think you should have married?

We have all done things as children/teens that we can look back on as embarrassing and/or immoral - it's the way we learn, by trying things. Why do you feel you can't let them go?

It all started when I saw a therapist who suggested that my chronic pain was coming from my own repressed emotions and my “past” whatever that means. That started a long and traumatising journey of self help that became an obsession with myself and my emotions. I think I actually became more afraid of emotions and discomfort than I ever had been. And a huge increase in my chronic pain, probably from all the stress and pressure I was putting on myself to heal as she described I could.

This all happened at exactly the same time I met my now husband. I had a few doubts at the time and was connecting that and all sorts of other random things to my pain whenever it flared up.

I’d never really been in a consistent, healthy relationship and my husband represented everything I knew I wanted deep down, and still do. But my mind was going crazy with what ifs.

I got stuck on the past again due to my therapist suggesting these events/memories were somehow causing me pain physically.

What I now understand is that it’s simply my day to day reactions to stress, emotions and all the physical and mental symptoms that have come with all that. BUT the anxiety is so strong, the thoughts are relentless and I’m suffering things like depersonalisation from all the overthinking.

So it’s all a bit of a maze in my brain and I can’t find the way out of it all.

That all sounds so ridiculous reading it back.

It all started when I saw a therapist who suggested that my chronic pain was coming from my own repressed emotions and my “past” whatever that means.

Well, that was a load of bollocks (excuse me for using a technical term). I hope you're not still seeing that 'therapist'?

Pain is effectively a signal from the body to the mind letting us know we have incurred some kind of damage that either needs to be tended to or protected to allow it to heal (often both).

In those instances when the pain we feel is no longer delivering any useful information and is now just ongoing chronic pain where no action is required, we can compare this to a fire alarm.

If the fire alarm in a building starts to sound we will probably want to check to see if there actually is a fire. If there is then we take the necessary action to put the fire out. But if there isn’t then the next step is to turn the fire alarm off - which is exactly what we can do with chronic pain; tell the subconscious to stop.

Try Amitryptiline. Good for pain and sleep and mood. It’s the gold standard against which all the others are measured.

Id avoid Duloxetine if you didn’t get on with Venlafaxine.

The best drug ever for me was Chlomiprimine. Not prescribed often, but was amazing.

Yes that makes sense now but at the time I was very vulnerable and now I can see I’ve added more and more tension and stress and the fire alarm is so loud I don’t know what do do. Going along with your analogy.

I have never been offered amitriptyline only one SSRI after another. Can I take it with mirtazapine? I have been on the lowest dose for two weeks and all it’s done is make me hungry and tired. And very irritable with my toddler :(

Sorry that last reply was for @ArseInTheCoOpWindow

I'm sure you're aware that the body responds to stress by firing up the 'fight or flight' reaction - tensing your muscles, using all your energy and focus in order to protect yourself or escape. Over time this can cause damage to your health as the body doesn't have the capacity to both be on high alert and do all the other things it needs to do - digest food, fight infection, repair cells, etc.

The body can't differentiate between actual danger (of which there is very little in modern life) and perceived danger that comes from your thoughts, memories and imagination (of which there is way too much in modern life). So the first thing is to realise that you are not in any danger, so you can relax. Box breathing and progressive relaxation (lots of Youtube videos on both) will give you some relief immediately.

The next thing is to put those 'past failures' in the right context. When we do something we generally don't think "this is going to go badly/this is really stupid but I'm going do it anyway". No, we want to try new experiences, we want to be part of the 'gang' (crucial throughout school and teenage years), we want to know what sex and drugs (for example) feel like.

So accept that you are no longer that person, that you now have the experience, knowledge and wisdom to know better, and that the things you did are in the past - you aren't planning to do them again, are you?

Thirdly please look into effective therapy for your pain. I'm a remedial hypnotist and I, and my colleagues, work with pain (once it's been established that there's no ongoing medical issues). Using the fire alarm analogy I work directly with the subconscious to switch off that response.

Amitryptiline isn’t used much now as an anti depressant because it’s dangerous in overdose. But it’s as effective as an SSRI and is really good for pain. Ask for it.

@Eyesopenwideawake ive had 3 sessions with Tim Box and it made no difference.

Its more the obsession with the whole situation that makes sense, rather than what happened in the past.

@ArseInTheCoOpWindow I will ask my doctor. Thank you. Do you know if it helps with tension as most of my issues come from severe neck tension which also causes problems with my eyes and depersonalisation which is making me suicidal

Yes it is a muscle relaxant. So it will help with tension. You need to go above 100 mg for help with mood.

@ArseInTheCoOpWindow Will call my GP and beg them for it tomorrow! Thank you for replying to me x

Mirtazapine can also agitate rheumatoid receptors. I was in so much pain on it,and l was a miserable and bad tempered cow when l was on it.

FYI there is a huge evidential link between childhood trauma and chronic pain/MS and Fibromyalgia by the way.

A staggering amount of people with these health conditions have a history of traumatic childhood experiences.

There is a huge evidence link between mental and physical health.

I'm sorry you're struggling so much OP x

I think you should try other antipsychotics. They can make you care less and calm you. I’ve never found antidepressants helpful either

I am going to see a private psychiatrist and ask for some more medication options thank you!!

@ArseInTheCoOpWindow well my GP prescribed amitriptyline 10mg over the phone. Apparently it’s safe to take together with Mirtazapine but as I said that’s just making me foggy and irritable so will ask if I can discontinue that if I see benefit from amitriptyline. Do you know realistically how long it might take to have an effect?

10mg is very very low. I got no relief under 50. I think it works quite fast for pain.

They take about 4 weeks against mood l think. Fwiw I’ve been on lots of AD’s and Mirtazapine was just vile. Made me really bad tempered and irritable. I used to pick fights with people all the time. It was a really horrible medication. Probably the worse in terms of mood adjustment.

@ArseInTheCoOpWindow how quickly did you move up to 50? GP has asked me to call back in two weeks to review. Sorry for all the questions

I started on 50.

The older ones aren’t like SSRI/SNRI. They don’t have the hideous mood start ups. They just make you feel spaced out and sleepy.

@ArseInTheCoOpWindow Ah okay. Well my husband has got me a private appt with a psychiatrist tomorrow so I am going to see what they say before I take the amitriptyline. Perhaps they will agree a higher dose is better. I massively appreciate your help. Out of interest how do you know so much about theee medications?

😂 I’ve had anxiety and depression since 16. I’ve been on them all!

The only ones I’d ever consider again are Fluoxetine which l became allergic to, Chlomipramine, Venlafaxine or Amitryptiline!