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

Chlomipramine was streets ahead of the rest in terms of mood/anxiety, but l couldn’t stop eating on it. It was like being cocooned in pink and golden clouds.

Gosh, it’s only been 6 years for me but things got pretty wild after I had my daughter 2 years ago.

The worst part of all this is how disconnected I feel from her as I’m so wrapped up in myself. It’s so upsetting.

Are you well now?

I’m well as I’m maintained on drugs. I wouldn’t be well if l wasn’t.

@ArseInTheCoOpWindow did you ever have the detached feeling I described? Do you have it now? I just need to feel love for my daughter again it’s absolutely destroying me

Yes. That feeling is horrific. It’s depersonalisation/derealisation. Your brain tries to detach itself from continuous anxiety by becoming disconnected.

It’s the worse feeling ever. It goes when you’re better though x

It would seem that they need to switch you to a different family of medications. You’ve had SSRi’ and SNRIs

Ask for a TCA.
Chlomipramine
Amitryptiline
Imipramine
Nortryptiline.

These fell out of favour due to toxicity in overdose, but they have less emotional side effects. If you didn’t do well on Fluoxetine or Venlafaxine, then they may be hitting the wrong neurotransmitters ( for you). They hit noradrenaline and serotonin.

Sertraline hits dopamine and seratonin.
Chlomiprimine and Paroxetine purely hit serotonin. These drugs might me more useful to you.

l can’t tolerate loads due to this. I did well on Paroxetine and Chlomipramine. Also Venlagaxine as I’m on a low dose so it’s not hitting Noradrenaline. Citalopram also mainly hits serotonin. Amitryptiline is slightly different but seems well tolerated by those who can’t tolerate lots of drugs. I think it’s main take up is Serotonin. It’s hits other neurotransmitters, but only weakly.

I imagine I’m prolonging the whole thing by getting so upset about that feeling :( @ArseInTheCoOpWindow

l think that’s normal though. It’s a hideous feeling. Horrible. Who wouldn’t get upset?

The other thing is Lithium for those who don’t respond well to normal antidepressants.

And Oxford do Ketamine transfusions which l think are 1/2 nhs and half private. You pay something. That’s meant to work straight away, but need redoing every 6 months.

EDMR might help you to get back into a better place.

I am sorry you had a difficult experience with a therapist. There is a lot of evidence for connection between chronic pain and mental health, but it sounds as though the therapist has been clumsy in this, leading you to believe it is somehow your fault, which it really isn't.
I really would encourage you to find another therapist and try to explore some of this. If you look for one whose qualifications are robust, talks about somatic experience and is able to work at relational depth, you may be able to do some work on this with them.

That’s exactly it and told me to journal about my traumas in childhood which left me processing some hard stuff on my own. I absolutely see where it all went wrong but have such a fear of the physical symptoms now and have definitely developed some kind of ocd / obsessive introspection that is very hard to break. I had looked at a somatic therapist but I don’t think I’m there yet as cannot really function

Gosh I don’t want lithium isn’t that a scary one? Or just its reputation?

I’ve heard of ketamine infusions I will look into it.

I’ve sat in front of the community MH team and said I am suicidal and cannot be left alone or I will do something I can’t undo. And they told me unless I have a “plan” I am not bad enough for psych ward. And gave me 15mg Mirtazapine.

15mg?! The normal dose is 30mg! 15 is just for sleep. They sound so crap!

OP I hope your appointment goes ok tomorrow 

@ArseInTheCoOpWindow what dose of clomipramine did you take?
I've been on it for a long time but unfortunately after a relapse earlier this year it doesn't seem to be working for me anymore.

150mg

Paroxetine is the next closest to Chlomiprimine.

Thanks @ArseInTheCoOpWindow
I was never able to take more than 75mg because it really reduced my blood pressure.
For a long time I was on 50mg and less though.
This time I've only been able to go to 60mg because any higher and it stopped me sleeping completely (as in zero sleep for weeks on end unless I took a sleeping tablet.)
I'm really upset that it hasn't worked this time but I guess that's what happens sometimes.
(Paroxetine was the first one I ever took but I had severe withdrawal probs with it even if very slowly and they don't want to prescribe it again.)

Amitryptiline will make you sleep! It’s used in chronic insomnia.

@ArseInTheCoOpWindow that was one suggestion but then dr decided not to add in. I'm very sensitive to medication so probably the reason.

OP sorry for hijacking your thread!
I don't have any personal experience of it im afraid but I've got a friend who found duloxetine very helpful. I hope that all this discussion has shown that there are different options.

@ArseInTheCoOpWindow Weirdly I had a few brighter moments today. Very fleeting but still… wondering if the Mirtazapine is kicking in, only been on it 2 weeks. I have enough to up the dose to 30mg myself but not sure whether to do that. Will probably go on the advice of the psychiatrist tomorrow. But I’m very impatient with meds usually and always come off after a couple of weeks as I don’t think they’re working !

It takes 4 weeks though!

@ArseInTheCoOpWindow I know but I’m always so desperate because I let things get so bad before I reach out for help! I came off my medication last year because I was feeling better and thought I didn’t need it anymore… that tells you everything! So perhaps I stick with the Mirtazapine as no thoughts of ending things today which is extremely rare.

It can take months to truly see the benefits of SSRI's, by keep stopping and changing you're making things worse! Your brain chemistry will be all over, no wonder you feel like shit!

Stick with the mirtazipine OP. All these SSRI type medications take a minimum of 3 weeks and often more like 4 weeks to start to work so by constantly stopping after 2 weeks and trying something else you’re never getting the benefit.

Actually to be fair I was on sertraline for 12 weeks and went all the way up to 150mg and fluoxetine for around the same but I gave up on escitalopram and citalopram too early for sure