Antidepressants not working

[LongWayToGoForNothing]

I'm hoping someone has been in a similar position or can offer help. I started mirtazapine at 30mg seven weeks ago for severe anxiety ( racing thoughts, unable to sleep, overthinking, low mood etc) and after a couple of weeks it really seemed to be helping and I started to feel like my old self again. However, as soon as I hit week 7, ALL of the symptoms are back again, along with heart palpitations and on the edge of a panic attack, sleeps gone to pot. For the first few days I've tried my best to muddle along but after an entire week of this I'm worried this isn't going to work. I can't tolerate ssri ( sertraline sent me highly agitated and a hundred times worse). Has anyone had this happen to them and did it get better?

speak about increasing it again
it can go up to 45mg

id also mix it with therapy to try and help
unless you're able to self manage with things

Thank you for replying. Problem is, I had exactly same response when I initially started at 15mg for a couple of weeks before increasing to 30mg - it worked wonders with my sleep and anxiety for a week but then just abruptly stopped. I'm concerned if I go up to 45mg the same thing will happen and then I can't go any higher. I do know strategies to help with anxiety but the gp agreed that I need to be at some basic level of functioning before they can be helpful.

the worst that can happen is the same thing happens, but at least you tried.

ive been on a range of different medications for MH issues

what other medications have you tried?

I know you're right, but it feels so cruel that I felt some hope for a few weeks, only for it to be ripped away. Sorry if I sound dramatic but I'm so tired of it all and living in this head. I've tried pretty much all of the ssris over the years and all sent me loopy, so I can say with some certainty, they're not for me. I was actually on mirtazapine ten years ago and they worked really well before but stopped working - gp said give them another go as it's been so long, but then this happens, so I'm worried there's nothing left for me to try!

Can you describe the agitation a bit more and how the SSRIs make you feel. I wonder if there's the possibility they are sending your mood high. Has bipolar ever been mentioned before. It might be worth reading up about hypomania to see if that fits

I get it. I’ve tried so many medications

you could ask to try another atypical antidepressant.
initially I’d ask to increase the mirtazipine again to the highest dose. Medication will only ever do so much and is best used in conjunction with therapy. There is a level of you need to be at a point where you can use the therapy but being in therapy can help you get to that point

I've sometimes wondered this too, but discounted bipolar as I never feel " happy high", on or off medication. The ssris increased my anxiety ten fold, jittery in mind and body, rapidly racing thoughts without managing to ' catch hold ' of one, extremely restless and irritable, delusional thinking, literally no sleep at all as my body is so revved up with adrenaline, rapid heart beat, can't sit still etc. Mirtazapine ( when it worked really well a decade ago), was the only medication that calmed me down and relaxed the over thinking and feelings of doom.

Thank you. I would happily do therapy but I'm really not functioning well enough to absorb anything at the moment. I know I need to implement strategies when I'm well enough, to prevent future relapses, but that feels very far away at present. I wouldn't know what other medication to ask my gp for if this doesn't work out - i think he thinks in a bit of an anomaly as sertraline etc works so well for most people.

have you ever spoken to a psychologist?

I haven't , no

High mood doesn't always mean happy. You don't have to have every symptom for it to count as a mood episode. I have bipolar disorder and I get mixed episodes whenever I'm put on SSRIs or other non-mood-stabilising meds which means I'm manic and depressed at the same time, and medical professionals don't recognise it very well or very quickly so if I lose insight I'm stuffed; mine start how you describe and if I'm left on the wrong medication I get worse and worse.

I'd seriously push for some sort of review with a proper psychiatrist (this may mean a referral), or get a private one ASAP if you can e.g. via Psychiatry UK or similar. Being left on medication that sends you potentially manic/hypomanic is really dangerous (it nearly killed me once) and you need a proper assessment at this point.

Good luck.

Gosh, thank you. That makes a lot of sense - i really did think bipolar manic meant feeling great, happy, high etc - which I never am! I'll do some more reading on this and talk to my gp when I next see him.

If I was to give you my top 2 misconceptions about bipolar one of the two would be that high moods are all happy!

You can euphoric or dysphoric high moods. Euphoric would be the happy and life and soul of the party moods but with dysphoric moods there can be lots of energy but also irritability, anxiety and restlessness. This can turn into mixed episodes where you have both depression and elevated moods at the same time

Mirtazapine seems to be a better antidepressants for those with bipolar. It is the only antidepressant I can tolerate and I have heard others say the same. With SSRIs my mood goes high in hours even with mood stabilisers and antipsychotics but mirtazapine has helped me with some tricky depressions although it has only worked in conjunction with mood stabilisers. Bipolar depression doesn't always respond as well to antidepressants. Quetiapine and lithium have been life changing for me at different times the mirtazapine just gives them a bit of a boost

It might be worth doing a bit more reading to see if it fits

Thank you so so much for such a useful post. I can identify with lots of what you've shared. How bizarre that mirtazapine is also the only anti depressant you can tolerate - that's been exactly my experience too (well until this recent bout). Which seems to fit with the bipolar possibility. No one has ever mentioned to me the different types of " high " ! Interestingly, When the sertrsline sent me into a complete spiral and the 15mg mirt stopped being effective, the gp mentioned anti psychotics to me as being helpful for getting some sleep ( complete insomnia), but I was scared by the reviews I read online and and I didn't want to be considered " psychotic " if that makes sense, so refused and therefore, he upped the mirt to 30mg. You've given me a lot of food for thought, thank you so much.

Oh don't worry about the name "antipsychotics", they just deal with the symptoms you've got. I'm on them right now (aripiprazole). You may have to try a few to get one with fewest side effects that effectively sorts your MH out, but I find they make the symptoms go away without affecting who I am or anything like that.
If you feel yourself getting too out of control, can't sleep for more than 2 days, or people around you are concerned, don't forget 111 option 2 can get you help, likely before your next GP appointment.

The second generation of antipsychotics the likes of quetiapine, olanzapine and aripiprazole are less scary than the antipsychotic of old.
They have antihistamines qualities which means they are sedating but can help regulate sleep which is good for mood disorders and I have definitely benefited from the good sleep habits that quetiapine has enforced. They act on serotonin so can help with the low moods and they act on dopamine which can help with high moods and psychosis as well as tempering the behaviour of antidepressants. They are pretty nifty medications! Sleep and weight gains are biggest downsides but I've been on quetiapine for 12 years and my weight gain has been minimal and age/life style driven - half a stone gain after turning 30 for example.

@MiraculousLadybug @Superscientist

Can't thank you both enough for sharing your experiences and helping me to work out what else might be going on with me. I can relate to an awful lot, and deep down I think I've always known that this is more than ' just' anxiety. I'll have to take another trip to the gp to ask about other meds to supplement the mirtazapibe, rather than asking for just a higher dose. I know It's daft, but the thought of taking antipsychotics has always scared the life out of me, but like you said it's just a name and I can't let " shame" get in the way. The gp specifically mentioned olanzapine before, so I'll ask about that. So good to know there are other people out there who have found the right help and are thriving ! Makes me feel hopeful.

I know waiting lists are endless but I think seeing a psychiatrist would be good if possible. I'm currently taking 3 types of meds and it took a while to get this combo right - but I don't think, from memory, that GPs can prescribe that way.

Tbh the gp hasn't even mentioned a referral - but if I can't get any relief, I'll have to ask. I was actually quite surprised when he mentioned an antipsychotic, as I thought only psychiatrist could prescribe those. If I had the finances, I'd go private but that's not going to be possible.

Olanzapine is licenced alongside an antidepressant for bipolar depression and quetiapine is slightly better as an antidepressant and can be used on it own or with an antidepressants. They are very similar drugs though. Personally I can't take olanzapine as it makes me dizzy but quetiapine has been great. For others olanzapine will be better or one of the other meds in the class. How a person reacts to a drug is depends on the person so it make take some trial and error.
The second generation are much improved on the first generation antipsychotics much lower risks of being "zombified" and other stereotypes that you might imagine a person on antipsychotics might be. The goal of the original antipsychotics was to allow those with pyschosis to live a life outside of a hospital and were less than ideal and came with stigma. The expectations about treatment outcomes are much higher nowadays. It's about being able to live a fulfilling life. I promise you, you could walk past me in the street and would have no idea I've been on antipsychotics for over a decade!
For the likes of olanzapine and quetiapine they are so much more than that. It's just what they were originally designed to do. It's a bit like aspirin originally designed as a pain killer but also works very well as a blood thinner. These meds are good at managing moods as well as psychosis. The doses are often lower for mood stabilising. I know more about quetiapine but at low doses it's a good sleep aid. At middle doses it can act as an antidepressant/mood stabiliser and only the higher doses are needed for anti manic or anti psychosis. It's not an exact science but loosely that's the pattern in prescribing

I have had them prescribed by GPs but usually following them calling the duty psychiatrist for advice as I was originally put on it for antidepressants induced mania and had a referral put in place at the same time. My GP has managed my quetiapine without psychiatrist input making small changes but more significant changes have had a referral back to the cmht.

It might be worth writing out the meds you have tried and how you responded it might help build a pattern of behaviour which will help you hopefully getting in front of someone that can help.
Try to dig into the symptoms too - say they disrupted sleep. Is that insomnia where you are tired but can't sleep, does it make you restless at night so it's hard to stay asleep or do you have a decreased need for sleep and 3h was more than plenty?
Thoughts - is that an increase in anxiety related thoughts, intrusive thoughts, all thoughts are fast and jumbled? And so om

@Superscientist

lot to take in there but your way of explaining, is easier for me to grasp than things I've read online today. I'm reading it over and over to and absorb all the info. I've had a very strange day today, mood wise, when I posted yesterday I'd had a whole week of symptoms with no let up and was feeling desperately low and hyped up with anxiety/ nervous energy. Today I've felt calmer, more reasoned in my thinking, more reflective, no heart racing, head buzzing, jumbled thoughts. But who knows what tomorrow will bring. I'm wondering if I was experiencing some sort of mania for a week. I really would like to talk about a mood stabilizer with my dr, I'm hopeful that this could be the missing link. the little I did read when I was offered the olanzapine, spoke of muscle tremours/ mouth lolling etc ( can't think of the correct term) which could be permanent and this obviously disuaded me from taking, so it's helpful to hear from people like you who've had a much better experience!

The insomnia is excruciating - my body is physically tired, but there is no " off switch" to shut my brain off. At its worst, I have random rapid unconnected thoughts or even just jumbled words appear in my head, which I have no control over or a song on repeat I can't stop. It's like a constant radio. Physically, my heart beats so loud it thuds in my ears, and my body often jerks around to try and release the energy. ' wired ' is one way of describing it, full of energy and adrenaline - like I'm stuck in fight or flight mode, but there is no visible threat! If I manage to get off to sleep I'll wake an hour later, with my mind fully alert and buzzing with more of the same. Sorry, I've waffled too much but hopefully you get the picture.