PTSD therapy, great, but meds needed for depression?

[Cantabulous]

My SIL has been working really hard in therapy for PTSD following CSA, but he has depression too which increasingly does not shift. Any ideas on what types of medication may be best in these circs? (Obviously he’s going to the GP etc, but I’d like to have some info for when I discuss with him). Thanks

Different types of antidepressants work for different people. It's a case of trial and error.

With certain specific disorders certain medications are recommended above others but that doesn't always work out. . I have BDD for example and they usually recommend an SSRI for that but they didn't suit me at all and I had almost every side effect on the box including severe suicidal thoughts, I am on mirtazapine which worked much better for me.

The NHS app say that "The 2 medicines recommended to treat PTSD in adults are paroxetinee and sertralinee.
Paroxetine and sertraline are both a type of antidepressant known as selective serotonin reuptake inhibitors (SSRIs))_."

So these may be a good first try, but they may not work for him so he may need to try a few before he finds the right one, which can take a few months or so (I had to try three for example). ADs usually take about 6 weeks to feel the full effect.

He also needs to be prepared to feel worse before he feels better, which is normal after starting ADs.

Thank you, I really appreciate your detailed response.

He has been fighting against ADs as he has worked in mental health and is negative about them, because of the side-effects. But he has struggled for so long now, poor love, personally I think he may need them to stay afloat.

I don’t have any side effects at all from mirtazapine. So side effects aren’t a given. I would say that if he has side effects he’s not happy with then he can stop and try something else. Be aware that some side effects wear off after a few weeks so you do need to give them a little time.

(Obviously he’s going to the GP etc, but I’d like to have some info for when I discuss with him).

He has been fighting against ADs as he has worked in mental health and is negative about them, because of the side-effects.

Without being rude, does he want to discuss this with you? You may have a great MIL/SIL relationship but is he open to discuss this?

He is likely aware of medication options if he works within mental health. He has a right to choose.

Antidepressants are hit and miss. They'll start him on the ones most commonly successful and if they don't work, switch. I went through 6 before I found an older one that worked, ironically the least likely to. And even then it was from a psychiatrist as the GP wouldn't prescribe it in a high enough dosage for depression.

If you can see a psychiatrist, I definitely would. They know their medications better than a GP and are more willing to try combinations of meds.

My GP gave it to me in the lowest therapeutic dose under dire warnings of side effects and general doom and extracted promises to visit A&E if I felt more suicidal than usual. My psychiatrist looked at my history, allergies etc, rolled his eyes and doubled it saying it was absolutely fine just not as refined or widely tolerated as the newer ones.

So don't be afraid to try them just because of side effects. I literally got none even on one that GP insisted I would. If he hates them he can always stop.

Obviously I’m not going to force him to discuss it with me, that’s crazy! But he has no family except for us now, so he does discuss things a lot, when he feels like starting the conversation. I totally respect his right to choose, pity his birth family didn’t give him that same respect 😡

Sertraline is recommended for use with ptsd.

I started on sertraline when IBM first diagnosed. It allowed me to stabilise so that I can actually engage in therapy and get out of bed and function.