Psychiatrist or MH nurse at surgery?

[Jenkib]

Bit of a back story - have tried various AD meds over the years (15 ish) .
Initially for low mood and Sertraline 50mg worked for ages along with exercise and I could function / laugh etc

THen anxiety took over and despite upping the dose it stopped. MH nurse at the surgery suggested venfalaxine 37.5 . This helped with the anxiety but wiped me out !!!!!
I did a couple of months with nothing (continued with the exercise , journalling , gratitude etc) but too overwhelmed. Back on sertraline at 100mg

I have had CBT in the past and in the middle of talking therapy sessions but unsure how much help they are.

Do I go back to the MH nurse and ask for a different drug ?
Those who have been to a psychiatrist, how have you been refered? has it helped? Is it costly etc?

I have low esteem and think it stems from that. Stable upbringing so is it a chemical imbalance ? (bro and sis are fine )
No major traumas (seperated 5 years ago, but amicable)

I only managed to see a psychiatrist through crisis, so i'm not sure how you go about getting a referral, or waiting list length. Didn't want to read and run :)

Ask for a referal to psychiatry or therapy and make sure you tell them how bad it is xxx

I see a psychiatrist through the CMHT. I’ve actually not found it that helpful as there’s been a high turnover and each one I see has a different opinion! Then there’s the hospital psychs when I have been sectioned who also have their own opinions!

Thank you.
I hope never to get to that point - I have days when I wish I had not woken up but I could not do that to my kids (or family)

That isnt helpful !!!!!
Do you mean different opiions on meds you should take ?
Thanks for replying

It took a lot for me to get referred to a psychiatrist. Not for anxiety which I had really badly for years. Yes, a psychiatrist is able to help you much better than a nurse or a GP. But honestly if you can afford it go private- you are more likely to get better medications

The chemical imbalance theory was debunked decades ago, although there is a genetic link to depression. When you feel anxious what are you anxious about?

Oh that’s interesting ? Don’t anti depressants boost serotonin though ?

Im anxious about loads of different stuff (money , my kids , my parents , the future , being lonely )
In addition , I put extra unrealistic pressures on myself (one example I am running for charity and want to do it in a set time and raise a certain amount )

You haven't said your age, but just wanted to check you couldn't be perimenopausal? Lots of women I know found anxiety increased in mid 40s and HRT helped. If not that, you can ask your GP to refer you to secondary mental health services in your area. However they may refuse to see you and say it's within primary care's scope. Or you may get onto their books, but might see a prescribing nurse or pharmacist. Actually getting to see a psychiatrist is the equivalent to finding a unicorn where I live.

I’m 44
I tried HRT for a bit but my mood deteriorated so they upped the sertraline and I came off the HRT
perhaps the two would have worked together

I find the MH nurse quite vague eg you could give this a go or that one . Although maybe it’s a case of trying different types of AD until find one that suits - trial / error

HRT with progesterone can make things worse in tablet or patch form. Some folks need a mirena coil to keep the progesterone localised. Then an oestrogen onlypatch or gel. But it's a lot to think about if you aren't feeling good. And it's no fun when you feel like you've tried ever anti depressant out there. Does/did any body in your family struggle with anxiety or depression? I think I read somewhere that there's evidence that which tablet works can run in families ( which makes sense if there is a genetic component to the condition). So if you've got a mum, dad or brother who's found an antidepressant that works for them, it could be worth a try.

Why ask for a different drug? Why not just ask for the next dose up on the sertraline if it suits you? 100mg isn't a lot

Private psychiatrist is definitely the best option if you have medical insurance or you can afford it yourself. Mine costs £170 per session and has kept me alive the past couple of years.

It isn’t helping the anxiety !

This sounds like what we GPs manage every day with no psychiatry or MH nurse input.

Mum had erratic emotions but addressed it through diet - tried to with me but realised mine needs more !!!
She is more accepting of meds than she used to be ( not for herself but for me )
Yes , I tried prog in pill form and oestrogen gel . Perhaps mirena would be a better try

Yes, different medications and differing thoughts on therapy.
My anxiety only really abates on 200mg of sertraline by the way x