Persistent depressive disorder: GP won’t help me, psychiatrist refused referral

[pressureonjulian]

My GP put me on 75mg of Venlafaxine and 15mg mirtazapine.
I used to see a community psychiatrist but they say I don’t need to be seen by them anymore, that my GP can treat me.
My mood and anxiety are a lot better than they were but I am still mildly depressed and when I deviate even slightly from my regular routine or am under any stress (even just a bad night’s sleep or a head cold or something) I get bad again and it takes a while to recover. I’m tired a lot and sleep a lot. My concentration is still crap, a little bit improved but still very bad.
I’m a sahm and after I drop dc to school I go back to bed. I also sometimes lie down in the evening when dp makes dinner.
He says it’s not right to be so tired all the time and he’s probably right.
I used to be the opposite, constantly wired. Now I’m so dull and always want to daydream and to sleep. It’s a relief to me but it’s not ideal obviously.
Anyway, the GP won’t increase the Venlafaxine. He says 75mg is “plenty” and won’t do anything else for me. The psychiatry team have refused the referral multiple times. The other thing they suggested was therapy. I tried three different counsellors/ therapists and it didn’t help at all.
I used to be on a maintenance dose of 225mg Effexor years ago before I got pregnant, can anyone tell me if I’m right in thinking 75mg is not very much?
It says on all the information it’s the starting dose.
Also, anybody got any clue what I can do? I’m at a stalemate with the GP.
The last time I saw a psychiatrist they said I had Persistent Depressive Disorder. I reckon what has happened is I had a Major episode and now I’m back to normal but what’s normal for me is actually mild depression.
I’m exhausted and I’m basically just dragging myself around. Do I just accept that this is as good as it gets for me? I could cope with it better when I was younger because I assumed it would get better eventually but it hasn’t.

Venlafaxine and effexor are the same, so why are you on such a low dose now?
Can you see a different GP and try to get them increased? If they worked for you before I don't see why you can't have a higher dose now

Can you pay for private psychiatry? You might not need many sessions x

Have you had blood test to see if there is a physical cause for your tiredness? Low vit D or low b12 can show up as tiredness and low mood.

I was seeing one GP, she started me off an 37.5 then put it up to 75mg. She was going to keep increasing it. But then she went on maternity leave. So I saw a different GP. I don’t know why he won’t increase it. He just point blank refused. Said it’s “plenty”.
Maybe I should try a different practice.

I really don’t think so. But I will look into it though, thanks.

Yes, I have had full bloods done a number of times. They always come back fine.

@Midnightlove
sorry, it was a psychiatrist who prescribed it before, not the GP. Then I came off it and relapsed. The GP was putting me back on it. I just realised that wasn’t very clear.

I'm on 350mg venlaflaxine so can definitely go a lot higher.i'd definitely push for higher dose or seek another Dr.

Not medically qualified but long term depression & anxiety here too OP. Wonder how you're on Venlafaxine & Mirtazepine & not on just the appropriate one dose of Venlafaxine? If that helped you most previously I would ask to see a different GP or if it takes changing to a different surgery to get someone willing to help you. IME Mirtazepine is doled out for "sleep" but is only effective at lower doses - maybe that's why you were prescribed it? It doesn't help me sleep ironically but I can only take it at night o'wise I'm too knocked out & unable to function if o take it during the day. That may make a small difference to you but really you need a higher dose of venlafaxine imo x

Yes, the mirtazapine is for chronic insomnia. I don’t want to go up on that as I know it can lose the sedative effect at a higher dose.
I was tried out on all sorts of different medications years ago because it was hard to find one that actually worked.

Thanks everyone. I will try to register with another GP and see if they will put the Venlafaxine up a bit.
I think part of the problem is the GPs are just not very comfortable with those particular meds. Since the psychiatrist discharged me to the GP, they just don’t seem to want to take any responsibility for treating me even though they are the ones writing the prescriptions and now the clinic won’t take me back.

How old are you? Im
wondering if this could be undiagnosed ADHD and perimenopause. I spent years being treated for anxiety and depression with the sane symptoms and actually have adhd which has been exacerbated by having dc and the perimenopause. I was late diagnosed in my 40s.

@pressureonjulian I do sympathise - it’s impossible to be seen by the MH Team - “anxiety & depression” gets massively dumbed down by services & made to be seen as purely a case of “low mood” not requiring specialist care. Unless you have an MH diagnosis of bipolar etc only then are you deemed eligible for services. The result is that you’re at the mercy of GP’s who are just not equipped to properly manage it. I’ve fought & fought to be reviewed by a psychiatrist (as used to be a standard practice) & the implication was I was being a massive waste of time. It really sucks.

I’m almost forty. I’ve always had bad pms and that does seem to have gotten worse. My mood is awful with that but I said that to the GP and they referred me to a gynae and they said there’s nothing they can do, hormonal contraception will just make it worse and I need to see a psychiatrist.
The GP said she thinks it’s a strong possibility that I have undiagnosed adhd but she wrote to the psychiatric team and they said they don’t test or treat for that and I would have to look into getting assessed privately which I just can’t afford. So I’m just sort of stuck between them all.

@GMF
Sorry to hear you had to go through that. It is really hard and I do feel like they think I’m just a time waster. It’s very disheartening.

Ask your GP to refer you for an ADHD assessment via the Right to Choose which is private but on the NHS. That’s how I was referred after waiting 4 years on the NHS to be seen. I was seen and diagnosed within 4.5 months of the referral being made.

@LegoTherapy
thanks, but I’m in Ireland so we don’t have that here unfortunately.

Lower dose mirtazapine makes you drowsy in the daytime. Ask them to increase it to 15mg.

That’s England and Wales though.

I’m on 15mg of mirtazapine.

My gp prescribed venlafaxine 5 years ago. 75mg is a starting dose. You can gslightly sedating and is sometimes used off label for ADHD. Best antidepressant ever. However have you considered social prescribing? Local to me, near Birmingham there is exercise classes and meet ups and recommend books available from the library. All free. You really need to push yourself as what you are doing isn't really working. Maybe now the weather is improving you can get outside, go for a walk. Do some gardening. I have suffered all my life but fortunately its never affected me in the same way as you. Good luck.id change surgeries if at possible.

Sorry I cross posted and am
guilty of being very Anglocentric with things like this but I’m trying to be more outside of my little bubble.

My sister was in a similar situation around your age and was prescribed HRT for her hormones. Her GP and NHS refused to prescribe it to her as she was “too young”. She saw someone privately and was prescribed HRT for perimenopause. Honestly, the difference it has made for her is staggering!

Agree with the last poster and I hope I don’t seem critical as I have suffered acute anxiety and depression. I would try not to go back to bed and sleep and try and sleep at night maybe without the mirtrapazine and yes I do understand it is a vicious circle. Try and look at different treatments for depression other than medication. Have you had any CBT , counselling. Have you tried practicing gratitude for low mood . It is possible that you have tried all other suggestions but the drs used to be so quick to prescribe anti depressants without trying other holistic life style changes.

@AmusedGoose
I read that about Venlafaxine and adhd. That was actually one of the reasons I asked to go back on it as opposed to a different ad.
I do go for walks. I’m a sahm with a five yo so I do a twenty minute walk to and from the school twice a day.
I have even made a couple of mum friends.
There is social prescribing in my area but I don’t think it’s for me. I’m not socially isolated.
The main problems are the tiredness and dips in my mood. Getting out for exercise and to socialise has helped generally but it has actually made me more tired and has done nothing for my motivation. I feel totally drained after socialising and it sometimes makes me depressed afterwards.

No worries. It would be great if we had that here. It’s a pity we don’t x