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.

I will try not to go back to bed. I think because my dc is still quite small, waking at night etc, that doesn’t help. I’m still not on my own sleep schedule iykwim.
I had cbt in the past. It didn’t help much tbh.
I tried three different counsellors but that didn’t help either. It actually made things a lot worse.

How do you go back to bed if you’re looking after a small child? Who are they with

I can relate to what you said about finding socialising draining . I tried to push myself to go to an art class but found being with other people so long really draining and thought I would be better off just doing it at home! I am giving antidepressants another go at the moment but they are just making me more content in my own company if that makes sense. Yes it’s difficult with younger children if you don’t get a good nights sleep.

@kerstina
I totally get what you mean! This is exactly my problem. The antidepressants just seem to make me blank rather than in good form and instead of making me motivated, they just make me not care.

I’ve only one. She’s five and still wakes up in the night most nights. I go back to bed after I drop her to school.

also low iron

OP don't feel guilty over resting if you need rest you need it, adding guilt in there will just make it worse.

I'm peri and tiredness is a big part of it. Look after yourself

Thank you.

I’m not sure if I am peri or not. I probably am but the GP said my hormonal levels etc are within the normal range so I don’t know what to think.

Oh I had that too with the 'tests in the normal range' then I saw another GP. The Nice guidance says not to do blood tests anymore, to go by symptoms, BUT I'm over 45.

I suggest seeing another GP maybe one with an interest in the menopause.

I am also lying in bed while my DH makes dinner for our two (much older) sons

Have you tried cognitive behavioural therapy? Alongside the medication it could be helpful

Thank you. I think I will do that x

Can I ask.sime questions to help us understand you better and consider the possible non medical aspects to your situation. You seem very focused on needing more meds - and that may be right - but I've also known people with moderate depression turn themselves around through basically deciding they'd had enough and taking small positive steps back towards normal life. Posting on here may be your first tiny step towards finding the right strategies for you. So if you feel able to answer:

Have there been times when you felt better, or has it been like this as long as you remember?

Do you have any friends or community groups you are part of?

What did you feel about work before you became a SAHM?

Are you aware of major unresolved issues - parents, childhood, marriage, trauma - which would make counselling very threatening?

Do you get any exercise? Have you ever been more active?

What's your diet like? Do you eat a lot of highly processed food?

Just some thoughts about some of the things I've known to make a difference.

Yes, I did it in the past once. It was okay but not massively helpful. When it became more well known and popular, I figured out I had completely the wrong end of the stick with it which might explain why it wasn’t more helpful.
I saw a community psychiatrist a few years ago. He basically told me they can’t provide it or refer me and to go off and research places who do free/ reduced cost therapy. I found one but at the assessment he convinced me to do a different type of therapy which didn’t suit me at all. I lost heart after that but I might go back and try for cbt. Thanks

I am on Venlafaxine at 225mg and wish I wasn’t. I had been on max 75mg then reduced to 37.5mg and stayed on it for years and years because coming off it made me ill. I had a big trauma 2 years ago and they increased it slowly to 225mg and it honestly made no difference. They prescribed mirtazipine but I didn’t want to get fat so didn’t take it. I paid for a private psychiatrist who added in Lamotrigine. That also made no difference. I then had CBT for CPTSD and that helped me vastly and along with time I am loads better. I got pretty much no benefit that I was aware of from the meds, still felt intermittently suicidal and awful mood swings. Am trying to reduce Venlafaxine now but it is so awful in terms of side effects. The lamotragibe was a doddle to come off.

I too have tried many anti depressants when younger. Nothing worked until Venlafaxine but now that doesn’t seem to do anything, probably because I have been on it so long. Although now I am pretty sure I would be fine without being on anything.

Anyway, not sure what my point is, apart from it might not definitely make any difference

@BishyBarnyBee
Hi,

I have had double depression where I have had a major depressive episode other than that I have mild to moderate symptoms and that is as good as it has gotten. I’ve never been depression free.

I have a couple of friends I made through dd’s school and that has helped a bit. I’m not part of any community groups or anything. That kind of thing is not for me. It would be too stressful and I don’t have the free time.

I have never worked. My mh problems have been a massive barrier to education/ employment. I have trained twice through a specialist program for people with disabilities to try to get a job but it didn’t work out.

I went through a lot when I was younger. My parents were in a violent abusive marriage and had problems with mh/ substance and alcohol abuse and we were neglected as children. I find I end up talking about these things in counselling and it just makes me more and more upset and doesn’t help. I wouldn’t go through counselling again for that reason.

I walk at least an hour most days. I used to do more but that’s all I can manage at the moment. My diet is crap. It was awful when I was younger then I managed to improve it especially when I was pregnant/ bf but it has gone to hell again and I can’t find the motivation to change.

@bigyellowtractorface
That is definitely worth considering that it might not make much difference anyway. It is horrible to come off. I remember being in the absolute horrors coming off it before. The dose I’m on has helped though, I just think it’s too low but I would go up again if it wasn’t making a difference. The less the better.

The big problem is that the meds (and the illness) are sort of making me feel blank. I was at a party the other week and apart from struggling not to fall asleep, I felt really detached from everything like I wasn’t really there. I actually looked around and thought I used to be really anxious in these situations but now I don’t feel anything and it’s so much better. But feeling nothing even though it’s better is not good really. It’s not a good way to live.

Aw, thanks for that and sorry to hear you've been through so much..
The walking an hour a day is brilliant and will be helping you even if you don't feel it is.
There is a very good therapy for trauma called EMDR which is evidence based and doesn't involve hours of dragging through the past. But I'm wondering if there are any mental health projects or support workers locally that you could go and talk to? Or any places offering supported volunteering? Where I volunteer, a lot of people are very open about their mental health problems and it's a very supportive and ultimately healing place to be.

I guess I'm saying - sometimes asking for help is the first step to getting well. And no-one else knows exactly what your next step might be. It might be deciding to get your 5 a day, or exploring support options, or finding out about volunteering, or something completely different. But sometimes small steps can build a route back to normal life. I hope you do find a way through this.

No it’s no way to live at all. 2 years ago I would have done anything not to feel anything but none of the increases achieved that.

i was first put on Venlafaxine 20 years ago for extreme anxiety and insomnia and it was life changing. I’d tried all sorts of antidepressants which didn’t work but Venlafaxine was amazing. I felt normal again.

I am sorry you went through all of that and the impact it has had on your life so far.

I had a type of CBT called reliving last year which was incredibly effective. It did involve revisiting a trauma but it felt like the therapist was metaphorically holding my hand through it and helping me reframe everything.

I think CBT probably would help you a bit. Maybe not a complete cure but an improvement. I have had it twice and it has been brilliant

@bigyellowtractorface
I know it sounds stupid but a massive part of my problem is basically myself. I refuse to believe that therapy will help, for example and then it doesn’t or else I won’t even go and try it because I know it won’t work. It seems like because I’m aware of this, I should be able to change it but I just can’t. For some reason I just can’t accept help or do anything that is good for me and feel good about it. I don’t know why. I have been like this since I was a kid so I would imagine it is some kind of a trauma response or something. I’ve worked with a lot of people over the years who have tried to give me different types of support with my mh or education/ training / occupational therapy etc and they generally tend to say that I’m very difficult or impossible to work with. It’s not that I’m unlikeable, I tend to get along with people but I just don’t let myself be helped. It feels like there’s someone else inside me punishing me. I’m my own worst enemy, I know it but I just can’t seem to do anything about it.
My partner says it’s very difficult that I don’t allow anyone to comfort me when I’m upset and that’s true.
My psychiatrist years ago also said that I was not able to talk about how I felt or to express any negative emotions at all except in terms of clinical symptoms. She had basically developed a way of communicating with me through this once she got used to it but that it would be a barrier in any kind of talking therapy because I am so bad at talking about my emotions. I was never allowed to talk about how I felt as a kid, maybe it came from that, but she was right. I do find it incredibly difficult to express or even identify bad emotions. It makes therapy very difficult.

I didn’t think 75mg of Venlafaxine was a therapeutic dose!! I was on 375mg for years but have dropped down to 225mg so that I can also take adhd meds. I thought that the lowest dose I’d ever been on was 150mg! 🤣

if it’s not working I don’t understand the logic in saying “it’s plenty”. It sounds like the gp doesn’t fully understand how it works.

75 mg is meant to be the maintenance dose.

But it’s specifically designed to go higher to hit noradrenaline. It doesn’t hit that until 150mg l think. Your doctor is talking real crap. It’s an SNRI. It doesn’t hit the ‘N’ until it gets to the higher doses.

15mg mirtazepine is more sedating than at the higher doses. It’s to do with its antihistamine properties at this lower dose.

So can you ask to stop the mirtazepine and increase the venlafaxine?

Thanks, that’s good to know. I will definitely not be going back to that doctor.

No, I need the mirtazapine because I can’t sleep without it. Venlafaxine alone makes my insomnia worse.