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.

Have you ever tried Seroxat ( parexotine) op ? That is the only medication that helped for me but I am not taking it now. I identify with a lot of what you say especially In that medicine can take away the anxiety but also the joy in life . I don’t feel that spark of joy anymore. Also I am aware of my problems , know what I should be doing but it seems impossible if you see what I mean.

Go private, the NHS nearly destroyed me, I have CPTSD. I had a proper diagnosis finally after years of being ignored by GPs and I'm on the correct dose of medication to keep me on the straight and narrow.

Maybe you could pay for a psych appt to write to the GP about the dose of meds?

I have found a book on CBT which was good, it is on Amazon and called "Change your thinking with CBT" if you wanted to have a go yourself.

I do know exactly what you mean.
I haven’t been on seroxat. My mum is though and she says it’s the only thing that has worked for her.
I honestly don’t know whether more meds is what I need or if there’s anything that will help at all.
It was harder in ways when I was younger because I always felt like I was missing out but I was sure that at some stage things would get better.
It is very different now. I have no clue what I want from life. All of my energy goes into my daughter because that comes easily to me, it makes sense. It’s myself that I have no idea what to do with.

I will see what our health insurance will cover. I really don’t think any GP is going to be helpful. This type of thing isn’t even really what they’re for.
And I’ll look that book up, thanks very much.

That sounds like a good plan to use the insurance, how is it going now? I also have depression and have an appt with the mental health team for a review on the 10th.

It doesn’t seem to cover out patient treatment as such. There’s partial cover for in patient treatment but I’m far from needing (or wanting) that.
Tbh I promised myself that I would make myself find a new GP this week but then dd came down with a virus and I forgot all about it 🤦‍♀️
I am going to try to set small goals for myself as well and see how that goes.
I hope your review goes well.
Are you happy with your treatment generally?

I'm just with the GP for now but one of them seems supportive- she is listed on their website as one with an interest in mental health. Babe another GP will be better for you.

I'm on venlafaxine 225 mg daily

Also Quetiapine. and mirtazapine

I sleep too much, still anxious, can't do shops,or busy places

A GP who had an interest like that would be ideal for me too I’d imagine. I don’t feel like I really need to see a psychiatrist.
Having a kid has actually helped my mh in a lot of ways. Helping her learn how to navigate things in life, to be social and confident and build self esteem, all that stuff is actually helping me to re-learn some of that stuff and understand why I don’t have these kinds of skills or confidence. It gives me a sense of purpose as well.
I am just trying to live one day at a time now. Sometimes one hour at a time tbh.
It is hard being tired like this all the time and having my thoughts and feelings dulled, but it is much better than the way I was off meds.

That sounds awful. Could you get your meds changed? That doesn’t sound like they’re helping very much.

I got v tired on ADs and had to stop as was counter productive. Idk for sure but I think they were affecting my potassium levels. Try eating more high potassium foods.

DD is on 150 mg of venlafaxine prolonged release once a day.

Are you on immediate or prolonged release OP?

I’m wondering if this isn’t a bit chicken and egg being mixed up.
Yes depression can cause fatigue, but also fatigue can cause depression.
Just like obesity can cause mobility disabilities, but also mobility disabilities can cause obesity.

The assumption running through all your posts is that the doctors think your fatigue is due to depression. But when I read your posts you clearly say you are depressed because you are so fatigued all the time. You tried socialising, exercising and so on but it was all too draining and exhausting. You have had CBT and therapy for depression, and it’s not helped your fatigue, which means your mood hasn’t ever been any better than mildly depressed. Therapists have even said you are impossible to treat and it’s like you are refusing to get better. You half believe it. You’ve been on antidepressants and they haven’t given you your energy back and so your mood stays low.

It seems they’ve tried everything that would help if your fatigue were caused by depression. It’s not worked, so

I am wondering if there is physical cause for the fatigue and if we fix or manage the fatigue, your depression might lift.

Have you been tested for glandular fever antibodies? For inflammation markers? Have you been given any kind of instruction regarding fatigue management and pacing? You may have undiagnosed CFS/ME which is in turn causing your depression because not only are you tired/fatigued all the time but you have been gaslit into thinking it’s your fault you suffer from fatigue when it may not be in your control or caused by you at all.

I didn't mean to say babe that was meant to say maybe! That sounds positive

I would not see that male GP again. Can you kindly request any decent female GP instead to discuss.

Yes I thought undiagnosed ADHD too. Without cash you're right, you'll be waiting years. I would however bring this up with a female GP again. Be quite certain about it and ask again for referral. You have to be confident that you believe you are or they'll fob you off.

I think CBT is bullshit. I have a great counsellor I found myself. It's important to have someone who is ND aware, who understands this, who takes a humanist approach and helps you explore all your struggles and make sense of them. I always see posts on here where ND people are having no joy with CBT. You can't CBT yourself out your very real struggles and emotional responses to that!

As you know, only a psychiatrist can prescribe, not the counsellor. But they'd cost a lot. So I'd press the GP ( female one) on the meds side as they can change dose. I'd look online for a female ND aware and familiar older lady if possible and see if you can explore all this with them. They often do concessions if people are financially struggling. I'd personally dodge anything CBT.