Correct medication for my anxiety and depression

[BurfordBrownEsq]

Hi, just wondering if anyone could advise me on what to do about my ongoing mental health problems. I’m a 66 year old female. In brief, I had quite a severe breakdown six years ago due to fairly catastrophic family problems/issues/losing 3 close family members due to bereavement in very quick succession ie a few months of each other, followed by another close family member withdrawing contact completely from my life.

Since this time I have had counselling, talking therapies, was started on fluoxetine which was a life saver at the time though it came with its own issues in some not nice side effects but I stayed with it for 5 years when I just felt it had stopped working etc. I was then put on citalopram by my GP but this didn’t work either. I should say throughout this time the anxiety has never really gone away. The GP then tried venlafaxine which was pretty horrific so came off after three months. I have now been put on mirtazipine which has zonked me out and made me really irritable and low. Been on this a month and now feel at my wits end with it all. Thanks for reading this far. Before trying mirtazipine my GP told me she was now scraping the barrel with me as far as antidepressants were concerned so I had really hoped mirtazipine would be the answer but I don’t feel I can tolerate it. Many years ago I was on paroxetine (seroxat) and this worked wonderfully but GP said no when I first asked for it again. So, as you can see I’m struggling with where to go from here. Any advice would be gratefully received. Thanks.

I can't comment on medication but after six years is it worth thinking about revisiting therapy or counselling? How is your life now?

I was offered the counselling etc again but chose not to as I didn’t feel it help previously. My life has certainly improved from six years ago but I’m living with a situation which has caused shockwaves not just for me but the family as a whole. I supposed I’m looking for a wonder drug which will enable me to live my life while coping with grieving someone who hasn’t died but have to respect their wishes. It’s all very complicated. I have lots of support from members of my family but the repercussions are still there. I just wish there was something to ease it all.

If your gp feels they don’t have the expertise to help you then they should refer you to an expert - a psychiatrist. I wouldn’t put up with feeling this way. Ask for a referral. When you mention a severe breakdown, I’m assuming that meant hospital?! Even if not, it doesn’t sound like a mild case or anxiety or depresssion here. I went to GP on and off for decades before I went ping with an episode of hypomania during perimenopause. Awful experience but does mean that I was fast tracked to fantastic support. I was discharged as too well to need CMHT. Great news obviously but when I was struggling repeated visits to GP didn’t help. In the end, desparate to avoid another episode I called CMHT and the psychiatrist called me back. She had me sorted with appropriate medication in 5 mins and checked up on me till I was feeling better. I’ve refused to be discharged now. My GP was faffing around with “ be careful when you drink caffeine” type advice for my insomnia - to be fair to them they did hint that next stage would be referral back to CMHT but I thought I had to be more ill to warrant that. The consultant told me lack of sleep was my biggest risk factor to relapse and gave me two week course of zoplicone.

if you’re anything like me, then a life time of more mental health that only got noticed when you went ping around your 50s, means that you probably undercomplain whilst feeling like you over complain.

I repeat - you don’t have to feel this way. I would be pushing for referral in your circumstances. I know some areas aren’t as great as mine but I think you need speicialist support. My GPs are amazing but they cannot manage my level of ill health.

I'm on escitalopram and found it has helped. Previously on sertraline. I also have propanalol for the physical symptoms of the panic attacks as and when needed I I feel this has been a game changer. It seems to stop me spiralling as the physical affects took over and made my anxiety and depression worse to control.

@WelshYellowDaffodilsthank you for your reply. I do think my GP just doesn’t know what else to do with me. I’m sure I do feel that I am overcomplaining and that I’m wasting their time. To be told they are scraping the bottom of the barrel has made me reluctant to go back. I think I will have to ask to e referred to CMHT as my gp doesn’t know what to do with me. I probably come across as very in control and with it etc but inside I’m dying.

Your post totally resonates with me. It’s just not visible from the outside. No one, including myself(!), has any idea how much I was battling internally until I spectacularly went ping.

I defintely suspect you’re under complaining rather than overcomplaining. I would fill in an e consult and say that you feel you need a referral.

This is a sample of the criteria for referral:
https://www.shsc.nhs.uk/services/community-mental-health-team/eligibility-and-selection-criteria-community-mental-health-team

why did you come off paroxetine? Did you doctor say no to going it on it again for high blood pressure or other reasons? Reading up it sounds as though it’s not advisable to take it if you’ve been on some of the other antidepressants.

@WelshYellowDaffodils Thanks for the link but I suspect I just fall outside it as it says up to 65 and I’m almost 67. The paroxetine was prescribed in my 40’s for a totally unrelated matter and did wonders for me. No idea why the GP said no to it this time.

Why can’t you go back in Paroxetine?

Tgeres also loads of other antidepressant’s TCA’s are still used.

Paroxetine is a potent in regards to Serotonin. Chlomiprimene is its sister in the TCA’s

I’ve been on both. Chlomipramine was amazing.

@ArseInTheCoOpWindowthanks for this. It wasn’t explained why I couldn’t go back on paroxetine, it was just a no, I thought maybe my age? I will ask again. There are loads of antidepressants around, not just the handful I’ve tried 🤣 but I assumed it was just the NHS

Well l had all the strange ones prescribed by my gp.

If the paroxetine is still a no no then I shall start asking for the strange ones 😂

Would you consider trying fluoxetine again as it helped before, I am on that and they increased mine to 40mg recently.

Also have you considered HRT / menopause could be involved? Might be an avenue to talk to the GPs about. Best of luck, and sorry to hear how difficult things have been.

There will be a separate service for people over 65. I don’t know your area but this is an example: www.lscft.nhs.uk/our-services/service-finder-z/community-mental-health-team-older-adults

I would consider fluoxetine again although it made me quite hyper and irritated my bladder terribly, we shall see. I have filled in an e consult with the surgery, thanks for your help.

Your gp is weird.

Paroxetine is THE one for anxiety.

I agree. I have a telephone consult in 2 weeks time and will ask for it again..