Difficult to treat depression experiences (and hopefully success stories?)

[MarmadukeM]

Hi I am having a bit of a shit time.
I have had a major depressive episode in summer and I ended up on Vortioxetine which I took for 5 months before coming off it due to side effects about 3 weeks ago (would’ve done it sooner but doctors wanted me to keep trying it and added other meds in for the side effects before I had to stop as I became so sedated I couldn’t do my job properly).
The problem is, I was never really ‘cured’ and so I’ve had this depression for 8 months now and feel like it will never end 😖 not great as feel more and more like I won’t recover the longer it goes on.
I have a diagnosis of bipolar disorder type 2 and am on Quetiapine and pregabalin but no antidepressant currently apart from 50 trazodone for sleep. .
Historically since first episode aged 18 I have been on mirtazipine, sertraline, venlefaxine, dothiapine and trazodone (as well as the Vortioxetine). Some worked some didn’t.
I have a psychiatrist appt on Monday and I am going to need to ask to go back onto an antidepressant. Would like to hear of any people similar to myself and what has/hasn’t worked for them - I do know we are all
individual and what suits one doesn’t suit another but I am really interested and I just need some hope I’m going to get out of this ongoing nightmare 🙁

I have had sleep issues since my hypomania episode a couple of years ago (and diagnosis of bipolar affective disorder). All sedation approaches (sleeping tablets, antihistamines, low levels antipsychotics) didn’t stop the depressive decline and I got quite desperate a couple of week ago, The pressure in my chest was awful and I couldn’t stop pacing. I didn’t know depression could present this way. My consultant was off sick and I saw a different one. He was brilliant. He had already thoroughly gone through my history before he saw me and said he thought my sleep was a primary circadian rhythm issue rather than a secondary bipolar symptom. He suggested trying melatonin. And I’ve had the first proper sleep in years. It’s an approach barely mentioned in the NICE guidelines for bipolar and other consultants can be dismissive - as melatonin isn’t that affective in trials for traditional insomnia (looking at you renal consultant I saw earlier this week). However I believe circadian rhythm is viewed as increased relevant for people with bipolar. It’s not just that I’m sleeping - phenaghan did that but just masked the issue - it’s actually proper sleep. It’s been a painful two weeks as my emotions have come back after going completely numb and my brain hurts… not a headache but a heavy soreness all over. But I think that’s everything coming back on line now I’m sleeping better. I’m still on the low side but coming back up out of depression for sure. I didn’t realise how ill I was. The crisis team didn’t take me seriously at all so I had to go to my GP to bypass them and go straight to consultant on my behalf.

All the best. It’s a hideous unseen and therefore hard to acknowledge condition. I would ask about trying melatonin. You need a mixed release type.

It's tricky without knowing what combos at what dose you've already tried. For years I was on 200mg quetiapine and 150mg venlafaxine which was fairly effective but the quetiapine was sedating. Have you considered lithium? I'm trying to switch across to it now, but it does require regular bloods.

1. speak to your psychiatrist
2. therapy
3. see if your psychiatrist or key worker will/can refer you to a mood on track therapy group. If you are lucky enough to get on one, do the entire course and commit to doing the work. Hang on in there, it can take a lot of time but it does get better.

@Ramblingaway ive never been offered lithium. I think maybe as I only had one really hypomanic episode and the rest have been sudden really bad depressive episodes.
I got terrible side effects from venlefaxine- couldn’t sleep at all etc so i never got beyond 75mg 😖
I’m on 350mg quetiapine extended release at night and 150morning 150 evening of pregabalin.
I just saw something called ‘aglomelatine’ that looks promising I don’t know if I can ask for something specific or if that will puss the doctor off.
@WinterFelinePurring i see what you are saying about the melatonin - I’m fairly heavily sedated from the quetiapine at night so going to sleep isn’t an issue. It’s more that I wake up early and feel so bloody down. I need an antidepressant I’m sure x

I prefer the immediate release quetiapine, find it wears off quicker in the morning so I'm less drowsy, but you might have already tried that.

I’m on lithium. I didn’t mention that.

The issue with sedation is that it looks like sleep but doesn’t actually restore the mind and body like sleep does if circadian rhythm is off. These things are individual but I’ve also only had one hypomania episode with depression more prevalent. I’ve gone from moderate depression where I couldn’t even face doing a basic household task to where I am today having been given this new approach to try. As an add on to the lithium. Worked for me but as you said initially these things are all individual.

I have completed a mood on track course. It wasx useful as I had to face the diagnosis I had been given and it was nice to interact with others with similar conditions but the course itself didn’t bring up anything I hadn’t already learned. But again this is individual too so it was an interesting course to do.