Treatment Resistant Depression (sensitive content)

[SB1967]

I suffer from very severe depression.
They've told me that according to their records I've tried every available antidepressant.
In April I saw a psychiatrist and asked for electro-convulsive therapy , which they rejected. I've tried to beat this depression with gym work, cycling and other exercise. None of it has worked. They told me to go to socials with other people struggling mentally and struggling with social isolation but my depression is just so deep that I don't want to be around other people , especially strangers .
I am now seriously planning my own s***e
I've told my closest relative that "I have to die". I suppose I should see a GP or ring NHS 111 but I'm not sure they'll help me. I'm struggling to leave the house during the day too. I absolutely cannot get out of this. I assume they'll continue to deny me electro convulsive therapy in which case I feel I have no choice but to delete myself.
The depression has become very extreme and frightening and I'm scared it'll turn into depressive psychosis. It's like they're waiting for me to get much worse before they help me. It has been a slow torturous descent into an extreme state and it's agony.

Does anyone have any experience of treatment resistant depression?

Op I am really sorry you are feeling so overwhelmed, and agree with pp that you should be receiving much better support.

Can you go to A & E as PPs have suggested? A friend of mine went to a police station when they were feeling like this and got some good support. She was totally honest with them and she ended up in a psychiatric hospital for six weeks, then had ongoing treatment at home.

I completely get that you feel hopeless so please forgive my inadequate response but I just wanted to say that circumstances and life never remains the same. Things that may seem impossible now can change suddenly , or change may be very slow and gradual but nothing ever stays exactly the same.

I know this is a really crappy response in the circumstances but sending strength and the hope that you can hold on 💐

Edited : I don’t think that you should have to wait until tomorrow to get help when you are in this much distress 💐

You absolutely cannot run out of venlafaxine in your current state.

Your GP could prescribe the tablets in whatever form is available. The pharmacist can call the clinic for you if you ask them.

You're not necessarily correct in thinking there's no chance of being hospitalised. If you're actively planning to die in the near future, your GP should refer you to the CRISIS team. If you tell them what you've said here, you could indeed go on the wait list for a bed. If you don't feel you can keep yourself safe, you can speak to someone at A and E and stay there. That is another route.

Please do not ever believe a GP who tells you that you're out of options. They do not know what they're talking about compared to a psychiatrist.

If you have given passwords for your financial matters to someone, written notes or made a will, you absolutely must mention those things and don't pretend to be comforted if you are still feeling desperate.

I don’t think your gp is correct in telling you that there are no other options. A lot of treatment resistant depression is actually bipolar disorder- have you tried a mood stabiliser plus an antidepressant. An antipsychotic medication is also an option. ECT is sometimes helpful- They are wrong to deny you this option. Is there anyone in your life who can advocate for you? Attend an appointment with you?

@SB1967 Sorry you are going through this. I am on 150mg Venlafaxine and 30mg Mirtazipine. For reasons I won't go into, but along the lines of your current mindeset, I landed in hospital last week and then onto the psychiatric unit. I have a meeting with a menopause specialist this week to discuss HRT, I am 40. After lots of research HRT might help me. Has anyone discussed HRT with you?

This post is a very helpful demonstration that someone in the OP's position can access a higher level of care as an inpatient and can be considered eligible for admission. I hope things work out for you.

@SB1967 I'm concerned that you are "only" seeing a gp. You need a specialist: a psychiatrist. A gp is good just for prescribing when you have found your dose and all is well. You are not there yet so need a psychiatrist to help you. Medication doesn't work the same way on every person. I have been on Venlafaxine 225 mg for over 20 years and it works for me. You might need an antipsychotic/lithium/something else. Only a psychiatrist is qualified to help you.

If you feel so down that you want to commit suicide then please please go to a & e and tell them just that. Then you will see a psychiatrist. And you will get Venlafaxine as well. Def do NOT stop taking it abruptly because you will suffer!

Also wanted to add- transcranial magnetic stimulation TMS can be used for treating severe depression when nothing else works. There are no side effects.

https://www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/about/pac-20384625

Pharmacists should be able to amend a prescription from tablets to capsules and vice-versa and they should really be doing so, given the circumstances. Otherwise contact your GP surgery and ask the admin team to send an urgent message to your GP for an amended prescription.

Did 111 put you in touch with the crisis team?

There is also room to increase your doses but GPs sometimes lack the confidence to do this because the side effects are better managed in a hospital setting.

I was going to suggest Liothyronine. I'm taking it for hypothyroidism, but a side benefit is that it immediately lifted my mood.

I cannot believe they've refused me capsules
When you're in my kind of situation every "minor inconvenience" is a fucking massive thing likely to send me right over the edge
WHY ? It's the same fucking medication

I'm so close to just fucking ending it

Has anyone in your family had ECT? It might be a good idea to explore it, if they have tell your GP and if they refuse ask for a second opinion!

No they haven't
I'll have to drag myself out tomorrow to sort this medication thing out
I'm certainly in no fit state to be darting about everywhere hoping someone has the medication
I'm going to crack up and perhaps that needs to happen

A few things in priority order - your pharmacist should be able to contact your GP surgery to get the prescription ammended to allow them to prescribe the form of tablets they can get hold of. I'm on 600mg of a medication and the 600 mg tablets are difficult to get hold of. When they aren't in stock the pharmacist asks the GP to change the prescription to 2 x 300 mg to ensure I never run out.

You can get the prescription released to a different pharmacy who is able to get the right form of the medication. I had 3 options for pharmacies 2 different local chains in our town and neighbouring town and boots in the majority station I used to commute through. The chain in our town is useless at getting stock, the neighbouring town chain is really good and boots is a back up and is able to search the stock in all boots stores in the county.

I had severe treatment resistant depression with psychosis after having my daughter. I had a 10 week admission in a mother and baby unit. I had tried 4 different antidepressants on various combinations of 2 at a time. I am bipolar and had my mood stabilisers doses increased to it's maximum dose. They started me on lithium and it made a big difference and they later added in lamotrigine as well which meant I was on 2 traditional mood stabilisers, an antipsychotic that also acted as a mood stabiliser and mirtazapine at 45mg. This helped my mood go from severe and unfunctioning to moderate and more functioning. I was then able to engage with life better and therapy and that helped my mood even more. It took just over a year from my discharge from hospital to get to a place of stability. When the lithium didn't offer the improvement we were needing my next options were ECT, a different antipsychotics, venlafaxine or lamotrigine.

It was agreed within the whole team that the ECT wasn't appropriate for me at that time as the risk of long term side effects would have similar consequences to the depression it was hoping to treat. The antipsychotic I had previously been on and had difficult side effects. They would have preferred me to be in hospital when I started on venlafaxine due to my risk of mania so I agreed to try lamotrigine first. It possibly helped a little bit but I think time and social stuff that the improvement from lithium and no longer being in hospital helped more. It was the first thing I dropped once I had stabilised.

I'm experiencing moderate -severe depression again and I've not had it confirmed but we have had limited response to treatment. I'm no longer on lithium due to me breastfeeding. I'm on mirtazapine and venlafaxine and my antipsychotic/mood stabiliser. I'm being referred for psychodynamic therapy. There has been a small improvement and the treatment has stopped it getting as severe as my previous episode and I've stayed out of hospital.

I would be asking for a referral to the cmht for a medication review and if there is anyother support they offer.

How are you doing today @SB1967? Did you get your meds sorted?

Thank you yes I got them but only after I pushed them more than I should have had to.
But I'm facing the same problems every day - inactivity, loneliness. It's just hell and I don't see a way out.

Sorry you are suffering so badly @SB1967. I’m the same age as you and I’ve struggled with severe depression and suicidal thoughts for decades too. I can’t remember whether you have tried seeing a private psychiatrist as they will definitely be able to suggest some more medication options and also more extensive therapy than is usually available on the NHS.
Have you tried Duloxetine as that seems to be stabilising my mood some of the time?

I've never had anything but antidepressants.
I should really see my GP but I just detest going outside during the day. Especially mornings. It's staggering that a GP tells me that I've tried every antidepressant then doesn't suggest anything else.

Could you ask for a telephone appointment then?

Yeah I'd forgot that, that it'd probably be a telephone appointment anyway.
But it might make a stronger impression in person , my strong suicidal state.

What action would you ideally like your GP to take?

Perhaps try me on Lithium or whatever is appropriate. I should show him some of the posts on this thread.

Definitely ask for a telephone appointment.

Ask, if I have tried all of the antidepressants available to me through you, what is the next treatment option?
Can you contact a psychiatrist for prescribing advice and guidance?

Do you have a list of the medication you have tried and for how long? I would doubt that you have tried every antidepressants as there are dozens and dozens. I imagine what they mean is you have tried all of their go to antidepressants.

Ask if there a GP within the surgery that has more experience within mental health or if they could discuss your case with another member of the team. I'm under my GP for fatigue and all of the common things have been ruled out. My Dr was stumped so spoke with a different Dr and on the back of that came up with 3 other things to test for. GP is a bit of a misnomer as they are "general" as such, they aren't specialists but whilst there's commonality in their experiences prior to becoming a GP they will have had different interests and experiences.

OP I was in a similar position many years ago and I’ll never forget that my psychiatrist made a point of always giving me hope for the future, saying if the current intervention (meds or whatever) wasn’t the solution, we still had options ahead of us, and he would tell me usually about the next two things he would try if necessary. It’s very poor that you’re not getting the same consideration from your GP.

Sometimes I would take the approach that I just needed to get through the day, and I would think of one thing that would make it tolerable.

I also attended support groups, which wasn’t a solution as such but kept me going.

You may find that it’s easier to handle of you look at it one day at a time as opposed to a solution, but I also don’t want to add my platitudes to your unpleasantness. You have all my sympathy, it’s very hard.