CBT, ADs (antidepressants) or both?

[Allein]

I know we have covered this one a bit, but with my CBT commng up and my depession not at it worste but not far off, what are peoples opinion, given the CBT isnt going to be a quick fix. I dont really know my new GP (the last one I really like retired) so trust is a little low.

1.) Try and hang on and see if the CBT starts working over the next few weeks

2.) Go back to the GP and try another AD - I guess I'm worried that the next will be as much as a disaster as the others I've listed elsewhere.

 

[Mugz]

Definitely give CBT a fair chance, some people really have a lot of trouble getting past all the waiting lists to get access to the service that it would seem a waste to let the opportunity go. Hope that it can hlp out for you. It won't be a quick fix, but fixing a problem like long term depression shouldn't ever be able to be a quick fix as it would lessen the value of the problem IMO.

Sometimes it is a good idea to get a new Anti Depressant going alongside CBT, so don't rule out a new med too, myself, I want to be off all psychiatric meds within the next 6 months so I can feel free again and not be bound down by anything, or the need to aquire medications when I am abroad and things like that. It feels a lot bettr to not be on any medication so I would definitely give CBT a fair crack.

 

[Allein]

^^^

Gonna try and hang on but I'm thinking a chat with my GP about the options might be a good idea. I'm so low at the moment, I know this is partly down to the benzos but it was like this last time I gave up the Booze. I probably need to give it a few more weeks. I also want to be clean of all chems (prescribed or otherwise)..if only to see what its actually like

Back to work tm after 2 weeks off and I'm actually looking forward to it, sad to say but the break has been an disiater family wise, think I'm best keeping out of the way at the mo

 

[NeighborhoodThreat]

I'm going to go ahead and edit the title of this thread to "CBT, ADs (antidepressants) or both" for clairification. OP, feel free to shoot me a PM if you've like me to change it back for whatever reason.

-NT

 

[Mugz]

you accidently deleted the C in CBT mate, gonna add it back in for you.

 

[effie]

Remind me which ones you've tried again?

As unfortunately they tend to take 2 weeks to work, and your CBT is in 2 weeks, I wouldn't expect anything dramatic to happen even if you do switch atm but having said that, I feel CBT works best when you are also treated with an antidepressant which is working, as it improves your energy and concentration and motivation. Do you have a good GP? If so I'd go back and ask them what they think, given what you have tried in the past and how you are feeling at the mo (I understand you might not want to mention your benzo tapering to them..) - CBT is a fantastic tool, but it does take time and effort so it would be really great if you also had the added back up of a good antidep. However, I appreciate you not wanting to get any negative effects at the moment..

 

[Tripman]

My biggest advice is stay with the same psych/doctor. ANd try new shit with him... CBT is greatly helpful but honestly it takes time and sometimes you don't have time... But I would recommend staying with the CBT as it is a fantastic form of treatment.

Stay clear of benzo's, please don't end up where I am. Tonight on 150 mg diazepam and 11mg estazolam...

Prescribed 80mg diazepam a day for withdrawals and it doesn't work...

I would recommend trying to stick with each anti depressant to try and stand the side effects to reach the therapeutic level.

Have you considered a mood stabilliser such as sodium valproate with a mix of effexor?

 

[Allein]

Effie - so far, starting last year:-

Citolpram - made me suicidal and caused hallucinations, really not a pretty , the physical nausea paled into insignificance compared to the rest of the side effects.

Lofepramine - I was on that for a few month last year when things were really bad (along side Chlorpromazine) - but it was giving me really bad dreams and I'm not normally bothered by such things, that and circulation problems, very cold feet and hands as well as making me really apathetic, so I came off.

Prozac - Just made me throw up violently

Sertraline - Seemed OK for a few weeks albeit made me feel very emotionally compressed then I had some internal bleeding so came off of that.

Mirtazapine - Just made my derealization much worse, ended up having a car accident.

Had a CBT session over the phone today and based on the assessment session she did she is arranging an urgent GPs appointment, I can't get a proper one in less than a 2week window unless I say its an emergency then its only a 5 minute appointment which is useless.

Given the discussion I had today its been a bit of a wake up call, I think I probably do need some chemical assistance, when they ask you those questions about "how often do you think about X...occasionaly ...weeekly every other day..daily" and you answer most of them "daily" its a bit scarey.

Maybe we could run a poll on what they will try on me next, I feel like they should isseu a small cage with a wheel in the corner and a selection of nuts to eat


Thanks for asking

 

[Tripman]

Mirtazepine: Made me sleep excessively at low doses and trip out at higher doses. No benefit was noticed from usage of this drug.

Pristiq/desvenlafaxine: Sent me beserk. I was super manic on this medication and now I suffer from hypomania with my Bipolar II disorder but I was fucking running around like i'd been smoking shards. It was dreadful for me.

Escitalopram/lexapro: Lasted on this medication the longest, don't think it had any benefits or side effects except if i didn't take it i got visual hallucinations... I tried to kill myself 3 times on it so i'd say it didn't work.

Heading into the anti-psychotic range:

Olanzapine/Zyprexa: Walking coma.... Sedative at night, fairly good for a rest but nigh on impossible to wake up in the morning. Then the rest of the day was spent in a catatonic state... Felt like a zombie.

Quitiapine/seroquel: Low doses are fantastic for sleep and suppressing impulses. High doses are similar to zyprexa, make you very very comatose during the day, i could take 6 hours to do something that should take me 20 minutes on 1000mg (high dose) When I got up to 1000mg's a day i said fuck it and dropped it completely. 400mg XR in the morning and 600mg IR at night so I was constantly in the seroquel daze.

Thorazine/lygactal/cholpromazine: The Chemical lobotomy, steer clear is all I will say. Fucking shitful. I was on 100mg basically to induce sleep when nothing else would.

Zuclopenthixol/clopixol/acuphase: 2 day coma from this injection... Not great but good for dealing with non compliant psychotic bipolar bears like me. NEVER and I say NEVER be non-comliant in an ER and seem psychotic or psych ward, they wont bring out the midazolam, they go straight for the zuclopenthixol and then boom it's lights out walking catatonic state for days...

 

[Allein]

^^^

Was in a secure unit last year and saw a couple of people forcibly pinned up, not very nice when your trying to get yourself together but both times the people were a danger to themselves and others and under section so I guess it had to be done

Funny Cholorpromazine didn't help me sleep at all, I was 50mgs a day but there were people in the unit on 100's of the liquid....not a great look !

Have been there and back a couple of times with self administered Benzos, actually on a short taper at th moment having slipped up a bit a few weeks back. TBH whiteout the booze they don't get me where i want to be anyhow and my addiction potential seems stupid these days. I can't see my GP letting me near them given my history, I think I'd refuse a script if he offered one anyway unless he came up with a very good reasson why I need to be getting addicted to something else having just got off the booze !

 

[Tripman]

Try 100-300 mg in one hit and you're pretty floored.

And yeah i was totally drug raped with the Zuclopenthixol, held down and IM'd in the arse... DRUG RAPE!!!

 

[Allein]

^^^
Yeah feck that and I have a cupboard full of em, I really didnt like the way it made me feel at all, I'd explain more but I'm unable to describe it

 

[Tripman]

I know the feeling of not being able to describe it... It just makes you feel... catatonic and shit?

I mean I have like 15 repeat scripts for 100mg IR quetiapine but fuuuuuuck that.

 

[effie]

^^^atm, sounds like SSRIs definitely aren't your bag! Really shit about the internal bleeding in sertraline, espesh as it seemed promising initially.. If I was your doc I'd be tempted to try venlafaxine except the side effects can be pretty harsh for the first two weeks (insomnia being one and I'm sure you've had enough of that with the diaz taper) and that's the last thing you need. You've only tried one tricyclic (lofepramine) so could try amitryptiline or dosulepin perhaps, they are both sedating too.. and to be perfectly honest a small dose of antipsychotic does augment antidepressants, so it would be an option altho def steer cleer of zuclopenthixol, hah!

I really think you need some psychiatry input into which antidep next but appreciate that isn't gonna happen in the next few weeks.. I'd enquire about other tricyclics if I was you, but def see what your GP has in mind

That's really good you are getting an emergency appt, seeing as it is pretty urgent.. stoopid GPs. Hope your phone sesh went well too

 

[Allein]

^^^

Thanks Effie, Mrs atm (we worked it out) is going to ring the doctors this morning since i always end up getting wound up by the receptionists 9wher do they get those people from they make me seem possibility reasonable).

The CBT counselor was really good, even over the phone, when I told her about the situation at my GP surgery and my last experience with an emergency appointment (the GP said "make sure you book an appointment with your own GP next time I've got enough depressants of my own2 ! mmmm nice bedside manner) she made it clear they would be giving me an appointment and quickly and to leave it to her. I definitely under estimated her based on the quick intro i had 3-4 months ago....go girl they stand no change at that surgery between her and Mrs atm.

I'll report back on the latest NHS cocktail as soon as i have the recipe, Benzo taper isn't causing too many issues if any, 30Mgs today and thats based on dodgy copies.

 

[Allein]

The merry go round continues, got a GP appointment today she basically saidthey wrere now out of their depth and i needed to be referred to a phychiatrist via the "Crisis Service"...she tried to ring them, no answer that was at 9:30 this morning, apparently they commit to a response in 24hrs. I'd kind of assumed that would be they picked up the hone and then called the patient back in 24 hrs not you had to wait 24hrs for them to pick the phone up

I guess they will call tomorrow, hopefully I can report back on the results of a proper phychiatric assesment soon and see what they suggest, thanks to the mods for allowing the thread to run .

 

[effie]

They really should call tomorrow, you are unlucky, here they respond in 4 hours at least to make telephone contact...

I do agree that chosing which antidepressant next is out of your GP's capability really, you've tried so many and had a serious reaction to one, it def needs to be a psychiatrist's input now! Also, fair play to your GP - crisis team is the only way to access immediate senior psychiatric support. If it wasn't for them you'd be waiting weeks if not months sadly.. got my fingers crossed they can suggest something helpful for you! They are generally excellent expect to see a nurse first then a doctor or the nurse might discuss your case with the doc and bring you the prescription themselves depending on how complicated yor case is.. good luck!

 

[Allein]

I do have other numbers if things get really out of shape, I should have been referred this way last year when I was discharged but it wasn't deemed required so at least I know some of the team there as i did see the psychiatrist the once.

The CBT lady was top notch even over the phone and to get me an appointment at my surgery in that kinda time she really came through for me.

I was so glad the GP suggested what she did because thats what I wanted anyhow, Mrs atm will be chasing them down for me if I don't get a call by 12pm.

At least things seem to be moving at last, even managed to pop in to see my drug and alcohol counselor for our last meeting (it was in the afternoon but he fitted me in as so many fail to turn up for morning appointments) He is such a good guy, I wouldn't be off the booze if it wasn't for his subtle support...how he seemed to just guide me into making a commitment to stop I'm still not really sure. He was shooting the breeze with me about the increase they are seeing in K users and after out conversation was going to do a bit of research into MXE.

Anyhow time to try and sleep, I only did 20Mgs of Diaz today which is ahead of schedule, TBH I feel so shitty and its doing nothing for me.

all the best

 

[Allein]

^^^

Honestly its like dealing with the chuckle brothers !!, waited until 12PM today no call.

Mrs atm calls up the doctors surgery, the doc I saw yesterday failed to make the call to the crisis line and was on holiday so was going to do it tomorrow !! I mean FFS the clue in the title ...crisis line.

Mrs atm gave'em hell, I just can't be dealing with them, I've got enough on my plate trying to hold down a job.

Any how they finally ring me at 3pm, they have no idea why they are ringing me, acted really odd when i said I was at work and I had to really push to get a meeting with them tomorrow at their office, they really wanted to do a home visit which i don't want with the kids at home.

I'm hoping not but i get the feeling tomorrow all I'm gonna get it a list of the same assessment questions I've answered 3 times in as many days with a social / key worker, rather than than the psychiatric assessment and properly selected ADs that even i can see i need and the GP said as much as well.

Its enough to drive you to drink and drugs just dealing with this kind of stuff, what I'd do if I didn't have Mrs atm to shield me from some of it I don't know.

 

[Allein]

Given the mods have let me have this open for sometime and its not really in keeping with BDD guidelines I'll make this the last installment.

I finally managed to see my local psychiatric crisis team today and the doctor there has prescribed Venlafaxine as well as Zopiclone.

Unfortunately the Chuckle Brothers...sorry I mean the GPs at my surgery couldn't manage to print this off and get it signed in the 5 hours they had even after being chased...apparently the GP who had the info and had actually printed off the prescription left at 3pm (they had the info at 1PM) but hadn't managed to sign it and it seems all other GPs have lost the ability to operate a computer or a pen.

I'd be interested in anyones experience with Venlafaxine, can a mod advice whether that question is best placed as a thread in BDD or TDS.