Mental Health Suggestions for alternatives to SSRI/SNRI/TCAs in the treatment of MDD & GAD?

[Rybee]

I started suffering from major depressive disorder and generalised anxiety disorder in 2011.

I've tried Citalopram/Fluoxetine/Venlafaxine/Duloxetine in the past and I could never really hack SSRI/SNRI drugs, I just found them to be very emotionally numbing, which was fine for the GAD, but it didn't help with depression in the slightest. Before, and after, I was on SSRI/SNRI medications, I'd experience the lows in life, but I'd sometimes be able to experience the highs in life too. When I was on them I just felt very blunt emotionally and didn't seem to experience any highs or lows, it was just flat-line all the way.

Because of this, I then tried Amitriptyline/Dosulepin as an alternative but I found them to be very sedating. Again, helped a lot with the GAD, but didn't help with the depression in the slightest and possibly made it worse due to the lethargy and fatigue.

I then tried Agomelatine (Valdoxan) as a novel alternative. Whilst I do think it helped, and I bought into the mechanisms of it more than I did SSRI/SNRI/TCA drugs (of which I'm still very skeptical), it gave me horrible nightmares. After weeks of nightmares and night sweats I gave in and came off of it. Shortly after this (November 2013) I fell down the stairs and suffered from a PARS defect and 2 herniated spinal discs. I was put on Morphine, then Fentanyl, then Oxycodone, over a period of 4 months. The pain is now stable and I take 3x10mg of Oxycodone daily and have been prescribed that until December, at which point I'll have a review with my pain consultant.

Both my anxiety and depression completely subsided when I was on higher doses of Morphine/Fentanyl/Oxycodone and it was the first time in 3 years that I wasn't taking any anti-depressants, I felt great. However, ~3 months ago my dose was lowered from 80mg Oxycodone to 30mg per day, as my back had since healed and my pain had largely subsided. Which was fine, I had no qualms about that because my consultant allowed me to slowly taper over 2 months - I never had any withdrawal effects. However, since being on a smaller dose I've started to feel low in mood and anxious again - my problems seem to have crept back into my life. I've started using diazepam again (px'd by my Psych) 10-30mg per day, sometimes more, sometimes less. I find it to be a really useful tool in managing my anxiety so I do try to use it as conservatively as possible and hold of as long as possible before resorting to it.

It's got to the point where I think my problems need to be addressed. I would be very reluctant to go back on any SSRI/SNRI/TCA again, and would prefer to try alternative medications before hand. I was just rummaging through my draw for an allergy tablet and found an old, though just still in date (expires October 2014) packet of Agomelatine and I found myself staring at it for a while, pondering whether to try it again..? It's got 3 1/2 weeks worth in it and usually kicks in quite quickly, so I thought I'd give it a go and if it helps, after 3 weeks I'd ask my Psych for a script to go back on it.

Then it got me thinking of exploring other alternatives to SSRI/SNRI/TCA's. I know my choice would be somewhat limited, but I know I'd have some choice.

Agomelatine is the only 'novel' antidepressant that I've used. So I was just wondering what other options people have tried, and how successful they were? I know everybody is different and I could react completely different to someone else on any particular type of medication. I think I'm going to book an appt with my Psych for ~3 weeks time and want to be a bit more clued up on alternative medications.

I've become very tired/lethargic/fatigued lately and think I'd benefit from some kind of stimulation. I think something like Ritalin would be a little too much and maybe make me more anxious, but if there are any AD's out there that are more stimulating, than sedating - such as Mirtazapine, I'd be very interested to know about them.

Sorry this has turned more into a rant... I just feel I have a lot going on in my head right now and BL has always been a welcoming place to vent and just scribble my thoughts which often helps.

Any input, negative or positive - if constructive, would help.

Rybee

 

[Mysterie]

i never understood the logic behind prescribing ritalin to someone with depression and anxiety

have you tried 25-50mg seroquel nightly for GAD?

 

[Rybee]

i never understood the logic behind prescribing ritalin to someone with depression and anxiety

have you tried 25-50mg seroquel nightly for GAD?

Yes I have actually. I went through a period of not being able to sleep and we (me and Psych) went through the usual suspects such as Temazepam and Alprazolam but they just weren't helping. He suggested taking 25mg of Seroquel/Quetiapine an hour or so before I sleep and it completely knocked me out within 25 minutes or so - I couldn't believe it. I did that for about 2 weeks but it just made me feel awful when I woke up. Really groggy and a bit dazed/confused until lunch time.

I still have some, but I don't like using it unless I really have to. It works like a dream but it just makes me feel so awful in the mornings.

 

[Mysterie]

IR or XR?

 

[Rybee]

Open to either.

 

[Mysterie]

i guess it doesn't really matter, i think if you were waking up groggy, its possibly you could have halved the dosage

 

[paranoid android]

Hmm well bupropion aka Wellbutrin aka Zyban which is a dopamine norepinephrine reuptake inhibitor does help some peoples depression who don't respond well to SSRI's and SNRI's. It's one of the few anti-depressants that actually brightened my mood and it usually starts to work after about a week or so. But unfortunately for people with anxiety since it is a mild stimulant it can increase your anxiety. I usually only take it during the winter to help my SAD which makes the bipolar depression i get worse but if i wasn't on clonazepam to control my anxiety i don't know if i would be able to take it.

As for seroquel i actually find that it helps my depression as well as the mania and mood swings i get. I usually have to get up to about 300-400mg's a day before the mood stabilizing effects kick in though. As it being used to treat anxiety your really only trading on it's strong H1 antagonism there to cause sedation so if you only intended to stick to low doses and only for sleep and anxiety you might be better off taking a strong H1 antagonist with no other effects like the anti-histamine hydroxyzine as it would be much safer.

Have you tried mirtazapine aka Remeron? It's a serotonin and norepinephrine enhancer along with being a really strong anti-histamine. It might be worth a shot if you haven't tried it already.