GAD - Mirtazipine and Sertraline Advice

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Looking for advice and similar experiences. Sertraline 200mg pooped out after 16 years of working brilliantly. with no life event triggers. I am normally a happy go lucky person (as most of us, the last person in a friends group that you predict would suffer from anxiety and depression). Initially, GP recommended through liaison with Mental Health specialist (pysch) to add Mirtazipine as it has a good track record working in combination and complementing with SSRI's (e.g. Sertraline) in kick starting them again.

Since September last year i have been on a roller coaster ride with doseage trial and error and it is completely obvious that my GP is unable to support as they just seem to agree with whatever i state based on my symptoms that i have been tracking through a spreadsheet.

I have been referred by my GP multiple times for an antidepressant medication review with a psych but i keep getting referred to the Wellbeing Team and talk based therapies. I am already undergoing online CBT calls with Wellbeing Team and using the online CBT Silvercloud service. However, despite repeated attempts from my GP to refer me to a Mental health specialist qualified to discuss medication, i am refrerred back to the same wellbeing team through their single point of access. I've now raised a complaint through PALS (Patients and Liaison Service) to intervene and arrange a session for me to meet with a qualified specialist to discuss my medication as i feel like i am going round in circles and the current system / referral process is failing me.

My latest self medication has been to gradually reduce Sertraline and maintain Mirtazipine at 30mg. I am at a point now where i am not sure whether to continue with Sertraline reduction, e.g. move down to 25mg Sertraline or reduce Mirtazipine. The evidence suggests i should reduce the serraline as i had a significant bad reaction for a number of weeks the last time i went below 30mg Mirtazipine so my gut feeling is to reduce sertraline. I have also suffered no signficantly bad reaction at all since reducing from 200mg sertraline through 150, 100, 75 and more recently 50.

I'm thinking of reducing the 50 to 25 this week and then see how i go on 30 Mirt and 25 Sert combined. I get the feeling it's still going to be a while before i get to speak to a pysch on the NHS.

All i can say is thank god i have loving family and friends to support me. God only knows what it must be like to navigate our underfunded / underresourced alone without any support. My GP told me that the triage lisaison decision making progress above is all due to underfunding for mental health support. The quick fix is drug and talk based therapies but you never seem to be able to speak to anyone with a specialist background in medication (e.g. psych)

Thanks X

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