Should I restart antidepressants after a prior poop-out?

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I feel a bit like I've hit a "brick wall" in recovery from anxious depression. I've been signed off for a couple of months now (and unemployed) but everytime I try to 'sign on' again to look for work I have a meltdown. So far I've been getting on my bike every other day, spending time using things I've learnt from counselling (worry time, keeping a rota - mixed results), eating well and spending what time I can with my partner. Taking time off has helped tremendously but I don't feel stable and the majority of days still... hurt like hell, frankly.

Antidepressants and me don't get along that well; most don't work or oddly enough, make me worse despite a good run on half the SSRIs and mirtazapine. Venlafaxine works.. but pooped out to the point where it wasn't working in the slightest. But the first year on it was great, after that, not so much.

Has anyone been through a similiar situation? My GP tells me only I can decide but I'm torn - I want to push myself but most days I feel like (and do) crawl back to my bedroom out of exhaustion, distress and stay there to sleep, try to make sense of it all or just focus on seeing if I can get any enjoyment out of this free time.

I'll be grateful for any advice smile

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  • Posted

    I'm somewhat in the same boat when it comes to deciding whether to go back on meds or not. I've been off for 5 years, except for the Xanax, and that's a "as needed" basis.

    When you tried the various meds, did you stay on them for the full amount of time needed for them to help? Some say 4-6 weeks, but some people get relief sooner, and others end up waiting for 8 weeks. The side effects are terrible during that time, but worth it in the end.

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    • Posted

      Must be tough, I've been off them for 5 months and felt constantly "in a fog", like I'm half-living. It's weird. Good you've got the xanax though - I suspect that's pretty stellar for agitation.

      I think I gave the ones I tried a pretty good run; shortest was mirtazapine at 1-2 months since I bizarrely and rapidly worsened. Fluoxetine did a similar thing but took longer, I remember being up and down crazy on it.

      I'll probably have a think over the next few days whether to resume venlafaxine. Tired of trying new drugs.

      Best of luck with figuring out what's right for you too. Let me know how you get on if you feel up for it!

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    • Posted

      I was only sertaline, but it was for years. I got a bit hard headed, figured I could try living without them, and quit cold turkey. Big, stupid mistake, but felt better after the withdrawal symptoms passed. I can't say the last 5 years have been easy, but they weren't extremely hard either, at least I didn't think so. Looking back, I can see how it was all coming back so slowly that it went unnoticed. Now it seems to be back, but some of it is situational, so I'm not sure which direction I'll choose to go. If I do go back on meds it will be for life, because I don't want to keep going back and forth. Eventually the merry-go-round has to stop.

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  • Posted

    Venlafaxine is likely your best bet for antidepressant therapy though augmentation with Cabergoline 0.25mg twice weekly can also help, especially with extrapyrimidal symptoms and libido.

     

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    • Posted

      Do you know if cabergoline is readily prescribed? I found the first few months on Ven made it -impossible- to orgasm. After a few months on any given dose I was halfway to normal mind you.
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  • Posted

    I was on Lexapro 10 mil for 9 yrs when I it stopped working! I am back on it at 20 mil for 5 days and I am having side effects of being gittery and nervous! I know it is early yet but still I am very anxious for it to start working! I know the feelings you are having and they suck!
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  • Posted

    I have been on almost every drug out there and I am running out of meds to try but my GP put me on something new. It is SSRI called viibyrd. I don't know if you have heard of it. It works well for me and when I find that nothing seems to help with the anxiety I do something like making a list. I take my mind off what is upsetting me and start listing colors, words, or names of anything around me to calm myself so I can think clearly once again. I hope this helps you and sorry if it dont make 100% sense because I have been up all night working as I have trouble sleeping at night so I found a 3rd shift job.

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  • Posted

    Same here - venlafaxine gives me erectile dysfunction within days, but cabergoline seems to rectify this. Unfortunately it is an off-label use of cabergoline so it is not likely that GPs will prescribe it without specialist recommendation first. It's a pity that all SSRIs and SNRIs destroy one of the few moments of heaven in existence... and indeed, they do little to treat anhedonia. Ergo, dopamine agonist, delta-opioid receptor agonist...

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    • Posted

      I hear some of the MAOIs work a little better for anhedonia... but they're impossible to get on and likely not viable for long-term use. They're also one of the few AD groups that make people feel good, shouldn't all ADs do that? I mean, that's why I felt venlafaxine worked (or initially). Life felt good again heh. I always wondered if it was due to it's incredibly mild opiate receptor effects or something. Or maybe its just as simple as being on of the seretonergics that my brain would accept.

      Frankly I'm considering ADs long-term or at least until it seems like my skin is thicker. The main difference is that I'm more motivated to take control of my lifestyle nowadays. I try as best as possible to 'harmonise' with the mental deficits, troubling thoughts and the emotions involved but some days I feel like I'm working with nothing. Don't want to go back on them but damn, my baseline well-being is horrible most days. Cardio helps cut through it most of the time.

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  • Posted

    Yes - venlafaxine is opioidergic in a similar way to tramadol, albeit weaker and less reinforcing. Venlafaxine has horrid withdrawals and is blatantly habit-forming but does feel good, especially in combination with other mu-opioid and delta-opioid agonists.

    As a medicinal chemist at university I am disheartened by the wholehearted focus on serotonin, which is unhelpful at best. Yes, serotonin does disinhibit endorphin, but confers little antidepressant activity per se. The monoamine theory of depression is grossly insufficient; more focus on delta-opioidergics, ionotropic glutamate/GABAergic and glucocorticoids would be helpful. Even mesolimbic dopamine should be considered, and on a less myopic level, structural changes within the brain.

    TL;DR venlafaxine and many tricyclic antidepressants are good for mood, attributable to opioid effects, which can be enough to push someone out of a depressive pit of hell.

    Unfortunately on the NHS GPs are terrified of MAOIs (some of which are very effective like tranylcypromine, moclobemide, selegiline etc) and even more terrified of anything which augments dopamine, which is what would *really* help with anhedonia, libido and motivation.

    Instead, there is an irrational obsession with aripiprazole, aka zombification.

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    • Posted

      Reboxetine is also an option though combination therapy is required, often with fluoxetine. Reboxetine is a selective noradrenergic reuptake inhibitor though there is evidence that the noradrenaline transporter also recycles synaptic dopamine within the prefrontal cortex where DAT is not expressed.
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    • Posted

      I figured as much about SSRIs... but what's so odd is that Venlafaxine helps at even the lower (SSRIesque) doses. I remember 3 days in; going outside and feeling OK again - like my head was quieter and I just wanted to take in the summer. Reckon that's the opiate receptor effects? I guess it's difficult to say. I do find codeine sometimes helps brighten the mood but only ever use it for headaches or migraines (which on Venlafaxine, was pretty frequent).

      I was considering lofepramine as its a) one of the TCA ADs the NHS will prescribe b) associated less with weight gain, sedation and the sorts. However it's really noradrenergic and I didn't tolerate mirtazapine (made agitation, sedation worse) so I'm not sure I'd suit it (or most TCAs). That said, I didn't really notice any unpleasant side effects at 150mg venlafaxine except sedation. Could just be mirtazapine and not NA-related. The sleep inducing sensation though, wonderful - my sleep pattern was like clock work for a while.

      If I could choose - I'd honestly go to moclobemide or a selegiline patch but frankly, I doubt my GP would even consider it. I'm in my mid 20s so I always feel a bit like GPs expect me to 'grow as a person', suck it up or something. Could just be me and how noisy my head gets going to the doctors.

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    • Posted

      Yeah GPs here are not much different. It takes alot for me to get him to listen. I am in my 30s and like i said have been on alot of meds. Some caused problems with orgasims and others cause me to have high anxiety or blood pressure. But I have seem to have the best luck with this med. I sleeping pattern was bad before but I generally get 7 hours at least now. I still have headaches but those are stress related. Do you know what your actual diagnosis is? Mine is major depressive disorder. I am hoping it is just my other disorder that is causing my resent lull and I hope you find what works best for you.
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    • Posted

      Headaches and well-being seem to go hand in hand. Stress migraines are nasty, there's also the depressive-fatigue headache variety I find.

      Not had a definite diagnosis, just things like 'GAD' and subsequently 'anxious depression' mentioned by counsellors. I know there's subtypes (atypical, major, dysthmia,...) but I'm terrible with self-diagnosing things. This year there's been some cognitive blunting so I hope its nothing worse. Could the brain recovering from meds. Either way I'm pretty confident my neurology is inherited.

      I'd try your best not to resent, its really tough to avoid it but if there's one thing I can tell you: it serves absolutely no purpose and you can't change past circumstances. Though frankly, I still feel a lot of remorse most days and terror about the future. There's a saying "the only time is now" and its a good mantra to work towards. Though sometimes what seems logical just doesn't fly when you're depressed (yay..).

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    • Posted

      Gah. You know what, I hate saying that because sometimes remorse is uncontrollable. Compassion intended >_<.

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    • Posted

      Yeah I try to remind myself from time to time if you can't do anything to fix it then let it go. In all the different meds I have taken over the years I have come to find that restarting a med when it stops working it will temporarily help again and then stop again

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