Should I ask to go back to SSRIs?

[Kseudonym]

So, short version. I'm depressed, it's pretty bad, and it has been agreed that drugs will help (and drugs are all the help I'll be getting for the forseeable future... that's another rant...). So, I started Citalopram (Celexa/Lexapro) 20mg. I had a pretty bad reaction to that... I was shaking, I was anxious, and I was having all the symptoms that my friends the Bipolar bears said reminded them of the not-fun version of hypomania. I was on it for about two weeks before I ended up spending the night in hospital for a pretty wound-up suicidal state - shaking and intrusive thoughts all over the place. The trouble is, I can't really blame all that on the drugs - a guy sexually assaulted me a couple of days before I started Citalopram. And the night I went into hospital was the night after I spent five hours in a police station going over and over what happened with two unsympathetic male police officers who ended up dismissing me completely. (I won't get into this, but it was the usual reasons - what do you expect if you allow yourself to be alone in a room with a boy, that sort of thing). So, I don't think it was all the drugs, or all the other stuff, more of a combo.

So I start Sertraline (Zoloft) 50mg, after my GP agrees with me that Citalopram was making me too anxious and shaky (I'd been on it over a month at this point). This is still pretty soon after the sexual assault thing, and I'm dealing with the stress of producing a theatre show on my own, something I've never done before (I'm 19). Sertraline sent me into a really good impression of a bipolar person on an up - talking fast, not sleeping, nervy, slightly paranoid; essentially like I'd done coke or something. I freaked out and clearly my GP did too, seeing as how I only spent a week on them.

I spent two weeks on Diazepam (Valium) 2mg, while the SSRI-produced symptopms went away, and my depression came back (I didn't realise until this point how much the SSRIs had taken away the depression, while replacing it with something that wasn't much fun either).

Now I'm on Mirtazepine (Remeron) 15mg, and, while now after the first week I think I can feel it starting to take some effect, I am wiped out. I'm tired literally all the time despite getting more than enough sleep, and I'm used to being someone with a decent amount of energy. I hate to complain about it because I think it actually is starting to improve my mood, but I'm not sure I can deal with how tired I am. For me, one of the worst things about depression is the inability to do anything because of the crushing lack of motivation, and now I still can't do anything because I'm too tired. I'm starting to think things like, at least on SSRIs I got things done.

The specialist put me onto Mirtazepine because he thought the bipolar-alike symptoms might just be what happens to me with SSRIs, but according to by bipolar friends, the state they saw me in on Sertraline was actually pretty mild, and something that you could manage with practice. More of a Cyclothymia-alike, perhaps. On the other hand, as I said, I think Remeron is kind of helping.

But, I guess the issue is really that if I can have a drug that makes me not depressed any more, I'd rather go for the one that gives me energy even if it means I have to go play with my punchbag in order to not chew through the walls some nights than one that makes me asleep for twelve hours and half-asleep the other twelve. I'm the kind of person who thinks of insomnia as a chance for more 'me time', so milage may vary.

So, internet, what should I do?

[Guest Vapourware]

I haven't taken Remeron myself but apparently the higher you go, the less sedating it becomes, so depending on how you continue to handle your current dosage and how it deals with your depression, that might be an option. I guess you've been on it for a week? so it's still early days.

If I were you, I would probably be a little wary of SSRIs since you had an adverse reaction to two of them. Perhaps SSRIs are not the drugs for you but ultimately it's your choice whether you want to try SSRIs again.

There's also the prospect of lithium if you don't mind taking the mood stabiliser path. Apparently it's good for lifting a person's base mood.

[Azk]

You're tough to have given Celexa a month, I don't think you'd get much help from any SSRI.

Try the mirtazapine, like Vap said. It can really work for some people without causing the problems SSRIs cause in some people.

As for mood stabilizers, you'd probably want to try Lamictal before Lithium or any of the others if you're mostly depressed.

[Edit: For a lot of us, myself included, we can't tolerate an SSRI alone. Sometimes SSRI + something is the solution, the sucky part is figuring out what needs to be added on.]

[Kseudonym]

I don't mind the idea of mood stabilisers but my doctor hasn't even mentioned them... my friend's mum is a mental health nurse and says she's surprised I'm not on Lamictal or something. Not sure why the dictor didn't give them as an option even though I gave him loads of space to - he kept going on about how sedated I was going to be and I kept going, 'So, is this the only way to go at this point, or are there other options?' and he kept saying, 'Well obviously there are other options if this doesn't work for you.' Also, when I said I wasn't looking forward to being sedated all the time, he said something about how I could always try managing my depression without meds, which sounds to me more like a threat than anything else... There is no chance of me getting talk therapy on the NHS any time soon, and I wouldn't have gone on meds in the first place if I didn't need something...

I just feel like I have no control over my treatment right now... other than pretending Remeron isn't working I don't see what I can do, because if I say I think it is working but complain about the side effects I'm worried I'll get the same shit about 'Well, if you don't like side effects, you can try not using drugs'...

I'm wondering if it might be related to the treatment my friend is getting. She is on Seroquel for her bipolar (having just switched off Zyprexa because it was failing to help her depression), and despite being Bipolar, she has never been offered mood stabilisers. Her current doc actually said to her that if she was male, he'd have put her on Lithium, but since she's a girl, she might have babies, and Lithium is very bad for babies, blah blah blah. She's explained that, at 19 and just going to uni, it's going to be a long time before she gets intentionally pregnant, but he just said something like 'Well, you never know...' She's decided to try Seroquel, but if she has any problems with it, she is going to go back to that doctor and demand that he treat her the way he would treat anyone with that condition - I understand the caution with Lithium, but surely if she's not actively trying to get pregnant, the notion of treating someone who is Bipolar with mood stabilisers is not so terribly risky and dangerous that it shouldn't be tried. I mean obviously I'm not Bipolar so that's a factor, but maybe this is part of why they haven't suggested mood stabilisers for me?

Also, this is just a weird thing and I'm wondering if it's an area thing - I know quite a few people IRL who've been on Lithium (all male, FYI), but absolutely no one who's tried Lamictal (which, from its descriptions here and on Crazymeds.us, sounds wonderful).

[Guest]

Lamictal is new in the UK, as far as I know, and not a first line treatment. It was pretty tough for me to get Liothium, I was on Depakote for years.

I have similar reactions to SSRI's. Thinking logically about all the stress you have been under recently, it is normal that getting an AD that works would also knock you out, sometimes trying a med is about taking you down from that ramped up place of not coping, and sleep is the best medicine sometimes. If in another month you are so tired that you cannot function at all, then maybe rethink. But this may just be the comedown?

[rowen]

You're not on a lot of Remeron. If you think it's helping, stick with it. Go up in dose, or ask for something to help pick you up (Maybe Wellbutrin, if you can get it).

Even if the hypomania was mild, it's not healthy to live that way. Hypomania can get worse if left alone. If you may or may not have Bipolar Disorder, you may end up having it officially if you allow yourself to stay hypomania for too long (Look up kindling).

[Kseudonym]

Hey, thanks for your help guys. I'm on 30mg now and feeling a bit better. Will see how it goes.