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All the side effects and none of the fun

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I'm desperately trawling the internet trying to figure out a solution to this problem: a) I have recurrent severe depression and b) antidepressants have historically made things worse. 

I've had problems with depression, anxiety, and a whole assortment of other weird and wonderful mental health symptoms since I was tiny, and my reaction to most meds has also been fairly weird (like, total inability to pee, a stutter, and hypomania on venlafaxine - that was interesting). Following a few medication distasters in a row in 2007, I swore off psych meds for about 8 years. During that time I was diagnosed with autism, which at least made sense of my wacky meds sensitivities. 

Towards the end of my med-free period I was put on a small dose of amitriptyline (30mg) for nerve pain/damage. This was a bit of a bloody revelation - my anxiety, sleep problems, IBS, and sensory sensitivities all got so much better, which had a knock-on effect on my mood. I was calling it a wonder drug for a year or so. But over time I started having problems concentrating, and trying to formulate any kind of argument for my university work was like herding cats while drunk. I also became really depressed again, so I decided to have another go at finding something to help with my mood and concentration. The first antidepressant I tried, reboxetine, certainly helped my concentration, but also made me super agitated and self destructive, and it didn't play nicely with the amitriptyline - my heart rate was consistently around 110, even though I'm pretty fit. I only got up to 6mg before I had to admit defeat and go back down to 4. Now everything is messed up, because I've had to go down to 10mg amitriptyline to tolerate even half the usual starting dose of reboxetine without having a heart attack or passing out every time I stand up, so literally none of my symptoms are under control.  

I have a bit of a dilemma: basically I need something that works like amitriptyline that won't mess up my concentration (I've read up on other tricyclics but can't figure out if they'd be just as bad for concentration), or I could stick with amitriptyline while taking something to help my mood/concentration that won't make my heart explode. My response to SSRIs and SNRIs has historically been identical to my response to reboxetine - it looks like a bipolar mixed episode (I don't experience hypomania or mixed symptoms off meds, just depression). Quetiapine also made me really agitated, oddly. Everything makes me agitated! I just want to be not agitated and not depressed, because it's getting to the point where I'm going to lose at least my job if I can't get my mental health to behave. I've seen so many psychiatrists and none of them knows what to do with me.

Thanks for reading, and any suggestions of future wonder drugs would be hugely appreciated. I'm really stuck.

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Perhaps an atypical AD like mirtazapine? It's a TeCA vs a TCA and has minimal/no anticholinergic affects.

It's classified as an NaSSA


FWIW my experience has been absolutely awful on it, so I don't have many good things to say about it. However it's generally acknowledged to be very tolerable and per a lancet meta analysis of studies (I won't go into possible issues highlighted with that analysis or that psychotropical link), it was ranked as the most effective AD.

Good luck, and as always, your mileage may vary.


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