What would you recommend? SSRI's exacerbate condition

[francesca_]

Hi all :flowers:

I'm new here...wondering if I could trouble you people for some medication advice.
I've had panic disorder/agoraphobia for 2+ years. During this time I was generally housebound, but did manage to travel short distances to either the gym/shops/library/doctors, etc. I was on a combo of pristiq and seroquel for majority of that time, which didn't work for me at all really, I only continued to take them because I found it too hard to withdraw without my doctors help (he kept recommending I increase the dose)
I became pregnant in July, and then managed to wean off all medication.
During my pregnancy my panic disorder has gradually worsened, to the point where I am severely housebound. I have also had a rough time with prenatal depression and because of this, I decided to go back on AD's.
My doctor prescribed 10mg Lexapro, which seems to be his favourite drug to prescribe. I have never reacted well to it, but being desperate caused me to give it another shot. On my 2nd day I endured about eight hours of sheer panic and slight psychotic episodes, so I didn't continue the dose.

I went to see another GP closer to my house because I couldn't make the trip to my original GP anymore. I was prescribed 50mg zoloft, which I have been cutting into quarters, just to ease the transition. Unfortunately I have had severe diarrhoea as a side effect, and as a lovely part of my anxiety comes from a fear of bodily functions, I cannot continue with this drug.
I am trying to do research to find out which medication might be best for me to try, as I only have about 7 weeks to go before I'm due to give birth, so there is a real need for me to find a medication that works for my anxiety, and that I can adjust to in time for the arrival of my little one. I'm not expecting miracles, I know there isn't a medication that will cure me, but I do need something that will ease my depression and anxiety enough for me to cope and function daily.
The only real side effect I am not willing to tolerate is diarrhoea, and I'm aware this can be a common side effect of most SSRI's...so I'm wondering if it is perhaps time to try a tricyclic AD?
Has anyone had any success with them? Or just your experiences in general with them?

I've read that they can be sedating and also relieve IBS symptoms, which would be pro's in my book as I prefer a sedating effect, and anything that slows my GI tract is good!

Any advice?

[Catriona]

Hey Francesca :welcome:

I am in a very similar situation to you (minus the pregnancy) and I have been on SSRI's, Tricyclics, and probably soon, MAOI's.

I too have problems with being out and about on my own, and public transport is a no no, so I know just how desperate you must be feeling, especially with the arrival of the little one soon.

Can I ask if you are seeing a psychiatrist? When first-line treatments such as SSRI's or SNRI's don't work the GP tends to refer the person on for more specialised treatment. I have never yet met a GP who prescribes tricyclics so you may have to wait for a referral. I am not a 100% on this though.

When I was on tricyclics I took them at night because of their sedating effect. I personally never had trouble with my digestive system but it does happen to some people. Like all anti-depressants they take time to work, roughly 4-6 weeks, and can make you feel worse before you feel better. Unfortunately for me they did not work so I was moved on to something else.

Have you ever tried CBT (cognitive behavioural therapy)? It is seen as a must-have treatment for people in our condition and can be very effective. But like all things it takes time and practice to master. I have had it on several occasions in conjunction with anti-depressants and I find it the most effective combination.

I really hope you are well and are looking after yourself properly. I hope my little insight was useful to you, but as you know, your doctor will know more than I do so when you next see them write down a list of questions. That's what I do!

Take care,

Catriona x

[francesca_]

Thank you for your response Catriona :)

In regards to your questions, I have been referred to see a perinatal psychiatrist but at the moment I'm just unable to make the appointments. It's about a 20 minute drive away and while I've tried all my usual tricks to get myself there, it just hasn't worked. I guess with the pregnancy hormones I'm much more highly strung than usual so none of my usual calming techniques are working. To be honest, I'm having trouble even going out the front door at this point in time :(

I tried CBT when my agoraphobia originally reared its ugly head, but discontinued after a few months because I found it wasn't really doing much for me besides thoroughly chewing through my bank account!

My roadblocks at the moment are basically just that I can't get out of the house, so my options for treatment are extremely limited. The GP closest to me is the only one I can get to at the moment, and I will be seeing her tomorrow to see what else she recommends.

I suppose giving CBT another shot is definitely something I need to consider, at least when I can get myself out of the house. Such a rubbish catch-22 of this disorder that I desperately need help, but can't get myself out of the house to get that help! :shrug:
But it's so nice to have people to talk to who understand and sympathise!

[MyNameIsTerry]

Hi Francesca,

Just to comment on the therapy side, if getting out is too much of a barrier right now, how about seeing a therapist via Skype? If you can't pick the one you would later see in a face to face capacity, perhaps you could user a separate one via Skype just to get you to the other one?