Help please! Should I go back on meds?

[anxiousjomo]

Hi,

Sorry for such a selfish post, but I would be grateful for some advice.

I was on Prozac for about 12 years (with a short break in the middle) and it worked well for me. I stopped taking it, was ok for 4 or 5 months, then had to go back on, but had brutal side effects. So we switched to Citalopram. Again, the side effects were brutal and after months and months of slowly coming off, I was off meds completely by about September last year. Then there was a looong process of regular exercise, meditation, CBT etc, and I was just about doing ok. However, since about April I have been really struggling. Insomnia (regularly only getting a couple of hours sleep a night), anxiety and all the rest. Not debilitating - I can go to work (though I do worry that my performance is down - if for no other reason than exhaustion), and am able to function. But it is an unpleasant struggle every day. I am so tired of it. And that then increases the depression. It just feels like all day I am worrying about it, and about how I will sleep and the effect of all this on my family (my wife and 7 year old son).

I have some Diazepam and some Zopiclone (both in the lowest doses). I take both very very rarely (I have only taken the Diazepam 10 times in the last year), partly because I worry about the addiction side of things, and partly because both make me feel very depressed/groggy the next day (and the Diazepam makes me feel more anxious the next day too).

So, with that in mind. Doc has suggested a possible low dose of amitriptyline or mirtazapine or Trazodone. I am not too worried about needing help with the depression side of things, as CBT and regular exercise are really helping with that. I just find the combination of no sleep + increased anxiety just really hard to take, and end up cycling round in obsessive thinking and worrying. Maybe a low dose of one of the above at night would help take the edge off and all my other techniques would then take care of the rest?

But, after having such a horrible time with the SSRI's and side effects, I am really worried about trying something else. Hard not to google all the possible nasty effects of these drugs...plus if it worked I would probably stay on it long term/forever at a low maintenance dose. And in an ideal universe I guess I would not be on anything at all. I am 38, by the way, and not on any other medication.

What do you think? Or should I just keep on fighting without the meds at all and hope I can make it?

Thanks for your thoughts.

[NervousKel]

Sorry you've been feeling rotten lately!!

If it were me, I would personally go back on medication, but I can understand why many people prefer not to.

What dose did you start at with the Citalopram? I had really bad start up side effects with that drug, but I think it was made much worse by the fact that I started at 20 mg, and then the doctor bumped me up to 40 mg within a week because my insomnia was so bad (apparently she didn't know that insomnia is a side effect of starting an SSRI, and neither did I at the time). I had to switch to escitalopram recently due to the citalopram no longer being effective for me after 5 years; I've started and stayed at a lower dose, and the side effects are much more manageable this time around. So, if you would like to consider another SSRI at some point, start low :-).

I'm also prescribed trazadone to sleep at night, as needed. I very rarely needed it the 5 years I was on citalopram (like maybe 5 times a year), but since my anxiety came back two months ago, I've needed it almost nightly. I try to fall asleep on my own, and if I'm still awake after a few hours OR if I wake in the middle of the night and can't fall back asleep, I take one 50 mg. pill. I then take a second pill if I'm still up after an hour or so. I find it's very effective for me.

Good luck with whatever you decide to do, and keep us updated:-)!

[anxiousjomo]

Thanks - yeah my mother in law is on a low dose trazodone for sleep and anxiety (along with a load of other drugs) so she recommended it.
My mum is on mirtazipine to help with her anxiety/depression/insomnia/lack of appetite. My mum had similar problems with SSRI's, so I wonder if our brain chemistry is similar...

It is just so hard to know what to do when it comes to these drugs. There is no real way of knowing what will work, or for how long...you just have to roll the dice! And for someone with anxiety issues, that is not what we like to do!

I was on 20mg Cit. When we went up from 10 to 20 the side effects got worse, and I lasted for as many months as I could before coming off. I don't think I could face trying another SSRI and having that increased anxiety again. The good thing about these other drugs is it sounds like grogginess/tiredness/weight gain are the more likely side effects. Which seeing as I am so groggy anyway from the insomnia right now, does not sound that bad.

But it just so hard to know what to do.

---------- Post added at 16:23 ---------- Previous post was at 14:29 ----------

Maybe I should just keep fighting. I am lucky that I have things nowhere near as bad as so many of you on here. And the insomnia is something I just have to learn to deal with without meds. Just "float and accept"

[anxiousjomo]

I am talking to myself here, but never mind. I look at the lists of potential side effects of all these meds, and the fact that I have no idea what they will do, and it makes me think I just need to keep fighting on my own. Sure I could try one of these and magically feel much better, and it will keep working happily until the day I die, but that seems pretty damn unlikely. I could very well end up making things worse (my anxiety is way worse than it was off meds originally since I had all the side effects from the SSRIs I took, and it feels like it will never recover). Or I could be ok for a while, and then end up having some horrible complication.

But then there are days like today and yesterday when i find it so hard to get out my head, feeling really depressed and anxious about how I feel. About why every day has to be a bloody struggle with feeling rubbish. About why I can't just feel happy again. Back when the Prozac was working for me, I never had any of these problems. I felt calm and relatively happy and all was ok. I just want to be that person again.

I don't know.

[anxiousjomo]

Well I got a prescription for 15mg mirtazapine. will start it this weekend and see what happens

[Bigboyuk]

Ok take a look at www.changes.org.uk it's unique 12 step programme will work for ALL MH conditions it's been proven for over 2 decades and has helped many people. They do have peer support groups in the Midlands and recently branched out in Bristol too study the 12 steps and start applying them today ATB

[anxiousjomo]

Thanks.

I have the meds in my cupboard now, but have not started them yet. Scared about side effects and also not sure if I should just keep struggling on without. Maybe if I give myself another few weeks I will be ok and not need them. I just dont know.

[Bigboyuk]

Thanks.

I have the meds in my cupboard now, but have not started them yet. Scared about side effects and also not sure if I should just keep struggling on without. Maybe if I give myself another few weeks I will be ok and not need them. I just dont know.Np :) Do watch that doc as soon as, and look at alternative ways to help you that's the important thing as it wont go away on it's own. ATB

[pulisa]

I think if you do decide to take the mirtazapine it may be better to start on a lower dose-maybe cut the tablet in half? This way you can build up to taking the 15mg but at your own pace. Definitely start it on a Friday night if you don't have to work on Saturday morning.

It's a very hard decision to take as to whether to go back on meds or not. No one can predict what will happen and this is the challenging bit. Personally I don't take meds but I struggle whether on or off them-it makes no difference.

It may be worthwhile taking a look at the mirtazapine subforum if you haven't already just to see whether there is some good advice on there about coping with initial potential side effects?

[anxiousjomo]

Thanks - the problem with the sub-forums is that most people who post are dealing with problems. If I had looked in the prozac forum, for example (that worked absolutely fine for me for about 12 years in total - the issues only arose when I came off it and tried to go back on), before I had gone on it, I would have been far too scared to do so!

And the issue also remains that, just because one person had a certain response to one of these drugs, is no indication I will have the same...

It is a very very hard decision. I currently have low level GAD and depression, but can make it through the day ok (it is just not exactly easy...). What is hard to know is if I am better off just dealing with it myself on a day to day basis, or if I can take one of these drugs and go back to how I was, without any of this being a problem.

The myth of the "magic pill" I guess. My wife has been on meds for 20 years (4omg of prozac), my mum is on mirt, my mother-in-law on trazadone and a number of other things...So they are obviously more pro-pills, and I do not want to be negative about their medication, but this means I don't get totally impartial advice.

At the end of the day, I guess no one can know except me. And no one can make the decision for me.
I just worry about looking back in a year's time and wishing I had not started taking anything, because it just made me worse...

[NervousKel]

If you do decide to take it, I'd recommend starting at a really low dose, and, if possible, stay at that dose for weeks. That will give you time to see what (if any) side effect will appear. You can then move up to the next dose if and when you feel ready (who knows, maybe a really low dose would be all you'd need!).

[anxiousjomo]

Thanks - yeah, I agree on that. I have had a couple of ok days in a row now (though I am feeling a bit more trembly/jittery right now) which has made me wonder if I can survive without the meds....just going round and round in circles! Ah well. I guess I just have to try and stop worrying about it...but that is not easy of us anxiety sufferers!

[pulisa]

You're going to be very aware of your "anxiety scale" at the moment because you are debating whether or not to start on meds. No one can give you an answer as regards your original question but I suppose if you feel your quality of life is really suffering or your anxiety is affecting the lives of your loved ones then that would make a decision far easier. If you are unsure it may be worth just seeing how things go for a few days and then re evaluating your situation? You have the prescription ready so it's not a question of making a GP appointment etc. Don't feel under pressure to make a decision.

[anxiousjomo]

Thanks - yeah. I have the meds but have not taken any yet. On the good days I feel like I don't need them, but on the bad days I find myself obsessing over whether or not to start and getting even more anxious/depressed about it.

Currently I think I will just wait until I feel like I am not coping I guess. It is not like taking them would be a magic pill and suddenly make me skip joyfully through every day anyway...

[anxiousjomo]

As to the scale - if 10 is feeling great, then I have been hovering between 6-7 for the last week, which feels good enough to me not to need the meds. If I go down to 3 or 4 (or lower) again for more than a day or so, I will re-think.

[anxiousjomo]

Decided to start back on Meds a few days ago - have been keeping a diary on here to track it.

[Rad1]

Hi Joni, sorry u have th dilemma. I hope u r doing ok. I’m going back on Ssri. Was previously on citalopram 3 years back. Horrible increase in anxiety and insomniac a fir 6 weeks, upped the dose and it started working. Came off around a year ago and was fine. Now suffering badly from anxiety due to struggling business. After trying to cope for several weeks of misery, I went to the dr and he put me on sertraline. 100 mg. Said maybe it might be easier on Saturday de effects. I cut the tablets in 4, so took 25mg for first week, now week 2 on 50mg. Still increased anxiety which is hard to cope with. I take nytol 1 a night and it gets s me 5 to 6 hours sleep followed by horrible few hours lying awake and chewing and ver my uncertainty. By wake up time I have to force myself down to get my daughter fed and ready for school. Anyway I’m battling on because I hope to god it makes me feel much re normal. Maybe with you your dose was too low? Good luck!

[anxiousjomo]

Thanks Rad. It is really tough, and I feel for you.
I have gone back on meds - am about a week in to a low dose of Mirtazipine (15mg) - is working ok so far - certainly less unpleasant side effects at the start than there were on those SSRIs. A little groggy etc, but otherwise ok.

If the Sert does not work for you, maybe try Mirt? It is well tolerated generally, and at lower doses really helps with sleep etc.

Good luck to you too!

[pulisa]

Thanks Rad. It is really tough, and I feel for you.
I have gone back on meds - am about a week in to a low dose of Mirtazipine (15mg) - is working ok so far - certainly less unpleasant side effects at the start than there were on those SSRIs. A little groggy etc, but otherwise ok.

If the Sert does not work for you, maybe try Mirt? It is well tolerated generally, and at lower doses really helps with sleep etc.

Good luck to you too!

Glad that you are tolerating the mirt and that sleep is better. We are all different with how we react to these meds so it's all unfortunately trial and error. I'm sure in years to come (many!) we will be able to have neural tests which prescribe the best med which is compatible with our pathways which would do away with this this broad spectrum hit and miss prescribing. Not in my lifetime though!