Worried that nothing is going to work

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I've had GAD and panic off and on for the last 20 years.
I was successfully on citalopram for a number of years but came off it because I was doing better and because of a family history of qt prolongation (about 4 years ago).
I've been really ill with anxiety since the beginning of the summer holiday (I'm a teacher). I'm particularly worried that I've got an overactive thyroid as the panic came out of nowhere and then spiralled, I also am losing a lot of hair, have irregular periods and have lost some weight.
The first doctor I spoke to prescribed sertraline but I felt hugely panicked when I took that as a family member didn't want me to take it as they had a bad experience with it. So phoned in a panic and the 2nd doctor prescribed me mirtazapine which I did persevere with for 8 weeks with not much effect. I'm now speaking to a 3rd doctor (but consistently them now) and they've switched me to Fluoxetine.

I'm now panicking that the fluoxetine won't work as I read a few things online that say it's "too stimulating" to work for panic. I feel like this is my last option as I can't ask to change again if this doesn't work.

Ive done CBT and counselling but 3 out of the 4 counsellors (the 4th didn't state an opinion either way) and several GPs have said they think it's a chemical imbalance and that I need to take medication long term.

I don't know what I'm asking really. I guess I just want to hear from people who fluoxetine has worked for. Or hear some words of encouragement / advice.

[panic_down_under]

I'm particularly worried that I've got an overactive thyroid as the panic came out of nowhere and then spiralled, I also am losing a lot of hair, have irregular periods and have lost some weight.

Have you had a thyroid function test and has your GP proposed a cause for the other symptoms?

The first doctor I spoke to prescribed sertraline but I felt hugely panicked when I took that as a family member didn't want me to take it as they had a bad experience with it.

Which doesn't necessarily mean you would also have had the same problems with it. Plus, was it the med, or the way it was taken? Many GPs prescribe starting doses which are too high for those with anxiety disorders. Pill phobia is another possible explanation.

I'm now panicking that the fluoxetine won't work as I read a few things online that say it's "too stimulating" to work for panic.

And yet there would be millions taking it successfully for PD. The bottom line on all of the above is that your experience will be unique to you and your biology. How others react to an AD tells you nothing about your likely response to it.

I feel like this is my last option as I can't ask to change again if this doesn't work.

Why not? There's a reason that there are so many different ADs on the market. These are not one size fits all meds and it often takes several attempts to find the right one. If fluoxetine doesn't work then ask for another. Remember, GPs are temporary employees paid for by your taxes, not your master. Make them earn their keep.

Ive done CBT and counselling but 3 out of the 4 counsellors (the 4th didn't state an opinion either way) and several GPs have said they think it's a chemical imbalance and that I need to take medication long term.

As per above, there is no chemical imbalance. What there is is a deficit of brain cells in the two hippocampal regions of the brain caused by high stress hormone levels killing the cells and inhibiting the growth of new ones. Both antidepressants and the cognitive, behavioral (CBT, REBT, etc) and the mindfulness therapies work by stimulating the growth of replacement cells. It is these new brain cells and the connections they form which produces the therapeutic response, not the treatments themselves. Just as there is no one size fits all med, there is no universal therapy which works for everyone. While I found some of the techniques useful, none helped me either.

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Have you had a thyroid function test and has your GP proposed a cause for the other symptoms?

They tested my TSH level three times over the past few years. As I was being investigated for blood in my stool (they couldn't find a cause but nothing to worry about) and then for the irregular periods (again no cause but nothing to worry about probably perimenopause [I'm 41]) My TSH serum level has been within normal range but has decreased each time. The last test was before the hair and weight loss and I haven't spoken to the doctor yet about that. I've just managed to book an appointment so speaking to them in a couple of weeks.

Which doesn't necessarily mean you would also have had the same problems with it. Plus, was it the med, or the way it was taken? Many GPs prescribe starting doses which are too high for those with anxiety disorders. Pill phobia is another possible explanation.

Yes, he started me straight on 50 even though I asked if I should I start on 25... I should have pressed this issue but I was pretty out of it... And didn't tell me to take in the morning so I was awake all night freaking out. Could definitely be pill phobia. It was an awful 24 hours...

If fluoxetine doesn't work then ask for another. Remember, GPs are temporary employees paid for by your taxes, not your master. Make them earn their keep.

Good point.

It is these new brain cells and the connections they form which produces the therapeutic response, not the treatments themselves.

Hopefully I will cultivate some soon :-)
It does make sense that stress is killing them off as when I get a very anxious few days I seem to then quite quickly spiral down the path of ever increasing anxiety.

I'm planning to get back into running once I'm off the mirtazapine. Running definitely does help me but mirtazapine has dampened my ability to run as hard and it's been a struggle.

Thanks for your advice

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I've just managed to book an appointment so speaking to them in a couple of weeks.

That's good. It's probably nothing serious, but it does pay to have anything unusual investigated. Sadly, anxiety disorders don't protect us from all the other things our bodies are prone too.

Yes, he started me straight on 50 even though I asked if I should I start on 25...

Sigh!! When I achieve my goal of world domination one of my first decrees will be that every doctor prescribing psychiatric meds must try them for at least 2 days. I expect patient care will be greatly imporoved.

And didn't tell me to take in the morning so I was awake all night freaking out.

It wouldn't have made much difference physically as plasma levels would have remained much the same, but it may have made a difference psychologically.

Hopefully I will cultivate some soon :-)

It takers about 7 weeks for hippocampal neurons to bud, grow and mature, but some improvement may begin earlier. That said, fluoxetine tends to take longer to kick-in than the shorter half-life SSRIs.

Running definitely does help me but mirtazapine has dampened my ability to run as hard and it's been a struggle.

Indeed, it does. Exercise can also promote hippocampal cell growth. For mild cases it may be all that's needed. Nor do you need to run daily marathons to get good results. In fact doing so may be counterproductive. A 30 minute walk 4-5 days a week is often enough to make a difference.

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Thanks for all the links. I had a quick look but definitely need to have more time to understand them properly.

Yeah it's definitely only psychologically that I needed to take in the morning, I just think anyone who is prone to insomnia is better off taking in the morning whenever possible or they're going to be up all night worrying about side effects.

I've had to start the fluoxetine straight on to 20mg as they don't prescribe the 10mg to adults here. But so far it's not been so bad, nausea and bad physical anxiety symptoms but that could equally be nocebo effects and my overall anxiety level. This Dr at least did prescribe me some propranolol to help with the palpitations etc.

7 weeks seems so long away. With the longer half life I definitely need to get back running to speed up my recovery.
Too tired today though and only just finishing work so think it'll just be a walk today so glad to hear that's enough to make a difference.

I'll be glad to speak to the doctor about my physical health worries. Although I had it pointed out to me yesterday that quite a few people had a lot of hair loss in the months after having covid so that is a possible cause for me as just before I got covid for the first time. The weight loss could be stress I guess. And they already said they think the irregular bleeding is perimenopause, they did ask me to go back if I had more changes like spotting which I have now had so I do need to check. But hopefully I'm physically fine...

Thanks for your support.

[panic_down_under]

I've had to start the fluoxetine straight on to 20mg as they don't prescribe the 10mg to adults here.

Sigh!

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I'm feeling pretty awful right now.
Been major panicked since yesterday pm.
I was meant to be traveling today but feel too bad to face the journey.

Does it make a difference where I take fluoxetine in the morning or the evening?

[panic_down_under]

Does it make a difference where I take fluoxetine in the morning or the evening?

Physically, no. With such a long half-life med plasma levels will barely change over 24 hours. Psychologically, maybe.

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Thank you