[slab_happy]

That's the third item in my meds cocktail! Has a lot of off-label uses, including as an add-on to antidepressants if they're not working on their own.

My late psychiatrist was a big fan of it as an add-on for people with treatment-resistant depression and anxiety.

However, like other anti-convulsants, it can have really heavy side-effects (I used to have a functional short-term memory ...). And it's now a controlled drug because it can be abused, so you have to get prescriptions for a month at a time, which is tedious.

So I wouldn't rec going on it as a first choice, but it's definitely got its uses when other stuff isn't enough.

[Fiend]

Thanks people especially tablet_happy

Rough withdrawals:  I think I can deal with this, when I've dropped my cpram from 20mg to 10mg I've done it very carefully over a few weeks. I did try to go off completely in the early 2010s but I couldn't handle it. I also fully expect to be on something lifelong so don't anticipate and to-zero withdrawals!

Stomach stuff / nausea: Is a risk I'm wary of. I could deal with cramps and runs and whatever but pure nausea I struggle with. I guess I might have to chance something.

Venlaflaxine:  Is something I'm more tempted by because as you say it hits other parts so could be an improvement over cpram (which although I say it has been working, it doesn't feel like enough). I've got another friend to chat to tomorrow who should know more.

Escitalpram: Could be an option and will mention it to the GP.

Combatting side-effects: I guess is more of an issue if I'm upping the cpram further. Not sure if that's the course of action I will take.

I don't mind being a bit of a rattling pill box. I do try to keep chemical influences on my brain to a bare minimum (hence fluctuating around the lowest doses of cpram), but I realise at certain stages I might have to put those qualms aside.

[Duncan campbell]

I was on Sertraline for a fair chunk of 2021 and found it to be very helpful.

No real side effects for me. Felt a bit worse for the first couple of weeks but after that felt much better.

Sorry to hear things aren’t great atm Fiend. Hope you find something to help 

[edshakey]

Got no knowledge to offer I'm afraid, but best of luck mate, fingers crossed the solution isn't too hard to come by. Glad you're trying to find it!

[slab_happy]

Combatting side-effects: I guess is more of an issue if I'm upping the cpram further. Not sure if that's the course of action I will take.

Yeah, I figured I'd just mention it in case you end up going that way.

Btw, if you've not already given them a go, might be worth taking some B-vitamins (moderate dose, you don't need the mega-doses that are in a lot of supplements, and in fact I find mega-doses worsen my anxiety).

Not remotely a substitute for meds, but being deficient in them can fuck with you and make it harder for the meds to work (many of them are involved in synthesizing neurotransmitters).

So, could be worth adding to the general self-care stuff while you work on getting the meds sorted.

[hansmaro]

Regarding venlafaxine. I was successfully taking escitalopram to counter som pretty nightmarish OCD which i develped during the first year of uni. Fast forward a few years and the med seemed not to be working anymore. OCD flared up worse than ever, and it felt like i was living in a perpetual nightmare. Psychiatrist suggested trying venlafaxine (amongst others..) For me personally, the side-effects were horrible. Severe urinary retention, erectile dysfunction, night-sweat and itchy skin. Tapering was impossible due to the withdrawal symptoms, the worst being sensations of mild electrocution in the head and arms whenever i moved my head around... Managed  to go off SSRIs completely in the end after switching to sertraline. Side effects were more tolerable due to its longer half-life. Obviously there are many people who respond well to venlafaxine, but the horrible withdrawal-symptoms seems to be a common theme... What has helped me most in the end has been to cultivate a more accepting attitude towards my own emotions (however bad) and a daily dose of lamotrigine.

[Fiend]

Cheers for the input hansmaro. That's scary stuff although the side-effects definitely vary from person to person. I'll recheck with my friend who is on it too.

[slab_happy]

Yeah, it's worth saying explicitly (if it hasn't been said already) that people's reactions to psych meds can vary hugely, so there's often a fair amount of trial and error in finding something that works and doesn't cause un-manageable side-effects.

A.k.a. the meds merry-go-round, on which I have spent a lot of time.

You can get an idea of the direction side-effects tend to lean in for a lot of people, but no way of predicting what you personally will or won't get.

It's frustrating as fuck, but on the plus side, if whatever you try doesn't work out: there are other options.

[Fiend]

Update from seeing the GP this morning.

Switching to Escitalopram, Sertraline and Venlaflaxine are all options. Switching to the first two is a fairly easy "fade one out, fade the other in" process. Switching to the last seems to be a more complicated process of tapering off the Citalopram completely and then starting taking Venlaflaxine which seems a recipe for a month of utter shitastrophe.

Since even the first two have some risks of disruption, and there's less chance of getting follow-ups, emergency prescriptions and what-have-you over the festive period, I've decided to stick to the 30mg of Citalopram for now and tackle any switches in the new year. The 30mg of Cpram currently doesn't feel enough, and previously going on it or going from 10mg to 20mg has had beneficial effects in 2 weeks, but maybe this increase is taking longer to help because I'm in a bit more of a state, who knows. Also I could sneakily increase to 40mg of Cpram if things felt worse as well as trying to tackle acute periods without more outside support.

TL,DR - not changing right now due to switching disruption over festive period.

[Andy F]

Having been on Sertraline (up to 150mg at my worst) I'd say be prepared for the numbness. I quit it after being sick of feeling nothing. I thought to myself "I'd rather feel down than feel nothing".
It was tough quitting Sertraline, I felt as if I had electric shocks in my brain, but I'm much, much better for doing it.

In the short term, low doses it's useful, but longer term or higher doses it's horrible. Just my opinion though.

[slab_happy]

TL,DR - not changing right now due to switching disruption over festive period.

Makes sense, but sympathies, it's stressful to have to wait and try to hang in there while you're in limbo.

The 30mg of Cpram currently doesn't feel enough, and previously going on it or going from 10mg to 20mg has had beneficial effects in 2 weeks, but maybe this increase is taking longer to help because I'm in a bit more of a state, who knows.

There's also a delightful phenomenon often referred to as "Prozac poop-out" (technically "antidepressant treatment tachyphylaxis"), where some people find that a given antidepressant gets less effective for them over time (apparently SSRIs may be more prone to this than other classes of antidepressant)

On the plus side, it can usually be fixed just by swapping to a different one.

[Fiend]

Cheers.

Andy - noted. From what I understand 150mg is a high dose (I think my ex fluctuates around there lifelong to manage her BPD). The GP said Sertraline starting dose would be 50mg. So if the effectiveness increase is remotely comparable to Cpram then I guess 150mg would have strong numbing / wrapped-in-wool effects. TBH there are times recently when I would definitely take the numbing (or being sedated / comatose) as a valid option short term. But not long term I concur. That's partly why I've kept the Cpram at the minimum manageable dose for me.

Slab_happy - yes, other people have mentioned that "you could be just used to the citalopram and getting less of an effect from it now". I haven't been sure about that because I've felt stable on the 10mg for years, upping to 20mg for the digestive-depression seemed to work, and I got through the pandemic and lockdowns on 10mg. Maybe it suddenly drops off after 10 years?? Or maybe it the current mental disruption just exceeds a threshold where it's effective enough?? Hmmm in that context, would switching to Escitalopram be worthwhile? Or too similar??

[slab_happy]

Slab_happy - yes, other people have mentioned that "you could be just used to the citalopram and getting less of an effect from it now". I haven't been sure about that because I've felt stable on the 10mg for years, upping to 20mg for the digestive-depression seemed to work, and I got through the pandemic and lockdowns on 10mg. Maybe it suddenly drops off after 10 years?? Or maybe it the current mental disruption just exceeds a threshold where it's effective enough?? Hmmm in that context, would switching to Escitalopram be worthwhile? Or too similar??

Yeah, I found myself wondering the same thing about escitalopram when I wrote that, but unfortunately this all falls into the vast psychopharmacological category labelled "Who The Fuck Knows???", with no way of answering it except trying it and seeing.

FWIW, I actually found myself weirdly feeling a lot better about psychiatry when I found out that the first antidepressants got discovered by accident in the 1950s when they were testing new tuberculosis drugs and found that a couple of them seemed to cheer the patients up. And since then, it's all been throwing shit at the wall to see what sticks and we still don't really know why it works, when it does; we have some theories but that's it.

Like, it's not that doctors are being cryptic and unhelpful, it's that this is an incredibly young field of medicine (and concerning an organ system where there are a lot more practical problems with cutting it open to see what's gone wrong with it), so of course we're floundering round desperately trying stuff.

[MarkJ]

These seems like an odd way to use my first post on the forum ( long-term lurker ! ) but it may be that I can add something useful from my own experiences to this discussion. It would be great if can help Fiend, because I like his vids a lot !

I ended up taking AD's back in 2007 with a really rough period of work stress which was compounded by taking Zopiclone for sleep. I found however that SSRI's just made me hyper and I had a mini breakdown from this combination.
Eventually a consultation with the local hospital put me on Trazodone ( an SNRI ) which has worked very well for me, but my problems are less about pure depression and more about anxiety and poor sleep causing depression.

In the process of the last few years I've found a small number of nutritional additions that help quite a lot, as well. They are :

Vitamin D - since I was starting to suffer from SAD, like my father, I tried taking more vitamin D, but found that capsules beyond 1000iu would tend to give me anxiety. In the end I bought a UV-B sun canopy in 2008 which I use once a week in the Winter, and now my winters are normal and productive, as much as other times of the year. My Vit D level is textbook perfect these days.

Vitamin B6 : tricky this one but I find it's essential for me to take some. I have tried reducing or stopping taking it but depression comes in. I take about half of a 50mg in the evenings. It can be anxiety or insomnia-inducing if you take too much, so if you don't take any, try something like 10mg/day to try , preferably pm.

Zinc : I have found this equally as important to me as B6, I take 25mg all the time and 2x25mg if I get into some acute stress or have been drinking too much eg. at Christmas. I have done an RBC zinc test a while back and my levels are just below midline, so I think I might have been mildly deficient before I started taking it, and it's known to cause depression if low.

Magnesium : another one that I have taken for years and have tested. I take a maintenance dose of about 200mg/day these days. I only take the chelated form, and a lot of the off the shelf common ones are oxide which is useless ( for me ) . I was mildly deficient in this for a long spell, maybe as a result of overtrianing as a cyclist.

Hope this is of some use.

[slab_happy]

Btw, Fiend, while you're hanging in there, my other rec apart from B-vits would be to try getting an hour or so of daylight into your brain each morning if possible.

Even if your depression isn't seasonal per se, getting adequate amounts of bright light can help (including with setting sleep patterns, which in turn impact on mood) and can be a major challenge at this time of year.

Again, not a substitute for the meds, but can help them work as well as possible.

A lightbox (for shorter durations) can be very effective, but also jittery/over-stimulating for some people; I wouldn't want to try that while about to start changing meds, as it makes it too hard to sort out what's causing what.

[slab_happy]

Hi Mark -- thanks for adding your experiences!

I have the same thing with finding B-vitamins essential, but anxiety inducing in high doses (and a lot of supplements seem to go for very high doses of some of them, presumably because they're cheap and it looks super-impressive to have 50 times the RDA of B12).

Biocare do some liquid B-vitamins, which are very handy because you can tinker with the dose by number of drops.

[Fiend]

Thanks for the further replies, noted and appreciated.

(and concerning an organ system where there are a lot more practical problems with cutting it open to see what's gone wrong with it)

Oh. So it might be a waste of time seeing if I can get trepanning on the NHS??

[slab_happy]

Yeah, "what if we cut a hole to let the demons out?" is no longer considered best practice.

[Andy F]

Thanks for the further replies, noted and appreciated.

(and concerning an organ system where there are a lot more practical problems with cutting it open to see what's gone wrong with it)

Oh. So it might be a waste of time seeing if I can get trepanning on the NHS??

Trepanning. Officially better for your mental health than the Tories.

[petejh]

Btw, Fiend, while you're hanging in there, my other rec apart from B-vits would be to try getting an hour or so of daylight into your brain each morning if possible.

Even if your depression isn't seasonal per se, getting adequate amounts of bright light can help (including with setting sleep patterns, which in turn impact on mood) and can be a major challenge at this time of year.

Again, not a substitute for the meds, but can help them work as well as possible.

A lightbox (for shorter durations) can be very effective, but also jittery/over-stimulating for some people; I wouldn't want to try that while about to start changing meds, as it makes it too hard to sort out what's causing what.

R4 prog on SAD lamps here: https://www.bbc.co.uk/programmes/m001f4xg

If you skip to around halfway through, 'Professor of Circadian Neuroscience' Russel Foster has this to say about SAD lamps:

A 2016 research paper looked at both seasonal and non-seasonal depression and compared 30 minutes of 10,000 lux in the morning with Prozac. "What was fascinating was that the light treatment was statistically more effective than Prozac and placebo at two weeks," says Russell, "and eight weeks is when Prozac became statistically significant from placebo, and light treatment was really much more effective than Prozac."

"So, we've got good evidence that bright light in the morning can reduce levels of depression, both in Seasonal Affective Disorder and in non-seasonal depression as well."

Not sure which study he's referring to, a quick search shows there are loads out there.

I don't suffer from depression but find my energy levels can sometimes drop during periods of prolonged low light (aka winter). I bought a 10,000 lux SAD lamp years ago and use it for 10mins at breakfast whenever I find myself feeling lethargic through the winter months. I notice the increase in mood and energy using it brings. I also take vit D drops daily from around mid Nov to end of Feb.

[slab_happy]

Yeah, there's a solid amount of research and it's fascinating. I can rec the Big Orange Book of Chronotherapeutics for anyone who wants to get hardcore nerdy about this stuff (and related topics like dark therapy for mania):

https://www.karger.com/Book/Toc/257464

[slab_happy]

Btw, for anyone thinking about a lightbox for depression, it's important to check the specs, because you need 10,000 lux at a feasible distance (usually having your eyes within 30cm of the box). Last time I looked, there are some cheap boxes which will claim "10,000 lux", but it then turns out that this is only true if your eyes are 10cm from the box, so watch out for that.

Dawn simulators and full-spectrum lights are not the same thing (though they have their own uses).

Needs to be right after waking, and the usual starting dose is 30 mins but may need to be adjusted up or down from there.

The downside is that it can have some of the side-effects of other antidepressants, notably making you feel jittery/overstimulated, or kicking you into mania or a mixed state if you have bipolar tendencies.

Which is why I wouldn't rec trying it while adjusting meds at the same time. But they can be extremely effective, including for non-seasonal depression.

I use mine in tandem with meds, though as we've probably established by now, my brain is a very special snowflake that requires a whole cocktail of stuff to keep it vaguely functional.

[Fiend]

Okay next question...

20mg of Cpram made me a bit dozy a few hours after taking it, and taking an evening dose generally got me to sleep well and sleeping through the night (I tend to sleep a fair bit probably due to metabolism / DVTs / digestion).

30mg of Cpram makes me get to sleep just fine as before, but I'm consistently waking in the very early morning and struggling to get back to sleep (not too much anxiety going on, just awake), inevitably before finally falling asleep just as the alarm goes off, feeling very sluggish, struggling to eat in the mornings etc.

To try to alleviate this, I'm taking 10mg Cpram in the morning, and 20mg in the evening as before, which doesn't help, neither did taking 30mg in the evening.

So....

Are there any supplements I could take to help me sleep through the night (not just get to sleep)?

Do I just need to paint more orcs before bed?

Is this an inevitable consequence of an increased dose?

Would Escitalopram with it's apparently reduced side-effects alleviate this problem?

[slab_happy]

Waking early and not being able to get back to sleep is, for a lot of people, a depression symptom (it's even a diagnostic marker for the "melancholic" subtype of depression -- for anyone who thought that "melancholia" went out with the 17th century, nope, still a thing).

It's so predictable for me that I can use it as a warning sign of when stuff's starting to slide in an ominous way, rather than just a passing dip.

So it could well be something that'll resolve when you get on meds that are more effective for you, rather than being a meds side-effect itself.

I realize that doesn't help in the meantime.

Supplement-wise, magnesium's helpful for sleep in general, melatonin is great (but needs a prescription), but I don't know of anything that targets the early-morning waking in particular.

I'd suggest avoiding bright light and blue light from computers, phones, etc. until you reach the time when you'd actually want to be waking up, but that's damage limitation to prevent it from worsening, rather than something that'll make the core problem go away.

[jshaw]

Waking early and not being able to get back to sleep is, for a lot of people, a depression symptom (it's even a diagnostic marker for the "melancholic" subtype of depression -- for anyone who thought that "melancholia" went out with the 17th century, nope, still a thing).

Do you have any more info on this?

I get this a LOOOT but haven't been able to pinpoint why.