How do you know if antidepressants working?

Hi

I'm going through a rough time at the moment and getting very depressed about it. I'm stating to question whether my antidepressant is really working, about 6 months ago I had to change antidepressant because it was causing me severe constipation. I remember feeling a huge drop in my mood when I eventually weened off it. I then started a new one but never felt a lift up in my mood. During this time I was doing quite well in terms of physical health problems and life was going OK, but my mood never seemed to lift. So I got increased to the max dose but again never really felt an improvement

So now its about 5 months later and my physical health has really deteriorated and as a result so has my mental health. I know its hard to figure out during rough times whether the antidepressant is helping but has anyone been through similar. Is it worth me talking to my GP and asking perhaps to try a different one?

I guess I'm worried that there is improvement but I haven't noticed it? I guess if I ween down and notice a big drop in mood it will mean it was working?

Don't worry I'm not going to do anything without talking to the dr. It's just my GP at the moment, I'm seeing a therapist but she doesn't advise on medication just on the coping and having someone to talk to.

I'll ask about the psychiatrist but it seems pretty hard to get referred to specialists and my GPs a bit useless

We don't have insurance in the UK its all the NHS so to see a specialist you have to be referred by a GP

I'm not sure I need a mood stabilizer as I don't have any periods of mania and the depression is fairly stable, some days better than others obviously but i don't get random periods of horrible depression, most of the time it's just I feel so physically unwell it brings me down.

Post Edited (Andy1986) : 9/28/2015 11:38:16 AM (GMT-6)

So I got an appointment today to see someone, wasnt my regular Dr as he wasn't in and it was a trainee. She was way out of her depth with a complicated case like me, I explained my situation to her, persistant nausea and gastro pain/hypersensitivity, and mood getting worse by the week as my physical problems continue, and she seemed to suggest I should just ween off anti-depressants and see how I did without them.

I obviously wasn't too enthused by this idea and told her how well the last one I was on worked and she seemed to relent and got her book out to look up different anti-depressants. So to help her out I just gave her the name of one I read about and want to try Nortriptyline as its related to amitriptyline which worked well for me both pain wise and depression wise, but she said she will consult with a more senior Dr and get back to me about what to do next.

So we'll see what she comes back with, part of me thinks she'll just ring and tell me to stay on it and just pull myself out of it, I must admit part of me is a bit scared to come off it, it seems to help with the nausea and I asked if I could stay on a low dose for that but she said no you can't take two ADs as they'll interact. Well I know thats not always true but I don't know enough about it to say anything else really. I mean I'm already on two ADs at the moment, just one is a very low dose.

She did also suggest it might be worth going back on amitriptyline and try to deal with the constipation which I guess is another option, but not sure it will work the second time, my dad came off an antidepressant that worked for him and quickly went down hill, but it didn't work the second time he went on it.

I am sorry that your regular doc wasn't there. And also that you didn't get any good answers. I hope that the nortriptyline works well for you. I hope you can start something soon.

I hope you find some answers to the tummy issues. That might solve more than one thing as was mentioned above.

Best wishes and have a good day Andy...

Hugs, Karen...

You should still probably have your D3 levels checked. Just to make sure. I take 5000 iu a day. Mine was low.

This time of year people's gets low.

I hope you have a good day.

Good luck with the gluten free lifestyle...

Hugs, Karen...

Well the Dr called me and basically wont give me a new AD, they want to put me on amitriptyline because "thats what they usually use", and I said the constipation was so bad and that I read some other tricyclics aren't as constipating but she was having none of it and wont even consider another tricyclic.

So I said I would ween down the Mirtazapine for a couple of weeks and think about it, unsure what to do now she said I could try Citalopram instead but I've been on that before without much success, and tricyclics are apparently the best for the pain I have, and the amitriptyline really helped my mood so Im sure others will work too. I have an appointment with my regular Dr soon anyway so I might defer to him and print off some of my research into the best ADs for my pain and hope he doesn't just think Im some hypochondriac. Otherwise looks like I'm going to have to go on the Amitriptyline and chug laxatives, it will mean I cant take any narcotic pain meds too :(

I guess you're right, better constipated than depressed, just would have liked to try something else. Unfortunately I don't really tolerate coconut oil, my stomach just objects to anything and everything it seems, sometimes I wish they would just remove it all and give me a feeding tube straight to my intestines I really do. I've ordered some magnesium oil which is topical so hopefully it will help, apparently works for some people.

I don't think the Mirtazapine is working well for my anxiety as well, getting lots breaking through at the moment. I'm in a lot of pain at times now and its really hitting my anxiety, finding it really tough, especially because lying down makes my reflux and pain worse so I feel like I can't do my relaxation tapes. I've got my new tablets to ween down, I'm scared now that I'm not going to sleep, I had a hell of time coming off amitriptyline with sleep but I was feeling well enough at the time to cope with it, not feeling like that now :(

I would try to relax with it, just watch for any unusual withdrawal effects. If you haven't noticed anything that is good. I think a lot of the anxiety is just going off of it. Or the thought of it. Try not to stress.

The diary is a good thing.

Well I didn't sleep at all last night after going down to 15mg. Well I feel asleep OK but woke as usual at 2 but this time couldn't dose back off. It was quite stressful by the morning. My mood hasn't been great today but that could be also due to the fact I haven't slept. Haven't cried today so can't be doing that bad, honestly my mood can't really get much worse anyway without me being suicidal so Ill be keeping an eye on it but hoping not much will happen.

My dr has given me 20mg of nortriptyline to get started on right away which should hopefully mean I don't get any sleep problems. I'm to take 10mg plus 30mg mirt tonight, then 20mg plus ,22.5 mg mirt the night after if I have no bad side effects. He did want me to just stay on 15mg but I'm not feeling well enough in myself at all to go through a period of no sleep, don't think I could cope so will do a more gradual taper of the Mirtazapine. At least the nortriptyline can start building in my body and hopefully help with the pain and nausea and I'll feel a bit better able to cope with coming off mirt completely.

No idea what I'm going to do if nortriptyline doesn't work as I'll probably have to be off that completely to try another tricyclic

I'm sorry that you have to face such ordeals. It's really devastating to suffer from depression.
Anti-depressants have many side effects. If it's not working for you maybe it's not the one you should be taking. Don't carelessly up dosages, make sure that it's doctor recommended before doing so. I would suggest that you try other methods in dealing with your depression. Some medication can only help at some point there are certain steps that an individual must do to increase the effectiveness of the medication.
Try counselling, group therapy, meditation, and other natural remedies. I did this before as well and it has reduce my anxiety significantly.

I stepped down again to 22.5mg last night and up to 20mg of nortriptyline, I actually slept better than I have in a while which was good, and was feeling a bit satisfied when I woke up, but this morning my mood has just been getting very low and even have thoughts of wanting to just end it. Been feeling quite sick and in pain, and a bit spaced out but that's probably the new nortriptyline. I feel like my mood is getting worse but I don't know. It is so up and down at the moment I can't really tell. Yesterday afternoon and evening i was ok moodwise but i had taken a painkiller so that might have contributed. Its so strange but when i take one of these mild painkillers i feel more normal and jst wish i could feel like that all the time. I keep a mood diary and since I've been reducing the medication its been up and down, but I don't know today feels a bit different. I think I have been crying more since reducing the dosage especially in the first few days.

I'm beginning to question whether I'm doing the right thing, coming off the Mirtazapine. I don't really feel like its helped but I'm having all these effects coming off it that maybe it was and life's struggles have just been keeping me down. No AD is going to make you immune to feeling down when you physically feel like crap and you break up with your GF is it. At the same time I don't feel normal in myself, I feel unable to cope with things that I normally would handle better I think.

Is it normal to have these dips in mood or crying spells when coming off an antidepressant that hasn't really been working for you? Just trying to stay relaxed for now and hope it passes. I did notice for a few days after I reduced from 45mg to 30mg that I was very weepy but it seemed to subside. Am I safe assuming these are just short term withdrawal effects?

I mean I'm still on a dose for depression so if I don't feel normal on this dose surely it means it isn't the right one for me?

Post Edited (Andy1986) : 10/14/2015 5:14:11 AM (GMT-6)