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[kittydaydream]

Hi all, I’ve been on two different antidepressants for a long time for anxiety and depression, since peri started a couple of years ago I feel they stopped working! I’m on estraderm 100, Utrogestan and testogel.
Just wondering if anyone has experience of this?

[CLKD]

Which AD and which dose?

[kittydaydream]

20mg paroxetine and 45mg mirtazipine

[CLKD]

Sometimes the brain can become used to a dose, when R U due for a review and who oversees your Medication?  I would think that upping the Paroxetine might be the way to go, mayB ring your prescribing pratitoner to discuss? 

I have been on ADs since 1988 and when my brain wakes feeing low for more than 3 mornings in a row, I up my dose: currently 5mg in the morning and 10 at night, I add 5mg in the mornings.  If after 5 days my brain hasn't felt 'better', I make an appt with our GP. 

[kittydaydream]

Thank you I’ll book a review but the last time I spoke to the gp about it they said my doses were already high and would t mess with them!

[CLKD]

So ask for a referral to a psychiatrist who can give advice about dosage .  As with HRT many GPs won't step outside the MIMMS advice nor do they think to discuss with colleagues 

[kittydaydream]

Thank you I will do that 🙏

[Penguin]

The dose of paroxetine isn't high on its own (you can go to 40mg easily) but perhaps it is the combination with mirtazapine that is the issue. In which case it may be time to switch paroxetine to another ssri or try another combination. I have taken various ssris, but it was only when I paid privately to see a psychiatrist back in April this year and he switched me from citalopram to fluoxetine and slowly helped me titrate up from 10mg to 30mg (the aim is to be on 40mg as you need higher numbers for obsessional anxiety apparently) that I really felt I'd got a grip on my mental health. He has given me a lot of support though. Are you able to ask for a psych referral, if the GP says they can't help you further? Or are you able to see someone privately? Now I am stable on my dose, with the last move up taking place at the end of this month, the GP is happily providing me with NHS prescriptions for what the psychiatrist prescribes. It has been a life saver for me, I was in such a bad way before getting specialist help.
The other thing I'd say is perhaps you need to change your hrt / get referred to a specialist menopause clinic. I did find increased anxiety with the combination I was on for a year, but others with more experience can advise on that.

[CLKD]

   Penguin - thought that U R on holidays ?

[kittydaydream]

Thank you Penguin, I’ve been struggling for a while and it’s gotten progressively worse, at the moment every little thing sets anxiety off, prior to that it was mainly social anxiety. I’m going to ask for a referral to a psychiatrist but I think that takes months, I may see if I can do a right to choose referral if not, I can’t really afford to go private as I’m not able to work right now.

[CLKD]

How much do you think that a private appt would cost ?  I'm surprised at some of the fees which in most cases are worth while paying for to get relief.  A friend of ours gave up her 3 annual holidays abroad to get herself sorted ;-)

[Penguin]

I think the first one, which was an hour long was 250. Subsequent ones, half an hour long, are 180. Given how many years I've suffered, and the amount of money we've spent on other things to try and help me with the anxiety (and believe me i have tried a LOT), it has been money well spent. Driving home from first appointment, husband said he wishes we'd done it years ago. Even getting a proper diagnosis was not really something the GP could do, with everything put down to Generalised Anxiety Disorder. Rather than what it is, which is a specific form of OCD combined with complex-PTSD. I realise we're lucky to be able to afford it and I really wish that everyone whose anxiety isn't easily helped by meds the GP feels comfortable in prescribing, could get an appropriate referral to a mental health professional, but sadly this isn't the case. However, I will keep suggesting it as an option as it has made such a difference for me in the four months I have been seeing him.

[kittydaydream]

Thank you both, I’m actually coming around to the idea of going private, my dr said I have general anxiety but I’m not so sure! Penguin how do you go about finding someone?

[Penguin]

I just googled psychiatrists near me, then for every one I found I looked them up on the Top Doctor website and read their patient reviews. I wanted someone who worked both NHS and private as they have further breadth of experience, plus someone who had held a senior NHS post and had been practicing for many years. Finally, I looked at what they said their area of special interest was and cross referenced it with their experience (as set out in their profile) in that area.

[kittydaydream]

Ok thank you I’ll look into it 🙏