So last week I saw the psychiatrist, in short, they were an idiot. They, first of all, wouldn’t shut up about therapy bullshit. It’s not that they were wrong, but the reason I was referred to a psychiatrist was that the general consensus of the people who had assessed me was that I was too busy to be able to do therapy properly. Which is true.

That wouldn’t be too bad but the medication option was to switch out venlafaxine for sertraline. The Psychiatrist was all like, have you tried sertraline? And I was like, no, but I have tried fluoxetine and escitalopram. For anyone who doesn’t know their antidepressant pharmacology, which apparently includes psychiatrists… Fluoxetine, escitalopram and sertraline all fall under SSRI. General guidelines say try one SSRI for about 8 weeks if there is still no response switch to another SSRI for another 8 weeks or you can increase the dose it varies a little bit. But overall once you have tried two SSRI you then switch out of class, which is when I was put onto venlafaxine.

Fluoxetine, escitalopram and sertraline all fall under SSRI. General guidelines say try one SSRI for about 8 weeks if there is still no response switch to another SSRI for another 8 weeks or you can increase the dose it varies a little bit. But overall once you have tried two SSRI you then switch out of class, which is when I was put onto venlafaxine.

Venlafaxine is classed as a SNRI so instead of only inhibiting the reuptake of serotonin it also inhibits the reuptake of noradrenaline. A lot of Drs will use venlafaxine to switch out of the SSRI class as it offers some additional opportunity for response with a minimal increase in side effects. I also take mirtazapine which is an atypical antidepressant so is also not a SSRI.

Anyway back to me, because that is the real importance of this rant… My main point isn’t what the guidelines say, it’s that when I tried both the SSRI’s I had no response at all, they did nothing. I got no side effects, but also no response, it was like they weren’t there. When I took venlafaxine above 150mg I have an improvement in my concentration, but other than that not a lot happened and long term I got a lot worse purely because my depression just wasn’t being treated.

Then sometime late last year I managed to convince my GP to add mirtazapine on top of the venlafaxine. Which within a week actually did something. I mean not fully recovered but at least it pulled me out of my suicidal phase.

The thing is the fact that my response to mirtazapine occurred so fast would suggest that the venlafaxine may have contributed to the response. Don’t get me wrong this combination is far from perfect but it is doing something and to seriously rock the boat by removing one for a fucking SSRI is just stupid based on my past history of response.

Anyway please tell me someone else follows my logic. If anyone got this far that is…..

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