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  • Q&A with Australian Health Practitioners

    What if SSRI's and SNRI's Don't work?

    Related Topics
    Anxiety Depression Mental Health
    I suffer from Major Depressive Disorder and General anxiety disorder. I have tried Pristiq, effexor XR, cymbalta, Zyprexa, Sodium Valproate and seroquel. Nothing seems to be working my moods are constantly up and down through out the day. It's been 7 months since I had a breakdown and still can't find the right drugs. I have an appointment with my psych next week. Please help me.
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  • Damien Haines

    Clinical Psychologist, Psychologist

    Damien Haines is a registered Clinical Psychologist who brings a warm and empathetic approach to therapy. He emphasises engagement in the world and encourages clients … View Profile

    I am making the assumption that you have been acurately diagnosed with those disorders. If so GAD is particularly “resistant” to pharmacotherapy and an isolated treatment. The combination of your disorders, in particular, would suggest that psychological treatment in tandem with drug treatment would be best. For a “taste” of evidenced based psychological treatments please see "http://www.cci.health.wa.gov.au/resources/infopax.cfm?Info_ID=46" for some assistance. However, please see a registered psychologist who has experience dealing with GAD and MDD. http://www.psychology.org.au/FindaPsychologist/

    I wish you well

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    Anonymous

    Hello and thanks for sharing and reaching out for help. Its really great that you are seeing a psychologist - keep in constant contact with your GP also to make sure that there are no other physical symptoms affecting your moods.

    My husband and I can relate to what you are going through so well. He also has Major Depressive Disorder and anxiety issues. He had a major breakdown 13months ago when we tried to change his antidepressant and hit a wrong note. He was put on 2 or 3 different medications in the space of 6 weeks which in looking back was not well managed. He was so distressed by his moods and anxiety that he was looking to opt out of being alive. At this point he was admitted to public mental health unit and was helped a little They also found his testosterone was very low which was affecting his moods a bit. They put him on a new medication which kind of helped and put him on Sodium Valproate which did really help to stabilise his moods - though regular bloods are needed to check on the levels.He also has high functioning autism which adds to his anxiety ability to cope with his moods and other changes.

    6 months after he was first admitted we were still asking when does this medication reach peak effectiveness and we were still being asked to wait a bit longer...we knew that they take 3 months to become fully effective but the way he was feeling was not fight for him and longer tolerable to us. We went to a private psychiatrist (not a psychologist, hes not a great talker) and he admitted him to a private hospital changed some meds and things have slowly got better from there. He is still on Seroquel (large doses) and Sodium Valproate (large doses)  and has found that Dulotexine (also high doses) works for him. When he is extremely anxious and cant cope with the feelings himself, in his mind using his Cognitive behaviour techniques, he also uses Ativan (low doses!) He is also getting help to cope with his moods and anger in other ways apart form medication and is gradually becoming less anxious and is gradually getting used to recovering from upsets himself. He is seeing the psychiatrist about every 2 to 3 weeks (he was discharged 4 months ago) so his care is still very intensive at the moment.

    I guess what I am trying to say is 4 different medications in 7 months is a lot of changes. When you change medication you feel positively awful ( I am going through this right now and wouldnt wish it on anyone!) and a lot of changes in a short time may be too much for your body to cope with. This is a process which takes a lot of time and when you are not feeling well every day feels like a lifetime so take life in tiny chunks at a time - start with milliseconds...when you feel that you can cope with that move on to seconds, then look to getting through the next minute, and as you cope with every small part and realise you can do this, the day slowly becomes managable again.

    Having said that, everyone is different and medications work differently for different people but none are going to reach peak effectiveness in a few weeks. So hang in there! There a better days ahead! I know because we are climbing this Everest. We had to spend a lot of time at Base Camp though! The main thing is, dont be put off by setbacks, just view them as an alternative way to the top.

    All the best and dont be afraid to change doctors if you are not getting the reassurance or getting along well with who you are currently seeing. A climbing partner needs to be someone you can work intimitely well with.

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    Dr Peter Heffernan

    Psychiatrist

    I am a Consultant Psychiatrist and Psychoanalytic Psychotherapist who specialises in Adult ADHD, Jungian Psychotherapy, and the Psychological Medicine aspects of Chronic Pain conditions. View Profile

    The seriously disabling mental disorder that very commonly underlies Treatment Resistant Depressive Disorders and Anxiety Disorders is Lifelong Attention Deficit Disorder (ADD) and Lifelong Attention Deficit Hyperactivity Disorder (ADHD).

    if there is any history of lifelong difficulties in attention, concentration, 'daydreamy states', distractibillity, difficulties with organisations and planning, it is most important to obtain a referral to an expert in the assessment and diagnosis of Lifelong ADD/ADHD, because treatment of the underlying ADD/ADHD frequently facilitates a helpful response to treatment of the presenting Anxiety or Depressive Disorder. 

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    Dr Peter Heffernan

    Psychiatrist

    I am a Consultant Psychiatrist and Psychoanalytic Psychotherapist who specialises in Adult ADHD, Jungian Psychotherapy, and the Psychological Medicine aspects of Chronic Pain conditions. View Profile

    A review of the pattern of mood instability is required to ensure the mood disorder pattern is not one of Bipolar Disorder, which requires a completely different medication strategy to the treatment of a Depressive Disorder, starting with the mood stabiliser, lamotrigine. 

    One would always consider the combination of venlafaxine and mirtazepine, and the addition of a mood stabiliser, such as lithium carbonate, lamotrigine, arsenapine, quetiapine, olanzapine, etc, etc. 

    One would always assess for medical conditions that limit possible treatment response, such as obstructive sleep apnoea, thyroid disease, cancer, etc.

    One would always consider the psychotherapies.

    One would always consider TMS, and ECT. 

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