Hello.
Right now I've been really clinically depressed and so far this week have found it very hard to fall asleep at night and end up sleeping at about 3am. I also awake at about 4pm so I have been sleeping like 13+ hours which is hypersomnia.
I am on Cipramil (Celexa in USA) 40mg which is 2 tablets after my GP suggested it as it wasn't stopping depressed symptoms on 30mg. Well considering I've been on this dose for over 3 weeks I am getting even more depressed. Four years ago I was on Effexor-xr for about 1 month or 2 and that was worse than Cipramil in terms of sideaffects.
These are the only 2 drugs I've been on. Cipramil I've taken for about 7 years. I know there is a whole market of SSRI's and Benzo's out there but I'm not comfortable with weaning off one and going on to another and using trial and error.
So, right now I'm at the point where I want to wean off Cipramil and pretty much not go on anti depressants ever. They were used to treat my major depressive disorder and chronic social anxiety disorder but I'm pretty much over trying to fight it and want to just accept it and just live.
The times I've had depressive episodes pre-medication were quite severe and would last for months. I would be so utterly paralysed and so anxious I did not know how to control myself.
I know there is a limitation as to what people can say on here regarding meds but from your experiences do you think I am doing the right thing? Sure, I do have "major/clinical depression, severe/chronic social anxiety disorder, mild OCPD, avoidant personality disorder and perfectionism" but I'm fed up of trying to mask them with drugs. I just want to live my life.
Thoughts?
p.s; Once the effects of the meds have subsided, I am looking at possible therapy again for coping with SA, being assertive, lessening my perfectionism and being happy with who I am.
I'd appreciate your thoughts.
Thank you for your question about medications. From what you have written, I understand you have been on citalopram (Cipramil, Celexa) for seven years, and are currently trying an increased dose of 30 mg and now 40 mg that you have been on for over three weeks. You previously tried venlafaxine (Efexor-XR) (but did not detail any dose), for about one or two months but were troubled with side-effects on that medication. From your description and spelling of the medications I assume your enquiry comes from North America, or at least not from Australia . For your information, while depressive symptoms may show some response after about a month or two of medicines, anxiety and obsessional features often take somewhat longer to respond, and can even need a higher dose of medication than is required normally for depression
As I understand it, you have been troubled with major depressive disorder and chronic social anxiety, as well as a tendency to be rather avoidant and perfectionistic with some obsessive personality qualities.
It sounds as though you have had some improvement in that despite some continuing disability in that you are not "so utterly paralysed and so anxious I did not know how to control myself" which happened off medicines. As such, though medicines may not have brought about a recovery from all of your symptoms, it sounds as though there has been some improvement at least.
Using medicines is always a balance of potential benefits against any adverse events that might occur. Adverse events for most of our modern medicines are mild and tend to lessen or go away completely with time, though there can be ongoing problems for some patients. One of your considerations now is whether the benefits you have already achieved are worth any adverse events that might be persisting. It is also important to try to separate out symptoms that might be more appropriately related to your depression for example rather than to the medication.
There are alternative treatments which you can discuss with your doctor. In addition, psychological treatments like cognitive behaviour therapy can assist medication treatment in achieving some better recovery. There are also programs for social interaction, engagement, and occupational and social rehabilitation. It is also important to look after your physical health. Particularly for social anxiety and avoidant behaviour, psychological treatments either individually, or in groups can be helpful. Sometimes if you are feeling too disabled with your difficulties, medicines can help your symptoms improve to the degree that you can build on that initial improvement with additional psychological treatments such as cognitive behaviour therapy.
For most people with significant impairment from psychiatric problems, medications bring about more benefits than a disadvantages. That is however an individual matter that you should discuss with your doctor so you can decide whether to increase the dose of your treatment further, change your medicines, or look to other treatments options.
I would emphasise that medicines do not just "mask" the illness. To some degree, all effective treatments including medicines, psychological treatments and social treatments seem to have an impact on the underlying illness and reduce the disabilities of those illnesses. If people are able to achieve remission (symptoms reduced to no greater degree than exists in the general population) then effective treatment can reduce the chance of further episodes arising.
Do give your medicines a chance, but do not see them as the only aspect of your treatment. Discuss your present medicines with your doctor and any alternatives that may be an option, recognising that you have to give a medicine a decent trial over a minimum of 1 to 2 months in an adequate dose. Do look after your general physical health, and consider psychological treatment as part of the process you could consider. Occupational and social rehabilitation may be required in due course. From your history, it sounds as though when you were not taking medicines you were significantly disabled and still feel very vulnerable, so it would seem most likely that you would be better off on medicines right now rather than off them. That must be discussed with your treating doctor.
One thing that is clear from research is that persistence with treatment pays off.
All the best for your ongoing treatment. I trust that it works out well for you. You are welcome to copy off your question and this reply, print it and take it to your treating doctor to discuss further, if that will help you in making further decisions about your treatment.