Bloody NHS!

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I've had enough of my medication troubles!

While I was living in the States, I was on a combination of Celexa and Neurontin (Celexa for severe depression that makes me more or less unable to function without medication, and Neurontin because the Celexa gave me seizures). It wasn't the perfect solution, clearly, but it's the only one that's ever cured my depression without making me feel either maniacal or doped.

I was taken off it by a doctor who wrongly (and I think very stupidly) diagnosed me with bipolar disorder. I spent four months on some sort of awful stuff (I don't remember what it was) that made my mind race and gradually made it harder and harder to sleep. Finally I was taken off that when I moved to the UK, but I was put on Mirtazapine and the insomnia only got worse. Nothing seemed real and I was afraid I'd sink through the sidewalk if I took a bad step. So they switched me again, and put me on Prozac. I felt drugged and sluggish and I gained 20 lbs. Now I'm on Lexapro, feel equally sluggish and have gained ANOTHER 5 lbs.

The NHS says they won't consider putting me back on Celexa and Neurontin. I'd like to know WHY, because it was a combination that WORKED, God f*ck it.

I think it's about time I go back and badger them to death. And release the tiger if badgers don't work.

Well, I don't have much experience in the real world, being the disgruntled little hermit that I am, but if I were in your position I'd consider sending in an elephant to do the job. First you must give it a large hat, it'll command more respect that way. Then train it up as your personal ambassador, stencil your demands onto it's torso and send it on it's way. That'll show them that you really mean business and if all else fails, you can just let your behatted creature sit on the desks of all those who defy you. For an NHS worker without a desk is like an elephant without a hat, thoroughly demoralized. Don't let those nature documentaries fool you, all Dumbo really craves for is snazzy headwear that just screams, "my trunk is bigger than yours". For centuries, man has struggled to control one of natures largest mammals; the elephant, but if they only knew to issue them a grand hat then all would be well and elephants would be running our factories, teaching our students, conducting our space launches and we'd all live like kings.

But if that all sounds a bit overcomplicated, just tell them that you're a black belt in morris dancing. No one can withstand the fearsome destructive power of morris dancing. But the important thing is to never give up. They'll give in eventually, whether it costs you a dozen elephants or a thousand. You can do this.

Wow, damn I'm bored. I'd offer some useful advice but I got nothing.

Au contraire, that was very useful! A little amusement was just what I needed.

Wow that is the most amusing thing I have heard here on wp!
I was laughing really hard And I bet it cheered up veruniel as well.

When I was still on meds that made me gain weight my doctor put me on diet pills to counteract the weight gain caused by the depression pills. Perhaps that would help (at least with the weight gain.) I no longer take medication but it helped me keep the weight down when I was .
I hope things get better for you. Good luck ! !

I asked about appetite suppressants. I'd heard Wellbutrin is good for counteracting the effects of Prozac. But they said they wouldn't do it for some reason.

I want to go back on Celexa. It was very effective at curbing my appetite. Ahh, well. With all the SSRIs out there these days, surely ONE of them will cause no extra weight gain.

Perhaps it is because they don't want to spend to much money (being government funded ) . You could always try telling them your health is declining due to excessive weight gain, then that may put you on it. You may not be having bad health, but you could tell them that anyway so you can get on diet pills. because eventually you will get bad health from it, so its not really a bad thing to say even if it is not fully true.

Either way hope things work out for you!

That's a good point. It may well be the reason. But if I told them about health problems I know they wouldn't believe me. I'm only 130 lbs. But I've gained 30 of those over the last few months and I don't like it.

Now they've put me on Paxil. I suppose it's worth trying, but I'm very worried about gaining more weight. I've read all sorts of alarmist websites saying people can gain over 50 lbs on this stuff..

*puts on professional hat*. OK I'm a pharmacist. I work for a large acute NHS Trust in the north of England, although I should point out I'm not a mental health specialist. I've worked with GPs too so I have a decent inside knowledge of the system. Maybe I can shed a little light and offer some advice on how to enter into a more satisfactory discussion.

(I'm also going to translate all your US Brand names into international generic drug names so I don't get confused )

Paxil = paroxetine
celexa = citalopram
prozac = fluoxetine
neurontin = gabapentin

OK. Some points... Feel free to PM me if you would like to answer privately.

1. You are talking about the NHS. Which bit? There are lots! Have you just seen your own GP (family doctor) or have you seen several different GPs to get different opinions? If so, are these at different practices or the same one? Or are you being seen by a psychiatrist? Do you see the same person each time? Do you have a CPN (community psychiatric nurse)?
I can probably suggest ways of targetting & improving your interactions with your healthcare providers if I know what you've tried already.

2. You say you are 130lbs. That's not heavy (Unless you are very short). Have you worked out your body mass index (BMI)? I know it's not perfect but it is a decent guide to what is a healthy weight for most people. Maybe if you work that out then you might find your sudden weight gain easier to take in, and worry about it less. A big change like that is always going to be hard to come to terms with but it actually sounds like this is a positive thing for you, although continuing to gain weight at this rate isn't going to be particularly positive! You should be able to get a referral to a dietician on the NHS if you continue to gain weight quickly however, or if your weight is significantly below or above the healthy BMI range of 20-25.

3. Was it ever explained to you why they stopped the citalopram & gabapentin? Were your bloods off? Both can affect certain readings. Was it "just" because of the seizure side effects? Seizures are taken quite seriously in the UK as it has serious implications for driving and certain jobs, let alone the risk to your health. Even though you say it has worked well for you, gabapentin is generally a pretty rubbish anti-seizure medication and they might have been concerned the seizure side effects of the citalopram may become unpredictable. It shouldn't have been a cost issue for these two though, they are both cheap as chips these days. You are entitled to explanations for decisions on your healthcare, but if depending on the attitude of your doctor you may need to do this tactfully rather than coming across as demanding. If you think you might find this hard, having someone else with you at appointments can help.

4. SSRIs as you say can be tricky to get right. Presumably you know to come off them as slowly as possible. For the record I don't know anyone who has experienced significany weight gain on them, other than a few pounds (including the ones you mention) but it does sound like you are prone to weight gain so I understand your concerns. Paroxetine can be particuarly tricksy to come off, as it does tend to have nastier withdrawal effects than the others so if you do need to come off them, do it REALLY slowly. There are all sorts of stories in the media about paroxetine too. Many of them are sensationalist, and there is very little evidence to back it up. Just be wary, but don't panic.

Let me know if I can help, I won't be offended if you'd rather not though

Thank you for your post. It was very helpful, especially regarding the gabapentin. The more I think about it, the more convinced I become that it would be safer for me to find an alternate SSRI instead of going back to citalopram... the spikes of anger were barely contained and seemed to get worse over time.

I just wondered, is there a chance of trying sertraline or venlafaxine if the paroxetine doesn't work out? I know I shouldn't assume the worst at this stage, but it would help to think that I have other options besides going back to the fluoxetine.

Hi there,

If the doctor looking after you thinks that SSRIs are the best thing for you then yes, sertraline is another option. Venlafaxine is an SNRI, so it's slightly different, and has been recommended in the UK to only be prescribed by specialists. Having said that lots of people take it and may be an option for you if your doctors think it's appropriate. It's difficult to say much more without knowing your medical history.

As you're probably aware there are still other SSRIs and even newer antidepressants as well so there are options (although the newer they are the more specialist the prescriber is supposed to be in general). Do try and resist jumping between medications too quickly as it's very hard to tell what effect they are having and therefore very hard to make logical treatment decisions.

I know leaping between them is bad, but I got spooked by the frustration on the Excitalopram. I had spikes of aggression on citalopram, but my mother had taken escitalopram with good results and she reacted exactly the same way I did to mirtazapine (insomnia, that is), so it seemed that our brain chemistries were very similar.

And I'm spooked of the paroxetine because I'm told the withdrawal is truly awful. Also because I read somewhere that 25% of paroxetine takers experience weight gain. More weight gain isn't an option for me because I'm an entertainer and I need to look the part. Besides which, I'm uncomfortable not being able to see my bones. I feel like they're drowning in flesh and it makes me very uncomfortable. When I got up to 118 I was happy because I didn't look like a complete stick anymore, but 130 is too much already and I know I'll go wild if I gain anymore.

weight gain attributable to SSRIs is usually to do with an increase in appetite - you should be able to get an NHS referral to a dietician to help you devise a plan of counter attack. Keep explaining your concerns to your doctor and asking for explanations, but not in a neurotic, demanding or know-it all way - that generally tends to make them answer with something very basic, designed not to explain things but to placate you. (We get a lot of people who think they are experts because of what their auntie doris had once, and a lot of people who come across aggressively, and think they can force the doctor to do whatever they say. We also have a lot of doctors who are not good at explaining what you are intersted in).

Explain that you are interested in the doctors' decision and would like to know more about your treatment and they shouldn;t see it as a challenge, and should respond with more of the information you want, and me more ready to enter into discussion about options.

Fingers crossed.