Coiled/anti-depressant combinations


I mess around with my meds sometimes.  I don’t think twice about adjusting the dose of something.  I suppose that’s kind of inadvisable.

I put myself back on the contraceptive pill because I had two boxes left from whenever the last time was I was on it.  I’ve had maybe three really awful cycles of PMT.  It’s been crap for months but now there seem to be fewer good months (in terms of PMT) than before.  Anyway, I’m feeling pretty hormonal today.  It’s like I’m coiled, tense inside.  I suppose it’s going to take more than six days of taking the pill again before I get a remission in the hormonal craps.

My PMT takes the form of a week (this is prior to the actual period) of emotional instability.  A week at the worst.  Three days at best.  During this time I oscillate between the reclusive curmudgeon, the bitchy cow, the misanthropic Scrooge-ess, the teary child and the impulsive/compulsive addict (compulsions ranging from buying stuff I can’t afford/don’t need, eating for triplets and necking wine or whatever’s handy).

I can’t have this every month – it’s so far removed from the fairly laid-back person I genuinely am the rest of the time.  But, yeah, guess I’ll have to give the pill another month to see if it can help me out with this a bit.

I’m also reducing the Aunty D, on the advice of my doctor.  Well, she sort of advised it, or maybe she didn’t, it was one of those confusingly “huh?” consultations.  What it was- I told her I’d heard a low dose of tricyclic AD was sometimes helpful for CFS related pain, headaches and to aid sleep.  So far so good.  She seemed on board with me when I broached this as a solution to crap sleep.

Then she did something amazing.

She looked the drug up on her internet database to check for interactions (oh, yes, she’s a true pro).

Uh Oh.  Actually, combining an SSRI and a tricyclic is NOT ADVISED – DO NOT DO THIS.

Then she double-checked in the British National Formulary book – a big doctory tome that is present in every surgery.

Yup.  They both concur.  You shouldn’t prescribe fluoxetine with amitriptyline because of the small chance that the patient could overload on serotonin.  Serotonin Syndrome  is rare but can be fatal.

So.  That’s that.  She suggested I reduce the SSRI (slowly, slowly, in manageable stages, as a man should de-flower a virgin) with a view to then being given the ami at a later date. 

It was a bit confusing.  I take the SSRI for depression (even if I don’t feel depressed, just because my episodes of depression are so debilitating/life-endangering that it’s hardly worth the risk coming off it totally- tried a couple of times, was fine for a while, then hit the floor).  I wanted the ami for my CFS symptoms. 

So it became a case of which condition would you like to treat more?  In the red box you have your SSRI.  In the blue box you have this new-old drug, amitriptyline (new to my medication menu, old in the history of AD medications).  They don’t get on together. 

Choose.  Really, that’s it?  They can’t be reconciled?  Can’t we send them to anti-depressant RELATE, where they could learn to put their personal feelings aside for the sake of their common goal – to get me feeling tip-top?  They could talk about repressed anger – how amitriptyline used to rule the roost, The One! The Only! A rock star for the 1960’s, bowing down only to his predecessor, Queen Imipramine.  Amitriptyline could speak about how he felt threatened when fluoxetine and the other newbies came on the scene.  Suddenly, it wasn’t cool to be a tricyclic anymore.  Now the SSRI’s had the floor – this was the first real threat to tricyclics, like amitriptyline.  Sure, it’s natural they felt some resentment.  The balance of power changed as new relationships blossomed.  Just as Bing and Sinatra were left licking their wounds, as Elvis swaggered in, so Imipramine, Amitripyline &co were over-shadowed.  Can they ever learn to love each other?  The SSRI’s were bold, new and daring challengers.  They were bound to catch the eye, what with their sexy newness, effective advertising and alluring specificity.  Specificity is always a turn on, no?

I feel that this bad blood between amitriptyline and fluoxetine, and indeed others like them, could be resolved.  We just need to get them in a room with one another, with a trained counsellor, and let them talk about their feelings.

Back to reality. 

I’m sort of reducing the fluoxetine anyway, but I..don’t know what I want to do in terms of whether I’d prefer to switch to amitriptyline.  I felt my doctor was rather partial to the idea of amitriptyline (from the CFS/headaches/sleep point of view), but I haven’t seen her many times, she doesn’t know me that well, and I’m used to fluoxetine.  If I ever felt stable I’d come off fluoxetine again, but it seems risky at this stage. 

I’m actually leaning more towards trying some non-drug therapies, like a chiropractor (for tension that builds up in my upper body and contributes to headaches and tiredness), maybe a CFS specialist, the alternative/complemetary therapy routes and perhaps a psychologist.  A psychologist, or other similar therapist, is a risky strategy for me, because I’ve experienced negative results, indifferent results and vaguely positive results from my forays into that arena.  If I was going to do it again I’d do it privately, research someone who had reasonable experience and whom I could ‘get on’ with in terms of their demeanor and personal approach.  In the past I’ve seen one psychologist through the NHS – a negative experience with no real improvement.  I’ve seen numerous person-centred counsellors, such as the kind that are free when you are at uni – this technique is useless to me.  I’ve seen god knows how many CBT-styled therapists, through various agencies, mostly free on NHS, or reduced-rate (because they were notching up their hours as relatively new therapists).  These have been sometimes helpful, sometimes not so much.  It may be a crass comparison, but I’m thinking shopping for a therapist is like finding the right hairdresser.  You can get your hair cut by lots of people, some you’d never go to again (spiral perm – 1991), some you are indifferent to – they’ve done a reasonable job of making my hair manageable and presentable (lots of hairdressers have fallen into this category), and then, now and again, you find an amazing hairdresser.  Someone who highlights the plainness of the others with dazzling understanding and execution of what it is you want and need.  They listen to what you want and then add their own ideas, based on their understanding of what can and cannot be achieved with your hair-type, lifestyle and maintenence budget.

If I do decide to shop for a therapist, I will do it differently than before.  I’d be paying a sizeable sum to go private, which has always put me off, but then again, it’s relative to what benefit I might get.  I wouldn’t think twice about saving £50 for a night out somewhere if I really wanted to go.  If I do find my Andrew Collinge of the therapy world I’ll let you know.


2 thoughts on “Coiled/anti-depressant combinations

  1. Really enjoying your blog. My first night on Paxil, I took it with St. John’s Wort (which I had been taking and nobody told me to stop) and induced full body seizures that lasted about 5 minutes. More hilarious than scary, what with the flopping out of bed and my body not responding to requests to “Stand,” “Get off the floor,” “Stop flopping about.” Serotonin syndrome was what it got called. There are other ways to spend a Saturday night.

    • Thanks for reading, Shelby. Your description made me smile but I’m sure I’d be terrified if it happened to me. May you have better Saturdays here on in x

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