Don't know where to turn or what to do

Just thought I'd update this as I had my much anticipated psych evaluation today.

We went through all the predictable stuff, discussed meds, history, how I’m feeling now etc and to be honest, I’m not sure how I feel about the suggestions/findings.

I hope they are not just based on my 45 mins of blabbering and more on previous notes/GP feedback etc.

In a nut shell they feel it’s a personality disorder rather than typical depression and that my best course of action is CBT.

That is not to suggest that medication will not help, but that it should not be the primary source of treatment.

It was also said that the challenge is that my way of thinking is possibly too heavily embedded to be significantly changed to achieve the desired result, but that pills might help the worst of it.

My enquiry into meds available in the USA and other countries led nowhere – i.e “not on the list = not happening”. Bupropion / Wellbutrin is not on the list.

I've been provided a list of their recommended/suggested ADs in their order of preference as Sertraline, Clomipramine, Trazoddone and Amitriptyline. But cited that all will likely carry undesirable side effects and sexual dysfunction. My research suggests that these are all available under primary care, so not the ‘special draw’ access I was hoping for at referral.

If I’m honest, I feel disappointed and somewhat let down/dismissed as a lost cause – i.e “Sorry, you’re just a stress head, but here’s some techniques to help you chill out and a selection of pills that might help”

I don’t know where to go from here, but there was no suggestion of follow up or after care and I feel the ball is very much in my court.

Thing is, despite trying to have an open mind, I can’t see CBT helping me overcome my zero coping mechanism issues and wanting to run away and cry at the slightest hurdle, nor my utter lethargy and lack of enjoyment of everyday life. It ‘feels’ clinical/chemical, not the result of a mind set that mood diaries and relaxation techniques could address, however that statement is based on my own ignorant perception.

Dunno – feel a bit abandoned and unsure of what to do next.

Perhaps it was unwise of me to put so much faith in secondary care.

I'm glad you've had your assessment. I'm surprised for CBT rather than ACT or DBT... They might also be avenues to explore...

I’m on amitryptaline and have take clomipromine in the past (which I was put on when in a psych hospital). Ami works differently from other ADs and is not usually the first one that’s tried and clomipramine is a 1950s drug that is very rarely used. What I’m trying to say is that I dont think you have been abandoned at all, and they’re thinking out of the box as far as meds go - so maybe that’s the case with other treatments itms?

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Originally Posted by Suzi

I'm glad you've had your assessment. I'm surprised for CBT rather than ACT or DBT... They might also be avenues to explore...

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Problem is, I'm not convinced as my periods of very low mood, despair and contemplation of suicide suggests something more heavy duty than therapy is required.

I'm also disappointed in the rather generic offering of ADs and am not sure what to do.

I was expecting to be taken under someone's wing and guided through a journey of specialist care, rather than just casually dismissed with a suggestion that I might want to try this or that.

I feel let down and on my own to sort myself out.

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Originally Posted by Paula

I’m on amitryptaline and have take clomipromine in the past (which I was put on when in a psych hospital). Ami works differently from other ADs and is not usually the first one that’s tried and clomipramine is a 1950s drug that is very rarely used. What I’m trying to say is that I dont think you have been abandoned at all, and they’re thinking out of the box as far as meds go - so maybe that’s the case with other treatments itms?

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Thanks - the list of side effects in the common or very common list makes grim reading, with sexual dysfunction near the top of the list in most cases.

I'm shocked that the ball has been left in my court. I'm almost coping at the moment, but being told to go and consider my options and click on a website for CBT self referral and chose from a menu of drugs is more than I can cope with. I feel lost and scared. Maybe I put too much of a brave face on it today and they thought I'm okay - despite me stating I'm not and need help.

It's like I've just been dismissed back to my GP and it's up to me to sort myself out. I'm more often than not incapable of sorting myself out, let along conjuring up the courage and fight to go and see a Doctor.

"So what pills have you decided to try next....?"

I'm sure it's not that simple at all! They wouldn't have referred back to your GP if they didn't think that was the most appropriate course of action for you..

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Originally Posted by Suzi

I'm sure it's not that simple at all! They wouldn't have referred back to your GP if they didn't think that was the most appropriate course of action for you..

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But my GP will ask me which AD from the four suggested do I want to try next - answer, none of them really as they all carry well published sexual dysfunction.

Some say sexual dysfunction is better than depression and worth putting up with - maybe for some, not for me. It caused/worsened my depression and feelings of low self esteem/worthlessness. I'm not going there again and my marriage is under enough strain as it is.

I'll put myself on the waiting list for CBT and see what happens, although I can't help feeling it's not the correct route - I just don't get how mind training will lift the invisible heavy blanket that encases me.

Just because something is on the list of potential side effects does not mean you’re going to suffer from them. People react differently to each one. As for the ball in your court, most people like to have a say in what happens next .....

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Originally Posted by Ovalbug

But my GP will ask me which AD from the four suggested do I want to try next - answer, none of them really as they all carry well published sexual dysfunction.

Some say sexual dysfunction is better than depression and worth putting up with - maybe for some, not for me. It caused/worsened my depression and feelings of low self esteem/worthlessness. I'm not going there again and my marriage is under enough strain as it is.

I'll put myself on the waiting list for CBT and see what happens, although I can't help feeling it's not the correct route - I just don't get how mind training will lift the invisible heavy blanket that encases me.

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Sexual dysfunction seems quite a common side effect with AD and for some one my age who lives alone the fact I'm pretty much none functioning in that department doesn't seem to matter. But you being much younger and in a relationship I can see how it would adversely affect you. I'm no doctor but have you asked your GP if there are any AD's which don't affect you so much in that department?

My husband didn't think that his last lot of therapy was going to help. He went along purely and simply to "cross it off the list and say I've tried it" and actually it's been a massive help. Don't write it off before you've even got there - but things like therapy only help if you're prepared to work hard at it.