SNRI dosage halved. Struggling with depression and anxiety.

[lucy657]

My partner was on max dose of SNRI med, he has taken this med for over 8 years.

There are several side effects that were becoming increasingly difficult to live with (body temp, always sweating, sleep disturbance and libido issues) 

So he went to GP and they halved the dose. We have since found out that this GP has never read his file, or history.  

His employer has been great, and supported him through several hospital admissions in the past, and sick leave etc. They have sent him to a psychiatrist for a 'fit for work' review, the report has since been sent to his (useless) GP. 

 The psychiatrist hinted at a full review, looking towards a medication change.  My partner has a GP appointment tomorrow, and will ask for a referral to a psychiatrist for this review. 

My concern is that his anxiety has streadily increased over the paat few weeks, he is more stressed and depressed than ever... he has attempted suicide previously and I feel that his immediate mental health is not safe. 

Is there something that the GP could prescribe to help out in between now and the psychiatrist appointment?  Should he go back up to the original (max) dose of the SNRI? 

Unfortunately I'm away for the weekend so not able to go with him today.  

Thanks x 

beyondblue's clinically-trained moderators often work offline (invisible to you) on issues relating to suicide or self-harm. At the same time, general supportive comments from the community are encouraged. If you have concerns around suicide or self-harm, please phone our support service on 1300 22 4636.

[Beltane]

I hope that the beyondblue moderators have gotten in contact with you, or you could get in contact with them on the phone number above. There are emergency psychiatric crisis teams (outside of hospitals) that can get in touch with your partner via phone and arrange immediate help, they can even send people to his home to offer support. This wouldn't necessarily result in a hospital admission unless he needs it- i've been helped by one of these crisis teams twice while in severe distress, and neither time did i end up in hospital. But i did get  appointments with their emergency psychiatrists and counsellors in a couple of days- long appointments too!, and could talk on the phone with them in the meantime. I think if you call beyondblue they could probably link your partner up with such a team in your partners area, otherwise a good GP should have their details.

An alternative step is for your partner to simply present to an emergency department of a hospital, if he is in immediate need of help or at risk of harm. i have also done this, and i got to see an emergency psychiatrist within an hour or two. i didnt need to stay in hospital as i wasnt a risk of harm, but your partner might like to stay for his safety and wellbeing

Yes, in short, there are short term anxiety medications that can ease the distress of changing between doses. Also changing between doses of medications has to be done very delicately and carefully- it sounds like you didnt think the doctor really studied your partners case properly, or that you trust this mans judgement. Its common to withdraw slowly from a medication over 4-8 weeks depending on how the person tolerates it, so to suddenly cut the dose in half overnight after 8 years on it is quite a drastic change and would certainly cause distressing mood changes and symptoms.

I would highly recommend getting a different GP. He needs ONE regular GP he sees frequently (eg at least 1-2 times weekly during this acute stage to ensure his safety and monitor his moods, less often of course when he feels better).

There are some doctors listed on this site under Menu> Get Support> Find a Professional. Otherwise of course he can try another doctor at the same clinic as they will already have the case notes which will be quicker, or he can get the case notes transferred to another clinic. He can just show up at another doctor without case notes but be sure he books a LONG appointment so theres time to discuss everything thats been happening.

[lucy657]

Beltane, Thankyou for your reply.

Firstly, yes the moderators got in touch with me and offered some alternative supports.  

My partner saw his GP today, and I'm once again confused and disappointed with the outcome.  

He now has a referral to a psychiatrist to review his medication, however this is not until May. 

I asked if he discussed going back to his normal dose in the interim, and he said that she cannot increase the dose without a psychiatric review.  Then why on earth would she HALVE it with no weaning or thought to the possible effects?? 

He also spoke about his (very) low mood and decline in the past week. She said there was nothing she could prescribe to help?  

I talked to him about triage, however he hasn't had great experiences in the past and doesn't feel as though he's at immediate risk. .. which I guess I have to respect.  

His workplace are arranging a psychiatric review, as May is not workable. 

Thankyou for the support, this is all new to me!

[White_Rose]

Dear Lucy

I heartily endorse Beltane's comments Your GP sounds completely useless if she cannot recognise someone is in urgent need of help. Specialist, of whatever calling, always have spaces for emergencies and the GP should know this. All she had to do was make the phone call to the psychiatrsist and explain.

I really urge you to find another (competent) GP. Find one on the BB list following Beltane's directions.

So pleased your partner's workplace is arranging a review. Obviously they are sympathetic towards people with depression.

Hang in there Lucy. You sound as though you are doing a great job of supporting your partner. Just remember to look after yourself as well. e.g. eating well and getting enough rest.

Regards

Mary

[Beltane]

This doctor sounds really useless... She can halve the dose but can't incresase it again?? Give me a break... He could show up at another clinic tomorrow- infact he should.

look some doctors are just idiots. About 6 months ago or so now I rocked up at my regular doctors clinic, my normal gp was on extended leave but my mood had yet again crashed severely  because we couldn't find an antidepressant that worked for me (I went through 7 of them). I saw some other GP and I flat out said these exact words "I am suicidal, do not let me leave this clinic, I am fearful I will do something stupid like hurt myself. None of these antidepressants are working and I need help".

you know what she said? "You need to get yourself out of this rut, you'll just have to deal with the fact that your body doesn't want antidepressants, what you need is a hobby". Just for some context, I'd had severe depression for 10 years and had been actively battling it for 3 with the 7 different antidepressants and therapies too. So she let me walk out of the clinic.

thank god I had the presence of mind to drive straight down to another clinic and explain my situation. I pm not a religious person, but something was looking out for me that day dos that clinic got me the help I needed.  Long story short, a lovely smart doctor saw me and said well, I am not going to throw more drugs at you- we need a psychiatric review, normally we can't get a psychiatric review for months- the waiting list is too long. But she thought, let's ring the crisis team for my area (melbourne) and I explained (in tears) my sitaution and they got me a psychiatric review within like 2-3 days. That psychiatrist sat with me for 2 hours and by the end realised I wasn't depressed, I was bipolar type 2. In all the years Id battled violent mood swings and depression, no one had ever explained a hypomanic episode or its symptoms to me before. When this psych explained it, a light bulb went off in my head "that's me!!!!!"

so yeah. Some doctors are idiots, some are wonderful intelligent people who won't ever let a sick person slip through the cracks.

moral of the story: a different doctor might be the saving grace your partner needs 

[geoff]

dear Lucy, thanks so much for joining the site, and offer my total agreement to what Beltane and Mary have said.

You wouldn't get a painter to do a plumber's job, same as a doctor, they must be up on all the medications they prescribe.

If you don't mind me saying this and please tick me off if you are upset by what I say, but I am concerned that he/you want to change this antidepressant as a major reason because he has no libido, and that's well and truly understandable in a relationship or a marriage, as it leads to frustration and probably annoyance.

When he finds a new doctor and finally talks to his psychiatrist this must be one of the first discussions they have to have, and the same applies if he goes to hospital which I realise he's not too keen to go, as when I went to the public hospital a few times I can't say it was worthwhile although it kept me safe, but everyone is different and has their own experience.

Take care. L Geoff. x