Difficulty with Doctors (UK)

[LylaMoshi]

TL;DR: I've had symptoms of depression and anxiety since the age of 11 (~2005) due to emotional abuse from my FOO. Been on medication for depression and anxiety since 2016. Sertraline made me completely numb, so I switched to Citalopram. 10mg > 20mg > 30mg > 40mg. On the max dose, realised this still wasn't right and wasn't hitting my most difficult symptoms. Doctors repeatedly refused to change it for over 9 months. Yesterday, after a 3 minute telephone appointment, my doctor tells me to stop taking Citalopram cold turkey and switch to Mirtazapine, giving 0 information about this new drug. Anger ensues.

So I arranged a phone consultation with my GP yesterday to discuss changing my medication (again). I opened up about discovering CPTSD as well, and I was spoken to like a naughty child. He completely dismissed my comment, and instead said, "Are you still using marijuana?" as if that's where I got the idea from??

I explained that I use marijuana because, as I've said to him multiple times before, my medication isn't mitigating my symptoms enough. It helps me relax if I'm triggered, makes me less hypervigilant, and helps me to sleep. He started telling me off and saying, "Well if we're going to keep giving you these medications we need to make sure you're on board". Excuse me?? You're not h@dfj$fiu% helping!!!!!

It seemed like he gave up by the end of the call and said, "Okay, just stop taking your Citalopram for 2 days and then start Mirtazapine". Nothing about the dangers of stopping antidepressants cold-turkey, what Mirtazapine is, whether it's suitable for me, how it's different to my current medication - nothing. I did some research and it shouldn't be taken if you have low blood pressure, which I very much do. It also gives 1/1000 people white blood cell die-off, which is a very high number in my opinion.

I've now tried 3 doctors in my village and all of them have been very much of the mindset that mental health just requires you to "smile more" and "do things you enjoy" and "exercise" and "just do your chores immediately instead of letting them pile up". It's so intensely obvious to me that they have no %$&*%$"^%*()) clue how these illnesses affect someone's life. My partner has decided that it's time to ditch the approach of being honest and cooperative, and instead use my GP as a means to an end. I.e., I understand my illness better than they do, and I need to utilise them as a dispensary to access the medication I need to get better.

Has anyone else been prescribed Mirtazapine?
Has anyone else dealt with incompetent doctors and felt like just completely giving up on the healthcare system?
Feeling rather demotivated by all of this 

[Libby183]

Hi.

Sorry to hear that you are having difficulties with doctors, but what you describe sounds very familiar indeed. I am in the UK as well.

In answer to your question, Mirtazipine was the last medication I took, just a few months ago. I had tried all the usual antidepressants, with little result and awful side effects. Mirtazipine is by far and away the most horrid drug I have ever taken. I have never self harmed before trying it. And the anger I felt on this drug was truly terrifying. I wanted to kill somebody or anybody. I ended up calling the surgery. A GP I had never met said to just stop taking it and maybe come back in a few weeks to see if anything else could be done for me. Couldn't have shown less concern. It was horrendous but was actually a breakthrough moment for me.

I realised that the NHS has nothing to offer me other than drugs. After twenty years of treatment, and this awful experience, I cannot see that these will work after so long. The complete lack of care and concern, or even minimal understanding, has left me with the belief that I was looking for help from the wrong people.

Since giving up on the idea of doctors, therapists and drugs I have done exceptionally well. I have taken control rather than looking to external forces to help me.

Forgot to mention that I rarely go to the doctors and the time I got a prescription for Mirtazipine, I had actually gone for help with sinusitis, because I had tried all the recommended treatments. I suspect they have me pegged as PD because if I complain of something physical, I am told it is a mental health issue. If I complain of psychological symptoms, I am told to get out and join a club! You've clearly had the same sort of reactions.

I am not recommending that you don't take the Mirtazipine. I just wanted to share my experience with it, as for me, it was a very different type of drug to the many antidepressants I have tried.

I too suffered physical and emotional abuse from parents and have been depressed and anxious from about five years old.

The conversations I have had on this site have been incredibly helpful and, at last, I feel I am making progress. I hope things improve for you.

[Three Roses]

I too suffered physical and emotional abuse from parents and have been depressed and anxious from about five years old.

Me, also.

I've been on Prozac (fluoxetine) longer than I want to admit. Here in the States, a diagnosis of cptsd is still unlikely, especially within my HMO. I am diagnosed with major depressive disorder and anxiety.

I know that some doctors receive payoffs for each cancer patient they put in chemotherapy, and I'm starting to believe that there are other cases where they receive benefits from prescriptions.

I've never taken any of the meds you've mentioned. I would definitely be very careful about abruptly ceasing a medication. I have a friend who is now disabled due to the mistreatment she received from her psychiatrist, telling her to cease a medication without titration. Even another psychiatrist told her she had a strong chance of winning a lawsuit.

While there is so much misinformation and irresponsible prescribing of harmful meds, it is up to us to educate not only ourselves but sometimes the health care professionals who serve us. If they don't like that, that's tough; it's our health in question, not theirs.

I use cannabis (CBD not THC) for anxiety and it works better than anything else I've tried, and with fewer side effects.

[LylaMoshi]

A GP I had never met said to just stop taking it and maybe come back in a few weeks to see if anything else could be done for me. Couldn't have shown less concern. It was horrendous but was actually a breakthrough moment for me.

I realised that the NHS has nothing to offer me other than drugs. After twenty years of treatment, and this awful experience, I cannot see that these will work after so long. The complete lack of care and concern, or even minimal understanding, has left me with the belief that I was looking for help from the wrong people.

Wow - this is exactly how I feel. I understand that they're overworked and underfunded, but there are real people on the other end of the phone just trying to make their lives work. You and I aren't trying to make their lives difficult - why are we treated like such inconveniences?

I'm quite lucky in that Citalopram has helped me control my anxiety-related symptoms and given me a lot more room to recover, but I know I could feel better. I just want the chance to see if anything else can help more.

...it is up to us to educate not only ourselves but sometimes the health care professionals who serve us. If they don't like that, that's tough; it's our health in question, not theirs.

I'm coming armed to my next appointment with my partner, printouts on cptsd for GPs, and the book Surviving to Thriving. Here's hoping it gets into their head.

[Libby183]

Best of luck at your next appointment. I would be really interested to hear if the gp takes on board the concept of CPTSD.

[Blueberry]

When I'd been on citalopram for a good few years, I was put on mirtazipine as well. I was in inpatient T at the time and they were encouraging more drugs. I got hit by a bunch of relatively minor side-effects in the first two days and then I think it was OK after that. Except that after the inpatient stay other docs / other inpatient places always used to ask how I was sleeping because apparently mirtazipine is used for sleep problems. But I didn't have sleeping problems back then!! So that always made me a bit suspicious.

In consultation with my outpatient psychiatrist, I went off mirtazipine a couple of years ago and reduced citalopram to 15/20mg (??). It's a half tablet. I have had spells of not taking my drugs: forget, forget, don't get round to it... 6 weeks later... I've never noticed a huge difference or even any sudden withdrawal symptoms. After about 4-6 weeks I notice a worsening of symptoms. However not everybody reacts the same way to drugs, so just because I don't seem to get withdrawal symptoms doesn't mean you won't.

I'm not in the UK or the US. It's interesting that in different countries docs seem to have different ideas on drugs and other treatment. Here most say that drugs can alleviate things a bit in order to help you to do your therapy and work-on-self but they won't work on their own, so I've never expected or even hoped that my symptoms would be covered up. But I'm in a country which allows for far more therapy than the UK so that might explain the difference. otoh I've been working on myself for like forever and I could see wanting to avoid that.

Good luck with your next appointment.  for taking backup and written info. Hope it helps!

[Kizzie]

Good grief Lyla, what a horrible attitude! It's nothing short of victim blaming - totally unconscionable and potentially damaging.   I have to agree with Three Roses:

While there is so much misinformation and irresponsible prescribing of harmful meds, it is up to us to educate not only ourselves but sometimes the health care professionals who serve us. If they don't like that, that's tough; it's our health in question, not theirs.

Yup!  It may be that the doctors you have seen will never allow themselves to be educated unfortunately (doctor knows best syndrome), but you can always try if you're up to it. There are a number of downloads about CPTSD, some specifically for medical professionals here.  There are also some tracking/history forms you could complete and take with you.

If you are able to range further afield you might want to consider expending the energy to locate a physician or  possibly a psychiatrist who is knowledgeable about trauma and can help with meds without blaming or shaming you. The ISTSS database contains names of trauma clinicians so you may be able locate someone through it - https://www.istss.org/find-a-clinician.aspx. 

Gah, I can't tell you how angry that makes me to hear your experiences - so sorry you've gone through this, it's the same story for too many of us unfortunately. 

[Boatsetsailrose]

Never should the advice be to stop an anti dep even lay persons know this ...
I haven't tried mirtazapine but i know being a forma nurse it can be sedating.
I would be putting in a formal complaint about your experiences and asking for a psych assessment with a community mental health team ...are u UK

[Eyessoblue]

Hi I'm from the uk too and have been in citalopram for 15 years, my anxiety was getting a lot worse do I got put on mitazapene, it gave me terrible heart palpitations and would wake me in the night they were so bad therefore my anxiety was a lot worse so came off. Then got put on propranolol, they were ok but I needed to take a daily max dose to feel the effects and therefore ended up like a zombie not being able to think and just wanting to fall asleep all the time. Like the others have said, coming of antidepressants is a really long process and you never should just stop, this can cause fits and all kinds of problems.

[Gromit]

Lyla,

How are you?
Also in the UK here, I did get a GP suggest I contact IAPT service where I am, community MH resource. I wasn't convinced as I had been down that route before but, this time, they assessed me on the 'phone, tested me for PTSD traits, which I had a high enough score on and put me on the waiting list for CBT. I didn't score enough to get EMDR.

Have to admit, having had the CBT last year, and found ACOA I have recently weaned myself off Citalopram 20mgs, but I did it way more slowly than any GP has advised when I came off other stuff. I do recall going cold turkey for two weeks when I changed drugs some years ago, as they wanted one drug out of my system quickly in order to switch to something else.

Try and see what you can find online for your area.
G

[Rainagain]

Something I believe to be true is that GP's and psychs often really hate it if a patient arrives with an internet based self diagnosis.

I've been diagnosed with cptsd and PTSD by different psychs, this might have helped me if I was able to access treatment.

What I have always done is simply answer their questions and done the short questionnaires they give me, I don't try to tell them what I think is going on with me, I just give them the facts they want.

Now, medics don't understand how we have been abused, lied to and about, invalidated and shouted down. So they see our attempts at self diagnosis as attention seeking delusions or something instead of a genuine attempt by someone ostracised to gain some sort of control over their situation.

They can be unforgiving in that way I think.

They misread the motives and can be dismissive, which is the last thing we need.

I haven't been guarded with them because I'm trying to be clever, I just go along with their process because I genuinely don't understand all of the effects my experiences have caused. I suspect I had PTSD which over time and extra trauma became cptsd or maybe I didn't have PTSD but now I do and its quite bad so has some extra symptoms so its more like cptsd.

I'm not sure * is going on with me so I just pile it onto the psych's desk and let them try to put it together.

My approach seems to work, my psych reports all differ but that is because the interpretation is their bag, I'm just there as the narrator of my story.

The psych reports are different interpretations of the same facts. But psychiatry seems to be like that, variable.

I'm not putting myself forward as better than anyone on here, I just think trying to offer a self diagnosis while a psych is trying to get your history to formulate their diagnosis seems likely to bump up against the psych's ego or vanity, for which you will get punished.

Its what people tend to do, no matter who they are, psychs are likely to have an innate superiority attitude with patients, they will see self diagnosis as a challenge to their personal self worth, esteem, maybe arrogance.

[Boatsetsailrose]

Rain again
I really like.your way of thinking about dealing with psych s etc...
I have taken a similar tact although i did bang on about complex trauma initially and iapt took me on. Also with gps and even the assessing nurse i needed to keep cptsd and its symptom framework in my language until it has had a chance to be absorbed as fact .
Its a fine balancing act .
However i did make a decision a while ago to stop the them and me attitude and  i don't understand all my symptoms and how they affect me and so i am looking to focus more on what happens for me , communicate it and let the clinical staff do their interpretations , sit back and watch how it unfolds. Ill know when its time to stand up and say cough cough and offer my angle and explanation on something attempting a more collabrative angle. Egos are at play as in a lot of people interaction .
Keeping an open mind alongside standing in the truth of my experience .
Harder in the beginning though often and the internet was the way i got my recognition from medical services and ultimately where i am now accepted into secondary services ...its been a long road of self advocating .
Going back to lylas thread here she is struggling to get the recognition she needs . ..at a Gp level ...i know that place and its lonely .. I needed someone to advocate for me and when i turned to look around i realized it was just me and so i needed to try my very best to get the basics of what i needed .i was and do fight for my life .  the Gp as  door way to recovery is a door that often can have a rusty lock and stiff and loud hindges ...

[Rainagain]

I found it very hard to access treatment in the uk, just as others describe.

Around ten years ago I was having emdr treatment and yet the therapist rejected my suggestion that I might have ptsd.

That was the last time I tried to discuss potential diagnosis, it felt odd that I was being treated for a disorder the therapist didn't think I actually had.

The emdr helped me, the treatment for PTSD actually helped even though I apparently didn't have the disorder the treatment was for.

I found it bewildering, I learnt from that experience not to seem to challenge or even question the experts, they don't seem to appreciate it.

Lyla, the way your cannabis use was treated by the gp is a warning sign to me. Not only is self medication with cannabis very common with cptsd it does help to relieve certain symptoms.

I found it was great for my chronic pain, it allowed me to come off a daily dose of 125 mg of amatryptiline, which was basically sedating me so much I misplaced 5 years of my life.

I stopped using cannabis as it was causing issues but it was the best thing for the pain I've ever found.

Its such a common thing that the GP should have recognised that fact, my last psych couldn't really accept I wasn't self medicating with drugs or alcohol, he asked me several times in different ways about it.

[SharpAndBlunt]

LylaMoshi I was prescribed Mirtazapine in 2015 and made the decision myself to come off them just last year. I was on 30mg. Initially I couldn't sleep and they helped with that.
The doctor diagnosed me with depression after a 5 minute meeting. I have had anxiety all my life which sometimes ends up in a depression but it is not the root problem.

I learned about cptsd through this site last year and since then I recognise this is what is affecting me.

I have been able to see a therapist in the last month or so through the NHS who agrees with complex trauma diagnosis. I have had to fight to get seen and listened to by doctors and psychiatrists and have been sent on courses for stress management, mindfulness, CBT. All of these things are useful but I have found much more education on the web and support on this forum.

Becoming aware of cptsd was a key moment that allowed me to take control a little bit though it is still hard.

I used to self medicate with alcohol and cannabis. Alcohol is really bad for the depression and mood in general and for me cannabis opens me completely to my emotions which is a dangerous place for me but I would advise you that if it works for you there is probably no need to tell your GP, especially with the judgemental attitude.

They seem to be telling you to more or less snap out of it which as we all know is a position coming from ignorance. I think it's good you are thinking of them more as a means to an end now.

I'm am in the UK as well by the way and I understand all too well the frustrations of being in the system.

[Wattlebird]

Just wanted to pop in and comment on cannabis, cannabis with high amounts of CBD has proven benefits to ptsd, and I'm also assuming cptsd. It has an anti psychotic affect, high THC is better for pain though it varies in individuals as does most things. The world health organisation has stated cannabis use is safe and many times better than alcahol but this attitude toward cannabis is still so indoctrinated it's hard for people to get their heads around the fact that it's possibly helping. Do your own research, I was firmly against cannabis use until I started researching it, there is some fantastic research coming out of Israel especially.
Just my opinion, I have found using and equal THC /CBD balance affective for sleep, anxiety and being able to reflect on my inner experiences without avoidance. I only have it at night but have found it invaluable.
Those doctors appal me, I'm sorry you had to go thru that, all the best. Wb