I wonder if I'm depressed again. Antidepressant suggestions?

[Mimicry]

Long rant ahead, sorry in advance

I've been ill with ME since 2008 (since I was 19 years old), and had mental health problems and related fatigue already before that because of my traumatic childhood. I have CPTSD, dissociative disorder (depersonalisation, derealization and side personalities) and I get triggered easily by people behaving in ways that remind me of my abusive family. I've been dealing with my mental health since 2011 after the death of my abusive alcoholist dad in 2010 and have come a long way since then with the help of meditation and talk therapy. I have good coping mechanisms and am not easily phased by my physical symptoms. Except this year it seems to be going worse again.

I have been going through a lot of huge life changes during the last two years, and while I first had a huge remission in my ME symptoms starting in September 2020, my symptoms have been getting gradually worse since spring 2021. I used to take the SSRI sertraline for depression and anxiety for approximately ten years but finally managed to taper off it completely in the beginning of 2021. I wonder if it's actually the thing that caused my relapse.

The February and March 2022 were especially hard on me. For months I had already been supporting a friend with bpd who was going through severe depression. She was really draining me and I had to finally cut contact with her because of her impossible demands. Then my beloved pet died, I got covid, the Ukraine war started (I live in Finland so I was panicking over Russia attacking us, too) and after I'd got over covid, I received news that a dear friend of mine had committed suicide (not the same friend I mentioned earlier). I was dissociating hard and could not feel or process anything, really. I was also trying to slowly up my dose of LDN that I had started in December 2021 and it gave me severe side effects every time I tried to increase the dose by as little as 0.4 mg.

For the rest of the spring I felt a bit better but then I got chronic headaches in May. They were worse at first but nowadays it's just constant pressure in my head, every day. Not very bad but unpleasant. And I feel nauseous and my anxiety levels have gone up. I've visited several GP's but all they have prescribed me is meds for migraine attacks. I'm guessing hormonal BC was making the headaches worse at first but I got rid of the BC and that might have helped.

I moved in together with my boyfriend in July and I have the house and garden I've been dreaming about for years. And I love him so very much. But now it seems that something in my head flipped a switch and I'm wondering if I'm depressed again. I'm guessing the events half a year ago are finally catching up with me. My motivation and activity level has plummeted even though I feel like my ME symptoms are not that bad and my muscles work fine, I just feel nauseous, dizzy, achy and sluggish. I smoke weed to be able to feel the emotions that are hidden underneath the dissociation and mental exhaustion and when I do that, I try to meditate on the emotions. There's so much sadness and fear of losing my loved ones. But the weed itself causes a sort of hangover when I'm sober so I can't take it too often even though it makes me feel so much better.

What makes the matters worse is that the mental health services here are not in very good shape and I can't get a psychiatrist's appointment (I've been talking to a social worker though and she's trying to find a psychiatrist for me).

I've been wondering if I should just ask my GP for a prescription for amitriptyline (which is a tricyclic antidepressant) since it apparently helps with nausea and headache. I found a half-full packet of my old antidepressants and started them on a tiny dose even though it might not be the best idea since I might have bipolar disorder (doctors refuse to diagnose it because my hypomanic episodes have never been bad enough for me to completely wreck my life, lol). I can't take bupropion or other stimulants because when I tried it for 8 months, my anxiety skyrocketed.

I'm not sure what the point of my rant is. Does anyone here have experience with amitriptyline? Thanks for reading, anyway

 

[katabasis]

I do have some experience with amitriptyline, but not as an antidepressant per se. Back before I had CFS, I was dealing with severe IBS, and was prescribed amitriptyline for that. The dose I was taking (25 mg) is much lower than the typical dose used to treat depression (75-150 mg per day, usually). I did not find it effective for IBS, and if anything I felt it actually made me depressed. It seemed like I was less able to feel strong emotions, which I suppose might be an advantage for someone who is actively depressed, but in my case it seemed merely to remove my ability to feel joy.

Like most tricyclic antidepressants, amitriptyline has lots of side effects and interactions with other drugs, especially compared to newer antidepressants like SSRIs. However, for some people, tricyclics are simply more effective. And of course, the situation is complicated by your having bipolar disorder - both tricyclics and SSRIs are a risk factor for mania or hypomania. A small dose may not be as much of a risk but it's something to keep an eye on.

One supplement I have found helpful for improving mood, and one which has also been used by several people I know to treat depression, is sarcosine, which is a glycine reuptake inhibitor. Notably, you can buy sarcosine online without a prescription, and it has much fewer side effects than most antidepressants. It is apparently also effective at treating schizophrenia as an adjunct medication, so it's probably not likely to provoke severe mania, though I've seen case reports of sarcosine triggering hypomania in schizophrenic patients (these were resolved with reducing the dose). If you try sarcosine keep an eye out for bipolar symptoms.

I also don't know how sarcosine would interact with ME/CFS - it seems like one of sarcosine's main mechanisms is by increasing mTOR, and I've seen research which suggests mTOR is already elevated in people with ME/CFS. Whether that's pathological, or a compensatory state which is actually beneficial, I have no idea. I have also not seen many experience reports on sarcosine from people with ME/CFS.

 

[heapsreal]

I have been going through a lot of huge life changes during the last two years, and while I first had a huge remission in my ME symptoms starting in September 2020, my symptoms have been getting gradually worse since spring 2021. I used to take the SSRI sertraline for depression and anxiety for approximately ten years but finally managed to taper off it completely in the beginning of 2021. I wonder if it's actually the thing that caused my relapse.

Possibly a reason was tapering off for your relapse as you mentioned, not that long apart or ago since being off.

If Sertraline worked for you in the past I'd stick with it. Sertraline and lexapro seem to be the best for most people including cost, side effects, effectiveness etc.

I also wouldn't rule out something else going on and get a full blood test covering all basics and if access to descent viral testing, get it too.

 

[Mimicry]

I do have some experience with amitriptyline, but not as an antidepressant per se. Back before I had CFS, I was dealing with severe IBS, and was prescribed amitriptyline for that. The dose I was taking (25 mg) is much lower than the typical dose used to treat depression (75-150 mg per day, usually). I did not find it effective for IBS, and if anything I felt it actually made me depressed. It seemed like I was less able to feel strong emotions, which I suppose might be an advantage for someone who is actively depressed, but in my case it seemed merely to remove my ability to feel joy.

Like most tricyclic antidepressants, amitriptyline has lots of side effects and interactions with other drugs, especially compared to newer antidepressants like SSRIs. However, for some people, tricyclics are simply more effective. And of course, the situation is complicated by your having bipolar disorder - both tricyclics and SSRIs are a risk factor for mania or hypomania. A small dose may not be as much of a risk but it's something to keep an eye on.

One supplement I have found helpful for improving mood, and one which has also been used by several people I know to treat depression, is sarcosine, which is a glycine reuptake inhibitor. Notably, you can buy sarcosine online without a prescription, and it has much fewer side effects than most antidepressants. It is apparently also effective at treating schizophrenia as an adjunct medication, so it's probably not likely to provoke severe mania, though I've seen case reports of sarcosine triggering hypomania in schizophrenic patients (these were resolved with reducing the dose). If you try sarcosine keep an eye out for bipolar symptoms.

I also don't know how sarcosine would interact with ME/CFS - it seems like one of sarcosine's main mechanisms is by increasing mTOR, and I've seen research which suggests mTOR is already elevated in people with ME/CFS. Whether that's pathological, or a compensatory state which is actually beneficial, I have no idea. I have also not seen many experience reports on sarcosine from people with ME/CFS.

Thanks for your reply! Yes, as far as I know tricyclics work differently when prescribed in small doses (for sleep and pain etc) versus in large doses. That's one thing I've been wondering about and I guess I need to ask the psychiatrist when I finally get an appointment. Also feeling less emotions might not be a good thing for me because I already have trouble feeling them due to the dissociation. Whenever I'm able to access them through meditation and/or weed I feel much better afterwards.

I need to read more about sarcosine (and mTOR), I'd never heard about it before and I've tried dozens of supplements! Thanks for the suggestion. I already have glycine in my cupboard because I read that it may improve sleep. Acetyl-L-carnitine and NAC are also said to help with mood but I've taken them regularly for months but haven't noticed much improvement, except maybe for brain fog.

 

[Mimicry]

Possibly a reason was tapering off for your relapse as you mentioned, not that long apart or ago since being off.

If Sertraline worked for you in the past I'd stick with it. Sertraline and lexapro seem to be the best for most people including cost, side effects, effectiveness etc.

I also wouldn't rule out something else going on and get a full blood test covering all basics and if access to descent viral testing, get it too.

Thanks for your reply! I actually have been wondering if there's something else going on. I started to use zinc, calcium, vit A, E and K supplements last month because based on what I've read I guess I might be deficient on those and I have Beau's lines in my fingernails that could indicate a zinc deficiency. My TSH, electrolytes, iron levels, liver and kidney enzymes + inflammation markers were checked on July and everything was perfectly fine, all the levels were basically right in the middle of the reference values.

I was diagnosed with ME a year ago and a year before that, in summer 2020, they did a more thorough bloodwork (IgG for EBV was elevated and cortisol was low, but ACTH test showed normal response to ACTH so apparently the problem is not with my adrenals but with my pituitary). I moved to a new municipality in July and got a new GP. I already talked to her about whether we should monitor my cortisol and she promised to read up on it before our next meeting in Oct 7.

I'm pretty sure though that the low mood I'm feeling right now is due to the difficult year. And I think it's pretty normal all things considered. I agree with you on sticking to sertraline. It used to have some super annoying side effects and seems to have triggered some hypomanic/mixed episodes in the past but I'll just need to look out for those and maybe use a lower dose than the full dose I used to be on.

 

[Emmarose47]

Hi Mimi
I relate a lot to your share ..
I have cptsd . I also parted ways with a long term friend with BPD .... Hard work !!

I take Amitriptyline low dose 10mg for nerve pain in my head . I've found it a sedating drug and couldn't imagine taking it in higher doses .

I take citalopram SSRI for the cptsd and it helps a bait I can't cry with is crap ...

 

[JES]

Hey, nice to see someone from Finland on PR, can't remember seeing another Finn in years here.

You mentioned bipolar disease. I learned about this a bit since I wanted to get a prescription for Abilify. It helps some of us with ME/CFS. So I went to a psychiatrist and suggested I had episodes of hypomania. Didn't work. Tried the same thing with another one. Turns out they are reluctant to diagnose bipolar disorder, can't understand why. It seems the only way to get a bipolar disorder diagnosis here is from the state hospital units or something, so I decided to not go further with my pursuit to get Abilify prescribed...

I did, however, manage to get one doctor to prescribe me lamotrigine. If you have hypomania and episodes of depression, lamotrigine supposedly helps with the depression part. I also read that in bipolar depression, typical antidepressants are not effective.

There are some other antidepressants you might have some luck getting prescribed. Moclobemide is one interesting one sold in Europe. I reckon people here on PR have had some response to it. Then there is of course bupropion and a bunch of tricyclics, not only amitriptyline, but also other ones like trimipramine.

Well, I hope that was of some help and it's also interesting that you managed to get a diagnosis with ME/CFS in Finland. That's even more difficult here than getting a bipolar diagnosis...

 

[Mimicry]

Hey, nice to see someone from Finland on PR, can't remember seeing another Finn in years here.

You mentioned bipolar disease. I learned about this a bit since I wanted to get a prescription for Abilify. It helps some of us with ME/CFS. So I went to a psychiatrist and suggested I had episodes of hypomania. Didn't work. Tried the same thing with another one. Turns out they are reluctant to diagnose bipolar disorder, can't understand why. It seems the only way to get a bipolar disorder diagnosis here is from the state hospital units or something, so I decided to not go further with my pursuit to get Abilify prescribed...

I did, however, manage to get one doctor to prescribe me lamotrigine. If you have hypomania and episodes of depression, lamotrigine supposedly helps with the depression part. I also read that in bipolar depression, typical antidepressants are not effective.

There are some other antidepressants you might have some luck getting prescribed. Moclobemide is one interesting one sold in Europe. I reckon people here on PR have had some response to it. Then there is of course bupropion and a bunch of tricyclics, not only amitriptyline, but also other ones like trimipramine.

Well, I hope that was of some help and it's also interesting that you managed to get a diagnosis with ME/CFS in Finland. That's even more difficult here than getting a bipolar diagnosis...

Moi! I'm super tired and heading to sleep soon but I'll try to type some sort of response, lol. Yeah AFAIK it's super difficult to get a ME diagnosis here and I feel lucky. I guess I managed to convince them at the hospital (I was diagnosed at TAYS väsymystyöryhmä, I don't have the brain power to translate that to English right now) that it can't be due to mental health issues because despite my mental health getting better all the time my physical symptoms were just getting worse year by year and since PEM has always been my worst and clearest symptom, it was a clear-cut diagnosis.

I've taken trimipramine for sleep and I feel like it might have triggered a bit of a manic state in me. I took bupropion for eight months and it made me super anxious. I've been considering lamotrigine but apparently it's better for preventing depressive episodes than treating them. Quetiapine helped my last "hypomanic episode" tremendously but I hated how dizzy it made me feel at night so I quit it after taking it for over a year, and it also made me anxious with higher doses so couldn't take more than 50 mg a night (bipolar is usually treated with 200-600 mg per day). Both me and the psychiatrists are stumped at whether I really have bipolar or not. My sister has the diagnosis but apparently does fine without meds. I'm not at all convinced that I have it but my last "hypomanic episode" two years ago was extremely uncomfortable, I felt agitated, anxious and restless and couldn't sleep nor eat and lost 8 kg in two months. So I definitely respect the possibility that a normal antidepressant might actually trigger mixed or hypomanic episodes. Sertraline helped my depression a lot but it wasn't perfect by any means.