I agree with my Pdoc but I feel 'cheated'

I saw my Pdoc today, she had done her homework on what meds I might be able to tolerate and the list was pretty short. Top and bottom of the list is Lithium, we talked this through and we both agreed that it isn't the right choice for me right now. The plan of action is that I stay on Agomelatine, which isn't causing me any problems and is really good at regulating my sleep, my appetite and energy levels but it isn't lifting my mood as much as I would like. I'm going to start Cognitive Analytical Therapy in the New Year, hopefully that will work on my mood. Until then I have plenty of support from a community psych nurse. So why do I feel a bit cheated?

I've had so many different problems with meds in the past couple of years that I was fearful of changing yet again and none of the meds I've tried have been a magic bullet so I'd no real expectation that I'd be cured by meds.

I've never been a huge fan of therapy, especially if it involves digging around in the murky recesses of my childhood. However, CAT isn't that kind of therapy and by reading through the material I've been given I can see how the examples relate to my behaviour and things I know I need to work on. Despite my general reservations about therapy I do believe this will be good for me.

My Pdoc has very much left the door open for me to go back and talk about trying Lithium any time I want. Part of me knows I've struck Pdoc gold, she listens, she doesn't push meds, she lets me make the choices and respects my opinion, most importantly I can change my mind if I want to. So why on earth do I have this vague antipathy that I know is completely unreasonable?

I would guess because there was no change in anything and secretly we all want a magic pill.

You might consider Lamictal instead of lithium as an augmenter. Low side effect profile. No worries about lithium toxicity and worse side effects. It lifted my mood and we tried it without any other changes to make sure we knew what it did. Within two weeks big elevation in mood and no side effects at all.

Any therapy is hard work. I like CBT very much at it only deals with the present.

I would also highly suggest meditation.

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I know you're right Zinco, I was being like a kid at christmas. I really wanted that puppy, I knew I wouldn't get the puppy, but until christmas morning there's always the dream. Now christmas morning has been and gone there's no puppy and nothing much to look forward to except another long wait.

Part of the problem is that having had such a long wait to get psychiatric care, I set too much store by it. I'd already figured out my choices were going to be limited, I just didn't want to hear that officially. My urinary problem has reoccured with enough ssri/snri/tca antidepressants to know that it won't be worth trying out the few I haven't already tried. My Pdoc doesn't favour MAOIs, there are no new drugs due for release in the UK anytime soon. That leaves Lithium, anti-psychotics and then anti-convulsants. I've got to try them in that order, apparently. Anti-psychotics could well cause urinary problems and when it comes to anti-convulsants, then it would be valporate or carbamazapine, in the UK Lamictal is only an option for Bipolar.

Now I've got to wait until the New Year for therapy and I really want that to help, I'm just so fed up of waiting. I ought to be quite good at meditation, I used to like breathing and relaxation exercises and be able empty my head pretty well. I say used to because depression seems to rob me of this and my ability to daydream too.

I know I'm being hopeless and helpless, I know I need to put in more work myself and rely less on the medical world. It is just SO hard to do that.

It's for sure hard when you are depressed. Meditation can be impossible. Everything is hard. You are making progress though and moving in the right direction. I think the UK is stricter because here they prescribe stuff off label all the time like Lamictal.

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I'm not sure whether the system is stricter or whether I just got a pdoc who doesn't like meds that much. I'm sure that there will be pdocs somewhere in the UK prescribing off licence, probably at the specialist regional centres or those in private practice. My pdoc is a community psych, then there are hospital psychs (sometimes one pdoc performs both roles), then there are the regional centres with their own specialists.

I'm feeling a bit better about things now, I just needed time to regroup. My biggest worry is work, they are really putting me under pressure wanting a date when I can return to full duties. I suppose I was hoping that tweaking my meds might have done the trick by christmas. Now I'll be telling them that I'll want half a day a week to see the therapist and that will be until Easter or beyond.

I figure the most important thing for me is keeping my anxiety in check and when everything else fails, I have the diazepam for that. I managed 30 minutes of relaxation exercises today and I was almost drifitng into meditation when the dog came and pestered me, she wanted a game. I didn't mind as playing with her is soothing in itself.

That is great, good for you. I think the pams can be life savers. Better to nip it in the bud before it spirals and leads to worse depression.

Work is the biggest dilemma when it comes to all this isn't it? It's the biggest problem I am facing.

Just been told that from April my job doesn't exist. Don't know anything more until Wednesday. Just when I come to terms with one thing I get hit by something else. At the moment self respect at zero.

WTF that's terrible. Does that mean you will get laid off? Or what you call redundant? I hate the word redundant for that situation.

As far as I can tell, I get to choose between an enhanced cash payment now or hanging on until April in the hope they find me another role. If in April I haven't got anything else then they give me 12 weeks notice before laying me off. I need to find out what my disability rights are as they might help make my choice easier. I have trouble admitting depression is a disability even though legally it is.