I know a few people here have experience of various meds, and I was hoping to ask for some advice.
My friend is struggling with a severe anxiety disorder. Over the years he has muddled through and self-medicated with booze, leading to predictably bad results.
He is also solidly neurodivergent (undiagnosed) and has always had a strong fear of meds, but knows he can't carry on like this. His GP recommended SSRIs, and he's terrified of the stories he's heard that the first 2 weeks can increase anxiety and cause suicidal thoughts. He's currently in crisis, is already having suicidal thoughts, and his anxiety is at 99.999% percent. In the last week he has been to A&E and asked them to section him (they didn't) and has moved into my front room because his home is full of things/memories that trigger him. There's just no room for anything that could increase anxiety.
Is the accepted strategy that you don't try to get on them in this state? Do you wait until the immediate crisis has passed and then try and taper on once you're in a better place, and might have headspace to deal with the side effects?
Any thoughts would be gratefully appreciated.
can't help i'm afraid but well done for supporting your friend. perhaps schedule another GP appointment so you could go with him and act as a another pair of eyes and ears? you could maybe ask the questions your friend needs to but can't or doesn't think to, and help remember what is said?
You call the doctors.
You ask NHS 24 or whatever the regional variation i.
You talk to a pharmacist.
You DO NOT act on advice on a mountain biking forum. Unless they caveat it with 'I am a doctor/ pharacist and am qualified to answer this" and "but they need to talk to their doctor/call nhs24/ talk to a pharmacist"
different ssris have different effects in different people. Suicidal ideation is mainly with one in particular iirc.
as above real asvice needed
Well done for stepping in, that is a very kind thing to do, make sure you also look after yourself.
as above, awesome work looking out for him.
The side effects always sounds horrendous and they have to be open about them but it doesnt mean he'll actually have them.
Its very individual but recent experience with SSRIs (escitalopram) suggest it was bloody fantastic. total game changer.
If he's with you anyway I'd say go for it, the GP (and probably also the pharmacist) will be checking in over that time so changes to dosage and/or type can be made.
best of luck
Can the GP refer him to the community mental health team?
it's the tapering off that's tricky. When starting, just follow the GPs instructions. (In my experience anyway)
Read the label (e.g. grapefruit and SSRIs don't mix well)
If there isn't one already, push for a referral for some actual therapy for the anxiety. It can really help but your friend will need to put the effort in.
Fwiw, I didn't have any adverse reactions to 50mg sertraline initially. Has affected my appetite though so I've gained a bit of chunk over time.
Made such a difference to how I handle life and my resilience when shit goes wrong has improved massively.
Can the GP refer him to the community mental health team?
That’s what I would suggest, referral to CMHT would come from GP and someone asking to be detained under the Mental Health Act 1983 sounds as though they are at crisis point.
The threshold for assessment in hospital is having a mental disorder of nature or degree which warrants detention, and being a danger to self or others.
He should be fine going on them and see real improvements in his mental health.Coming of them is a different story as mentioned above.Once stabilized on the medication he will then require some Counselling as well.Good luck and well done you.
We all need friends like you at times of crisis, you are a star.
I wasn't in full crisis when I saw my GP. We discussed my concerns about side effects, I was prescribed a low dose of one with reduced risk AND referred to appropriate therapy.
But the starting point is a GP/health professional. Here in Derbyshire we have a facility to contact the mental health teams direct ourselves.