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Stuck with antidepressants
Hello Doctors
I was diagnosed with Generalized Anxiety Disorder (GAD) and Major Depressive Disorder (MDD) around 10 years ago.
Treatment history
• Initially treated with SSRIs and Venlafaxine for ~3 years → mood improved but developed severe sexual side effects (ED and PME)
• Later tried Bupropion XL → developed intense suicidal thoughts within 1 week, so stopped
• Then used Citalopram and Escitalopram intermittently
• For the last ~4 years, I have been on Desvenlafaxine 50 mg + Mirtazapine 7.5 mg, later reduced mirtazapine to 3.75 mg
Current medications:
• Desvenlafaxine 50 mg daily (recently advised to increase to 100 mg)
• Mirtazapine 3.75 mg at night (cannot reduce further due to insomnia)
• Supplements: magnesium glycinate, fish oil, vitamin D3, vitamin B12 (regular)
Past trials:
• Vortioxetine – no noticeable benefit or side effects
• Mucuna pruriens – caused discomfort, so disc
Answers (16)
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Please start taking therapy. It's beneficial and can help medicine to work better.
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Hi
It is always good to take therapy along with medicines. Mental disorders treated along with both will have far more sustainable results than just medicines.
Next Steps
Consult a clinical psychologist asap
Change your psychiatrist and explain to him your issue and if he can reduce the medicines
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Do this asap
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It is clear that you have been managing these challenges for a long time, and seeking support is a significant and brave step toward your well-being.
When dealing with Generalized Anxiety Disorder (GAD), it is helpful to view psychotherapy as a long-term commitment rather than a quick fix. Through consistent, structured work, you can develop the resilience needed to navigate future stressors and learn practical tools to address the underlying anxiety patterns and negative thinking cycles that keep the GAD going.
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Regarding your treatment plan, it is important to remember that therapy is not a substitute for medication. Decisions about specific medicines related to psychiatry ,their frequencies, and durations—must ONLY be managed exclusively by your psychiatrist. However, we often find that biology and behavior work wonders when addressed together; with the right combination of medical supervision and psychological support, improvement is absolutely possible. Over time, as you gain more coping strategies through therapy, there are often chances that medication dosages may be reduced under a doctor's guidance.
Health Tips
Structured Therapy: Work on anxiety rumination, sleep regulation, and behavioral activation.
Somatic Anchors: Practice deep breathing and grounding to manage physiological symptoms.
Movement: Incorporate regular physical movement or exercise to support mood stability.
Routine: Establish small daily routines to provide a sense of predictability and control.
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Hi!
For Generalized Anxiety Disorder (GAD) and Major Depressive Disorder (MDD), a combined approach works best. Counselling helps manage thoughts, emotions, and coping skills, while psychiatric treatment supports biological balance. Together, they provide more effective and lasting recovery.
Next Steps
For counselling you can contact me.
Health Tips
As early as possible take counselling!
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Hi psychotherapy is very helpful for you
Next Steps
Connect
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Connect
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Hi,
You’ve been fighting this for ten years. That’s not weakness. That’s endurance. First, the sexual side effects on SSRIs/SNRIs are common. They’re not “in your head.” They’re a known biological effect of increased serotonin dampening dopamine and sexual signaling. Your body is responding predictably. Second, the suicidal thoughts on bupropion within a week that matters. Rapid emergence like that is a red flag for you personally. That medication may not be your match, even though it works well for others..
Your mirtazapine dose (3.75 mg) is basically being used as a sleep regulator, not an antidepressant. At that low dose, it mainly acts as a sedating antihistamine. That explains why you can’t drop it without insomnia returning.
What matters most right now is this question:
Are your current symptoms mostly anxiety? low mood? low motivation? sexual dysfunction distress? sleep?
Treatment direction depends on the primary suffering.
Next Steps
Psychotherapy focused on anxiety regulation medication alone rarely resolves GAD fully.
Health Tips
stabilize your nervous system daily. Not theory. Practice.
Twice a day, 5 minutes:
Slow breathing. Inhale 4 seconds, exhale 6–8 seconds. Longer exhale tells the brain “we’re safe.” Do it even if you don’t feel anxious. This trains your baseline.
shrink your day.
Depression overwhelms by making everything feel heavy. Don’t aim for productivity. Aim for three non-negotiables daily: 3 not 10
1 small body task (shower, short walk, stretch)
1 responsibility task (email, bill, work item)
1 human connection (text, call, brief conversation)
stop wrestling thoughts.
GAD feeds on “what if.” When a worry shows up, say internally:
“Maybe. Maybe not. I’ll handle it if it happens.”
You are not trying to win the argument. You are refusing to fuel it.
protect sleep gently.
Wind-down routine 45 minutes before bed.
No analysis of life in bed.
If awake more than 20–30 minutes, get up, dim light, boring activity, return when sleepy. This retrains insomnia instead of fighting it.
sexual side effects.
Shame makes this worse. Stress worsens erectile response. Pressure worsens it further.
Remove performance focus. Shift to connection, not outcome. Anxiety shuts down arousal through the same fight-or-flight system you’re already dealing with.
monitor, don’t obsess.
Once a week, rate:
Mood (1–10)
Anxiety (1–10)
Sleep quality
Energy
That’s enough data. Daily checking increases rumination.
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GSD and MDD needs to be treated in a holistic approach for complete recovery otherwise you might face a lot of side effects.
It can be well treated with counseling sessions and homeopathic medicine effectively and without any side effects.
You can consume both allopathic and homeopathic medicine together for some time to get stability and avoid relapse or withdrawal symptoms.
Long term allopathic medicines may not do any good but can worsen the situation.
You need to be patient enough during the holistic line of treatment
You need an expert Homeopathic psychiatrist who is a good counselor.
Next Steps
I have been working as a homeopathic Psychiatrist and Counseling psychologist for the last 17 years of experience. You can contact me through an online appointment for further assistance.
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Consultation with me is advised
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Hi,
I understand, that you have been navigating this for many years , that reflects strength.
Medication adjustments are important and must always be guided by your psychiatrist, especially given your past reactions.
But medication manages symptoms; it doesn’t always address the underlying anxiety patterns, negative thinking cycles, or emotional processing that keep GAD and depression going.
With structured psychological therapy work can make a meaningful difference alongside medication. Anxiety and depression are highly treatable when both biology and behavior are addressed together.
Most importantly , any return of suicidal thoughts during medication changes should be treated as urgent and discussed immediately with your doctor.
With the right combination of medical supervision and psychological support, improvement is absolutely possible.
Health Tips
Do deep breathing, begin structured therapy to work on anxiety rumination, sleep regulation, and behavioral activation also , small daily routines and regular physical movement , exercise can significantly support mood stability.
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Hi,
Please consult a Psychiatrist.
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Hi, Consult a psychiatrist
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Hi
connect with the psychiatrist and a psychologist
Next Steps
Connect
Health Tips
seek help
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Hi
Next Steps
psychotherapy session
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hi
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Mr. Gunjan Maithil
Psychologist
13 yrs exp
Bangalore
Hi... This is a common issue and since you have not mentioned what you are seeking out here. I believe you're feeling stuck in this loop of anti-depressants- SSRI, NDRI, SNRI, NaSSA, etc. and seeking a way out.
Most people with such conditions often misunderstand treatment or aren't properly guided on their recovery journey by the professional (doctor/psychologist) they are consulting.
Professionals often avoid sharing prognosis in initial sessions to avoid any negative interferance caused out of stigma, prejudice, inhibitions attached to a mental health condition. But after 6-8 weekly therapy sessions (psychologist) or 2-3 months of medications (psychiatrist) have a fairly clear picture of what the person is suffering from and how long will it take for them to recover.
Psychoeducation - 'Educating the client about how his/her treatment will work', is an integral part of their treatment and without it, the client feel lost, demotivated, and lacks confidence in his/her ability to recover.
You can ask for a recovery status from the professional you are consulting and also seek guidance from other professionals by consulting them in a formal session.
In most cases, therapy and medications go side-by-side but often clients have a prejudice about one form of treatment so they follow only the other one that they consider effective. This not only elongates their treatment duration but also creates hurdle in their recovery if they have opted for the part of threatment that is not the main cause of their condition. For example, if the cause is more psychosocial - therapy will take primacy. But if the cause is more biological, genetic, neurological - medications and other forms of treatment will become more relevant.
I hope I have answered your query. Please trust the treatment and the professional you are consulting. You can always take a second opinion from another similar professional (psychiatrist, in your case) if he feels disillusioned.
Next Steps
Consult a Psychiatrist for any change in Medications.
Consult a Psychologist.
CBT along with Interpersonal Guidance and Counselling is absolutely necessary.
Try to follow a healthy routine, in terms of, proper and timely - meals, sleep, exercise, and breathing/ meditation. It will help you catch hold of your present mental state.
Health Tips
Mr. Gunjan Maithil
Senior Psychologist
Cell: nine six seven one three zero three one three four
Website: https://gunjanmaithil.wixsite.com/therapy
App: http://wix.to/fechb08?ref=cl
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Ms. Rizwana Parvin T M
Counselling Psychologist
7 yrs exp
Coimbatore
It seems like a chronic illness, so it will take time to get better. Start with weekly counselling sessions.
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Ms. Smriti
Counselling Psychologist
18 yrs exp
Bangalore
Connect with psychiatrist and psychologist
Next Steps
connect
Health Tips
consult
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Disclaimer : The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding your medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.