Citalopram and practice

Re: Citalopram and practice

Braden Collins — Sun, 05 Oct 2014 15:01:10 GMT

Sounds like you need a new boss!

Thinking a bit outside the square - we have one of our vets who has bouts of depression. At their last annual review, we decided that we would give her an extra week off each year which can be taken as individual days, so she can either ask to have a day off at short notice, or if we notice her struggling we can make her take a day off. We found each time she was heading down hill she would start to make mistakes with billing in particular. She is such a great team member that we wanted to look after her, and avoiding those billing mistakes makes it worth while having her away for the day. We have already had to ask her to have one day off, but it seemed to help her immensely (I think mostly just because she knew we cared), and she came back with a bit more of a spring in her step. She has told us she was about to take time off for stress leave anyway, so the reality is it didn't cost us anything extra, and had a lot of benefits.

Would your boss be open to such an idea? If they're worth your loyalty they have to help you out, otherwise they'll lose you as a vet. I know it's not the complete answer, but if work is a large part of the problem some of the solution needs to come from there.

Re: Citalopram and practice

listhestar — Sat, 04 Oct 2014 21:37:38 GMT

Is there any ability to change jobs? When I had health problems I went to boss, explained that my hours were contributing to poor health and I needed to reduce or I would move to another job (not bribing more just that I understood if the business cant afford to support it). You only get one life and health is priceless. My father worked hard all his life, so hard sometimes that we'd ask him to stop, heart attack at 52, nearly died and dementia by 60. He turnt to me the other day and said "look where working so hard got me". It makes you think and reassess life.

Good luck. I hope you find a resolution. Feeling like this is horrid.

Lisa

Re: Citalopram and practice

Anne Seawright — Tue, 16 Sep 2014 22:04:47 GMT

Antidepressants aren't 'clean' drugs. They work by increasing neurotransmitters, some more specific neurotransmitters, such as SSRI's (but even some of them have affects on other neurotransmitters, such as noradrenalin) and some several neurotransmitters, such as TCAs (which will have more side effects). However, there aren't any psychoactive medications that target specific neurotransmitters receptor sites and that means that tey have an action at both pre and post synaptic receptors and in lots of different pathways. This means the effects are complex and vary depending on relative amounts of existing receptors in that individual and interactions with other neural pathways and other neurotransmitters. That doesn't mean that people suffering from depression don't have deficits in neurotransmitters, or that antidepressants aren't a useful treatment, just that it isn't as simple as there being a deficit, giving a supplement and everything going back to normal. Psychoactive medication is also not a cure all to allow a person to cope with extreme stress or demands being put on them. Believe me, I know how difficult it can be to get away from work situations that are not healthy but changing jobs, or being able to effectively manage your work sounds like it would be more effective for you than any amount of medication. As for getting your boss to listen to you and give you the support you need, I don't know what to suggest, other than agreeing that they sound like someone you would not want to work for! Like others have offered, feel free to PM me if you want to talk more. I am very happy to share my experiences. (By the way, the theraputic dose rate for fluoxetine for an adult is 20-80mg and when we suggest a low loading dose we suggest under therapeutic dose, so would suggest about 10mg for a week/ 2 weeks depending on patient response, before gradually increasing to effective dose to prevent the pretty common horrible gastro-intestinal side effects.)

Re: Citalopram and practice

bob lehner — Tue, 16 Sep 2014 13:53:38 GMT

Well if what you say is true, your boss is an idiot and you should leave.

Re: Citalopram and practice

Mark Hedberg — Tue, 16 Sep 2014 13:03:01 GMT

If you're not getting the support it's time for you to move on. It's not fair to you to bottle things in so he doesn't have to face the music. The 50mg is a good dose for about 2 months, then try bumping up to 100mg. Don't feel resentful; the meds are a tool, not a crutch.

Re: Citalopram and practice

An On MRCVS — Tue, 16 Sep 2014 13:00:13 GMT

Thanks for the replies, it does help to hear from people who have been there.

[quote user="Kate Richardson"]Firstly find yourself a new doctor who is more knowledgable and caring about depression- waiting for a referral appointment for months only to get sent back to the doctor is ridiculous. [/quote]

I do have a good GP - she is fantastic, knowledgable and caring. Unfortunately I live in an area where mental health services are over-stretched and underfunded, and more geared up to addiction etc. The MHT is nurse led so can't prescribe, so they asked my GP to prescribe an antidepressant while I continued to see, and am still seeing the MHT, with GP appointments as necessary. I realise that wasn't clear in my post - sorry.

[quote user="Kate Richardson"]Secondly, don't think about them as anti-depressants- I think of them as a supplement my body needs as it doesn't produce enough of it itself.[/quote]

This is the thing I really struggle to accept. I'm not convinced about the evidence and I also feel that if you are just topping up what is missing, why would there be such bad side effects. If you give the correct dose of florinef to an addisonian, insulin to a diabetic, or thyroxine to a hypothyroid you get a return to normal, not unpleasant additional reactions.

[quote user="Kate Richardson"]All of the advice re diet and exercise is good, but when you get depressed motivation becomes much more difficult[/quote]

It's not motivation that's the problem, it's just not having enough time because of my workload I have two lively dogs who provide motivation whether I like it or not

[quote user="Anne Seawright"]One thing I would suggest that not many doctors seem to (but we do with animals) is using a low loading dose for the first week/fortnight to minimise the side effects[/quote]

The starting dose I was prescribed is 50mg which the GP said is the lower end of the dose rate

[quote user="Anne Seawright"]You may not be in a situation to consider it at the moment but it sounds to me like the pressure from your work is the major contributory factor, and no amount of medication will mask being over worked. Are you able to make any changes before you completely burn out?[/quote]

This is the real problem and another reason why I feel almost resentful about having to consider medication to cope with a situation that is becoming untenable. I am the only full time vet in the practice, my working days are significantly longer than any of my colleagues or my supposed hours, my responsibilities are heavier, my turnover is higher (relatively aswell as absolutely) so it isn't that I am not able to work hard. I have a few years ago been signed off with work related stress and my boss knows about my depression, yet any attempt to discuss my workload or other issues results in him simply trying to avoid the problem by shutting down the conversation as fast as he can, and making it absolutely clear that he feels my problems are nothing to do with him or the practice. The last attempt, where I actually said I felt I was heading for a breakdown and couldn't cope, he got ever more hostile which left me in tears but it hasn't been mentioned since. I am not the first employee he has done this to and I know I need to leave but it is difficult for lots of reasons

It really does help to hear other people's direct experiences and it does make me feel happier about trying medication again. Really - thank you. It does help to feel not so alone

Re: Citalopram and practice

Anne Seawright — Tue, 16 Sep 2014 10:13:13 GMT

Different anti-depressants suit different people so just because you have had a negative experience on one doesn't mean you will have the same with another. One thing I would suggest that not many doctors seem to (but we do with animals) is using a low loading dose for the first week/fortnight to minimise the side effects, as at the start of the course is when they are likely to be worse. You may not be in a situation to consider it at the moment but it sounds to me like the pressure from your work is the major contributory factor, and no amount of medication will mask being over worked. Are you able to make any changes before you completely burn out?

Re: Citalopram and practice

Noweia — Mon, 15 Sep 2014 19:37:44 GMT

Me! I switched to it after fluoxetine made my dry eye flare too much. Tried citalopram but it wasn't helping the eyes either so now on sertraline. I've noticed less heartburn with it than with fluoxetine.

PM me if you fancy a chat!

Re: Citalopram and practice

Kate Richardson — Mon, 15 Sep 2014 12:41:00 GMT

Just like to add that the birth of my daughter itself wasn't traumatic (well no more than I expected although you really don't care when it all kicks off!)- don't want to put anyone off having children! Best thing ever, and gets better every day, bless her little cheeky monkey climbing on everything and getting into pickles cotton socks! Nothing can prepare you for the reality, though and the initial stress and anxiety of the unknown just triggered some anxiety and hence back onto meds. That and wine now keep me sane!

Re: Citalopram and practice

Bob Russell — Mon, 15 Sep 2014 10:39:58 GMT

I got ratty and had really vivid dreams and woke up with a bit of a sense of unreality. I was then put on mirtazapine (at night) which knocked me out so I slept like a baby but did not want to get up in the morning! Killer headache when they were stopped!!

All I use now is occasional mirtazapine to help with sleep when clients/accountants/bank managers wind me up too much.

Re: Citalopram and practice

Kate Richardson — Mon, 15 Sep 2014 09:24:10 GMT

Firstly find yourself a new doctor who is more knowledgable and caring about depression- waiting for a referral appointment for months only to get sent back to the doctor is ridiculous. There ARE good doctors out there!

Secondly, don't think about them as anti-depressants- I think of them as a supplement my body needs as it doesn't produce enough of it itself.

Regarding Sertraline, I have been on it for 18 months now. I had been on venlafaxine for several years which I had no noticeable side effects on. I managed to very slowly wean myself off, plus got myself in a better place mentally, but had a relapse following the birth of my daughter, so the doctor put me on sertraline as I was breast feeding. I have no side effects, except when I forget to take it! and that goes for the venlafaxine as well, withdrawal effects are a bit unpleasant but manageable (mainly nausea in my case) but that and my mood reminds me to take it!

All of the advice re diet and exercise is good, but when you get depressed motivation becomes much more difficult. Medication helps you get yourself into a better place and then you may find you can work through your issues and eventually come off the medication. If you can't, no big deal. My attitude and enjoyment of life changed immeasurably for the better since I started my serotonin supplement.

So go for it and good luck

Re: Citalopram and practice

Mark Hedberg — Mon, 15 Sep 2014 08:56:12 GMT

Sertraline is a big improvement over citalopram. PM me and let's talk.

Cheers,
Mark

Re: Citalopram and practice

An On MRCVS — Sun, 14 Sep 2014 22:19:28 GMT

Apologies for digging up an old thread but it's a similar theme. Has anyone experience of taking Sertraline (Lustral or Zoloft).

I've been having problems with depression for a while but particularly bad the last year. I've been unwilling to take anti-depressants because of feeling wary of messing around with something as fundamental as neurotransmitters. Saw my GP in January who referred me to the mental health team. Several months later when I had my 1st appoinment they felt I was too depressed to be able to manage any sort of talking therapy and asked my GP to prescribe an antidepressant. I decided to give it a try because it made sense. I was prescribed 2 weeks of Fluoxetine and, although I was expecting some side effects, I wasn't prepared for just how ill I felt. I had nausea, severe heartburn (which I've never had before), could barely eat, felt freezing cold all the time, shivering, and wasn't sleeping more than 2hrs a night (the rest of the night felt like every negative memory possible was buzzing round my brain and I felt suicidal on a daily basis). I stuck out the 2weeks, and the side effects did not reduce at all, so I was glad when they finished because I was barely functioning and worried about making mistakes at work.

Several months further on my depression is worse, mainly due to my workload/responsibilities getting ever heavier to the point at which I have begun feeling physically ill aswell. I keep getting told to eat a good diet, exercise etc but I am not leaving work until 1-2 hours beyond my finish time each night and the work is more and more intensive during the day so it is difficult to take breaks. I asked my GP about trying a different drug but when I came to take the first dose I just couldn't do it through fear of going through the same sort of hell, particularly at a point where I am even less able to cope with it.

Re: Citalopram and practice

elizabethellison — Wed, 15 Dec 2010 19:40:09 GMT

Hi All

I just wanted to add my experience in case it helps anyone and to say I agree with many of the things written so far. I was prescribed citalopram for post natal depression after having 3 babies close together (including a set of twins so not entirely to blame for that!!) and found it wonderful with no side effects. I was advised by my very good GP that serotonin gets depleted when we experience stressful things and drugs like citalopram purely help to restore the levels to a point at which we can cope better. Like a previous poster's experience with diazepam it actually made me realise how generally stressed and miserable I was for many years and only wish I'd taken it earlier when advised to by a GP when I had to have 2 weeks off work with 'stress and anxiety'. I do know several people who take it and they have all been helped. It takes at least 2 months to really start working and I was advised that I had to take it for at least 6 months after feeling 'normal' (whatever that is!). For various reasons I have reduced the dose but not yet come off it and it has really helped me to 'live in the moment' and enjoy life so much more than before.

I so much agree with what has been written about us focusing on negatives and complaints and cases that have gone wrong. Why do we never go home at night and think through all the positive achievements of the day? All the consults that went well etc. I go through episodes of severe self-doubt as soon as something goes wrong and worry about it for ages...could I have done things differently? was I really the best persone to have done that op? etc etc.

Re: Citalopram and practice

An On MRCVS — Tue, 14 Dec 2010 23:07:54 GMT

Many thanks to all from me too (the OP).

As you may have gathered from the other thread, about anonymous log-ins, I did go for the citalopram and so far it has been a quiet and gentle flowering, rather than any sudden bursts of improvement. It's been hard to be objective about progress, but in general I think I'm doing better and - in the middle of a particularly stressful time - I feel like I've reset somewhat, so that I can cope with the stresses calmly and rationally. I'll certainly carry on for a good long while and see where we get to.

In case Jonathan's reading this, I should point out that I have a counselling session tomorrow and will be seeing my GP again the day after. I've cut out the booze completely (although I'll be taking the occasional sherry at Xmas) and kick-started my exercise routines, and trimmed the excess stress out of my daily life. Things are good.

Andrew - I did say I'd contact you directly and I must apologise for not doing so - circumstances rather beyond my control, which I'll explain in due course.

Re: Citalopram and practice

Andrew Mellor — Tue, 14 Dec 2010 09:52:40 GMT

For all those that have been brave and contributed to this thread, and all those that have read it and recognised something of the discussion in themselves but not felt able to contribute I hope you are all well, and I wish you all a stress free ( is that possible any more?) and very Happy Christmas.

Re: Citalopram and practice

Andrew Mellor — Fri, 03 Dec 2010 10:24:46 GMT

[quote user="listhestar"] I now suffer with awful migraines and associated dip in mood associated with it.[/quote]

me too thought I had a brain tumour because one lasted 13 days took weeks to get my mood back up after that, totally crippled by it I had give in to it eventually and spent a lot of time researching migraines - lot of different causes but try feverfew it really works for me I was having migraines at least twice monthly before I started it, now maybe one every 3 months and nothing like as severe - I tried all " medications" with no improvement , now daily dose of feverfew think it is 360mg capsule from Holland and barrett , google feverfew and migraines

Hope all those that have have contributed to this thread and those that have read and are suffering have a good weekend,

Re: Citalopram and practice

Bob Russell — Fri, 03 Dec 2010 09:48:00 GMT

[quote user="listhestar"]

To everyone

Fair play to this thread. There is too much stigma attached to depression and mental illness. I now suffer with awful migraines and associated dip in mood associated with it. It's better since being on anti epileptics. The only thing I would say is,and I know anti epileptics are different to anti depressants but you need to give the drugs enough time to work with your body. The first week I was on mine I nearly came off them but now the side effects have settled down.

So what is the problem in the vet profession- stress? poor work/life balance....I've had more poor health since being a vet. I also think depression is an insidious process, you don't see it coming.

Lisa

[/quote]

Problems with the profession? All of the above. It is the type of job where you can never really win!

Even if you do a good job a small but vociferous group of clients will not be satisfied and it is funny how these affect you out of all proportion to the many that think the sun shines out of parts of your anatomy.

I have had one written letter of complaint in two years and this sticks in my mind more than the dozens of 'thank you' cards!! Crazy situation but most vets care perhaps more than is good for them.

The pay is usually cr*p as well.

Re: Citalopram and practice

listhestar — Thu, 02 Dec 2010 16:53:42 GMT

To everyone

So what is the problem in the vet profession- stress? poor work/life balance....I've had more poor health since being a vet. I also think depression is an insidious process, you don't see it coming.

Lisa

Re: Citalopram and practice

Wren — Thu, 25 Nov 2010 09:37:08 GMT

I had to take Paracetamol, Ibuprofen, Diazepam and Codiene, all several times a day. I had no idea that you could take so many NSAIDs without rotting your stomach. I wasn't keen on driving as everything was a bit fuzzy round the edges but bizarrely I checked on the IOC website purely for interest and I would have been legal to compete in the Three Day Event at the Olympics with all that lot on board. Frankly scary!

Re: Citalopram and practice

Bob Russell — Thu, 25 Nov 2010 09:22:48 GMT

[quote user="Wren"]

[quote user="Vikki Halliday"]

Those people who appear to sail through life with little problem or no worries are more than likely crakcing up inside too, as there are very very few vets who do not succumb to at least a mild form of insecurity and depression at some point in their careers. If you think the majority are fine, you are probably kidding yourself.

[/quote]

I have to say that I thought I was one of the above 'chilled' vets. Until I took a prolonged course of Diazepam for a bad back and realised just how much easier life was whilst I was on it and how things that I thought I was oblivious to were actually causing me quite a degree of subconscious stress. Oh, and the nurses commented that I was a much nicer person on it too.

[/quote]

I did the bad back thing - voltorol and diazepam - absolutely wonderful. Does little for your back but you don't care about it so much!!! Nurses had to check I was not talking even more rubbish than usual!!!

Re: Citalopram and practice

Wren — Thu, 25 Nov 2010 09:08:00 GMT

[quote user="Vikki Halliday"]

[quote user="Wren"]Oh, and the nurses commented that I was a much nicer person on it too.[/quote]

Oh dear. I suspect you were not their favourite vet before then?

[/quote]

Bizarrely I am! But that's more of a comment on the other vets than me.....

Re: Citalopram and practice

Vikki Halliday LLB — Wed, 24 Nov 2010 16:15:52 GMT

[quote user="Wren"]Oh, and the nurses commented that I was a much nicer person on it too.[/quote]

Oh dear. I suspect you were not their favourite vet before then?

Re: Citalopram and practice

Wren — Wed, 24 Nov 2010 16:08:29 GMT

[quote user="Vikki Halliday"]

[/quote]

Re: Citalopram and practice

Andrew Mellor — Wed, 24 Nov 2010 10:52:43 GMT

Just a thought for all us sufferers to ponder over: control is an illusion, you cannot control other people's actions, only your own. the more aggitated you become the more aggitated your client, nurse, employer, employee will become and the harder any situation will become. Don't let the Bas***ds get you down, rise above with a smile- it is so disarming !