Sertraline vs Non-Sertaline: A case study

Due to a suite of Unhelpful Behaviours (all since passed) and a persistent Depressive Tendency (there's two Culture ship names for free there) I've been taking antidepressant drugs of one sort or another for a really very long time indeed. I think I've used the following in total:

• Fluoxetine
• Citalopram
• Escitalopram
• Paroxitine
• Mirtazapine

Which is practically all of the SSRIs plus mirtazapine, and there's also been the odd sleeping pill or anti-anxiety thing but neither of those for about a decade. What I've been on for the longest time is sertraline. This is a fairly typical SSRI although not generally one of the first used. I've been on the lowest available dose for around five or six years but in recent times the dose has gone up. What tends to be the happen is this:

The red line is me on sertraline. Basically, feeling alright most of the time - rarely feeling very much good but also rarely feeling very much bad. This leads to a kind of lethargy; I'm not getting much pleasure from very much and so I can't be bothered doing productive or positive things. On the other hand, I'm also never wanting to go and freeze to death in a forest. What ends up happening is that I forget to take my meds for a day or so and I get a brief phase during which I can enjoy some things and I get stuff done. I enjoy feeling like this and so skip the meds a bit longer, the brain zaps will be kicking in at this stage but I tell myself I'll be fine. Then for whatever reason I have a massive crash and feel like going to freeze to death in a forest.

The latest episode of the (not quite) mania has managed to persist for long enough for the brain zaps to subside but the last day or so has gotten me into some really serious slumps. Looking at the current situation my choices are:

• manage alright but don't really do anything until I retire/die of natural causes
• get some stuff done while having to periodically talk myself down from going to freeze to death in a forest

Of course, there's a third option which is what I'm going to be aiming for - go back to the meds roulette table and spin it until my number comes up. I need to find something that blocks off the slumps but also brings the red line a little higher so I can start doing some more things. I'm booked in for next Tuesday and we'll see after that if find something that suits me a little better. The options to go back onto sertraline or freeze to death in a forest will still be there later after all, might as well try some other ideas first.

That's all to say for now, but it's meant to be helpful to talk about mental health so there it is.

PS: Anybody who finds this via a random search and posts about doctors being in cahoots with psychiatric medicine firms will receive very short shrift indeed. The shortest of shrifts.