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Skeptical about medication after trying many. Keep trying?

I've tried citalopram, sertraline, fluoxetine, amitriptyline, mirtazapine and I'm currently on a relatively new one called vortioxetine that my psychiatrist gave me.

None of these have had any effect at all. I have diagnosed borderline personality disorder (and anxiety and depression) and none of these medications have even touched the intense emotions that I feel. Therapy wise, I've only been offered CBT which I've had five times over the past six years to no avail.

I am skeptical (and always have been) about the ability of medication to change my negative thoughts and thus my mood. Should I keep trying? I just can't imagine how they would work so one day I magically wake up and don't think like I normally do.

Feel like I've reached a dead end.
Original post by Anonymous
I've tried citalopram, sertraline, fluoxetine, amitriptyline, mirtazapine and I'm currently on a relatively new one called vortioxetine that my psychiatrist gave me.

None of these have had any effect at all. I have diagnosed borderline personality disorder (and anxiety and depression) and none of these medications have even touched the intense emotions that I feel. Therapy wise, I've only been offered CBT which I've had five times over the past six years to no avail.

I am skeptical (and always have been) about the ability of medication to change my negative thoughts and thus my mood. Should I keep trying? I just can't imagine how they would work so one day I magically wake up and don't think like I normally do.

Feel like I've reached a dead end.


Hi there! Medication is a tricky one. No one really knows how it works, and psych meds don't have a uniform affect on patients. Some benefit and some do not from meds.

Also, don't make the mistake in thinking that medication is a panacea. Medication is only a small part of the treatment and will not solve all of your problems. At best, medication can alleviate some symptoms but often does not solve the root causes. You say you are sceptical of meds being able to change your negative thoughts- that's not really what medication does. It's more of a kick up the arse for therapy when you are feeling demotivated. Therapy and practising what you have learned in therapy is what really helps your negative cognitions.

Therapy in conjunction with medication has the highest rates of efficacy vs meds alone.

Regards BPD, I don't know how effective CBT is for that. I have heard that a common treatment for that is DBT. It's odd how you haven't been offered other types of therapy. BPD is often caused by childhood trauma and CBT does not deal with this as it focuses on the present and one's behaviour. I think you could benefit from a therapy which digs deeper into your past and your thought processes. I would recommend CAT and DBT. Although please talk to your psychiatrist about this.
(edited 7 years ago)
My psych said that in his experience the meds which are the most effective have been escitalopram, venlafaxine and mirtazapine. Although the matter can make one gain weight.

And yeah, meds won't 100% solves your issues. They can give you a boost when you feel like ****. But it's therapy where you learn better coping skills and how to better regulate your emotions. CBT is usually offered because it's quick and cheap for the NHS. I read an article once where a psychologist said he thought CBT was a load of bull. CBT attempts to teach you new and more helpful behaviours, but doesn't really focus on why you have those unhelpful behaviours or earlier life experiences.

You sound like your issues are more complex and need a more targeted therapy.
Original post by Anonymous
My psych said that in his experience the meds which are the most effective have been escitalopram, venlafaxine and mirtazapine. Although the matter can make one gain weight.

And yeah, meds won't 100% solves your issues. They can give you a boost when you feel like ****. But it's therapy where you learn better coping skills and how to better regulate your emotions. CBT is usually offered because it's quick and cheap for the NHS. I read an article once where a psychologist said he thought CBT was a load of bull. CBT attempts to teach you new and more helpful behaviours, but doesn't really focus on why you have those unhelpful behaviours or earlier life experiences.

You sound like your issues are more complex and need a more targeted therapy.


*latter can make you
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Anonymous #1
OP
Thanks for your replies

Original post by Bubblyminty
Hi there! Medication is a tricky one. No one really knows how it works, and psych meds don't have a uniform affect on patients. Some benefit and some do not from meds.

Also, don't make the mistake in thinking that medication is a panacea. Medication is only a small part of the treatment and will not solve all of your problems. At best, medication can alleviate some symptoms but often does not solve the root causes. You say you are sceptical of meds being able to change your negative thoughts- that's not really what medication does. It's more of a kick up the arse for therapy when you are feeling demotivated. Therapy and practising what you have learned in therapy is what really helps your negative cognitions.

Therapy in conjunction with medication has the highest rates of efficacy vs meds alone.

Regards BPD, I don't know how effective CBT is for that. I have heard that a common treatment for that is DBT. It's odd how you haven't been offered other types of therapy. BPD is often caused by childhood trauma and CBT does not deal with this as it focuses on the present and one's behaviour. I think you could benefit from a therapy which digs deeper into your past and your thought processes. I would recommend CAT and DBT. Although please talk to your psychiatrist about this.

I am well aware of DBT but it is not offered in my area as far as I know. I have spoken to my psychiatrist about it, who had never heard of it (!) and my CBT therapist told me she hadn't heard of it being offered in my county. Since being diagnosed I have reached out to others (near me) who have BPD and one girl told me she only got put on a DBT programme by going to A&E and having an assessment there. It's just really frustrating because we get told to ring the crisis line for emergencies, yet the only people I know who have accessed good mental health care have got it through A&E. Plus I've rang the crisis line twice, once they told me to go for a walk and the other time they told me to get a dog. Not really the best advice when you are obviously on the edge which is why you are calling.
Original post by Anonymous
My psych said that in his experience the meds which are the most effective have been escitalopram, venlafaxine and mirtazapine. Although the matter can make one gain weight.

And yeah, meds won't 100% solves your issues. They can give you a boost when you feel like ****. But it's therapy where you learn better coping skills and how to better regulate your emotions. CBT is usually offered because it's quick and cheap for the NHS. I read an article once where a psychologist said he thought CBT was a load of bull. CBT attempts to teach you new and more helpful behaviours, but doesn't really focus on why you have those unhelpful behaviours or earlier life experiences.

You sound like your issues are more complex and need a more targeted therapy.


I've not heard of the first two you mentioned. Will take note and mention them at my last appointment. Mirtazapine has literally been the worst thing I've taken. It was helping me in the sense that I was sleeping better (a major issue for me), but I gained two stone in the short period I took it, which was about a month. This was late last year and I haven't lost any of that weight yet and I'd say it's made my mood worse. I have self image issues and used to be bulimic so I'm kind of annoyed I was put on it in the first place because the weight gain has made my mental health x10 worse.
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Original post by Anonymous
I've tried citalopram, sertraline, fluoxetine, amitriptyline, mirtazapine and I'm currently on a relatively new one called vortioxetine that my psychiatrist gave me.

None of these have had any effect at all. I have diagnosed borderline personality disorder (and anxiety and depression) and none of these medications have even touched the intense emotions that I feel. Therapy wise, I've only been offered CBT which I've had five times over the past six years to no avail.

I am skeptical (and always have been) about the ability of medication to change my negative thoughts and thus my mood. Should I keep trying? I just can't imagine how they would work so one day I magically wake up and don't think like I normally do.

Feel like I've reached a dead end.


Medication can be difficult to get right and sometimes the side effects or hassle can be more trouble than they're worth. That said, whatever conditions you have can be very intrusive and stressful and it may be worth the effort and struggle for months or even years to find the right fit if it will help you for much longer. It's not really up to anybody else and you need to work out for yourself if it's worth it.
Some people can give you some suggestions and things to consider, but what I would suggest is writing a pros and cos list and having an in depth conversation about it with somebody you are close to and your psych.

One thing I would suggest, if you're not doing it already, is therapy. I found that medication helped to level me out a little, but I didn't really notice a huge difference until after i'd had some therapy. I think meds kinda help to level things out and put some foundation so therapy can do it's thing and make the real long lasting changes. I know there is some scope for more intensive therapy and even residential care which can help in cases where a more mild approach just hasn't managed to kick it. I'm not sure how realistic that is though because I don't think it's available on the nhs and I think it can be very expensive.

But yeah have a good long think about what you need and maybe take some time to let yourself come to a decision before trying anything else. Bring all that thinking you've done to an appointment and have a chat with your psych about what options you have and what you want to do.

Hope that helps. Wish I could give you the magic answer but unfortunately there isn't one. Good luck :smile:

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