Withdrawal hell?

[panic_down_under]

The consultant psychiatrist at the MHAU felt that AD's weren't the answer for HA and I was referred for CBT which is ongoing. It's been very up and down since then so my GP decided to throw mirtazipine in the mix which my psychiatrist was happy with but it's not had any effect over the 6 months odd I've been on it other than the zombie like effect every morning which I was uncomfortable with.

15mg mirtazapine is usually prescribed as a sleep aid. For the antidepressant effect most need to take 30-45mg/day at which it usually becomes less sedating.

As for ADs for HA, I tend to agree with the psychiatrist, at least with regard to SSRIs and SNRIs. I think the TCAs are a better options mostly because they tend to produce milder side-effects initially and most come in low dose tablets relative to their therapeutic range which makes it very easy to start on extra small doses and ramp it up in small steps to contain any side-effects which may develop.

]I'm seeing a new psychiatrist on 12/2 so I'll discuss the next step there

One thing you might want to get the new psychiatrist's opinion on is trying the amino acid analogue N-Acetyl-Cysteine (NAC). It is showing promise in the treatment of OCD (HA is arguably part of the OCD spectrum), both alone and to boost AD effectiveness. It usually produces few, if any side-effects. Medically, it is used to protect the liver in cases of paracetamol overdose, and to reduce fluid build-up in those with some lung diseases.

Caution: while NAC can be beneficial for asthmatics, it may cause shortness of breath in some, so caution is needed if you have asthma. It is contraindicated for those taking nitroglycerin, vitamin K and some blood pressure meds. One study found NAC (and Vitamin E) may increase the risk of lung cancer in smokers (note, it doesn't cause lung cancer, only maybe reduces the ability of the immune system to detect and destroy existing cancerous cells, at least in genetically susceptiple mice). This finding has been the subject of much debate because there are many other studies showing NAC protects against lung cancer so it is almost certainly not the final word on the subject. FWIW, I'm a lung cancer survivor and have take NAC for over 12 years because it is the best thing I've found for reducing fluid in my remaining lung.

and I guess try and tough out this withdrawal although it's pretty grim right now!

'Toughing it out' is not a good idea, imho. Please talk to your GP as there are no positives from suffering unnecessarily.