Venlafaxine & Quetiapine no longer working - advice needed

[Mitch88]

Hello all, this may be a long post and I will try to be as brief as possible.

I have suffered OCD since before I started school aged 4. Since the age of about 8 it has manifested and troubled me mainly in thoughts (I don't use the term 'Pure O' as I still have compulsions.). I was eventually diagnosed in early 2000 as that was when I first sought help. Been on venlafaxine pretty-much ever since, 150mg since 2004.

If I think how things will pan out regarding a given situation I have to 'feel' as though I will feel if that situation happens. Because I have also suffered from GAD from a young age.

The worry also provides content for the OCD: things I worry about, I have to think through and through, in order, with the right words and feel 'right' at every stage and until I feel that the feared event won't happen.

Self-medication of these issues in addition led to alcoholism. I haven't drank for nearly 5 years.

About a year after quitting anxiety and worry led me to breakdown, about 3.5 years ago.

At this time a psychiatrist prescribed Prozac and took me off venlafaxine. This was a mistake as the times I tried to come off it previously (with no replacement), my worry, anxiety levels and OCD went through the roof. They did again. She put me back on venlafaxine and quetiapine 150mg.

Since then then the worry has been constant. In addition I suffered the loss of my mother unexpectedly in late 2014 and my grandfather in early 2015. I have guilt issues about their deaths, particularly Grandad's (I will elaborate if needed).

I seemed to be improving slightly but since Summer 2016 I have been nearly as bad as when I come off the venlafaxine 3.5 years ago.

I started seeing a psychologist to deal with my issues but she said that I was not in a fit state for therapy and I needed to review my medications. (I am not sure she was any use anyway, to be honest, her approach seemed to be to tell me there should be no guilt and to use thought stopping.)

My psychiatrist upped the quetiapine to 200mg a day in late 2016 to go up to 300mg.

I have upped to 200mg and that feeling of impending doom is still here. All they are doing is making me exhausted and completely devoid of motivation and unable to do the self-help reading I need to do to have any chance of getting better. So I am reluctant to go up to 300mg, as I doubt I would be able to work on them, the morning drowsiness would be that bad.

So what I ask is this:

1. Which medication(s) would help me to get rid of that feeling that everything will go wrong, that fear and dread? If any? And waking up with my mind immediately trying to remember what I was worrying about or 'OCDing' about before I went to sleep and then 're-opening' the worry and/or OCD?

2. Which would help with motivation (whether that is currently low due to hopelessness and/or quetiapine)?

3. Which would/could do the above with minimal tiredness/drowsiness?

4. Have you ever come of venlafaxine to try these medications, and did you fare okay?

I am asking because I think I need to go back to the psychiatrist but want to be able to suggest a few things from people who have walked this path a little.

Thanks for reading.

[panic_down_under]

Hello all, this may be a long post and I will try to be as brief as possible.

Welcome to No More Panic

At this time a psychiatrist prescribed Prozac and took me off venlafaxine. This was a mistake as the times I tried to come off it previously (with no replacement), my worry, anxiety levels and OCD went through the roof. They did again. She put me back on venlafaxine and quetiapine 150mg.

Venlafaxine can be the hardest antidepressant to quit, for many much harder than benzodiazepines. Why doctors persist in prescribing it ahead of other antidepressants when it has no advantage over them is beyond my understanding. The best way to quit venlafaxine seems to be a slow cross taper to Prozac and then to wean of it.

Which medication(s) would help me to get rid of that feeling that everything will go wrong, that fear and dread? If any? And waking up with my mind immediately trying to remember what I was worrying about or 'OCDing' about before I went to sleep and then 're-opening' the worry and/or OCD?

The two antidepressants with the best OCD track record are the SSRI fluvoxamine (Luvox) and the TCA clomipramine (Anafranil). Most doctors will prefer fluvoxamine simply because it's a SSRI, but it interacts with many other medications and supplements, etc, which can complicate treatment if there are other health issues. Even if there aren't any now, there inevitably will be some in the future. Therefore, I believe clomipramine is the better long term bet. It is also arguably the most potent (non MAOI) antidepressant currently available.

The issue with both is that you will need a psychiatrist who really knows what s/he's doing to switch from venlafaxine to either without quitting it first. There is no easy way of doing this, you're in for a rough ride, but I believe in the long run you'd be better off without venlafaxine. I'm also not convinced antipsychotics should be prescribed for anxiety disorders unless all the other options have failed and I think you're a long way from that being necessary.

[Mitch88]

Thanks for you reply. Life got in the way and I didn't see this until now.

Will the clomipramine also deal with the awful feeling that something will go wrong and the 'need' to worry to get rid of the perceived threats?

[panic_down_under]

Will the clomipramine also deal with the awful feeling that something will go wrong and the 'need' to worry to get rid of the perceived threats?

Clomipramine is generally one of the two most effective antidepressants for OCD so there is a very good chance it will, but, as with everything about antidepressants, there are no guarantees.

If your GP hasn't already suggested therapy I suggest you ask about it at the next consultation. I understand most NHS trusts pay for some CBT sessions. OCD is the most difficult of the anxiety disorders to treat so the more avenues of attack the better.

[Mitch88]

Thanks PDU. I was seeing a psychologist but she sent em back to the psychiatrist as she said that there was no point seeing her when the anxiety wasn't stabilised as I wouldn't be able to do the work she wants me to. The psychiatrist upped the quetiapine...

Will clomipramine also help the anxiety? It's that which is producing the doom, dread and hopelessness at the moment.

[panic_down_under]

Will clomipramine also help the anxiety?

Yes. Anxiety is a central component of the disorder

It's that which is producing the doom, dread and hopelessness at the moment.

Anxiety, plus a degree of depression by the sounds of it.

[Mitch88]

Thanks PDU. I will book an appointment to see the psychiatrist to discuss this.