CBT Therapist is anti-medication. ..

[tommackent88]

Again thank you both for your invaluable comments.

Firstly I was not aware that the Ven will only function as an SSRI at this level - although I have a feeling my psychiatrist will increase it when I see him later this week.

I've googled the CBT folks and they are BABCP accredited and they do have a large team of therapists so I assume they are fairly established. And at the end of the day I like the like the therapist I see.

I can understand his frustration as I do tend to feel absolutely naff one way or another every time I see him. Either caused by anxiety or by side effects. Having GAD I do tend to focus on the negative.

My fist 3 months of CBT was very positive - it got me back to work, in to shops and on public transport. I then had relapse after relapse ever since and I'm back at rock bottom as we speak, hence stating the Ven.

I agree that the combination of CBT and medication is the way forward for me. I'll certainly ask the questions mentioned above and I think I will suggest going back to CBT basics. The only harm it will do is to my bank balance.

T

[Davit]

Do you mind if I ask what exactly you do for CBT. How much is cognitive and how much is behavioural. Exposure is behavioural but what you think doing exposure is cognitive.

[tommackent88]

I'd say there has been a god mix of both - started on the cognitive and moved on to exposure work after about 8 weeks, although recently there is been little exposure. Both I have found useful but the exposure I found very hard indeed. I seemed to get so far with it and then fell to the ground with a bump and never really got back up.

[Davit]

I prefer to change how I see things than have to cope by getting used to them through exposure. That way they go for good instead of just getting used to them.

[MyNameIsTerry]

Just incase, here is the Code of Ethics for BABCP:

http://www.babcp.com/files/About/BAB...and-Ethics.pdf

This is promising because IAPT have informally told all their therapists to join BABCP.

From what you have said now, the issues that have stalled your CBT are not medication but multiple relapses. CBT must have failed to help you to deal with those hence deciding to try further medication. So, whilst the side effect window for Ven could cause therapy to slow down or stand still, it was not the reason why things stopped anyway. Your therapist should recognise that and understand your decision but for him to say your progress is solely hampered by starting medication is false as he could already see things stalling out after a positive start.

I think your therapist needs to recognise the truth and come up we a new strategy or give you a break or slow down sessions to account for the time spent battling through the side effects window. Its not like you are with the IAPT guys (who will treat you alongside meds!) where you only have 12-15 sessions, this guy has treated you for double that and I can't see how a month is such a big deal in those terms.

I'm on Duloxetine, another SNRI, an I didn't know about the adrenaline threshold until I joined NMP and read about it. There is some quite detailed info about on the net showing how the med changes in its action between certain dosages. It made sense to me because when I started at the adrenaline interaction level, my side effects were all adrenaline based and prior to that they were little different to the Citalopram I had been on earlier (thankfully other than insomnia which wasn't an issue on Duloxetine!). I can't say I fully understand it but what I have read is convincing about these meds and how they act as SSRI's before the threshold.

There is a supportive group of people on the Ven board who will help you through it all though. Ven seems pretty popular compared to mine. I've seen people on there who don't even go to the 150mg dose and find it helps them so maybe you won't need too much of an increase?

The only possible issue otherwise that I can see with Ven and your CBT is how they start small and work up to find the right dose. Your therapist might be concerned about the impact of that since each move up could mean a side effect period.

---------- Post added at 07:35 ---------- Previous post was at 07:28 ----------

Found what I read first. It seems it is about how it has to provide a maximum to serotonin before it moves to norepinenephrine:

https://drugs-forum.com/forum/showthread.php?t=36429

It made sense to me as my adrenaline threshold is said to be 60mg and thats the standard dose for GAD, depression, etc. I'm less sure on that with Ven but I've seen a few people have the side effects I did once they hit 150mg.

Ven is supposed to have a ratio of 30:1 serotonin to norepinephrine. Duloxetine is 9:1. So, perhaps that is the reason why and that the level of interaction with norepinephrine is so low until you reach that level that its not classed as a clinical interaction?

[mark84]

I've just skim read through this, but I'd highly recommend SSRI's and therapy together. I know beta blockers and Exposure therapy together can be frowned up on, but any kind of therapy with SSRIs is a powerful combination- in my opinion unless the patient expresses otherwise it should be the first choice for combating anxiety issues.
You'll do well I think, stick with it

[tommackent88]

Thank you all for your support. I hope that a new CBT strategy along with the right doses of meds will help me get off the ground (and out the house).

I've read the info about the adrenaline threshold - I don't understand it whatsoever but these are all questions I can ask the psychiatrist this week.

I think a good honest chat with all my various practitioners will help. At the moment they seem to be slagging each other off which is frustration.

I'll also go back to look at the Ven boards.

Thanks again