Vortioxetine 10 mg

[MyNameIsTerry]

No, I suspect what is really sick is the system treating you. Seems to have little flexibility and appears to be fixated on third rate drugs such as mirtazapine and pregabalin which may be making things worse.

Are you being treated by a GP, or psychiatrist? If the former and vortioxetine proves not to be the answer then insist on seeing a psychiatrist. I appreciate that is apparently not as easy as it could/should be.

Preg can be hard to access in the UK. Scotland are very difficult and Buckinghamshire in England has blacklisted it purely on cost.

It's still costly so some GP's will come up with some "creative" reasons why you shouldn't have it.

[panic_down_under]

It's still costly so some GP's will come up with some "creative" reasons why you shouldn't have it.

No great loss for most. And a gold star to the GPs for not inflicting gabapentin (Neurontin) on the patients instead.

[MyNameIsTerry]

No great loss for most. And a gold star to the GPs for not inflicting gabapentin (Neurontin) on the patients instead.

That's the problem with Buckinghamshire, they did it to cut costs so forced everyone onto gabapentin. Not just for anxiety, it was across the board so the epileptics were switched too.

The NHS is like a cottage industry with all these local trust & CCG's.

It must grate on those people when the NHS touts it's "what's best for the patient" line out.

[panic_down_under]

It must grate on those people when the NHS touts it's "what's best for the patient" line out.

I'm rapidly coming to the conclusion that the NHS doesn't have a clue what is really "best for the patient"! Empirical data is a very useful tool, but it should not be the sole basis for determining treatment. In medicine art can be just as important as science, and this is especially so with psychiatric disorders.

The NHS seems to be trying to reduce it to a numbers game. If patient A has symptom X, give drug 1. If no response apply drug 2. Still no response, throw hands in air and pack patient off to the end of a psychiatrist's queue ...which I understand can be interminably long.

They could save a lot of money on the first act of this tragedy by replacing GPs with a mobile phone app!!

[TRISTAN]

Up to 20 and having really bed time , is this normal ?

[panic_down_under]

Up to 20 and having really bed time , is this normal ?

Unfortunately, it is fairly common with most antidepressants and especially so with SSRIs and SNRIs. It's caused by the initial increase in serotonin activity. The brain and other organs will respond within a week or two by down-regulating serotonin synthesis and expression and things begin the calm down, however, side-effects may surge again for a short while after dose increases, but tend to be less severe.

If your main issue is a spike in anxiety then a small dose of diazepam (Valium) should help, just don't stay on it any longer than you need to as there is evidence benzodiazepines can inhibit the antidepressant response (Boldrini M, 2014; Nochi R, 2013; Sun Y, 2013; Wu X, 2009; Stefovska VG, 2008).

Alternatively, ask your doctor to prescribe some hydroxyzine (*Vistaril), a prescription antihistamine with fairly strong anti anxiety properties. It isn't as potent as diazepam, but is often potent enough to make a difference.

*Hydroxyzine comes in two forms, hydroxyzine pamoate (Vistaril) and hydroxyzine hydrochloride (Atarax). Anecdotally, the pamoate form is supposedly the more effective anxiolytic.

[lliiaamm0099]

There seems to be a great deal of discontent for the NHS in this forum which is quite disheartening as I am currently training to be a Doctor myself, although I am intending to specialise in Neurology not Psychiatry. There also seems to be quite a few misconceptions related to how the NHS prescribes medications and what it prescribes. One of which is that Pregabalin isn't given to patients as the brand of if by Pfizer is expensive. It's true that Lyrica is expensive somewhere in the region of £95 a month, however, there are plenty of generic versions available which can easily be found on the EMC, which will be about the same price as Vortioxetine. The more common reason that Pregabalin is unlikely to be prescribed for anxiety is because Pregabalin works by binding to what are called voltage dependent Calcium channels which when are opened on nerve cells cause positively charged Calcium ions to go into the cell which leads to neurotransmitters such as Noradrenaline and Dopamine to leave the cell. This means that Pregabalin simply stops nerves from sending these neurotransmitters out meaning that its anxiolytic effect is simply by making the patient feel drunk, drunkenness is even one of the most commonly reported side effects as is euphoria and ataxia. This why many Doctors are reluctant to prescribe it as you are essentially getting the patient drunk to treat their anxiety, not only this but prolonged use of such drugs can lead to issue with the pacemaker of the heart called the sinoatrial node.

As far as the whole Mirtazapine is prescribed alot because it is "dirt cheap" this simply isn't true it is used because it acts as a presynaptic Alpha2-Adrenoceptor antagonist meaning that it will increase nerve cell output of Noradrenaline and Serotonin and many patients don't want to get sexual dysfunction and Mirtazapine doesn't cause this, however it isn't licensed to be used in Anxiety disorders in the United Kingdom. It is also a very potent Histamine H1 receptor antagonist which means that it can sometimes be used in anxiety for its sedative effects.

[TRISTAN]

Thanks for you responding only been on 20 for a week now and body and mind has reacted badly , I guess I will have to wait a few more weeks to see

[panic_down_under]

Thanks for you responding only been on 20 for a week now and body and mind has reacted badly , I guess I will have to wait a few more weeks to see

The worst of the side-effects usually diminish within a couple of weeks of them starting (they don't necessarily begin immediately after first taking a med), but they may return for a while after dose increases. All you can do is treat the symptoms as they occur.

[pulisa]

There seems to be a great deal of discontent for the NHS in this forum which is quite disheartening as I am currently training to be a Doctor myself, although I am intending to specialise in Neurology not Psychiatry. There also seems to be quite a few misconceptions related to how the NHS prescribes medications and what it prescribes. One of which is that Pregabalin isn't given to patients as the brand of if by Pfizer is expensive. It's true that Lyrica is expensive somewhere in the region of £95 a month, however, there are plenty of generic versions available which can easily be found on the EMC, which will be about the same price as Vortioxetine. The more common reason that Pregabalin is unlikely to be prescribed for anxiety is because Pregabalin works by binding to what are called voltage dependent Calcium channels which when are opened on nerve cells cause positively charged Calcium ions to go into the cell which leads to neurotransmitters such as Noradrenaline and Dopamine to leave the cell. This means that Pregabalin simply stops nerves from sending these neurotransmitters out meaning that its anxiolytic effect is simply by making the patient feel drunk, drunkenness is even one of the most commonly reported side effects as is euphoria and ataxia. This why many Doctors are reluctant to prescribe it as you are essentially getting the patient drunk to treat their anxiety, not only this but prolonged use of such drugs can lead to issue with the pacemaker of the heart called the sinoatrial node.

As far as the whole Mirtazapine is prescribed alot because it is "dirt cheap" this simply isn't true it is used because it acts as a presynaptic Alpha2-Adrenoceptor antagonist meaning that it will increase nerve cell output of Noradrenaline and Serotonin and many patients don't want to get sexual dysfunction and Mirtazapine doesn't cause this, however it isn't licensed to be used in Anxiety disorders in the United Kingdom. It is also a very potent Histamine H1 receptor antagonist which means that it can sometimes be used in anxiety for its sedative effects.

Very interesting post and thank you for this. I didn't know this about pregabalin but it doesn't surprise me.