Adding Venlafaxine to Mirtazapine - advice please.

[Istherehope?]

Hi, so I saw a psychiatrist today. She is adding Venlafaxine to the Mirtazipine I'm on. I'm currently on 45mg Mirtazipine so she said to take 37.5mg Venlafaxine and 45mg Mirtazapine for the next three days and then to take 75mg Venlafaxine and 30mg Mirtazapine after that. I forgot to ask what time of day is best to take the Venlafaxine - does anyone know if it matters? Feeling a bit daunted by the prospect of meds change and possible side effects so any positive stories out there would be good too...

[A63]

Hi,

I've never taken Venlafaxine, so cannot offer any guidance on it, but I know it is meant to work very well with Mirtazapine. The combination is known as 'Californian Rocket Fuel'. I am crossing my fingers for good results for you!

I had very severe physical anxiety on Friday, on top of the ongoing severe depression. Rang doc: absolutely no joy. Later that day, I took a mini overdose and my husband called the paramedics.

So. I am upping my Mirtazapine to 45 mgs as of this evening. I've been on 30 mgs for seven weeks and am still extremely depressed. I feel I have nothing to lose by upping it, although I realise it could heighten anxiety, but that is a risk I feel I have to take at this stage. Tomorrow I transfer money from a savings account to my bank account. Then I will book a private appointment with a psychiatrist in the nearest town. I feel this is my only realistic option now: I can't wait for weeks on end.

I rang the Crisis team last Friday am, as well. They are meant to be sending me info. on how to 'self-refer' to their 'complex needs service'. Nothing as yet.

I've worked for most of my life - I am in my early 50s - and paid my taxes. I claimed Job Seekers for two weeks in 1997, as I recall. Now I need mental health care and, quite frankly, it's an absolute joke, at least in my area.

I hope the med changes work very well for you. All the very best. xx

[Istherehope?]

It's good to hear from you A63...and thanks for the kind thoughts.

I am so sorry that you are not receiving anything like proper care, it sounds so tough for you...I think I've been fortunate so far, or maybe Leicester is a little better than some places. Please keep posting here though (if it helps) I am often thinking of you and wondering how you are. I really hope 45mg of Mirt shifts things for you.

Like you I'm concerned about increased anxiety side effects...actually I'm terrified of them. I don't want to ruin Christmas for my kids, but I'm in a pretty desperate place so need to take the risk too.

Hugs to you xxx

[A63]

Thanks so much! I really hope the Mirt/Venlafaxine combo produces quick and good results for you.

Hugs to you too.

xxx

[aprilmoon]

Hi
I'm on this combo.
I take the Ven in the morning and the Mirt at night.
I've been on them both in the past and they've helped me both times

[Istherehope?]

Thanks aprilmoon, that's helpful and nice to hear from someone who has benefited from the combination x

[Doze]

I'm sure things will start to work themselves out for you Is. You have the support in place and given time the meds will do their job.

[MyNameIsTerry]

There is a good Ven support crowd on the Ven board so I would encourage you to get a thread going on there too. They are experienced with the dosage adjustments and start up effects of each dose.

If you are going beyond 150mg you also need to be prepared for the norepinephrine side effects which from my own experience with Duloxetine these can be very different to what you experience with SSRI's. Whilst Ven is a SNRI, it only really works with Serotonin <150mg.

[Istherehope?]

Thanks Terry...I'll get a thread going on there too. Hope you're doing Ok?

[MyNameIsTerry]

I'm ok thanks. I've not been on here much as I'm busy with Xmas prep.

Xmas is the hardest time for me so things are a bit up & down and not much sleep with being so busy.

[A63]

Thanks Terry...I'll get a thread going on there too. Hope you're doing Ok?

Hi Is,

I hope you're doing well. I've been wondering how things are for you, and how the Venlafaxine/Mirt combo is going, although it's obviously very early days for you. Very best wishes for Christmas and the New Year.

I am making a bit of progress.

Rang the local CMHT yesterday, as felt desperate (I put myself up to 45 mgs of Mirt on Monday eve, as I'd been on 30 mgs for seven weeks with no real improvement).

Turns out that one of their psychiatrists had recommended medication changes for me, and that these changes were written on my notes. Well, the information hadn't come in my direction, and the CPN was unwilling to tell me what, exactly, the changes were.

In the past two months, I have had to initiate everything, and I am hardly firing on all cylinders.

I spoke to two CPNs yesterday, and got nowhere.

So here I am, two months down the track, getting very little sleep, and still severely anxious and depressed. Had an anxiety attack this am, so rang GP surgery. They were excellent - I am delighted with the service I have received from my GP surgery - and the GP I spoke to told me that 'mental health services are in meltdown'. They certainly are in this area (South Oxfordshire).

I now have 50 mgs of Trazodone to add to the 45mgs Mirt and 30 mgs Citalopram I take daily. I should add that, physically, I am something of an old boot: it takes a sledgehammer to knock me out.

In an ideal world, I would rather not take medication, but after three minor suicide attempts, I am willing to do whatever it takes to feel a bit more normal. If this involves taking a lot of medication, and if that medication makes me fatter, then so be it. I will do whatever it takes.

A very, very happy Christmas and New Year to all of us.

A x

[Istherehope?]

Good to hear from you A63 :)

I can't believe how messed up your care has been - youve done so well to keep persevering but I guess when you're very desperate you get driven to keep contacting people. It's horrible that you've felt you needed to overdose but I can understand that place...I think it's a good job there's no simple, painless way to end it all as the temptation would be too much for me.

I really hope the new stuff helps. Like you I would prefer to avoid medication but am rapidly accumulating a pharmacy by my bedside! My morning was pretty rough too and I really wanted to close my eyes and never wake up. I eventually gave in and took some diazepam which did help. Saw the crisis team this afternoon and he encouraged me to use diazepam over the next week or so while my body adjusts to the new meds if I needed to. I hate taking it but think I need it to get through this process.

Not really expecting to enjoy Christmas but will do my best for the kids - I suspect I may sneak onto this forum a few times too. I hope you are able to get some respite over the next few days.

Joy (ironically my real name!)

[SmilingAlbert]

Sorry to hear you're in the wars.

In my experience, sadly MH services have always been in meltdown, with demand far exceeding supply. At least the range of medication out there is much better than in the past. Don't be worried about taking meds = it is what they are there for.

Ideally, we wouldn't need them, and they'd be for other people. But at least they exist, and when you find the one(s) that work for you, you will get back on an even keel.

Very happy xmas to you too!

Albert

[A63]

Hi,

Many, many thanks, Joy and Smiling Albert, for your replies to my post.

What has happened to me is that I have spiralled down and down: severe anxiety and depression combined with no sleep made me plummet, unsurprisingly, and I ended up just wanting to blank everything out; I reached points where I felt I couldn't deal with my difficulties any more.

My work have been brilliant: very supportive, as has my GP surgery. Last Friday, I kept getting severe panic attacks - very unusual for me. I rang the doc, but he wouldn't give me anything to deal with the anxiety: they never will; I've never been prescribed anything for it. I was advised to use 'self-help'. Unfortunately I'd gone beyond that, and I took a few too many sleeping tabs; I felt a strong need to blank everything out by then.

Now my husband has charge of my meds!

I think Smiling Albert is absolutely right. There is a lot of negative 'feedback' on anti-depressants on this and other forums, but what are they there for, ultimately? Yes, of course they will have side-effects, and some of these will be distinctly less than brilliant. A very common side-effect with Mirtazapine is weight gain, and many people get very upset about it. But, I keep thinking to myself, surely it is better to be fat than dead?

I am sure your children will want you with them at Christmas however you are, Joy. I feel sure you will get through this.

All the best to you both. Happy Christmas!

A :):):D

[Istherehope?]

Hi A63, just wondering how your Christmas Day was?

I did better than I expected, I think because we're staying at my in laws and they're pretty much doing everything. Going home tomorrow which is causing some anxiety - I just feel overwhelmed by any responsibility.

I totally agree with you about the weight gain stuff - I'd rather be overweight and not anxious/depressed or dead. Mirt hasn't really increased my appetite though so it doesn't look like I'll be putting that theory to the test.

Anyway, thinking of you and hope you're doing OK (whatever that is!) Joy x

[Doze]

Glad to hear your Xmas went well Is.

---------- Post added at 14:08 ---------- Previous post was at 13:11 ----------

I'd also add that, for me at least, depression seems to override the glutinous side of the Mirt. On my better days I've felt the ravenous urge when eating, but when anxious or depressed it's not been there. Over Xmas there's been a ton of chocolate and snacks available but I have little interest in any of them, and I usually love chocolate. Even when I have felt hungry I don't think I've been eating much more.

[A63]

H
Hi A63, just wondering how your Christmas Day was?

I did better than I expected, I think because we're staying at my in laws and they're pretty much doing everything. Going home tomorrow which is causing some anxiety - I just feel overwhelmed by any responsibility.

I totally agree with you about the weight gain stuff - I'd rather be overweight and not anxious/depressed or dead. Mirt hasn't really increased my appetite though so it doesn't look like I'll be putting that theory to the test.

Anyway, thinking of you and hope you're doing OK (whatever that is!) Joy x

---------- Post added at 14:55 ---------- Previous post was at 14:54 ----------

Hi Is,

---------- Post added at 15:02 ---------- Previous post was at 14:55 ----------

Hi Is,

Very glad to hear that your Christmas Day went better than expected! I really understand the overwhelming feelings: I'd like to get back to work in the New Year, but the anxiety needs to be much more manageable first.

My Christmas Day was OK: fortunately I wasn't cooking; I think that would have been too much for me at the moment. Myself and my husband went out for a Christmas meal with a good friend of his. I had a poor night on Christmas Eve, because I was worried about getting through Christmas Day, but I did better than expected!

I have been put on another drug - Trazodone - in an attempt to deal with the persistent insomnia. I'm not finding it sedating so far. So now I am on three anti-depressants: Citalopram, Mirtazapine and Trazodone. The good news is that I have an appointment with a psychiatrist on Fri 8 Jan. My GP kicked up a fuss on 23/24 Dec and the CMHT have at last sprang into action.

Like you, Mirt hasn't really increased my appetite, as far as I can tell.

Good luck tomorrow! All the very best, A x

[sauly1991]

I've only just come off Venlafaxine which has been replaced by Fluoxetine, advised to do so by my psych because of my recent OCD troubles.

But I was taking that combo for 2/3 years, 30mg of Mirtazapine and 75/150mg Venlafaxine, which I took both at night. The only bad thing I noticed about the Venlafaxine was slight sexual dysfunction, nothing horrifying though, just a difference?

I should also add that, like you, I was originally taking Mirtazapine THEN Venlafaxine was added, and the "side effects" of the Venlafaxine being added were VERY minimal!!! I was pleasantly surprised, I noticed some added anxiety but that was only for 2/3 days, and that was down to me worrying about going on to a new med, which I imagine is very common. Of course, everyone is affected differently by these things, but if I was okay I can't see why someone else won't be. :-)

In my opinion, the Mirtazapine is more noticeable than the Venlafaxine. For me it made me sleep and eat a whole load, which was cool I was as skinny as a rake before lol, but the Venlafaxine just balanced my mood abit more, I would be VERY up and down anxiety and mood wise, the Venlafaxine just added some stability.

Also, I should add, I've been off the Venlafaxine a week, I took half dose for a week then stopped and replaced with Prozac, again, very minimal side effects :-)

I hope that all made sense and helps, a lot of people are quick to dismiss Venlafaxine, I was at first, but it can make a difference when therapy is applied too.

I would still be taking it now if it wasn't for my recently developed OCD problems!

Sauly

[Istherehope?]

H

---------- Post added at 14:55 ---------- Previous post was at 14:54 ----------

Hi Is,

---------- Post added at 15:02 ---------- Previous post was at 14:55 ----------

Hi Is,

Very glad to hear that your Christmas Day went better than expected! I really understand the overwhelming feelings: I'd like to get back to work in the New Year, but the anxiety needs to be much more manageable first.

My Christmas Day was OK: fortunately I wasn't cooking; I think that would have been too much for me at the moment. Myself and my husband went out for a Christmas meal with a good friend of his. I had a poor night on Christmas Eve, because I was worried about getting through Christmas Day, but I did better than expected!

I have been put on another drug - Trazodone - in an attempt to deal with the persistent insomnia. I'm not finding it sedating so far. So now I am on three anti-depressants: Citalopram, Mirtazapine and Trazodone. The good news is that I have an appointment with a psychiatrist on Fri 8 Jan. My GP kicked up a fuss on 23/24 Dec and the CMHT have at last sprang into action.

Like you, Mirt hasn't really increased my appetite, as far as I can tell.

Good luck tomorrow! All the very best, A x

Thanks A, glad you did better than you expected too, and so glad to hear you have a psychiatrist appointment at last. I really hope the Trazadone works for the insomnia, not sleeping on top of everything else is horrible.

I don't know about you but it feels strange to be taking more than one antidepressant, I guess I'm still coming to terms with the fact that I've needed it all and with quite how ill I am.

This site has definitely helped though!

---------- Post added at 17:40 ---------- Previous post was at 17:35 ----------


I've only just come off Venlafaxine which has been replaced by Fluoxetine, advised to do so by my psych because of my recent OCD troubles.

But I was taking that combo for 2/3 years, 30mg of Mirtazapine and 75/150mg Venlafaxine, which I took both at night. The only bad thing I noticed about the Venlafaxine was slight sexual dysfunction, nothing horrifying though, just a difference?

I should also add that, like you, I was originally taking Mirtazapine THEN Venlafaxine was added, and the "side effects" of the Venlafaxine being added were VERY minimal!!! I was pleasantly surprised, I noticed some added anxiety but that was only for 2/3 days, and that was down to me worrying about going on to a new med, which I imagine is very common. Of course, everyone is affected differently by these things, but if I was okay I can't see why someone else won't be. :-)

In my opinion, the Mirtazapine is more noticeable than the Venlafaxine. For me it made me sleep and eat a whole load, which was cool I was as skinny as a rake before lol, but the Venlafaxine just balanced my mood abit more, I would be VERY up and down anxiety and mood wise, the Venlafaxine just added some stability.

Also, I should add, I've been off the Venlafaxine a week, I took half dose for a week then stopped and replaced with Prozac, again, very minimal side effects :-)

I hope that all made sense and helps, a lot of people are quick to dismiss Venlafaxine, I was at first, but it can make a difference when therapy is applied too.

I would still be taking it now if it wasn't for my recently developed OCD problems!

Sauly

Thanks for this Sauly, it really helps to hear from someone who has taken the same stuff and in the same order - I really appreciate you taking the time to reply. So far I'm not doing too bad with side effects so hopefully I'm responding in a similar way to you.

Sorry to hear you've got OCD to contend with now though. Is that what the Prozac is for, or are you taking it to help you come off the

Thanks again.

[sauly1991]

No problem! I was told at the time it was quite a common treatment route, and I think the side fx are minimal because the Mirtazapine is doing a lot of the work! I hope it does everything you want it too! And don't forget if you need to increase the dose in time then don't worry... again, for me it was relatively easy to adjust! I started at 75mg, when to 150mg.

And yes I've been put on the Prozac as a result of the OCD sadly, I've only just started suffering from it and apparently Prozac is the bee knees for OCD, so instead of taking 3 different meds we decided to replace the Venlafaxine with the Prozac. Again like I say, I was very pleasantly surprised with the transition of coming off the Venlafaxine, and I'd been taking it for 3 years, and within a week and a bit I'd stopped taking it (mainly because the Prozac acted as a "bridge", made it a tad easier), still....much easier than Mirtazapine and Fluoxetine (was on fluoxetine before anything else by the way, let's hope it works 2nd time around lol)! Depression and anxiety/panic wise, Venlafaxine worked wonders! You may feel abit dull to start with, but me personally, I'd take dull over full of excess anxious energy haha! But give it at least 3-4 weeks and you should notice a great difference :-)

Sauly

[karenp]

Three years ago when I got divorced (and it was messy so I was very ill), I was cross tapered from Mirtazapine to Venlafaxine but only stuck it 5 days as I could not tolerate it but know so many people who can and feel great now on it. So just wanted to say good luck xxxx

[Istherehope?]

Thanks Karen...one week in and not doing too bad with side effects, so hopefully it should be manageable.

Now just worrying that it won't make any difference, so helps to know that that it could be a 3-4 week wait, thanks Sauly.

Tired of my brain today...it's got into the whole hopeless/everything is pointless type of thinking. Keep trying to tell myself that's the illness speaking and it isn't true...think I'm tired of battling to get through each day.

[Doze]

I know that feeling Is. :hugs: I guess we just have to keep on and eventually it will get better.

[Istherehope?]

Thanks Doze :hugs:

[Doze]

Hey Is how's the Ven treating you? What doses are you on now?

I'm thinking I might ask about trying another AD along with the Mirt as I'm struggling to take a higher dose of it without loosing sleep, so I don't think it will be an effective AD for me.

[Istherehope?]

Hi, I'm on 75 Ven with 30 Mirt. It's been ok so far, no improvement yet, so ok is a relative term for pretty crap really! I've only been on 75mg for 6 days so too early for much difference to be made I suspect. Ven is meant to be pretty bad to come off so I'm not delighted to be on it but it's preferable to staying in a very dark place.

---------- Post added at 11:31 ---------- Previous post was at 11:27 ----------

Have you heard from the crisis team yet?

[Doze]

I doubt I'll hear from anyone for a day or two tbh. We'll see. I'm not feeling to bad so far today. Touch wood.

I was on paroxitine for years and that's meant to be very hard to come off, but I just did it very very gradually and it wasn't too bad at all. I found the initial uptake adjustment much harder tbh. Just a shame my anxieties came back after being off the meds for a while, so now I wish I'd just accepted I would have to stay on them forever.

If things continue to be bad on the Mirt, I don't see why I wouldn't try adding another AD. It hasn't been effective and I can't wait to get off it tbh, but I need something to keep me sane. Not sure the answer is Ven though, even though they apparently combine well, it has a reputation for making some people rather tired, I already have enough of that.

[Istherehope?]

Glad today isn't so bad Doze.

Like you I wish I'd stayed on citalopram as it worked well for me first time around... I'll be in no rush to come off once I find something that works this time.

I've not noticed any extra tiredness but can understand you'd want to avoid it with your illness. Adding something extra does sound like a good way forward though. I think I've noticed pregabalin as another one used with Mirt, but I don't know what it's like.

Hope the rest of today goes OK.

[Doze]

I've been taking small amounts of Mirt during the day, a little at breakfast, another at 1, in the hope of staving off the worst of the anxiety and negativity and so far it seems to be helping.
I've found that after taking my evening dose I feel a lot better, so I thought I'd try this way of increasing my overall dose and keeping calmer during the daytime. It's like I can feel the Mirt wearing off in the mornings and my arms start to feel odd and then I go slowly down hill. When that started in the morning I took 3.75mg and it went away, I did the same after lunch and it helped again but was rather too sedating for a while. It's not a long term solution, but maybe it is a workable solution for now.

At least with adding a second AD I know the unpleasant side effects will a, go after a while and b, lead to hopefully a positive medication. With the Mirt I started to just get lost in it seemingly not really going anywhere.