Adding Venlafaxine to Mirtazapine

[Istherehope?]

Hi I've been hanging out in the Mirtazapine forum until now, but yesterday I saw a psychiatrist for the first time and she has decided to add Venlafaxine to my medication. I'm currently on 45mg Mirt and for three days she said to take 37.5mg Ven, then after 3 days to go down to 30mg Mirt and take 75mg Ven.

To be honest I'm terrified, terrified of possible side effects, of it not working and being stuck in this anxious/depressed state and terrified that I'm going to ruin Christmas for my three kids....

So I guess I'm here for a bit of moral support and to ask if there is a best time to take Venlafaxine or if it doesn't really matter...and if anyone has any positive experience that might help morale but I realise most people come here because they've had a tough time.

Thanks all x

[nicola1980]

Hi I successfully take ven for my anxiety and it has helped me tremendously so I would definitely recommend you give it a go, the mirt/ven combo is supposed to be very effective so you might not need to go as high as me just on the ven, I take 187.5mg slow release once a day, I take mine in the morning but try and take it with food as it can make you feel a bit nauseous to start with, I always used to have a biscuit then take it as I don't eat breakfast. As for side effects you might feel slightly nauseous, I felt quite tired and my pupils dilated too which freaked me out but it's very common and soon settled, you might notice your anxiety heightened slightly but as your not going above the 150mg dose where it kicks starts more transmitters this should be bearable. I hope this helps XX

[Istherehope?]

Thanks Nicola.

Two days in and I'm not sure I can do this...anxiety increasing and I've got nothing left...just want to die. This is so hard.

[MyNameIsTerry]

Stay in contact with the people on here and they will help you through this. Nicola will tell you how she had a very hard time in her last adjustment but people were here to support her through it.

Just take it one day at a time. Don't think about anything except getting to tomorrow and think to yourself "anyday now it will break and reduce". Thinking this got me through 8-10 days of the worst hell I've ever had by miles when I started Duloxetine.

It may be helpful if your GP can give you some Diazepam as you go through this. Whilst it will still be very hard, it can really help to have a couple of hours of relief. I did this the last 2 days by taking one when I woke as the adrenaline rushes were unbearable, I felt like my chest was going to burst, I wanted to sprint a marathon (think the lift scene in the film Crank).

[Tims]

Hi the Ven will take a few days to settle and you should be fine, especially at that dose.
Il be interested in hearing how you get on with Ven/mirtazapine combo as I think il be doing the same shortly. I would like to take it in the day if poss and not rely on it as a sleeping aid, however it seems to be very sedating according to other folks experiences. Have you been on the mirt long, and when do you take it?

Tims

[MyNameIsTerry]

Something that might be worth talking about on here is which version you use. I've seen how people say they struggled more on the standard version than the XR. This makes total sense to me because the XR has a similiar half life to Sertraline but the standard is very short and it makes me wonder whether this has a significant impact because I just can't see how you can keep it stable as it's heading out of your blood plasma so quickly each day and a couple of doses spread out just wouldn't keep it up to the higher levels you would experience on the XR.

[Istherehope?]

Thanks Terry, I really appreciate your messages so much. I've taken some diazepam which has helped a bit...and yes I think I might have to keep sending sos messages out on here.

Interesting point about the slow release - I'd wondered the same about the short half life, seems a bit crazy. I'm currently on the standard version, I'm guessing they're cheaper?

And Tims, yes I'll keep you posted. I've been taking Mirt for just 12 weeks. To be honest it has been great for helping me sleep and maybe slightly taking the edge off the anxiety but I've still been feeling pretty terrible. I take it approx 10pm because of the sedation. When I started on the lower dose I was really knocked out but that passed after a couple of weeks. I still think it's helping me sleep at 45mg (highest dose) but other people tend to find it stops sedating at 30/45mg.

Is there a reason you want to take it in the day? It might be tricky to stay awake to start with if you do.

---------- Post added at 12:58 ---------- Previous post was at 12:56 ----------

Ps Terry sounds like your mornings are pretty rough right now. Hope they settle soon for you.

[MyNameIsTerry]

Pricewise a years treatment on 75mg of standard is £17.94 or for XR it is £287.04.

So, it's a no brainer for a GP - unless you press them for it, they won't offer it. :winks:

Don't you find it interesting how cheap it is? So, that £8.20 we pay that we are told is a "subsidised prescription charge" would cost you far far more over a year than this. So, they make a profit. And if you think it's the logistics & dispensing, just look up your meds on the online pharmacies who will sell them to you on private prescription from a doctor and the prices tend to be the same which shows it's pure profit to the NHS. The NICE guidelines for GAD even state to use Sertraline "off label" as the first line drug because it's cheaper, not better! Lovely.

This is my night time, my days are upside down. Part of my OCD I'm afraid.

[nicola1980]

You can do this, I had an awful time earlier this year increasing my dose, my anxiety rocketed to a level I'd never experienced and don't want too again and I very nearly gave up and if it wasn't for the support on here I think I would have but now I'm so pleased I saw it thro as I'm so much better. Yes Diaz is a godsend when your starting up and increasing, I was taking it daily to help me and it did take the edge off. I was started off on the standard release then when my dose got higher I asked for the slow release, the slow release is alot more expensive hence why you don't get automatically prescribed it but I do feel you get a smoother ride on it but most people are started off on the standard release, when you increase to 75mg take 37.5mg 12 hours apart twice a day XX

[Istherehope?]

Thank you so much Nicola...honestly the kindness of people like you and Terry taking the time to help really amazes me...thank you both.

Tomorrow I have to reduce Mirt from 45 to 30mg as well as increasing to 75mg Ven, I think the diazepam will need to be at the ready, I'm honestly dreading it.

And Terry, if this is your night time it doesn't look like you're getting much sleep, hope you get some rest soon.

Joy (my real name...a bit ironic in the circumstances)

[MyNameIsTerry]

Thanks Joy. In some ways it had helped because before lack of sleep would trigger catastrophizing for me but with my OCD actually restricting my sleep I have found I cope with it far better. I still have the odd off day but it goes off even then and some days my mood is even good (as opposed to just normal balanced) which is a big thing for me.

Sadly the drawbacks are that I can't very anywhere as I live at night.

[nicola1980]

Good luck with your increase today, use your Diaz to help you thro, I hope you feel a bit better for Christmas XX

[Istherehope?]

Thanks Nicola - I've just been reading some of your older posts, you've been through such a lot...there's a lot of useful stuff in those threads. I'm definitely hoping I don't have to go over 150 on Ven now though!

And thanks again Terry, I guess we benefit on NMP from you not being able to go anywhere as we get lots of helpful input from you...must be tough though. Thanks for all ymy r thoughtful replies, hey have made a real difference for me.

Joy

[Nannybex]

Just been reading this thread and it's really helped so thank you.

I've been on varying low doses of prolonged release venlafaxine for 14 years but 2 years ago got signed off work for 6 months with depression/anxiety related to work stress. I've since left that job and now have a wonderful job and amazing support from my management team and colleagues.

Last May I was put on 225mg venlafaxine and 15mg mirtazapine. The mirtazapine was increased to 30mg in December and the venlafaxine reduced to 150mg. The withdrawal symptoms from reducing the venlafaxine was awful and lasted nearly 3 weeks. Last week my gp decided to increase the mirtazapine to 45mg and said we will decide about the venlafaxine dose once I'm settled on the new mirtazapine dose. I was nievely thinking I wouldn't have any side effects with an increase in dose but feel nauseous, shaky and exhausted.

Does anyone have any advice on how long the side effects have lasted with them in terms of increasing doses of mirtazapine? Thanks

[Heaven_Scent]

Hi

I'm in a similar position however waiting to be prescribed venlafaxine. How did you find it when first on it? I'm in a crippling depressed mood and have been for about 4 weeks following months of experiencing anxiety which I put down to good old work stress. Been signed off work by my Dr but aren't getting any support, my OH has said we can get therapy privately but I need something to get my arse back into gear before even thinking about laying myself bare to a therapist.

Xx

[Nannybex]

Bless you, that's tough. I'm so lucky to have the most supportive gp. I've had a bit of therapy but only got 6 weeks on nhs so I felt like I was only just starting to get somewhere when it stopped.

I found venlafaxine a wonderful AD and I never had any major side effects when first put on it or when my dosage was increased. However it was a nightmare when I had my dose reduced; but I think that's just because my GP just dropped me down a dosage rather than reducing slowly.

I think like any new AD, you'll feel worse before you feel better but I personally think it's worth pushing through. It might be worth booking in for some private therapy to help you through that initial dip. I found it so helpful to verbalise things.

[Heaven_Scent]

Thanks for your reply. I've referred myself to IAPT (3 weeks ago) but have yet to get a response. I am a huge supporter of the NHS but services are so stretched so I think private is going to have to be the way forward to get seen quicker.
My GP has been fab but says her hands are tied in relation to prescribing venlafaxine so I'm waiting on a mental health team appointment basically just to get the medication, in the meantime I've just been left.

[Nannybex]

Oh no! That's rubbish. It's so true isn't it, the nhs are amazing but so over stretched. It's strange that your gp says they can't give you the venlafaxine until you've seen the mental health team when other gp's can. I really hope it all comes through quickly for you.

I can't believe I'm feeling so rough with upping my mirtazapine. I was obviously dreaming when I thought increasing wouldn't give me side effects! But I know this drug is good for me so I'm determined to ride it out and I'll chat it through when my gp calls me on Friday.

[Heaven_Scent]

Thank you. Suppose we've got to take the rough with the smooth. I hope you start to pick up soon and the side effects aren't too bad but if you know it works for you then it'll be worth a few days of feeling crap.

Xx

[Nannybex]

Absolutely. I thought it was overkill for him to sign me off work for 2 weeks while adjusted and was determined to be back at work on Monday. I'm starting to think he was right!!

Do let me know how you're going when you get your venlafaxine 😊

[Heaven_Scent]

I've been off work for nearly 3 weeks now, just want to get back to being me. Be good to yourself.

I will :)

[Xtrastrongbint]

Oh this is interesting - I've come to the realisation that my 18 years on Paroxetine (although great for 10 years) has made me become totally apathetic so I'm waiting to see the MH assessment team to see if I can have Ven. I take it it's good for anxiety..I've read a few good things and wondering if I should push for it?

[Nannybex]

Hi, It's been brilliant for my anxiety. I was put on it 14 years ago as they suspected my serotonin was low and causing all sorts of symptoms they couldn't pin down and been on it ever since! Through a process of elimination they've concluded that I naturally produce almost no serotonin on my own. Definitely worth pursuing 😊

[Xtrastrongbint]

Brill - thanks Nannybex - it's an SNRI rather than an SSRI isn't it? I'm hoping it would be a bit more "activating" than a straight SSRI because my apathy is really hard to fight off x

[Nannybex]

Yes I think it is. I'm finding the combination of both drugs works really well. Although I'm dreading calling into work tomorrow to tell them I'm signed off for another week. I was so convinced I'd only need 1 week to adjust to the higher dose.

[Xtrastrongbint]

Aww Nanny - it's so frustrating isn't it! I'd give yourself a few weeks - it's tricky xxSo is the mirt for depression? I don't really suffer with depression x

[Nannybex]

Thanks. I'm trying not to be too tough on myself. Always find it hard to put myself first - so much easier to put everyone else first. I suffer from anxiety and depression so need the combination as the venlafaxine on it's own just wasn't enough any more.

[Xtrastrongbint]

Ah I see...yes, I think most of us anxiety sufferers feel the same. I hate being ill (in any way!) and am very impatient with myself. Thanks for your replies :)

[Istherehope?]

Hi all...I'm glad this thread has been helpful. Just wanted to add that while Venlafaxine is an SNRI, if you take 150mg or less it is only an SSRI as you have to take the higher doses for the 'N' to kick in.

Also to say that adding Ven to Mirt worked really well for me. I'm currently on 150mg Ven and 30mg Mirt and been feeling pretty much "normal" for the last month or so.

---------- Post added at 20:20 ---------- Previous post was at 20:15 ----------

Nanny I'm sorry to hear you're going through it with the Mirt increase. I hope things settle for you soon. And Heaven_Scent I can't believe you're being left to wait it out...that's really tough. I ended up seeing a Psychiatrist very quickly through the crisis team so I guess if it gets too much that might be an option for you. It is a bit luck of the draw depending on where you live though. I've received very good support in Leicester but it seems I'm in the minority with that.

[Nannybex]

I'm so upset. I've been waiting for a call from my Dr all day. I literally run out to grab some milk as I've been in all day and he phones! It's been such a rough week with the change to my meds that I was desperate to speak to him. I'm so angry with myself for going out.

[Istherehope?]

I'm so sorry you missed your Dr. Did you manage to speak to him or was that it? I know it's easy to do but please don't be angry with yourself, I'm sure loads of us would have done the same - particularly if it was needed for a cuppa!

How are you feeling today?

[Nannybex]

No, but I'm hoping to speak to him tomorrow. I've spent the weekend going from being angry at myself for missing the call, to being angry at myself for being angry! Not the best but I'm trying to regain my perspective on it. Fingers crossed that it will be a productive conversation when I speak to him. Thanks for replying to my rant!

[Istherehope?]

Oh poor you - I bet you'd be so much more understanding if it happened to someone else. Being kind to ourselves can be so tricky. I hope you managed to have a helpful conversation today?