Mirtazapine seemed to be helping but...

[Shazamataz]

Hi All,

I've been on a fairly long journey with this awful thing we call anxiety since October last year. Had some bad experiences with SSRIs and was on nothing for a bit (apart from maintenence diazepam 2mg twice a day as I became tolerant and need to wean off when I'm ready). Of course the diazepam no longer works which is pretty scary.

Anyway 6 weeks ago I reluctantly started Mirtazapine as things were so bad. I noticed quite a bit of improvement to start with (sleeping better etc), then had a bad few days, then bounced back a bit for a couple of weeks (sleepng better again), but now am on day 4 of really bad anxiety again and no sleep. Waking up with pounding heart and all over body anxiety. Haven't had an actual panic attack as such (which is what I started out with) but a fairly constant level of anxiety I'd rate at about a 5, though this morning its a 6 or 7 :(

I guess my question is, is this normal? If it was helping is it normal to go up and down a bit before things settle? I really thought I'd be so much better at the 6 week mark and find myself very frustrated and feeling quite hopeless as there aren't really any other options.

I'm also on a beta blocker (bisoprolol as can't take propanolol due to asthma). I've read people benefit from pregbalin but we don't seem to have that here in NZ.

Encouragement please!

[hanshan]

Hi Shazamataz,

Sorry to hear about the anxiety returning. It's normal to have some ups and downs even with meds, so stick with it a bit, but if the anxiety doesn't go away, you may need to consider other options.

I don't know exactly the situation in New Zealand, but if it is like Australia, pregabalin may not be officially authority approved for anxiety (in Australia it's the Pharmaceutical Benefits Scheme - PBS). The drug is still available and doctors can prescribe it for anxiety, but in Australia the patient must pay the full cost (no government subsidy).

I took that path (after convincing my GP to prescribe it), and I think I was paying about five or six Australian dollars a day for 600 mg (lower doses might cost less). It's not cheap, but I was prepared to pay because it worked for me. I'm in Japan now, still taking pregabalin and handing over loads of yen.

[MyNameIsTerry]

Hi hanshan,

I wonder how much of that is political because if Wiki is accurate, it's S4 which shows as:

Schedule 4 Prescription Only Medicine (Humans) or Prescription Animal Remedy (Animals)[edit]

Schedule 4 (S4) drugs and poisons, otherwise known as prescription only medicines, are substances and preparations for therapeutic use that:
Requires professional medical, dental, or veterinary management or monitoring
Are for ailments or symptoms that require professional medical, dental, or veterinary diagnosis or management
May require further evaluation for safety or efficacy
Are new therapeutic substances
No drugs under schedule 4 need to be authorised by the health department
One's doctor may call the health department to get a drug approved that is not listed on the Pharmaceutical Benefits Scheme (PBS) so that the purchase price can be subsidised under the scheme
Not all drugs can be authorised for the (PBS)

Some states have subsets of Schedule 4 with additional requirements (see below). Schedule 4 medicines cannot be advertised directly to the public.

Or is there something in the last statement that covers Pregablin?

I hope you are ok. I thought you were in Japan. Have the recent earthquakes been near you?

[hanshan]

Hello Terry,

It's a bit tricky. The drug scheduling system (S number) is separate from Pharmaceutical Benefit Scheme listing (government subsidy).

For example, some drugs which are S2 and S3 can be bought over the counter with no prescription at pharmacies at full cost, but if prescribed may get a PBS subsidy.

Other drugs may be prescription only (S4), but still may not be PBS subsidised.

Often a drug is PBS subsidised for one condition, but not another. Pregabalin is now PBS subsidised for some conditions, but still not anxiety. I think cost and maybe some lobbying from interest groups is involved in listing. Perhaps people with mental health issues are not as vocal as other groups - I don't know.

The bit about a doctor contacting the health department for a subsidy if a drug is not PBS listed is news to me - in practice I don't think it happens too often.

And earthquakes! I'm about 200 km from the focus of the earthquakes. I've felt the earth shaking several times, but nothing serious.

[MyNameIsTerry]

That's more complicated than over here. If it's approved for use by the NHS, the subsidy applies on meds. So, when it became licenced for GAD, it became available.

I think you are right about doctors not chasing up individual drugs for PBS. It's a bit of a strange one anyway since you could end up with hundreds of doctors initiating it. They must surely have a process to catch that or it would become very unruly? Perhaps it's just there on paper but not actually used, a flexibility clause that in real world just isn't used?

Glad to hear you haven't been caught up in the terrible earthquake disasters.

[SmilingAlbert]

Sorry to go a bit off-topic:

A reminder of how lucky us Brits are with the NHS. The NHS has many problems, but the fact that even wage-earners can have as many meds as they are prescribed for £10 a month is frankly amazing.

When I tell American friends this they look to the moon; many there pay hundreds of dollars a month. Together with their health-insurance payments, it adds up to a serious bill, and I think often offsets lower income etc. tax-rates. US spends 17.1% of GDP on healthcare; the UK, a not dissimilar country per capita wealth-wise, 9.1%.

UK average life expectancy is 81; US, 79. I think I know which country does health better.

I don't now how health care works in NZ. I also don't know the Preg situation in NZ; it seems to be available, but for pain and epilepsy but perhaps not anxiety. I have read here that doctors in most countries are able to prescribe off-label within reason. Again, I don't know if this rule applies in NZ; if you think it's worth it, I suggest finding some anxiety folk in NZ who are on it; I suspect there will be many, and there may be forums. Then it's a case of finding how they got it. Many wealthier folk probably get it via a doctor in AUS, at a guess.

Good luck with it; many here find Mirt + Preg a very effective combination.

Albert

[Shazamataz]

Thanks Albert,

So frustrated as the Mirt seemed to be helping for a short while. It's the insomnia that's doing me in as being tired just makes the anxiety worse :(

No optimistic about pregbalin here, otherwise why would doc never have mentioned it?

[Istherehope?]

At the risk of sounding like I get commission, do you know if Venlafaxine is available in NZ?

Also is it possible the doc didn't mention Pregabalin because of the cost, either to the health system or to you?

Also just wondering, did you mention on another thread that you came off Temazepam? I don't know much about it but could you be experiencing withdrawal?

And yes, Albert, couldn't agree more about our NHS, battling and beleaguered as it is. All of my children have received hugely expensive life saving care for free and I couldn't be more grateful for my prepayment certificate!

---------- Post added at 22:45 ---------- Previous post was at 22:45 ----------

p.s. realised that's a lot of questions Shaz, if it's a bit overwhelming feel free to ignore x

[MyNameIsTerry]

How does the £10 a month work? Is it that scheme? I've always paid per prescription all my life and that includes my asthma inhalers.

In some cases the prescription charge is actually worse and the NHS are cashing in on the old statements about it being a subsidy. For instance, it's now far cheaper to buy some generics like Citalopram and Sertraline from a pharmacy yourself with a prescription. But how many people know? I didn't when I was on it but now I'm on Duloxetine which costs more than the prescription charge.

[SmilingAlbert]

Here you go Terry:

http://www.nhsbsa.nhs.uk/1127.aspx

It's not as very well known as it should be, but if you're on a few meds/month, you can save a lot of £££s.

[MyNameIsTerry]

Thanks Albert. That works out at £8.66 so it certainly saves me money as I have more than 12 prescriptions a year.

[Shazamataz]

At the risk of sounding like I get commission, do you know if Venlafaxine is available in NZ?

Also is it possible the doc didn't mention Pregabalin because of the cost, either to the health system or to you?

Also just wondering, did you mention on another thread that you came off Temazepam? I don't know much about it but could you be experiencing withdrawal?

And yes, Albert, couldn't agree more about our NHS, battling and beleaguered as it is. All of my children have received hugely expensive life saving care for free and I couldn't be more grateful for my prepayment certificate!

---------- Post added at 22:45 ---------- Previous post was at 22:45 ----------

p.s. realised that's a lot of questions Shaz, if it's a bit overwhelming feel free to ignore x

Hi Is, venlafaxine is available here, practically everyone is on it! I'm not keen to add anything else just yet. I guess this thread was aimed at finding if it was normal to continue having so many ups and downs this far into the medication.

Temazepam, yes I did reduce it but only by half what the dr said. She was pretty insistent that it shouldn't be a problem as it's a low dose, that said she isn't the one taking it! It sure hasn't done much for my sleep lately :(

I don't know about the pregbalin, on the NZ site for meds it is only listed for pain and a couple of other things so maybe not available for anxiety here. To be honest, on thinking about it the idea of adding anything else makes me more anxious so I'm probably best to stick with the Mirt but may try splitting the dose (though that makes me nervous too!)

[Istherehope?]

No, I can understand not wanting to add anything at this stage, and I can also remember being very anxious about doing anything that might make things worse - I cried every day for two weeks telling the crisis team how scared I was when I added Venlafaxine.

As far as normal goes I wish I knew. My experience on Mirt was up for two and a half weeks then a steady decline into the blackest place I've been over the next ten weeks. Yours sounds different though - more changeable, which is why I'm wondering about the Temazepam. Over here they don't recommend taking it for more than 10 nights because of addiction risks, I'm guessing it's similar for you?

Hugs to you Shaz...and wishing I could just take some of the rubbish anxiety away for you x

[Mugs]

Hi
Mirtazapine helped me sleep initially and decreased the morning anxiety but it was short lived, even dose increases never helped. Have just tapered off after being on it for over a year. Still have bad anxiety every day.
Hope it works better for you.