Anyone taking Mirtazapine told to start Sertraline?

[Catsjulieanne]

Any advice please. Been on Mirtazapine for 3 weeks with awful side effects. Doctor told me to stop (immediately) and start Sertraline the next day. I am terrified of Serotonin Syndrome especially considering how sensitive I have been to taking Mirt and obviously withdrawals from Mirt and new side effects from Sert? If you have any experience of this please share. Thanks.

[MyNameIsTerry]

Cautious cross tapering is the recommended strategy in switching from Mirt to Sert so it would be fine for your GP to reduce one and introduce a low dose of the other and build up while phasing out. So, switching the way he is doing it is not the same but there will be a lower level of overlap between the meds.

However, please remember that Serotonin Syndrome is rare yet switching or cross tapering these meds is very common. Just look how many people on here are switching between various Serotogenic meds? Barely anyone ever has had a Serotonin Syndrome issue from what seen and read a lot of the meds threads since being here. In those I have seen potential Serotonin Syndrome issues it has been because of GP's making bad mistakes with meds in switching or adding on when they shouldn't and your GP, whilst not following the exact correct guideline, it's using a cautious similar strategy.

I believe you will be fine but I do understand how you feel. I struggled with side effects going on both my meds and it was scary.

Your GP will know about Serotonin Syndrome and will be monitoring you.

[Catsjulieanne]

Thanks Terry, I will possibly take half of a 50mg tablet tomorrow, so scared of suffering even MORE side effects :shrug:

[MyNameIsTerry]

That seems sensible.

With meds that work with your Serotonin, these abrupt or cross taper switches are supposed to ease the possibility of side effects because they reduce withdrawal by supporting each other.

[Catsjulieanne]

Thanks Terry, will be panicking even as I take it :huh:

[LittleMissAlone]

Julie

When I took sertraline I took half my 50mg tablet for the first week or so. After that I took the full amount. When I look back on it I wonder if I would have been alright if I'd stuck with only 25mg a day, but ultimately you've got to trust the doctors. Try ringing pharmicists for reassurance too, they know what they're talking about. ��

[MyNameIsTerry]

You are far from alone feeling like this about meds, Julie. Many of us have had difficult experiences so know how scary it can be to commit to it. You have support on here and there is a good load of support on the Sert board too.

[Shazamataz]

Try not to panic when you take it. I know it's hard but if you believe it will make you feel bad then it probably will. I have not mastered this myself yet so am being a hypocrite, but heaps of people get great benefits from sertraline. I wonder why the doctor didn't give you it first as it's usually firstline treatment as opposed to Mirt.

Hope it's gone well

Hugs

[Catsjulieanne]

Hi, so I took half of a 50mg tablet of Sertraline at 8pm last night, at 10pm I got into bed and went into a deep sleep for first time in weeks and was then woken up after midnight by my partner banging about turning the fan off (that I need for the Mirtazapine sweats) I was so upset and distressed and took off to the spare room but by then the damage was done.

Don't think I'll take another half of Sertraline today, this morning I was more shaky and felt incredible panic, and I ventured to the park with my son a couple of hours ago and felt so sick and dizzy I only managed to stay 15 minutes.. I think I am going to have to stick with the Mirtazapine for a few more weeks (just over 3 weeks on it now) so its back to the doctors for me on Monday.

Tearful now as I am so angry with my partner when he knows how desperately I need some sleep, and upset that my son has gone back to his dads again. Another awful long agonising weekend ahead. It's just relentless overwhelmingly awful to be me. I wish it would all just stop. :weep:

[LittleMissAlone]

Was your partner sorry? Hopefully he'll be more considerate in future.

Really don't know what to say about the pills. Don't you have sleeping tablets as well? They should surely help.

I know I've mentioned it before but YouTube vids may help. I've selected one but I've not tried it myself.

https://m.youtube.com/watch?v=Wv5t8NDczB0

Hang in there! I've achieved nothing again today, just been out and tried to do a simple thing, but can try it again in a little while.

---------- Post added at 17:26 ---------- Previous post was at 17:17 ----------

Me again!

I've heard that in cases like yours they give out diazapine (Valium). That would work I'm sure, but doctors are probably reluctant to prescribe. But if you're sounding really really desperate they may consider it.

If you can't wait until Monday there's always A & E.

Good luck. Xxxxxx

[Catsjulieanne]

Thanks so much for your reply, I have been given Zolpiderm sleeping tablets for a couple of weeks. Partner hasn't apologised, he has gone out for a couple of hours its probably sweet relief for him to be away from me going on about ailments and how bad I feel. I will check out the link you sent. I have Mirtazapine to last until Monday when I will get back to the doctors. Dreading the weekend, well dreading this evening, tonight, tomorrow, every day. I am so tense can feel every knot in my shoulders, back and neck. I am just so dreadfully low :hugs:

[LittleMissAlone]

I'm probably writing rubbish but I want to help. I may as well write on this thread, since it's yours!

That boyfriend seems a waste of space, does he add to your woes? If so you don't need that.

I've been reading up about extra strong mints being good for nausea related anxiety so will head out and buy some.

I live the life of a princess... Xxx

[Catsjulieanne]

Partner has tried to be supportive, I can understand how boring/draining it must be for him listening to me and my excuses for how I'm not up to days out etc. The thing is yesterday I said to him I'm only getting 2 hours sleep he said I don't know how your surviving cos he'd be a wreck! So for him to then wake me up when I was in a deep blissful sleep made me think, well you don't give a damn then do you?

Funnily enough I have been eating extra strong mints for a few weeks, I use it as a calming thing, not sure why, if I go anywhere I make sure I have mints and when I feel anxious I suck on a mint. Unfortunately I also smoke about 8 a day and my partner hates it (I understand that) but at the moment I need that cigarette occasionally for even the briefest of respites from the overwhelming panic x

Looking at clock thinking how long til bedtime then immediately anxious thinking PLEASE LET ME GET SOME SLEEP. I swear if I got a decent 8 hours nothing would seem as bleak throughout the day :unsure:

[Shazamataz]

I hope you've managed to sleep, Julie. I've had times when it's all I can think about but was dreading going to bed as I knew I'd just wake up in a panic not so long after falling asleep.

That seems to have settled a bit with me starting to take my beta blocker at night instead of morning (was waking with pounding heart and then it kept me awake most of the night).

I've also split my Mirt dose and take 15 at night and 15 in morning. Sleeping a bit better but very sleepy also during the day. I'm wondering about coming off the stuff or at least reducing the dose to 15 just at night.

This WILL end/get better for all of us, it just HAS to!

xx

[LittleMissAlone]

Morning Sharon

I wonder if 15mg will be enough for you as it is for me. I take it at night and sleep well and have normal energy levels during the day. Ok my social anxiety is still awful, but I can function perfectly well if not heading out. Perhaps 30mg is too much, but lower is better.

Also, I've heard terrible things about beta blockers, side effects worse than taking them for anxiety. My friend was given some a few months ago for panic attacks. Unlike us he doesn't normally suffer from them, but he'd badly broken his ankle and leg and so couldn't move, etc, and had operations on it so he'd suffered a major trauma. He hardly used them but he found when he did he would be really aggressive to his family.

I remember being prescribed bets blockers for anxiety when I was about 23 (another Gp later said that was a bad idea) and I found they made me depressed so immediately stopped them. However you are saying that they help so goes to show we are all different.

Hi Julie

I didn't buy the mints yesterday, deciding I don't want to take something that would rot my teeth. So I'm going to head to herbal Rescue Remedy drops instead. So many people swear by them, but I've a sneaky feeling my anxiety is the too far gone. My nervy stomach (gassy, bringing up air) is what is stopping me from doing normal things now.

Worth a try.

Really hope you had a good night's sleep.

��������

[Shazamataz]

Yep, I am wondering if the 15 mg will be enough. I'm slightly better anxiety-wise than before I started the Mirt but energy levels are really bad. I have Chronic Fatigue anyway but not like this for a long time.

The psychiatrists gave me 30 mg and insisted I needed it for depression as she decided depression was my main issue after only meeting me a couple of minutes (she had read my notes though from the other doc). However, I am adamant my low mood is because of the anxiety and if the Mirt isn't fixing it and is making me exhausted as well then something's going to have to change.

I never noticed anything with the beta blocker. Maybe because mine is very specific, unlike propanolol as I can't have that due to asthma.

Hoping your insides settle, that sick feeling is just terrible.

[LittleMissAlone]

Hi, yes, and another massive advantage of 15mg is your appetite will reduce! So you'll have more energy, you'll be able to do more and you'll sleep better at night. Win win!

I've always had an incredibly nervy stomach. I can be out, feeling worse and worse with the nausea, and then the second I make the decision to turn back and head for safety it lessens. Even when I'm going through good periods at work it's noticeable. Perhaps it will be worth doing proper hypnotherapy to get to the bottom of it. I don't think it's diet, though I suppose it might be something glaring in my diet, like milk I put on cereal every morning.

Anyway, will see how things are today. Xxx

[Shazamataz]

Hope you have a better day. It's evening here now so I've survived another day. I've definitely put on far too much weight as can't stop eating so a reduced dose may be just enough to take the edge off the anxiety but not make me as hungry. Also being tired is an anxiety trigger for me so taking meds that make you tired aren't that helpful foe me!

I wish the SSRIs had worked. I had no issues with them in the past but had terrible start up effects early in the year so they were a no go this time :(

Have you tried antacids? They helped me at times my tummy has been upset. Or antinausea tablets, if it's not acid related?

[LittleMissAlone]

Antacids don't work. My friend who has the same issue swears blind by ranitidine, and I know there's stronger tablets for stomach acid but I've always thought the problem is in my head rather than stomach. Also those tablets are not recommended for regular use as they are well known for causing horrid side effects like osteoporosis and, eek, cancer.

I don't think I've heard of antinausea pills, must look into that. There are also those acupuncture wrist things used for travel sickness. Could give that a go.

Thanks so much for helping with this, it's given me something to ponder on! Hurrah for the Internet, it can cause good! Xxxxx

[MyNameIsTerry]

Have a look at natural remedies. When I had a mild case of IBS last year, I went and bought some peppermint tea from Tesco. Just basic stuff and it greatly helped.

There are quite a few natural things for the stomach. I've seen peppermint tablets are used by the NHS, I think it was in the elderly.

Ginger is supposed to be good for the stomach. A German liquorice is another one.

There are sites out there with lists of ones you can try.

You can also get an anti nausea wristband from chemists & supermarkets that is sued for sea sickness.

When I was relapsing I was feeling sick at work a lot and I looked up some acupressure techniques. There was one where you hold your thumb into the side of the wrist for a few minutes, which is where the wristband is applying pressure, and it did seem to help. The diagrams are on Google and there are YouTube vids for stuff like this.

[LittleMissAlone]

Thanks so much, very helpful. I've just been researching the bands and will definitely try them today. I've known about them for years but I've never bothered with them. I feel a bit silly now - the one thing I haven't tried and so cheap and not at all invasive. There comes a time when you'd take up bloody religion if it helps.

Thanks for your work tip too. I know lots of people suffer with this and yet st the mo I still feel just a bit lacking in confidence getting back to work. Yesterday I got a P60 through telling me how much tax I've paid, quite a lot but I've earnt less than the tax threshold so jolly well hoping for a tax rebate. Welcome indeed, as I've not cost the government a penny while being ill these past few months.

Don't want to make out I'm worse than I am and I'm grateful I can function relatively well.

Enjoy you weekend, Terry.

[LittleMissAlone]

Hi terry

I've found acupuncture bands in Blacks half price only £2.50 so will get it today in town. Parking is easier on Sundays, but it'll still be difficult.

Will let you know.

[Catsjulieanne]

Thinking of you heading into town, it's terrifying isn't it but at least you are going with the purpose of buying something that will hopefully help you x:hugs:

[LittleMissAlone]

Yes, I'm already thinking it's about 15 mins to the shop, I've got to find the bands, and then they might not have it in! I could do this no worries not so long ago.

How easily these things spiral out of control.

Not having a partner I've got yo do it myself, but that's a good thing, I like being independent.

Right, off I go! Xxx

---------- Post added at 11:27 ---------- Previous post was at 11:08 ----------

Terry

I've literally just now had a revelation. Chewing sugar free gum! No I've not gone mad, I've chewed 1 or 1.5 pieces of gum every day for ages now, over a year. I've just googled and it's bad news for the stomach, apparently.

Well, it's one if my few pleasures in life, but it's worth quitting if it helps the nervy tummy. Knew it had to be something simple but obvious!

Have you heard about anything along these lines?

[MyNameIsTerry]

In what way is it bad for the stomach? I thought the excess saliva it would cause would then settle stomach acid?

It's hard but you are right, not giving into avoidance and doing your shopping is best if you see it through. If not, trying again and not avoiding it going forward so you don't keep reinforcing it being a feared situation. It's hard though. Try and acknowledge the achievement of doing it too.

That seems a good price for the bands. I know I've seen them on Amazon before so you could compare the prices.

You could probably suck a natural remedy like ginger but probably not too excess because of your teeth. It's probably why ginger sweets were popular for traveling. Maybe mint ones? Mint like peppermint is good for stomach problems. There should be plenty on the natural remedy websites about all this.

[LittleMissAlone]

Hi Terry

There's loads of information, but I've picked this:

http://articles.mercola.com/sites/articles/archive/2014/02/03/6-chewing-gum-side-effects.aspx

It makes sense too because even though I don't chew it a lot, only very recently have I taken the extra half and I'm sure the nervy stomach has got worse in that time.

I don't get bloating or even pain, but I get a crippling acidy feeling when combined with stress when out, and by stress I mean going for a little walk on my own with nothing to worry about.

I've not bought the band yet, I'll just see how I get on with cutting out the gum.

Feeling hopeful! X

[LittleMissAlone]

Hey Terry

I've just bought some Sea Bands, hang the expense. I'll try them out this afternoon attempting to do something I find very difficult . I had them on slightly earlier and the are really tight, despite having slim wrists.

Will let you know how I get on.

[hanshan]

Sugar free chewing gum often contains sorbitol, which is sweet but is not "sugar". However, it still has around two thirds the calories of sugar, and is a potent laxative if you swallow enough. One or two pieces of gum should not be a problem for most people, but some people may be intolerant of it. Ordinary gum with sugar may be a better alternative.

[LittleMissAlone]

Thanks Hanshan. I'm giving it a wide berth for now to see how I'm affected in general.

[hanshan]

Hi LittleMissAlone,

Other related sweeteners are mannitol and xylitol. They also pop up in mouthwash and toothpaste, so check the ingredients list.

Xylitol seems the best of the bunch, but Wikipedia has this to say:

"Like most sugar alcohols, xylitol has a laxative effect because sugar alcohols are not fully broken down during digestion, however the effect varies from person to person. In one study of 13 children, four experienced diarrhea when they ate more than 65 grams per day. Studies have reported that adaptation occurs after several weeks of consumption.

As with other sugar alcohols (with the exception of erythritol) consumption of xylitol in excess of one's "laxation threshold" (the amount of sweetener that can be consumed before abdominal discomfort occurs) can result in temporary gastrointestinal side effects, such as bloating, flatulence, and diarrhea. Adaptation (that is, an increase of the laxation threshold) occurs with regular intake. Xylitol has a lower laxation threshold than some sugar alcohols, but is more easily tolerated than mannitol and sorbitol."

[LittleMissAlone]

I don't know why the government doesn't step in about this! It's terrible, but I suppose they'll say it's better than sugar rotting the nations teeth and causing obesity!

So interesting about toothpaste. My problems stem from arm and hammer toothpaste which is very heavily salted (emetic), but I hadn't thought there might be sweetners in too. I now stick with the plainest Colgate I can find and double rinse.

Thanks for this.

[MyNameIsTerry]

Xylitol is one of the better artificial sweeteners too. Very bad for dogs though, it can kill them.

So, it's a bowel tolerance issue then? Vitamin C is the same in that respect but the level is high. So, maybe looking at the tolerance levels is worth a try? Stay below it and see how you feel.

The government won't care, it's just GI discomfort so it's a lesser of two evils by far compared to sugar for them. Not even the dentists agree with the NHS on sugar when we have NHS England telling us to get more fruit and dentists telling us to stop eating the stuff! :doh:

It's not as bad as the alcohol debate at least. One week a glass of wine keeps your heart healthy, the week after they report a new study saying how bad it us for us. I've given up bothering to listen.

Those sea bands will be tight because they work on the acupressure point in the wrist. So, it will probably have a nobbly bit on the inside that presses on that point. I used to do it with the tip of my thumb after reading about it.

Hopefully it will help.

Lets not tell the PC brigade about the toothpaste issue, they will probably insist on a "always use in close proximity of a toilet" label. :biggrin:

[LittleMissAlone]

Hi terry

Hanshan was just quoting something about bowel troubles, fortunately I don't have to worry about that one!

Also for alcohol too as I don't drink, but I always believe everything in moderation. If eating and drinking certain foods make you happy I say go for it, just don't have too much.

[hanshan]

Hi LittleMissAlone,

Unfortunately, I discovered the laxative effect of sorbitol a while back the unpleasant way, after swallowing some industrial-strength Japanese mouthwash (I'm sure there was a warning not to swallow it in small Japanese characters that I could only decipher slowly with the help of a dictionary, and that I didn't see).

Thankfully, I was at home at the time, and not on a bus or teaching an English class (my line of business). The effect came quickly without much warning, and my digestion is usually of the cast-iron variety.

Generally, there should be no problem if nothing is swallowed and the mouth rinsed out

[LittleMissAlone]

Oh dear!

I know for sugar free mints (which I never eat) there is a warning of a laxative effect if eaten to excess. But these chemicals are also carcinogenic aren't they? I bet sales would plummet if the packets also said, 'may cause cancer'. Evil.