Really not sure

[PixieP]

Hi all
I've now been taking Pregabalin for just over 5 weeks after referral to a psychiatrist. Started on 50mg twice daily for a week (no improvement), 100mg x 2 for another week (slightly better) and then after another week 150mg x 2 daily. I started to feel some benefit at this dose but after 2 weeks agitation (rather than full blown anxiety) started to creep in so a week ago the psych increased again to 200mg x 2 daily. I've had a few good days (although every morning I still wake feeling awful) but the last 2 days I feel like I'm going backwards - today I've not felt calm at all.
So...do I stick it out at 400mg daily or increase again to 500? The psych says it's up to me but I just don't know what to do for the best.
For those who have experience (and success) with Pregabalin at what dose did you really feel benefit and how long did it take to kick in? I'm starting to wonder if I've increased too quickly and would do better on a lower dose.
The trouble is I've been on and off different medication for 8 months now to the point where I no longer know what's me and what's the medication. I'm also taking 30mg mirtazapine but the psych doesn't think that it's really doing anything for me. The only reason I'm still on it is because she didn't want to introduce the Pregabalin and taper off the mirt at the same time.
Quite honestly though I feel like tapering off everything right now but I'm scared of feeling worse than I already do.
I have GAD and just feel like I'll never feel truly calm again. I just want to open my eyes in the morning and feel refreshed rather than instantly on edge and thinking how I'm going to get through another day :weep:
Sorry for the self-pitying post but I'd heard such good things about Pregabalin and just can't stand the thought that it might not work and I'll be back to square one :(

[Cherryade]

It took about 3 months on a steady dose of 2x75mgs before I felt at ease. I still have times when I feel very anxious but they pass. I think its best to stick to a steady dose for at least 8 weeks. There is not a quick fix for anxiety unfortunately.

[hanshan]

Hi Pixie - Are you still taking the mirtazapine + pregabalin combination that the psychiatrist prescribed at the end of April?

[PixieP]

Hi and thank you for the replies.
I'm currently taking 30mg mirtazapine which I had already been taking for 6 weeks before my first psych appointment. She then added in the Pregabalin but said that she didn't think the mirt was doing much, if anything, for me but she didn't want to remove the mirt before I found a stable dose of Pregabalin.
Maybe I'm just being impatient or have increased doses too quickly? Certainly when I was on 300mg daily I had about 10 days where my mood, sleep and anxiety levels were much better but then I started to feel agitated again hence the increase to 400mg.
I just don't know what to do for the best - to increase or not to increase, to stick it out at 400mg for longer or even to decrease back to 300mg and try persevering at that dose!
My next GP appointment is in 2 weeks and psych appointment is middle of July but actually user experience is sometimes a better measure of efficacy than doctors who can only go from their prescription guidelines. I wish there was a magic answer to this but if there was no one would have anxiety!
Have a good day all and thanks for al the support on here. I think I would have gone insane by now without it!

[hanshan]

If you are currently taking 30 mg mirtazapine + 400 mg pregabalin daily, then I'm not sure that a big change of these two meds is going to have an immediate effect (although some have pointed to a positive effective at 600 mg pregabalin daily).

Since you are still in the changeover period with pregabalin, it's worth persisting a while where you are now, to see if things stabilise.

If the mirtazapine/pregabalin combo does not work, there are still other meds available via psychiatrists, so do not give up hope.

[PixieP]

Thanks Hanshan.
There has been a lot of upheaval in my life recently and I've been struggling to accept some of what's been going on. I think I may also be mildly depressed although that may just be due to the anxiety. My closest friend for many years appears to have moved on and is becoming distant which has hurt me greatly as I know I haven't done anything to warrant it and it's left me feeling insecure. The family were all out this afternoon and I felt so lonely that I had a really good cry (didn't think I'd ever stop at one point) but I actually feel much better for it and can think more clearly.
I am going to stick with my current doses at least until I see my GP. I actually think the Pregabalin is doing something for the anxiety as I'm not the barely functioning wreck I was but nor am I anywhere close to being "normal". As for the mirt....the psych has already suggested replacing it with venlafaxine but wants me to even out on Pregabalin first.
I guess there's not going to be a quick fix but there's plenty worse off than me so I need to stop feeling sorry for myself and crack on with this thing called life!

[hanshan]

I'm sorry to hear of your life upheavals - I hope things get better soon.

I'd go along with what the psychiatrist has suggested, giving the pregabalin a chance to even out, and if things still aren't working out, try combining pregabalin with venlafaxine rather than mirtazapine. I haven't taken venlafaxine myself, but I did read one poster who made a similar switch and found it beneficial. The very best of luck to you.

[PixieP]

Thanks for your support Hanshan. I'm still hopeful that the Pregabalin will start to work soon as I'd heard such good things.
Out of interest, have you ever split the dose differently than 50/50 twice a day? I'm just thinking would it be worth me trying 300mg in the evening and then 150mg in the morning? Would it help morning anxiety do you think? That's the worst time of day for me, although in truth the physical feelings never let up.
If I end up trying the max dose of 600mg daily I think 300mg in the morning may be too much to drive on!
With regard to switching from mirt to ven, I was on ven for 2 years from 2014 but it didn't work this time when I tried it (before my current cocktail). However the psych said it could work in combination with preg?
Just the small matter of tapering off mirt first if that's the route I go down!
Hope everyone's had a great Sunday!

[hanshan]

Hi Pixie - I've taken pregabalin at different times of day according to my anxiety.

For a long time I had waking anxiety as soon as I woke up, so I took all of my dose in the evening, to work on me even while I slept. I think a lot of that anxiety was work-related, just stressing over what was coming up.

Now I have retired from full-time work, and I don't wake up so stressed, so I split my dose morning and early evening, which evens out the day for me. I take mirtazapine just before bedtime.

Sorry to hear that venlafaxine didn't work for you last time. It may combine well with pregabalin, however. An alternative SNRI to venlafaxine is duloxetine - if you tell the psychiatrist about your experience with venlafaxine, that might be a possibility.