Ever increasing venlafaxine, plus mirtazapine

[Dying_Swan]

Hello everyone

I hope all are well on this fine sunny day.

I'd been on 75mg Ven for 5 years until May, when due to ongoing struggles for months with anxiety/depression/PTSD the GP upped it to 150mg. I take it twice daily immediate release, being one of the few who can't tolerate XR because I start withdrawing between doses.

I'd tried upping it before but gave up due to side effects (mainly just exhaustion). Anyway got through that but wasn't feeling better. I felt numb, distant, flat. Derealisation maybe, also some pretty difficult thoughts. I went to a psychiatrist and had an assessment. He diagnosed "an episode of depression with prominent anxiety" and after a few negotiations, he has persuaded me to up it again to 225mg, as he says that's where the noradrenaline receptors kick in. Psych was good about listening to my views on meds so we reached a compromise.

We've decided that I'll take 150mg XR in the morning, and 75mg immediate release at night. I have to take the night dose earlier, like 5pm, because my sleep has been terrible. He's also added 7.5mg mirtazapine at night, "as and when", to help with sleep. I took the first mirtazapine last night and it knocked me out for 10 hours! I still feel exhausted.

Today I'll increase the Ven and take the first 150mg XR. I was waiting until I didn't need to drive for a few days to try these.

Sorry this is so long. I'm just interested to know if anyone has had this sort of combo before?! Thank you in advance

[panic_down_under]

he has persuaded me to up it again to 225mg, as he says that's where the noradrenaline receptors kick in

True, but not by much. Despite what it says on the label, venlafaxine is really a SSRI, not a SNRI. Paroxetine is a more potent noradrenaline/norepinephrine reuptake inhibitor, albeit still only a weak one.


I took the first mirtazapine last night and it knocked me out for 10 hours! I still feel exhausted.

That isn't that unusual. The effect tends to diminish after a while. It also lessens for most as the mirtazapine dose increases.


I'm just interested to know if anyone has had this sort of combo before?!

Using mirtazapine as a sleep aid is fairly common with serotonin reuptake inhibitors which can be quite activating, though some experience sedation instead.

[Dying_Swan]

Thank you for your reply, panic down under. That's really helpful. He wanted to switch the Ven entirely to mirtazapine but I declined (due to worrying about weight gain), hence the compromise on Ven increase. Maybe paroxetine would have been better :/

Do you know whether the sedating effect of mirtazapine will diminish if I just use it occasionally? On the one hand I'm encouraged that it worked, but on the other hand I don't want to feel so tired in the morning. He didn't specify how often I should take it. As far as I know, there's no plan to increase it, and it's for sleep only rather than for its AD properties.

I'm also unsure about why there would be a benefit in having the 150mg as extended release. I have to go back in a few weeks so will ask, but it's always helpful to hear of others experiences.

Thank you again.

[panic_down_under]

He wanted to switch the Ven entirely to mirtazapine but I declined (due to worrying about weight gain), hence the compromise on Ven increase. Maybe paroxetine would have been better :/

I'm not a fan of mirtazapine as the only anti anxiety, or depression med. Venlafaxine is likely to be a better bet. As may paroxetine, however, it can be difficult to quit due to its very short half-life and lack of active metabolites so I'd try another SSRI first should that be required. Venlafaxine's active metabolite desvenlafaxine performs better as a SNRI, as does duloxetine.


Do you know whether the sedating effect of mirtazapine will diminish if I just use it occasionally? On the one hand I'm encouraged that it worked, but on the other hand I don't want to feel so tired in the morning.

Ask your psychiatrist about trazodone. Like mirtazapine it is very sedating at low doses, but it has a much shorter half-life, about 1-3 hours compared to mirtazapine's 20-40 hours, so is less likely to be sedating into the next day.


I'm also unsure about why there would be a benefit in having the 150mg as extended release.

I'm guessing because plasma levels are more consistent so less chance of a yo-yo effect which many find disturbing.

[MyNameIsTerry]

I'm also unsure about why there would be a benefit in having the 150mg as extended release. I have to go back in a few weeks so will ask, but it's always helpful to hear of others experiences.

As Ian says, less harsh side effect profile due to a longer half life. It's the one they switch too from immediate release for those who struggle with the side effects.

What I do find interesting is the immediate release night dose. That's going to be a short half life and it's not going to mean getting 225mg a day (unless the peak periods overlap) but it is going to give your blood plasma levels a boost in this drug towards the end of the day when the XR is winding down. That's not necessarily a bad thing though because with a shorter half life drug over the course of the day we can eliminate quite a bit of it and a later boost might help.

On this basis it may be a suck it & see and maybe they will adjust it to better times if needed?

[Dying_Swan]

Thank you both. Your replies are both really helpful. I will ask about trazodone next time I go. I'm hoping the mirtazapine is a temporary thing just to help me reset my sleep schedule. So far, so good, but I think something shorter acting might be better. He wasn't keen on benzos because he said it might worsen depression.

I had thought the immediate release night dose was to pacify me and my concerns about interdose withdrawal. A while ago I briefly took XR twice a day and didn't sleep a wink. Interesting and helpful to think there could be some benefit to doing things this way. I'd never have agreed to revert to once daily.

Thanks again. Lots of food for thought and very reassuring.

[panic_down_under]

He wasn't keen on benzos because he said it might worsen depression.

They also inhibit neurogenesis which is the mechanism that produces the antidepressant and therapy response. They may be useful for helping get onto antidepressants, but can be counterproductive in long term use.

[Dying_Swan]

They also inhibit neurogenesis which is the mechanism that produces the antidepressant and therapy response. They may be useful for helping get onto antidepressants, but can be counterproductive in long term use.


Really helpful to know, thank you. I'll be mindful of that when taking diazepam. I've had 3 good nights sleep thanks to Mirtazapine :yesyes:

[Maca44]

Im coming off Mirt and starting Ven so at the moment its a cross over taper. Been on Mirt over 3 yrs and can say the drowsiness does or did go away after a week or so. I always have a hangover feeling am on mirt @ 30mg and yes I gained 3 stone in weight in the 3 yrs the tabs don't pick the food up and force feed me but my god it don't half give you cravings so you gotta have alot of willpower not to gain weight.

[Dying_Swan]

Hi Maca.

Thank you for your reply and the information about mirtazapine. How are you getting on with your cross taper? The weight gain aspect worries me and I've definitely had the munchies a few times. I'm being careful though and watching my weight closely.

So far, this medication regime has worked really quite well for me. I've always been sceptical about whether antidepressants did anything for me, but I noticed an improvement within 2 days this time. The mirtazapine hangover only lasted a day and then disappeared. My prescription for mirtazapine is "as needed" so I don't take it every night now, although I think my mood the next day is better if I do. Getting some sort of sleep pattern back I'm sure has helped, as I was previously up and down all night. For some reason, 150mg Ven didn't agree with me at all, and I'm better on 225mg, even with my strange mix of XR and IR. I've noticed my mood seems to dip around 5pm so maybe the boost of 75mg IR at that time is a good thing. I'm already dreading the thought of reducing it, but I'll cross that bridge if and when I come to it. Back to the psych soon so will see what he has to say.

Good luck Maca with your med change ��

[Maca44]

Yes early days for me I'm 3 days into starting Ven @75mg so I think the plan is to get on the ven and reduce/come off the Mirt. I am the opposite to you, I start to feel better around 5pm into evening but suffer first thing. The only side effect so far on the Ven is I feel kind of wired am, on edge, its hard to explain really. The weight thing is about self control but the mirt munchies get so intense I can't stop myself eating junk about an hour after taking it, can't blame Mirt for this but it turns me into a piggy its very much like the munchies you get after smoking weed, I smoked it many year ago but don't touch it now., im in a mess already so touching alcohol or weed would be a very bad idea.

Onwards and upwards take care.

[Dying_Swan]

Thanks Maca.

I've slowed down on how often I'm taking the mirtazapine, mainly because I've not needed it so much as my sleep has improved. I have also quite literally locked away snack foods and allow myself a certain amount only!

Funny isn't it how we're getting our symptoms at opposite ends of the day. I'm sorry you're feeling on edge with Ven. I will head over to your post, but wanted to respond here too as appreciate you taking the time to reply.

[Maca44]

Yes lets keep switching between posts 😀 I will pop in to see you and you can come visit me on my post.

[Dying_Swan]

Yes lets keep switching between posts  I will pop in to see you and you can come visit me on my post.

:yesyes:

[Maca44]

Try again keep deleting posts.

I think the Mirt will work better for sleep if only taken now and then. I remember my first dose knocked my right out and I felt drunk the next day.

[Dying_Swan]

Same for me. The first dose was so effective it scared me and I felt exhausted the next day. Luckily that has got better.

I've been back to the psych who wants me to take the mirtazapine every day now, because he thinks it will help my mood. Still just 7.5mg, and continuing with 225 venlafaxine. I asked about trazodone and he said he prescribes it a lot but he thinks mirtazapine is better for me. He thinks I'm improving but still have a way to go, which I guess I agree with. I'll see him again in a few weeks.

Onwards and upwards, hopefully :blush:

[Maca44]

The lower dose of Mirt makes me feel more sedated/sleepy but the 30mg not so much. I am thinking that Ven & 15mg or 7.5mg of Mirt might also work well for me. Always hoping some combination will hit the sweet spot.

[Dying_Swan]

Yes maybe that's an option you could speak to your GP about? I'd never heard of them in combination but seems several people take both. It's interesting that the lower dose mirtazapine seems to be more sedating and I'm not sure why that is. I don't know if you go even lower than 7.5mg, whether that effect is even stronger.

[Maca44]

Yes maybe that's an option you could speak to your GP about? I'd never heard of them in combination but seems several people take both. It's interesting that the lower dose mirtazapine seems to be more sedating and I'm not sure why that is. I don't know if you go even lower than 7.5mg, whether that effect is even stronger.

I know it acts differently at higher doses but don't know the technicality of it but sure someone here does. How are you getting on ?.

[panic_down_under]

I know it acts differently at higher doses

Mirtazapine is mostly a very potent antihistamine at low doses blocking histamine H1 receptors which produces most of the sedation. It is also an antagonist (blocker) of serotonin 5-HT2a and 5-HT2c receptors which lengthens REM and slow brain sleep duration. At higher doses it enhances noradrenaline, aka norepinephrine, neurotransmission which is activating. The higher the dose the more activating it becomes.

[Maca44]

Mirtazapine is mostly a very potent antihistamine at low doses blocking histamine H1 receptors which produces most of the sedation. It is also an antagonist (blocker) of serotonin 5-HT2a and 5-HT2c receptors which lengthens REM and slow brain sleep duration. At higher doses it enhances noradrenaline, aka norepinephrine, neurotransmission which is activating. The higher the dose the more activating it becomes.

I was just about to say that, honest 😉

[Dying_Swan]

Mirtazapine is mostly a very potent antihistamine at low doses blocking histamine H1 receptors which produces most of the sedation. It is also an antagonist (blocker) of serotonin 5-HT2a and 5-HT2c receptors which lengthens REM and slow brain sleep duration. At higher doses it enhances noradrenaline, aka norepinephrine, neurotransmission which is activating. The higher the dose the more activating it becomes.

Thank you, panic down under. That's really interesting. Is it also true that the lower the dose, the more sedating it is? And the longer REM sleep I guess is responsible for the weird and wonderful dreams?

I'm doing ok thanks. Up and down and feel a bit like I've reached a plateau, but it's a better plateau than the one I was stuck on a few weeks ago. I've been more anxious but in a strange way I feel like that's a good thing, as on 150mg I felt like I had no emotions. A bit of anxiety is more normal for me, if that makes sense :blush:

[Maca44]

Sounds posative' I know what you mean about having anxiety in a different way' I can get really anxious at work due to the stress but kind of like it as once the work is calming down I get a feeling of relief and that relaxes me. Its different from the pure panic anxiety.

[panic_down_under]

Is it also true that the lower the dose, the more sedating it is?

Yes, mirtazapine is usually most sedating at the low end of the dose range as it doesn't need much med to saturate the histamine receptors, becoming less so as the dose increases and noradrenaline activity becomes stronger, however, antidepressant side-effects can be different from person to person so your mileage may vary.


And the longer REM sleep I guess is responsible for the weird and wonderful dreams?

Not sure if it because dreaming lasts longer, or because REM may not be as deep as before so dreams might intrude more into consciousness. I can't say whether the dreams are really more vivacious than before, or only appear so because we remember them in greater detail. Enjoy the ride as it can be temporary.

[Dying_Swan]

Thank you panic down under. You know so much about this stuff and it's really helpful. I'm quite happy for the dreams to be temporary, I just hope the sleep effect of the mirt isn't. I'm terrified of it stopping working!

[Dying_Swan]

Ok, I'm having some pretty wild mood swings. I feel like I can switch from high to low to high minute by minute, but I'm finding a really noticeable dip in my mood about 5pm. Tonight is the worst that dip has been, to the point I was scared and almost called 111. I take my 75mg immediate release Ven about 6pm (150mg XR in the morning). I told the psych about the 5pm decline which I think is why he said to take the mirtazapine every day, but I have done for almost a week, and it's getting worse. Anyone have any ideas?

[Maca44]

When you say scared do you mean scared of your low mood or something else ?.

[panic_down_under]

Anyone have any ideas?

You would probably do much better taking 3 x 75 XR daily, one when you get up, the second around 2-3 pm and the third just before bedtime. I found people do so even with the longer half-life ADs. I certainly do. Doctors don't like prescribing them this way because the more times folk need to take a med the more likely they are to stop taking it altogether - nine out of ten doctors agree medicine is an enjoyable occupation except for the $@#*%~^ patients (the other one has prescribed himself too much Haldol to care!). :ohmy:

[Dying_Swan]

Sorry Maca, yes I mean I was scared by my low mood. It lifted in a couple of hours but was horrible. Maybe aggravated by the hot weather :/

Thanks panic down under. I will ask about it. I'm not sure why he put me on the XR at all and I really hope this 5pm business doesn't last. What would you think about 150mg in the morning and 75 in the evening, but all immediate release? Or do you think three times daily would be better?

[panic_down_under]

What would you think about 150mg in the morning and 75 in the evening, but all immediate release? Or do you think three times daily would be better?

The trick with ADs is to keep plasma levels as constant as possible and 3 x 75mg XR would be more likely to do so, especially in your case where even the morning XR dose seems to be running out of steam by 5pm. It will likely to be even worse if you switch to 150mg immediate release which has a half-life of only 3-7 hours.

[Maca44]

How are you feeling Dying swan,
Are you still getting the low mood at tea time.

[Dying_Swan]

Thanks PDA. Ok sounds like 150am/75pm IR wouldn't be a great option. I already know that I metabolise the XR very quickly, as when I was on 75XR once daily I'd withdraw between doses. Eventually I found a study on one patient who was the same and showed it to my GP. I'm not getting the withdrawal symptoms though, just this horrible low mood.

Thanks Maca. I'm ok, felt quite rough again yesterday evening but am sure the heat didn't help. The mirtazapine is still helping with sleep thankfully.

[Maca44]

Isn't it funny how we are total opposites in moods, I pick up at 5pm until bed then mood is low from waking.

[Dying_Swan]

It's weird isn't it?! I'm wondering if that is the time to do something, like exercise. For you, in the morning, and evening for me. But of course it's the time you just want to collapse in a heap, and it's so damn hot too. Last year I started couch to 5k, in the ridiculous heat. I didn't even finish the first week, but then it was 30 degrees :D if it cools off, I might try to force myself to start it again, at 5pm. I feel like between us, there must be an answer!

[Maca44]

About 3yrs ago before this episode of low mood/anxiety, I did the 5k podcast and ended up running 6 miles after it was finished, lost loads of weight and felt amazing. I look back and see that was the start of my problems, I injured my calf so had to stop running then mood nose dived anxiety set in, so I find myself 3 stone heavier, could just about walk 6miles and have no confidence. I need to find another form of exercise other than running, exercise made a huge difference

[Dying_Swan]

6 miles! Very well done. Not a chance I could do that. Agree exercise makes a difference. Last year was the most active I've been in years, and I generally felt good. I'm not sure which came first, if that makes sense. I'm sorry to hear about your calf - that must've been frustrating. Do you like swimming? I do, when I can motivate myself to go, which I haven't in months. I did think about my exercise pledge at 5pm, but meh. Tidied up my tip of a house a bit instead. Still felt yucky, but more physically yucky today. Strangely that gives me hope, as felt like the Ven increase side effects I've had before, meaning it might just get better.

[Maca44]

Lets hope so

[Dying_Swan]

I've been back to the psych and told him about the mood swings. I wasn't keen on any of his suggestions but he's got a knack of getting me to agree to things I'd normally refuse. So next step is I'm increasing to 15mg mirtazapine and staying at 225mg venlafaxine. If that doesn't work it's either 300mg ven or adding in quetiapine :unsure: He says 15mg mirtazapine should still help with sleep. I'm supposed to ring 111 if I get more of the awful low moods. We'll see. I'm worried about weight gain, although managing to keep it fairly stable, going up and down by a couple of pounds

[Maca44]

Gotta keep trying things and im sure you will soon fine the sweet spot. The 15mg Mirt should still help with sleep just keep an eye on the weight that is my only gripe with Mirt, I won't knock it because it got me out of right mess 3yrs back. Keep at it we will all get there in the end.

[Dying_Swan]

Thanks Maca. Let's hope so. I'll try out the 15mg mirtazapine tonight and see how it goes :blush:

[Dying_Swan]

Bl**dy hell. 15mg mirtazapine certainly makes you sleep :wacko: I feel completely exhausted. 3 nights of it now. I know this should probably be in the mirt section but I don't want to start a new thread. I've also noticed a weird feeling when the mirt kicks in, like I'm falling. It is as I fall asleep, and last night was combined with anxiety but I couldn't keep my eyes open. I'm not worried about it, it just feels different. On the plus side my appetite has decreased and my weight is back to where it was pre-mirtazapine. I've started calorie counting again because I really don't need to be gaining weight. Exercise feels like a mountain to climb right now. CBT therapist wants me to join clubs and book holidays, but I'm just not in that place. Having a shower feels like hard work. I really hope this passes soon.
Also, night sweats. Sorry if TMI. Again I'm not exactly worried about it but it's a bit of a pain. I have a feeling that's the Ven. I remember sweating a lot when I tried to increase it in 2016.
It is helpful to have somewhere to write all this.

[Jo79]

I know what you mean about the sweating, definitely the Venlafaxine. I have to bring a towel with me wherever I go at the moment! It’s been a nightmare the last couple of days as it’s been so humid where I am in Hampshire!

[Dying_Swan]

Thanks Jo. It's a nuisance isn't it? I'm glad you also think it's the venlafaxine, was starting to wonder if it was my hormones but they shouldn't be doing things like that just yet! Yes it's pretty warm. Great for drying all the washing I'm creating :blush: Hope you are feeling ok today

[panic_down_under]

I'm glad you also think it's the venlafaxine, was starting to wonder if it was my hormones but they shouldn't be doing things like that just yet!

It is almost certainly the venlafaxine. Serotonin isn't just a brain neurotransmitter. It has many functions in the body, including being a signal protein involved in blood vessel tone - constriction and dilation. The skin and its small blood vessels use about as much serotonin as the brain. Serotonergic antidepressants can affect this function initially producing skin related side-effects such as heat rashes and sweating (hyperhidrosis). They usually diminish after a week or two, but can return for a while after dose increases. BTW-serotonergic antidepressants may increase photosensitivity so use a good sun block if going outdoors for any length of time.

Small 1mg doses of the blood pressure medication terazosin (Hytrin) have been shown (https://www.ncbi.nlm.nih.gov/pubmed/22731399) to significantly reduce SSRI/SNRI induced sweating, as has oxybutynin (http://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2010.10091348) (Ditropan) which is prescribed for overactive bladders, but I suspect doctors would be reluctant to prescribe them for sweating, however, it won't hurt to ask. It might be worth discussing this with your pharmacist as there are effective topical preparations that reduce sweating.

[Maca44]

I felt drunk on 15mg of Mirt when I started but it goes, I now wish it had the same effect 😀.

[Maca44]

+ 1 on being sweaty, been sweating loads when out doing light work in the garden just gotta keep hydrated.

[Dying_Swan]

Thank you PDU and Maca. Very interesting about the effects of Ven on skin. I had heard about the sun sensitivity but wasn't sure if it was a myth. That'll explain the number of times I've managed to get burnt this year then! I'm hoping the sweating will ease off. It only seems to be at night for me, but then I'm so comatose from the mirtazapine it probably doesn't help. I do remember it being an issue in the day time last time I increased though. Sorry Jo and Maca that you're also getting the sweats.
I still slept heavily last night but haven't been quite so sluggish today. Hoping it continues to improve.

[Maca44]

Yes the sluggish feeling will go.

[Dying_Swan]

Thank you for reassuring me. It seems to be easing up a bit. Hope you're doing ok today

[Maca44]

First dose of 150mg yesterday and sleep weird again, asleep at 8.30pm awake at 12.30am and awake till 4 30am then a couple of hours sleep. Must be the Ven as Mirt still at 15mg. No biggy it doesn't bother me.

[Dying_Swan]

Glad it's not stressing you out now. I think that's half the battle with insomnia. I'm still sleeping quite excessively with mirtazapine. Gone are the days when 5 hours was plenty. Just reminding myself it's early days. Appetite is mainly unchanged thankfully, although I had a mishap with some cookies :ohmy:

[Jo79]

Those mishaps are called snaccidents! I have been having them quite frequently the last couple of days, a whole 4 pack of mars ice creams just fell into my mouth today 😋

[Maca44]

I swear those cookies have legs and walk into my mouth.

[Dying_Swan]

Snaccidents :D Love it. So glad it's not just me! Thanks guys

[Maca44]

Hi DS,

How are you doing ?

[Dying_Swan]

Hey Maca. I'm alright thanks. I've had a few more snaccidents which I need to be careful about. Mood is up and down but not as bad as before so hopefully that's progress. I forgot to take mirtazapine last night and I'm 3 hours late with Ven today so feeling a bit odd but that's my own fault. How are you getting on?

[Maca44]

Same as you really, abit up and down with mood/anxiety but nothing major. Sleep still odd with whacky dreams, some good some horrific. Woke up with Mirt cravings so was eating a Snickers bar at 3am, mad isn't it. On the whole I would say things are getting alot better.

[Dying_Swan]

It is odd. Yes, I polished off a packet of jammie dodgers last night. Not good! The dreams are very strange. The psych said that it's the brain processing after months of not sleeping properly, but I'm not convinced and think it's the meds. Maybe it's both. I've had a couple of nights of feeling really agitated and a bit panicky, and then some slightly mad moments of feeling quite euphoric, but nothing that's made me want to call for help again thankfully. I'm so pleased that you think things are on the up for you, and I guess it will be a little up and down. As long as overall it's improving, that's the main thing. What is your GPs plan? Are you sticking at 150 Ven and 15 mirt? How's it going with zopiclone?

[Maca44]

I think its the meds causing the dreams as well its pretty well documented. The plan is to come off Mirt but I'm going to suggest both as they are I think its a good combination. Still taking Zop it will be the last to reduce but as I'm not getting panic in the day I don't need to take half to calm down at work, which is good but im realistic in as far as I know it will be hard coming off.

[Dying_Swan]

Yes I agree about the dreams. I don't really mind it though, for the most part. I'd not heard about the ven/mirt combo until I started it but keep coming across it more now. As long as it's not causing you any problems then yes, seems sensible to stay on both. It's great that you're not needing the zopiclone in the day now and I think feeling more positive overall will help when you do reduce it. Are you going to increase the ven again?

[Maca44]

No mention of Ven increase yet but gp is on hols so not seeing her until next month. All depends on how well the Ven works so will prob give it a couple of months for it to kick in 100%, Mirt took about 3 months to fully work.

[Dying_Swan]

Ok sounds reasonable. Yes I think it takes a good while to tell how you're going to be on a particular dose, especially when it's combined with other meds too. I'm hoping missing one dose of mirt won't be too much of an issue. Feeling steadier now Ven is back in my system

[Maca44]

A few months ago I reduced my Mirt from 30mg to 15mg and thought this is easy but about a week later it hit me and I got into a pickle. I think Mirt stays in the system for a while so missing a dose should not cause you any harm.

[Dying_Swan]

Thank you :) Super tired today. I think the mirt likes you to have plenty of sleep! Hope you're having a good morning

[Dying_Swan]

I went back to the psych today. He wants me to stop mirtazapine and start quetiapine :scared15: I'm a little scared but he said I can just try it out sometimes and take mirtazapine at other times if I want. Starting 25mg, he said to build up to 100mg over the next few weeks. Worried about weight gain but he doesn't think it will be any different to mirtazapine regarding appetite.

[Dying_Swan]

He said it would help as much as mirtazapine with sleep. Took first dose and Ive been up all night :wacko:

[Maca44]

O dear, I reduced Mirt last night from 15mg to 7.5mg and also been awake most of the night with horrible nightmares when I did drop off. Hope this doesn't last long.

[Dying_Swan]

Oh I am sorry to hear that. Sleep is so important and everything feels worse when you're tossing and turning all night. I emailed the psych in a panic so will be taking mirt again tonight with quetiapine. Fingers crossed for you that you sleep better tonight and I really hope it gets better soon

[Jo79]

How’s things going on the quetiapine DS?

[Dying_Swan]

Thanks Jo. Not a great day and not feeling well, waiting on a call from the GP. Right now I'm back on mirt with quetiapine and ven, after a huge meltdown at the weekend. The mental health team said to take diazepam too if needed but today I have felt sick, dizzy etc so not too sure. I'm supposed to increase the quetiapine again at some point but not willing to do that yet. Thanks for checking in. It does help to share journeys with you guys x

[Dying_Swan]

Duty GP called, terribly nice but on explaining I felt like I'd had half a bottle of vodka, he wanted to know how I knew what that felt like and launched into a discussion about alcohol. He's not willing to give advice on the psych meds because psychiatrist is involved. I do understand that but don't want to hassle the psychiatrist, having already emailed a couple of times over the weekend. Maybe I'll just see how tomorrow goes.

[Maca44]

I think most people would know what half a bottle of Vodka would feel like even if they never drank it. You were just describing a feeling so no need for a lecture about alcohol, but I guess they were just trying to help.

[Dying_Swan]

Well exactly. I would think most people have been drunk at some point. I've emailed the psych again on GP's advice so will see. I hate feeling like a nuisance but really need to know what to do with meds now, and I'm not due to go back for a month.

[Jo79]

Oh, how I miss a G&T! Not touched any alcohol since June :scared15::noangel:

[Sunnysideup]

Oh, how I miss a G&T! Not touched any alcohol since June :scared15::noangel:

Yep, really missing a glass or two of prossecco. Last time I tried that was April and I felt totally shit the next day. Looking forward to the day when that's not a problem.....hope it comes.

[Dying_Swan]

You guys have greater will power than me. I am limiting it though, just having a drink occasionally.

Last night was the first night I didn't sleep well despite mirtazapine. Hoping it was just a one off, as feeling shattered today. I'm sure I need much more sleep on mirtazapine than I ever used to.

[Maca44]

When I was on 30mg of Mirt alone I used to sleep 12hrs often but felt hungover am.

[Dying_Swan]

Thanks Maca. Yeah, 12 hours seems to be what I need with mirtazapine! Slept better last night thankfully, albeit with weird dreams. Hope you're doing well today

[Maca44]

Thanks Maca. Yeah, 12 hours seems to be what I need with mirtazapine! Slept better last night thankfully, albeit with weird dreams. Hope you're doing well today

Yes thanks its been a good couple of days for me work was really hectic yesterday and normally I would be a complete wreck and stressed out but I was just calm as anything and just enjoyed it, I am now able to take one thing at a time instead of looking at all the deliverys in the van and going into melt down. Its quite amazing how my thinking has changed I have never been able to do this.

[Dying_Swan]

That's great Maca. So pleased it's made such a big difference for you :)

[Dying_Swan]

Just updating after another review. Ven down to 150mg, quetiapine up to 300mg. Still on mirtazapine for now but will switch to trazodone asap. Currently feeling quite wired but I know this happens when I increase quetiapine, so hopefully it'll calm down soon, otherwise I may be forced to go running in my pyjamas in the middle of the night :wacko:

[Maca44]

Is running in Pyjamas listed as a side effect 😉

[Dying_Swan]

Is running in Pyjamas listed as a side effect 

:roflmao:Running at all would be an amazing side effect for me. Thankfully, for my neighbours, I managed to stay in the house.

[Maca44]

I know that some people on Zopliclone can go night driving and wake up not knowing they had done so, odd isn't it.

[Dying_Swan]

Oh wow, that's quite scary. I think quetiapine can also make you sleep walk etc, but I've not yet noticed anything. Are you still on the zopiclone?

[Maca44]

Afraid so still use it as a sedative if things get out of hand so im under no illusion that im totally addicted to it. Doc wants mood/anxiety under control before zop reduction.

[Dying_Swan]

That's fair enough. Probably a good idea to have a decent period of stability before making any more changes.

[Sunnysideup]

How are you doing, DS?

[Dying_Swan]

Hi Sunny. I'm not too bad thanks. I'm on 150 ven now and am feeling some withdrawal, though not too bad. I think I'm going to go back to 75mg twice a day rather than 150 XR just in the morning. Switching Mirtazapine to trazodone soon so hoping that won't be too bad. How are things with you?

[Sunnysideup]

Hi Sunny. I'm not too bad thanks. I'm on 150 ven now and am feeling some withdrawal, though not too bad. I think I'm going to go back to 75mg twice a day rather than 150 XR just in the morning. Switching Mirtazapine to trazodone soon so hoping that won't be too bad. How are things with you?
Good to hear things are relatively okay.
I'm also not too bad. Had a great run of 8 anxiety free days, then something silly wound me up and I crashed yesterday, was really anxious all day. Spilled over into today, but is resolving this evening. Ugh. 8 weeks in tomorrow and still levelling out, really.

[Dying_Swan]

Sorry to hear you had a blip, but I hope it was just a blip and you're out the other side now. It is really tough when you think everything's going well and then you crash. Just remember the snakes and ladders. I think I might be on a ladder at last, but I'm so scared to think that in case a snake comes along :blush:

[Sunnysideup]

Sorry to hear you had a blip, but I hope it was just a blip and you're out the other side now. It is really tough when you think everything's going well and then you crash. Just remember the snakes and ladders. I think I might be on a ladder at last, but I'm so scared to think that in case a snake comes along :blush:
Yeah, it can be so unpredictable.Fingers crossed you're on that ladder, I reckon you are. My blip has blipped off, thank god.

[Dying_Swan]

I'll raise a glass to that. Blips can blip off :yesyes:

[Maca44]

Bloody blips 👹

[Maca44]

Lets all hope the Snakes get shorter and Ladders longer 🙂

[Sunnysideup]

I'm raising that glass to blips blipping away :D

[Dying_Swan]

Hell, me too. Didn't have a great day yesterday and it's so damned frustrating. I started trazodone the night before and of course, it didn't make me sleep, until many hours later when I couldn't keep my eyes open and my mood crashed. I'll give it a week or so but I'm so tired of med changes and snakes. Have a feeling I'll be switching back to mirtazapine. Happy blipping weekend all!

[Maca44]

I feel for you, constant med changes that are not working so well must be so disappointing. I will be coming off Mirt soon so am expecting sleep issues its like saying goodbye to an old friend. Guess your only option is to keep plugging away.

[Dying_Swan]

Yes, you're right. I'm trying to be positive but last few days have been turbulent. I don't know if it's switching mirt to trazodone, decreasing ven, having had a couple of drinks at the weekend, or what. I had a difficult CBT session yesterday too, as basically neither of us can decide whether it's worth continuing with. Ho hum. Hopefully this snake is a short one. Good luck with your GP tomorrow.

[Maca44]

Thanks will report back what GP does.

I can handle the Slow worms, its the Pythons that im not so keen on.

[Sunnysideup]

Hell, me too. Didn't have a great day yesterday and it's so damned frustrating. I started trazodone the night before and of course, it didn't make me sleep, until many hours later when I couldn't keep my eyes open and my mood crashed. I'll give it a week or so but I'm so tired of med changes and snakes. Have a feeling I'll be switching back to mirtazapine. Happy blipping weekend all!
REALLY frustrating, isn't it? Sorry your day was shitty. Sleep, or lack thereof, is such a hassle at times. I'm going through a phase of being wide awake at 4 am....:lac:No, brain, that's too early. Bliptastic.

[Sunnysideup]

Thanks will report back what GP does.

I can handle the Slow worms, its the Pythons that im not so keen on.
:D

[Maca44]

I had the phase of going to sleep then waking 3 or times wide awake so I just got up some nights I was washed dressed at 4am. This does go away.

[Dying_Swan]

Thanks folks. Slightly better today, even though I didn't get to sleep until the birds were singing. The weather has such a massive impact, it's annoying. Hope you are both sleeping soundly without a python in sight!

[Sunnysideup]

I had the phase of going to sleep then waking 3 or times wide awake so I just got up some nights I was washed dressed at 4am. This does go away.
Glad to know it blips off, I also just tend to get up and make tea rather than lie in bed fretting.

[Sunnysideup]

Thanks folks. Slightly better today, even though I didn't get to sleep until the birds were singing. The weather has such a massive impact, it's annoying. Hope you are both sleeping soundly without a python in sight!

Eek! Hopefully no python dreams or real ones tucked into the duvet.......

[Dying_Swan]

Actually that's a good point. I'm not dreaming as much, maybe due to decreasing ven or stopping mirt. I've noticed I get a really horrible skin crawling feeling about an hour after taking quetiapine, so will talk to the doc about that, as it's making sleeping more difficult. I had my NHS mental health assessment and came out feeling ten times worse than when I walked in. On that day I rated my mood as 4-5/10, and apparently that single score means I'm not ill enough for any help, nevermind the fact that the assessment was suggested by my psychiatrist and MIND's crisis service, and the assessor had seen all the crisis stuff in my records. But of course I'm too ill for the IAPT service. I can really see how people fall through the cracks and it's frightening. Sorry, just need to vent. I know mental health services are chronically underfunded.

[Maca44]

I have no faith in the NHS mental health service anymore, such a shame people have to suffer.

[Dying_Swan]

You're right. It's so disappointing. What really worries me is the number of people who simply cannot access help. I'm far from wealthy but have been able to fund some private support, but so many people can't. It just beggars belief :(

[Jo79]

I’ve got my assessment next week so I’ll probably get the same as my mood is good at the moment. It’s so frustrating after all they are the ones who tell you that drugs will only get you so far and you need to put in the effort e.g. psychological therapy to get better but then don’t give you that help????? I’m almost tempted to lie and just say I’m feeling bloody awful

[Dying_Swan]

It's true, though I hope your assessment is more "successful" than mine. I've been trying to be more active which probably didn't help my cause. The nurse phoned me earlier and said their psychiatrist has been through my records and has decided all my problems are due to my childhood and that I need cognitive analytic therapy, but obviously they don't provide that. Seems that because I've got a degree, that means I "live well" so don't need their support. On the other hand, apparently I gave her no eye contact which means I'm too ill to go to work. Happily, they don't think my problems are bad enough to be a "disorder", but that doesn't include anxiety or depression. What they are happy to do is farm me out to various charities who don't get back to me. Fascinating how this psychiatrist who's never met me has made all these assertions, but there we are. I'll try to remove my tongue from my cheek over the next few days. Good luck Jo!

[Jo79]

That is shocking...especially them saying you’re ok because you’ve got a degree. I can’t really see how that’s relevant. I would actually be tempted to complain if I thought it would get anywhere :mad:

[Dying_Swan]

I know. Those weren't her exact words but it's basically what she was saying. It's absurd and has absolutely nothing to do with anything. I'm going to talk to my psych about it next week. Really hope you get on better x

[WiredIncorrectly]

Seems that because I've got a degree, that means I "live well" so don't need their support.

When I wanted to get admitted a few years back I begged the psych. His words were "It's not a place for somebody with a degree and family". I asked "What is that meant to mean?" and the question was avoided by him. They think because we've been through University it must mean we've dealt with more pressures in life than most and we did so successfully. I'm sure that's how they see it.

This thread is relevant though. I need to go up on ven. They don't seem to be doing what they used too anymore.

[Dying_Swan]

That's exactly it, Wired, and exactly what they're getting at. To my mind, that just stigmatises mental illness even more and totally ignores the fact that anyone can be affected. A relative of mine was an FE teacher and told me that rates of eg eating disorders are disproportionately high amongst Oxbridge students. I'm not sure if that's just anecdotal, and I don't have an eating disorder nor did I go to Oxbridge, but just as an example. Everyone has stressors and risk factors. It infuriates me and I'm really sorry you were treated like that.

What dose of venlafaxine are you on now? Is there a plan for you to increase?

[WiredIncorrectly]

What dose of venlafaxine are you on now? Is there a plan for you to increase?

x75mg twice a day. I missed the evening dose Saturday, and the morning dose Sunday. I took a dose Sunday evening when I was home and one this morning but today I've got what feels like a nasty hangover and increased anxiety. The delayed reaction to missing a dose is horrid. Does the side effect of missing a dose get worse when the dose increases? I try not to miss a dose but this weekend was unavoidable. I stayed over with my brother and packed my diazepam and an empty box of ven.

[Sunnysideup]

Utterly shocking, the state of mental health care in this country. I am sorry for what people here have had to go through. Actually bit sad for myself too, because of the lack of knowledge NHS GPs seem to have about antidepressants and tapering etc.

[Dying_Swan]

Sorry for delay in replying. It's been a tough week one way or another, and everything hit the fan. The upside, if it is one, is that the NHS had second thoughts and have opened my case to the CMHT, so according to the letter I got, I've now got an NHS psychiatrist and a CPN. It seems some discussion took place with my private psychiatrist, so I'm not sure what's happening there. He told me to email him after I've seen them. I understand his point that it might not be helpful to have two different doctors advising on meds, but I find it quite difficult to think of changing psychiatrists and therapists all at once. I'm relieved in some ways but feel wary of being too hopeful that the CMHT will do anything.

As for meds, I'm now on 400mg quetiapine and down to 75mg venlafaxine (37.5 twice a day). Having a bit of withdrawal from ven and my mood has plummeted. I was doing pretty well a couple of weeks ago, and just don't understand it. I'm only 2 days into this regime though.

Wired, I'm not too sure about missing doses when you're at a higher dose. I used to skip a dose quite often on 75 but don't think I missed any on 150 or 225. It's bloody horrible though. I totally empathise.

[Maca44]

I read that Ven is a tough one to reduce so hope it settles for you.

[Dying_Swan]

Not sure where to put this but don't want to start a new thread. Luckily ven withdrawal didn't last long and I'm down to 75mg, with 400mg quetiapine. I swapped back to mirtazapine from trazodone. I've had my first appointment with the CMHT and it seems like I have to meet with the CPN a number of times for her to make her assessment, and then there is a meeting to decide what to do with me. I decided to make another appointment with the private psych, but apparently I'll also see the NHS one, so I hope they agree with each other's decisions. I also decided to quit my CBT but I should be starting some other therapy soon.

I hope everyone is doing ok, and I hope it's alright to use this thread as a kind of journal.

[Maca44]

CBT for me was horrendous but I think this was due to the person didn't speak great English and was reading off a bit of A4 like a script, also she went in far to fast with things that make me anxious like my HA so I stopped half way in.

Not to say I wouldn't try it again as I read it is good but that all depends on who is giving you the therapy.

[Sunnysideup]

Hello there, been off forum for a bit, hope you're doing ok :)

[Dying_Swan]

Thanks both.

Maca, that doesn't sound good! I've had lots of CBT and it has helped with some things but right now I don't think it's quite what I need. Not quite sure what I do need!

Ive just put a cake in the oven as decided baking might be therapeutic. I think the mirtazapine will be grateful, my waistline not so much :D