Mianserin or Tolvon

[beautifulfreak77]

Hi my psychiatrist has offered me mianserin but I can’t find any reviews online it’s like it doesn’t exist, please has anyone here tried it? May of been called Tolvon in other countries....it’s making my anxiety high that I can’t find anything to do with this antidepressant, I know it’s an old antidepressant I just want some reviews....thanks for reading 🙂

[MyNameIsTerry]

There is a guy who posts on the Meds board called panic_down_under. He (Ian) knows tons about meds so I expect he can help you here. He knows a lot of TCA so I expect he can help with this.

[beautifulfreak77]

Okay thank you I will see if I can try and ask him then.

[beautifulfreak77]

Hi my psychiatrist has offered me mianserin or maybe known as Tolvon, I know it’s an old tetracyclic antidepressant but I can’t find any reviews online, i wrote on another thread and someone said to write here as a very nice man named Ian maybe able to help, but obviously if anyone else knows anything too It would be great to hear from you, thanks everyone....

[panic_down_under]

my psychiatrist has offered me mianserin but I can’t find any reviews online it’s like it doesn’t exist

Might be time to get a new psychiatrist. Mianserin is an old drug that was a mild sensation when first released until doctors, eventually, realised it was slightly less effective than sugar pills. The makers then slightly tweaked the chemistry and relaunched it as mirtazapine, which, imho, isn't that much better.

Is there a reason he's suggested this and not a SSRI, SNRI, or TCA? Have you tried them and not responded?

[beautifulfreak77]

Hi, oh right this doesn’t seem like it will be much help then. Psychiatrist offered these as I’ve tried a lot of antidepressants including mirtazapine, ssri’s Give me bad anxiety I have panic disorder with agoraphobia and GAD this was for my depression though as I have severe depression and no other antidepressants have helped a couple actually just made me feel very sick and numb, as if I didn’t even care or have feelings for people including my family. This is just getting more depressing as nothing is shifting this depression also I’d like the anxiety gone but at the moment I’m on diazepam for that. The last antidepressant I tried was Duloxetine can’t get passed the starting dose just made me ill. Thank you for your reply though someone said you’d be the man to know ��

[KK77]

Might be time to get a new psychiatrist. Mianserin is an old drug that was a mild sensation when first released until doctors, eventually, realised it was slightly less effective than sugar pills. The makers then slightly tweaked the chemistry and relaunched it as mirtazapine, which, imho, isn't that much better.

Is there a reason he's suggested this and not a SSRI, SNRI, or TCA? Have you tried them and not responded?

Which begs question as to why it's still on market and being prescribed, Ian :lac:

I think you should go back to psych and look at other options, OP.

Have you tried Venlafaxine as side effects are usually milder than Duloxetine? There are also Tricyclics like Clomipramine and Lofepramine which might be worth considering.

[panic_down_under]

Which begs question as to why it's still on market and being prescribed, Ian :lac:

Good question. I am surprised it still is. Haven't had anyone ask about it for years. If I remember correctly, most enquiries came from Italy and Cyprus for some reason.

Mianserin is better than mirtazapine in one respect, small supplementary doses - 15-20mg - may significantly diminish AD induced sexual dysfunction in about 60% of cases when taken daily. I don't know why, but mirtazapine is apparently much less effective as an adjuvant.

[panic_down_under]

Psychiatrist offered these as I’ve tried a lot of antidepressants including mirtazapine, ssri’s Give me bad anxiety

Unfortunately, antidepressants often worsen anxiety at the beginning. There is no real way of avoiding this, but it can often be kept at tolerable levels by starting at a low dose and ramping it up every week or so by the same small amount. I suspect you've been started on relatively high doses more suited to those with depression.


I have panic disorder with agoraphobia and GAD this was for my depression though as I have severe depression and no other antidepressants have helped a couple actually just made me feel very sick and numb, as if I didn’t even care or have feelings for people including my family.

Before SSRIs and SNRIs the 'gold standard' AD for panic disorder was imipramine (Tofranil). While the newer drugs soon replaced it this wasn't because they were more effective. Arguably they are less so. It is a pretty good anti depressive too.


This is just getting more depressing as nothing is shifting this depression also I’d like the anxiety gone but at the moment I’m on diazepam for that.

Diazepam may be worsening the depression. Anxiety and depression are symptoms of the same underlying biological disorder, atrophy (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC60045/) of parts of the two hippocampal regions of the brain due to high brain stress hormone, mostly cortisol, levels which inhibits the growth of new brain cells. The hippocampi are one of only 2 or 3 areas of the brain where new cells grow (neurogenesis) and a constant turnover seems to be required to keep them functioning. Antidepressants and therapy turbo charge the growth of replacement cells. The new cells and the interconnections they forge produce the therapeutic response, not the ADs and therapy directly. This is why ADs takes weeks to become effective. There is good evidence [1] that benzodiazepines inhibit neurogenesis, however, at this stage this is of less importance than getting you onto an effective antidepressant.


The last antidepressant I tried was Duloxetine can’t get passed the starting dose just made me ill.

Duloxetine is often highly effective, but because it is inactivated by stomach acids there are no options for starting on a very low dose which I think is what you need to do.

Imipramine inhibits both serotonin and noradrenaline, aka norepinephrine, reuptake just as duloxetine does. The recommended starting dose for depression is 75mg/day, however, because it is prescribed at low doses for other indications such as diabetic neuropathy, it is also available in 10mg tablets and 25 mg capsules/tablets which makes it easy to start low and titrate up in small steps to the usual minimum therapeutic 100mg dose. While you would probably have few problems starting at 25mg I suggest taking only 10mg for the first 7-10 days if only to build confidence in the med.

[1]
Boldrini M (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4374628/), 2014; Nochi R (https://www.ncbi.nlm.nih.gov/pubmed/23963779), 2013; Sun Y (https://www.ncbi.nlm.nih.gov/pubmed/23639432), 2013; Song J (https://www.kurzweilai.net/how-the-brains-stem-cells-find-out-when-to-make-new-neurons/comment-page-1#comment-96481), 2012;Wu X (http://www.biologicalpsychiatryjournal.com/article/S0006-3223(09)00106-1/abstract), 2009; Stefovska VG (https://www.ncbi.nlm.nih.gov/pubmed/18991352), 2008.

[MyNameIsTerry]

What dose of Duloxetine did you start on? For depression they prescribe 60mg but for anxiety they start at 30mg to reduce side effects. I found 30mg mostly caused nausea but 60mg was a nightmare to stick with so someone going straight onto that with anxiety could find it a bad experience.

[beautifulfreak77]

Hi thank you for your detailed reply, very interesting. It’s all a bit weird the reason how I ended up feeling so low. I was given an injection of fluanxol in early October the next day I felt a bit weird and higher anxiety then the day after I couldn’t don’t sit still but standing up I had to keep walking but very small steps I was trembling all over it ended up that I couldn’t sit or lie I was walking very slowly on my treadmill but this was just tiring me I couldn’t eat it was like my throat wouldn’t allow food it wasn’t swollen I just kept choking. I rang psychiatrist and she prescribed Procyclidine which did help a bit with the trembling and I could sit down for 10 mins and then have to move. I was also given promethazine to try to help me sleep and they increased my Valium, I couldn’t watch the tv without the sound of the adverts putting me into a panic attack,after 10 weeks these side effects went but left me feeling as if I wasn’t me anymore,I went to my gp as my psychiatrist said the injection was out of my system and I was just overreacting...I told my gp I don’t like my music anymore,reading,my tv programs everything I liked before I did t like,I just wanted to be dead,but only as I said because I felt like I wasn’t me. The gp told me I was severely depressed and rang my psychiatrist and said I needed something I’ve tried imipramine,I tolerated it but no help on the mood,I tried duloxetine it made me sick even taking anti sickness but as I said it numbed me and my family said this isn’t right it’s like talking to a robot,so I’ve just stopped them, and this is when she offered the mianserin.... I have tried many antidepressants over the years for anxiety/depression but never had this depression where I feel I’m not even me, my psychiatrist doesn’t seem to listen. And I can’t get another one as she’s the main one where I live there are a couple others but they’re no good to me as I’ve been told. Yes so now I have this very bad depression and my anxiety is even higher but she’s saying she doesn’t know what to give me that’s why she’s probably chosen a rubbish antidepressant to shut me up for a bit. I really don’t know what to do,if I say no to this she won’t offer anything else. But I can’t live with this, music used to be like therapy to me and now I don’t even like what were my favourite songs I barely eat I’m a bit better than I was but I still choke on things, and I’ve totally isolated myself.... sorry for the long reply but just wanted to explain what had happened...thank you again for your reply,it’s nice to know someone has took notice of what I said.

[beautifulfreak77]

Which begs question as to why it's still on market and being prescribed, Ian :lac:

I think you should go back to psych and look at other options, OP.

Have you tried Venlafaxine as side effects are usually milder than Duloxetine? There are also Tricyclics like Clomipramine and Lofepramine which might be worth considering.


No i have not tried these medications and never been offered them. Maybe I should ask psychiatrist about them although she’s saying if I don’t try mianserin she’s not prescribing anything else :weep:

[beautifulfreak77]

What dose of Duloxetine did you start on? For depression they prescribe 60mg but for anxiety they start at 30mg to reduce side effects. I found 30mg mostly caused nausea but 60mg was a nightmare to stick with so someone going straight onto that with anxiety could find it a bad experience.

Started on 60mg but couldn’t handle it,so put me on 30mg it just made me sick still and very numb. After a few weeks I was upped to 60mg again and I just couldn’t handle it,so she took me off that and has offered the mianserin...

[panic_down_under]

I rang psychiatrist and she prescribed Procyclidine which did help a bit with the trembling and I could sit down for 10 mins and then have to move.

Procyclidine is prescribed for Parkinson's disease and other movement disorders. I'm surprised it was prescribed for what sounds like agitation to me.


I was also given promethazine to try to help me sleep and they increased my Valium

Promethazine is a sedating antihistamine with anti nausea properties.

How long have you been taking Valium (diazepam) and what is your current dose?


I told my gp I don’t like my music anymore,reading,my tv programs everything I liked before I did t like,I just wanted to be dead,but only as I said because I felt like I wasn’t me. The gp told me I was severely depressed

Were you still on procyclidine, promethazine and the higher dose of Valium at this point? All three can be sedating so I'm wondering if the "depression" is in fact simply that you're over sedated. Are you on any other meds?


I’ve tried imipramine,I tolerated it but no help on the mood,

What was the maximum imipramine dose you took and how long were you on that dose?


I tried duloxetine it made me sick even taking anti sickness but as I said it numbed me and my family said this isn’t right it’s like talking to a robot,so I’ve just stopped them,

ADs can trigger nausea and detachment in the first few weeks, or for a while after dose increases, but these side-effects almost always soon diminish.


my psychiatrist doesn’t seem to listen. And I can’t get another one as she’s the main one where I live there are a couple others but they’re no good to me as I’ve been told.

...she’s saying she doesn’t know what to give me

It sounds like your psychiatrist has run out of ideas and I'm puzzled by some of her med choices, not least by why she would prescribe mianserin and not the newer mirtazapine. I'd give the others a shot as she's is no longer earning her keep, imho.

[beautifulfreak77]

Procyclidine is prescribed for Parkinson's disease and other movement disorders. I'm surprised it was prescribed for what sounds like agitation to me.

They prescribed this as I was trembling and couldn’t even sit down,I was rushed into hospital 3 times as the doctors couldn’t understand why the injection had given me these side effects, it was a lot more than agitation I’m agitated most of the time,my heartrate was all all over the place and my blood pressure was high for me, they said I had a very bad reaction to the fluanxol injection....


Promethazine is a sedating antihistamine with anti nausea properties.

yes I couldn’t sleep whilst feeling like that so she prescribed them hoping I’d sleep, and wouldn’t feel sick from the injection. It’s used a lot here instead of sleeping tablets.

How long have you been taking Valium (diazepam) and what is your current dose?

ive took Valium on and off for years but this time for about 4 years 15mg a day 1 3 times a day...



Were you still on procyclidine, promethazine and the higher dose of Valium at this point? All three can be sedating so I'm wondering if the "depression" is in fact simply that you're over sedated. Are you on any other meds?

No I had stopped the meds and then the depression hit, I’m agoraphobic before the injection I had took years of work to go out locally, and after the injection I didn’t step outside apart from when the ambulance took me hospital 3 times, for 10 weeks, yes I take ompeprazole, bisoprolol , atorvastatin , co codamol folic acid opti-fibre I have a gut transit disorder,


What was the maximum imipramine dose you took and how long were you on that dose?
i think the highest I went to was 200mg. For 5 months. And I’ve taken it before for over a year when a gp prescribed it.



ADs can trigger nausea and detachment in the first few weeks, or for a while after dose increases, but these side-effects almost always soon diminish.

Yes even on the lowest dose after taking anti sickness tablets I was still sick and I have to be careful due to my stomach problems,the higher I went just made me very ill on duloxetine so my gastroenterologist said it wasn’t good for my other problems,I also have fibromyalgia,narcolepsy,irregular heartbeat seizures and as I mentioned my stomach problems. Panic disorder with agoraphobia,GAD,EUPD,depression


It sounds like your psychiatrist has run out of ideas and I'm puzzled by some of her med choices, not least by why she would prescribe mianserin and not the newer mirtazapine. I'd give the others a shot as she's is no longer earning her keep, imho.

yes she tells me there isn’t much left to try and I have tried mirtazapine before not when I wasn’t this badly depressed but she said if it didn’t work before it won’t when I’m this badly depressed, I can’t see any other psychiatrist she’s the main one at our mental health hospital, I guess I either live this life of sitting alone everyday getting more depressed or I end it if there’s nothing left to help me not a great choice. Thank you for your help. All I do with the psychiatrist now is say what’s the point. She doesn’t listen to what I say my gp has written a few times saying I desperately need help I have therapy psychodynamic therapy once a week she doesn’t think the psychiatrist is listening to me. But I can’t do much else I can’t afford to go private. Thanks for taking the time to read part of my story.

[beautifulfreak77]

Sorry I dunno how you pick out different quotes from what you said so I’ve wrote under your answers it’s not just that little bit at the bottom....

[panic_down_under]

I have to be careful due to my stomach problems,the higher I went just made me very ill on duloxetine so my gastroenterologist said it wasn’t good for my other problems,I also have fibromyalgia, narcolepsy, irregular heartbeat seizures and as I mentioned my stomach problems. Panic disorder with agoraphobia,GAD,EUPD,depression.

Given the stomach and gut issues SSRIs, SNRIs and serotonergic ADs are going to be problematic therefore ADs targeting noradrenaline, aka norepinephrine, are likely to be a better bet. That means either desipramine, lofepramine, or nortriptyline. UK GPs and psychiatrists seem to favour lofepramine from what I read here so it is likely to be the one you're offered.


yes she tells me there isn’t much left to try and I have tried mirtazapine before not when I wasn’t this badly depressed but she said if it didn’t work before it won’t when I’m this badly depressed

If mirtazapine didn't work then why would she expect mianserin to when it is pretty much the same med developed by the same company? There may be a rational reason, but blowed if I can see it. Mianserin is a more potent noradrenaline reuptake inhibitor (NRI) than mirtazapine, albeit still only very weak, but if that was the objective then why not go for the real NRIs desipramine, lofepramine, or nortriptyline?


I can’t see any other psychiatrist she’s the main one at our mental health hospital,

...She doesn’t listen to what I say my gp has written a few times saying I desperately need help

I don't know enough about how the NHS works to be able to advise you, but your GP should and I think you need to pressure him to find an alternative, or prescribe something himself. This is his job after all.

[beautifulfreak77]

Given the stomach and gut issues SSRIs, SNRIs and serotonergic ADs are going to be problematic therefore ADs targeting noradrenaline, aka norepinephrine, are likely to be a better bet. That means either desipramine, lofepramine, or nortriptyline. UK GPs and psychiatrists seem to favour lofepramine from what I read here so it is likely to be the one you're offered.

Yes I will try and give her a call today and see if she’ll change it to something else,although I don’t hold out much hope as she was reluctant to even offer mianserin.... But I can ask....


If mirtazapine didn't work then why would she expect mianserin to when it is pretty much the same med developed by the same company? There may be a rational reason, but blowed if I can see it. Mianserin is a more potent noradrenaline reuptake inhibitor (NRI) than mirtazapine, albeit still only very weak, but if that was the objective then why not go for the real NRIs desipramine, lofepramine, or nortriptyline?

would it be because my anxiety is so bad? And maybe these meds make it worse? So she’s chosen a weaker med to start me on? See how I tolerate that? I really don’t know and I really don’t understand her thinking most of the time,she changes her mind of things to often..


I don't know enough about how the NHS works to be able to advise you, but your GP should and I think you need to pressure him to find an alternative, or prescribe something himself. This is his job after all.

as I am under the mental health team here my gp won’t prescribe any kind of drug to help, only if the psychiatrist writes to him and says to try me on a certain drug. Our system is quite weird, and so many people with mental health problems are just being ignored, the NHS just doesn’t have the money for everything so cuts are being made everywhere....

[panic_down_under]

would it be because my anxiety is so bad? And maybe these meds make it worse?

Unfortunately, any med may make it worse, including mianserin. It is just the nature of the treatment. The diazepam should help limit the severity.


the NHS just doesn’t have the money for everything so cuts are being made everywhere

Short termism strikes again. :mad: When will the powers-to-be finally wake up to the fact that every pound/dollar/peso/rouble spent on mental health saves many more in the long run!! :weep:

If a definition of insanity is doing the same thing over and over again and expecting a different outcome then most governments should be on industrial strength antipsychotics administered intravenously with fire hoses. :ohmy:

[MyNameIsTerry]

April 2019 statistics - cost per year:

Mianserin (30mg) - £400.66

Lofepramine(140mg) - £223.73
Nortiptyline (75mg) - £95.77

Any thoughts on this situation now Ian given cost seems not to be the issue with this psychiatrist if they have discounted the others you guys on this thread have mentioned? I'll also point out Mirtazipine (30mg) is £13.91 per year and considering you say its the same drug this psychiatrist is possibly wasting money?

[panic_down_under]

April 2019 statistics - cost per year:

Mianserin (30mg) - £400.66
Lofepramine(140mg) - £223.73
Nortiptyline (75mg) - £95.77

Any thoughts on this situation now Ian given cost seems not to be the issue with this psychiatrist if they have discounted the others you guys on this thread have mentioned?

I'm not surprised mianserin is so expensive, Terry. The market for it must be tiny now so the cost of making it would be high, plus I suspect there may be wastage from meds reaching the use-by date unsold. Unless there is some huge market for it in an obscure part of the world that I don't know about, I really can't see why they bother. There can't be much profit in it even at 400 quid for a year's supply. Just announce production will cease in say 6 months and all patients should be switched to mirtazapine and be done with it.


I'll also point out Mirtazipine (30mg) is £13.91 per year and considering you say its the same drug this psychiatrist is possibly wasting money?


Yeah, prescribing a drug that costs 29 times as much as its claimed superior analogue isn't going to win her the Nobel prize for economics - though it might put her in the running for exchequer! :D The mental machinations of psychiatrists have long baffled and confounded me. I've concluded most have far more screws loose than any of their patients. :ohmy:

BTW-do you have costings for dosulepin/dothiepin and tranylcypromine?

[MyNameIsTerry]

I'm out at the moment and have the report open on my laptop so will post it for later. The other you mentioned earlier wasn't listed, we probably don't use it anymore, but there was a good list. There are older public reports too, I have a link for one off those I can check. I should be able to find the total prescribing costs per med, I've linked them in the past, so we can see whether we even use the med this psychiatrist is offering. I'm thinking the OP's GP might have some success nudging them away from the most costly antidepressant to one they haven't considered that is cheaper because it is the GP who will take the repeat prescription costs later :winks:

[beautifulfreak77]

Hey I didn’t mean this to become a thing about the cost etc I was just saying they are cutting back on mental health and all other kinds of health problems and yes it seems silly to give a medication that costs so much if it doesn’t even work. I can’t get over trimipramine is £7,819 a year
dosulepin 75mg is 63.44 a year
tranylcypromine 10mg is between 243-336 for 28 tablets depending what company are making them.

And I have rang my psychiatrist and she’s adamant to try me on these. Obviously came back with the answer just because it didn’t help others doesn’t mean it won’t help you. And if these don’t work then maybe she’ll look at something that I suggested....so now I’m stuck. Stay suicidal and depressed don’t take anything, take those she’s offered n basically waste my time n money... such a great choice!

[panic_down_under]

.so now I’m stuck. Stay suicidal and depressed don’t take anything, take those she’s offered n basically waste my time n money... such a great choice!

Sigh! Medicine used to be the art of doctors amusing the patient until nature cured them...or not. Now it seems to be patients having to play along until their doctors exhaust their standard bag of tricks and start taking them seriously. :weep:

Taking the mianserin seems to be your only option. It might surprise, but if it doesn't at least you're one step closer to getting something which is likely to.

[MyNameIsTerry]

I'm not surprised mianserin is so expensive, Terry. The market for it must be tiny now so the cost of making it would be high, plus I suspect there may be wastage from meds reaching the use-by date unsold. Unless there is some huge market for it in an obscure part of the world that I don't know about, I really can't see why they bother. There can't be much profit in it even at 400 quid for a year's supply. Just announce production will cease in say 6 months and all patients should be switched to mirtazapine and be done with it.



Yeah, prescribing a drug that costs 29 times as much as its claimed superior analogue isn't going to win her the Nobel prize for economics - though it might put her in the running for exchequer! :D The mental machinations of psychiatrists have long baffled and confounded me. I've concluded most have far more screws loose than any of their patients. :ohmy:

BTW-do you have costings for dosulepin/dothiepin and tranylcypromine?

It's as Kerry says. Prices at 02/2018:


Dosulepin (25mg) = £0.96
Dosulepin (75mg) = £1.21
Tranylcypromine (10mg) = £239.94


Prices at 04/2019:


Dosulepin (25mg/5ml solution) = £1.61
Dosulepin (75mg/5ml solution) = £4.88
Tranylcypromine (10mg) = £287.07



When prices are this high it says only one thing to me, these are artificial prices hiked up by manufacturers to discourage anyone buying them. The same has happened with others meds, as I'm sure you know all to well, and the response from bodies such as the NHS is circulars with do not prescribe written all over them.

Sources:

https://www.nhsbsa.nhs.uk/sites/default/files/2018-01/Drug%20Tariff%20Part%20VIIIA%20February%202018.pdf
https://www.nhsbsa.nhs.uk/sites/default/files/2019-03/Drug%20Tariff%20April%202019.pdf
https://www.chemist-4-u.com/guides/pharmaceutical-advice/antidepressant-statistics-uk (http://gmmmg.nhs.uk/docs/cost_comparison_charts.pdf)

Yeah, I you are right some doctors are great at science but need management to tell them they can't do it all unless they have more funding. That and how doctors are well known to waste huge amounts of money on pointless stuff or simple waste issues that any business would be sacking people over.

In recent years the NHS has been more proactive in changing this but it's always staggering that an organisation of this size, one of the problems actually as it hides problems all too easily, has been on his knees for decades yet it wasted so much money.

[MyNameIsTerry]

Hey I didn’t mean this to become a thing about the cost etc I was just saying they are cutting back on mental health and all other kinds of health problems and yes it seems silly to give a medication that costs so much if it doesn’t even work. I can’t get over trimipramine is £7,819 a year
dosulepin 75mg is 63.44 a year
tranylcypromine 10mg is between 243-336 for 28 tablets depending what company are making them.

And I have rang my psychiatrist and she’s adamant to try me on these. Obviously came back with the answer just because it didn’t help others doesn’t mean it won’t help you. And if these don’t work then maybe she’ll look at something that I suggested....so now I’m stuck. Stay suicidal and depressed don’t take anything, take those she’s offered n basically waste my time n money... such a great choice!

Kerry, that's ok, for my part I was wondering whether your GP could use this angle in persuading the psychiatrist to look for another solution given there are meds you haven't tried yet that are far cheaper than this and it will be your GP who will be paying these huge costs at a time they are being told to cut back on them. But if you need it, you need it and I fully support that too.

I think your GP should be working harder in this because they are still your primary care point. If there are better meds you could try then they could pick up the phone and have a discussion with psychiatrist, something many GP's reluctant to do which has always been :shrug::doh: to me!

[beautifulfreak77]

Thank you both for your replies. I shall try and talk to my gp again but he doesn’t like to go against what the psychiatrist says as he says they know what they’re doing more than he does. Which I suppose is true or else I wouldn’t of been referred after trying the few that they suggest. I don’t know if he will be bothered about the Money if he thinks it’s going to help? I really don’t know. It’s not really a fair thing is it to make someone feel worse for having a tablet that costs more I’m already severely depressed I don’t really need the costs of it hanging over me and if it doesn’t work then it’s been a waste of money. Due to my anxiety and my EUPD I’m starting to overthink it all and get stressed and worrying I’m going to waste money that could be better spent...I don’t know what to do. Thanks for your help about this mysterious drug that I couldn’t find any reviews on. Maybe they don’t even make them here anymore and she’ll have to try something else.

[MyNameIsTerry]

Ian,

You might also find this interesting. Number dispensed:

Report to the House of Commons for 2017 = 3,834.

https://www.parliament.uk/business/publications/written-questions-answers-statements/written-question/Commons/2018-07-11/163180/

This one for NHS Scotland only financial year 2017-2018 shows 402 but at a cost of £34.68.

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=18&ved=2ahUKEwjI3tiB1vnjAhV4QxUIHTGVDHgQFjARegQIBRAC&url=https%3A%2F%2Fwww.isdscotland.org%2FHealth-Topics%2FPrescribing-and-Medicines%2FPublications%2F2018-07-24%2FPrescription_Cost_Analysis_2018.xlsx&usg=AOvVaw3DWPxG4FwEijATyOpq9eTL

(note that an Excel spreadsheet)

[MyNameIsTerry]

April 2019 statistics - cost per year:

Mianserin (30mg) - £400.66

Lofepramine(140mg) - £223.73
Nortiptyline (75mg) - £95.77

Any thoughts on this situation now Ian given cost seems not to be the issue with this psychiatrist if they have discounted the others you guys on this thread have mentioned? I'll also point out Mirtazipine (30mg) is £13.91 per year and considering you say its the same drug this psychiatrist is possibly wasting money?



Ian,

Note that these were likely pre 2019 financial year prices as Mianserin is now £13.58 (10mg 28 tabs) and £30.82 (30mg 28 tabs). Mirtazipine (30mg 28 tabs) is now only £10.70.

Something that irks me about the NHS is how it complains of expensive drugs yet doesn't tell us about the mass use of very cheap ones. Our prescription charge is now £9 per item yet look how cheap generics are. They make a profit from that charge which was always sold to the masses as a subsidised cost. :lac:

EDIT: Apologies all, the tariff prices were in pence but it wasn't made clear in any of the tables or definitions. I've adjusted all the posts to reflect this. So, this drug isn't quite as expensive as I thought and my earlier comments about cost are incorrect however it's still more expensive than Mirtazapine which (at 30mg 29 tabs) is only £1.07.

[MyNameIsTerry]

Started on 60mg but couldn’t handle it,so put me on 30mg it just made me sick still and very numb. After a few weeks I was upped to 60mg again and I just couldn’t handle it,so she took me off that and has offered the mianserin...

Kerry,

That's a shame. Considering you have GAD the advice is to start at 30mg which is presumably because of the effect it can have on us whereas for depression only it can be started on 60mg. I think the prescriber made a mistake there but it's a shame even the 30mg wasn't easy. There could have been an element of that higher dose just rocking you badly and needing a load of time to get your anxiety levels down too but only you will know whether that is likely or whether the 30mg was inappropriate.

I have GAD and to be honest I had a terrible time getting on this med. Knowing what I know now I would have insisted on coming off it but my GP kept insisting it was just my anxiety. I had never felt anxiety like that and ended up with a year and more far worse than before starting it.

I hope you find something which helps. It seems you have others that could be tried, although that must make you despair at going through the rollercoaster of it all, so I hope you get some support in more than this med as it sounds like it shouldn't be the end of this. Something which annoys me about the NHS is how there seems to be such a dead end with one person like a specialist and doctors don't seem to have, or at least don't utilise, a second opinion.

[panic_down_under]

Considering you have GAD the advice is to start at 30mg which is presumably because of the effect it can have on us whereas for depression only it can be started on 60mg. I think the prescriber made a mistake there but it's a shame even the 30mg wasn't easy.

Some generics now come in 20mg tablets which may have made a significance difference to to both you and Kerry's experience. Hopefully, one of them makes it in 10mg pills some day, not so much as a starting dose, although this would certainly help those with health anxiety, or prone to severe side-effects, but mainly for those weaning off duloxetine.

[beautifulfreak77]

Thank you for all the info etc and reading my posts, yes I was quite disappointed that the duloxetine didn’t help, I have a problem with my stomach and as I said even taking the anti sickness wasn’t helping with that and the numb feeling,well I don’t feel like myself at the moment anyway which is bad enough I can’t cry I don’t like what I used to like music wise and reading,tv,just everything and I’ve just pushed everyone away. So being on something that made me feel like I didn’t even care about my family,my children etc was to hard to cope with. I didn’t laugh once when on them. Yea maybe one day il find the right tablet, not that I really believe one tablet can sort out all my mh problems but il keep trying.

[beautifulfreak77]

Some generics now come in 20mg tablets which may have made a significance difference to to both you and Kerry's experience. Hopefully, one of them makes it in 10mg pills some day, not so much as a starting dose, although this would certainly help those with health anxiety, or prone to severe side-effects, but mainly for those weaning off duloxetine.

Maybe that would of been better to start on a very low dose. But she said we only have 30mg so I just went along with it. I will see if I can get the mianserin never know I’m quite backwards with drugs maybe it’ll work ha. Thank you for taking time out to reply to me... I really appreciate it.

[panic_down_under]

being on something that made me feel like I didn’t even care about my family,my children etc was to hard to cope with

Depersonalisation is one of the less frequent AD side-effects, but also a fairly common symptom of depression. As a side-effect it does usually diminish after a while, but it can linger for some. It all comes down to how the med meshes with individual biology.


I will see if I can get the mianserin never know I’m quite backwards with drugs maybe it’ll work ha.

I won't be shocked if it does. Stranger things have happened with ADs. :wacko: These meds can be highly unpredictable with everyone's experience being unique to themselves. So fingers crossed. :emot-cheering:

[MyNameIsTerry]

DP/DR can also come from higher levels of anxiety/panic. I've found from observation of people on here, and my own experience, that such things become a byproduct of the ramping up of anxiety from meds as a side effect.

Obsessive-compulsive behavours & thoughts are another one that is greatly affetced by increased overall levels of stress/anxiety.

The 20mg tabs are useful to allow a for a better taper. They tend to be tablets inside the capsules rather than the beads so it might be easy to reduce them further, although getting past the throat or gut might still be required but that's at least easy to do with an existing capsule or buying cheap bags of them. The only problem will be GP's who rely on old fashioned advice telling them you withdraw in halves. :doh: And it's more expensive to them if they have to add two prescriptions together to make a dose...although I think the profit from the prescription charge might be a way for savvy sufferers to inform GP's it's not always as the NHS chiefs say it is :winks:

[panic_down_under]

They tend to be tablets inside the capsules rather than the beads so it might be easy to reduce them further, although getting past the throat or gut might still be required but that's at least easy to do with an existing capsule or buying cheap bags of them.

This isn't something I'd be comfortable recommending. Cutting a scored IR tablet in half, or dissolving the contents of IR desvenlafaxine in a measured quantity of orange juice and drinking half at a time is one thing, but measuring out 10mg of duloxetine to say +/- 0.25mg accuracy while maintaining enteric integrity is something else entirely, and that assumes the division will always result in each half having the same slow-release properties which may or may not be the case and that could vary between the brand and generics and from generic to generic.

[KK77]

This isn't something I'd be comfortable recommending. Cutting a scored IR tablet in half, or dissolving the contents of IR desvenlafaxine in a measured quantity of orange juice and drinking half at a time is one thing, but measuring out 10mg of duloxetine to say +/- 0.25mg accuracy while maintaining enteric integrity is something else entirely, and that assumes the division will always result in each half having the same slow-release properties which may or may not be the case and that could vary between the brand and generics and from generic to generic.

I experienced wildly unpredictable results when I tried cutting down on Venlafaxine capsules, each of which contained 6 mini "modified release" tablets. Some of the tablets appeared to be far less effective than others, probably due to different absorption rates as they pass through gut. Some days it felt as though I'd missed my dose, with electric shock sensations soon building, whereas other days I felt OK. I switched to modified release tablets in the end and won't be messing about with those pesky capsules again :lac:

Status: Hit and miss

[beautifulfreak77]

Yes I suffer with depersonalisation anyway but honestly I’ve never been so depressed in my life,and I’ve never felt this numb and it changed within 2 days of taking the tablets my kids are a bit older but my whole family stopped talking to me as they said I was like a robot I didn’t join in conversations I tried so hard my friends/parents said they couldn’t speak to me like that as I just come across like I didn’t care and I was trying to,but it wasn’t coming out. I just sat alone for hours not even doing anything. When I came off them I felt a bit better,I still feel very depressed and don’t feel like myself,and I’ve become a very angry person through all this but I can occasionally laugh. Strange thing I went to see my therapist today and my psychiatrists secretary came out and said psychiatrist needs to speak to me, so I don’t know if she’s changed her mind or maybe it’s hard to get hold of, she’s meant to be calling in the week so il keep you updated with what she says. But she said it’s to do with the medication....

[MyNameIsTerry]

This isn't something I'd be comfortable recommending. Cutting a scored IR tablet in half, or dissolving the contents of IR desvenlafaxine in a measured quantity of orange juice and drinking half at a time is one thing, but measuring out 10mg of duloxetine to say +/- 0.25mg accuracy while maintaining enteric integrity is something else entirely, and that assumes the division will always result in each half having the same slow-release properties which may or may not be the case and that could vary between the brand and generics and from generic to generic.

I agree, it's a matter that would have to be researched first. I was raising it as a possibility where the capsule can be re-used/replaced identically and the tablet inside has no time release or specific coating (e.g. enteric) or use of layering to make it different to homogenised meds.

[MyNameIsTerry]

Yes I suffer with depersonalisation anyway but honestly I’ve never been so depressed in my life,and I’ve never felt this numb and it changed within 2 days of taking the tablets my kids are a bit older but my whole family stopped talking to me as they said I was like a robot I didn’t join in conversations I tried so hard my friends/parents said they couldn’t speak to me like that as I just come across like I didn’t care and I was trying to,but it wasn’t coming out. I just sat alone for hours not even doing anything. When I came off them I felt a bit better,I still feel very depressed and don’t feel like myself,and I’ve become a very angry person through all this but I can occasionally laugh. Strange thing I went to see my therapist today and my psychiatrists secretary came out and said psychiatrist needs to speak to me, so I don’t know if she’s changed her mind or maybe it’s hard to get hold of, she’s meant to be calling in the week so il keep you updated with what she says. But she said it’s to do with the medication....

It could be good news, she may have found an alternative to try? It may even be she didn't realise about the costs and when weighing up the benefits it's not the best to try for you? But she still needs to do something and it's not like you've tried all the med options from what I've read here.

Cost issues do get in the way even for more mainstream meds e.g. Pregabalin, where some doctors won't prescribe it due to costs and even some local CCG's blacklist it creating a postcode lottery issue :lac:

[beautifulfreak77]

It could be good news, she may have found an alternative to try? It may even be she didn't realise about the costs and when weighing up the benefits it's not the best to try for you? But she still needs to do something and it's not like you've tried all the med options from what I've read here.

Cost issues do get in the way even for more mainstream meds e.g. Pregabalin, where some doctors won't prescribe it due to costs and even some local CCG's blacklist it creating a postcode lottery issue :lac:


No the news was she was going to start me on a very very low dose to try and avoid side effects but I told her I just got put on a anti sickness tablet,I mentioned earlier I have a stomach problem as I was being sick a lot so gp has put me on these tablets and now I can’t go on mianserin as the anti sickness could cause serotonin syndrome, so I really don’t know how long il be on anti sickness and she said okay we will just wait til you’re off the anti sickness,I asked if I could try something else , again, and she said no... so my depression anxiety and everything isn’t going to be sorted anytime soon as my stomach problem isn’t going to go away. Yes I may come off the anti sickness but I can’t see a gastroenterologist until March 2020,only if something bad happens. I don’t know what they want to happen I was took into hospital the other day with this problem but nothing was done or moved forward.... I’ve been on pregabalin they used to be hard to get prescribed them but seems to be gp’s favourite tablet to prescribe at the moment. My son is on them now. They aren’t doing him any good, but that’s his choice he’s 25 he just hasn’t got the guts to say what he thinks to his psychiatrist where as I gave up caring n said exactly what I think and feel.

[panic_down_under]

No the news was she was going to start me on a very very low dose to try and avoid side effects but I told her I just got put on a anti sickness tablet,I mentioned earlier I have a stomach problem as I was being sick a lot so gp has put me on these tablets and now I can’t go on mianserin as the anti sickness could cause serotonin syndrome,

What is the anti sickness med? Even without knowing I'm very sure the claimed serotonin syndrome risk is nonsense, but I'll save further comment until I know which med you've been prescribed.

[beautifulfreak77]

I read the leaflet it does mention it, but I thought I’d be okay on a small dose, the anti-sickness is Ondansetron.

[panic_down_under]

I read the leaflet it does mention it, but I thought I’d be okay on a small dose, the anti-sickness is Ondansetron.

I thought it might be it, or another of the 'setrons.

I don't have time to get into this as deeply as I'd like now so will reply in more depth about it tomorrow, but you have as much chance of developing serotonin syndrome from taking ondansetron and *mirtazapine together as you have of flying to the Moon by flapping your arms.

I might also have some good news about ondansetron too.


*Edit: :doh: :doh: Oops, I meant mianserin, not mirtazapine :doh: :doh:

[beautifulfreak77]

I thought it might be it, or another of the 'setrons.

I don't have time to get into this as deeply as I'd like now so will reply in more depth about it tomorrow, but you have as much chance of developing serotonin syndrome from taking ondansetron and mirtazapine together as you have of flying to the Moon by flapping your arms.

I might also have some good news about ondansetron too.


I shall look forward to your more in depth message about it tomorrow, ooo good news would be nice, and make a change.

[panic_down_under]

Okay, firstly, ondansetron, mianserin and serotonin syndrome/toxicity (SS/ST). The product info leaflet list SS/ST because the muppets at medicine regulators such as the FDA, WHO and I assume the UK's Medicines and Healthcare products Regulatory Agency wouldn't know serotonin syndrome if it slapped them across the face with a halibut. This isn't my opinion, but that of SS/ST experts such as Ken Gillman (https://scholar.google.com.au/citations?user=ea6KeD0AAAAJ&hl=en) and others:


Regulatory Agencies (WHO, FDA) Offer Ill-Conceived Advice about Serotonin Toxicity (Serotonin Syndrome) with 5-HT3 antagonists: a Worldwide Problem (https://psychotropical.com/serotonin-toxicity-and-5-ht3-antagonists/)


Can 5-HT3 Antagonists Really Contribute to Serotonin Toxicity? A Call for Clarity and Pharmacological Law and Order (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4883185/)


Demystifying serotonin syndrome (or serotonin toxicity) (PDF (https://www.cfp.ca/content/cfp/64/10/720.full.pdf), p724)

The 'setrons aren't the only meds for which the muppets have gotten SS/ST badly wrong. Worse when presented with the evidence of their error the usual response is to dig their heels in, block their ears and sing LALALALA. :mad:

Bottom line: Ondansetron can't trigger SS/ST because it has no known impact on serotonin transporters which is the central requirement to induce SS/ST.

Mianserin also can't trigger SS/ST (https://psychotropical.com/serotonin-toxicity-spectrum-concept/) because it is an extremely weak inhibitor of serotonin reuptake. In the past mianserin was often prescribe (https://www.cambridge.org/core/journals/advances-in-psychiatric-treatment/article/combining-antidepressants-a-review-of-evidence/10A101DFD409DCB1FDCBB951F391F7AE/core-reader) together with SSRIs, just as its analogue mirtazapine is now. The ability of a drug to bind with receptors and transporter molecules is measured in Ki units which are based on the amount of the drug needed to saturate receptors/transporters. The less drug required the lower the Ki. Mianserin's value for the serotonin transporters (SERT) is about 4,000 Ki (https://en.wikipedia.org/wiki/Pharmacology_of_antidepressants#Receptor_affinity) . To put that into perspective the value for the most potent SSRI, sertraline, is 0.21 Ki, and for the least potent, citalopram, it's 1.38 Ki. You would have problems physically swallowing enough mianserin to equal the serotonin reuptake blocking ability of a single sertraline dose, and even if you could SS/ST would be the least of your worries.

But this isn't the only reason mianserin can't induce SS/ST. The danger of the syndrome is the large spike in body temperature it causes. This can become high enough to kill. The potent 5-HT2A antagonists (blockers) cyproheptadine and chlorpromazine are the recommended treatments (https://psychotropical.com/treatment-of-serotonin-toxicity/) for preventing the temperature spike. Mianserin is also a fairly potent 5-HT2A antagonist which could counteract the temperature spike if ondansetron and mianserin were capable of triggering SS/ST.

Now for some potentially good news re ondansetron. I first heard of this med from my then psychiatrist who had been following its drug trials back in about 1990. All the indications were that it was a highly effective anti anxiety med, particularly for panic disorder, which not only had fewer side-effects than antidepressants, but could also ease nausea, a common anxiety symptom. So we both waited and waited for it to come onto the market, but it never did, at least not for anxiety. It seems the eyes of the Glaxo beancounters lit up like the Sydney Harbour News Years Eve fireworks when they realised how effective it was in blocking chemo and radiation therapy triggered nausea and how much cancer clinics were prepared to pay for it. While it was in patent it was selling for US$5 a tablet, wholesale!

It is still fairly expensive, though maybe not as much as mianserin, so while you may not be able to get it prescribed for anxiety at least you get to have a test run and hopefully enjoy a significant reduction in anxiety levels while you're on it.