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Jo79
04-10-19, 09:42
Iím currently on 225mg venlafaxine and 30mg mirtazapine and my psychiatrist has decided to introduce quetiapine as my other meds donít seem to be helping. Iím still very up and down with anxiety and depression.

I was under the impression the quetiapine would help with sleep but it seems to be having the opposite effect with me. I started on 25mg but was waking up at 5am feeling really agitated and restless, pounding heart and then was told to increase to 50mg yesterday but woke even earlier this morning and had to take a diazepam to get back to sleep.

Mood wise Iím ok today (but that could be the diazepam) but Iím really shaky and jittery. Is this a normal reaction? Should I maybe think about reducing one of my other meds as Iím concerned iíve got all these chemicals flying about. Mirtazapine seems to be less effective for sleep and my psychiatrist wants me to come off that eventually.

Iíve emailed her this morning but Iím just getting desperate for a solution to all this as iíve Been ill since January and have had enough.

Iíve been on 30mg mirtazapine since mid feb, started on venlafaxine in July and been on 225mg since the end of August. I have previously tried citalopram a few years back which worked well and came off that when I was pregnant. Started sertraline after the birth of my son and that worked ok until this year and changed to escitalopram in April which worked amazingly until June.

Sorry for rambling just fed up and want to get better.

Dying_Swan
04-10-19, 20:32
Hi Jo. This is basically exactly what I've experienced with getting onto quetiapine. It kept me awake and has made me really agitated every time I've increased (I did 25>50>75>100>150>200>300). I have found though that the worst of the agitation lasts about 2 days and then slowly eases. Mirtazapine has also stopped being so helpful for sleep, and I'm waiting to switch to trazodone. It's hard to know what to advise for the agitation, other than taking diazepam when you need to, and maybe getting some exercise if you can. I don't think you need to worry about the number of meds if you psych is happy. I've just reduced to 150 ven and I can feel some withdrawal, so personally I'd stick to what you're on, at least until the quetiapine is stable.

Jo79
04-10-19, 22:56
Thanks DS, it’s so frustrating isn’t it? I’ve been on OCD overdrive all day not been able to stop thinking about meds and side effects.. in fact I suppose the increased OCD is probably a side effect too :blush:. Just popped my quetiapine and mirtazapine for the night and hoping I get a better nights sleep tonight. Hope you do too x

lebonvin
05-10-19, 01:31
Hi Missy

I'm on venlafaxine and 50mg Quetiapine and a tiny bit of benzos. From what I got explained, Quetiapine is very sedative at the lowest dose ie 25 and 50. When it goes up high yous get restless legs etc.
So my guess is that you could come off Mirtazspine but then I'm no expert only going by my own experience.

Dying_Swan
07-10-19, 19:35
How's it going Jo? Has the agitation settled at all?

Jo79
08-10-19, 10:33
Well I’m sleeping better but anxiety and intrusive thoughts are still quite high during the day and having the occasional crying fit out of pure frustration. I’m trying my best to ignore the thoughts and push on through. I think I’m ok at the moment but I’ve almost forgotten what normal feels like :shrug:

Dying_Swan
10-10-19, 13:35
Glad you're not too bad. I understand not knowing what normal feels like. Sometimes I wonder if I'm making a fuss about nothing, other times I wonder how on earth things got so bad. Really hope you're finding some benefit from the quetiapine and it's helping with the intrusive thoughts.

Jo79
13-10-19, 17:19
Not having such a good day today. Was fine most of this week but very agitated today for some reason. At times I canít even tell if Iím extremely happy and excited or really anxious and am really motivated but at the same time I have no energy...it just all feels so weird today 🤯

Dying_Swan
14-10-19, 12:55
I'm sorry to hear that. It's unbelievably frustrating being so up and down. My mood has crashed the last couple of days too, and today I'm feeling a bit agitated. I don't know why either, it would just be good to have a stable period. I think I understand not knowing if you're happy or not. It's like a wild energy that you don't know what to do with? I've tried to explain to professionals I feel like I could pull an all-nighter in a club, or stay in bed. Does that sound similar? Somewhere in between would be good. Do hope you're feeling better today.

Jo79
14-10-19, 13:10
Thanks, much calmer than yesterday, had the usual agitated feeling on waking up this morning and have just felt like I needed to cry all morning. I got myself out and got on with doing everyday stuff though and am feeling much better and calmer this afternoon. I know exactly what you mean about the energy, it’s like my brain is telling me one thing but my body is telling me another. I felt like I needed to go out for a run around the block first thing this morning but at the same time I just feel so tired. I’m currently fighting with myself about going for a swim, I know it will do me good but the weather is so crap I just want to curl up indoors and watch rubbish tv :D

Dying_Swan
14-10-19, 14:24
Strangely enough, I'm having the same battle about swimming! I'll go if you go :D the weather really doesn't help, but I'm glad to hear you're feeling brighter this afternoon. Agitation is so hard to cope with.

Jo79
22-10-19, 09:50
Well after another four or five days of feeling pretty good Iím back to the crying fits, feeling down and agitated again 😣 I think overall Iíve improved but canít decide whether to increase the quetiapine or not. At my appointment with the psychiatrist on Friday I was feeling good so we agreed that I would stay on 50mg for now and Iíll see her again on 8th Nov. Part of me is thinking itís still early day and hang in there but I just canít decide 😬

panic_down_under
22-10-19, 11:32
we agreed that I would stay on 50mg for now and Iíll see her again on 8th Nov. Part of me is thinking itís still early day and hang in there but I just canít decide 😬

It is still early days, Jo, and 50mg is only a small dose, so I wouldn't read too much into what you're experiencing today. The fact you had 4-5 good days suggests you're on the right track.

Jo79
23-10-19, 17:30
Thanks PDU. I had my assessment with community mental health today, the cpn was quite surprised at the number of meds Iím taking (225 venlafaxine, 30 mirtazapine and now 50 quetiapine) so they are going to refer me to a psychiatrist on the NHS to make sure they are right for me. I canít see the problem as it was a private psychiatrist that put me on this combo but I suppose different psychiatrists have different opinions 🙄. Iím now worrying that this cocktail might be too much for me and causing me unnecessary anxiety but who knows🤯

panic_down_under
23-10-19, 23:16
the cpn was quite surprised at the number of meds Iím taking (225 venlafaxine, 30 mirtazapine and now 50 quetiapine) so they are going to refer me to a psychiatrist on the NHS to make sure they are right for me

A good move, imho, Jo. I don't understand the rationale of taking both mirtazapine and quetiapine as they hit the same receptors to about the same degree. The main difference is mirtazapine is a little more sedating.

Jo79
03-11-19, 11:36
Well I increased to 75mg just over a week ago, had a few good days and then boom...the OCD intrusive thoughts and ruminations are back again �� I can’t stop thinking that I should just leave my partner but at the same time I can’t bear these thoughts and can’t stop crying. I’m totally fed up of this now, fed up of having a few good days and then going backwards. I’m seeing the psychiatrist again on Friday so I expect she will want me to increase to 100mg (or whatever is the most effective dose for my constant anxiety and racing thoughts). I haven’t heard anything from CMHT so still no idea when I’m going to see the psychiatrist they mentioned so I suppose I’ll have to give them a call tomorrow.

One other thing that is really getting to me at the moment is that I can’t stand being around people close to me. My partner, son and my mum all annoy the hell out of me and I really feel hatred towards my in-laws. I’m finding this really upsetting as I feel like i’ll never feel comfortable being with important people in my life.

panic_down_under
03-11-19, 21:56
Well I increased to 75mg just over a week ago, had a few good days and then boom...the OCD intrusive thoughts and ruminations are back again

Unfortunately, this is a common pattern with many psych meds, Jo. It is all too often a matter of one step forward, followed by several back at the beginning. While the bad days can be really dispiriting they aren't significant provided the good days keep increasing while the bad diminish.


Iím seeing the psychiatrist again on Friday so I expect she will want me to increase to 100mg (or whatever is the most effective dose for my constant anxiety and racing thoughts).

This is likely as 75mg is on the low side. The usual dose range for anxiety and depression is 150-300mg.


One other thing that is really getting to me at the moment is that I canít stand being around people close to me. My partner, son and my mum all annoy the hell out of me and I really feel hatred towards my in-laws. Iím finding this really upsetting as I feel like iíll never feel comfortable being with important people in my life.

It is important that you tell your psychiatrist about this and all the other problems you're having, both generally and with the meds specifically. I find making a short reminder list helps because these consultations tend to go off on tangents and important issues get forgotten.

Jo79
04-11-19, 09:13
Thanks PDU, Iíve made a note of my previous post on my phone along with a couple of other things - Iíve got this constant tremor in my hands which is bugging me. I have propranolol so wondering if this might help.

Iím also thinking of asking for some more diazepam, Iíve got several left from a prescription back in July, Iím only taking them very occasionally when Iím desperate as Iím worried about addiction. I gave in this morning as I woke in the early hours with loads of adrenaline and havenít had that for a while 😞

Either that, or Iíve heard hydroxyzine may be beneficial and less of a problem where addiction is concerned

Dying_Swan
04-11-19, 09:28
Hi Jo.

Sorry things are tough. I totally understand one step forward and two back, and to say it's frustrating is an understatement. I'm also quite irritable with family, not sure why. I think you're sensible to be sparing with the diazepam, but don't be afraid to use it if you need to. Fingers crossed you'll soon hear from the CMHT. Waiting is so hard x

panic_down_under
04-11-19, 11:39
Iíve got this constant tremor in my hands which is bugging me. I have propranolol so wondering if this might help.

It probably will. Beta-blockers are the med of choice for essential tremor and in some sports such as shooting to still muscles.


Iím also thinking of asking for some more diazepam, Iíve got several left from a prescription back in July, Iím only taking them very occasionally when Iím desperate as Iím worried about addiction.

If you're only using it sparingly then a shorter acting BZD would be the better option, imo. The problem with diazepam is it has a very long half-life so even if you only take it say ever 7-10 days there is always some still remaining in your system. With a shorter half-life BZD like lorazepam (Ativan) it would be metabolised and eliminated in under 72 hours providing a 4-7 day 'washout' period in that situation which significantly reduces the chances of dependence developing. The problem is many GPs are wary of prescribing them because if they are taken often dependence will probably develop earlier than it would with diazepam.


I gave in this morning as I woke in the early hours with loads of adrenaline and havenít had that for a while 😞

The beta-blocker might have been just as effective, perhaps more so, and kicked-in sooner.


Either that, or Iíve heard hydroxyzine may be beneficial and less of a problem where addiction is concerned

It can be very effective. Not quite as potent as the BZDs, but often potent enough.

Jo79
04-12-19, 11:37
Hope you’re doing ok DS. I’m currently one week into increasing to 100mg. Last week was great but have been feeling low again this last couple of days, not sure if it’s just the increase settling in, PMT or both it’s so annoying that every time I have a dip I can’t seem to reassure myself that it’s normal. I just have this overwhelming sensation that I’m sliding backwards again. I’m seeing the CMHT this afternoon so maybe some nervous feelings about that too.

Dying_Swan
04-12-19, 22:04
Hey Jo. I understand the whole "plateauing" feeling, and it's hard to know if you need to increase or if it's just a blip. How did you get on with the CMHT? Was it your first appointment? I'm up to 500mg quetiapine now and supposed to be going up to 600. I'm still being "assessed" by the CMHT and caught in the middle of two psychiatrists until they decide who's in charge.

Jo79
05-12-19, 11:06
My appointment went well, I met a lovely lady from the psychological services team who is going to book me in for a course of mindfulness based cognitive therapy. I’ve always been a bit sceptical about this kind of thing but I’m willing to keep an open mind and try it out. She said that the course they run at CMHT is recommended by NICE and very effective at preventing anxiety and depression coming back in people who have suffered multiple relapses as I have. She’s given me some stuff to read and so far it sounds very interesting.

http://mbct.co.uk/ (http://mbct.co.uk/)
just in case anyone is reading this and is interested here’s the link to the website she gave me :)

https://www.amazon.co.uk/Mindful-Way-Through-Depression-Unhappiness/dp/1593851286/ref=sr_1_1?crid=1UMLTSJC7L8NU&keywords=the+mindful+way+through+depression&qid=1575543846&sprefix=The+mindful%2Caps%2C147&sr=8-1
and this this the book recommendation, the first few pages sound amazingly like me :blush:

Jo79
05-12-19, 13:06
I’ve just gone through my mood journal and worked out the number of good days I’ve had each month since July....

July 0%
August 10%
September 20%
October 50%
November 60%

it’s taking a while, but I’m happy with that :)

KK77
05-12-19, 13:11
My appointment went well, I met a lovely lady from the psychological services team who is going to book me in for a course of mindfulness based cognitive therapy. I’ve always been a bit sceptical about this kind of thing but I’m willing to keep an open mind and try it out. She said that the course they run at CMHT is recommended by NICE and very effective at preventing anxiety and depression coming back in people who have suffered multiple relapses as I have. She’s given me some stuff to read and so far it sounds very interesting.

http://mbct.co.uk/ (http://mbct.co.uk/)
just in case anyone is reading this and is interested here’s the link to the website she gave me :)

https://www.amazon.co.uk/Mindful-Way-Through-Depression-Unhappiness/dp/1593851286/ref=sr_1_1?crid=1UMLTSJC7L8NU&keywords=the+mindful+way+through+depression&qid=1575543846&sprefix=The+mindful%2Caps%2C147&sr=8-1
and this this the book recommendation, the first few pages sound amazingly like me :blush:

That's a very positive attitude, Jo, and I hope this therapy helps. Mindfulness acts to "reset" our chattering and catastrophising minds but requires practice, persistence and determination.

Sure you will do well :D

Dying_Swan
06-12-19, 12:41
That sounds really positive Jo, and you have evidence of your improvement which will hopefully reinforce it. Good luck with the MCBT. With practice, it's supposed to be very helpful. Let us know how you get on :)

Jo79
06-12-19, 16:33
Thanks KK and DS, I am looking forward to it, not starting until the new year so need to do a bit of research beforehand :)

I have had a really weird day today. I’ve been on 100mg for two weeks now and woke up this morning feeling really spaced out like I’ve not quite woken up. I thought it would wear off after a shower but I’v felt like this most of today, just completely numb and can’t keep my eyes open. Is this normal after two weeks??

Dying_Swan
07-12-19, 19:03
I'm not sure it would be the meds and wonder if you just had an "off" day. The only thing is, if I don't get enough sleep on quetiapine I can definitely tell. I'll not just be tired, I'll be exhausted. Could it be that maybe?

Jo79
08-12-19, 16:23
It could have been a particularly bad day, Iíve not been great all week, really sad and irritable. This weekend has been tough especially as OH is bedridden with flu so Iím looking after him as well as keeping my 4 year old entertained...hard enough even when youíre ok!

Iím all out of diazepam so I went into the pharmacy yesterday to ask for some phenergan to help with the agitation I get with these blips. Once I mentioned the meds Iím taking he wouldnít give me any, said they would stop the meds working properly. Suggested I try Kalms instead. I got home and the packet says do not take if youíre taking meds for anxiety. Iím hoping PDU sees this as Iím not sure whether to take them now 😒

Dying_Swan
08-12-19, 17:24
Ive also found pharmacists are super cautious once they hear the word quetiapine. Sorry things are difficult at home right now. That must be tough. I think quetiapine does add to feeling irritable, at least that's what I'm finding. Hopefully PDU will see your post and can advise on the kalms.

panic_down_under
09-12-19, 00:55
Suggested I try Kalms instead. I got home and the packet says do not take if youíre taking meds for anxiety.

I assume the advice is mostly regarding taking benzodiazepines with it as valerian is the main ingredient and they may significantly increase the effects of each other. Quetiapine and valerian aren't a major issue, but there might be some extra sedation and difficulty concentrating as a result so don't go juggling chainsaws, parachuting, or doing anything else potentially hazardous if affected (sorry for being a party pooper :weep:).

Jo79
11-12-19, 12:37
Thanks PDU I tried the kalms but they didnít make any difference anyway! It does say you have to take them for a few weeks for an effect so balls to that, fed up of waiting for drugs to work!

Iím feeling run down at the moment due to a virus, I keep feeling dizzy and my heart rate is quite high, sometimes 120bpm 😱Partner has flu as he didnít get the flu jab but I got one so Iím assuming what Iíve got is just a milder version and the high heart rate is just my body trying to fight it off.

panic_down_under
11-12-19, 22:47
Iím feeling run down at the moment due to a virus, I keep feeling dizzy and my heart rate is quite high, sometimes 120bpm 😱Partner has flu as he didnít get the flu jab but I got one so Iím assuming what Iíve got is just a milder version and the high heart rate is just my body trying to fight it off.

It could simply be the flu, but get it checked anyway as a resting heart rate of 120 bpm is a tad high.

Jo79
15-12-19, 09:13
Well this week has been truly awful, have felt completely wiped out with this virus and now my anxiety and depression feels like itís coming back with a vengeance 😢 I just donít know what to do, itís been 3 weeks on 100 now and starting to think another increase is in order

panic_down_under
15-12-19, 11:59
Well this week has been truly awful, have felt completely wiped out with this virus and now my anxiety and depression feels like itís coming back with a vengeance 😢 I just donít know what to do, itís been 3 weeks on 100 now and starting to think another increase is in order

Infections can worsen anxiety and depression. In several respects, anxiety and depression are the symptoms of an immune system disorder (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002174/). Patients taking immune system boosting meds such as interferon (http://www.hepmag.com/articles/hepatitis_interferon_depression_2501_22378.shtml) to treat viral diseases and cancers are now often also prescribed ADs because of this. Immune system proteins may also reduce the effectiveness (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3337012/) of antidepressants - not sure about antipsychotics. So I wouldn't rush to judgement about quetiapine's effectiveness at the current dose until you're over the virus and your immune system has calmed down, although admittedly 100mg is a smallish dose.

Jo79
17-12-19, 14:39
I’ve been thinking for a while that I should go up to 150 as everywhere I read the dose range should be between 150 and 300. I bit the bullet and called the psychiatrist yesterday as I was in a complete mess and she agreed I should increase which I did last night.
The quetiapine seems to be the only thing that has helped but I’ve had enough of the whole Venlafaxine/mirtazapine combo now - been almost 6 months on the ven and a year on the mirtazapine and I really think they have done bugger all but the private psychiatrist is reluctant to change either of these. Hopefully the NHS one will think differently when I see her next week.

panic_down_under
17-12-19, 22:34
The quetiapine seems to be the only thing that has helped but Iíve had enough of the whole Venlafaxine/mirtazapine combo now - been almost 6 months on the ven and a year on the mirtazapine and I really think they have done bugger all but the private psychiatrist is reluctant to change either of these.

The ways of psychiatrists is often baffling. What is the point of taking meds which don't work. :ohmy: He might as well prescribe a sugar pill, not only as effective but with much fewer side-effects unless you're diabetic.


Hopefully the NHS one will think differently when I see her next week.

I've found the trick with GPs and psychiatrists is to be firm and tell them what you want. While many seem to see themselves as minor deities, shrinks especially, they are really only the hired help, someone you pay, directly, or indirectly by taxes, and as with any business transaction, the person with the money gets to have the last word.

Jo79
21-12-19, 09:29
Well I increased to 150 on Monday. Saw the psychiatrist yesterday and she wants me to go up to 200 and see how I go. If thatís unsuccessful the next step may be to add Lamotrigine 😬

panic_down_under
21-12-19, 21:44
Well I increased to 150 on Monday. Saw the psychiatrist yesterday and she wants me to go up to 200 and see how I go.

Sounds like a plan. There's not much point in taking a med at an ineffective dose.


If thatís unsuccessful the next step may be to add Lamotrigine 😬

What is your diagnosis and what meds have you tried for it, what was the maximum dose taken and how long were you at the dose?

Jo79
21-12-19, 23:26
Treatment resistant depression and anxiety and OCD has also been suggested. This is my fifth and longest episode in 10 years (i’ve been unwell since January)

I was on 200mg sertraline and 15mg mirtazapine since 2017. I increased the mirtazapine to 30mg in January and changed sertraline to escitalopram in April. Was feeling great for two months but crashed again so stopped the escitalopram and have been taking venlafaxine since July, increased to 225mg in August but didn’t get much response (The odd day of euphoria) so added the quetiapine in October. I’ve had some reasonable periods of stability, maybe a week to 10 days at a time but then going downhill again for 2-3 weeks.

panic_down_under
22-12-19, 03:42
Treatment resistant depression and anxiety and OCD has also been suggested. This is my fifth and longest episode in 10 years (iíve been unwell since January)

I was on 200mg sertraline and 15mg mirtazapine since 2017. I increased the mirtazapine to 30mg in January and changed sertraline to escitalopram in April. Was feeling great for two months but crashed again so stopped the escitalopram and have been taking venlafaxine since July, increased to 225mg in August but didnít get much response (The odd day of euphoria) so added the quetiapine in October. Iíve had some reasonable periods of stability, maybe a week to 10 days at a time but then going downhill again for 2-3 weeks.

I wonder why a TCA isn't being considered instead of antipsychotics and anticonvulsants. For example, clomipramine (Anafranil) has the best track record for OCD, is the most powerful SNRI on the market and is, imho, a better bet than what you're on, or is proposed. Plus, I think it's way too early to apply the 'treatment-resistant' label when just 2 ADs from the same class and another which is arguably not much different have failed.

Jo79
22-12-19, 13:20
Thanks PDU, i’m seeing the NHS psychiatrist on Tuesday so will ask about the TCA’s. It will be good just to get a second opinion on the meds but apparently the NHS psych is a good friend of the private one so I’m hoping that doesn’t influence any decision ��.
Increased to 200 last night and I feel extremely agitated today :wacko:

Dying_Swan
22-12-19, 21:58
Sorry to hear you're feeling agitated Jo. Quetiapine increases do that to me too, although I've found its less pronounced at higher doses. Good luck with the NHS psychiatrist x

panic_down_under
22-12-19, 22:03
Increased to 200 last night and I feel extremely agitated today :wacko:

That is the irony of most psych meds, they all too often trigger the very symptoms they are supposed to treat at the beginning and after dose increases. :sad:

pulisa
23-12-19, 08:33
That's probably why psychiatrists struggle to treat anxiety with medication.

Jo79
23-12-19, 12:20
The agitation has its positives though, the last few weeks Iíve felt depressed and no motivation to do anything so Iím very behind on getting ready for Christmas. These last couple of days Iíve been charging around like the Duracell bunny on speed 🤪

pulisa
23-12-19, 20:46
I agree that agitation can be used positively. I couldn't get through my daily workload without it.

Good luck with seeing the NHS psychiatrist.. Are you expecting a different diagnosis?

Jo79
24-12-19, 12:59
Thanks all, just got back from my appointment. Diagnosis hasn’t changed but she doesn’t agree with adding Lamotragine to the mix or changing anything as I still have two meds that aren’t at maximum dose yet. She has suggested I increase my venlafaxine to 300mg first and see her again at the end if January. I can’t say I’m overly keen at the thought as the last time I increased venlafaxine was horrendous but I’m hoping the quetiapine will make it a bit easier this time :scared15:

panic_down_under
25-12-19, 21:32
Diagnosis hasnít changed but she doesnít agree with adding Lamotragine to the mix or changing anything as I still have two meds that arenít at maximum dose yet.

That seems the better option, imho. As someone who only responds to ADs at, or over, the recommended maximum doses I think a med shouldn't be discarded without maxing it out first if possible.


the last time I increased venlafaxine was horrendous but Iím hoping the quetiapine will make it a bit easier this time :scared15:

No guarantees, but quetiapine may take the edge off.