Increasing Venlafaxine to 300mg

[Cornish Andy]

Hi. I hope everyone doing ok today. I could really do with some advice if anyone is able.

I’ve been on Venlafaxine 225mg for panic disorder and anxiety for the last 4 years. I was previously on Paroxetine but that stopped working for me. Switching was pretty rough but, to be fair, I’ve not been doing too bad on it since. I don’t think we are ever ‘cured’ are we, but things were much more manageable.

Since lockdown things have changed. The situation brought about some triggers for me, and the panic returned. High level panic lasting days at a time. Racing thoughts, trembling, the full works . I know myself quite well and i know I fear the fear itself. Doctor gave me some diazepam 2mg for the worst moments, but of course I was even anxious about taking these!

I’ve never considered myself to have depression, but over time I’ve been feeling increasingly tearful, hopeless and unable to enjoy or even engage with anything. This has been accompanied by a spaced out disconnected feeling (depersonalisation?) which freaks me out even more.

I was lucky to get a psychiatrist appointment, and she has recommended increasing the Venlafaxine to 300mg. Now, I know 225mg is considered the maximum dose for anxiety and panic, but 300mg or higher can be given for clinical depression. At higher doses I also know the drug behaves differently and can increase adrenaline.

How is this going to make me feel? Could this make my anxiety/panic worse? Will I feel even more spaced out and drugged up at this dose?

I know there are no definite answers and it’s a case of see what happens, but wondering if anyone has any experience of 300mg, especially anyone more prone to panic and anxiety than depression.

Best wishes to everyone.

[panic_down_under]

I was lucky to get a psychiatrist appointment, and she has recommended increasing the Venlafaxine to 300mg. Now, I know 225mg is considered the maximum dose for anxiety and panic, but 300mg or higher can be given for clinical depression. At higher doses I also know the drug behaves differently and can increase adrenaline.

Although venlafaxine is classified as a SNRI it is really only a SSRI, Andy. It only begins to inhibit noradrenaline (NA), aka norepinephrine, reuptake at around 225mg/day, but even at the maximum recommended 375mg/day the NA inhibition is still weak. It doesn't increase adrenaline release. Several SSRIs actually inhibit NA reuptake more strongly than venlafaxine does, albeit still only moderately compared to other SNRIs and some TCAs.


How is this going to make me feel? Could this make my anxiety/panic worse? Will I feel even more spaced out and drugged up at this dose?

You'll probably feel not much different once any side-effects triggered by the dose increase subside.

[Cornish Andy]

Although venlafaxine is classified as a SNRI it is really only a SSRI, Andy. It only begins to inhibit noradrenaline (NA), aka norepinephrine, reuptake at around 225mg/day, but even at the maximum recommended 375mg/day the NA inhibition is still weak. It doesn't increase adrenaline release. Several SSRIs actually inhibit NA reuptake more strongly than venlafaxine does, albeit still only moderately compared to other SNRIs and some TCAs.

You'll probably feel not much different once any side-effects triggered by the dose increase subside.

Thanks so much Panic_Down_Under. This is reassuring. I forgot to mention I’ve been taking an additional 37.5mg add on for the last couple of months as recommended by my GP, but this wasn’t extended release so the psychiatrist didn’t think it would have had much of an effect. The 300mg is now all extended release. I’m just hoping it’s enough to calm me down and give me a bit of boost.

[panic_down_under]

I forgot to mention I’ve been taking an additional 37.5mg add on for the last couple of months as recommended by my GP, but this wasn’t extended release so the psychiatrist didn’t think it would have had much of an effect.

The extra 37.5mg may have been doing more harm than good because of the med's very short half-life - 5 hours +/- 2 h. It would have been setting up a yoyo effect as blood plasma levels rose and fell over the day.


I’m just hoping it’s enough to calm me down and give me a bit of boost.

There is a good chance it will, however, it will take some weeks. Antidepressants have no direct effect on anxiety, or depression in the way say aspirin has on a headache. They work by stimulating the growth of new brain cells (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC60045/) (neurogenesis) to replace cells killed, or prevented from growing by high brain stress hormone levels. The therapeutic response is produced by these new cells and the stronger interconnections they forge, not the meds directly, and they take time to bud, grow and mature. For more detailed explanations see: Depression and the Birth and Death of Brain Cells (PDF (https://www.americanscientist.org/sites/americanscientist.org/files/20057610584_306.pdf)) and How antidepressant drugs act (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3025168/).

[Paradise10]

Hi Andy, there is a thread on here from a user called Nicola1980 and she increased to 300mg and had anxiety rather than depression. She did well on this dose from reading it.

I've just been through an increase myself after being stable on ven and it took 8 weeks to settle completely although things started improving before then, so hang in there.
Ava x

[Cornish Andy]

Thanks both. Panic_down_under, thanks for the really useful links and information. It’s great to have someone practical like you on the forum to talk about what these medications are actually doing.

Ava, I’m glad you’ve had a positive experience, and hope you continue to go from strength to strength. I’ll check out Nicola’s posts too. Thanks for your kind words of encouragement.

[Jo79]

Please don’t be anxious about taking diazepam if you need to, they really can take the edge off and you won’t get addicted if you only take them occasionally.

Your post sounds exactly how I am feeling at the moment. I have OCD anxiety and depression and am currently on 337.5mg xr but my psychiatrist wants me to go up to 375mg 😬. On my previous increases I have had increased anxiety for 3-4 weeks but it does settle. I used diazepam to help with it and only when I really needed to.

[Cornish Andy]

Thanks Jo. I do take the diazepam very occasionally but usually no more than two 2mg per day, and then for as few days as possible.

ive been on the increased Venlafaxine for 2 weeks now, and it’s been going quite well. I know it’s still early days, but it feels like it’s had a positive effect so far. I’ve had no real side effects other than a few head zaps from time to time, and I’m generally not feeling as anxious.

Jo, if you are on 337.5 are you taking a 37.5mg tablet that isn’t extended release (because they don’t do XR in that dosage)? I was doing this previously, and I think having all extended release definitely works better. Either way, look after yourself. There are bound to be ups and downs, but you’ll get there.

[Jo79]

Hi Andy, all my tablets are extended release, even the 37.5mg. They are called Venlalic XL. I have also had 37.5mg extended release capsules.

I definitely agree with you that the extended works better. When I started venlafaxine 18 months ago I was given the standard tablets and was taking the whole dose in the morning and was up and down like a yo-yo. Nobody told me the standard tablets had to be taken in split doses am/pm 🙄

[Cornish Andy]

I had been doing well on the increased dose. It’s only 2 and a half weeks so I know there’s longer to wait for the full effects, but it felt like I was improving in the meantime. Now, all of a sudden, the old shaky feelings are back. A big problem for me is anticipatory anxiety and I’m probably focusing on, and dreading, a change of routine that’s coming next week. I know I shouldn’t but it’s very hard not to. I guess I was hoping the increased dose might prop me up a little better to help cope with it.

I hope everyone else is doing ok today.

[panic_down_under]

I guess I was hoping the increased dose might prop me up a little better to help cope with it.

Unfortunately, there is nothing quick about ADs, Andy, apart from the speed of side-effects onset. :weep: But a few more days could make a difference. 🤞

[Cornish Andy]

Unfortunately, there is nothing quick about ADs, Andy, apart from the speed of side-effects onset. :weep: But a few more days could make a difference. [emoji1696]

Thank you panic_down_under. I’ve let things build up in my head this week and, for some reason, just your simple reply opened the floodgates and turned me into a crying mess! But that’s a good thing. It’s best to let it out I know.

I’ll see how the rest of the day goes and perhaps have one of my very occasional diazepam later to have a more relaxed evening. It sometimes helps to break the cycle.

All the best to you and everyone else here. Onwards and upwards again.


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[Cornish Andy]

I’m back again with another question. These irrational worries never end.

Has anyone ever experienced a problem changing from one generic brand to another? I’ve always been on a generic version of Venlafaxine - ‘Vensir’ - but the pharmacy have issued me a different brand this time. What with the recent increase still in progress I’m hoping this won’t cause any upsets.


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[Jo79]

I’m back again with another question. These irrational worries never end.

Has anyone ever experienced a problem changing from one generic brand to another? I’ve always been on a generic version of Venlafaxine - ‘Vensir’ - but the pharmacy have issued me a different brand this time. What with the recent increase still in progress I’m hoping this won’t cause any upsets.


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A lot of people worry about changing brands, I used to worry about it too but that’s just the anxiety talking. The ingredients are exactly the same so shouldn’t be an issue. You’ll be fine 🙂

[panic_down_under]

Has anyone ever experienced a problem changing from one generic brand to another?

As Jo has said, there shouldn't be any difference. A study years ago when generics became more available found generics were on average 14% less effective than the brand, not because of what was in the packet, but printed on it, i.e. psychology, not chemistry.

Back in the days when the ancient AD I take was still available in the brand version I found I did better when taking the generic. I suspect the difference was the brand tablets had a much thicker red coating which I was reacting too.

[Cornish Andy]

Thanks both. Day one on the different brand today, but I’m sure it’ll be fine. I’m struggling anyway at the moment, but I know I’m doing it to myself with anticipation of a challenging few days coming up.

Best wishes to everyone.


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[Cornish Andy]

Hi folks. I hope you’re all well.

So, I’ve done a month on the different brand, and I don’t think it really made a difference. Just picked up my prescription for this month and I’m back on the original brand, and I’m not going to worry about it.

What is getting me down is the lack of overall progress. I’ve been on the increased 300mg dose for almost 7 weeks now. I have had some good days, which is positive, but still a lot of very bad days and not much change overall. Sometimes I can’t even tell if it’s anxiety or depression. It seems to be a bit of both. Sometimes I feel scared and physically shaky, yet numb at the same time.

A little way in to this 7 week period I did face a significant trigger for my anxiety which sent me into a bad period, so I’m committed to allowing more time to give this increase a reasonable chance to work. I’m just not sure how much longer, if I don’t start to feel any better soon. Or what the next step might be.


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[panic_down_under]

A little way in to this 7 week period I did face a significant trigger for my anxiety which sent me into a bad period, so I’m committed to allowing more time to give this increase a reasonable chance to work. I’m just not sure how much longer, if I don’t start to feel any better soon. Or what the next step might be.

I would be expecting a better result by now, Andy. More good days than bad at least. But given your history it could take longer than usually for a AD to kick-in so it might be too early to pull the plug just yet.

As for where to if venlafaxine proves to be a dud, the next step will probably be a switch to fluoxetine (Prozac) as quitting venlafaxine directly can sometimes be difficult due to its very short half-life. There is a reasonably good chance fluoxetine will work, if it doesn't citalopram (Celexa) has a pretty good track record for working when other SSRIs no longer do if your psychiatrist wants to stick with that AD class. However, my recommendation would be one of the TCAs, amitriptyline or imipramine with a preference for the latter.

Before the advent of SSRIs/SNRIs imipramine was the 'gold standard' AD for panic disorder. The newer meds didn't replace the TCAs (and MAOIs) because they were more effective, they aren't, but because they were regarded as safer in overdose which turns out isn't actually true of all of them.

[Cornish Andy]

I would be expecting a better result by now, Andy. More good days than bad at least. But given your history it could take longer than usually for a AD to kick-in so it might be too early to pull the plug just yet.

As for where to if venlafaxine proves to be a dud, the next step will probably be a switch to fluoxetine (Prozac) as quitting venlafaxine directly can sometimes be difficult due to its very short half-life. There is a reasonably good chance fluoxetine will work, if it doesn't citalopram (Celexa) has a pretty good track record for working when other SSRIs no longer do if your psychiatrist wants to stick with that AD class. However, my recommendation would be one of the TCAs, amitriptyline or imipramine with a preference for the latter.

Before the advent of SSRIs/SNRIs imipramine was the 'gold standard' AD for panic disorder. The newer meds didn't replace the TCAs (and MAOIs) because they were more effective, they aren't, but because they were regarded as safer in overdose which turns out isn't actually true of all of them.

Thanks panic_down_under. Really useful advice once again.

What's actually been happening is a few good days where I feel ok, better even, then I 'break down' again with really high anxiety but also, more recently, very low mood as well. Feelings of hopelessness, bleak thoughts and no motivation. Worrying about my thoughts and low mood then adds more anxiety.

I saw my usual therapist today, and he is very concerned how quickly and low my mood drops, and suggests I go back to the psychiatrist as soon as possible to look for something to stabilize my mood, which I am trying to arrange now. I'm nervous of changing antidepressant (aren't we all!) or adding anything new because the process knocked me for six last time, but I guess I have to acknowledge that I'm not well now so there's not much to lose.

It feels different now to 'straightforward' panic disorder which was my initial diagnosis, but I know these things are two sides of the same coin. I don't have a history of depression, and I'm fairly sure it's driven by my anxiety which wears me down. Lockdown has played a big part too by turning my regular routine upside down.

[panic_down_under]

I saw my usual therapist today, and he is very concerned how quickly and low my mood drops, and suggests I go back to the psychiatrist as soon as possible to look for something to stabilize my mood, which I am trying to arrange now. I'm nervous of changing antidepressant (aren't we all!) or adding anything new because the process knocked me for six last time, but I guess I have to acknowledge that I'm not well now so there's not much to lose.

Your psychiatrist will likely recommend adding a mood stabilizer, Andy. Imho, it isn't the best option, but it is the easiest, least disruptive and quickest option.


It feels different now to 'straightforward' panic disorder which was my initial diagnosis, but I know these things are two sides of the same coin. I don't have a history of depression, and I'm fairly sure it's driven by my anxiety which wears me down. Lockdown has played a big part too by turning my regular routine upside down.

It's hard to judge, however, if the anxiety was bought under control the other things would probably begin to fall away.

[Cornish Andy]

Your psychiatrist will likely recommend adding a mood stabilizer, Andy. Imho, it isn't the best option, but it is the easiest, least disruptive and quickest option.


Can I ask why you think this might not be the best option?


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[Cornish Andy]

My GP tells me that the psychiatrist noted on my record that the next thing to try could be to switch from Venlafaxine to Sertraline. Basically, I need to decide if I want to try this.

Any views on whether this could be a good switch? I assume if I go ahead I’m going to need to cross taper very slowly. I’m wary given my already high anxiety and low mood.


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[panic_down_under]

Can I ask why you think this might not be the best option?

Firstly, because it is adding another med in an attempt to make up for the deficiencies of the current one. It mostly results in taking two ineffective drugs. Secondly, mood stabilizers can have unpleasant ongoing side-effects.


My GP tells me that the psychiatrist noted on my record that the next thing to try could be to switch from Venlafaxine to Sertraline. Basically, I need to decide if I want to try this.

Any views on whether this could be a good switch?

I'm not convinced going to another SSRI is the best option given one, paroxetine pooped-out and another venlafaxine isn't working that well. In these circumstances an AD from another class such as a TCA can be a better bet. However, some psychiatrists (and even more GPs) have little experience of TCAs these days and cross tapering from venlafaxine to a TCA can be tricky so many psychiatrists are wary of initiating it.

[Cornish Andy]

Thanks again PDU. I’m going to take a little while to think it over. Seems like there are pros and cons to every option. If an SSRI would be an smoother switch perhaps that’s not a bad thing in my current condition.

I would say that Paroxetine worked for a long while, 15 years or so, before pooping out. Not sure if that makes any difference.

It’s been really helpful bouncing thoughts off of you panic_down_under. How are you, anyway? I hope life is good for you at the moment.


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[panic_down_under]

Seems like there are pros and cons to every option.

This is true of just about everything in life and often we don't really understand which are the true pros and the cons until much later, Andy. But just think how boring life would be if everything was clear cut and predictable. :ohmy:


If an SSRI would be an smoother switch perhaps that’s not a bad thing in my current condition.

Perhaps. But don't just accept what your psychiatrist recommends. Make him to earn his fee by asking him what your options are and have him justify his choice.


I would say that Paroxetine worked for a long while, 15 years or so, before pooping out. Not sure if that makes any difference.

Hard to say though if poop-out happens it most often occurs much earlier. Was anything significant happening in your life around the time it began to fail?


How are you, anyway?

I'm okay, just tired. Today was the second time this week I've driven from one end of the state to the other and back again, round trips of about 450 miles which have me feeling my age even with the car doing most of the driving. :sad:

[Cornish Andy]

This is true of just about everything in life and often we don't really understand which are the true pros and the cons until much later, Andy. But just think how boring life would be if everything was clear cut and predictable. :ohmy:



Perhaps. But don't just accept what your psychiatrist recommends. Make him to earn his fee by asking him what your options are and have him justify his choice.



Hard to say though if poop-out happens it most often occurs much earlier. Was anything significant happening in your life around the time it began to fail?



I'm okay, just tired. Today was the second time this week I've driven from one end of the state to the other and back again, round trips of about 450 miles which have me feeling my age even with the car doing most of the driving. :sad:

Thinking back, I changed from Paroxetine not long after my second child was born, so a pretty significant time you could say!

I don’t know your history PDU, but if you have any history of panic or anxiety, just being able to drive that far is amazing! Sounds like you should put your feet up over the weekend though [emoji6]


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[panic_down_under]

Thinking back, I changed from Paroxetine not long after my second child was born, so a pretty significant time you could say!

That would account for an increase in anxiety/stress. Did you try upping the dose, Andy?


I don’t know your history PDU, but if you have any history of panic or anxiety, just being able to drive that far is amazing!

Fortunately, ADs control my PD+agoraphobia almost completely and they don't often restrict me from doing what I please.


Sounds like you should put your feet up over the weekend though

The place is often overrun by tourists clogging up the roads and hogging the best fishing spots so I usually take it easy on weekends anyway.

[Cornish Andy]

Hi everyone. I’m back again!

So it’s not been going that well. More bad days than good. My mood has been low and anxiety and agoraphobia much higher.

To cut a long story short, I’ve now gone to a private psychiatrist to try to get some more detailed advice and move things forward.

He has recommended adding the tricyclic Lofepramine at a starting dose of 70mg twice daily to my existing Venlafaxine 300mg. He doesn’t want to lower the Venlafaxine yet so that no withdrawal effects get in the way of progress. He’s also prescribed a beta blocker Atenolol to help bring down the physical symptoms of the anxiety.

This is all against the advice of a GP who recently wanted to lower the Venlafaxine as I was experiencing palpitations and raised blood pressure, and wouldn’t prescribe a beta blocker as I previously had mild asthma, which I don’t really suffer with any more.

As you can imagine, all these changes and differences of opinion are a lot to take in. I’m mainly worried about taking two antidepressants side by side while the dose of Venlafaxine is still so high. But the psychiatrist seems more knowledgeable than the GP so I have to trust him and go with it for now. I just need to relax and stop worrying so it has a chance to start working. Easier said than done.

Any similar experiences or words of advice would be welcome. As always, hoping you are all having a good day and taking care.


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[panic_down_under]

He has recommended adding the tricyclic Lofepramine at a starting dose of 70mg twice daily to my existing Venlafaxine 300mg. He doesn’t want to lower the Venlafaxine yet so that no withdrawal effects get in the way of progress. He’s also prescribed a beta blocker Atenolol to help bring down the physical symptoms of the anxiety.

So he is essentially creating a bespoke SNRI. Not sure venlafaxine is the best SRI for that, but you have to work with what you've got and maybe that will be addressed once the lofepramine kicks-in.


This is all against the advice of a GP who recently wanted to lower the Venlafaxine as I was experiencing palpitations and raised blood pressure, and wouldn’t prescribe a beta blocker as I previously had mild asthma, which I don’t really suffer with any more.

Is the psychiatrist fully aware of this?


As you can imagine, all these changes and differences of opinion are a lot to take in. I’m mainly worried about taking two antidepressants side by side while the dose of Venlafaxine is still so high.

Creating bespoke SNRIs was very popular back in the day and often produce very good outcomes in treatment resistant cases. Lofepramine is only a weak serotonin reuptake inhibitor and venlafaxine a weak noradrenaline reuptake inhibitor so on that score there shouldn't be any issues. There may be other potential problems, but you have to defer to his expertise.

[Cornish Andy]

Panic_down_under I knew (hoped!) you’d be the first to reply.

I did make the psychiatrist fully aware of what the GP had said, but he said it shouldn’t be a problem. Apparently, Atenonol is less likely to cause problems with asthma as it targets the heart as opposed to both heart and lungs like Propananol.

As for the Venlafaxine, if the new AD does start to work I think my preference would be to maybe get back to 225mg it as I do worry about being on such a high dose, which might not be needed with the combination approach.

What other problems do you foresee?


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[panic_down_under]

What other problems do you foresee?

Nothing specific, just that there are better meds for the creation of bespoke SNRIs. Sertraline was old timers preferred serotonergic AD for this because of fewer drug-drug interactions and any of the SSRIs except maybe paroxetine would be easier to quit than venlafaxine.

[Cornish Andy]

I’m back, and having another low. Very anxious, scared and emotional right now I’m afraid.

I struggled quite a bit with the start up of the new medication. After 2 weeks my new psychiatrist then lowered Venlafaxine back to 225mg alongside the Lofepramine 140mg (2 x 70mg). After a few days the mists started to clear, and I had a run of just over a week feeling the best I have in a while.

Then, 5 days ago, he lowered Venlafaxine further to 150mg and increased Lofepramine to 210mg (1 in the morning, 2 in the evening). His plan is to get me off the Venlafaxine altogether. Now, I’ve hit rock bottom and have broken down again. Been crying non-stop for 2 days. And the psychiatrist is away for the next week.

I’m guessing this is all natural at this stage - one drug going down, one going up, but it’s unbearable in the moment. I have resorted to diazepam and hoping I’ll be able to keep this to a few days maximum, as the thought of dependence terrifies me.

Perhaps I need to reduce the Venlafaxine more slowly?

Grateful for any advice at all, and best wishes to everyone. None of us are alone.


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[panic_down_under]

Then, 5 days ago, he lowered Venlafaxine further to 150mg and increased Lofepramine to 210mg (1 in the morning, 2 in the evening). His plan is to get me off the Venlafaxine altogether. Now, I’ve hit rock bottom and have broken down again. Been crying non-stop for 2 days. And the psychiatrist is away for the next week.

What a pity the dose changes couldn't have waited until he was back from wherever he's gone.


I’m guessing this is all natural at this stage - one drug going down, one going up, but it’s unbearable in the moment. I have resorted to diazepam and hoping I’ll be able to keep this to a few days maximum, as the thought of dependence terrifies me.

Benzodiazepine dependence is not the evil it is often claimed to be, plus it will take longer than you're likely be taking it. Quitting venlafaxine can be at least as hard as stopping BZDs.


Perhaps I need to reduce the Venlafaxine more slowly?

I don't know a lot about lofepramine as the UK is about the only place it is prescribed and then not often. In the ~25 years I've been participating in support groups I've only known of maybe 4 cases. So I can't really comment, but I suspect this would be easier if the dose changes were smaller for both ADs.

[Cornish Andy]

Thanks PDU. From what I’ve read Lofepramine seems most similar to Nortriptyline and Protriptyline, if you have come across those at all.

I do worry about reducing/coming off Venlafaxine as I know it’s a hard one to withdraw from, and I know I’m very sensitive. When I next speak to him I’ll suggest going as slow as possible. I think I might be able to change from the extended release capsules which only come in a minimum 75mg here and can’t be split, to the standard release which comes in 37.5mg and, I think, are in tablet form.

In my current state I’m just looking for some positives to reassure me. I was so hopeful when I had a few days feeling better last week.


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[panic_down_under]

From what I’ve read Lofepramine seems most similar to Nortriptyline and Protriptyline, if you have come across those at all.

While they are all primarily noradrenaline/norepinephrine reuptake inhibiting TCAs my observation, albeit from only a very small lofepramine sample, is that people react differently to it than nortriptyline which is the more popular NA inhibiting TCA. I don't recall anyone being on protriptyline which is a good thing given its side-effects profile.


I think I might be able to change from the extended release capsules which only come in a minimum 75mg here and can’t be split, to the standard release which comes in 37.5mg and, I think, are in tablet form.

Immediate-release is definitely the way to go.


I was so hopeful when I had a few days feeling better last week.

I wouldn't read too much into that. I suspect the relatively good week you had was more serendipity than a direct response to the 225mg venlafaxine plus 140mg lofepramine combination as you weren't on it long enough to have had much of an impact on the brain.

[Cornish Andy]

It’s been a while, but wanted to post an update on my situation, in the hope of some further advice and support.

I’m almost six months on the combination of Venlafaxine 150mg and Lofepramine 210mg and it’s not working. I’m in a cycle of feeling ok, even good for a week or two. Then, the extreme anxiety and accompanying depression return with a vengeance. I’m so overwhelmed I sometimes can’t tell if it’s anxiety or depression. My heart races, my mind races with worry, I can‘t sleep. I get desperately tearful and everything feels worthless and frightening. During these periods I can’t distract myself or enjoy or engage with anything.

I take diazepam for a few days, then it usually starts to lift after about a week, and I’ll feel ok again for a while. It’s so frustrating.

I’ve privately changed to a new psychiatrist as I wasn’t getting on well with the previous one. His attitude didn’t help me and he was more interested in pushing a form of EFT tapping therapy which I tried but didn’t find helpful.

I’ve seen the new psychiatrist a couple of times by video call, and he had suggested a couple of options.

First he wants me to taper off one of the antidepressants, keeping the one I feel helps the most. This is a difficult choice as I don’t feel either are helping right now. The Venlafaxine did for a few years whereas the Lofepramine hasn’t made much difference since starting this year, so I’m veering towards keeping the Venlafaxine.

He then suggests adding either either Quetiapine or Mirtazapine to the Venlafaxine. I just don’t know what to think.

Quetiapine worries me somewhat. I know it’s used as a mood stabiliser, but it’s an antipsychotic and I’ve never been on this class of med before.

Mirtazapine seems the less scary option as it’s another antidepressant. Apparently the combination of Venlafaxine and Mirtazapine is known as ‘California Rocket Fuel’ and considered by some as a good combination.

Both options cause significant sedation from what I’ve read, which I’m really not keen on. I have two children and a mentally challenging job.

Does anyone have experience with any of these combinations? Any help or advice much appreciated as always.

Sending best wishes to everyone out there.





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