Here I am again!!!

[Siggsy49]

Been on sertraline for 8 years approximately. Then they stopped working? Or the stress of the coronavirus and working in the hospital. Its been like working on a battlefield! Alas Christmas eve I couldn't even get out of bed. My anxiety was terrible and no energy. I can't believe this has happened again!
Have been trying mirtazipan for 6 weeks with no effect.
So now been put on venlafaxine.
Any words of encouragement be grateful. I now on day 3 so will use this thread to keep a diary. Just hope these will help get me on my feet and back to work???
Kind regards 😇

[panic_down_under]

Been on sertraline for 8 years approximately. Then they stopped working?

How much were you taking when sertraline stopped working and if it was less than 200mg was increasing the dose tried?


Or the stress of the coronavirus and working in the hospital. Its been like working on a battlefield! Alas Christmas eve I couldn't even get out of bed. My anxiety was terrible and no energy. I can't believe this has happened again!

Even those who have never had an anxiety disorder or depression are crumbling under the strain. :sad: Everyone has their limit.


Have been trying mirtazipan for 6 weeks with no effect.

Not really a surprise. It is mostly just a sedative, not an AD.


So now been put on venlafaxine.
Any words of encouragement be grateful. I now on day 3 so will use this thread to keep a diary. Just hope these will help get me on my feet and back to work???
Kind regards 😇

Unfortunately, there still isn't any way of predicting which AD will mesh best with individual biology. It all comes down to trial and error. That said, venlafaxine has a good chance of working, certainly better than mirtazapine. Fingers crossed 🤞

[Siggsy49]

Hi there! Thank you for your reply. So I'm having a good day today. I actually didn't have to drag myself out of bed. I did my hair put make up on. Walked into town. Omg my back and legs were killing me but I just kept sitting and resting as I felt more clear in my head and my body seemed more attached to my brain! I hope this isn't just a placebo?
Yes mirtazipan wasnt good for me at all!
I hope this continues 🙏

[Siggsy49]

I was on 200mg sertraline

[panic_down_under]

Walked into town. Omg my back and legs were killing me but I just kept sitting and resting as I felt more clear in my head and my body seemed more attached to my brain! I hope this isn't just a placebo?

It might well be down to the exercise. It is unlikely to be the venlafaxine. No AD works that quickly, unfortunately. But exercise can do wonders.

[Siggsy49]

Now finished week 2. Im now able to do more than I've done in 3 months. Onwards and upwards!
My only problem is my sleeping. Ive gone from sleeping excessively to not much at all. Hopefully this is just medications adjusting?

[panic_down_under]

My only problem is my sleeping. Ive gone from sleeping excessively to not much at all. Hopefully this is just medications adjusting?

SSRI induced insomnia is a fairly common side-effect. It often diminishes after a few weeks, but can linger. Nytol tablets/liquids containing diphenhydramine often work, as may herbal supplements for insomnia. If they don't then ask your doctor to prescribe a small dose of mirtazapine (if you can get it 25mg immediate-release trazodone would be even better as it has a much shorter half-life, but UK GPs are reluctant to/can't prescribe it for some reason).

[Siggsy49]

How do you know if your dosage needs increasing?
Doctors are reluctant to prescribe alot of medications these days. But its the government apparently saying this.

[panic_down_under]

How do you know if your dosage needs increasing?

Keep increasing the dose until symptoms diminish. The trick is to be as anxiety (&/or depression) free as possible. The usual venlafaxine dose range for healthy adults is 75-225mg/day with a recommended maximum of 375mg according to the NHS (https://www.nhs.uk/medicines/venlafaxine/) with most taking 100-225mg extended-release. Venlafaxine only begins to inhibit noradrenaline, aka norepinephrine, reuptake at around 225mg, albeit still only weakly.


Doctors are reluctant to prescribe alot of medications these days. But its the government apparently saying this.

If by "a lot of medications" you mean high doses, then yes. But many seem quite willing to add another med or more instead of exploring the upper limits of the dose range which is, imho, madness. Some people, e.g. me, need to take near maximum doses of an AD, sometimes even above, to get a good result. I've always needed to take more than the recommended maximum dose of every AD. After 34 years almost continuously on these meds my brain still hasn't turned to porridge.

[Siggsy49]

Why i asked this question is I've had a few really good days and now I feel as though I've gone a few steps back. I've requested a call back from the doctor to ask to increase my dosage. I hear alot about the slow release venlafaxine. Is this better? I'm only on 37.5mg twice a day. This has been for 2 weeks now.
Thank you for your input PDU! Are you taking venlafaxine yourself?

[panic_down_under]

I hear alot about the slow release venlafaxine. Is this better?

It should give you a smoother rise as there will be less fluctuation in plasma levels.


I'm only on 37.5mg twice a day. This has been for 2 weeks now.

As with all ADs, it will likely take 4-12 weeks to kick-in. Plus that is only a starting dose. Most need to take 100-225mg/day for optimum results. Venlafaxine only begins to inhibit noradrenaline/norepinephrine reuptake at around 225mg. The maximum recommended dose is 375mg.


Are you taking venlafaxine yourself?

Nope, I took it for two days back in the 1990s, but as with all the SSRIs I've tried it made me hyper/manic. I'm on the TCA dosulepin which is no longer prescribed to new patients in the UK because of its cardio toxicity.

[Siggsy49]

So past few days im feeling bad again? I have to go online to request a call from the doctor to discuss upping my dosage. This was Tuesday morning. I got a email saying I'll get a call back Thursday morning. Im really struggling after feeling well for a few days. The support for mental health is poor. Im sure a quick call Tuesday to get my dosage increased wouldn't of taken too much time.

[panic_down_under]

So past few days im feeling bad again? I have to go online to request a call from the doctor to discuss upping my dosage. This was Tuesday morning. I got a email saying I'll get a call back Thursday morning. Im really struggling after feeling well for a few days.

I don't think the venlafaxine is having much, if any impact at this stage, good or bad. Too low a dose and not enough time for new neurons to grow much. They take about 7 weeks to mature although they can begin to have some positive effect a little earlier.


Im sure a quick call Tuesday to get my dosage increased wouldn't of taken too much time.

True, but would he have been paid for it? :unsure:

[Siggsy49]

So I've been waiting for a call from the doctor today. I checked my emails and he has just emailed saying to take 75mg in the morning and 37.5mg in the evening. So didn't even get to ask about getting slow release. Its so hard trying to discuss anything with my doctor. He doesnt seem to be very supportive or understanding my mental health. He avoids as much as possible.

[panic_down_under]

he has just emailed saying to take 75mg in the morning and 37.5mg in the evening. So didn't even get to ask about getting slow release.

Maybe not ideal, but at least he did authorise a higher dose.


Its so hard trying to discuss anything with my doctor. He doesnt seem to be very supportive or understanding my mental health. He avoids as much as possible.

I know it isn't easy, but I'd be looking to change to another, or asking for a referral to a psychiatrist.

[Siggsy49]

Hi all. So last week my doctor increased my medication to 150mg slow release. I think I have slept most of the week away!
I've not really had any bad side effects up until now. And thats the excessive sleeping after been put on slow release. Is there anyone else taking this medication. Or anyone else with knowledge on this medication? Many thanks 😊

[Siggsy49]

So here I am again......
Now on 300mg venlafaxine. The reason I'm sticking with this medication is that I have improved alot taking it. I can go 7-9days feeling good but then I start feeling tired and have to lie down. Then wake up a few days later. Ive been on 300mg nearly a month now. Any views on this dosage?

[panic_down_under]

I can go 7-9days feeling good but then I start feeling tired and have to lie down. Then wake up a few days later.

You sleep for several days straight? Are you getting around 8 hours sleep on the 7-9 days you feel good? Have you discussed this with the prescribing doctor?


Ive been on 300mg nearly a month now. Any views on this dosage?

The recommended maximum venlafaxine dose is 375mg/day so you're at the high end but some of us need high doses to get optimum results.