Sigh :mad: Your doctor/s seem to be from the 'kitchen sink' school of prescribing. Just keep on throwing meds at the problem until hopefully they strike the 'magic' combination that cures all the patient's problems. It never works. In large part because there usually isn't any rhyme or reason behind the meds and doses selected. :sad: For example, what is the point in prescribing both diazepam and pregabalin which do essentially the same thing. Why not just increase the dose of one of them until or works and if it doesn't within its dose range discontinue it (and yes, I understand pregabalin was apparently prescribed to enable you to tolerate vortioxetine which is another crazy idea, imunho!).
I have to agree PDU they had lost ideas and kept throwing things at me and none, except pregabalin helped and then for short spurts
I have no idea whether imipramine is readily available in the UK. I'd be surprised if it isn't, but clomipramine (Anafranil) would be my second choice. Like imipramine is is only a weak antihistamine.
Again totally agree I think imipramine is available, but am so so scared of the consequences of change. It really really scares me that I will now lose my life to this terror !!!!
Having a close relative who did well on a med does improve the odds of it working for you though it isn't a guarantee. She might have done even better without the lorazepam.
Again totally and I told them that in hospital 6 years ago and they came back with Trazadone which did nothing, absolutely nothing
Then second hospitalisation and they came back with Brintillex and pregabalin, on top of Mirtazipine and diazepam
I suspect the only med in your cocktail that is actually doing much is the pregabalin which has me wondering how much of the withdrawal symptoms were actually just the dose dropping below its therapeutic window.
I didn’t realise how much pregabalin was doing until I went into withdrawal and now it is no longer having the same effect. It’s lost it’s helping hand now and I’m feeling really a hopeless case once more !!!! Sorry I’ve had enough of this illness and it’s taken soo much from me !!!!
You won't need to come of mirtazapine, but I doubt it is actually doing much so I don't see the point of being on it. But that's an issue for another day. Yes, you will need to come off vortioxetine (Trintellix aka Brintellix). According to the
NHS guideline, switching to imipramine can be done either by a cross-taper over 2-4 weeks, or by stopping vortioxetine and then starting imipramine after some days. Given the choice I'd do the cross-taper, but I suspect the Pdoc will be more comfortable with the second option [Edit: on reflection given your previous experience with amitriptyline tapering off vortioxetine before starting imipramine is probably the wiser choice]. For clomipramine you will need to taper off vortioxetine and then start on the TCA.
I have read the NICE guidance on switching and imipramine can be cross tapered, with low dose of the TCA. But won’t I get even worse with the withdrawal from brintillex ???? And I can’t handle that !!!!
Imo, there also needs to be consideration given to discontinuing the diazepam as it is almost certainly inhibiting the effectiveness of vortioxetine to some degree and will have the same effect on the TCA too [1]. How much I can't say as while diazepam and the other benzodiazepines do block neurogenesis, the mechanism by which ADs (also therapy) work, pregabalin may have some protective effect on this by speeding up the maturation of the new brain cells the ADs stimulate into growth. Just how much pregabalin might be countering the effects of diazepam I can't say, but the sooner you come off it the better, although I'd wait until you're stabilised on the TCA as changing two meds at the same time is a bad idea as you can't be sure which might be causing any problems that arise.
Again totally agree would have to stop brintillex before starting Clomiprimine and again I’m so so scared of where that will take me and the cost of change, which could be the end of me PDU !!!
Can I ask should I still expect a response within 6–12 weeks at a therapeutic dose ????
I don’t know how I will react to a TCA and my only barometer is that time I mixed Amatriptyline with other AD’s and tachycardia scares me. I’m not bothered about sedation that’s fine as I would take before bed - Your thoughts please on my experience with amatriptyline please ????
Unfortunately, there are only two ADs which do not usually cause sexual dysfunction, bupropion (Wellbutrin) and trazodone. Bupropion is by far the most stimulating AD, far too stimulating for most with anxiety disorders, though some do well on it. Trazodone might be worth considering at some later date.
Tried both and not touching either one ever again bupropion made me angry back in 2011 and Trazadone did absolutely nothing, not a thing and caused me to fall asleep easy, but wake up every hour. So woke up 7/8 times a night, it was a terrible meditation for me !!
Im so unsure, but know I can’t continue much longer until something happens and I feel hopeless and helpless. It’s a horrible position
In the past 6 years I just battled my way through things and got to about 65/70% recovery. But never full remission as I have always had in the past. I don’t know what to do and feel wrecked by all mental health, I’ve no time for it anymore I’ve lost all hope PDU !!! Sorry !!!
There
are ways of reducing the impact of sexual dysfunction.
References:
[1]
Boldrini M, Butt TH, Santiago AN, et al. (2014)
Benzodiazepines and the potential trophic effect of antidepressants on dentate gyrus cells in mood disorders.
Int J Neuropsychopharmacol. Dec;17(12):1923-33 (
Abstract |
Full text)
Sun Y, Evans J, Russell B, et al (2013)
A benzodiazepine impairs the neurogenic and behavioural effects of fluoxetine in a rodent model of chronic stress.
Neuropharmacology. Sep;72:20-8 (
Abstract)
Song J, Zhong C, Bonaguidi MA, et al (2012)
Neuronal circuitry mechanism regulating adult quiescent neural stem-cell fate decision.
Nature. Sep 6;489(7414):150-4 (
Article |
Study full text)
Wu X, Castren E. (2009)
Co-treatment with diazepam prevents the effects of fluoxetine on the proliferation and survival of hippocampal dentate granule cells.
Biol Psychiatry. Jul 1;66(1):5-8 (
Abstract)
See also: the 'Ugly' part of
Benzodiazepines: The Good, The Bad, and the Ugly.