Can’t see Ven as my forever med any more

I haven’t been on here in ages but I thought I’d update.
I’ve been on Ven for ages, over a year anyway. It’s dealt superbly with my anxiety without making me drowsy which is great. I’m just feeling fed up with the downsides again. My sleep is awful. When I go to bed my head is buzzing, I wake several times in the night and I wake early (sixish) so I rarely get more than 6 hours and build up a deficit which wipes me out. There’s so much I want to do in my new un-anxious world, but I’m too tired to do it!
I’m also fed up with chewing my cuticles and compulsively shredding the inside of my mouth. When I clean my teeth the blood flows. I also still get ear/sinus issues and often just feel generally unwell.
It seems to me that everyone reacts differently to these meds, so no one knows what advice to give. I want to lower my dose by a quarter (I’m on 75mg). I want the anti-anxiety effect but not all the rubbish that comes with it. I’m just terrified of rocking the boat and ending up making things worse. I basically lost 2018 trying to find a med that helped me. Oh, and I put back on the 2 stone I lost when I was between drugs. Happy days. Sorry to moan.

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Originally Posted by Sleepy

I’m just feeling fed up with the downsides again. My sleep is awful. When I go to bed my head is buzzing, I wake several times in the night and I wake early (sixish) so I rarely get more than 6 hours and build up a deficit which wipes me out. There’s so much I want to do in my new un-anxious world, but I’m too tired to do it!

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Have you discussed this with the prescribing doctor and there are ways of treating this such as adding a small dose if mirtazapine. OTC alternatives such as melatonin, or the antihistamine diphenhydramine found in Nytol tablets and liquid preparations could also be sedating enough. If it works diphenhydramine might be a better option than mirtazapine because it has a much shorter half-life so is less likely to still be sedating the next morning.

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I’m also fed up with chewing my cuticles and compulsively shredding the inside of my mouth. When I clean my teeth the blood flows.

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Does your GP know about this? Also have you taken more than 75mg in the past? I'm wondering if these are from anxiety, rather than the med and an indication you should be on a higher dose. 75mg is the low end of the usual therapeutic range.

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I also still get ear/sinus issues and often just feel generally unwell.

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Have other potential causes been ruled out?

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I want to lower my dose by a quarter (I’m on 75mg). I want the anti-anxiety effect but not all the rubbish that comes with it.

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The problem with sub/borderline dosing is that it could increase the risk of the med pooping out.

ADs work by stimulating the growth of new brain cells (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 this requires a minimum level of the med in the system to initiate and sustain.

Taking sub/borderline therapeutic doses could interrupt neurogenesis whenever the med's plasma levels drop below the amount needed to sustain it which could lead to the second issue, the growing evidence antidepressants become progressively less effective every time they are stopped and restarted. Two studies, Amsterdam JD, 2016 and Amsterdam, 2009 found the likelihood of antidepressants working after each restart drops by between 19-25% (see also: Bosman RC 2018; Amsterdam JD, 2009; Leykin Y, 2007); Paholpak S, 2002). Taking a low dose for months might create a similar situation as stopping and restarting it. While the neurogenesis interruptions may only be of short duration, they will likely occur much more frequently.

I can understand the sleep issue as I have poor sleep then after a week of getting up in the night im knackered and sleep like a baby. Im on 300mg which ive been taking for the last 3 weeks since being on 225mg for several months. Anxiety is low so with that my OCD and self harming has greatly reduced so I personally am happy to live with any side effects this drug produces, I guess you just got to weight up whats best for you, increased anxiety or side effects.

Many thanks for taking the time to reply to my post.

Regarding the sleep issues, it is very much associated with my anxiety and I have been on Zopiclone for 20 years. I know I am addicted and it probably no longer works for me but I have not felt strong enough to withdraw from it and take on all the extra insomnia etc. That would trigger. I have tried Nytol and it doesn’t work for me. Melatonin is not available to us in the UK but I have just sent off to the US for some. I have also tried cbd but it conflicts with my medication.

The cuticle/mouth shredding has been highlighted to all of the various gps I get sent to by my practice, and to my psychiatrist. I have never taken a higher dose of Ven as the advice has been that the side-effects will be worse. It is thought that my symptoms are not anxiety-driven. My anxiety of more than 20 years’ duration has been handled by the 75mg.

I saw an ENT consultant about the sinus/ear issue. He believes they are caused by the meds.

I seem to be very sensitive to these ADs and have coped well on very low doses of others. My last one became too expensive for the NHS and then unavailable.

I can live like this, but would be so much happier without the above complications.

I know what you mean, Maca44. I too am delighted not to be paralysed by panic, but after 18 months I’m wondering if I could fiddle with my dosage and feel better physically. My son has OCD so I understand something of what you’re going through.

I’ve recently discovered Michael Mosley’s “fast-asleep” which is really worth a read. I’m a really tough nut to crack insomnia-wise but since implementing some of his recommendations, I’ve been falling asleep within ten minutes for the first time in years. I’m looking after my micro-biome!

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Originally Posted by Sleepy

Regarding the sleep issues, it is very much associated with my anxiety and I have been on Zopiclone for 20 years. I know I am addicted and it probably no longer works for me but I have not felt strong enough to withdraw from it and take on all the extra insomnia etc. That would trigger. I have tried Nytol and it doesn’t work for me. Melatonin is not available to us in the UK but I have just sent off to the US for some. I have also tried cbd but it conflicts with my medication.

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Have you tried mirtazapine? While marked as an antidepressant it is mostly a very sedating antihistamine, especially at low doses. The main drawback is it has a fairly long half-life so the sedation may continue into the next day. Unfortunately, the best med for this purpose, trazodone (Molipaxin), apparently can't be prescribed by NHS GPs, only psychiatrists.

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I saw an ENT consultant about the sinus/ear issue. He believes they are caused by the meds.

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Sinusitis is a listed venlafaxine side-effect so the consultant could be right.

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I seem to be very sensitive to these ADs and have coped well on very low doses of others. My last one became too expensive for the NHS and then unavailable.

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What was it?

I have tried mirtazapine and it didn’t help my sleep. I also don’t want to take another drug that makes me gain weight.

The drug I had to discontinue was Trimipramine. I slept beautifully with it but it wasn’t as good as Ven for anxiety. On reflection, I was sleeping my life away - 12 hours was common. At the end it was costing my gp practice about £40,000 a year to prescribe it to me.
I have recently started taking the supplement Bimuno and have noticed a marked improvement. For the last few nights I have taken less than 10 minutes to fall asleep. I haven’t done that since I was in my twenties.

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Originally Posted by Sleepy

The drug I had to discontinue was Trimipramine. I slept beautifully with it but it wasn’t as good as Ven for anxiety. On reflection, I was sleeping my life away - 12 hours was common. At the end it was costing my gp practice about £40,000 a year to prescribe it to me.

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You slept great on trimipramine because it is, like mirtazapine, mostly a sedating antihistamine having little effect on serotonin and noradrenaline pathways. You might do better on another TCA class AD amitriptyline. It is slightly less sedating than trimipramine, but is an effective serotonin and noradrenaline reuptake inhibitor so more likely to ease anxiety and is as cheap as venlafaxine, about £33/yr for 75mg tablets (PDF).

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I have recently started taking the supplement Bimuno and have noticed a marked improvement.

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There is ever growing evidence that our gut can be a major player in anxiety and depression, in fact in many illnesses. Arguably, we're just life support systems for the gut biome.

Thank you for your advice, it’s very kind of you to take the time.

Unfortunately I tried amitriptyline, it was the obvious go-to after trimipramine. I reacted very badly to it, it gave me distressing bladder issues which persisted for months. I was also forced to withdraw far too quickly from trimipramine after having been on it for ten years. When I came off Seroxat it took 18 months of hell.

I agree with you about the microbiome. This supplement has made such a difference to me. Before I started it I got 5 and a half hours sleep. Last night I got over 8 hours. I never do that!

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Originally Posted by Sleepy

Unfortunately I tried amitriptyline, it was the obvious go-to after trimipramine. I reacted very badly to it, it gave me distressing bladder issues which persisted for months. I was also forced to withdraw far too quickly from trimipramine after having been on it for ten years.

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That is surprising.

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When I came off Seroxat it took 18 months of hell.

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Paroxetine (Seroxat, Paxil) can be difficult to quit because it has a short half-life and no active metabolite to extend this. Only venlafaxine can is worse. The best way of quitting both is to switch to the very long half-life fluoxetine (Prozac) and weaning of it.