So I take 15 mg at night but run out , my friend has given me a 45mg is it ok to snap a bit off till I get mine Monday ?????
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So I take 15 mg at night but run out , my friend has given me a 45mg is it ok to snap a bit off till I get mine Monday ?????
Can you snap these safely ?
Don't know what med you are referring to Tristan - but a quick call to pharmacist would answer your query safetly.
Oh ok, just realised you are on the Mirtazapine page. Definitely ring the pharmascist for advice, these I think are coated tablets without score lines ? You won't be getting a proper dose strength just by 'snapping a bit off', but I realise it is also important to continue and not stop this med, so could you not get an emergency prescription today ?
Yes Tristan it's no problem at all as they have score lines.
I have done it many times.
If you take 22.5mg today it wont do you any harm or you could chip a little more off to get it closer to 15mg.
Wow two different answers
Well, not really, I have never used it and didn't know it was a scored/breakable tablet, so advised ringing the pharmacist. However, bikermatt has used it and says it is breakable and has score lines. So, he overrides me.
Yeah you can def do it Tristan.
So just been put up to 30 , not sure what to expect???
any advice please
Why are mornings and life so fing hard
Some find anxiety worse in the mornings, others, e.g. me, have it peaking in the evenings. Maybe we need to find a way of melding our minds, ala Mr Spock, Tristan.
My observation is the fickle fingers of fate leave few lives totally untouched by hard times. The survival trick is to focus on where you want to be, not where you are in the moment. Keep reminding yourself that this too will pass.Quote:
and life so fing hard
“Life is not meant to be easy, my child; but take courage: it can be delightful.”
― George Bernard Shaw
So fays get slightly better but mornings still hell , might ask to go up again to 45
Back in the shit and scared again !!!
Just been put up to 45 ,
3 weeks at 45 and not doing well at all doctor has told me it takes 4 /6 weeks to reach Therapeutic affects ?????
I know it’s hard waiting but you really need to give it more time. I’ve started to realise looking back that I’ve never gone more than 4/5 weeks before increasing/adding anything so not giving the meds enough time to settle down which could be why this episode has been going on for so long.
I’m currently 4 weeks and 4 days into an increase to maximum dose of 375mg ven and still feeling like shit with the occasional ok-ish day but I’m determined to wait it out until at least the 6 week mark. Seeing the psychiatrist on 2nd March and won’t be surprised if she suggests increasing my mirtazapine to 45mg or quetiapine to 300mg next (although she was keen to get me off these last time)
A very good point. Unfortunately, there is nothing fast about ADs and not much that can be done to speed up kick-in. Patience is definitely needed
If so ask her what the advantage is in taking both mirtazapine and quetiapine given they both affect the same mix of receptors to about the same degree. It is a question for which I've never been able to get a definitive answer.Quote:
Seeing the psychiatrist on 2nd March and won’t be surprised if she suggests increasing my mirtazapine to 45mg or quetiapine to 300mg next (although she was keen to get me off these last time)
Do you have faith in your psychiatrist, Jo? It seems as if you are on a lot of medication which isn't doing much for you. My son is in a similar situation in hospital.
Too early to say with my current psychiatrist as it wasn’t her who put me on all of these meds. It was the private psychiatrist I started seeing from March last year. Two AD changes and an antipsychotic later she was planning on putting me on Lamotrigine just before Christmas. I then got accepted for treatment under the NHS so trying max dose of my current meds first before I add or change anything. My current psych did increase me up to 300 and then 375 venlafaxine with only three weeks in between which i’m now feeling pretty annoyed about as I was just starting to feel ok on the 300 but she insisted that 375 would help me even more. Now my OCD is back with a vengeance and anxiety is through the roof. 5 weeks in tomorrow and I really hope it settles down soon or I don’t know what else I can do.
It's a difficult situation because you need to trust these psychiatrists to make the right call even though it's all such a grey area and you're the one left suffering when meds aren't effective. I'm surprised you were only on 300mg for 3 weeks but maybe it would be an option to decrease back to that level if you are still not benefiting from the 375mg when you next see her?
Sigh!! Poly-pharmacy, adding more and more meds in the hope something will work, is the curse of the psychiatric profession. :sad:
What ADs have you tried, at what maximum dose and how long were you on that dose. Is OCD your main issue?
Three weeks at a dose is nowhere near long enough to determine if it is going to be effective. <several expletives deleted> :mad:Quote:
My current psych did increase me up to 300 and then 375 venlafaxine with only three weeks in between which i’m now feeling pretty annoyed about as I was just starting to feel ok on the 300 but she insisted that 375 would help me even more.
Psychiatrists are the only profession where they are not held responsible for poor decision-making. It's all guesswork and trial and error and poly-pharmacy and the poor patient is left to deal with the distress and confusion caused by their blase approach to prescribing powerful drugs which may or may not work.
The first AD I took was Citalopram - 20mg in 2008 and then up to 60mg in 2011. Start up side effects were horrendous but in the end it worked brilliantly but was switched over to amitriptyline in 2013 while trying for a baby. When I went back on Citalopram a third time due to PND in 2015 the side effects were even worse and I was switched to 100mg sertraline. This was increased to 200mg in 2017 after another bout of anxiety and depression and 15mg mirtazapine was added.
Starting January 2019 I was still on 200mg sertraline and 15mg mirtazapine but started getting anxiety and depression again. GP increased mirtazapine to 30mg mid February. I started seeing the private psychiatrist beginning of March and she changed sertraline to escitalopram beginning of April and continued with 30mg mirtazapine. This combo kicked in within two weeks and I felt great for two months then after a night out drinking too much in mid June my anxiety and intrusive thoughts came back. Psychiatrist increased escitalopram to 30mg at the end of June and then changed to 75mg venlafaxine mid July increasing to 150mg after 1 week. Increased to 225mg a few weeks later at the end of August and then 25mg quetiapine was added at the start of October. This was gradually increased to 200mg by mid December and by then I started seeing the NHS psychiatrist. After 1 week on 200mg quetiapine she increased my venlafaxine to 300mg. After a couple of weeks I started feeling OK (could have been the quetiapine increase kicking in?) and after 3 weeks the venlafaxine was increased to 375mg. Now the OCD intrusive thoughts are through the roof, I feel exhausted with all the adrenaline rushes and I’m just at the end of my tether not knowing whether I should give it more time or if this is just all too much and should reduce something. I’ve got a constant grief-like ache in my chest and I’ve just had enough.
I would say OCD is my main issue as I suffer with intrusive thoughts and constantly seeking reassurance from my worries but non-stop googling. Depression is also there but only mildly and I think it has improved. I am functioning and managing to do every day stuff but things aren’t getting done due to the amount of time I spend reassurance seeking online :blush:.
Right, time to get some laundry on...
Forgive me if this is a stupid question but surely you have been offered some form of therapy for the reassurance-seeking as opposed to just bombarding you with meds?
Hi Pulisa, yes I had 8 sessions of CBT last year but it didn’t help. Not sure what method the psychologist used but he would challenge my thoughts by asking if I thought they were true and then questioning how I would feel if I didn’t have those thoughts. He never gave me anything to take away and work on between sessions which I thought was the point of CBT.
I’ve just started an 8 week course of mindfulness based cognitive therapy. Only two weeks in but currently finding it difficult remembering to practice every day as my mind always seems to be elsewhere...but now I’ve just reminded myself I’m going to lie down and have a go now 😀
So the dose was progressively increased because anxiety/depression kept coming back?
Which probably wasn't actually necessary. Paroxetine (Paxil) is the only SSRI with clear evidence for increasing birth defects. How much amitriptyline did you take and how effective was the med?Quote:
but was switched over to amitriptyline in 2013 while trying for a baby.
Which is quite common when returning to a previously taken AD. A higher dose than before to achieve the same level of response is also often needed.Quote:
When I went back on Citalopram a third time due to PND in 2015 the side effects were even worse
This is where things start going off the rails, imho. If an AD isn't capable of adequately containing the disorder/s it's prescribed for even at the maximum recommended dose then what is the point of continuing to take it while adding more and more supplementary meds? (The exception to this may be buspirone (Buspar) which has a pretty good track record for boosting the effectiveness of serotonergic ADs, and reinvigorating those that have pooped out.) All the 15mg mirtazapine was capable of doing is sedating the anxiety into submission to some extent, but it doesn't last.Quote:
and I was switched to 100mg sertraline. This was increased to 200mg in 2017 after another bout of anxiety and depression and 15mg mirtazapine was added.
The sedation eased allowing the anxiety and depression symptoms to reassert themselves.Quote:
Starting January 2019 I was still on 200mg sertraline and 15mg mirtazapine but started getting anxiety and depression again. GP increased mirtazapine to 30mg mid February.
Sounds like you are no longer responding to SSRIs, even at doses well above the recommended maximum.Quote:
I started seeing the private psychiatrist beginning of March and she changed sertraline to escitalopram beginning of April and continued with 30mg mirtazapine. This combo kicked in within two weeks and I felt great for two months then after a night out drinking too much in mid June my anxiety and intrusive thoughts came back. Psychiatrist increased escitalopram to 30mg at the end of June
And now there is the same pattern, the primary med isn't working so start chucking more and more meds into the pot in the hope something will work. Sigh.Quote:
and then changed to 75mg venlafaxine mid July increasing to 150mg after 1 week. Increased to 225mg a few weeks later at the end of August and then 25mg quetiapine was added at the start of October. This was gradually increased to 200mg by mid December and by then I started seeing the NHS psychiatrist. After 1 week on 200mg quetiapine she increased my venlafaxine to 300mg. After a couple of weeks I started feeling OK (could have been the quetiapine increase kicking in?) and after 3 weeks the venlafaxine was increased to 375mg.
This is just more evidence that you're no longer responding to SSRIs (despite what it says in the label, venlafaxine is really only a SSRI even at the maximum dose) and it seems you're no longer responding to the antihistamine driven sedation of quetiapine and mirtazapine.
OCD is by hardest of the anxiety disorders to treat often being resistant to both meds and therapy. The two ADs with the best OCD track record are the SSRI fluvoxamine (Luvox) and the TCA clomipramine (Anafranil). IMHO, clomipramine is the better choice because fluvoxamine interacts with many medications which can be make life complicated if there are other health issues, plus in your case SSRIs don't seem to be that effective now, and may not ever have been. A good result from the TCA amitriptyline you took a few years ago might be a pointer to clomipramine prospects.Quote:
Now the OCD intrusive thoughts are through the roof, I feel exhausted with all the adrenaline rushes and I’m just at the end of my tether not knowing whether I should give it more time or if this is just all too much and should reduce something. I’ve got a constant grief-like ache in my chest and I’ve just had enough.
I would say OCD is my main issue as I suffer with intrusive thoughts and constantly seeking reassurance from my worries but non-stop googling. Depression is also there but only mildly and I think it has improved. I am functioning and managing to do every day stuff but things aren’t getting done due to the amount of time I spend reassurance seeking online
Unless there is a significant improvement in the next month, or so from the 375mg venlafaxine I think it should be dumped, no point taking such a large dose (or arguably even a small one) for no gain and replaced with clomipramine via an initial reduction in the venlafaxine dose and then a gradual cross-taper. Another possibility is replacing the quetiapine and mirtazapine with one of the noradrenergic/norepinephrinergic ADs, nortriptyline, lofepramine, or desipramine to essentially create a bespoke SNRI, although venlafaxine isn't the best SSRI to do this with, and especially not at 375mg.
Just how easy would it be to come off 375mg venlafaxine though?
Looks as though there are supply problems with anafranil in the UK though and it shouldn't be prescribed alongside ven.
WRT to citalopram, I was taking 20mg for two years but then stopped cold turkey as I was feeling fine and kept forgetting to take it anyway. I didn’t know at the time that this is a big no no. I relapsed badly a couple of months later and went back on it but gradually titrated up to 60mg as the original 20mg wasn’t as effective, obviously because I messed around with it so much. However, the 60mg worked very well for me and I weaned off this under the proper direction of my GP with no problems at all.
WRT amitriptyline - after weaning off Citalopram I was put on the minimum dose, 10mg - not even therapeutic for anxiety and depression I’ve been told. I suppose you could say I had fully recovered after the Citalopram but I just wasn’t comfortable with being completely med free. Anyway, I managed to go two years on this tiny dose until I had my son and the PND hit me.
Maybe I’m not responding to SSRIs anymore but it could just be that I’m not giving them enough time. I remember being on the Citalopram it wasn’t until around week 8 that I felt better the first and second time, Sertraline took 6 weeks and maybe if I had realised it was just a blip on the escitalopram and carried on it might have settled.
I’m going to keep going on the ven for now, the prospect of coming off terrifies me but it’s good to know there are other options, even if it takes another few months to get there. Thanks PDU for your advice xx
Even most psychiatrists are still not aware of the dangers of missing doses, stopping CT, etc, despite the evidence, both from studies and anecdotal from patients.
This changes my thinking a little. Citalopram might still work, the problem being that 40mg is now the recommended maximum dose because of fears about its potential affect on the heart at greater doses which may be overblown, but which a GP probably won't want to exceed and should 60mg prove inadequate it is unlikely any GP or psychiatrist would be prepared to go higher. If buspirone (Buspar) were more readily available in the UK than it appears to be taking 40mg + 20-30mg buspirone could be worth a shot.Quote:
However, the 60mg worked very well for me and I weaned off this under the proper direction of my GP with no problems at all.
Anxiety and depression aren't static disorders, they wax and wane over cycles that can last months and years. I think you got lucky and entered the waning part of the cycle. While sub therapeutic dosing can lead to the brain no longer responding to the AD, the tricyclics seem to be more resistant than SSRIs and SNRIs.Quote:
WRT amitriptyline - after weaning off Citalopram I was put on the minimum dose, 10mg - not even therapeutic for anxiety and depression I’ve been told. I suppose you could say I had fully recovered after the Citalopram but I just wasn’t comfortable with being completely med free. Anyway, I managed to go two years on this tiny dose until I had my son and the PND hit me.
One of the problems with ADs is that doctors often claim ADs will begin working within 2-4 weeks and will either start ramping up the dose, or switch patients to another AD if they haven't responded. Those that do respond are almost always getting the benefit of the placebo effect, not having a genuine response until a few weeks later, but this perpetuates the 2-4 week myth. ADs work by stimulating the growth of new brain cells and it is the new cells and the connections they forge which produce the therapeutic response and brain cells don't grow overnight. They take about 7 weeks to reach full maturity, however, they may begin having a positive effect a little earlier with many beginning to see improvement at 5-6 weeks. But it can take up to 12 weeks for some.Quote:
Maybe I’m not responding to SSRIs anymore but it could just be that I’m not giving them enough time. I remember being on the Citalopram it wasn’t until around week 8 that I felt better the first and second time, Sertraline took 6 weeks and maybe if I had realised it was just a blip on the escitalopram and carried on it might have settled.
Cool. There are many more options should they be needed.Quote:
I’m going to keep going on the ven for now, the prospect of coming off terrifies me but it’s good to know there are other options, even if it takes another few months to get there.
BTW - ask your doctor about taking N-Acetyl-Cysteine (NAC) supplements for OCD.
A number of small scale studies have found NAC can reduce OCD intrusive and compulsive thought patterns and also boost the effectiveness of antidepressants for OCD and other OCD spectrum disorders. There is a large scale multinational study currently underway to test this. NAC is generally a safe supplement with few side-effects. It is mostly used medically to protect the liver in cases of paracetamol, aka acetaminophen, overdose and has other medical uses. Doses of 1,800-3,000mg/day taken in 3 divided doses seems to work (start with one dose per day of around 500-600mg and increase by the same amount every 2-3 days to avoid triggering diarrhoea). NAC is best taken on an empty stomach about an hour before meals.
HOWEVER, be aware that a study found NAC (also Vitamin E) may increase the risk of lung cancer in smokers, or those with some specific lung diseases (note, it doesn't cause lung cancer, only maybe reduces the ability of the immune system to detect and destroy existing cancerous cells). This finding has been the subject of much debate because there are many other studies showing NAC protects against lung cancer so it is probably not the final word on the subject.
Don't take it without getting advice from your GP, or psychiatrist. While it can be beneficial for asthmatics with fluid build up in lungs, it may cause shortness of breath in some, so caution is needed if you have asthma. It is contraindicated for those taking nitroglycerin, vitamin K and some blood pressure meds.
I have to admit that I already have a supply of NAC after seeing a previous post of yours about it :blush:. I’ve not been taking it religiously as I wasn’t completely convinced it would help and was only taking one 600mg a day if I remembered. I’ve doubled the dose over the last few days but will double check with my psychiatrist when I see her next week and increase it to 1800mg if she agrees :).
I too find it incredibly frustrating when doctors suggest improvements after only a couple of weeks. Every time i’ve increased or added something and have asked the question I’ve always been fobbed off with ‘you should start feeling better in a couple of weeks’. Even the psychiatrist I was seeing privately who is a Professor of psychiatry and also the lead psychiatrist at my local NHS health authority was insistent that 2-4 weeks would be enough time :wtf1:
So I’ve decreased my venlafaxine to 300mg, been on this dose for 4 weeks now. My OCD intrusive thoughts and general anxiety have improved massively, but I’m still experiencing the odd days of low mood, irritability and agitation which is to be expected I suppose. My psychiatrist thinks I’m doing well especially with the current circumstances which are affecting everyone at the moment.
My biggest concern at the moment is the amount of weight I’ve gained. The psychiatrist has suggested I reduce my mirtazapine next, from 30mg down to 15mg for a few weeks with a view to coming off completely. Then if my mood deteriorated I can try increasing the ven back up to 337.5mg.
I’m just wondering if reducing the mirtazapine will bring the sedative effect back on and maybe reduce the remaining agitation and irritability I’m still experiencing?
Four weeks is too short a time to draw any conclusions, especially given the stress we're all experiencing atm, however, it is looking very positive. :)
As a generalisation antihistamines are most sedating at lower doses becoming progressively less so as it increases. However, this doesn't necessarily hold at the individual level, especially when higher doses have been taken in the past. So there is no guarantee, but an increase in sedation is more likely than not. The only way to know is by trying it. Sorry, I can't be more definite :sad:Quote:
I’m just wondering if reducing the mirtazapine will bring the sedative effect back on and maybe reduce the remaining agitation and irritability I’m still experiencing?
Well I bit the bullet and gave the 15mg a go last night. I didn’t sleep any better than on 30mg and feeling quite depressed this morning 😒 so think I’ll be more comfortable staying at 30mg for now and will just deal with the days of irritability and agitation as they come and go.