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I saw a different doc and she asked why I had been put on 50mg Quetiapine an anti-psychotic when antihistamine would have been just as effective in making you drowsy. I need some more information before taking this step because the Q works quite well..
This is one for panic down under I guess.
How do I go safely from Q to AH?
In case anybody wonders why I'm asking here and not doing what the doc says is that I don't trust them. My sister was a physio and hated most doctors. They only know what they had to study to pass exams. Then when they're on the job they're too busy (or lazy) to keep abreast of latest developments or read medical articles. I had one doc tell me anxiety was a symptom not an illness so I should put up with it.
Here in the USA with the insurance paying docs are almost like salesmen giving you stuff you don't need.
As for psychiatrists - it would help if they listened to their patients. One actually told me once that he had to listen to so many fairy stories from severely ill patients that he found it difficult to concentrate! Incredible.
I think you UK patients are lucky to have your free NHS although that BoJo guy is trying to dismantle it. The downside is that you have to go to a GP whose like a gatekeeper and they refer you to a specialist. In most countries you go straight to the specialists. I guess it's a matter of cost effective but I don't see how a GP can be an expert on all the conditions that afflict man.
I was shocked to read that all the veterinary practices in the UK have been taken over by big business who know nothing about animals except maybe racehorses and they want their employees to sell blood tests etc. and shit that isn't necessary to doctor a cat. That's the kind of thing you'd expect to have borrowed from the USA but you Brits have a gone a stage further than us. It really sucks. It's embarrassing how USA employment practices like zero hors and self employed have caught on quick in all the other English speaking countries. Disadvantages of a shared language. Canada may have bucked this trend because they got a large French population who really do care about liberate and egalitr.
She's right. Sedation from meds like quetiapine and the antihistamine drugs like mirtazapine, and yes it is really mostly an antihistamine, not antidepressant despite what it says on the box, are produced by their impact on histamine (H1) and serotonin 5-HT2a receptors. The relative stats for the two meds are:Quote:
Originally Posted by lebonvin
Mirtazapine: H1: 1.6 Ki, 5-HT2a: 69.0 Ki,
Quetiapine : H1: 6.9 Ki, 5-HT2a: 118.0 Ki,
Ki is a measure of the binding potential of the med calculated from how much drug is required to saturate the receptors so the lower the Ki value the more potent the med. As you can see mirtazapine beats the antipsychotic hands down on both counts.
Another antihistamine, hydroxyzine (Vistaril) should also be considered as it has pretty good anti anxiety properties too. It's Ki values are:
Hydroxyzine:H1: 2.0 Ki, 5-HT2a: 50.0 Ki,
However, all of the above have fairly long elimination half-lives which can, and often does cause daytime sedation. Therefore, imho, the antidepressant trazodone (Desyrel) is the better sleep aid. At the low doses typically prescribed for insomnia it acts mostly as a moderate H1 and potent 5-HT2a antagonist, plus also blocks α1 adrenergic receptors which also promotes sedation.
There are several factors that need to be considered which your doctor is far better placed to determine so defer to her advice.Quote:
How do I go safely from Q to AH?
Well he, and I'll bet good money on it being a he, is partly right on the first claim, though not on the second. Both anxiety and depression are the symptoms of the same physical brain deficits/illness, atrophy of the dentate gyrus region of the two hippocampal areas of the brain, not really diseases in their own right. In fact, there is no such thing as a real mental disorder. The mind is only a construct of the brain, not an organ so can't be diseased.Quote:
I had one doc tell me anxiety was a symptom not an illness so I should put up with it.
It's the same in Australia. The thing is there are almost no restrictions here on how many GPs you consult and how often, but there may be on specialists. There is nothing stopping me from consulting every GP in the couintry if I have a mind too, and deep enough pockets, but psychiatrist visits are limited to, from memory so I could be wrong, 25 a year, plus additional allied mental health services such as therapy from a psychologist. Until about 12 years ago it too was unlimited until one patient ran up 1,000 psychiatry visits in a year. It was then progressively reduced.Quote:
The downside is that you have to go to a GP whose like a gatekeeper and they refer you to a specialist.
As my former GP says, GPs know less and less about more and more and specialists more and more about less and less as the specialities splinter into ever more sub specialists. But generally I think the system works well, in part because many are qualified in at least one advanced area. For example the former guy was also qualified in obstetrics and emergency medicine. Most GP know when something is beyond their expertise and pass the patient on to the relevant specialist. Ime, they are sometimes too quick to do so. Having an argument about this very thing atm with my new and soon to be ex GP.Quote:
I guess it's a matter of cost effective but I don't see how a GP can be an expert on all the conditions that afflict man.
Hi panic
Thanks again for your expertise.
Unfortunately I tried Mirtazapine once once and only lasted 3days. Restless leg syndrome and frequent urination side effects as in having to hit the John every 5 minutes. So I guess it doesn't agree with me
Then trazodone would probably be the better bet. It is the most prescribed non benzodiazepine sleep aid in the U.S. so you shouldn't have any problems getting it prescribed (for some reason UK doctors are reluctant to prescribe it, I assume because of NHS protocols).Quote:
Originally Posted by lebonvin