Venlafaxine and mirtazapine

[LouiseC63]

Hi there, I've been taking venlafaxine 225mg and mirtazapine 30mg for many years. This winter was my worsed by far and for the first time I suffered severe anxiety so the shrink put me on prebalin 75mg x 2 daily for 2 weeks but it started to make me feel depressed, so she changed me to Risperdal 1mg, well I only took one at night and it was way too powerful for me and I didn't sleep for 3 days and felt proper off my head on it, so stopped taking that. I usually suffer worse with depression in the winter and the doctor usually ups the venlafaxine but wasn't prepared to this winter stating i was at the top end and couldn't increase any more, hence why i was then given an appointment with the shrink.

I am due to start anxiety management on Friday and actually looking forward to it.

I seen the same shrink twice then last week I seen a different oneas the other one had left and as my depression has now taken over the anxiety she suggested i start to take 375mg of venlafaxine, to which I questioned this as I was under the impression that you could only increase ven to 375mg if you were hospitalised, please can anyone verify this. So she said as i was anxious about doing that maybe we could increase the mirtazapiine tomg this I agreed to do, but haven't got the pescription yet.

I was amazed at how she was giving me my options, I mean I'm not qualified, yet she is, but she was asking me what I wanted to do.

I am at present on a bit of a health kick, trying to excersise to see if this helps with my condition. I know you increase weight with mirtazapine and wondered if I could possibly alleviate this, or is it inevitable?

I just want me back.

Any advice about what I've put on here would be great.

[Emphyrio]

I've had a look online and it seems that you don't have to be hospitalised to be on 375mg of venlafaxine, though it also mentions that doses above 300mg should only be prescribed by a specialist.

At the highest dosage, venlafaxine inhibits reuptake of dopamine also, which can have an added antidepressant effect.

I think its good how you are being involved in your treatment - most doctors will tell you to take something or other and not give you any say in the matter.

If its depression that you're facing - have you considered taking vitamin D or B-vitamins to help your mood? Also consider a supplement called L-Tyrosine. I've taken these supplements with antidepressants before - but as you're taking a really high dose I would run it by your GP/psychiatrist for their opinion. Generally, the vitamins should be safe, however. Omega 3 fish oil would be beneficial too.

[LouiseC63]

Thanks for the reply. I've had a think and I guess your right about having more control with the meds. I have as well been looking into vitamins and supplements. I may look into Omega 3 with higher strengths of EPA and also B complex may be worth taking also.

Could you explain more about...."At the highest dosage, venlafaxine inhibits reuptake of dopamine also, which can have an added antidepressant effect."

Thanks

[Emphyrio]

Basically, venlafaxine has an affinity for multiple receptors. At low doses, it has the greatest affinity for the serotonin receptor, and acts just like an SSRI. Any serotonergic effect over 75mg is likely to be minimal. However, at around 150mg of venlafaxine, it starts binding to the norepinephrine receptor. This is because all the serotonin receptors have affectively been 'occupied'. Likewise, by the time you reach 300mg+ - all your serotonin and norephinephrine receptors have been occupied - so then it starts binding to dopamine receptors.

http://thelastpsychiatrist.com/2007/...e_most_im.html explains how this works.