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Thread: Daughter

  1. #11
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    Re: Daughter

    Sorry to hear this, fishman. I guess this is one of those events that puts everything else into perspective somewhat?

    As pulisa has said these meds can do powerful things to young people which is why there are the additional warnings so I doubt she is the first as bad as it is for anyone to go through. This might be a case of a bad med reaction coupled with life problems so it's worth checking out whether she has been a lot worse since starting. You know what it's like starting these meds, you ask for help when you think you can't take any more pain and you are told to wait out the side effects including ones that make your original disorder worse.

    A good note side effect wise here is that with her being on them for only a week the secondary effects of downregulation won't have kicked in and coming off/switching is easier. She has only just passed the steady state threshold timescale so it won't be even more to cope with (withdrawal).

    It's not a long half life drug so within just over a week it should all be back out but it does reduce by 50% per half life (considering normal usage) so it sharply reduces anyway.

    Serotonin Syndrome is rare even in severe poisoning according to the NHS and Drugs.com state no reports of toxicity leading to what you must have feared, which seems in her favour a long with being younger. I'm sure your GP would have had her straight up to the hospital if he/she thought it was a risk or they have the tox lines they use for advice too.

    I hope she is feeling a bit better soon and able to have a good discussion with you about how she feels and gets into some therapy. And her GP should take this as a sign for some very close monitoring of SSRI prescribing with her.

    ---------- Post added at 23:42 ---------- Previous post was at 23:38 ----------

    Quote Originally Posted by fishman65 View Post
    Thanks again guys, some really sound advice there and a real understanding. Buster, mine and your lives seem to be mirrored on more than one level.

    Pulisa, yes I think that's why the GP wanted the mental health team involved quickly. Sertraline seems the 'go to' anti-dep these days, but I need to make sure she's not going to suddenly go cold turkey after being on it for a week, that can't be good? Anyway they know best I suppose.

    Darksky yep at 19 something like this feels earth shattering. She idolised him but he had some side projects going on, I may suggest she becomes a nun.
    No, cold turkey is for long term use with SSRI's. Switching advice or cessation would be immediate withdrawal when on so short a time.

    I couldn't say about the impact of a much higher dose in terms of giving her a real knock to her anxiety/depression though. The therapeutic range is up to 200mg anyway so she may not be too far over and with Serotonin there is only so much they do in terms of saturation and it's gradual effects on top of that. It's perhaps going to be like someone jumping too high a dose to then reduce down again, maybe not pleasant but will fade as the drug is eliminated.

    Have you got a local Crisis team line? Given the situation I would have thought they would be involved or at least you given their number until she is seen.

    It's still horrible but thankfully not as bad as something like painkillers.

    ---------- Post added at 23:47 ---------- Previous post was at 23:42 ----------

    Fishman, maybe not the time but I remember you saying she had a BF who she feared would stray (again) and she wanted you to drive her quite a way to stop what she perceived from happening. We can just be like that when we are young and take things hard but it sounds like maybe some help with her thoughts, feelings and emotions regarding what she sees as important in her life might be helpful to her.

    Don't put this on yourself either, you seem to spend your life supporting others. Recent situations are about more than your own involvement in what (may) have led to your wife's cheating anyway and more of it actually sits on her regardless as she took the action. Just wanted to add that as we are terrible for kicking ourselves and you have enough on your plate right now.
    Last edited by MyNameIsTerry; 25-01-19 at 09:40.
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  2. #12
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    Re: Daughter

    Thank you Terry for that explanation, that's really helpful. Yes she started on the sertraline about a week ago, 50mg per day so if I'm right, the 7 tablets she took last night would be a dose of 350mg? The GP would no doubt have calculated that himself?

    She was given some literature when first prescribed the ADs with numbers to call. She's been calling the Samaritans but I want her to talk to us too of course. The only trouble in the night is that my mirtazapine knocks me out. However we've talked through about suicide being a permanent solution to a temporary problem, she's hopefully taken that on board. As you say, this does put other domestic issues into perspective. Thanks for your input mate, you're a top bloke along with a psychotherapist and pharmacist

    Need to get to bed though, night all.
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  3. #13
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    Re: Daughter

    Yes, that is right. But perhaps what we don't always realise is how when we take them daily there is an overlap and this is in your daughter's favour as it seems less extreme.

    If you use the standard calculation of (5 x half life) to reach steady state it comes out quite close to the recorded clinical steady state for this med. So, it's a decent guide with this one, it can vary per drug and per person so it's only ever a guide. The opposite way, elimination, is the same calculation but each half life sees a 50% drop in the drug until it cycles it's way out. At 5 x it's <5% or below having any clinical effect.

    The elimination half life is 23-26 hours.

    So, if you think about people on the highest licenced dose of 200mg daily they have quite an overlap anyway. The drug peaks in absorption at around 4-6 hours from taking orally. Someone taking it the same time everyday has only seen a 50% dip anyway. The next day that original dose has gone down to 25%, then there's 50% of a second dose and a full new dose.

    Whilst we may have a set level we take each day our body is managing a different level but the prescribed dose is the overall effect we must get with the overs & unders removed.

    Some psychiatrists, as seen with members on here, have even used twice daily dosing which causes obvious overlap of a split dose that should be once a day and means even more of the drug is there due to the fast absorption and slow elimination.

    It might seem strange that these drugs overlap but when you think about how withdrawal affects us it becomes pretty obvious why you wouldn't want to go from 100-0% in 24hrs. People on Venlafaxine (standard form) have to take multiple doses per day to prevent this and missing one can mean withdrawal starts. Pulisa knows about Ven from her experiences (I think her daughter was on it for a while?) so will know the hassle that is. Blood plasma levels need to be kept pretty stable and lurching from high to low wouldn't be good when that would mean changes in Serotonin levels.

    This isn't to downplay any of this but it must be terrifying to hear your child has taken an overdose and maybe it's helpful to know that these meds, for all the nasties they bring us in side effects and being a doctor's guinea pig as they haven't a clue how we will be affected, that they don't strictly work on a 24hr basis as doctors may appear to say?

    Obviously, this is best left to a pharmacist. It's only an amateur interpretation of information found on professional sites. In a case of overdose, things may not be strictly the same as normal dosing and the professionals need to fully manage it. Only they have the training & experience to interpret unusual results.

    Thanks for your kind words, just glad if anything picked up along the way helps as my GP was pretty clueless on these meds (but an otherwise excellent doc).
    Last edited by MyNameIsTerry; 25-01-19 at 09:33. Reason: Typo
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  4. #14
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    Re: Daughter

    It's so easy for GPs to hand out anti depressants these days but absolutely no monitoring and no awareness of potential side effects. Just the "suck it and see" approach which, given to the wrong person, can be a huge risk. I had an absolutely farcical appointment last week where I was basically given prescriptions for 3 months worth of 2 different ADs and told to choose which one I wanted to take!! I won't be going back.

    I have always been told to keep the communication channels open with my daughter and to hide all meds just as a precaution. It'll take time for your daughter, Fishman, but she'll hopefully meet someone new in due course and will realise that there are much better and kinder people out there for her.

  5. #15
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    Re: Daughter

    Thank you both and for that very extensive reply Terry. I asked her along to my Dad's today but she declined. So I phoned 'Changing Minds' and arranged for a counsellor to phone her for a 45 minute phone assessment on Monday morning. Nothing from the mental health team, though I've questioned her myself and there doesn't seem to be many signs of anxiety, more depression I think but then the two co-exist quite readily as we all know. She has a friend staying tonight so that's good.

    My own anxiety has kicked off today but I can't allow it to compromise my ability to be there for her. That's interesting about the venlafaxine Terry, I'm on it myself. 150mg in the morning and the same at night, slow release capsules.

    Pulisa, that's incredible. I've never heard of doctors offering a choice?! Maybe several next time, like a lucky bag. Kids, they grow up but you never stop worrying about them.
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  6. #16
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    Re: Daughter

    Glad she has a friend with her tonight and is occupied-nothing worse than sitting in her bedroom and ruminating. She'll look back on this and learn from the experience.

    I'm sure you will do your very best to support her and that's all you can do. Don't hold your breathe re the mental health team-they are notoriously pretty elusive but you may have a better service than most of us. They are pretty quick to respond to calls from Windsor and Sandringham though....

  7. #17
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    Re: Daughter

    After something so traumatic I bet you are all washed out so being low makes more sense really and exhausted. It's going to mess up the Serotonin levels which spikes and dips so the next few days are bound to be odd ones but as long as she isn't in a total mess it must be such a relief? That med is also quite activating, more so in term of adrenaline than your SNRI (Ven's a very week SNRI, it does more with Serotonin despite it's classification), so I think I would take it as a good sign that she isn't bouncing off the walls with agitation.

    Interesting that you are on slow release with a split dose as that's normally a once a day med to get around the 2-3 times dosing a day on that one. The thing is with splitting the overall level of a once a day dose into multiples will be that whilst the initial hit at peak is higher with an all in one, you should get a higher blood plasma level your way as it just won't fall as low over the day. That's if you compared it to say mine, Duloxetine, which is daily. It must be better for some to maintain a higher balance than deep as low as a once a day can do.

    I'm guessing Changing Minds will be the IAPT partner? If so you may go in a standard queue so it's worth mentioning what has happened as she may get into a higher level quicker.
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  8. #18
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    Re: Daughter

    You are so right fish..you never stop worrying about your kids. I have sons in their early 3Os and I worry myself to death over them. If anyone hurt them, despite being grown men, i would react like a tiger. It's all part and parcel of parenthood.
    It's good she has a friend with her, that will help. They often can talk better with their peers than talking to their parents. It's no wonder your anxiety has spiked, you would have had to be some kind of superman for that not to have happened. But your inner tiger will surface and you will do what you have to. It amazes me, how we all have an inner strength, a steel core that carries us through things, even when we feel like an anxious puddle.
    Take care xx

  9. #19
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    Re: Daughter

    Thanks guys for your support, it means a great deal. She didn't want her friend to come over after all, didn't want to come downstairs when my Dad was here today, and they are very close. I'm not banking on the mental health team, so will phone the GP surgery on Monday to find out what's going to happen regarding the sertraline. She's promised not to try anything, as in harming herself. I really don't know what else to do?
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  10. #20
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    Re: Daughter

    You can't do anything else. The sad thing is that things have to get a hell of a lot worse before any action is taken. Give her time and keep talking to her if she wants this? Your GP may not be able to talk to you about her case due to patient confidentiality.

    I know it's frightening because I've lived with this situation for many years but all you can do is keep your own meds secure and maybe encourage her to have that friend over?

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