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Thread: Advice needed

  1. #41
    Join Date
    Mar 2019
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    135

    Re: Advice needed

    So, after playing around with my venlafaxine dose for the last few months I decided that I just couldn’t take the higher dose as it just kept sending my OCD and anxiety through the roof. I came back down to 300mg which made me feel a lot calmer but my mood just wouldn’t lift. Psych decided to try increasing my quetiapine to 300mg first, then a couple of weeks later I upped Mirtazapine to the max 45mg, which i’ve now been on for two weeks. I’m getting the usual increased anxiety and OCD, feeling zonked all the time and my mood still isn’t great. Not sure what to think, probably too early to tell if this will work. I soooooo hope it does as i’ve really had enough now. If this doesn’t work the next step will be weaning off the ven and starting vortioxetine.

    I’ve been googling meds again (OCD ) and really don’t understand what all the fuss is about regarding venlafaxine, and why all the doctors I’ve seen have referred to it as ‘the big one’ which I assume they mean it’s a very powerful drug, but looking at the pharmacology it looks pretty weak, the Ki numbers are much higher than vortioxetine and most of the SSRI’s so I assume that means it isn’t as potent (hoping PDU sees this ). If this is the case then I’ll be pretty pissed off that I was given ven in the first place seeing as it will be a bar steward to withdraw from

  2. #42
    Join Date
    Jan 2017
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    2,349

    Re: Advice needed

    Quote Originally Posted by Jo79 View Post
    Psych decided to try increasing my quetiapine to 300mg first, then a couple of weeks later I upped Mirtazapine to the max 45mg
    Why increase both? They both hit the same receptors at about the same potency so upping just one will have about the same impact.

    really donít understand what all the fuss is about regarding venlafaxine, and why all the doctors Iíve seen have referred to it as Ďthe big oneí which I assume they mean itís a very powerful drug, but looking at the pharmacology it looks pretty weak, the Ki numbers are much higher than vortioxetine and most of the SSRIís so I assume that means it isnít as potent
    It isn't. In fact several of the SSRIs are far more powerful SNRIs than it is, albeit still only weak ones on noradrenaline/norepinephrine reuptake. I really don't understand the fascination UK GPS and psychiatrists seem to have for it. It is less powerful, has more potential risks and can be a real bugger to quit as you've sadly discovered. If they believe a SNRI is warranted then the TCA clomipramine (Anafranil) is the most potent on the market closely followed by another TCA amitriptyline and the SNRI levomilnacipran.

    If this doesnít work the next step will be weaning off the ven and starting vortioxetine.
    Why vortioxetine?
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    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

  3. #43
    Join Date
    Mar 2019
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    135

    Re: Advice needed

    Iím assuming because itís the next step n the NICE guidelines 😏

    ďVortioxetine is recommended as an option for treating major depressive episodes in adults whose condition has responded inadequately to 2 antidepressants within the current episodeĒ.

    She did suggest the option of trying other SSRIís into our previous discussion, and suggested giving Citalopram another go, but seems very keen on Vortioxetine.

    Whatever I choose I will have to wean off the ven first. I was hoping she would say I can cross taper but Iím on two other meds which could make it a bit dodgy.

    Anyway, Iím still crossing my fingers that the mirtazapine increase will help and it wonít come to that 🤞

  4. #44
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    Jan 2017
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    Re: Advice needed

    Quote Originally Posted by Jo79 View Post
    Iím assuming because itís the next step n the NICE guidelines 😏

    ďVortioxetine is recommended as an option for treating major depressive episodes in adults whose condition has responded inadequately to 2 antidepressants within the current episodeĒ.
    Sigh. The NHS must be run by retired regimental sergeant majors. "If patient has A, prescribe X...if X fails apply Y..." I don't know why they bother employing doctors. They could probably train a chimp to hand out prescriptions based on the guidelines within a few days. Heck, the robots that trundle around the wards of my favourite hospital delivering meds could likely do it with a few tweaks to their programming.

    She did suggest the option of trying other SSRIís into our previous discussion, and suggested giving Citalopram another go, but seems very keen on Vortioxetine.
    So you've effectively already tried at least two SSRIs, citalopram and venlafaxine without success so her answer is yet another one, albeit with the added twist of also having some effect on 5-HT1a receptors. An old trick to resuscitating pooped-out SSRIs, or increasing the effectiveness of those which are nearly, but not quite working 100% effectively is adding the 5-HT1a agonist buspirone (Buspar) to the mix. Vortioxetine is basically a SSRI with added buspirone like properties. It hasn't exactly set the world on fire. I suspect the problem is the amount of 5-HT1a action is fixed whereas it can be fine tuned with buspirone+SSRI combination. Unfortunately, in its infinite wisdom the NHS apparently don't approve of buspirone.

    Whatever I choose I will have to wean off the ven first. I was hoping she would say I can cross taper but Iím on two other meds which could make it a bit dodgy.
    It wouldn't be that hard, but for the lack of confidence. And that's the problem with the prescribing by the numbers approach. Reduces people to cogs in the machine with no confidence, so no initiative or innovation either.

    </soapbox>
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    - - What to know about: Telepsychiatry | Teletherapy - -




    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

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