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Thread: Advice needed

  1. #21
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    Re: Advice needed

    Quote Originally Posted by Jo79 View Post
    I know itís hard waiting but you really need to give it more time. Iíve started to realise looking back that Iíve 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.
    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

    Seeing the psychiatrist on 2nd March and wonít 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)
    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.
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  2. #22
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    Re: Advice needed

    Quote Originally Posted by panic_down_under View Post
    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

    You would think that psychiatrists would know this and advise accordingly. Makes me angry to think that I could be feeling much better by now if I had just waited a bit longer. Another thought crossed my mind - I recovered much more quickly from previous episodes when Iíve been under the care of my GP alone. Itís only since seeing a psychiatrist that Iíve been unwell for over a year. Quite worrying.


    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.
    Thanks PDU I will ask 🙂

  3. #23
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    Re: Advice needed

    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.

  4. #24
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    Re: Advice needed

    Quote Originally Posted by pulisa View Post
    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.

  5. #25
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    Re: Advice needed

    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?

  6. #26
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    Re: Advice needed

    Quote Originally Posted by Jo79 View Post
    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.
    Sigh!! Poly-pharmacy, adding more and more meds in the hope something will work, is the curse of the psychiatric profession.

    What ADs have you tried, at what maximum dose and how long were you on that dose. Is OCD your main issue?

    My current psych did increase me up to 300 and then 375 venlafaxine with only three weeks in between which iím 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.
    Three weeks at a dose is nowhere near long enough to determine if it is going to be effective. <several expletives deleted>
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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.

  7. #27
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    Re: Advice needed

    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.

  8. #28
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    Re: Advice needed

    Quote Originally Posted by panic_down_under View Post
    What ADs have you tried, at what maximum dose and how long were you on that dose. Is OCD your main issue?
    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 .

    Right, time to get some laundry on...

  9. #29
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    Re: Advice needed

    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?

  10. #30
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    Re: Advice needed

    Quote Originally Posted by pulisa View Post
    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 didnít 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 didnít have those thoughts. He never gave me anything to take away and work on between sessions which I thought was the point of CBT.

    Iíve 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 Iíve just reminded myself Iím going to lie down and have a go now 😀

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