Well here we go... 150mg

[Paradise10]

Very true PDU, I went for my x-ray on Monday afternoon and I was so lucky as I got the most amazing man who was taking my x-rays. I burst out crying before he had even started. He stood me in front of the machine very quickly and took the X-Ray, had a look at it and said, "i'm not allowed to give you results but I will say don't worry what you have been worrying about," he then went on to say that if he saw anything suspicious like that he would need to take a side x-ray and he wouldn't be doing one of those. I could have hugged him. He also said to call my doctors for the results on Tuesday afternoon and then something about my ribs but I was that focused on that it wasn't lung cancer that I didn't hear what he said about my ribs. I need to try my doctors after 2pm for the results as I called them yesterday and they said they wasn't back. I also have blood tests today at 1.30.

My anxiety has been reduced since Monday evening without a doubt, I still have it but I would say it is just there bubbling away all day rather than peaking in panic attacks throughout the day. I would say it has dropped from a 10 to a 6, which has helped.

With regards to symptoms at the moment I am experiencing...
Anxiety at about a 6.
Tired and dragging myself around.
My bra feels too tight in the middle and I have been getting really breathless, and also pains around my left breast and back, and wanting to burp constantly.

Surprisingly I took a rennie this morning which I haven't done since last year and my breathing feels easier and my chest not as tight. I guess it could all be gas, crazy that it could make you feel like that. I will see how I go with this over the next few days.

My step daughter is coming this afternoon and then my son and his girlfriend are coming tonight as they fly to Spain on Friday for Christmas, so we are having a family night.

That's is for now, Ava x

[Paradise10]

Morning all, another day on this scary journey that I would really rather not be on.

So, Yesterday... Bit of a mixed bag really, started the day shaky as normal with the anxiety just bubbling away, did some work and got a few bits done at home. Went for my blood test at half 1 and I was ok. Had to park the car quite a bit away from the doctors and I was fine walking round there. Got home and did some more work and sorted some bits for secret santa today and coped with the background anxiety fine. I went to pick my son up from work at 5pm and I felt really strange on the way there, couldn't describe it if I tried but it was really scary. This spiked my anxiety quite a bit, it ramped up to a 95 but I didn't go into a full on panic attack. This feeling went about 8pm but I felt really unsettled after that and I was just left feeling unwell and tired.

I think I have figured out why I don't like feeling unwell, it's the uncertainty of not knowing what is happening to me. I have never dealt well with uncertainty most of my life, I have to know one way or another even if it's nothing major. So if I feel ill and it's quite non descript I feel like I have to know what is going on.

Still waiting on the X-Ray results from my doctor and also had my blood done yesterday and they said to call Friday afternoon for results. At least I will know on Friday that maybe everything that is going on is just anxiety. I would really like to go work from my parents during the day but the dog has just had an operation on his leg and is not allowed to run around and they have a dog so mine would run around like crazy there so I have to stay at home. I am going to meet my team at lunch time today in a pub car park to swap our secret santa gifts, it's about an hour away so will get me out for a couple of hours. Also have a few online meetings. My planner said hair and makeup this morning which I have done, been a bit lax on it the last few days, also haven't been writing down and challenging my thoughts so I really need to make an effort with that today.

Catch up soon. Ava x

[Paradise10]

Morning my lovelies, so used to starting out with what day I am on that its quite weird not to. Just another day on the anxiety merry go round, I really would like to get off now though.

Yesterday was same as really, anxiety all day and evening only letting up when I went to bed. I am so ready to get off the train now! So yesterday I went to meet my work team at lunch to swap gifts, bit would up and anxiety on the drive and while I was there. Came back and tried to keep busy with work. Finished work and went for my walk, I even jogged a few lampposts then came home and watched TV with the husband. Anxiety went quiet about 11pm. Slept through and I am now sat in the garage car park waiting for them to open as my car has its mot. I have my 2nd cbt session tonight with mum. So will update more later as I am on my phone.

[Paradise10]

Anxiety was less yesterday than it has been, although I was really tired as it took me ages to get to sleep the night before so I only got about 6 hours. I was OK at the garage minimal anxiety while I was waiting for my car. It picked up in the afternoon though as the tiredness kicked in. I picked my son up from work at tea time, then I took the dog out for a long walk. Came in and watched some TV with the family and fell asleep about 11. What I notice I am doing though is tensing up a lot, sometimes I notice that my shoulders are up round my ears and I am pulling my stomach and chest muscles in. I am relaxing into the anxiety though and I am also changing my thoughts to more positive ones afterwards, so hopefully this will have some effect soon.

I am going to Leeds this morning with my husband and two friends for the weekend to get some last minute Xmas bits and look round the Xmas Market so I best go get ready.

Ava x

[Paradise10]

Morning all, well it's Monday morning so back at work.

It's quite strange as the journey I am on to address my blip without increasing my medication seems to be following the same path as when I have increased my medication previously. I started off with really high anxiety 24/7 with panic attacks thrown in throughout the day, this is when it is this bad that I increase my medication as it's truly horrible. What normally happens is my anxiety increases for a while, then the panic attacks stop and I just get anxiety all day, then the anxiety slowly starts to decrease in severity, it then changes to a frustration and wound up feeling and I go through a really sluggish cant be bothered phase and then I start to come right. This seems to be what is happening. This time I read a cbt self help guide and made a commitment to follow it for a minimum of 6 sessions which is when it said i should start to notice a change. I committed to do what it said so I relaxed into the panic and anxiety and when I had the scary thoughts I started to change them, such as 'What if I stay like this' I would then follow that with 'I have been here many times before and always come through it.' This was really difficult at first but I have continued doing it and it is becoming easier. My anxiety has lessened a lot over this week and this weekend it hasn't really been there at all, I have however felt like I was dragging myself around and I have felt really flat. The last two evenings though I have felt close as back to normal. I have really pushed myself though in that I went to Leeds and walked round the shops on Saturday and then went out for a meal with friends in the evening, then Sunday again went round the shops and then took the dog out when I got home and watched tv with my husband. The mornings are the hardest and it seems to get easier as the day goes on.

Well that's it for now, I have my planner done for this week and I will stick to it, keep eating healthy and drinking enough, get daily exercise and also keep changing the thoughts.

Catch up soon. Ava x

[Angiesuggs]

to NMP, Angie

Hope you don't mind me butting it.



While I understand the reluctance to take high doses of an antidepressant (AD) taking too little can often be a bad thing. ADs do not directly ease anxiety (or depression) in the way say aspirin does for headaches. These disorders are the emotional expression of a physical brain disorder, atrophy of parts of the two hippocampal regions of the brain caused by high brain stress hormone levels killing hippocampal brain cells and inhibiting the growth of new ones. ADs stimulate the growth of new cells (neurogenesis) and it is these new cells and the connections they form which produce the therapeutic response. For more detailed explanations see: Depression and the Birth and Death of Brain Cells (PDF) and How antidepressant drugs act.

The problem with low doses for most ADs is that plasma levels need to be high enough to saturate around 80% of the serotonin transporters to initiate neurogenesis and this must be a constant as interruptions may increase the risk of the med pooping-out. I suspect this is why the citalopram failed when you most needed it as the minimum recommended dose is 20mg. The recommended minimums are set with the ~80% occupancy rate in mind.



It is common for AD dose increases to produce significant side-effects for a few weeks. They would likely have soon diminished. It's possible that citalopram may have worked at a higher dose, but it's equally possible that it wouldn't have.



Mirtazapine is more a very sedating antihistamine than antidepressant and mostly eases anxiety by sedation. It is actually more potent than some of the meds marketed as antihistamines. It seems to work well for some, but it is very prone to poop-out and the powerful carbohydrate cravings it often induces can become a real problem.

Ian

Hi Ian and Ava

Sorry for the late reply as I didn't know you had responded. I really appreciate the information and I am reading your other posts to get updated. I would love to carry on this conversation. I stuck with the 75mg up until two weeks ago when ,y doctor put me up to 112.5. I was doing really well on the 75 and each day seemed to get better. I managed well in work and could do most of the things I previously struggled with like shopping and socialising. I started the 112.5 and had a little headache and off my food but that was normal. I took the 75mg at 6am before leaving for work and the 37.5 at my lunch break at 12 noon. I couldn't take it all in one go as I couldn't eat enough at 6am not to feel sick. I thought I was doing great as not had any anxiety or low mood for a few weeks. But for some reason the last few days gave not been great and today of all days I have had bouts of anxiety. I got afraid that I was going backwards. I always have a fear of going back to what happened in the summer when I was a complete mess. Rationally I know this can't be as the Ven has been working really well for me. Am I right in thinking the increase will not have had much effect as yet? I appreciate your advice xx

[panic_down_under]

Rationally I know this can't be as the Ven has been working really well for me.

Welcome back

It could still be a response to the dose increase. The most immediate effect when first taking SSRIs/SNRIs, or raising their dose is an increase in serotonin synthesis and expression. Despite the common myth serotonin is not a 'feel good' neurotransmitter. It is anything but as anyone who has had their anxiety levels shoot into the stratosphere in the weeks after first taking these meds will testify. Often this begins within a few hours to a couple of days, but some experience a delayed response and this might be what is happening to you now.

However, it could also be caused by other factors such as higher than usual stress because of the holidays, or a placebo response which has been more responsible for the improvement than than the med has now ended with the med not yet contributing much.

Am I right in thinking the increase will not have had much effect as yet

Yes, you are. It will likely take at least a month for the higher dose to have an effect. I wouldn't read too much into the last few days. Setbacks are quite common at the beginning. It can often be a case of one step forward then two or more back. All part of the rich tapestry of life on ADs.

[Angiesuggs]

Hi Panic down under - Ian

Thank you so much for your response. I have only ever been on one AD and that was citalopram as previously said which worked amazing for 15 years. Maybe I was on it too long, I don’t know. I did forget to add that my dose of citalopram was increased about 4 years ago to 20mg again without any issues and I bobbed along quite happily until June this year. After losing my dog and about half a dozen other life factors my exterior cracked and my dose was upped to 30mg which I thought would work happily again but it didn’t so it was upped to 40mg which made me worse each day and I couldn’t even leave my bedroom. My doctor changed me to Mirt 15mg which I thought I was cured as felt so good. But it didn’t last long so was upped to 30mg. I paid to see a psychiatrist (Prof Tahir). Who upped my dose to 45mg and on review a few weeks later as I wasn’t making enough progress told my GP to add in Ven to dose as my GP advised but only up to 150mg max due to serotonin syndrome. I have been on Ven at 75 for 10 weeks and 112.5 the last two weeks. I do not have much experience with AD’s at all. So glad I found this thread. Ava’s blog is amazing and your comments are so informative. I feel very lucky to have met you both. Am I right in saying these tablets will take a while longer to work their magic? I just want to be me again. Thanks in advance.

Angie 🤗

[panic_down_under]

I have only ever been on one AD and that was citalopram as previously said which worked amazing for 15 years. Maybe I was on it too long, I don’t know. I did forget to add that my dose of citalopram was increased about 4 years ago to 20mg again without any issues and I bobbed along quite happily until June this year.

After losing my dog and about half a dozen other life factors my exterior cracked and my dose was upped to 30mg which I thought would work happily again but it didn’t so it was upped to 40mg which made me worse each day and I couldn’t even leave my bedroom.

One significant life event can be enough to trigger an anxiety disorder and/or depression. Half a dozen in succession will push many over the edge.

As per my reply to your initial post, Angie, I suspect a contributing factor to the citalopram failing to work when you needed it the most was the length of time you were on only 10mg which is a sub therapeutic for most.

I paid to see a psychiatrist (Prof Tahir). Who upped my dose to 45mg and on review a few weeks later as I wasn’t making enough progress told my GP to add in Ven to dose as my GP advised but only up to 150mg max due to serotonin syndrome.

Was there any mention of weaning off mirtazapine in the near future? Imho, there's no point taking an AD that isn't working, but all too often I see reports here of doctors just adding more and more meds in the vain hope of striking some magic combination that works. It rarely does from what I've observed. Polypharmacy is sometimes necessary, but not that often and it should be among the last options tried, not one of the first, imho.

There is zero chance of serotonin syndrome from taking both mirtazapine and venlafaxine even at their respective recommended maximum doses of 45mg and 375mg/day, despite the NHS Guidance (PDF) claiming there is. It is wrong. This isn't my opinion, but that of one of the two leading SS/ST experts, Dr Ken Gillman who used to spend a large part of his semi retirement trying to correct this misinformation until the futility of it all became overwhelming (he details some of it here):

"As I have pointed out before, drugs like bupropion and mirtazapine, that have no significant serotonergic activity, are no more likely to cause ST than is vitamin C. This scenario has already been enacted, over a decade, with the antidepressant mirtazapine, which was claimed, erroneously, to have serotonergic activity. Many poor quality case reports of ST with mirtazapine were published. This probably led to misdirected treatment of overdoses, some of which may have caused morbidity. It took several reviews to correct this error and establish that mirtazapine cannot cause ST"

PK Gillman, 2010 PDF. See also: A systematic review of the serotonergic effects of mirtazapine in humans

And lest there still be doubt, the other leading expert, Prof Ian M. Whyte, whose team at the Hunter Toxicology group wrote the SS/ST diagnostic criteria now used world wide to diagnose SS, agrees (note: 5-HT=serotonin):

"In some cases this has led to reports of serotonin toxicity for drugs that, from well-defined receptor binding studies, are unlikely to cause increased levels of CNS 5-HT. Important examples include the 5-HT2A receptor antagonist olanzapine and the 5-HT receptor antagonist mirtazapine."

Dunkley EJC, et al, (2003), The Hunter Serotonin Toxicity Criteria, QJM, Sept, vol 96(9):635–642

Moreover, mirtazapine is a serotonin 5-HT2a receptor antagonist (blocker) which can prevent the spike in body temperature which does the damage in SS/ST although in humans the recommended treatments are the more potent 5-HT2a antagonists cyproheptadine and chlorpromazine.

I have been on Ven at 75 for 10 weeks and 112.5 the last two weeks.

...Am I right in saying these tablets will take a while longer to work their magic?

I'm afraid so, Angie. These disorders are often a long time in the brewing and they can take a while to bring under control. But if one AD worked for such a long time then there is a very high probability that another will be just as effective. Unfortunately, it can sometimes take time to find the right one.

[Angiesuggs]

Hi Ian

Thank you so much for your informative reply. It’s so nice to meet someone that can give you answers to many questions. My doctor wants me on both meds for 9 months then see how I am. I have always had trouble sleeping so the Mirt is a godsend for that. I am lucky as well as I have not had any carb cravings or put on any weight. I have gone the other way and struggle to eat at times. But I have weight to lose so not so bothered by it. I would like just to be on 15mgs cor Mirt for sleep as the lower dose is more sedating. I am still reading the other articles you sent and they are so interesting.

I find it hard to remember when I started Citalopram how long it took to work and for me to move on. I know your brain blocks out stuff that it deems isn’t essential to remember. It must have taken sometime as these things don’t work overnight.

I feel a lot better today so hoping things are starting to work. I always get a headache and upset tummy for a while when they are increased.

My sister lives in Australia 🤗

Hope you had a good day

Angela 😊