Starting quetiapine

[Dying_Swan]

Good advice. I don't take them daily, only if I really need them. Increasing my own dose of quetiapine was a bad idea and now I definitely wouldn't recommend it. Another lesson learned. Waiting to see the CMHT but don't know what they'll do with meds. The thought of switching again is just too much.

[panic_down_under]

Waiting to see the CMHT but don't know what they'll do with meds. The thought of switching again is just too much.

Understood. But, otoh, there is no point on being on a med which doesn't work when you could be taking one that will. Unfortunately, finding the right one can be about the most frustrating thing you'll ever have to deal with as there are no real guidelines. You might as well pull the name of the next med to try out of a hat. Indeed, it might be a better option than taking the CMHT's choice as it won't be influenced by personal prejudice.

[Dying_Swan]

That's a good point, thank you. I really thought the quetiapine was working for a bit, it's so disappointing. I've tried citalopram, fluoxetine and venlafaxine before. Honestly not sure anything will do much, but you never know.

[panic_down_under]

I've tried citalopram, fluoxetine and venlafaxine before. Honestly not sure anything will do much, but you never know.

Then it might be time to bring in the big gun TCAs, amitriptyline, imipramine, or clomipramine with one of the latter two being my pick.

[Dying_Swan]

Really? Are they effective? Side effects? Sounds scary, but then I was scared of antipsychotics a few weeks ago!

[panic_down_under]

Really? Are they effective?

TCAs have been keeping me mostly anxiety free for most of the past 32 years, initially imipramine which was the gold standard panic AD before the SSRIs became available, since around 1997 by dosulepin which you won't be offered as it is being phased out in the UK. The SSRIs and SNRIs didn't become the preferred ADs because they were more effective, arguably they aren't, but because they were perceived to be safer in overdose. That has proven not to be true for all of them.

Side effects?

They often trigger fewer initial side-effects and can be easier to discontinue, but may have more ongoing side-effects, mostly nuisance ones such as dry-mouth and constipation which can usually be managed.

Sounds scary, but then I was scared of antipsychotics a few weeks ago!

TCAs are usually less problematic than psychotics.

[Dying_Swan]

Thank you PDU. I took a small dose of amitriptyline years ago for sleep. It is encouraging to hear that you've got on well with them. I have read in the NICE guidelines that dosulepin shouldn't be prescribed. I'm seeing the CPN from the CMHT tomorrow, and I also managed to arrange a follow up with the private psych for later in the month. I decided to quit my CBT, rightly or wrongly, so for me it feels important to have at least some continuity with psychiatrists. I guess TCA's could be worth a try. I know there's MAOI's too, but they've never been mentioned to me.

Do you know anything about akathisia? About an hour after I take quetiapine, I get this horrible electricity-type feeling up my spine and absolutely have to move. I presume it's akathisia, and when I (stupidly) decided to increase my dose, it was horrendous. I'm unsure what to do about it. It does wear off after a few hours but the thought of it not wearing off is terrifying. I'm wondering if they just increase the quetiapine whether that will only get worse.

[Jo79]

I was on Citalopram from 2011 which worked brilliantly but was changed to 25mg of amitriptyline 6 years ago when my partner and I were trying for a baby. My GP at the time said there was more evidence that it was safer during pregnancy as it’s an old drug. I had no problems at all and took it all the way though pregnancy until I had my son in 2015, got a new GP who put me back on the Citalopram as I started getting symptoms of PND. I reacted badly to the Citalopram and since then I have tried sertraline, escitalopram, mirtazapine and venlafaxine.

i suppose now I’m wondering...could the reason nothing is working well be because I have had a more powerful drug in my system in the past?

i’m now thinking I should ask my psychiatrist if I can change one of my drugs to a TCA, probably the mirtazapine and keep taking the venlafaxine and quetiapine for now. Is that a do-able combination? I’m reluctant to change the ven as I know it can be rough to get off.

or perhaps I should stop jumping the gun and give the quetiapine more of a chance

[Dying_Swan]

Hey Jo. I'm really not sure so hopefully PDU will be able to advise you here. All I would say is that decreasing venlafaxine hasn't been nearly as bad as I'd expected, so I presume the quetiapine took care of that. I did get some withdrawal but it didn't last very long and wasn't too bad. I'm still on 75mg though, so not sure if stopping it completely would be worse. How much quetiapine are you on now?

[Jo79]

I’m still on 75mg, I increased myself (slapped wrist) two weeks ago but will probably wait until I see the psychiatrist on Friday before increasing again. As PDU said, the usual dose for anxiety and depression is 150-300 so still room for improvement there.

I’ve just got no motivation and been feeling really irritable and aggressive lasting most of the weekend through to this morning but feeling a bit calmer this afternoon, Perhaps it’s because my son has gone back to school after half term, partner gone to work and I have the house to myself again

how long did it take you to get to 75mg of ven? Glad it didn’t cause too many problems and I suspect the quetiapine did help with that. Maybe any anxiety/depression you’re still feeling could just be withdrawal and may settle in time? Also good to know you still have a lot of options wrt TCA’s and there are other antipsychotics and mood stabilisers...my psychiatrist even suggested lamotrigine to me but I decided to give quetiapine a go first.