Steve72: New here and in a bit of a mess

[Steve72]

Hi all from the UK, 

 

Long story but my history

 

I was first diagnosed with anxiety in my final year at university. Despite becoming an insomniac I managed to successfully graduate but could not function like that in a job so I was put on paroxetine in Autumn 1995. This worked well for my anxiety but gave me sexual disfunction and I quit cold turkey around 12 months after starting it.

 

I told the GP I wasn’t depressed just anxious and asked to be put on beta blockers. I was subsequently prescribed 80 mg long acting propranolol. I have been on some form of propranolol (currently taking 40mg daily) since back then.

I decided to go back on antidepressants in 2007 when I was put on fluoxetine following a stressful time in my personal life. I took fluoxetine until Dec-14 and was stable for the majority of that time until it seemed to stop working for me, although I was about to be made redundant so that was a factor. In 2015, I tried Sertraline (made me nauseous), Escitalopram and Citalopram ( neither worked) and Paroxetine again at my request in desperation to find something that worked.

 

I was on Paroxetine for 2 years until Autumn 2017 and quit cold turkey because of sexual disfunction and emotional numbing, although it was great for anxiety. I crashed big time and the GP suggested Venlafaxine. I took venlafaxine 75mg from late 2017 to March 2023. I tried to quit cold turkey in Spring 2022 but it ended badly and I reinstated at 37.5mg until Dec-22 (and managed okay during a stressful period). Over Christmas 22 I was struck down with a depressive episode which left me suicidal. This may have been a delayed reaction to my boss dying suddenly in September 2022 and was subsequently increased to 75mg which did address the depression. 37.5mg was sufficient to treat the anxiety and whilst it did cause side effects – they were manageable. At 75mg I had very bad sweating,  sexual disfunction and emotional blunting.

 

I saw a NHS psychiatrist in Feb-23 and asked whether there was anything else I could try. I was prescribed Vortioxetine (15mg). This worked well until a stressful time at work in Sept-23 when a deal I was working on went badly wrong (I work in finance). This led to me developing air hunger and a permanent knot in my stomach. Tried 20mg Vortioxetine but it didn’t do much for me.

 

In my panic I started back on Venlafaxine for 16 days without doing a washout period on the Vortioxetine. This led to really bad anxiety. My options as I saw them back then were to stay on the Venlafaxine or try Fluoxetine again. I started out on fluoxetine at 20mg for 6 weeks and then as the anxiety wasn’t being greatly relieved decided to go to 30mg. This led to significant insomnia and left me barely unable to function.

 

The GP prescribed Mirtazapine 15mg at the beginning of Jan-24 (before that I had tried promethazine which left me so dizzy and unable to function). That combination worked well for about 3 weeks at which point my anxiety heightened still further and I decided to try 40mg fluoxetine I lasted 10 days at 40mg as the anxiety, jitteriness and insomnia (even with Mirtazapine) were unbearable. I later decided that I am a very slow metabolizer of CYP2D6 so even small increases would cause adverse effects.

 

I subsequently decided to taper back to 25 and then to 15 in the space of 3-4 weeks. No side effects from doing this. I spoke to my GP in Feb and asked to try Duloxetine. I subsequently tapered down to 10mg for 8 days with a view to switching over but held off pending a call with a private psychiatrist. They suggested increasing my fluoxetine to 20mg and holding Mirtazapine at 15mg. I never started the Duloxetine. They also suggested I could add Gabapentin into the mix, which I declined.

 

I felt the Mirtazapine was causing side effects (post nasal drip) and decided to halve my dose at the end of March-24. That didn’t go well, developed insomnia and suicidal ideation after less than 2 weeks I reinstated at 13.5mg. I have since tapered down to 10mg. I kept the fluoxetine at 20mg the same throughout the Mirtazapine taper but my anxiety levels have not eased much. I get bad dizziness caused by over breathing, bad flatulence (either from taking in too much air and/or a nervous stomach, tense shoulders, stomach and back, shaking hands and ongoing irregular insomnia. When insomnia is bad I will take zopiclone either 3.75mg or 7.5mg. That generally tends to work. On average I have been taking c 2-2.5 tablets per week over the past year. To be fair what I didn’t do is hold the fluoxetine at 20mg and Mirtazapine at 15mg for any length of time.

 

At the beginning of July I finally got to see a NHS psychiatrist and we agreed that I would switch back to Venlafaxine 37.5mg. He advised a 7 day washout period of the Fluoxetine before commencing Venlafaxine. I did the 7 day washout period and felt the calmest I have felt in a year – the mirtazapine was actually making me feel tired (!) so decided to extend the washout period in the hope that maybe I would not get withdrawals. On day 13 of the washout I noticed markedly increased anxiety and difficulty sleeping. I subsequently decided to reinstate Fluoxetine at a low level 5mg (I only have 10 mg tablets – so have been taking on alternating days). This regime started on 18^th July 2024. I have noticed over those past 5 days that my anxiety has been very high with worsened dizziness (quite debilitating) and flatulence (harmless but not socially acceptable in an open plan office).

 

That has left me wondering whether I should switch to the venlafaxine. I have been given immediate release 37.5mg tablets – previously I took extended release. I am reluctant to switch back to venlafaxine (despite me asking to do so) because of the side effects and I know it is in the most difficult camp to taper off). However I am petrified that all these changes will send me over the edge. It does feel like I have developed some form of kindling from all the changes I have done this year. I don’t think I have had akathisia but I can no longer sit still and relax and when my body twinges it makes me jump. It I have also noticed that my memory become more forgetful) and verbal coherence has suffered as a result. I also worry about how it will interact with the Mirtazapine.

 

It does feel as though my race is run with the fluoxetine but my questions are 1) do I try and stabilise at 5mg, if so how long for and if I need to change, when should I do it, should that be upwards or downwards and by how much (I have asked my psychiatrist for liquid fluoxetine) or 2) ditch the fluoxetine and revert to the venlafaxine? If I knew the Venlafaxine was going to work then I would switch but I am petrified that I will have the same experience as I have had with Fluoxetine, second time round e.g. it won’t work and then I have 2 very difficult to taper meds in the system (venlafaxine and mirtazapine). I am also petrified that the change to venlafaxine will further adversely impact my already frazzled nervous system.

 

I should also add that I self-referred and was accepted as a medicinal cannabis patient back in June-24. The hope was that this would allow me to gradually withdraw from the fluoxetine and mirtazapine. I am taking c0.5ml of CBD:THC oil daily and have tried to vape as well but not really noticed much if any benefit, other than it does make me more tired. I am told that there should be no interaction with the pharma meds as they act on different receptors.

 

I would be really grateful for any help or insight that people can offer me.

 

Thanks. 

 

Steve

Edited July 23 by Emonda
Name to title

[Erimus]

Hello, and welcome to Surviving Antidepressants. We are a peer support forum to assist in tapering off psychiatric drugs safely, or recovering from psychiatric drug withdrawal.

 

You need to stop making changes to your medication if you are to achieve stability. You are using medication as a coping mechanism to deal with anxiety, but all these changes are worsening the problem. Taking antidepressants on alternate days is one of the worse things you can do. You need to take a consistent daily dose of fluoxetine and mirtazapine, and I suggest you stop the zopiclone for good. I also recommend you stop the cannabis. There are far too many drugs poking your brain chemicals at this point, the fewer the better.

 

We recommend tapering by no more than 10% of your CURRENT dose each month, to limit withdrawal symptoms. E.g. 10mg --> 9mg --> 8.1mg --> 7.29mg.

Edited July 23 by Erimus

[Erimus]

Here are a few of the most useful links:

 

--------Important topics in the Tapering forum and FAQ--------

 

Micro tapering

 

Why taper by 10% of my dosage?

 

Taking multiple psych drugs? Which drug to taper first?

 

How to make a liquid from tablets or capsules

 

Using a scale to weigh and measure doses

 

--------From the Symptoms and Self-Care Forums--------
 
What is withdrawal syndrome?
 
About reinstating and stabilizing to reduce withdrawal symptoms
 
The Windows and Waves Pattern of Stabilization

 

Hypersensitivity and Kindling

 

Regards

Erimus

[Steve72]

Hi Erimus,

 

Thankyou for taking the time to respond to my post. Looking back over the past 9 months since Vortioxetine seemed to stop working I have been quite manic in my desperation to find a combo which brings my anxiety back to acceptable levels. I did not want to go back on Venlafaxine which whilst great for anxiety, caused intolerable side effects. Its seems for me anyway that the stronger the antidepressant (Venlafaxine, paroxetine) then the better it works for my anxiety but the greater the side effects. I have a consultation with Mark Horowitz yesterday and he said the same thing i.e., all the changes in doses will likely have destabilized my nervous system leading to my current predicament. His recommendation was to do nothing i.e., don't change the dose of Fluoxetine and Mirtazapine for the next 3 months as a minimum. I need time for my nervous system to settle down and that could take several months. It was helpful to have that clarity, which I have been missing. Now the hard part starts i.e., being patient. I am not even thinking of doing a taper until I can settle and then will only be tapering slowly - 5-10% of previous dose per month.