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About going off mirtazapine plus venlafaxine (Effexor) aka "California rocket fuel"

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Altostrata

"California rocket fuel" is a combination of mirtazapine and venlafaxine that is a fad among some psychiatrists.

From the Carlat Report at http://pro.psychcentral.com/research-updates-in-psychiatry-6-2/003265.html

 

Does “California Rocket Fuel” Work?
The combination of Effexor (venlafaxine) and Remeron (mirtazapine) has been dubbed “California Rocket Fuel” by Stephen Stahl (see page 290 of his Essential Psychopharmacology, 2nd Edition) because of the multiple ways the combination boosts various neurotransmitter systems. The STAR-D study found that this combination outperformed the MAOI Parnate (tranylcypromine), though the difference was not statistically significant (McGrath PJ et al., Am J Psychiatry 2006; 163(9): 1531-1541). Psychiatrists in Ireland recently reported on a series of 32 patients with refractory depression who were given this combination. The response rate, based on the Clinical Global Impression Scale, was 44% at four weeks and 50% at eight weeks. Most patients who responded were on Effexor XR at 225 mg/day or higher and Remeron 30 mg to 45 mg HS. In terms of side effects, 12% of patients reported moderate to severe weight gain and another 12% reported at least moderate sedation (Hannan N et al., J Psychopharm 2007;21(2):161-164).

TCPR’s Take: Since this is only a case series, it doesn’t prove the value of Effexor/ Remeron, but the combination is fairly well tolerated and certainly worth trying in patients who have not responded to anything else.


Please note that in the Ireland study, 24% of the subjects had serious side effects (plus others not mentioned in the above summary). The study itself http://www.ncbi.nlm.nih.gov/pubmed/17329295reports
 

At 6 month review, 18 patients (56% of the original cohort and 75% of those still receiving treatment) had significantly responded. Clinical response typically occurred at moderate and high dose treatment with both agents. A total of 44% experienced some adverse effects with sedation (19%) and weight gain (19%) most frequent.


In other words, "California rocket fuel" was "effective" (usually this is measured on a depression scale) about half the time, and of those people, 44% had "some" adverse effects.
 
HOWEVER the combination of mirtazapine and venlafaxine can have serious adverse effects http://www.drugs.com/interactions-check.php?drug_list=1640-0,2296-0&types[]=major&types[]=minor&types[]=moderate&types[]=food&types[]=therapeutic_duplication&professional=1
 
 

Interactions between your selected drugs
Major

venlafaxine mirtazapine
Applies to: venlafaxine, mirtazapine

MONITOR CLOSELY: Concomitant use of agents with serotonergic activity such as serotonin reuptake inhibitors, monoamine oxidase inhibitors, tricyclic antidepressants, 5-HT1 receptor agonists, ergot alkaloids, cyclobenzaprine, lithium, St. John's wort, phenylpiperidine opioids, dextromethorphan, and tryptophan may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. Symptoms of the serotonin syndrome may include mental status changes such as irritability, altered consciousness, confusion, hallucination, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea.

MANAGEMENT: In general, the concomitant use of multiple serotonergic agents should be avoided if possible, or otherwise approached with caution if potential benefit is deemed to outweigh the risk. Patients should be closely monitored for symptoms of the serotonin syndrome during treatment. Particular caution is advised when increasing the dosages of these agents. The potential risk for serotonin syndrome should be considered even when administering serotonergic agents sequentially, as some agents may demonstrate a prolonged elimination half-life. For example, a 5-week washout may be advisable following use of fluoxetine and 3 weeks following the use of vortioxetine before administering another serotonergic agent. If serotonin syndrome develops or is suspected during the course of therapy, all serotonergic agents should be discontinued immediately and supportive care rendered as necessary. Moderately ill patients may also benefit from the administration of a serotonin antagonist (e.g., cyproheptadine, chlorpromazine). Severe cases should be managed under consultation with a toxicologist and may require sedation, neuromuscular paralysis, intubation, and mechanical ventilation in addition to the other measures.


In effect, psychiatrists know the combination of mirtazapine and Effexor potentially dangerously accelerates nervous system activity, but think it's good for "refractory depression," i.e. "depression" that does not seem to go away with other drugs.


If you are taking this combination, you probably will want to taper the Effexor first with the hope that the remaining mirtazapine will maintain sleep. See 
 
Why taper by 10% of my dosage?
 
Taking multiple psych drugs? Which drug to taper first?
 
Tips for tapering off Effexor (venlafaxine)
 
Also see Tips for tapering off Remeron (mirtazapine) for background.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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nz11

Thanks for posting this.

 

If this is how doctors are now going to treat refractory depression protracted ssri/snri withdrawal then this is a most disturbing frightening trend.

 

Look at the high doses they have had to use to bomb and zombie-ize the brain into submission and then no doubt inferring successful treatment.

 

Clinical response typically occurred at moderate and high dose treatment with both agents. ....Most patients who responded were on Effexor XR at 225 mg/day or higher and Remeron 30 mg to 45 mg HS.

 

 

Might i suggest a combination of a bottle of vodka AND a bottle of Sherry might have produced the same result?

 

What a nightmare for anyone trying to get off 225 ven plus 45 rem. These doctors have no idea of the fate that awaits.

 

Lets not forget the Star*D trial from my understanding/reading had no placebo control group.

So since there is no evaluation of what recovery might have been with placebo treatment there is no way of knowing whether their recovery was actually due to the medication they had been given.

 

Decided to look up this  Clinical Global Impression scale  (CGI-I) thingy....

...later.....it requires the CLINICIAN to assess how much the patient's illness has improved (NOT the patient)

 

Its up to the doctor to SUBJECTIVELY determine improvement based on HIS clinical experience. 

I wonder if it takes into account 'stockholm syndrome' ? placebo effect? pharma inducements for a supportive outcome? etc? or dare i say it ...patients opinion???!?

 

 The response rate, based on the Clinical Global Impression Scale, was 44% at four weeks and 50% at eight weeks. Most patients who responded were on Effexor XR at 225 mg/day or higher and Remeron 30 mg to 45 mg HS.

 

Heres the thing most often a 50 % reduction in symptoms is used as a criterion of what is called a 'clinical response'. One problem with this method is that most of the severely  depressed patients who show a clinical response are still depressed at the end of the clinical trial- despite the fact that their depressive symptoms have been cut in half. (Johnson and Kirsch 2008).

 

Do those psychiatrists in Ireland have any conflicts of interest? Just curious thats all !


Thought for the day: Lets stand up, and let’s speak out , together. G Olsen

We have until the 14th. Feb 2018. 

URGENT REQUEST Please consider submitting  for the petition on Prescribed Drug Dependence and Withdrawal currently awaiting its third consideration at the Scottish Parliament. You don't even have to be from Scotland. By clicking on the link below you can read some of the previous submissions but be warned many of them are quite harrowing.

http://www.parliament.scot/GettingInvolved/Petitions/PE01651   

Please tell them about your problems taking and withdrawing from antidepressants and/or benzos.

Send by email to petitions@parliament.scot and quote PE01651 in the subject heading. Keep to a maximum of 3 sides of A4 and you can't name for legal reasons any doctor you have consulted. Tell them if you wish to remain anonymous. We need the numbers to help convince the committee members we are not isolated cases. You have until mid February. Thank you

Recovering paxil addict

None of the published articles shed light on what ssri's ... actually do or what their hazards might be. Healy 2013. 

This is so true, with anything you get on these drugs, dependance, tapering, withdrawal symptoms, side effects, just silent. And if there is something mentioned then their is a serious disconnect between what is said and reality! 

  "Every time I read of a multi-person shooting, I always presume that person had just started a SSRI or had just stopped."  Dr Mosher. Me too! 

Over two decades later, the number of antidepressant prescriptions a year is slightly more than the number of people in the Western world. Most (nine out of 10) prescriptions are for patients who faced difficulties on stopping, equating to about a tenth of the population. These patients are often advised to continue treatment because their difficulties indicate they need ongoing treatment, just as a person with diabetes needs insulin. Healy 2015

I believe the ssri era will soon stand as one of the most shameful in the history of medicine. Healy 2015

Let people help people ... in a natural, kind, non-addictive (and non-big pharma) way. J Broadley 2017

 

 

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Terry4949

I read this article that you have posted as I was on Effexor, then mirtazapine was added back in January 2015 , as you can see you in my history , so I was on the both , Effexor had stopped working and I was and still am in severe w/drawel , mirtazapine was added to help the Effexor and I was told by my gp that this is called California rocket fuel , however because they did not know about protracted withdrawel , both meds were stopped basically cold turkey over a 2 to 4 week period , I believe that the reason my w/d has been so bad is because of the mixing and removing of these two drugs , the worst being some 8 months later mirtazapine was given to me as I was told now that the Effexor is well and truly out of my system the mirtazapine will work better ! Stupid me , currently withdrawing slowly


100mg Effexor 2000 untill jan 2015 severe withdrawals . Tapered 4weeks.

Jan to end of Feb 4 weeks on 15mg mirtazapine 20mg quetiapine , tapered of both 2 weeks , severe withdrawals , still some from Effexor possibly

End of Feb 2015 to end of July 30mg citolapram tapered 2weeks severe withdrawal , anxiety high , bouts of sever depression , severe emotional moods

Currently on 30mg mirtazapine appx 5 months , high anxiety, March cut dose 22.5 mg going on to liquid still no improvements with the depression , also started sept 2015 200mg pregabalin , currently on 22.5mg mirtazapine tablet form doing really badly. Cut beginning of May remeron 20mg still bad anxiety,August 15mg remeron ,100mg pregablin , severe depression headaches anxiety , oct 2016 doctor stoped pregablin c/t , 15mg mirtazapine still no let up in physical symptoms ,high anxiety ,Nov 2016 remeron 13.5 mg , Jan 2017 mirtazapine stopped flouxetine20mg added by hospital admission, no choice , doing really badly , akathesia suicidel ,, Flouxetine c/t by hospital after 7 weeks 20mg daily , currently on nothing , God help me

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nz11

This Star*D trial is worth reading about. Sequenced Treatment Alternatives to Relieve Depression or Star* D.

 

Just thought i would add this link to Star*D trial info

 

https://en.wikipedia.org/wiki/STAR*D

Patients entered four different levels of treatment

It looks like one level got the Californian rocket fuel.

 

Level four consisted of the monoamine oxidase inhibitor tranylcypromine or a combination of venlafaxine and mirtazapine.

 

Despite dismal results of this study..

[although approx 67 % of patients recovered the remission of symptoms was temporary with approx half of the patients who recovered relapsed within a year...and because no placebo controlled group we therefore cant say for sure that the recovery of those 50% was due to the drugs with certainty. Im not that clear myself on what actually happened here did those who had their depression go into remission on an ad then, after the 14 week trial get CT off the drug and observed for the rest of the year? Keep in mind that the idea of this trial was to prove the drugs effectiveness in the real world and over longer periods of time. It failed to show that antidepressants were effective at the end of one year.]

 

..it appears it is being used to inform doctors that if one drug doesn't work try another and then another then try a cocktail.

 

(Apparently this is called the 'tailoring hypothesis' - one has to find the right drug for the right person....because supposedly [erroneously] different patients suffer from different chemical imbalances. )

 

Yet why ? since the study doesn't suggest to do this at all. In fact it says:

"Among the patients who were switched to a different antidepressant, there was no significant difference among the different antidepressants."

 

Whitaker explains why...Apparently its all to do with CPGs

 

Clinical practice guidelines (CPG) are put together and developed by expert panels who review the literature.

 

The CPG committee cited the Star*D study 13 times yet not once mentioned the poor 1 year outcomes.

 

Instead they used the Star* D study to discuss drug switching or drug augmentation strategies for patients who hadn't responded well to a first antidepressant. The Star*D trial the CPG committee wrote, "provided evidence for continued efficacy of medication augmentation."

 

Let me summarize 5 pages:

[Question: Are antidepressants helpful over the long term?

Answer: In summary, data is piling up (including the Star*D study,Rush study, Fava' studies, El-Mallakh - who coined the term tardive dysphoria ) that show evidence that the drugs may have an adverse long-term effect.

"Antidepressants  may worsen the progression of the disease in the long-term." Fava]

 

Whitaker says ...However, the APA's CPG committee did not discuss any of this mounting information.

 

Instead, it recommended that antidepressants could be used as a "maintenance therapy."

 

If this drug treatment failed, the APA recommended that the patient could be "given continuation ECT." Any worry about the long-term negative effects of SSRIs is simply absent from the CPG, even though this is information that prescribing physicians and their patients would surely want to know.

 

So what on earth is going on here ? 

 

Perhaps you are now wanting to ask the same question as me.  Who are these people on the CPG committee?

 

Whitaker gives us an insight into this,

 

"In a 2009 review of the CPG panels for depression, bipolar disorder, and schizophrenia, researchers found that 18 of the 20 members had financial ties to the pharmaceutical companies that manufactured the medications recommended in the guidelines as first-line treatment. (e.g. had equity in a company that made the medication, was a consultant or corporate board member, or received honoraria). 14 of the 20 worked as consultants to pharmaceutical companies.

 

On the CPG panel for bipolar disorder, all of the members had ties to the companies whose drugs were identified as "first-line pharmacological treatment."

 

The CPG for depression listed 9 drugs as optimal medication, and all of the companies that manufactured one of those nine drugs had a financial tie to one or more of the panel members.

 

The same was true for schizophrenia: the CPG listed 16 drugs that were commonly used, and every manufacturer of one of those drugs had a financial tied to one or more of the schizophrenia panel members.

 

None of the three CPG's disclosed the financial conflicts of interest of the panel members.

 

The 2010 CPG contains over 1000 references, 106 of which were papers that had been authored by one of the panel members. On average, each panel members work was cited nearly 20 times in the guideline most of these articles were research reports, reviews, or editorials involving a pharmaceutical.   "

 

p140 Psychiatry under the Influence.

 

"There was a tight web of mutual interest present as psychiatry developed its expert consensus guidelines', and again and again, the experts recommended the new drugs as first-line treatments.... In his report, Rothman summarised the production of the schizophrenia "expert consensus guidelines" in this way: "From the start, the project subverted scientific integrity, appearing to be a purely scientific venture when it was at its core, a marketing venture for Risperdal". p150

 

nz11

Apologies if i got a bit off topic.

Totally ok to move it if you want.


Thought for the day: Lets stand up, and let’s speak out , together. G Olsen

We have until the 14th. Feb 2018. 

URGENT REQUEST Please consider submitting  for the petition on Prescribed Drug Dependence and Withdrawal currently awaiting its third consideration at the Scottish Parliament. You don't even have to be from Scotland. By clicking on the link below you can read some of the previous submissions but be warned many of them are quite harrowing.

http://www.parliament.scot/GettingInvolved/Petitions/PE01651   

Please tell them about your problems taking and withdrawing from antidepressants and/or benzos.

Send by email to petitions@parliament.scot and quote PE01651 in the subject heading. Keep to a maximum of 3 sides of A4 and you can't name for legal reasons any doctor you have consulted. Tell them if you wish to remain anonymous. We need the numbers to help convince the committee members we are not isolated cases. You have until mid February. Thank you

Recovering paxil addict

None of the published articles shed light on what ssri's ... actually do or what their hazards might be. Healy 2013. 

This is so true, with anything you get on these drugs, dependance, tapering, withdrawal symptoms, side effects, just silent. And if there is something mentioned then their is a serious disconnect between what is said and reality! 

  "Every time I read of a multi-person shooting, I always presume that person had just started a SSRI or had just stopped."  Dr Mosher. Me too! 

Over two decades later, the number of antidepressant prescriptions a year is slightly more than the number of people in the Western world. Most (nine out of 10) prescriptions are for patients who faced difficulties on stopping, equating to about a tenth of the population. These patients are often advised to continue treatment because their difficulties indicate they need ongoing treatment, just as a person with diabetes needs insulin. Healy 2015

I believe the ssri era will soon stand as one of the most shameful in the history of medicine. Healy 2015

Let people help people ... in a natural, kind, non-addictive (and non-big pharma) way. J Broadley 2017

 

 

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Bruin

I have just picked up on this thread. I was on Effexor 150 mg and Mirtazapine 30 mg for 15 years. In retrospect it was terrible 

for me, my life and my relationships. However I had endured a really hideous bout of depression and bought the chemical 

imbalance nonsense. It was widely promulgated and supported. Anyhow I muddled through until about 13 months ago when I rapidly tapered Effexor.

About a month or two after stopping I went into the most awful withdrawals. I ascribed my ill health to a tough treatment 

I had done with Interferon during the previous year. It was only when I was prescribed Lyrica, Dec 2015 ,for the symptoms I was presenting,

that I realised I was in serious protracted withdrawal from the Effexor. I had such a horrible reaction to Pregabalin that I began to investigate 

my situation and history with Ads. I came off Lrica too quickly 2 months ago Am still in protracted withdrawal with the added layer 

of Lryica discontinuation. Am very concerned that my many years of Mirtazapine and Effexor may have caused me irreparable damage. 

Am still on Mirtazapine but not really sleeping or functioning all that well. Any advice would be gratefully received. I have even considered 

a very small reinstatement of Effexor to see if it restored better function. I guess it is a long way out and there has been the added problem of 

pregabalin.


Anti Depressants for  25 years. Valium between 2006 to 7 tapered off over a month without too bad withdrawals.

For last 15 years 150 mg of Effexor and 30 mg of Mirtazapine. Occasional short term benzo use without habituation.

March 2015 stopped Effexor after rapid taper. 6 weeks. 

One month fluoxetine June 2015...stopped CT July 2015.

October 2013 to December 2015 Zopiclone 15 mg at night,

Dec 2015 to Early March 2016 Lyrica 75 mg at night. 

Stopped too quickly as  adverse side effects.

January to May 2016 tapered Zopiclone to 7.5mg 

Crossed over to Valium and now ..March 28th 2017 Benzo Free.

Also on 30 mg Mirtazapine and holding until have finished Benzo taper.

IN protracted WD from Effexor.

 

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Area1255

Yes, Mirtazapine is an alpha-2-adrenoreceptor antagonist as well, and effexor has norepinephrine-reuptake-inhibiting properties, the combination may result in hypertension and tachycardia due to too much norepinephrine building up.

http://www.ncbi.nlm.nih.gov/pubmed/10884561

http://www.ncbi.nlm.nih.gov/pubmed/9669506

http://www.ncbi.nlm.nih.gov/pubmed/9007838


Past AD Experiences : (Fluvoxamine 3 years, D/C'd @ age 15).

Light thinks it travels faster than anything but it is wrong. No matter how fast light travels, it finds the darkness has always got there first, and is waiting for it

~Terry Pratchett~

 

WITHDRAWAL REGIMEN/STORY

Originally for OCD, the luvox took about 6 months to taper off.

Withdrawal supplements; lemon balm, Vitamin B3, black water/fulvic acid, high-protein diet to restore neurotransmitters, aniracetam to counter memory issues, deprenyl for persisting anhedonia.

Regimen still maintained til this day. Lemon balm, generally as capsules, however, as I suffer chronic Insomnia, I often use essential oil or as aromatherapy before bed , in combination with magnesium and lysine on bad nights.

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JanCarol

Somehow this "CA rocket-fuel" combination in "treatment resistant" depression - 

 

brings to mind the overuse of GMO's and glyphosate causing treatment resistant weeds - and the ghastly toxic combinations that they need to use to fight the superweeds....

 

"We've made your depression resistant to our treatment (with our long term treatment), so now we're going to have to bomb your brain into oblivion."

 

I do think that the example is apt.


"Easy, easy - just go easy and you'll finish." - Hawaiian Kapuna

 

Holding is hard work, holding is a blessing. Give your brain time to heal before you try again.

 

My suggestions are not medical advice, you are in charge of your own medical choices.

 

A lifetime of being prescribed antidepressants that caused problems (30 years in total). At age 35 flipped to "bipolar," but was not diagnosed for 5 years. Started my journey in Midwest United States. Crossed the Pacific for love and hope; currently living in Australia.   CT Seroquel 25 mg some time in 2013.   Tapered Reboxetine 4 mg Oct 2013 to Sept 2014 = GONE (3 years on Reboxetine).     Tapered Lithium 900 to 475 MG (alternating with the SNRI) Jan 2014 - Nov 2014, tapered Lithium 475 mg Jan 2015 -  Feb 2016 = GONE (10 years  on Lithium).  Many mistakes in dry cutting dosages were made.


The tedious thread (my intro):  JanCarol ☼ Reboxetine first, then Lithium

The happy thread (my success story):  JanCarol - Undiagnosed  Off all bipolar drugs

My own blog:  https://shamanexplorations.com/shamans-blog/

 

 

I have been psych drug FREE since 1 Feb 2016!

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Area1255

Somehow this "CA rocket-fuel" combination in "treatment resistant" depression - 

 

brings to mind the overuse of GMO's and glyphosate causing treatment resistant weeds - and the ghastly toxic combinations that they need to use to fight the superweeds....

 

"We've made your depression resistant to our treatment (with our long term treatment), so now we're going to have to bomb your brain into oblivion."

 

I do think that the example is apt.

Yeah, mirtazapine and it's cousin drug mianserin are actually very effective anti-depressants and are pretty safe, it's the effexor which is the issue.

SSRI's are pretty much all garbage.


Past AD Experiences : (Fluvoxamine 3 years, D/C'd @ age 15).

Light thinks it travels faster than anything but it is wrong. No matter how fast light travels, it finds the darkness has always got there first, and is waiting for it

~Terry Pratchett~

 

WITHDRAWAL REGIMEN/STORY

Originally for OCD, the luvox took about 6 months to taper off.

Withdrawal supplements; lemon balm, Vitamin B3, black water/fulvic acid, high-protein diet to restore neurotransmitters, aniracetam to counter memory issues, deprenyl for persisting anhedonia.

Regimen still maintained til this day. Lemon balm, generally as capsules, however, as I suffer chronic Insomnia, I often use essential oil or as aromatherapy before bed , in combination with magnesium and lysine on bad nights.

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nz11

Yeah, mirtazapine and it's cousin drug mianserin are actually very effective anti-depressants and are pretty safe, it's the effexor which is the issue.

 

?!?!

Sorry, I don't see it this way  its same church different pew they are all unsafe, they are all immensley harmful..the whole lot !

 

I have seen many people struggle to get off mirtzapine just like all the others. Don't know about mianserin havent heard of that one before its probably hiding behind lots of names and im too lazy to look it up.

(Effexor like mirtz is a newer antidepressant and effexor is an SNRI...and words like 'newer', 'more effective than' is just marketing hype)

 

 Kirsch  "the differences between one antidepressant  and another are virtually non-existant.

 

Breggin 2014 says

All classes of psychiatric drugs can cause brain damage and lasting mental dysfunction when used for months or years. Although research data is lacking for a few individual drugs in each class, until proven otherwise it is prudent and safest to assume that the risks of brain damage and permanent mental dysfunction apply to every single psychiatric drug. 


Thought for the day: Lets stand up, and let’s speak out , together. G Olsen

We have until the 14th. Feb 2018. 

URGENT REQUEST Please consider submitting  for the petition on Prescribed Drug Dependence and Withdrawal currently awaiting its third consideration at the Scottish Parliament. You don't even have to be from Scotland. By clicking on the link below you can read some of the previous submissions but be warned many of them are quite harrowing.

http://www.parliament.scot/GettingInvolved/Petitions/PE01651   

Please tell them about your problems taking and withdrawing from antidepressants and/or benzos.

Send by email to petitions@parliament.scot and quote PE01651 in the subject heading. Keep to a maximum of 3 sides of A4 and you can't name for legal reasons any doctor you have consulted. Tell them if you wish to remain anonymous. We need the numbers to help convince the committee members we are not isolated cases. You have until mid February. Thank you

Recovering paxil addict

None of the published articles shed light on what ssri's ... actually do or what their hazards might be. Healy 2013. 

This is so true, with anything you get on these drugs, dependance, tapering, withdrawal symptoms, side effects, just silent. And if there is something mentioned then their is a serious disconnect between what is said and reality! 

  "Every time I read of a multi-person shooting, I always presume that person had just started a SSRI or had just stopped."  Dr Mosher. Me too! 

Over two decades later, the number of antidepressant prescriptions a year is slightly more than the number of people in the Western world. Most (nine out of 10) prescriptions are for patients who faced difficulties on stopping, equating to about a tenth of the population. These patients are often advised to continue treatment because their difficulties indicate they need ongoing treatment, just as a person with diabetes needs insulin. Healy 2015

I believe the ssri era will soon stand as one of the most shameful in the history of medicine. Healy 2015

Let people help people ... in a natural, kind, non-addictive (and non-big pharma) way. J Broadley 2017

 

 

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Altostrata

Neither of these drugs is superior to the other or to Effexor as antidepressants, and all have withdrawal issues.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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btdt

A person i know who did this combination and thought he was off all ADs is now on Cymbalta and did not know it was an Ad so I had to break it to him... sadly he seems to be losing his marbles and has one eye that acts and looks funny odd... not funny it does not look right to me ...lots of new blood pressure meds is what he did know ... sad and crazy both nobody believes me... I wish I had the magic that made people believe me. 


WARNING THIS WILL BE LONG
Had a car accident in 85
Codeine was the pain med when I was release from hosp continuous use till 89
Given PROZAC by a specialist to help with nerve pain in my leg 89-90 not sure which year
Was not told a thing about it being a psych med thought it was a pain killer no info about psych side effects I went nuts had hallucinations. As I had a head injury and was diagnosed with a concussion in 85 I was sent to a head injury clinic in 1990 five years after the accident. I don't think they knew I had been on prozac I did not think it a big deal and never did finish the bottle of pills. I had tests of course lots of them. Was put into a pain clinic and given amitriptyline which stopped the withdrawal but had many side effects. But I could sleep something I had not done in a very long time the pain lessened. My mother got cancer in 94 they switched my meds to Zoloft to help deal with this pressure as I was her main care giver she died in 96. I stopped zoloft in 96 had withdrawal was put on paxil went nutty quit it ct put on resperidol quit it ct had withdrawal was put on Effexor... 2years later celexa was added 20mg then increased to 40mg huge personality change went wild. Did too fast taper off Celexa 05 as I felt unwell for a long time prior... quit Effexor 150mg ct 07 found ****** 8 months into withdrawal learned some things was banned from there in 08 have kept learning since. there is really not enough room here to put my history but I have a lot of opinions about a lot of things especially any of the drugs mentioned above.
One thing I would like to add here is this tidbit ALL OPIATES INCREASE SEROTONIN it is not a huge jump to being in chronic pain to being put on an ssri/snri and opiates will affect your antidepressants and your thinking.

As I do not update much I will put my quit date Nov. 17 2007 I quit Effexor cold turkey. 

http://survivingantidepressants.org/index.php?/topic/1096-introducing-myself-btdt/

There is a crack in everything ..That's how the light gets in :)

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andy

It's hard to comprehend that intelligent people prescribe these evil drug combinations


2012 put on Citalopram and diazepam for 3 months for "depression" after filling in a 3 minute form at the doctors, had a massive reaction with panic attacks and extreme anxiety,never suffered panic attacks or anxiety before citalopram.Told to quit cold turkey which led to two hospital admissions during 2012/2013

December for 6 months Seroquel dosage adjusted up and down 50mg ,150mg ,100mg, caused severe tinnitus ,told to quit cold turkey

2013 January for 12 months Lorazapam given to me like sweets,told to quit cold turkey

2013 May Zoloft for 6 months ,told to quit cold turkey, reinstated 50mg tapered 2nd time over a month (to fast but I survived)messed up my sleep

Zyprexa April 2103 5mg until august 2014 ,dropped by doctor down to 2.5mg for one month went well but sleep was very poor for 3 weeks

End of 2015 I had to reinstate back up to 5mg due to constant insomnia that wouldnt go away Started a slow taper and found an understanding doctor who listened to me while I reduced
May 2016 drug free, sleeping and doing well in life again, it can be done http://survivingantidepressants.org/index.php?/topic/12078-finally-off-zyprexa/

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Mjau

Somehow this "CA rocket-fuel" combination in "treatment resistant" depression - 

 

brings to mind the overuse of GMO's and glyphosate causing treatment resistant weeds - and the ghastly toxic combinations that they need to use to fight the superweeds....

 

"We've made your depression resistant to our treatment (with our long term treatment), so now we're going to have to bomb your brain into oblivion."

 

I do think that the example is apt.

 

I love your analogy with glyphosate!!  :lol:

At the same time I feel like crying - so many brains are bombed into oblivion, so sad  :mad:


1997-1999 Citalopram 20 mg

1999-2014 Sertraline 50 mg

2012 Sertraline very quick taper due to side effects. Switched to Wellbutrin 150 mg-300 mg. Reinstated Sertraline 25 mg-50 mg.

2013 Exhaustion. Wellbutrin 150 mg. Sertraline 75 mg-100 mg.

Sept 2014 Found this site. Started tapering. Sertraline 87,5 mg + Wellbutrin 150 mg 

Aug 2015 No more Wellbutrin!! Sertraline 50 mg

2016 Sertraline 35 mg (January) - 33 mg (March 21st) - 32,5 mg (July 11) - 32 mg (July 27)

2017 March 28,2 mg and holding

 

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blazesboylan

This is an interesting topic. I am on the so-called Californian Rocket Fuel. The mirtazapine is at a relatively low dose however. I'm not sure how sedating it is although having said that I generally don't have any trouble sleeping. I am over-sleeping at the moment actually and I feel very fatigued a lot of the time. I am tapering the Effexor now which luckily seems to be the advisable route from what I have read here.

 

Thanks for the information.


Previously - zopiclone, risperidone, lyrica (pregabalin), ativan (lorezapam)
 
01/Aug/2016 -  65mg effexor, 4.5mg olanzapine, 15mg mirtazpine
12/Aug/2016 -  75mg effexor, 4.5mg olanzapine, 15mg mirtazpine
03/Oct/2016 -  70mg effexor, 4.5mg olanzapine, 15mg mirtazpine
29/Oct/2016 -  65mg effexor, 4.5mg olanzapine, 15mg mirtazpine
25/Nov/2016 -  65mg effexor, 4mg olanzapine, 15mg mirtazpine
25/Dec/2016 -  60mg effexor, 3.6mg olanzapine, 15mg mirtazpine
18/Jan/2017 -  60mg effexor, 5.25mg olanzapine, 15mg mirtazpine
27/Mar/2017 -  54mg effexor, 5.25mg olanzapine, 15mg mirtazpine
23/Apr/2017 -  54mg effexor, 7.5mg olanzapine, 15mg mirtazpine
09/May/2017 -  75mg effexor, 7.5mg olanzapine, 15mg mirtazpine
08/Jun/2017 -  75mg effexor, 6.75mg olanzapine, 15mg mirtazpine
18/Jul/2017 -  75mg effexor, 6mg olanzapine, 15mg mirtazpine
 
Sometimes valium. Not daily. Supplements - Sterols and Stanols.
 
Note : I would really hope that nobody uses my tapering history as a guideline. It might not work well for somebody else tapering similar medications.

 

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cogitoergonumb

I am also on California rocket fuel after 6 months of polydrugging nightmare. Ive managed to cut the Mirt to 7.5mg without too much trouble but Effexor is causing me a lot of problems.


August 17 Venlafaxine 1 week - Psychosis

August-17 to December 17 Commited to Hospital 4 1/2 months

Drugs administered include (had to look this up there because it was a blur no exact dates noted in my release notes):

Olanzapine, Lorazepam, Sertraline, Escilatropram

Mirtazapine, Lamotrigine, Venlafaxine (again!?)

2018 Venlafaxine/Effexor 225mg ; Mirtazapine/Remeron 7.5mg; Propranolol 80mg; Lamotrigine/Lamictal 200mg

Lamictal was tapered very quickly Dec/Jan 2018 with no strong side effects

Began Effexor tapering Jan 2018

Came down from 225 to 75 within a month

 TOO FAST!!

Reinstated with just over 75. Mirtazapine reduced to 7.5 for sleep

Current:  Venlafaxine 80mg; Mirtazapine 7.5mg; Pipamperone 20mg

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Allreadygone

How are people doing coming off the CRF combo?Im currently tapering Effexor but hit a wall going to fast amongst other things.Has anyone had sleep issues on this combo?Remeron worked for a yr or 2 then stopped last 15yrs was just scared to lower.


1992-1995 Tofranil : was hospitalized 

1996 Zoloft, Larazepam- CT 1996

1996-  Effexor till now

2002- Remron till now

2008- Trazodone 

2010- Zyprexa, Seroquil

2010 hospitalized then CT Zyprexa, Seroquil

2010-  Lamictal till now

2011- tapered off Trazodone

2011- tapered Effexor from 150mg to 75mg / Tapered Remeron 30ng to 7.5mg / Tapered Lamictal 50mg to 37.5mg

1/27/2017 Tapered Effexor 75mg to 31.25mg

 

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Altostrata

BMJ. 2018 Oct 31;363:k4218. doi: 10.1136/bmj.k4218.

Mirtazapine added to SSRIs or SNRIs for treatment resistant depression in primary care: phase III randomised placebo controlled trial (MIR).

Kessler DS1, MacNeill SJ2, Tallon D3, Lewis G4, Peters TJ3, Hollingworth W3, Round J3, Burns A3, Chew-Graham CA5, Anderson IM6, Shepherd T5, Campbell J7, Dickens CM7, Carter M7, Jenkinson C7, Macleod U8, Gibson H8, Davies S9, Wiles NJ3.

 

Erratum in

Mirtazapine added to SSRIs or SNRIs for treatment resistant depression in primary care: phase III randomised placebo controlled trial (MIR). [BMJ. 2018]

 

Abstract at https://www.ncbi.nlm.nih.gov/pubmed/30381374 Free full text https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6207929/ 

OR https://www.bmj.com/content/363/bmj.k4218.long

 

OBJECTIVE:

To investigate the effectiveness of combining mirtazapine with serotonin-noradrenaline reuptake inhibitor (SNRI) or selective serotonin reuptake inhibitor (SSRI) antidepressants for treatment resistant depression in primary care.

 

DESIGN:

Two parallel group multicentre phase III randomised placebo controlled trial.

 

SETTING:

106 general practices in four UK sites; Bristol, Exeter, Hull, and Keele/North Staffs, August 2013 to October 2015.

 

PARTICIPANTS:

480 adults aged 18 or more years who scored 14 or more on the Beck depression inventory, second revision, fulfilled ICD-10 (international classification of diseases, 10th revision) criteria for depression, and had used an SSRI or SNRI for at least six weeks but were still depressed. 241 were randomised to mirtazapine and 239 to placebo, both given in addition to usual SSRI or SNRI treatment. Participants were stratified by centre and minimised by baseline Beck depression inventory score, sex, and current psychological therapy. They were followed up at 12, 24, and 52 weeks. 431 (89.8%) were included in the (primary) 12 week follow-up.

 

MAIN OUTCOME MEASURES:

Depressive symptoms at 12 weeks after randomisation, measured using the Beck depression inventory II score as a continuous variable. Secondary outcomes included measures of anxiety, quality of life, and adverse effects at 12, 24, and 52 weeks.

 

RESULTS:

Beck depression inventory II scores at 12 weeks were lower in the mirtazapine group after adjustment for baseline scores and minimisation or stratification variables, although the confidence interval included the null (mean (SD) scores at 12 weeks: 18.0 (12.3) in the mirtazapine group, 19.7 (12.4) in the placebo group; adjusted difference between means -1.83 (95% confidence interval -3.92 to 0.27); P=0.09). Adverse effects were more common in the mirtazapine group and were associated with the participants stopping the trial drug.

 

CONCLUSION:

This study did not find evidence of a clinically important benefit for mirtazapine in addition to an SSRI or SNRI over placebo in a treatment resistant group of primary care patients with depression. This remains an area of important unmet need where evidence of effective treatment options is limited.

 

 

From the paper:
 

Quote

 

....

The STAR*D study (Sequenced Treatment Alternatives to Relieve Depression) found that half of those treated failed to experience at least a 50% reduction in depressive symptoms after 12-14 weeks of treatment with a single antidepressant.3 A substantial proportion of those who take antidepressants in an adequate dose and for an adequate period do not experience a clinically meaningful improvement in depressive symptoms.3

 

The National Institute for Health and Care Excellence advises general practitioners to reconsider treatment if patients show no response after 4-6 weeks of antidepressant use.4 Limited evidence is currently available to guide doctors in the management of patients who meet the ICD-10 (international classification of diseases, 10th revision) criteria for depression after taking a serotonin-noradrenaline reuptake inhibitor (SNRI) or selective serotonin reuptake inhibitor (SSRI) at an adequate dose for a minimum of six weeks.5 Several drug strategies have been proposed, including increasing the dose, switching antidepressants, combining two antidepressants, and augmenting the antidepressant with another psychotropic drug, such as lithium or an antipsychotic.6 A systematic review of antidepressant combinations for those who did not respond to monotherapy found that the small number of trials and methodological drawbacks of those trials precluded definitive conclusions about effectiveness, and some of the combinations carry a substantial risk of adverse effects and are not considered appropriate for initiation in primary care.7 There is a pharmacological rationale for adding a second antidepressant with a different and complementary mode of action to SSRIs or SNRIs. Mirtazapine, a noradrenaline (α2 adrenoreceptor) and serotonin (5 hydroxtryptamine receptors 2 and 3) antagonist, has the potential for an additive and perhaps synergistic action with SSRIs and SNRIs and could enhance clinical response compared with monotherapy with SSRIs or SNRIs. Four trials have been carried out of this combination against SSRI and SNRI monotherapy in participants who are treatment resistant and in those without treatment failure, with mixed results.8 9 10 11

 

We determined the effectiveness of adding mirtazapine to an SSRI or SNRI in reducing depressive symptoms and improving quality of life at 12 weeks (primary follow-up) and at 24 and 52 weeks compared with adding placebo for patients in primary care who still experience depression after an adequate course of treatment.

....

This study did not find convincing evidence of a clinically important benefit for mirtazapine over placebo when given in addition to an SSRI or SNRI antidepressant for patients who had remained depressed after at least six weeks of antidepressant treatment, recruited from primary care.

....

In the mirtazapine group, 46 participants who reported adverse effects stopped their drug compared with nine in the placebo group. Adherence was therefore substantially lower in the mirtazapine group than placebo group and is likely to have been a consequence of adverse effects.

....

 

 


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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LiferButOK

I was prescribed mirtazapine 15mg in Dec 2018, to add to longterm Effexor150mg. It made me swirly and limp like a bag of water on the couch.  After a week or two, my knees started giving out while walking!  So the vial went into my drawer of “tried but failed” meds with a scrawled note to keep for use as a muscle relaxer.  Fast forward to May 2020 when Abilify was making me torqued up with chest and head pains.  I took a Mirtazapine to relax, got swirly, and passed out in bed.  It did let me escape the fear but very strongly zonked me out.  Perhaps I am a “paradoxical responder,” but I found Mirtazapine in combo w Effexor to be a very strong opposite of jet fuel.  Interestingly, the practitioner who prescribed it to me is now just gone.  The office says he’s no longer there and no, they don’t know where he went.  


1990 -  1996 Buspar for anx/depression.  (Previous tries with some others).

1996 BEGAN EFFEXOR for anxiety, depression, painful bladder spasms.

2006 breast cancer treatment year, including chemo.  I’m still here 🌾🌞 

2007, 2008, 2016 3x tried synthroid, Tirosint for low thyroid. Leg cramps +, foul mood.

2008-2011 Catapres 0.2mg clonidine patch for BP + anx added to Effexor; had to discontinue for possibility it was harming my memory (at work).

2013 Got retired early due to memory failures and mood control breakdown.

Dec2018 tried Mirtazapine 15mg to boost mood; it zonked me + my muscles!

Apr2020 tried Abilify 2mg with my 150 Effexor. BAD cardiac effect in 11days.

May 2020 direct switch from 150mg Effexor XR to 50mg Pristiq. AWASH in 4d.

23May2020 BACK again to just 150mg Effexor XR brand (now on it for 24yrs).

Other:  Krill oil, vit D drops, infreq 100%B vit.  Hibiscus or ginger/turmeric, or dandelion root teas seem helpful.  Believe in Source.  Starting MgCl2 in aloe w some glycerin as skin lotion.  Minimal coffee.  Trying to put play before work.  

 

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