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[Gilla999]

I have been in a complete mess since the beginning of May, worsening since the start of July. The biggest mental health crisis I've ever had, brought on by chronic, severe, prolonged insomnia. It seemed to coincide with a big rise in my Estrogen levels (still ovulating every month, was on a small dose of 1/4 of a 25 Evorel patch). I came off that patch on Tuesday last week and although my Estrogen levels don't seem to have changed much, I'm in a whole world of hell. I had previously been under the care of a psychiatrist from when this happened before, but he's been pretty useless with suggesting strategies and GPs even worse. I wondered if anyone had any tips of medication strategies that have worked for them that I could raise with my psychiatrist next time I speak with him?

I currently take:
Mirtazapine 15mg
Trazodone 150mg
Amitryptiline 10mg
Diazepam 4mg at night but has been between 6-8mg for the last 4 weeks
Atenolol beta blocker - half a 25mg tablet a day

Its very strange in that some days I seem to be OK enough, and then others I have uncontrollable sobbing and tremors/shaking and hypnic jerks preventing me from sleep. The anxiety has now taken on a life of its own, I've never had it this bad before.

I do find Atenolol helpful but beta blockers lower Melatonin and benzos also reduce slow wave sleep, so not ideal. I realise no one can give medical advice, but just wondered if there are any ladies out there who have suffered with extreme anxiety that have found any decent medical solutions that I could raise with my doctor for their opinion? Xx

[CLKD]

Yep.  I think that you are taking far too much similar medication so your body doesn't know whether it's flying a bike or riding a kite!

Diazepam = valium = is used as a pre-med as well as an anti-anxiety medication.  4mg is hardly any dose at all.  Eventually was taking it as necessary, 5mg the night B4 an event that I was unable to get out of.   Because it worked I never required the 5mg during the next day and effects lasted 3 days 4 me.

Who suggested halving a 25mg tablet?  I was taking propranolol: initially 80mg 3 times a day dropped after 4 weeks to 40mg 2 times then I dropped down to 20mg at night.  Prescribed to ease early morning surges which worked for me.  Eventually I was waking with low background headaches and as we went into lockdown I stopped completely.  Didn't know whether it was the BB or Covid-19  .

When do U take the Mirtazapine and why was it prescribed?  My friend had good results with it but I don't know which dose nor how often.

A psychiatrist worth his salt would never be at a loss!  They do after all: I may have said B4: colleagues and drug companies with who to discuss treatment regimes.  When did U last discuss your regime with him?

When my anxiety floored me I thought that I would never C the light of day, eventually with medication I came out of the dark. 

Where did U read that BB lower Meltaonin?  I've never had trouble sleeping since I left my very busy responsible job - on nights when I don't drop off that;s it I have to read.  Sometimes I wake in the early hours and realise that if I'm not tired, then my body is well rested.

I used to wake up to see whether I'd been asleep  so sleep problems can impact hugely.

Why did U stop your patch? 

[Nas]

Gosh Gilla, that sounds brutal, you poor thing.

What do you take the amitriptyline for? 10mg is a low dose. I take 37.5 for sleep each night, else I wouldn’t sleep at all.

Does the mirtazapine not help the insomnia? Have you tried CBD oil or gummies? Healing cauldron do a low dose hybrid oil which I find relaxing.

No other solutions unfortunately. I refuse to give in to my anxiety and just ( somehow) power through with my job / garden / house etc . I find if I am very busy, my anxiety is better. The less I do, the worse it is.

You are taking a good whack of meds already.. is it all necessary and beneficial do you think?

Good luck and hopefully some of the ladies will pop over with some suggestions x

[CLKD]

U could also make an appt with a Pharmacist to discuss your current regime, a new eye on what you are taking may well help from a professional point of view.

[Mariab]

Gilla, it sounds like you are having a pretty rough time....
Can I ask how long you have been taking these meds??. And did you start hrt before or after? 

[bombsh3ll]

Blimey that's some cocktail, I'm not surprised your psychiatrist is now at a loss.

There's ketamine, that's being used by some psychiatrists but I'm not sure about availability on the NHS.

Also if multiple psychiatric meds haven't worked out, it suggests a different approach might be more worthwhile.

If you think there's a hormonal component, and to be clear a quarter of a 25mcg estradiol patch wouldn't affect a mouse, it's just not biologically plausible for that to have affected you negatively, but if it seems hormonal what about shutting down your own system and adding back a stable consistent level of hormones with a combined pill taken continuously?

I take Zoely continuously and it's brilliant for keeping me bleed free and hormonally stable. No ups or downs, it's a hormonal monorail not a rollercoaster.

You could also add a small dose of oral progesterone at night which might help you sleep, if you haven't already tried that alongside the patches?

[AnonoMiss]

I have been in a complete mess since the beginning of May, worsening since the start of July. The biggest mental health crisis I've ever had, brought on by chronic, severe, prolonged insomnia. It seemed to coincide with a big rise in my Estrogen levels (still ovulating every month, was on a small dose of 1/4 of a 25 Evorel patch). I came off that patch on Tuesday last week and although my Estrogen levels don't seem to have changed much, I'm in a whole world of hell. I had previously been under the care of a psychiatrist from when this happened before, but he's been pretty useless with suggesting strategies and GPs even worse. I wondered if anyone had any tips of medication strategies that have worked for them that I could raise with my psychiatrist next time I speak with him?

I currently take:
Mirtazapine 15mg
Trazodone 150mg
Amitryptiline 10mg
Diazepam 4mg at night but has been between 6-8mg for the last 4 weeks
Atenolol beta blocker - half a 25mg tablet a day

Its very strange in that some days I seem to be OK enough, and then others I have uncontrollable sobbing and tremors/shaking and hypnic jerks preventing me from sleep. The anxiety has now taken on a life of its own, I've never had it this bad before.

I do find Atenolol helpful but beta blockers lower Melatonin and benzos also reduce slow wave sleep, so not ideal. I realise no one can give medical advice, but just wondered if there are any ladies out there who have suffered with extreme anxiety that have found any decent medical solutions that I could raise with my doctor for their opinion? Xx

Benzos can become addictive after 2 weeks of continuous use so please be careful

Tsrt cherry extract is a milder alternative to melatonin

Have you tried utrogestin on its own for the anxiety ie without estrogen?

Neurofeedback can help anxiety, depression and many other issues - Neuroptimol is a type you can rent at home and do yourself, lots on Google and YouTube

Lithiam orotate 5mg can help anxiety

Have you had your B vitamins tested and if low have you looked at the MTHFR gene mutation? Again lots on Google

Also do you have any histamine issues as that can also cause extreme anxiety and peri can cause you to go intl estrogen dominance which makes that side worse, it can also contribute to leaky gut which causes yet more histamine and anxiety

Perhaps a functional medicinr practitioner  might be able to look at all this Holistically for you

[Gilla999]

Thanks all for your replies, much appreciated. I don't need to be told it's a rubbish cocktail, I'm well aware... it's come about through repeated bouts of severe hormonal insomnia over the last 5 years and because I can't get off any of them quickly - I have to taper down really slowly - so I get really low and then get another bout and go back to square one. Up until recently I was on very low doses of the Amitriptyline and Mirtazapine, it was only the Trazodone that was at a normal starting dose. But since this bout - which has been worse than I've ever known - I've been desperately trying to fix it and so have put up my Mirtazapine, but it's not seemed to work.

In terms of patches - I know I absorb more transdermally of all things than most and patches have a high variability of absorption between women, so I do think I was getting a notable amount from it... I certainly would feel it if I reduced or took it off (or increased it even slightly). But my Estrogen levels from the weekend's blood test don't really support that there is anything wrong or unusual there since taking it off. My Progesterone level did come back at unusually low, even for the follicular phase at <0.2 nmol.

I'm already way past the stage of becoming addicted to benzos, I've been taking the valium for over a year. Honestly, all that matters right now is that I find a way to get out of this crisis and I will deal with all the tapering and resetting of meds etc later - I've never known anxiety this bad, for this long. It's something very physical going on in my body and nothing to do with anxious thoughts. I've lost over half a stone in weight in just one week, because I literally can't eat or sleep.

@Bombshell, funnily enough I did try Zoely for 3 months right at the beginning of my peri journey. It didn't have enough estrogen in at the time for me to control my night sweats and 3am insomnia, but I seemed to be going through something quite specific then and maybe it could be worth another shot. A hormonal monorail sounds like absolute bliss. The only thing is I'm on day 8 of my cycle now, so it would really need to wait until next month to start it.

@Mariab I have been on HRT for about 5 years and these meds for around the same time, but as I said I had got really low on most of them until this happened.

@CLKD that's reassuring to hear you didn't have insomnia on propranolol. The heart palpitations and ectopic beats are one of my worse symptoms, so maybe I should rely on my Atenolol more. I have requested another appointment with my psychiatrist this week but not sure when it will be. I just feel like I need some kind of strategy to get out of this immediate crisis and that he's not helping me with suggestions for that at all.

[Gilla999]

Update: I've decided this morning to put back on my 1/4 patch of Evorel 25. Although I very much felt at the end of my last cycle it was too much Estrogen causing the issue (my day 21 levels were 916 pmol) I have never experienced this level of intense physical anxiety before (even when I do feel like I'm sleeping) and I can't help feeling there is something more in HRT than we see on an Estradiol blood test that your body withdraws from when you stop it. Please wish me luck / keep your fingers crossed for me, as I'm so nervous it could backfire 

[Penguin]

Personally I'd find a psychiatrist that is willing to do gene testing, there is a specific panel that identifies whether or not a certain medication will work well for you or not. Genesight is the US version of the test but read recently on here it's not available in the UK. There definitely is a test that is though as my psychiatrist was going to order it if my medication didn't work.
Only other thing I can contribute is to say I'm prescribed 2mg of slow release melatonin for sleep and that works really well. I'm getting better sleep now (duration and quality) than I've had for years. It isn't a forever solution though and I'm going to try and stop them at the end of summer now I'm more settled in my job.

[CLKD]

If U feel that you need to withdraw from some/all of these medications, then a Psychiatrist should be qualified enough to support you !  My GP did so ......... for an AD, can't remember which nor why I needed to withdraw.

As for 'valium', people become addicted to the need on an 'in case this dose isn't enough' basis, then the body/brain become used to the drug.  4 me it gave me 3 days relief without any top up. 

I wouldn't suggest trying to withdraw from all at once.  Good advice from Penguin .......... with support these meds can be withdrawn.  Some people have an addictive personality too!  However, most of what you are on: singly: can be Life Savers
.

Lack of sleep can be tiresome!   Also, who measured your oestrogen levels, blood tests are reliably un-reliable!

[bombsh3ll]

If Zoely suited you but didn't have enough estrogen you could always add a low strength patch as well. Some specialists do this as the progestin is potent enough to cover it.

Perfectly reasonable when you look at the estradiol dose in Qlaira (although I wouldn't recommend this, it isn't monophasic and dienogest doesn't shut you down at the pituitary level as effectively).

You don't have to wait until your period to start a birth control pill - it just can't be relied on for contraception for the first week if you start elsewhere in your cycle.

[Gilla999]

I agree CLKD - although the cocktail of meds situation is far from good, it makes me more anxious to think about that and I know that I can (slowly) taper off these meds as I've done so before. The most important thing is getting myself out of this immediate crisis.

I have always found the blood tests to be fairly reliable (done at clinics, not finger prick) but I do think that there is more to our hormone levels than what is simply reflected in a blood test, that's for sure.

I seem to have this situation where every so often my hormone levels (not just Estrogen; Progesterone too) spike very, very high and it triggers off one of these episodes. Unfortunately reducing or stopping my HRT seems to have limited benefit and (like this time) can actually cause its own set of withdrawal issues. I think going forward I need to try and think of some way of shutting down ovulation, so that at least (hopefully) the fluctuations will be limited. I can't carry on losing 3+ months of my life every year. Maybe Zoely or a Progesterone only pill. @Bombshell that's a good idea on Zoely. I think adding anything extra into the mix today might not be the way to go and could cause its own set of problems, but definitely something to think about maybe for the start of my next cycle.

I really do appreciate the support on this forum, it's a very scary thing to go through this level of anxiety and insomnia on your own.

[AmandaJR]

Gilla999.
Checking on you, how are things?
Sending hugs.x

[CLKD]

Any news this morning?