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[Relentless tide]

Hello,
I was put on Mirtazapine for anxiety last July and as the dose increased my symptoms/side effects got worse. I am now being changed over to Venlafaxine which I start in just over a week.
It appears that the effect on norephidrine by the Mirtazapine was what made my anxiety worse. The Venlafaxine also increases notephidrine and I am really worried the same thing will happen.
Has anyone else been in the same situation? Did the Venlafaxine work without worsening the anxiety?
Please no horror stories as I am already so worried.

[CLKD]

Hi.  Which symptom would you like to ease and is there any correlation with your monthly cycle?

It is recognised that anxiety can become problematic during peri-menopause.  When are your symptoms at their worst?

If U find that Venlavafaxine raises levels - which may be expected initially - perhaps your GP would prescribe Propranolol.  I have used this successfully over the years in varying doses to stop the early morning anxiety surges.

R U having a break from the Mirtazapine? 

[Relentless tide]

Thank you for replying.
I have been on the mini pill for years and so haven’t had periods. I started HRT a couple of weeks ago, mainly for metal health reasons but with other perimenopause symptoms as well.
I’m stopping the Mirtazapine over a week then a week with nothing (starting Monday) then am supposed to be starting the Venlafaxine. The anxiety has been crippling and has also developed into agoraphobia, the depression has been the worst of my life as well. I should add I have lived with anxiety and depression for most of my life and have managed it. Now it is out of control.
I have tried propranolol but it didn’t help as I have more psychological symptoms rather than physical, I get awful nausea 24/7 which means I can’t eat and have lost 3.5 stone over the past few months.
I am at my wits end, I can’t work at the moment but need to be able to as we still have bills to pay, also I am terrified of the anxiety getting worse as it has taken me to very dark thoughts before.

[bombsh3ll]

You do not just have to be passively "put on" this or "taken off" that.

You have agency over what medication you choose to take and unfortunately noradrenergic agents are generally unhelpful for anxiety.

I also do not personally believe SSRIs really have any merit either however this class is usually preferred where anxiety is prominent.

Benzodiazepines will always be the only really effective "as required" anxiety treatment however they are now very much demonised due to historic abuse by a minority of patients.

My suggestion particularly as your symptoms are cognitive as opposed to physical, would be to try and access some non drug psychological therapy, either through the NHS or self funded if you can afford it.

Having some sessions with a trained psychologist can really help you develop tools to really minimise the impact of anxiety on your life that you can take forward without taking medication long term.

[Relentless tide]

Hi Bombsh3ll, I’ve been trying to get NHS help with my mental health for nearly a year now with no success. It’s dire here! Private help is unfortunately not an option.
There is nothing passive about changing the medication, it is being done at my request due to realising that the decline coincided with the increasing of dosages . I feel I let myself down by not realising this sooner.
I am just scared that because both affect norepinephrine the same thing will happen again so was wondering if anyone else had been in this situation.

[CLKD]

WHOOA - U have certainly not let yourself down!

Anxiety is reactive: flight or fight response, to keep humans safe.  Try not to separate psychological from physiological that's a rabbit hole.  I had my 1st panic attack at aged 3, suffered intermittently life long turning in the 1990s to being unable to leave the house, unable even to go into our garden  .  With support from a loving husband, good GP and appropriate medication we have a life together again. It took 4 months in those dreadful years to begin even considering going out. Whether this was related to peri-menopause I have no idea, hindsight suggests 2 me that it may well have been.

I do wish that medics would prescribe appropriate medications, whilst some anti-depressants may relieve anxiety: Venlafaxine is supposed to help anxiety surgeries: a dedicated pill that gives almost instant relief should be offered: i.e. 4-6 weeks of 'valium' under the supervision of a GP.  Gives the sufferer head space as symptoms ease. This was a Life saver for me. Eventually I used 'as necessary', 5mg usually the night prior to an event that I was unable to avoid. Knowing that I could take another 5mg the next day, which I never required.

R U phobic about food? For over 45 years I ate enough to keep me upright, when I look at photos  ........  propranolol stopped the nausea which enabled me to develop a healthy eating pattern. [now mid-70s]. 

R U able to explain exactly how the anxiety affects you? Which is the worst to deal with, depression or anxiety?

4 me it's sudden nausea, my thighs followed by my calves go weak and I hit the floor!  I do have an emergency pill to swallow which either enables or sends me to sleep. Relief!

[I have to attend a big funeral next month, so will be using Propranolol in varying degrees to get me through. Suggested by my GP 12 months ago when depression side-lined me = upping my escitalopram and adding the betablocka prior to going away for our wedding celebrations].

Bachs rescue remedy mouth spray or pastilles may help, I would use the spray and not think whether it was working/not. Exercise supposedly helps some with mental health issues as I suppose it encourages the proper endorphins etc. the humans need, of which we have lacked due to driving everywhere and become sedentary.  .

How is your sleep pattern currently?  Do U have a relaxation time, mine is my bubble bath ;-)

In what way didn't the Mirtazapine help, my friend found it really useful when we suffered trauma about 9 years ago.

[Relentless tide]

I’ve had depression/anxiety/panic for 30 years but the last 6-7 months it has been horrendous and as with you, leaving the house is now an issue.

I have diazepam but I hate taking it as I feel like a zombie and utterly useless. I’ve always worked full time and at 48 it’s what I want to and should be doing.

Propranolol didn’t help me as it seems my anxiety symptoms are more psychological than physical. It did absolutely nothing for the nausea, I’ve also tried seasickness tablets and they didn’t help at all either.

I have anxiety/sense of doom 24/7 which causes the nausea to the point I can’t eat and end up retching. It all gets so overwhelming my head feels like it’s going to explode and I can’t think straight.
When the panic sets in I lose rationality, pace around, hyperventilate, even more overwhelm etc.

The depression is like being in a big black pit, there is a speck of daylight but whatever I do I just can’t get to it. I feel hopeless and have no interest or pleasure in anything at all.

I’m not phobic about food, I’ve always loved my food, a bit too much, and then all of this hit. If the nausea does drop a bit by the time I’ve made something it’s back again so I have been going for toast or bread, fruit or things which are quite bland and very quick to put together. I cook my partners supper each day and even that, knowing it’s not even for me puts me off. There’s just nothing I fancy eating any more.

Sleep is not good, I wake up at 2:30-3am with the dreads. I don’t get up as I’m so exhausted.

I used to enjoy a bath very much but now the effort feels like climbing a mountain and I just sit there thinking about everything round and round in my head which makes me feel worse.

I’m so desperate to find something which works and so anxious that this new medication will just do the same thing again and I will lose more weeks/months to being stuck where I am.

Edited to add-
The Mirtazapine didn’t make any positive difference at all. I was on citalopram which had seemed to stop working hence the change. Things have got worse while I’ve been on the Mirtazapine.

[CLKD]

It can B a vicious circle.  Which dose of valium and mayB taking it at night might ease those woozy feelings. 

Grazing helped me a lot. Dried fruits and nuts to hand 24/7; ginger biscuits; bananas; Rice pudding from a can; lots of toast with Marmite ; my issue is to eat B4 my body lacks energy so that the nausea doesn't strike.  Pancakes: these will keep a few days in the fridge for instant cooking. They freeze, though do tend to curl up !  Chocolate.  When ill I am unable to tolerate any1 eating an egg, cooking sausages or chips. Fish smells is a no-no.

I was advised by NAPS to eat every 3 hours to help keep energy levels even.

My brain gets used to ADs after several years.  I also have an emergency anti-anxiety pill. 

[bombsh3ll]

If there has been a clear worsening around perimenopause then it is reasonable to hope that the hormone therapy may improve things for you once you get stabilised and if you are on a therapeutic dose.

Do you work for a large organisation? If so there may be mental health support available through your employer.

Otherwise there are some private and third sector mental health providers who operate on a means tested basis that might enable you to see a psychologist, even if it is remotely.