Depression Forums
General => Medication => Topic started by: Russell on September 07, 2014, 09:59:56 PM
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Okay guys, you're all brilliant! I have made a few life changes. I have volenteerd as a tour guide for a Victorian tour guide, been invited to join the Buddhist order and started my teaching degree in the past 7 dayo. I am now on such a massive high it actually hurts! How do I handle this? I know this will lead to the inevitable low. Is this the other side of venlaflaxin? Or should I just go with it? Feel like I could go for 10 days without sleep.
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While the idea of a Buddhist guide to Victorian England appeals to me and I favour teachers getting as far as they can with qualifications, I think we'd have to admit that Venlafaxine isn't proving to be a run away success. Your mood is still cycling and this high seems to be higher than you have experienced before. You haven't done anything disastrous but that is more by luck than judgement.
Maybe it is time to get a definite diagnosis of Bipolar and more effective medication than Venlafaxine. GP's are very variable in their
willingness to make psychiatric diagnoses. Some are happy to do it, others prefer a referral to a specialist agency which is usually
your local Community Mental Health Team. I would return to my GP and say I think I am definitely Bipolar and need different medication. If he will do that, great. If he won't then you ask for a referral to your CMHT.
That can take a while so you might need to ask for something to tide you over until your CMHT appointment came through.
You probably could go 10 days without sleep.I had the misfortune of being on a psychiatric ward with a guy who went night after
night without sleep.
Love
Steve
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Thanks for that Steve!
I totally agree,this high is almost physically painful. Yet last Thursday,I thought my suicide was inevitable. Venlafaxine seems to amplify my moods and increase the frequency of swings.I have a follow up appointment on Wednesday morning,in which I will give your suggestions to my GP. I have no doubt that I am bipolar and can only emphasise how frightening the lows are.
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Good news that you are happy. Volunteering does help as it keeps your mind occupied on something constructive. If someone had told me three years I would be helping out with a lunch club I would have laughed. I started at one that's on a Friday then we moved to another town so I only continued until last Christmas. By that point I was helping out at another one twice a week which is virtually on my doorstep so gave the first one up. The lunch club I still do twice a week also does meals on wheels as well.
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What medication should I be expecting from GP,if they take me off venlaflaxin?
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I presume you need a mood stabilizer and Venlafaxine (Efexor) is an SNRI
There are a few alternatives for mood stabilizers depending on your particular kind of Bipolar, whether you tend to go more on a high mood or on the depressed side. This has to be properly diagnosed by a specialist.
I would certainly wait for the day after tomorrow to see the GP, but as Steve said you may have to take the initiative to go see a psychiatrist who can make this kind of diagnoses.
My best wishes Russell ..... with the right medication you will certainly feel better!
Grace
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What you might be prescribed depends on a couple of things. The first is whether you are still cycling or if you have settled into a high and are staying there. If your high is more or less there all the time a doctor might want to bring you out of it before attempting long term stabilization. There are a number of anti psychotics that would do that. Quitiapine was popular for a while but there are 4 or 5 choices at least.
If a doctor decided to go straight to mood stabilization I think Lithium and Depakote are the most common still but there are a good
few choices. Your GP might not want to start you on Lithium. You have to have various blood tests before you start and while you are taking it. My GP refuses to initiate Lithium treatment. He prefers to leave that to the Community Mental Health Team.
When I was in hospital I was amazed at the amount of benzodiazepine tranquillizer Clonazepam that people with Bipolar were on. This was to keep people calm while everyone waited for the mood stabilizer to kick it. Whether a GP would consider this use I am not sure.
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Went to GP this morning,said I had been on this forum,and the intensity of the highs and lows I have been experiencing. The doctors answer-"Well what do you think we should do about it?" Not exactly helpful I have now been given Sertraline 50mg to take every other day witk venflaxin. Still no nearer a proper consultation. Still on a high which is good news,but what will the next low bring?
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Dear Russell,
I really don't understand the rationale for this new prescription of Venlafaxine with Sertraline. Did the doctor make a diagnosis?
If I were you I would try to get an appointment with a specialist! I do not know anything about NHS (I live in another country) but you need to get a second opinion. Otherwise I would go to a private doctor ..... but that depends also on the honorarium they might charge in England.
I wish someone else on the forum can advice you, in the hope that I'm not seeing it right!
Grace
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"Well what do you think we should do about it?" isn't a really very helpful question to someone who doesn't have a fair degree of
sophistication in psychotropic drugs. His thinking puzzles me. Venlafaxine is a SSRI/SNRI drug. It increases the amount of Serotonin and Noradrenaline in the gaps between nerve cells. Sertraline is an SSRI which increases Serotonin. Too much Serotonin can be a bigger problem than too little, it can trigger a syndrome that can kill you. Why the alternate day taking of Sertraline I haven't the faintest idea.
I hesitate to mention it but sexual problems come into things. The people I met who had sexual problems on Venlafaxine have generally experienced delayed or lack of ejaculation. I read a document from the then patent holders for Sertaline. They went the whole hog and just described the percentage experiencing "impotence." This is not the area of drugs I would really be keen on you exploring.
I think it may be time for some more specialist intervention. You have described the classic symptoms of BiPolar twice to your GP. If he is not going to make a definite diagnosis he really ought to be thinking about referring you to someone who can. It shouldn't be a problem for him. GP's refer people to specialists every day. That means referral to the Community Mental Health Team. They do have waiting lists. There is nothing to stop your GP from ringing the CMHT psychiatrist and explaining your situation and asking for advice on how to proceed pending a CMHT appointment coming through. I think that is a perfectly reasonable use of a specialist psychiatrist.
I would probably write my GP a letter requesting CMHT referral since you only saw him today and drop it off at the surgery. There are also plenty of test if you are bopolar pages on the Internet. Downloading one, filling it in, and including it with the letter would be a good idea.
In the meantime I will keep my fingers crossed that things don't get worse. If they do there is always the Crisis Team but I think they wouldn't regard you as deep in crisis yet.
Love
Steve
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Have you thought about getting a second opinion from another GP?
There are doctors in our surgery who are the ones to see for diabetes or angina or other specific needs. It's worth asking to see another doctor.
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I have seen 3 different doctors over the past 3 weeks at the same practice and they all spout the same thing. I was supposed to have an appointment with Solihull Healthy Minds 2 months ago,which hasn't materialised yet. Rang them today,told them about my recent obsession with jumping in front of a train,on my low days,and that seemed to make them take notice. I really have no idea what to do. I feel great ATM. Loving life,no sexual disfunction,sleeping well,no headaches etc. Are the venlaflaxin kicking in? Do I try the new meds? Totally confused ,but happy for now.
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I have decided to stick with venlaflaxin and it really seems to be working. Still waiting on Healthy Minds Solihull after 10 weeks and requests from myself and GP. Other meds made me tired and out of it. Feeling good for now.
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Sorry not to have replied sooner. I have spent a day and a half as decorators labourer. We bought a load of Amazon posters that had been priced wrongly. They honoured the contract with us and we ended up with about twenty posters for about £5. Deidre decided she wanted to move them all around.
I am glad you are still feeling OK. I dug out my old case notes on two people with bipolar who were on Venlafaxine and found they were both also on mood stabilizers as well, both Depakote. I decided to look up what Venlafaxine is officially licensed for and found that it has four licensed indications.
Major Depressive Disorder
Generalized Anxiety Disorder
Social Anxiety Disorder
Panic Disorder with or without Agoraphobia
You'll notice the absence of Bipolar Disorder in the list and the fact that you don't fit into any of them that are on the list. I can't see you having some weird presentation of Major Depressive Disorder. It is impossible to ignore the cycling.
I think that having some form of specialist assessment from the Community Mental Health Team is the best way forward.
I was also concerned about thoughts of jumping in front of a train. When I was a kid of about 12 the mother of my best friend was on a station waiting for a stopping train a couple of feet away from me. As an express train approached she simply walked to the edge of the platform and jumped off just in time to be hit by the front of the train.I won't go into details but the next couple of hours were horrendous.
You need a back up plan in case the impulse becomes too strong. The first thing is to remember that 999 deal in mental health as well as physical. Ring 999 and the paramedics will come pretty quickly. Then there is 111 . You tell them the problem and they will work out with you the best course of action. Bipolar can take you into some very deep lows.
Love
Steve
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Having told my manager about my depressive issues/medication she has been very supportive,however I am coming down again and am scheduled for a meeting tomorrow which I really feel I cannot face. The meeting is in relation to a project manager role I had been promoted to, which I have subsequently stepped down from. I know this meeting will involve a personal attack on me/my performance ( a task I could perform in an empty room at the moment!). How should I approach this? Still not sure about my meds either and still no further with Solihull Healthy Minds.
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The Solhull Project waiting time is difficult to estimate. In Leicester the wait for short term Cognitive Therapy is about 6-8 weeks. The waiting time for long term psychotherapy is not far short of two years. Shorter term and group therapies tend to be way shorter than individual ones. All you can do is make a phone call and see what estimate they give you.
I am not sure of your medication. You have been stable for a while but whether this is due to Venlafaxine or just one of the ups and downs of Bipolar it is difficult to tell. Then there is the question of diagnosis. I have been working on the basis that you are suffering from Bipolar but I am not a psychiatrist although I had had a job that involved diagnosis. You really need a proper diagnosis from a proper clinician. This needs a referral to your Community Mental Team.
I had a look at guidelines for dealing with Bipolar. The advice was in the event of hypomania or Mania, take the person off any anti-depressant they were on. So if the guidelines were followed you shouldn't be on Venlafaxine. Probably.
When it comes to work all you can do is explain what you have been experiencing but stress that psychiatry has treatment and that many people are stable on medication.
Hope that is of some use.
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The Solhull Project waiting time is difficult to estimate. In Leicester the wait for short term Cognitive Therapy is about 6-8 weeks. The waiting time for long term psychotherapy is not far short of two years. Shorter term and group therapies tend to be way shorter than individual ones. All you can do is make a phone call and see what estimate they give you.
I am not sure of your medication. You have been stable for a while but whether this is due to Venlafaxine or just one of the ups and downs of Bipolar it is difficult to tell. Then there is the question of diagnosis. I have been working on the basis that you are suffering from Bipolar but I am not a psychiatrist although I had had a job that involved diagnosis. You really need a proper diagnosis from a proper clinician. This needs a referral to your Community Mental Health Team.
I had a look at guidelines for dealing with Bipolar. The advice was in the event of hypomania or Mania, take the person off any anti-depressant they were on. So if the guidelines were followed you shouldn't be on Venlafaxine. Probably.
When it comes to work all you can do is explain what you have been experiencing but stress that psychiatry has treatment and that many people are stable on medication.
Hope that is of some use.
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Hi Steve,May I take chance to tell you how much I appreciate your continued support,it really is helping me through a very difficult time.I go back to GP tonight after 4 weeks on venlaflaxin to see how things are. My best attempt at vocalising my experience would be last week so up I felt like a child on Xmas eve all week. This week I feel as if a loved one is in a critical condition in hospital and I have to put on a super-human defence just to get through the day to day. Is this Bipolar? Do I need to increase the dosage? Should I go back to Citalopram? These are the questions I shall be asking.
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The only reason for going back on Citalopram would be if you had a diagnosis of unipolar depression, and you don't. There lies the problem in that you have a prescription but no diagnosis. The area you are experiencing can be difficult. People with normal depression experience variations in their mood. They have good days followed by bad ones and good periods followed by bad one. But people with Bipolar cycle more often and in a more extreme way.
Someone has to be prepared to say that you are depressed or you are bipolar. It isn't looking good for this being your GP so you are going to have to see your Community Mental Health Team. I think I would ask my GP if he is prepared to state that you have bipolar or have simple depression. If not then he has to refer you to the local CMHT.
You could ask him if he would give you a trial on a mood stabilizer. For various reasons that comes down to Depakote.
I don't think increasing your Venlafaxine is much of an idea. It hasn't made much of a difference for you. It doesn't make sense for a GP to increase a drug when he doesn't know what he is treating.
I would be happiest fpr you to leave your GP with a tentative diagnosis of bipolar, a referral to CMHT for a definitive diagnosis and a prescription for Depakote. Whether you can get that I don't know. Stressing the continuing cycling and the suicidal thoughts might just sway your doctor.
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So the upshot of my meeting with the GP is that it didn't happen! Waited 40 minutes and had to leave. I am giving the Sertraline a try and they seem to be okay so far.I have my Healthy minds appointment for next week, so I will plug on with Sertraline until then. Last week was a bummer,but this will happen. One thing I have learnt is that it is alright to ask for help. Until now I have muddled on alone and seen this as a sign of weakness,but I'm learning it is quite the opposite. Much happier today!
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Hope Healthy Minds goes well for you. One downer I ought to mention just in case it happens to you. Some projects see people to assess whether the service is suitable for the person. If they are they get put on another waiting list. We have one large counselling project in Leicester that does this. It causes endless frustration. Hopefully Healthy Minds works differently.
Hopefully Healthy Minds will have clinicians who can make diagnoses as well. What these projects do varies tremendously. Hope you can find time to let me know how you get on.
Steve
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How are you doing Russell?
Your 'high' sounds worrying. Phew. I haven't had chance to read all the follow-up replies yet but will do - I just wanted to comment about the medication as Steve also mentioned it.
2 things that have helped me more in the past few months than at any time in the past 30 years... Becoming friends with my wife (letting her in to my darkness) has had a massive (positive) impact and, secondly, opening up a bit more to my doctor which led to a better prescription.
I decided to mess around with my medication intake last winter and it was a big mistake. I've been spiralling all over the place emotionally for years and hiding it all away, including plodding on with the same prescription without mentioning my ups and downs.
Speaking more openly to my wife has allowed us to become friends - something I had prevented by never coming clean about how I'm feeling. She is now actively involved in my 'coping' and I even had her come to the doctors with me to make sure I didn't forget to say anything important. She also now understands what the modified prescription was done for and what happens next.
I guess, in summary; I started talking and it helps.
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Into my second week of Sertraline 50mg and things seem to have calmed down. Healthy Minds meeting this Wednesday morning. One side effect seems to be occaisionally feeling "out of it", like I've had few drinks. Is this normal? Also what are the guidelines for alcohol with Sertraline? As regards sexual side effects, I haven't experienced any real change,which is good news!
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Dear Russell,
Good to hear from you and that Sertraline is making you feel better. Your feeling "out of it" ma be a side-effect, and if it is, it will abate by time. About alcohol my advice would be to refrain, though some wine during meals may be allowed. Though others here can perhaps advise you better. Though in my case I do take some liqour every if an opportunity arises, but surely not on a regular basis.
Your healthy minds appointment is very soon so the best of luck ..... in that I hope you'll find some professional who really listen and maybe make a clear diagnosis!
Grace
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Dear Russell, I have just read what I have wirtten and here is the revised vesion:
Good to hear from you and that Sertraline is making you feel better. Your feeling "out of it" may be a side-effect, and if it is, it will abate by time. About alcohol my advice would be to refrain, though some wine during meals may be allowed. However others here can perhaps advise you better. In my case I do take some wine furing meals and some liqour if an opportunity arises, but surely not on a regular basis.
Your healthy minds appointment is very soon so the best of luck ..... in that I hope you'll find some professional who really listens and maybe make a clear diagnosis!
Grace
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Hi Russell. The majority of anti-depressants can cause a spaced out feeling, especially at higher doses. Pfizer, who synthesized Sertaline, published the side effects that people experienced in clinical trials. 13% of people experienced "somnolence." I guess what you get could be termed that without stretching the meaning of somnolence to breaking point. I would say what you're getting is a side effect.
Pfizer recommend avoiding alcohol. They also advise avoiding grapefruit juice. But I have known people drink on all the SSRI's and nothing has ever happened. What you are usually being advised to avoid is potentiation. This is where taking two drugs produces an effect that is greater than the simple addition of the effects of the two. I don't think Alcohol and Sertraline have that relationship. But Pfizer do recommend avoiding alcohol so there must be some kind of possible hazard.
Good luck with Healthy Minds. I hope their package of services matches what you need.
Love
Steve
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Just back from first Healthy Minds session. Bi-polar is suspected and also that I may be on the wrong meds! Counsellor was surprised at how my case has been dealt with by GP's so far and is referring me to a specialist. Feel totally drained and very tearful after this first session,is this normal? Have to go into work now,but truthfully feeling like going to bed for 6 hours. Got another appointment for next week,so things should start moving now.
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Hello Russell,
Thank you for the good news! In fact many of us here were suspecting this kind of diagnosis and that you were probably not on the right medication! I do understand your feeling drained and tearful. These appointments do take a lot of energy ..... but isn't it a relief to know that you will be in better hands, and that your depression will be better delat with?
You are in my thoughts Russell!!
Grace
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I am glad things went well this morning. I can remember writing a while back that I would like to see you with a tentative diagnosis of Bipolar, a referral to your Community Mental Health Team for a definitive diagnosis, and a prescription for Depakote. Well you have achieved two out of the three. Healthy Minds obviously don't have the personnel to write prescriptions.
I am afraid you may be about to enter your second waiting list. I have never run across a CMHT that didn't have one. I decided I wanted to see my psychiatrist and was given an appointment 8 weeks into the future. And I am already on their books. But many CMHT's don't confine diagnosis to psychiatrists. In the team I deal with all the different professions except the Occupational Therapists see new patients and make diagnoses. That speeds things up and cuts waiting times. The psychiatrist gets to see the complex and problematic cases. That certainly doesn't apply to you.
Diagnosing you as Bipolar is pretty much a formality. The symptoms you have experienced will scream Bipolar at any clinician. But Bipolar comes in two varieties One and Two and it will be necessary to work out which you are experiencing. Then there is the possibility of you entering your third waiting list. Unless you see a psychiatrist for your first visit you'll need to see one to prescribe appropriate medication. I acquired a diagnosis and then had to wait 6 weeks to get hold of a prescription. The team I use is unbalanced. It has 8 or 9 Community Psychiatric Nurses, half a dozen Social Workers but only one Psychiatrist. An additional psychiatrist would transform the service they are able to offer. Hopefully Solihull have their staffing better sorted out.
If I were you I would give some thought to what you are going to do with your GP and with Sertraline. I would be going to my GP and telling them that I now had a tentative diagnosis of Bipolar. I would ask to be taken off Sertraline and put on a mood stabilizer on a trial basis until things are finally tied up with the CMHT. You seem to have been pretty stable for a while but I can't help thinking you have had a strong element of luck. For a while you were quite ill and your mood cycling was rapid. The working definition of rapid cycling is more than three or four complete cycles in a year. You were certainly exceeding that.
It doesn't seem right that you should have to work your way through the CMHT system before you are on an appropriate drug. I'm assuming that Healthy Minds have taken you on for once a week counselling. That is significant progress. Good luck with waiting times.
Love
Steve