Advice needed

[Jo79]

Well I bit the bullet and gave the 15mg a go last night. I didn’t sleep any better than on 30mg and feeling quite depressed this morning 😒 so think I’ll be more comfortable staying at 30mg for now and will just deal with the days of irritability and agitation as they come and go.

[panic_down_under]

Well I bit the bullet and gave the 15mg a go last night. I didn’t sleep any better than on 30mg and feeling quite depressed this morning

Mirtazapine has a longish half-life, up to 2 days so a single change in dose probably won't have much affect. It may take up to 8 days for its plasma levels to stabilise to a new steady-state.

[Jo79]

I’m assuming because it’s the next step n the NICE guidelines 😏

“Vortioxetine is recommended as an option for treating major depressive episodes in adults whose condition has responded inadequately to 2 antidepressants within the current episode”.

She did suggest the option of trying other SSRI’s into our previous discussion, and suggested giving Citalopram another go, but seems very keen on Vortioxetine.

Whatever I choose I will have to wean off the ven first. I was hoping she would say I can cross taper but I’m on two other meds which could make it a bit dodgy.

Anyway, I’m still crossing my fingers that the mirtazapine increase will help and it won’t come to that 🤞

[panic_down_under]

I’m assuming because it’s the next step n the NICE guidelines 😏

“Vortioxetine is recommended as an option for treating major depressive episodes in adults whose condition has responded inadequately to 2 antidepressants within the current episode”.

Sigh. The NHS must be run by retired regimental sergeant majors. "If patient has A, prescribe X...if X fails apply Y..." I don't know why they bother employing doctors. They could probably train a chimp to hand out prescriptions based on the guidelines within a few days. Heck, the robots that trundle around the wards of my favourite hospital delivering meds could likely do it with a few tweaks to their programming.

She did suggest the option of trying other SSRI’s into our previous discussion, and suggested giving Citalopram another go, but seems very keen on Vortioxetine.

So you've effectively already tried at least two SSRIs, citalopram and venlafaxine without success so her answer is yet another one, albeit with the added twist of also having some effect on 5-HT1a receptors. An old trick to resuscitating pooped-out SSRIs, or increasing the effectiveness of those which are nearly, but not quite working 100% effectively is adding the 5-HT1a agonist buspirone (Buspar) to the mix. Vortioxetine is basically a SSRI with added buspirone like properties. It hasn't exactly set the world on fire. I suspect the problem is the amount of 5-HT1a action is fixed whereas it can be fine tuned with buspirone+SSRI combination. Unfortunately, in its infinite wisdom the NHS apparently don't approve of buspirone.

Whatever I choose I will have to wean off the ven first. I was hoping she would say I can cross taper but I’m on two other meds which could make it a bit dodgy.

It wouldn't be that hard, but for the lack of confidence. And that's the problem with the prescribing by the numbers approach. Reduces people to cogs in the machine with no confidence, so no initiative or innovation either.

</soapbox>

[sparky10]

Whatever happened to TRISTAN?? not seen him on here in quite some time and he was in a bad way?