#treatmentresistantdepression — Public Fediverse posts

SleepyCatten's log.

Earth date: 2024-07-21.

As of yesterday, we're down to 25 mg venlafaxine. Although we've only been prescribed 100 mg sertraline, we had sufficient spare 50 mg tablets to increase our sertraline dose to 125 mg daily, which has offset the reducing venlafaxine dose.

We've got a phone appointment with our NHS GP this coming Wednesday (the date we're completely stopping venlafaxine) to formally request an increase to 150 mg daily of sertraline.

The 150 mg bupropion extended release is continuing to work its magic, but it's been a bit limited by us physically and mentally pushing ourselves further than we should have for chores, looking after wife, etc.

We're still waiting for our backup supply of sertaline to arrive from an IndiaMart seller, so if the official sertraline prescription difficulties continue, we won't be at risk of running out.

We've said this before, but honestly we're just SO looking forward to being off venlafaxine entirely.

#MentalHealth #depression #TreatmentResistantDepression #SNRI #SSRI #NDRI #venlafaxine #sertraline #bupropion #SleepyCattenLog #AuDHD #ActuallyAuDHD #ADHD #ActuallyADHD

SleepyCatten's log.

Earth date: 2024-07-13.

As of yesterday, we're down to 75 mg venlafaxine and up to 100 mg sertraline, alongside our 150 mg bupropion. Can't wait to be entirely off venlafaxine now.

Definitely getting the feeling already that 100 mg sertraline won't be enough by itself, so getting ready to ask for an increase in the prescription to 150 mg sertraline daily.

The bupropion is continuing to work its magic. Having to get reaccustomed to hyperfocusses though... and not getting snappy if someone interrupts them 😅

Also, looks like we picked a fun time to move to sertraline: many pharmacies are having trouble getting hold of it 🙃

Guess what we've just ordered on IndiaMart to give us a backup supply?

#MentalHealth #depression #TreatmentResistantDepression #SNRI #SSRI #NDRI #venlafaxine #sertraline #bupropion #SleepyCattenLog #AuDHD #ActuallyAuDHD #ADHD #ActuallyADHD

SleepyCatten's log.

Earth date: 2024-07-04.

We're down to 125 mg venlafaxine daily, along 50 mg setraline and 150 mg bupropion.

We've made a minor adjustment to our original scheduled regimen. On 6th July, when our venlafaxine dose decreases to 112.5 mg, we'll up our setraline dose to 75 mg then, rather than increasing it straight up to 100 mg on 12th July without an intermediate step. (It helps to have a precise pill cutter.)

What's kinda funny is that the longer we're on bupropion, the more we're acting a bit more like a stereotypical combined / hyperactive ADHD person on ADHD meds allowing them to focus. But unlike how other ADHD meds work (i.e., they may be short-lived, or last for maybe part of a day), the effect on bupropion is constant.

We're still having to be careful, as despite having the mental energy to do more stuff, we keep pushing ourselves too hard and overloading ourselves, particularly our speech centre. (Yep: we can go completely non-verbal if we overload.)

NGL though: bupropion is awesome and it's a disgrace that the NHS won't prescribe this in the UK. It could help SO many people with ADHD and depression!

#MentalHealth #depression #TreatmentResistantDepression #SNRI #SSRI #NDRI #venlafaxine #sertraline #bupropion #SleepyCattenLog #AuDHD #ActuallyAuDHD #ADHD #ActuallyADHD

SleepyCatten's log.

Earth date: 2024-07-01.

Yesterday we finally got down to 150 mg of venlafaxine, meaning we could start cross-tapering with setraline :MentalHealthFlagButterfly:

Today's mental health regimen was:

• 150 mg venlafaxine prolonged release
• 150 mg bupropion extended release
• 50 mg setraline

Our venlafaxine dose will continue to decrease by 12.5 mg every 2 days. When we reach 75 mg daily on 12th July, we will be increasing our daily sertraline dose to 100 mg.

Our last dose of venlafaxine will be on 23rd July. From 24th July onwards, we will officially be off venlafaxine, and we indeed to stay that way.

We won't know for a while whether 100 mg sertraline will be sufficient for us, but we have the option to ask our GP surgery to increase it further if we tolerate it well and it's helping.

We don't want to up our bupropion dose, as 150 mg already seems to be massively helping. Also, SSRIs and NDRIs kinda make each other more potent, so we want to be very careful there.

Also, bupropion is both helping with some aspects of our ADHD, whilst bringing others more to the surface 😅

Before bupropion, we would have said we meet the criteria for either inattentive or combined ADHD. On bupropion, we're much more hyperactive, but we're also able to mostly channel the energy into productive tasks, albeit via task hopping sometimes if we're tired.

It's also giving us way more energy and alertness, but with the downside that we can now limit break, causing us to keep going until we crash hard. (We've crashed our language centre twice. Hannah had to step in to tell Evie what to write via WhatsApp messages to Evie's wife to explain.)

Our thinking is also a lot clearer, but we're making a lot more silly errors when typing. Plus we can hold more than 3 things in our head at a time now (!!!), but we might forget the thing you just told us a moment ago 😅

It's swings and roundabouts. Overall very positive though.

#MentalHealth #depression #anxiety
#TreatmentResistantDepression #SNRI #SSRI #NDRI #venlafaxine #sertraline #bupropion #SleepyCattenLog #AuDHD #ActuallyAuDHD #ADHD #ActuallyADHD

SleepyCatten's log.

Earth date: 2024-06-18.

First day of being down to 225 mg of venlafaxine. Emotions definitely getting more prominent. Countermeasures have been deployed to maintain equilibrium.

No symptoms of serotonin syndrome yet from taking 150 mg bupropion extended release alongside the venlafaxine prolonged release.

Despite the bold warnings about the risk of serotonin syndrome, the reported cases are almost exclusively where folks have overdosed on their medications. Conversely, our venlafaxine dose is lowering and we will keep our bupropion dose steady until we have successfully switched from venlafaxine to an SSRI at a stable dose.

#MentalHealth #depression #anxiety #TreatmentResistantDepression #SNRI #SSRI #NDRI #venlafaxine #sertraline #bupropion #SleepyCattenLog

SleepyCatten's log.

Earth date: 2024-06-17.

Last day of 237.5 mg venlafaxine daily now before we go down to 225 mg.

Now that our venlafaxine dose has been significantly reduced, today marks our first official day of taking a bupropion 150 mg extended release tablet alongside.

We were originally going to wait until we had fully switched over from venlafaxine to setraline, but we need the boost in noradrenaline and dopamine levels sooner.

We are still on course to reach 150 mg venlafaxine on 30th June, at which point we will begin taking 50 mg sertraline alongside.

Once we have reached 75 mg venlafaxine daily on 12th July, we will increase our setraline dose to 100 mg, assuming that we've had no bad reaction to the setraline by then.

Our last dose of venlafaxine is scheduled for 23rd July, at which point we will be on 100 mg sertraline and 150 mg bupropion daily.

#MentalHealth #depression #anxiety #TreatmentResistantDepression #SNRI #SSRI #NDRI #venlafaxine #sertraline #bupropion #SleepyCattenLog

SleepyCatten's log.

Earth date: 2024-06-16.

We're down to 237.5 mg venlafaxine daily now.

How much is it affecting us?

We're starting to think that the Americans were right to change S to Z in words where there's a -ze or -zing sound at the end.

e.g., realise / realising --> realize / realizing

Coming off venlafaxine is no joke, folks.

#MentalHealth #depression #anxiety #TreatmentResistantDepression #SNRI #SSRI #NDRI #venlafaxine #sertraline #bupropion #SleepyCattenLog

SleepyCatten's log.

Earth date: 2024-06-08.

We're down to 287.5 mg venlafaxine daily now. Really beginning to feel how much it might have been helping to control some of our ADHD side 😅

• Our short-term memory is definitely being negatively affected.
• We've simultaneously got more energy and no focus to it.
• Our short-term memory is struggling.

Nonetheless, we're continuing onwards, and hoping that we can use techniques to keep us focussed and on task, until we can start making the cross-tapering switch to sertraline.

We won't be able to get bupropion (an NDRI - noradrenaline-dopamine re-uptake inhibitor) prescribed to go alongside this, but let's just say we know affordable ways around this.

#MentalHealth #depression #anxiety #TreatmentResistantDepression #SNRI #SSRI #NDRI #venlafaxine #sertraline #bupropion #SleepyCattenLog

SleepyCatten's log.

Earth date: 2024-06-06.

We're now down to 300 mg of venlafaxine daily, from a starting point of 375 mg on 2024-05-26.

We're still on target to be down to 150 mg by 30th June to start cross-tapering with sertraline.

Our sleepiness appears to be decreasing, at least in terms of the need for a daily nap after work, but it feels like our reading comprehension has decreased a bit currently.

We're still feeling a bit headachy and more emotional, but these are to be expected and we're taking steps to keep them under control.

#MentalHealth #depression #anxiety #TreatmentResistantDepression #SNRI #SSRI #venlafaxine #sertraline #SleepyCattenLog

SleepyCatten's log.

Earth date: 2024-06-02.

We've started block 4 of the venlafaxine reduction. Our daily dose is now 325 mg.

At the current rate, we should be down to 150 mg by 30th June, so we should be able to begin sertraline at 50 mg by then.

We're feeling a bit sleepy and a bit headachy, but nothing major. We've had a surprisingly productive day and didn't feel the need for a nap.

So far, reducing our dose at a rate of 12.5 mg every 2 days seems to be keeping any major withdrawal effects at bay.

We don't intend to keep doing a daily log, but we'll try to keep doing updates when possible.

#MentalHealth #depression #anxiety #TreatmentResistantDepression #SNRI #SSRI #venlafaxine #sertraline #SleepyCattenLog

SleepyCatten's log.

Earth date: 2024-06-01.

We've been reducing our venlafaxine dose by 12.5 mg every 2 days.

We're in the 3rd reduction block now, so we've gone from 375 mg last Sunday to 337.5 mg yesterday and today.

Whilst we're not feeling any strong common side effects from the withdrawal, we are noticing that:

• our focus and attention are a little all over the place.
• we're a bit more emotional.
• we're a bit more forgetful than usual.

Some of these could be attributed to external life stuff though, so it's hard to be sure what's being caused by the steady reduction in venlafaxine dose.

No brain zaps so far though.

What we will say is that it's kind of crazy when we hear or read about any medical professional recommending coming out venlafaxine at 75 mg weekly!!!

Trust us when we say that you need to come off venlafaxine slowly.

By most accounts, we're doing a fast reduction because we need to get down to 150 mg before our GP will prescribe us a starting dose of 50 mg of sertraline, so we can begin the switch to that.

And even at our current pace, it will take us 5 weeks to get down to 150 mg from 375 mg.

In venlafaxine terms, that's practically a speedrun.

#MentalHealth #depression #anxiety #TreatmentResistantDepression #SNRI #SSRI #venlafaxine #sertraline #SleepyCattenLog

• SNRI - serotonin-noradrenaline reuptake inhibitor
• SSRI - selective serotonin reuptake inhibitor
• NDRI - noradrenaline-dopamine reuptake inhibitor

Hey folks

As many of you will know, we've been struggling a lot rather too frequently recently.

After a lot of research and reading up, we asked our GP to switch us over from venlafaxine (SNRI) to setraline (SSRI).

In order to do this, we first need to slowly titrate down from 375 to 150 mg daily of venlafaxine. It needs to be done slowly, as coming off venlafaxine too quickly (or even missing a dose) can cause super nasty withdrawal symptoms.

Fortunately for us, the venlafaxine capsules we get (Vencarm XL) each contain an appropriate number of 12.5 mg tablets. This makes it very easy to titrate down slowly, by removing a set number of tablets from each capsule.

We'll be gradually reducing our dose by 12.5 mg every other day. This should hopefully allow our brain to gradually adapt to the lessened serotonin and noradrenaline levels, rather than going down in single big steps of 37.5 or 75 mg weekly.

Our GP will then prescribe us 50 mg sertraline daily to take alongside as we continue to titrate down our daily venlafaxine dose.

Assuming no negative side effects (or at least no more than on venlafaxine), our GP can then increase the setraline dose as required, likely to 100 mg.

If there are negative side effects with sertraline, we have backup plans of fluoxetine and, if necessary, citalopram (which we've had before).

Once we're off venlafaxine and on a stable dose of an SSRI, we will then start taking bupropion (NDRI) extended release at the starting dose of 150 mg daily. This should help boost our noradrenaline and dopamine levels somewhat, which should, alongside the setraline, should help more than venlafaxine ever did.

We sadly can't get bupropion through the NHS, so we'll have to acquire it via means outside of the NHS prescription system. Yes: NHS England and NICE are quite a bit behind the times on many things.

In case anyone is wondering why we would even consider an initial switch from an SNRI to an SSRI in the first place, it's because we discovered that it really doesn't boost noradrenaline levels by much: as little as 1/30th to 1/10th as much as it boosts serotonin, depending on dose.

Additionally, venlafaxine just isn't working for us, and our only realistic remaining option medically is to switch to an SSRI first, then bring in a well-reviewed NDRI to give us a decent boost in noradrenaline and dopamine.

#SNRI #SSRI #NDRI #venlafaxine #sertraline #fluoxetine #citalopram #bupropion #depression #TreatmentResistantDepression #MentalHealth

Terms

• SSRI = Selective Serotonin Reuptake Inhibitor
• SNRI = Serotonin-Noradrenaline Reuptake Inhibitor
• NDRI = Noradrenaline-Dopamine Reupdate Inhibitor

(Please note that we're using noradrenaline instead of norepinephrine.)

For those of you who've followed our mental health updates, you will have noticed that our mental health has declined overall over the last year.

We started back on venlafaxine (an SNRI) at 150 mg, and then slowly titrated back up to 300 mg. We are now at the maximum daily dose of 375 mg.

Despite this keeping us from spiralling entirely into the void, we're increasingly realising that it's not enough, and we increasingly suspect that we have treatment-resistant depression.

We have already taken multiple additional steps to reduce feelings of depression and anxiety in our life.

e.g.,

• We've had a lot of productive and helpful therapy sessions.
• We're fully aware of the various techniques to prevent negative thought spirals and build resilience.
• We've taken all possible steps to avoid triggering news articles and social media posts.
• We have a strong support network.
• We have many reasons in our life to keep pushing on.

Despite all this, it's not enough. Every single day is a struggle and we're constantly tired.

The heightened noradrenaline is sometimes the only thing giving us any energy, and the serotonin is the only thing balancing out our lows.

We've reached out to the practice manager at our GP surgery to ask them to refer a query to the senior partner there. We havea sked for an unapproved combination of an SSRI and an NDRI in place of the SNRI we're currently on.

This might seem like an easy ask, but no NDRIs are licensed in the UK for the treatment of depression. Bupropion is available on prescription, but only to assist with smoking cessation.

We don't really have a choice of just stopping and getting signed-off work as unfit for work. We've already used up all our full-paid sick pay and we cannot afford to go on half-pay.

There's no actual safety net in the UK if you're unable to work for any length of time for mental health reasons. Eventually you'll eventually run out of statutory pay too and be denied for benefits like Personal Independence Payment.

You are more than welcome to offer thoughts here, but we mostly just wanted to vent and give you all an update :MentalHealthFlagHeart:​

#MentalHealth #depression #anxiety #SSRI #SNRI #NDRI #venlafaxine #TreatmentResistantDepression