# Now on Mirtazapine



## RockiNToM (Jun 15, 2009)

So I finally got my doctor to prescribe me another type of anti-depressant. The only other one left was Mirtazapine. I was a bit reluctant at first because the weight gain side-effect I've read about scares me a little, but in the end I decided that I'd rather just feel better, so I decided to go on it.

So my dose of Effexor has been dropped to 37.5 mg from 75 mg for 4 days while I take 15 mg Mirtazapine as well. For the first day doing this while only taking 37.5 mg from 75 mg of Effexor I felt pretty fine, no adverse effects, no withdrawals, nothing. So then in the evening I took my Mirtazapine like I was supposed to, and then for some reason I had the worst reaction I have had to any med ever. First I felt really sleepy, which was expected, then as I drifted to sleep one leg started getting restless while the other was fine. So at the point I couldn't sleep, but I needed to. Then, as I tried to get to sleep because my restless leg was preventing me, I had the weirdest, most drugged up type of feeling I have ever had. I felt like I was hallucinating, getting extremely bad negative thoughts (Horrible images in my head, that were terrifying). I was freaking out, but there was nothing I could do, I was too drugged up to do anything. In the end, I did fall asleep, and when I woke up it was 15hrs later... All day today since waking up, I have been feeling the most depressed, and suicidal I have felt in a long time. Everything I just seem to think and feel is negative, and amongst this I am irritable and bad tempered.

I just don't know what to do. Shall I keep taking the mirtazapine or do I just stop? This reaction is only after one dose, so I'm thinking for the sake of my sanity, about not taking it... But at the same time, part of me thinks it might all go away in a few days when I keep taking it and more of it is in my system. However I am struggling to rationalise taking it further while I feel so bad. I hope that makes sense.

So I'm in a tricky situation, and any advice about this would be greatly appreciated.


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## arth77 (Jun 4, 2009)

since they are different types of antidepressants it seems you need an AD free wash out period of about 10 days to get the effexor out of your system

also the new AD starting dose may need to be lowered for a while

many anxiety sufferers have severe reactions or side effects to new antidepressants, which sadly some docs wont accept


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## RockiNToM (Jun 15, 2009)

I've been on 5 different medications over the years, and never have I EVER had this type of reaction.

It isn't because I am anxious or whatever either. There is an actual DIFFERENCE. I went into starting this med very positive and actually happy at trying something else. Then I took it, and then I had this strange reaction. I could understand if I was anxious or apprehensive to begin with, but I wasn't. It's like it messed something up in my head. It actually induced depression rather than helping it. 

Understandably I am reluctant to take it now because I don't want to risk feeling this way again.


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## Jrock (Dec 16, 2008)

I think you should quit taking until you consult your doc.


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## RockiNToM (Jun 15, 2009)

I didn't take it last night, and already then felt mildly better. However today, I still feel depressed and suicidal, so either mirtazapine just added the final touch and/or I am already feeling that way due to reduced dose of Effexor. 

I tred to contact my doctor today, but I was told the earliest time I could be seen was next week. What a crock of ****.


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## Ash09 (Apr 27, 2009)

Could well be suffering withdrawl, just increase your dose and see if it goes away.


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## IllusionalFate (Sep 10, 2008)

Those results are common with Mirtazapine. If you can't handle its effects then I would completely wean off of Effexor before restarting treatment.


Wikipedia said:


> Mirtazapine has mild psychedelic effects which are occasionally encountered by some of its patients. Reports include vivid, bizarre, or even lucid dreams, and auditory and visual hallucinations. These effects tend to be most prominent upon first commencing treatment and usually dissipate with time.


Wikipedia also lists agitation and Restless Legs Syndrome as side effects, but after the list containing both of them it mentions that "Most of these side effects are generally mild and become less prominent with consistent dosing over time."

Your depression and suicidal idealization are being mediated by the Effexor tapering, at least that's the most likely rationale for them.


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## RockiNToM (Jun 15, 2009)

It could well be the Effexor, but I felt that the Mirtazapine worsened the effect. I'm now on day 2 of the reduced Effexor (at 37.5mg) and I didn't take Mirtazapine last night, and already I feel better. I still feel depressed and suicidal but it slightly less extreme, plus I don't have other crazy effects from when I first took Mirtazapine. 

Despite everything that's happened, I think I'm going to try and persevere with the Mirtazapine. I just hope, I get better. Tonight I'm gonna take it and I pray that things are slightly better this time round. I've never felt so bad on any medication ever before so this reaction is quite surprising.


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## euphoria (Jan 21, 2009)

It's hard to say exactly what caused you to feel so bad; it was probably a combination of coming off Effexor and the side-effects of mirtazapine. You might want to try mirtazapine again once the withdrawal has passed, as then you'll get a clear view of its positives and negatives.


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## RockiNToM (Jun 15, 2009)

Ok, so this may seem really weird, but on the second day of taking Mirtazapine I felt like I hadn't even taken it... I had no drowsy effects, no depressed or suicidal feelings, nothing. The only thing that is starting to kick in is the withdrawals, as today I'm getting brain zaps, dizzy spells, etc - all of which are definite signs of Effexor withdrawal.

Despite all that is happening or that has happened, today for the first time in what seems like ages, I'm starting to feel brighter and generally less apathetic towards everything. I actually enjoyed watching a movie today, which is something I haven't done in quite a while. Most of the time before, watching a movie felt like I was just watching a moving image onscreen and nothing more - this all while I was on SSRI/SNRI's. So that to me shows how much they affected my ability to enjoy and be engaged into things, which is something I was severely lacking. Either that, or I have been severely depressed for a long time and not realised it, and I'm just starting to feel better. Who knows.


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## RockiNToM (Jun 15, 2009)

Also, I'm starting to notice a trend. I'm on 15mg which I take at night, and for the first few nights it knocked me out, but now it doesn't fully knock me out. I don't really get tired at all or anything. I still sleep sure, but I have no problems getting up in the morning or anything, which I was kinda expecting, since I had this problem on SSRI/SNRIs. Weird.


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## jim_morrison (Aug 17, 2008)

RockiNToM said:


> I still sleep sure, but I have no problems getting up in the morning or anything, which I was kinda expecting, since I had this problem on SSRI/SNRIs. Weird.


Mirtazapine enhances REM sleep, while SSRI/SNRI's decrease it. So even though Mirtazapine can make you sleepy immedietly after taking it due to it's sedative nature, I find it makes you less tired/fatigued overall because you get a better and more natural quality of sleep every night.


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## RockiNToM (Jun 15, 2009)

Yeah, I kinda figured that. But I still don't get why it doesn't knock me out like it's supposed to. Last night I took it at 12am and I didn't sleep until around 3am..


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## jim_morrison (Aug 17, 2008)

RockiNToM said:


> Yeah, I kinda figured that. But I still don't get why it doesn't knock me out like it's supposed to. Last night I took it at 12am and I didn't sleep until around 3am..


You may have to up the dose to 30 mg, anything less than that doesnt knock me out. 
Also it tends to take about 2 hours to kick in usually, so try taking it earlier in the night.


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## RockiNToM (Jun 15, 2009)

Really? I thought 15mg was the most sedating dose.

Anyway, currently this med is really not doing anything for me at all, and I actually feel like I am getting more depressed... I'm gonna speak to my doctor about getting a higher dose, but I kinda feel inclined to just quit it. Would this be possible? I've only been on it a few weeks and as it's making me more depressed I just want to come off. I'm hoping that if I do quit I won't getting any withdrawals, but you never know for sure...

Edit:

I've just remembered by going through my old CBT diaries while I was on other anti-depressants, that for my depression side of things on Zoloft was actually getting better. But Zoloft didn't work so well for my anxiety so I'm thinking maybe Mirtazapine and Zoloft together might be more helpful rather than just increasing the Mirtazapine on its own. 

The general feeling I get from Mirtazapine is not a feeling I get from any other anti-depressants - it doesn't feel like it's working on my mood in terms of stopping the darkness of depression... For my anxiety I think the sedation of the medication is doing something as I haven't had any panic attacks or problems with anxiety so far and I'd like to stick to the 15mg of mirtazapine for that. So I'm thinking a 25mg of Zoloft to start with might be something to try along side Mirtazapine.

What do you think?


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## jim_morrison (Aug 17, 2008)

RockiNToM said:


> Really? I thought 15mg was the most sedating dose.
> 
> Anyway, currently this med is really not doing anything for me at all, and I actually feel like I am getting more depressed... I'm gonna speak to my doctor about getting a higher dose, but I kinda feel inclined to just quit it. Would this be possible? I've only been on it a few weeks and as it's making me more depressed I just want to come off. I'm hoping that if I do quit I won't getting any withdrawals, but you never know for sure...
> 
> ...


Yeah if your on 15 mg your probly not going to get any antidepressant effects, the threshold dose for that is 30 or above mgs.

As for the sedation, I know that some literature claims that lower doses are more sedating, but to be honest I found it to be more sedating at higher doses.

In relation to mood improvement, I see no problem with adding zoloft, many people have succesfully added Mirtazapine to an SSRI or SNRI in the past. 
Just talk to your doctor about increasing the Mirtazapine dose and adding the zoloft first ofcourse.

Good luck.


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## euphoria (Jan 21, 2009)

RockiNToM said:


> The general feeling I get from Mirtazapine is not a feeling I get from any other anti-depressants - it doesn't feel like it's working on my mood in terms of stopping the darkness of depression... For my anxiety I think the sedation of the medication is doing something as I haven't had any panic attacks or problems with anxiety so far and I'd like to stick to the 15mg of mirtazapine for that. So I'm thinking a 25mg of Zoloft to start with might be something to try along side Mirtazapine.
> 
> What do you think?


It's not the sedative effects that bring anxiety relief, it's the way in which mirtazapine blocks serotonin receptors that'd normally be producing anxiety.

Mirtazapine + sertraline? Go for it. These combinations have been reported to produce hypomania, which is always an indicator of efficacy. I'm actually using mirtazapine and an SSRI myself very shortly, along with some other stuff. If your doctor says there is any sort of risk combining them together, ask him to wipe the dust off the pharmacology books on his shelf.

Oh, and 15mg is way too small of a dose if you have significant problems. Keep in mind that up to 180mg has been used on inpatients without adverse reactions.


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## RockiNToM (Jun 15, 2009)

Yeah I hear combinations work quite well. They seem to cancel each others side-effects but keep the positives.

Can I ask to what advantage does 180mg provide? I would imagine that it stops being more effective at a certain dose. I hear 45mg is the most effective dose, and anything higher doesn't do much.


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## euphoria (Jan 21, 2009)

180mg is a bit ridiculous, yeah, but the effects would just be a much stronger version of what they're like at 15mg. At some point though, you would probably reach an upper limit on effects because (AFAIK) mirtazapine only has the ability to block serotonin on those receptors, and there's only a certain amount of serotonin at any given time. Of course, this limit would change if you were on sertraline.

Actually you'd probably be tripping balls at that dose, due to mirtazapine's weak effects on 5-HT2A (the psychedelic receptor).


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## MissMay1977 (Oct 25, 2008)

My bf Noca is on 45mgs of Remeron and says it works great for him with little to none side effects. He says the higher dose helps take away the drowsiness side effect but its still a long way from being anything like a stimulant.


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## RockiNToM (Jun 15, 2009)

I've been trying 30mg for a couple of nights and gradually I've noticed my mood is getting worse. Today I am feeling extremely depressed and upset over nothing. I feel like someone I know has just died. So not a good feeling. 

I'm starting to wonder if Mirtazapine just isn't the medication for me. I mean, don't get me wrong, it does some things much better than SSRI/SNRIs but my mood is just terrible. I really wanted it to work, but the longer I try to stay on it the worse I keep feeling over time. I think I may just give up on anti-depressants altogether for a while and see how I feel about things.


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## jim_morrison (Aug 17, 2008)

RockiNToM said:


> I've been trying 30mg for a couple of nights and gradually I've noticed my mood is getting worse. Today I am feeling extremely depressed and upset over nothing. I feel like someone I know has just died. So not a good feeling.
> 
> I'm starting to wonder if Mirtazapine just isn't the medication for me. I mean, don't get me wrong, it does some things much better than SSRI/SNRIs but my mood is just terrible. I really wanted it to work, but the longer I try to stay on it the worse I keep feeling over time. I think I may just give up on anti-depressants altogether for a while and see how I feel about things.


It's a shame that the SSRI/SNRI's and mirtazapine havn't worked for you, perhaps you should try out one of the old TCA antidepressants, or even a beta blocker to reduce the physical sypmtoms of SA, and if that doesn't work then try to find a doctor willing to prescribe MAOI's or Benzo's I guess.


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## Medline (Sep 23, 2008)

jim_morrison said:


> It's a shame that the SSRI/SNRI's and mirtazapine havn't worked for you, perhaps you should try out one of the old TCA antidepressants, or even a beta blocker to reduce the physical sypmtoms of SA, and if that doesn't work then try to find a doctor willing to prescribe MAOI's or Benzo's I guess.


TCAs have never shown to be effective for SA and have pretty bad side effects.


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## RockiNToM (Jun 15, 2009)

Well, I have both anxiety and depression which is one of the reasons why I needed an anti-depressant. Sure there are benzos for helping the anxiety, but what good are they when my mood is up and down? So I need something to help my mood as well as my SA. Thing is, I don't think such a medication exists and if it does my doctor probably won't prescribe it. Maybe I should just give up.


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## euphoria (Jan 21, 2009)

RockiNToM said:


> Well, I have both anxiety and depression which is one of the reasons why I needed an anti-depressant. Sure there are benzos for helping the anxiety, but what good are they when my mood is up and down? So I need something to help my mood as well as my SA. Thing is, I don't think such a medication exists and if it does my doctor probably won't prescribe it. Maybe I should just give up.


MAOIs? If your doctor won't prescribe one, he is an idiot, but you can easily get one yourself. I'm sure you could get a script for moclobemide.

Are you not seeing a psychiatrist? Doctors are the wrong people to go to for mental health issues, and are usually very limited in prescribing power.


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## Medline (Sep 23, 2008)

euphoria said:


> MAOIs? If your doctor won't prescribe one, he is an idiot, but you can easily get one yourself. I'm sure you could get a script for moclobemide.


Moclobemide is weak compared to the unselective & irreversible MAOIs in real life.


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## RockiNToM (Jun 15, 2009)

I was seeing a psychiatrist 3 yrs ago but he retired and back then I didn't really think it was much of a problem with my doctor taking over (as silly as that may sound). So, my GP has taken over his duties and monitors me. I've complained several times that I need someone who is a specialist in mental health to help me as I require more help than what is given to me, but my GP doesn't listen... The fact I was referred to a mental health team and to a psychiatrist before surely speaks for itself but no...


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## RockiNToM (Jun 15, 2009)

Guys and gals, I need some advice. I want to stop taking Mirtazapine because today really just was the final straw. I've been generally feeling bad, and it seems to have worsened since increasing my dose to 30mg over the past 2 days. So I'm coming off it, I've had enough. So my question to you all is, I've only been on this just over 2 weeks would I be able to quit it cold turkey or would I still need to taper?


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## honastud (Jul 13, 2009)

RockiNToM said:


> . So then in the evening I took my Mirtazapine like I was supposed to, and then for some reason I had the worst reaction I have had to any med ever. First I felt really sleepy, which was expected, then as I drifted to sleep one leg started getting restless while the other was fine. So at the point I couldn't sleep, but I needed to.


Sounds like me when I had my first *seizure*.
Don't take anymore. I have a feeling this is what happened to you rather than RLS


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## RockiNToM (Jun 15, 2009)

I doubt very much that I had a seizure, just a weird reaction.

Anyway, I'm coming off the stuff I cba with any of it anymore. I feel like I am wasting my time trying things I know won't work. I can't go outside the serotonin anti-depressant circle either as my doctor doesn't believe in trying other medications so that means I'm screwed. I can't be bothered anymore, I really can't.


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## gadman80 (May 10, 2009)

*MIrtazapine*

Hey Tom I felt the same way as you did maybe its time for a new Doc.....

I have been on Mirtazapine for about 45 days the first month I started at about 30mg..now for the past 2 weeks I have been on 45mg. The first few nights when I started out I really did feel the histamine effects. I slept about 10-12 hours the first 3 days I started it and after that I was pretty tolerant of any histamine effects. I could take it after the first week even if I only had 5 hours sleep and I was fine..a little harder to wake up but still managable..I realized that I did become somewhat more lazy but I just pushed myself out the door everyday. At 30mg I have not noticed any weight gain soo far. If I let the drug take control I probably would because it makes me again feel lazy, not tired..but I can't complain. Now as for my general symptoms at 30 mg I have noticed alot of negative thinking just vanish. I notice now that when I am sitting around doing nothing I am not always constantly thinking negatively about myself. As for the GAD I did not notice any signifigant changes....Now 2weeks in I did not take Mirtazapine for 3 days just to see what would happen...I felt nothing out of the ordinary but I did notice by the 3rd day alot of my negative thinking resumed..no withdrawal. At 45 mg for 2 weeks I still feel exactly the same. Thats all I can really say. I will note any changes but soo far soo good. I cant really hype up the mystique some users have said about how this drug helps but at least it has done something with no side effects as a result....thats more than I can say about every SSRI I have taken.


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## RockiNToM (Jun 15, 2009)

Thanks for the info gadman80 but I'm sorry to say I'm now off the med completely. I just decided to stop taking it a few days ago since I just kept feeling more and more suicidal I couldn't justify staying on it any longer. I mean heck, I'd be lucky if I was around to keep taking it, that's how bad things were getting.

So far no withdrawals or anything but then I was only taking it for a few weeks. So since coming off it, I have been feeling more myself, and the suicidal thoughts and feelings have went away. The one thing I also immediately noticed coming off it was my libido came back. I know on Mirtazapine people say it shouldn't affect your libido but it made no difference to me, it was the same loss of libido like the other SSRI/SNRIs I had taken before. I know this may sound gross, but I was so horny the other day, it was like my body was trying to make up for it. lol. 

Anyway, I can think even clearer again in the sense I make more natural decisions rather than me having to say to myself "Hey wake up man! You need to think!" as that's how I always pretty much felt on anti-depressants. Also reminding myself to respond less apathetic towards people was a problem, because I was absent of the understanding of emotion.

Anyway, I'll see how I go. Maybe this break will do me some good.


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## euphoria (Jan 21, 2009)

RockiNToM said:


> Thanks for the info gadman80 but I'm sorry to say I'm now off the med completely. I just decided to stop taking it a few days ago since I just kept feeling more and more suicidal I couldn't justify staying on it any longer. I mean heck, I'd be lucky if I was around to keep taking it, that's how bad things were getting.
> 
> So far no withdrawals or anything but then I was only taking it for a few weeks. So since coming off it, I have been feeling more myself, and the suicidal thoughts and feelings have went away. The one thing I also immediately noticed coming off it was my libido came back. I know on Mirtazapine people say it shouldn't affect your libido but it made no difference to me, it was the same loss of libido like the other SSRI/SNRIs I had taken before. I know this may sound gross, but I was so horny the other day, it was like my body was trying to make up for it. lol.
> 
> ...


Did you ever try mirtazapine with an SSRI? I forgot.

Psychiatrists do actually prescribe these two together in resistant patients; it's the next thing I'm trying after moclobemide (well, legitimately anyway). Not sure about doctors, but you'd probably be able to convince them.


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## RockiNToM (Jun 15, 2009)

Nope, I couldn't tolerate the effects long enough to try it with an SSRI. I feel disappointed but I just couldn't cope with the suicidal thoughts and feelings, and since my doctor has been unreachable during that time, I took myself off it.

Currently I've been off Mirtazapine for a week now, and I haven't really had any withdrawal but like I said before; I was only on it a few weeks. One thing I have noticed now, especially today, is that my anxiety is back. All that cruddy IBS, constant adrenaline, worrying thoughts, all are back. I haven't felt this bad with my anxiety in a while; making it quite difficult to handle. One thing I am pleased with despite the horrible anxiety and mood swings, is that I am enjoying things a little bit more in areas I was unable to while on medication.

There must be a way of beating this without having to be on an anti-depressant. So if anyone has some ideas of other medications, supplements, techniques that might help I am all ears because right now, my anxiety level is at a super high and I'm feeling quite desperate and willing to try anything.:sus


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## shychick2 (Oct 20, 2008)

I've tried both 
Effexor I was horribly sick for 1-2 weeks and came off very slowly (to nothing).
Mirtazapine I came off a few weeks ago. I occasionally got a restless leg like I just couldn't sit still and desperately wanted to move and just felt uncomfortable.
The main thing was I fell asleep 8-9pm every night and started getting obsessive about food when I was in the house and have snack after snack. Apparently it's used for weight gain in the elderly.

Re: initial post. It depends how uncomfortable the side effects are. They can go away in a few days or weeks. You don't want to put up with something awful but I wouldn't stop at a really mild manageable effect e.g. headache or a little sick. You could always phone up the Dr or a medical line or pharmacist for advice. Ultimately they know best.

Re: last reply. I'd go back to your GP if you haven't and say you have come off as you may need monitoring or a new anti-d.


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## shychick2 (Oct 20, 2008)

RockiNToM said:


> There must be a way of beating this without having to be on an anti-depressant. So if anyone has some ideas of other medications, supplements, techniques that might help I am all ears because right now, my anxiety level is at a super high and I'm feeling quite desperate and willing to try anything.:sus


I've actually found out a lot recently
Have you been for an assessment on the NHS? My GP surgery has a mental health unit attached and I saw a therapist today. She was actually really helpful and sympathetic. It may depend who you see. You could always ask for someone else. I wrote everything down as was worried about being able to tell her everything in person. As it happens she was nice and perceptive picked up on things like me struggling to connect/concentrate when talking and being able to hide depression. I've seen some unpleasant people on the NHS (2003), so it might be worth going back to the Dr and asking for something else if they turn out to be useless.

You can be given a password for computer CBT on the NHS, and can get on moodgym for free without referral
If desperate and the NHS is doing nothing you could always go private. See these support groups too, they have therapy and phone therapy
http://www.nhs.uk/Conditions/Anxiety/Pages/Supportorganisations.aspx
Anxiety UK (if you join) has a psychologist you can phone for advice on what type of therapy would suit you, but generally CBT :b They have support lines/email for anyone to use without joining.

If nothing else there may be a local support group (see anxiety UK website) or contact Mind in your area.
There are even groups through my surgery/NHS on managing anxiety, long term health conditions, sleep problems and relaxation. Anxiety UK suggested I contact PALS (NHS advice line basically) about support groups, who told me to contact Mind and told me about courses on managing long term health conditions.


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## euphoria (Jan 21, 2009)

Good post ^.


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## RockiNToM (Jun 15, 2009)

shychick2, I've seen various people over the years for my anxiety and depression and I my first line of treatment began with CBT. I did CBT for 2 years where I was able to challenge and understand myself and my symptoms. Then, it reached a point where my anxiety and depression was untreatable, so then came in the psychiatrist. My psychiatrist put me on medication because there were symptoms I was suffering from that I could not control with CBT alone. Through the medication route, I was put on anti-depressants all of which have been somewhat helpful but have caused too many additional problems. My Psychiatrist retired and I never got to try and other form of medication, so because of that I was referred back to my GP and that's where I am now.


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## euphoria (Jan 21, 2009)

Why not just tell him you would like to see a psychiatrist again?


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## RockiNToM (Jun 15, 2009)

I wish it were that simple. I have asked and asked my doctor so many time and I'm told "I would prefer to monitor you myself"...


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## euphoria (Jan 21, 2009)

Just say that if he is unable to prescribe outside of SSRIs/SNRIs/mirtazapine, you are not getting adequate relief and would like to see someone more specialised. He will have 2 choices: send you to a psychiatrist, or prescribe a different drug.


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## jim_morrison (Aug 17, 2008)

Since your in the EU, I think that Lyrica is now approved for General Anxiety, maybe he'd give you that.


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