Mental Health Chaotic episodes, venlafaxine and mirtazapine

[Jm1988]

I'm new here, and I am looking for the experience and opinion of other whilst I'm in between treatment plans.

For the last 20 years or so (since childhood) I've suffered with "low mood" and some type of mental health issue. Since May, they have really impacted my ability to cope, and I have had some serious crises(sp).

Since then I've tried some different antidepressants either recommended by psychiatrict liaison staff at my local hospital or suggested by a psychiatrist whom talks with my GP (not me). I have tried mirtazapine on full dose (45mg) for around 5 months with no response. In November it was changed to venlafaxine (dose increased to 225mg, the most they will let me take) with no response.

It has now been suggested that I try both medications together. I am very sceptical as I did not have any response to either med, and from what I've read from others, they had some sort of response to at least one of these drugs before trying both together.

A recent consultation with the crisis team, queried whether my issue is actually depression at all, as I keep presenting with "chaotic episodes" in crisis. Most recently, this weekend triggered by an old friend. The police were called and I was taken to A&E. No one really explained what they meant by chaotic, I don't know whether they are implying bipolar or borderline or some other sort of personality or mood disorder. My knowledge is limited although I am a nursing student so it is probably more than some.

Any insight or experience with these two medication similar to mine ie. Not responding to either and then trying them together. Would be appreciated.

Many thanks Jess.

P.s I was asked to compile a list for when I see the consultant but I am unsure of what I should put in the list. Any suggestions would also be appreciated.

 

[Ozle]

Given what you describe, I share your doubt that your issue is MDD, or at least that it's your only issue.

Can you give a more detailed description of your states, both in a crisis and outside of one?

 

[Jm1988]

Thanks for the response.

Saturday night I met a few friends, had a couple of glasses of wine. One of the girls turned on me, whispering horrible things when no one else could hear. By the time I got home I just snapped. Couldn't talk through the hysteria, was screaming for my boyfriend to help me, I knew I was going to hurt myself. Over a two hour period, he removed all medicines (recent serious OD), locked the doors and took the phones. I tried to climb out the window screaming. He gave me the phone. I left the house bare footed, and called 999. Knocking on neighbours doors screaming for help. The police arrived, I was sitting in the road soaking from the rain still hysterical. They left, an ambulance didn't come. The boyfriend went to bed and I proceeded to try to do the job with a knife as he had removed all medicines.

Then an ambulance finally came. By this point I was removed and withdrawn, hardly able to make sense of my thoughts, listen or communicate in anyway. (There has been other similar situations).

Day to day, I'm constantly exhausted, either sleep all day or don't sleep at all. I lose my temper easily, break plates and cups for stupid reasons. Have recently walked out of work for no reason. I have a serious issue of identifying my emotions and what they mean, all I can pin point is a void and a deep dark dull ache. I can't do anything I used to enjoy because I just can't decide, or I'm too distracted by the "void".

I can't really explain it, daily is just emptiness and doom.

 

[RDP89]

If neither med worked, I doubt the combo will work much better. I don't know why they don't try something else with a better chance of helping you.

 

[Jm1988]

RDP89, that's my thoughts. Everything I've read suggested the combo was great for partial response or tolerance (Id like to be wrong and someone come forward and say it worked against all odds). I'm just going to jump through their hoops until I see the psychiatrist.

 

[Ozle]

Right. I am definitely NOT a doctor, but to me this very strongly suggests borderline personality disorder. I notice you used the term "hysteria" twice in your last post; BPD happens to be one of the currently recognised disorders that are derived from the now archaic label of hysteria (the others being histrionic and avoidant personality disorders, PTSD/CPTSD, DID/DDNOS, and conversion disorder).

Do you have any history of abuse, in childhood or otherwise? What is your current official diagnosis? Can you give a list of all the major medications you've been on and summarise how they affected you?

 

[CopperChloride]

Right. I am definitely NOT a doctor, but to me this very strongly suggests borderline personality disorder. I notice you used the term "hysteria" twice in your last post; BPD happens to be one of the currently recognised disorders that are derived from the now archaic label of hysteria (the others being histrionic and avoidant personality disorders, PTSD/CPTSD, DID/DDNOS, and conversion disorder).

Do you have any history of abuse, in childhood or otherwise? What is your current official diagnosis? Can you give a list of all the major medications you've been on and summarise how they affected you?

THIS. I have suspected BPD and take 15mg mirtazepine and 90mg duloxetine, which is the "other" SNRI - I definitely find it better than the max dose of venlafaxine which was to put it bluntly, bloody horrible. It definitely helps my anxiety as I no longer have to stuff myself full of diazepam + rc benzos just to go to the supermarket. I still go in the middle of the night though! (Also, am a speed freak, which obviously doesn't help at all!) My memory is buggered from the venlafaxine and speed, and i have tinnitus which i've had for years (I blame Pantera in 1999 for that though!) but it seems more noticeable now - might just be getting old though!

But yeah, I started on citalopram in 2011, then fluoxetine, then venlafaxine for several years and my new dr when i moved down south last year put me pretty much straight on duloxetine after me showing no improvement, probably slight decline over three months. started the mirtazepine about four months ago, and if it weren't for *general life drama* i'd be pretty happy, i think.

i''m happier than i was, i think, at least

 

[CopperChloride]

Uh, apologies if that made little sense. I've been up all night drinking wine and having life drama with my gf (who also has bpd - at least we can see it in each other though!)

Feel free to edit my post, mods, or anyone PM me for clarification (eg yes pantera were definitely worth 17yrs of tinnitus!)

 

[Jm1988]

Until the Overdose, I took sertraline, nortriptyline, codeine, diclofenic and tramadol (chronic pain condition for the pain killers). These days just the venlafaxine and the mirtazapine, which I'm now taking together but previously separately.

Previous antidepressants include duluxetine and amitriptyline.

I do not have an existing "diagnosis" past GP/MD's saying its depression and medicating. It has never been confirmed by a psychiatrist.

I do have history of childhood trauma. Very messy relationship with my dad, and I do have abandonment issues which I'm aware of and trying to work through. My dad was a heroine addict, who used to beat my mum badly and regularly. Minimal physical abuse on my part, but plenty of of emotional abuse.

I had suspected BDP, in recent months mainly because of my lack of recognising emotion, and my self-worth being directly attached to my relationships and mood. Hence the old friend causing a crisis. But dont most mental health conditions have a higher diagnosis rate in those with childhood trauma?

I haven't had many issues with the venlafaxine passed initial side effects of insomnia and nausea, and it not working. The mirtazapine is the devil to me, it makes me so sleepy I can barely get out of bed (even on max dose, which apparently it shouldn't).

Luckily, i rarely suffer anxiety, unless I'm on the edge of crisis.

I guess if the crisis team suspected bipolar they would have used the word manic opposed to chaotic.

** sorry to edit this came to mind afterwards..

Since all of this has been going on, friends and family have come forward and expressed concern that they had thought I was bipolar. Mainly because when I'm "good" I'm really good. I suppose my view point is swayed by how dark things are now.

For instance when I'm good, I'm super productive. My house will be spotless by 8am, I'll be immaculate, I'll work 6 days straight and not complain. I'll start going to the gym everyday. I'll be out shopping constantly even though I have no money. I'll take on extra work and help others with there's. I'll be overly professional, helpful, a "model adult" (apart from the spending).

This has all been since I got 24-25. Before that it would be the pub every night. Going to work on little sleep, being VERY promiscuous, even if the person isn't attractive to me at all. Engaging in very risky behaviours, until I ended up in a bad situation (I don't know if i was spiked or blind drunk, but I was found in a field naked and had clearly had sex). Although I have never taken illicit drugs, alcohol used to be my escape.

Then there will be some sort of "trigger" and I'll spiral down. For instance the above incident caused a year or so of "depression".

 

[Ligaturd]

That sounds like borderline personality disorder to a T. I have a couple friends with it and you described them pretty much.

 

[Jm1988]

Thanks for your insight ligaturd. I guess deep down BPD is my main concern. There's a certain part of me that thinks bipolar would be easier. As stupid as I know that sounds and is, none of the are easier than the other. I guess I just hate therapy, and from what's available to read in the UK, it all says therapy. Taking a mood stabiliser seems less intrusive.

(That is literally how I feel, and doesn't mean to lessen or unvalidate the difficulties either condition pose. I know they can both be very destructive for the individual).

 

[Ligaturd]

It may be tough to want to get the process started and it may unearth a lot of pain or bring up a lot of uncomfortable emotions but you will attain a better understanding of yourself and how to manage any episodes or even learn to mitigate the severity of any episodes. Medication isn't going to solve all of your problems, it is likely that they will put you on medication but why not put in work on your end as well? I am struggling with mental health issues right now, I was put on many medications as a teenager and none of them fixed my problems and I am worse off because of it. I am going to put my heart into therapy and learn to cope and overcome all the areas of life that I am missing out on because of my mental health issues.

I hope you find something that works for you and think about therapy as well as the medication because those episodes seem pretty intense and perhaps one day you might do something you regret.

 

[Jm1988]

You are very right, everything you have said is true. Medication is doing nothing for me. I am currently engaging in talking therapy, and I've recently had 4 months of cbt. I've just put up a lot of barriers, and they don't seem to want to come down no matter how hard I try. I guess time will tell, and it may be that I'm receiving the wrong type of therapy. Seeing as they have all been for depression and nothing else.

Therapy has at least helped me to recognise that I have barriers, the weight relationships have for me, and that when people question my worth it triggers crisis. All of which I'm guessing will help put into place a crisis plan, and without the therapy I wouldn't have been able to recognise those risk. Counselling itself is today, I know she will be upset about the weekends events. Personally we mech really well, but I can often see that she just wants to hug me.

Thank you.

 

[Jm1988]

I saw a psychiatrist yesterday, and you guys were right. BPD-Impulsive type. Start quetiapine tonight, and DBT & ERT soon. Thanks for your insight.