How are things progressing Isap

[Isap]

I'm going to have to come off Tramadol too. I've had a good run on it and it's helped me through some really rough spells, but on the lower dose I am getting the full range of side effects (not withdrawal effects which are even worse). Migraine, nausea, constipation and tinnitus. Not sure how to go about it so have asked my Japanese doctor for advice. If his advice doesn't sound right, there's the pharmacist.

[deb1960]

Hi Chris

I'm sorry I didn't reply to your earlier post. My head's been all over the place. I see the doctor today so will have a chat with her.

How do you feel about coming off the tramadol. It's a big step and will take some strength I think, though that's something you don't lack.

Talking someone out of suicide is an exhausting job I would think but one that you or many people could avoid.

I will finish my post a bit later. I have to go to the doctor now.

God bless
Debs xx

[Isap]

Hi Debs

Thanks for your kind reply.

Actually the Tramadol thing is no big deal really. I'm going to try taking it just one day a week which might work at a slightly higher dose. I've only being taking since last December unlike clonazepam for 4 years. I've had to come off so many medications while here (which didn't work, including Pregabalin) that I'm not really phased.

My cellmate has been a bit happier recently. Because of his bipolar he is compulsive and always asks favours at the wrong time instead of waiting for the moment, which he is probably incapable of. Then gets depressed when he's ignored or turned down. He's annoying but not nasty. The nice American here is watching out for him too so he's less gloomy. There are three other westerners I never talk to because so obnoxious. One has already been convicted of rape he probably didn't do because he swore at the judge and prosecutor. Bipolar/BPD not sure which but he should be on medication too. In fact out of 6 westerners only 1 does not have serious mental issues.

God bless

Chris xx

[Isap]

Tramadol has been in the news again. Tramadol addiction has become a major health epidemic in Africa and parts of the Middle East. It's manufactured cheaply (in India) and shipped everywhere. The coastguards in the poor countries can be easily bribed and tramadol affordable on low incomes.

Regarding coming off medications you're to varying extents dependent on, it can be done relatively easily if you do it slowly. I think it is human nature to try and get off stuff as quick as possible so that you can kid yourself "I'm not ill anymore." For people like us whose mental illness is hereditary, you have to accept that medications are necessary.

The hardest part of coming off medications is the psychological factor "what might happen to me" and exaggerated fear of withdrawal symptoms.

[Isap]

Hello Debs

I found some interesting information replying to a post I made on another MH forum regarding what can you take when ADs don't seem to work anymore.

I had always thought that tricyclics (TCA) were all basically the same but it appears not. Some are similar to SSRI, others to SNRI.

The ones similar to SNRI are nortyptyline (Aventy, Pamelor) and desipramine (Norpramin). These would be alternatives and apparently stronger versions of venlafaxine and duloxetine.

The TCA lofepramine which I was on for 5 years acts on both the S and the N, not one or the other.

The said individual takes a TCA and doesn't believe that SSRI and SNRI are any improvement except that more difficult to OD on.

God bless

Chris xx

[caro]

Hi Chris

How are you doing today?

I was interested to read about the TCAs.
I tried almost all the SSRIs, with no positive results.
Lofepremine worked quite well for a while, which was a breakthrough.

I am now on 25mg Amitriptyline, prescribed for fibromyalgia pain. I have some pain relief, but have the added bonus of feeling in a better mood.
It's only a small dose, but i am sensitive to meds, and am not very heavy.

Doctors are reluctant to prescribe TCAs, which is a shame

Take care xx

[Isap]

Hello Caro

Glad your amitriptyline is helping. I know it's often added to other antidepressants to enhance effect.

I was also surprised to hear that doctors are reluctant to prescribe TCA. Lofepramine worked ok for me for 5 years. I didn't respond to any SSRI either.

I read that SSRI and SNRI have less side effects than TCA. Therefore they are tolerated better. They are definitely less strong though. I am also not convinced they are more effective in general. The main TCA side effect is dry mouth but if you hydrate well it is no problem.

Take care

Chris xx

[Isap]

Hello Debs

It's unusual for you to go a week without a post. I hope you're ok.

My thoughts and prayers are with you

God bless

Chris xx

[deb1960]

Hi Chris

In part a friend being ill.

In part my anxiety is getting worse at a distressing rate.

It is virtually impossible to see a psychiatrist. I've made an appt to see the gp but I have to wait a month to see the one i want. I'm not sure how able she is but my husband likes her.

My brother offered to pay for one. The cost is outrageous. It occurs to me though that I could perhaps get a medication review and that would give my gp something to work on.

My problem is in part, my psychological dependence on venlafaxine. I've taken it since 2002 and have a very real fear of becoming depressed again without it. I'm on a high enough dose 225 mg to feel reliant. On Saturday I cut down a dose. My anxiety though makes this hard.

All in all I'm finding life tough.

God bless
Debs xx

[Isap]

Hello Debs

Sorry to hear about the persistent anxiety. It's commendable that you have time for s friend in spite of that.

I'm guessing a private psychiatrist costs £100 - £150. I've had to go private on two occasions. I'd be inclined to accept your brother's kind offer despite the cost. He needs to ask if there is a time limit i.e. is that for a one hour consultation? If he is semi-decent it will be. Then, you need to write down your mental health history with years and medications before you go, plus family history of others with similar problems. That will save a lot of time.

My guess is that he'll want to switch you to another SNRI, duloxetine (Cymbalta) or desvenlafaxine. I can assure you it will be a painless switch. There are also the two TCA I mentioned earlier.

I also assume he'll want you to come off Pregabalin. It's not nearly as difficult as you think, I've done it. When you see that reducing has no ill effects, it should give you confidence and help your anxiety.

God bless

Chris xx