I blogged in June about reviewing my anxiety medication, specifically because during the first 4 weeks of coronavirus lockdown I had experienced a significant reduction in anxiety and an insight into how life could be.
I currently take 600mg of Pregabalin, (300mg in the morning and 300mg in the evening) and 100mg of Sertraline in the morning for my anxiety, in the form of generalised anxiety disorder.
I telephoned my doctors surgery to make an appointment to speak to my doctor and was advised that appointments were not available for general medication reviews, but that I could add a note to a repeat prescription request. I therefore, decided to write a letter to my doctor, which I shared with you in my June post.
In response I was offered a telephone appointment and discussed my medication and how I had been feeling. My GP’s style works for me, in that he is to the point and his manner emphasises that it is I, the patient that is in control, by that I mean, he regularly asks ‘what would you like to do?’.
Options we discussed were: a) I could contact the mental health team hub, b) come off the Pregabalin and then review, c) change the Sertraline medication.
I asked about Venlafaxine and Paroxetine, which are mentioned on NHS website page for GAD and/or NICE website about GAD as possible medications to treat Generalised Anxiety Disorder. My doctor said that Paroxetine was generally not prescribed for the treatment of anxiety and he mentioned Mirtazapine.
I was reluctant to contact the mental health hub, partly because I did not want to draw on their limited resources, but mainly because I felt I could try changing my medication with my GP. To be honest, I was scared to come off the Pregabalin, because I have been on it for so long and because it is referred to as being used when other medication has not worked for anxiety, it felt to big a risk. Changing to a new medication by stopping the Sertraline seemed the most sensible option for me. As the doctor had mentioned Mirtazapine, I was drawn towards trying this as a new medication, it felt the safest option.
Mirtazapine is a serotonin and noradrenaline reuptake inhibitor (SNRI) and we agreed that I would taper my Sertraline medication by reducing it by half for a week at a time and then I would start the Mirtazapine at 15mg a day for the first week and then increase the dosage to 30mg a day. The doctor mentioned that the medication had a sedative effect and was best taken at night, about an hour before bed.
I have now been taking the higher dose of 30mg of Mirtazapine at night, together the 300mg of Pregabalin in the morning and evening and found it helps a lot with my anxiety. Firstly, the sedative effect has meant that the majority of nights I sleep for 8 hours, which in itself I recognise helps greatly. I feel tired and worn out towards the end of the day, but that is okay. My anxiety levels are a lot lower, I do not wake up and get a wave of anxiety washing over me each morning, I worry less and feel stronger and more capable of dealing with lives day to day worries and problems. I am going out more, having ridden my motorcycle a couple of times each week and I am not using avoidance as much, so have been popping out to the local shop. I am pleased with how I am feeling and happy with my current medication for anxiety. I am also just coming to the end of a refresher Cognitive Behaviour Therapy (CBT) sessions which I will blog about separately. What I must remember is: to take small steps and not overdo it; so I can learn that life is safe and doing things is okay.