Ultra high doses of mirtazapine

Although Partridge in "Usage and Abusage" says don't use "substantial" where you would use large or big, I get the impression that this is more stylistic. Substantive=tangible - in that sense an atom is substantive. In the OED (1980ish edition) all but one of the definitions of substantial refer to considerable in number or of size, only one refers to the more chemical definition.

I don't believe you find many people take more than 45 mg, but if you  do and the GP is cool then who am I to say anything.

But don't ask for an opinion if you dont like it, this is an open forum. The community are here to help each other and at the end of the day it up to the individual to decide what they do and that will never change despite what you or I put

            in answer to where I read that prescribers may go above BNF limits, the answer is that I read this from the Deneral Medical council website at the following location:

http://www.gmc-uk.org/guidance/ethical_guidance/14327.asp

In response to the discussion in the use of term overdose. The conversation has gone:

I stated that I had seen that GPs are prescribing Mirtazapine at a 60mg dose,

To which you replied "I suspect NICE and the CQC would be interested in knowing GP that are giving patients overdoses."

Following your logic,your include in your use of the term "overdose" any prescription above the BNF limit (in this case being anything above 45Mg).

In a later post you state that 45 Mg is the maximum dose and finish of the same posting with "please please please don't self medicate" with the "don't self medicate" in bold. Neither Jetchan nor myself had even hinted at self-medication. The implication is therefore that Jetchan and myself are by suggesting that a 60mg might be a reasonable dose for some patients are also advocating "self-medication" for those same patients. My concern is very much with the use of the word "overdose". By using this emmotive and technically incorrect term (technically incorrect as this is the prescribed dose for some people) you are saying that patients that taking this dose are doing something both unsafe and illegal. This may not have been your intention but it is what you have done. I can see that your principal motivation is to help other people not experience the same negative experience that you experienced which is a laudable motive. I had no agenda replying to Jetchan other than reassuring them that what they proposed was a reasonable proposition and that it was significantly safer than the gold standard treatment Lithium (which also I do not wish to put people of because it is still probably the most effective anti-depressant medication available). I want Jetchan to be comfortable when discussing with their prescriber that the data supports that is a reasonable and relatively safe option and that other health care professionals are already prescribing to the 60mg level. 

    If there is anything that is incorrect or inaccurate in my posting, one of the benfits of an open forum is that can be pointed out and corrected. My posting is intended to reassure those on this drugs that it is OK to look at higher than BNF licensed doses as option (always assuming that they can tolerate it at lower doses). I believe there should be no stigma associated with using "off-licence" doses. If you believe there should be negative pressure put on patients not use prescribed "off-licence" doses, I think that is definitely worth an open debate because I suspect that there are probably quite a few people who like yourself feel extremely uncomfortable with the concept of "off-licence" prescribing and I believe if we can discuss the concept in an open forum that many more people (hopefully including yourself) will when they go thru the data will feel much more comfortable with the practice of "off-licence" prescribing. This in turn I believe will help people who when they find a drug that they can tolerate well to choose jointly with their precriber, the most effective dosage for them, whether this be on or off licence.

I really hope it goes well as Lithium treatment is pretty scary stuff get the right balance. Im guess your depression is pretty severe. What every you do I hope it works for you 

    Jimmy, I have a fundemental belief that modern day pysc meds are aimed at making your brain work the way it was designed to i.e. they are returning an incorrectly functioning brain back to the way it was designed to function. The deficiencies in modern pysc drugs is a reflection that we have not yet get to the real root cause of the malfunctions but this like cancer is a battle we will win. There should be no shame in taking psyc meds. Decisions on choice and dose of pysc meds should be made on the best quantative evidence available. I understand there is general antipathy to taking medication in the media and in particular there is real antipathy to pysch meds .I firmly believe that this an unhelpful perspective and that it would be better if we got everybody agreeing that "evidenced based medicine" is the best way forward. 

But can I say, my sister is a GP and she doesn't treats her children. They have another GP and if they are sick she takes to their GP or in emergency she takes them to the hospital. She is too involved with their own care and therefore needs to obtain the help of others. She is an extremely competent GP but she hands over the care of her children to others. Likewise it is a good thing to be able to take the responsibility off our own shoulders and where possible to give that to others. On the other hand I recently changed GPs because I didn't think that I could rely on the previous one. I decided in effect that he was not being proactive in reminding me when my next blood test was needed, suggesting that I was getting side-effects from my meds and not going by everything that my pdoc said.

hi UK-Ven-medicate

I too was on mirts'@

45mg and it became a nightmare it was like it let the bogey man back in my GP has now put me on Venlablue started last week at 35.5mg so I am very concerned what to expect from V/blue I have suffered with depression and major anxiety for several years but did not address it earlier

what I'm asking is does anybody think things will improve on New meds Vblue

Thank you xx

I'm on here just qurious, it is really late, researching my 45mg prescription. I don't have long at all to see a specialist, but things have just got horrific on these 😐