Venlafaxine and psychiatric treatment

Hi

Im sorry you are feeling so depressed at the moment - hang on in there it WILL get better.

I take 375mg Venlafaxine per day and was prescribed this by a psychiatrist.

225mg is a high dosage of this powerful anti depressant drug and though you say you don't want to see a psychiatrist I would advise you do. Ive seen three and they were all very different in their approach and manner but the important thing they have in common is an expert knowledge of psychiatric drugs, their combinations, dosages and known side effects. A GP does not have that level of knowledge in this area - even if they are well read up on it.

If you are really very depressed you need a specialist not a generalist GP to diagnose and treat you, and ideally a psychologist or psychologically trained therapist for talking therapy. Medication plus talking therapy has been found to work best in treating depression - it has worked for me. A psychiatrist would be in a very good postion to refer you for a range of possible psychological therapy treatments.

There is lots of help out there, be strong and make the best use of it.

Best wishes

Andy.

I was put up to 225mg today. The GP never mentioned anything about going to see a physc. I was finding that my depression was coming back after loosing my job a few weeks ago.

We'll have to wait and see what the GP says in 2 mths time and whether my depression gets any better at the new dose.

Not looking forward to the new round of side effects though....

Depression, psychiatrists, clinical psychologists, talking therapy - all sounds so simple, doesn't it?

Re. depression. This isn't simple. First of all one must be clear what type of depression one has. Is it a one-off reactive depression - reacting to a negative and/or stressful event? Or is it a more ingrained type of depression - e.g. recurrent depression (mild, moderate or major depression that occurs, goes away, comes back, goes away and so on, or dysthymia, a chronic depressive state of mild or moderate depression). Ingrained mild or moderate depression can, ofcourse, be overlayed with a discrete period of major depression, i.e. a person with dysthymia can have a period of major depression. Also is there anxiety going on aswell? Also there is the issue of personality disorder - an underlying personality disorder makes any other mental health problem much more difficult to treat.

Now, all this would seem to lead to the need for a psychiatrist, wouldn't it? But I absolutely sympathise with Tormented's wish not to see another psych. I've seen many in my time and they haven't made any difference. They may be deemed to be \"experts\" but, unfortunately, this does not guarantee that they are all people of integrity, performing to professional standards, who put your health and welfare first. Also, within the NHS, plain old depression is not likely to get much shift, when services are struggling to look after people with severe psychotic illnesses properly. In my experience and observation, and also the plain truth as told to me recently by a clinical psychologist, mental health services are only likely to put some effort in if you are very likely to kill yourself or are a risk to other people.

Also, with regard to psychs, it is, in my opinion, wrong to give psychs the same status as other specialist doctors, e.g. cardiologists. There is very little science backing up psychs - think, no blood tests, X-rays, etc, etc, to substantiate their diagnoses. Psychiatry is the field of opinion, and virtually nothing more than opinion. This is probably why many people with long-standing mental health problems can acquire a long list of discarded diagnoses as they see different psychs.

Re. talking therapies. Well, tablets don't always work, and neither do talking therapies. My advice is view talking therapies the same way you would any other treatment - it isn't necessarily the golden path to recovery regardless of how much it is hyped up.

[quote:ccdf4d9e35]Also, within the NHS, plain old depression is not likely to get much shift, when services are struggling to look after people with severe psychotic illnesses properly. In my experience and observation, and also the plain truth as told to me recently by a clinical psychologist, mental health services are only likely to put some effort in if you are very likely to kill yourself or are a risk to other people.

[/quote:ccdf4d9e35]

I believe this to be totally true; because I haven't tried to harm myself yet I feel my depression has been pretty much overlooked.

I was fobbed off with a 4 free councelling sessions a year ago and three different doses of medication by my GP.

It's frustrating because I feel like I haven't dealt with any cause for my depression, just suppressed the symptoms. It almost feels like I'm making a big deal over nothing, even though I feel terrible.

Re Bitter Guest's comments

While it is wise to be sceptical of all claims for treatments for mental illness and I agree with many of the criticisms that you have raised on the diagnosis and treatment of depression (on scientific and medical ethical grounds) I think you have used the question presented by Tormented as a reason to vent your frustration against the ineffectual medical treatment for depression which you have unfortuanately personally received.

I agree completely that depression is not simple, as your first paragraph outlines using psychiatric and psychological terms. It is difficult to diagnose correctly and even harder to prescribe a treatment that works for an individual case. I agree psychiatrists do not have the same knowledge and understanding or working model of their field compared to a cardiologist. But even specialist doctors like cardiologists get it wrong on occasion, even though the cardio vascular system is fairly well understood and is a far less complex system than the human brain and the rest of the central nervous system.

Psychiatry and clinical psychology are relatively new medical sciences dealing with the phenomenon of how the processes in the brain, CNS and so on produce and affect human behaviour and mental experience and principally diagnosing and treating people when things go “wrong”. This area is very difficult at present to investigate using an empirical scientific method, but these are attempts to do so. The linking evidence to produce a widely applicable and effective working model for psychiatric or psychological treatment will probably come from continuing neuroscience and behavioural studies and research but it will take a long time. But then medical sciences’ success in treating so many physical diseases effectively has taken hundreds of years and many chance observations to achieve. Before pathogenic microbes were seen by microscopy and identified as the cause of diseases like typhoid, there were many theories to explain the cause of these diseases and many prescribed treatments or avoidance strategies. Most of these were ineffective, but some based on observation or trial and error worked; though the explanation was then unknown. In the case of typhoid; drinking beer instead of water from a contaminated well worked. Preventing Small Pox by scratching your arm with pus from a cow pox sore does sound like shaman magic on the face of it. But Jenner’s scientific method behind his experiment led to the principle of inoculation.

In no sense do I believe psychiatry, clinical psychology or especially talking therapy are providing “golden paths to recovery” but they may help, and there is statistical evidence to support this.

Currently this is what Medicine has to offer.

Back to Tormented’s question: he should be seeing a psychiatrist if he is to continue taking 225mg of Venlafaxine as this is a higher dosage than a GP would normally prescribe of a moderately strong SNRI and the GP knows the patient should be monitored by a psychiatric doctor. Of course, he could alternatively not take the drug at a higher dose or stop taking it at all and look elsewhere for a solution which may help him.

As for the NHS struggling to fund treatment for depression I think it is wise to use it or lose it. If people do not demand treatment for depression, even when it is not life threatening, then funds will go elsewhere and clinics will close.

BTW I work in education not mental health.

I have been to the docs this morning. The GP has now uped me to 300mg. I have been under CHMT before but he hasn't mentioned that he wants to send me back there. Getting a little confused with just uping the dose every tim eI see him. He put me up to 225mg in December. Ven does seem to help over all and I have been doing some really positive things but I then will have weeks where I sink very very low and potentially could do something very stupid and would probably put me a way! I am not too sure some day on how to cope. I seem to be very good at hiding how I really feel and not very good at leaning on my friends when I do feel really crap and could give up.

Sorry for the rant. I am sure that it is better to write these things down and move forward than dwelling on an illness which at times could take over my life. How easy that would be....