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TherapistMarryAnn, Therapist
Category: Mental Health
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Experience:  Over 20 years experience specializing in anxiety, depression, drug and alcohol, and relationship issues.
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Kate. My antidepressants (Agomelatine) have now been doubled

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Kate. My antidepressants (Agomelatine) have now been doubled to the maximum dose. I have been on this higher dosage for a week now. How long should it take for them to start having an impact on my mood please?

I was put back onto the caseload of the crisis team on Boxing Day and have seen their psychiatrist, which was when my Agomelatine were increased. When I saw the on call psychiatrist at the hospital Boxing Day she said that she felt my Olanzapine needed reducing. I mentioned this to the crisis team doctor who asked whether they had ever considered Lithium. This has been talked about before but never prescribed. What would be the advantage of switching from Olanzapine to Lithium?

Finally, my anxiety levels have soared through the roof this week. Have you got any suggestions as to how I can reduce this please? I am on the verge of discharging myself from the mental health team and pulling out of group therapy because I feel like I can't deal with anything anymore!

I would be grateful for any help or suggestions you may have please.


Hi Sue, it's good to hear from you.


I am sorry I did not get back to you sooner. The Just Answer system has been down all morning and though it seems to be back up now, it keeps kicking me out of my account. I hope they will have it all fixed soon.


It can take the Agomelatine several weeks to start helping reduce your symptoms. During this time, you may feel worse because the side effects of the medication start before the medication itself begins to help you. You may want to try to continue treatment as much as you can to help you cope with your symptoms and side effects. Also, you need to let your treatment team know how you are feeling so they can alter treatment as needed to help you.


In comparisions between Olanzapine to Lithium, it depends very much on your specific symptoms. Studies have shown that Olanzapine was just as effective as Lithium in reducing symptoms of mania in Bipolar. Talk to your doctor about comparing the two in your situation and if one would work better for your symptoms than the other.


Keep in mind that everyone reacts differently to medications. What may help one person can cause another person to feel worse. Trying different medications until you find the right one for you is common. I would give the Agomelatine a chance to work but if you continue to get worse tell your doctor you would like to try another medication.


There are many ways to reduce your anxiety. Here are some ways you can work on how you feel:


It helps to know that anxiety is caused by your thoughts. Changing your thoughts and therefore how your body reacts to your thoughts is one techneque to help you feel better. You also can learn about how to let yourself float through your anxiety thereby gaining more control over how you feel. When you feel anxious, you can allow it to flow over you without tensing or panicking in response. This makes the anxiety reduce or go away faster.


There are numerous resources to help you learn more about anxiety and how to control your feelings. Here are some to get you started:


The Anxiety and Phobia Workbook by Edmund Bourne is excellent for any fears. It is self help and contains everything from supplements to relaxation techniques.


The Cognitive Behavioral Workbook for Anxiety: A Step-by-Step Program by

Bill Knaus Ed.D. and Jon Carlson Psy.D. Ed.D.


From Panic to Power: Proven Techniques to Calm Your Anxieties, Conquer Your Fears, and Put You in Control of Your Life by Lucinda Bassett


You can find these books on or your local library may have them for you.


You can also use stress reducing techniques to help you feel calmer. Here are some to try:


Exercise- most people has some trouble considering this option because the thought of exercise sounds so unappealing, but exercise serves two purposes: one, it helps you get out your physical energy which gets pent up when you experience strong emotions. And two, you promote good chemicals in your brain (endorphines) which automatically lifts your mood. You can do anything from take a walk to punching the heck out of a punching bag. Picking an activity that you like helps motivate you.


Yelling into a pillow helps, talking to someone about how you feel, writing out your feelings are all ways to express your feelings. Sharing how you feel takes the burden off you and has stress reducing effects.


Guided imagery is also good. Imagine yourself floating through a cloud or in water. Picture yourself on a tranquil beach. Listen to the sounds of the ocean, taste the salt air and smell the breeze. By imaging yourself in these situations. your thoughts will help you relax and you will be more centered.


Listening to music is very helpful. It may sound simple, but music has the ability to change your mood, and you can choose the mood. Classical is relaxing, rock is energy producing, and sad music can help you get in touch with your feelings.


If you are feeling overwhelmed by your anxiety, try going out to be around people. Being with others makes you aware of more than just how you feel and brings you out of being too introverted. Plus being out makes time go faster and takes more energy to manage than being in, which can make you sleep better.


I hope you are feeling better soon,


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Customer: replied 4 years ago.

Hi Kate


Apologies for the delay in replying but I think I must have been experiencing the same problems as you, as I couldn't access the website at all yesterday!


Anyway, thanks for your reply. I have been discharged from the crisis team today because they are a short term treatment team and my time with them is up! Hence the need to find some way of reducing my anxiety.


Having spent over an hour and a half with the nurse today she believes she knows what is at the root of my anxiety. At group therapy last week I told them that since Christmas I had felt suicidal and that I was self harming on a daily basis. They asked a bit about my mum and our relationship at which point I said she was never there for me, nor did she protect me. They then said that if I was angry at mum for not being emotionally accessible to us how could I even consider doing the same to my boys by taking my own life. I felt as though I had been punched in the stomach ... I felt as though I had failed them ... I felt that if my actions could be compared so easily to mum and I was just like her then they would be better off without me! There is nothing that anybody could say that would hurt me more than they did last week.


The reason I have told you all this is because I now don't know whether it's anxiety generally that I need to address or whether it is negative thoughts? Any ideas please? I am very guilty of homing in on one negative thought, even if there are 100 positive ones, but I think that's probably because of being brought up being told I was a failure and always would be!


I think I am quite an anxious person anyway, so I obviously need to do some work on that. I often feel like I am full of nervous energy, so punching a pillow or screaming into it sounds like just the job.


I get very overwhelmed by it when it's at the level it's at right now, to the point I try to avoid contact with people for fear of having another panic attack.


If I'm honest then I'm scared about how powerful this anxiety is. I don't know if I can change it but, for the sake of my children, I need to try to change.


Sorry, I've probably told you much more than you need to know!


One final question please ...... do you honestly believe that people can change as much as I need to? Can therapy really make me change the way I think, even after all these years? Can someone ever properly get over traumas which are rooted in childhood?

Sorry, that was 3 questions and you may not be able to answer them! Sorry



Hi Sue,


Yes, you can get better. All it takes is a desire to get better. That is it. As long as you are working towards recovery, no matter what, you will get better. That is because most recovery is about the effort and not the technique. The desire to get better is what makes the difference.


It is not anxiety that you need to address. Treating the symptoms will not help. It is your thought process that needs to change. It's not just the negative thoughts, but the way you think that helps anxiety stay. The books I recommended, particularly the Cognative Behavioral book, are excellent guides to how you can stop your anxious thoughts and beliefs about yourself and make yourself less anxious. Also, here is an helpful guide on how to use Cognitive therapy techniques to help yourself with anxiety:


You can get over traumas from childhood. Realizing how they affect you, talking about your loss as a result of your childhood and working on ways to overcome the effects of your childhood are all ways to move towards a healthier life. The group you are in is good and therapy helps. Reading books about childhood abuse and it's effects can help as well. One good book is Adult Children of Abusive Parents by Steven Farmer. It is an excellent guide to how adult children play out the effects of the abuse and compares it to what is normal behavior.


It sounds like you are on a good path to recovery. You are in therapy, you are talking about your needs, you are reaching out and you have insight. All good signs that you are on your way to feeling better.



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