Help my mum has had a break down and getting worse after 6 weeks of treatment.

[Universitydilema]

I’ve posted on here before about my mum who was prescribed mirtazapine for severe anxiety. She has taken it for 6 weeks but seen no improvement infact if anything she is worse. She is sitting at home hyperventilating and unable to eat. I called the GP this morning and a paramedic called her back and said to try lavender and she would make her appointment for next week. I’m terrified the anxiety is going to cause a heart attack or stroke. I’m wondering if I should try getting her to take a lower dose (currently on 15mg) tonight just in case the Mirtazapine is making her worse. She does have a small supply of dizapam left but is reluctant to keep taking it. Not sure what I should I be doing to help. I have popped into see her 3 times today. She is with my dad so not alone.

I would let her take the diazepam to calm her overnight, and contact the GP again in the morning for a more realistic answer than lavender. If her meds are having no effect after 6 weeks I would have thought they need changing. Remember 111 is for mental health too if she's getting worse.

Thanks so much for your reply @OneSnugBear. Do you think she should lower the mitazapine? I’m not sure close you can take diazepam to mitazapine

Do you have a crisis team ?

Mirtazapine can have this effect it’s not always suitable. What dose is she on ?

"To try lavender " ffs how useless was that paramedic?!

I'm glad she's not alone, anxiety is a bitch. From someone who has been exactly where she is, please tell her it does get better. It may not feel like it right now, but it will.

Don't mess with her prescribed dosages, she could end up with rebound symptoms if you tell her to reduce her dose and that'll make her feel worse.

She might need a dose increase, or she could try another anti depressant. Mirtazapine helped me but it wasn't until I switched to duloxetine that I noticed a real difference (especially after dose increases of it).

You could call a local 24/7 pharmacy, there are usually Boots ones nearby and ask to speak to the pharmacist you can give clear advice on how to space out mirtazapine & diazepan.

Sorry just saw 15mg. Can you contact the local crisis team?

Diazapam can be taken with most anti depressants.

Has she seen a psychiatrist rather than just the GP OP? If not I’d be pushing for a referral to the community mental health team. A suggestion of lavender is quite unhelpful at this stage and it sounds like this anxiety is having a huge impact on her. How old is she? Is she eating and drinking OK?

Hi. Diazepam is fine to take with ssris. She should take 5mg. It’s awful when anti-depressants make you feel worse. She probably needs to taper off it over a few weeks. Otherwise she could have withdrawals.
What dose is she on?

Non medical things which can help panic attacks:

Box breathing: breathe in for 4 seconds, hold for 4 seconds, exhale for 4 seconds, hold for 4 seconds. Repeat and keep repeating. Especially helpful when hyperventilating.

Movement: a walk around the garden for example

54321 grounding: https://www.verywellmind.com/5-4-3-2-1-grounding-technique-8639390

And when she's out the panic attack, eating at least 1 nutritious meal a day. Doesn't have to be a big one, and could be finger food, but it made a noticeable difference to my severe anxiety & panic attacks the next day if I ate healthily the evening before.

I'm sorry your mum is struggling with her anxiety.
Mirtazapine 15mg is quite a low dose and, ideally, should be increased, if tolerated, after a couple of weeks, to a maximum of 45mg.
It's a good antidepressant and can help sleep and improve appetite. It can also help treat anxiety along with anxiety management techniques ( breathing exercises, relaxation, mindfulness).
If this medication does not help, despite increasing the dose, I would ask Gp to review.
Your mum might respond better to another antidepressant which can target anxiety, such as Sertraline. Again, it's important to aim for a therapeutic dose. Some Gps start people on meds but can be reluctant to increase the dose.
Another suggestion would be to ask the Gp to refer to the mental health practitioner linked to the surgery. They will be able to assess and refer on into secondary mental health services for additional support and treatment to address the cause of her anxiety.
Diazepam can be helpful in the very short term but brings a risk of dependancy.

How old is she? There’s lots of information regarding menopause and anxiety/depression - this weeks Louise Newson podcast is particularly sad re PMDD - the poor woman got so bad she tried to commit suicide, then someone joined up the dots (long after she had and tried to advocate for herself) and gave her hormones
https://podcasts.apple.com/gb/podcast/the-dr-louise-newson-podcast/id1459614845?i=1000783984951

Agree. It's also worth pushing for blood tests, some deficiencies can worsen anxiety.

A paramedic said that?! there are no words. I wonder if they've been told to say these incredibly stupid things.

Yes, she can take those two together

Ring 111 and tell them she needs an urgent appointment with her GP. It sometimes helps to go via 111.

if she can't eat, then a sugary drink might be good? Especially a smoothie. Speaking from experience as I've nearly checked myself into A&E a couple of times. The science behind it, but I can't remember what it is - something to do with reducing cortisol. I couldn't eat.

Don't change the mitazapine without medical advice. I'd really encourage her to take the diazepam. If she gets any worse call 111.

PS, how much diazepam has she been taking? Not enough to cause rebound anxiety I hope because it does do that. I mean, I love it, but you need to know what you're doing with it.

she needs urgent medical attention from someone who knows what they actually doing but I suspect you know this. I'm so sorry this is dreadful.

Call crisis team on 111 option 2. 15mg of mirtazapine is the smallest dose. She probably needs to go up not down or change anti anxiety med. Book for counselling/therapy.

Definitely heed previous posters' advice re medication: best not to mess with prescribed meds but to push them to get reviewed asap as it could indeed be that they are contributing to the problem. Definitely seeking a crisis team referral needed if she's so bad that she can't be left alone - they might not agree to assess her but you never know, and it would probably be the fastest way to get expert eyes on the situation. Highlight any concerns about her safety.

The breathing and grounding techniques that a poster suggested could indeed be great but better to introduce one at a time only, to practise with her gently and make sure it doesn't feel overwhelming. Also good to set expectation that it isn't going to take the anxiety away but might provide a break from it - people often try this stuff and say 'it doesn't work' but that's sometimes because it's been missold to them.

If your mum is able to articulate her worries / sources of anxiety, that would be amazing, but some people can't put it into words. Never useful to try to rationalise someone out of anxiety when they're in the grip of the worst of it. A rule of thumb for anyone in distress is to validate their emotions to show you've listened properly and care about them; gently and firmly reassure (without getting into any sped of logic-based argument), and if possible try to redirect attention to a distraction of some sort (but the latter step isn't always possible). If you have kids, this is sort of similar to what we might do with a little child if they're upset - and I don't mean that in a rude way! It's just the observation that when anxiety takes hold and emotions feel overwhelming, it can be sort of similar to how it is as a little kid: not able to express what we want or need; a deep need for warmth and comfort and firm support.

Crucially, no idea what your mum is like and what she's been through in her life, but most distress is understandable when you know the context (however inexplicable or irritational it might look to an outsider). There is always hope for recovery. And hopefully you and your dad can take care of yourselves and one another through this, because supporrting someone who is struggling takes a toll, no matter how much (or perhaps because) you love them - any way for you to give one another breaks / time away would be good.

@DiscoElysia If someone had asked me to express what I was feeling when in the grip of panic, I wouldn’t have even understood the words. Just explaining that in case OP does it and find she doesn’t get a response.

I also needed open space which was a bit problematic in the middle of the night, but what can you do?

And I did recover, so yes there is hope. Also, through my circle, I know of someone’s mum who had this recently and she was admitted for a stay in hospital after initially going downhill on medication. It was shocking, but she is recovering well.

Recontact gp surgery and state you require a GP review and not a paramedic suggesting lavender !
is your mum under the NHS community mental health team ? If so -contact them. If not -ask GP for immediate referral.