Are antidepressants controlled substances

Antidepressants - "How long do antidepressants stay in the body?"

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Does an established practitioner have a positive effect on the course of his patients?

Patrik Roser: The therapeutic relationship plays a very relevant role in the success of a treatment, so an attentive and empathetic therapist has a positive effect on the course.

I take czmbalta 60mg and have severe bloating. can that be a side effect

Patrik Stephan: Side effects in the gastrointestinal tract are observed relatively frequently during therapy with antidepressants, including with Cymbalta. The timing is important here: If the flatulence only appeared after the start of therapy, this could indicate a side effect.

What can you do about antidepressants? Is there a remedy for it? Still have antideressives where I have to take.

Patrik Roser: How can I understand your question? Are you talking about an overdose?

Good day gentlemen. I've heard that St. John's wort can do the same thing as an antidepressant. Now the question arises why this is only rarely used in treatments. I look forward to a detailed answer.

Matthias Hilpert: Certain St. John's wort extracts can basically achieve effects comparable to those of antidepressants. These drugs are more likely to cause adverse skin reactions, especially when exposed to sunlight. Problems also arise more frequently when various other drugs are taken at the same time, the breakdown of which can be accelerated by St. John's wort extracts, so that they no longer work reliably. I could imagine that St. John's wort extracts are prescribed less often than other antidepressants for the reasons mentioned.

For a few weeks I have been experiencing depressive moods, since the severe Depr. & my husband's 17th stay in the clinic demanded a lot from me. Question: I spoke to the doctor about taking an antidepressant. Now the laboratory report showed - in the context of hyperthyroidism, reg. Checked the values ​​- that the B12 is massive in the basement, including the ferritin (10). Do you advise raising your B12 level first and only then thinking about AD again?

Patrik Stephan: Antidepressants need a few weeks to take effect. Since you have been suffering from depressive moods for a few weeks and there are still certain psychological stressors, my suggestion would be to start antidepressant therapy at the same time to correct iron and vitamin B12. It is also often the case that the administration of iron and vitamin B12 does not improve the mood significantly. It is also important that the thyroid hormones are in the normal range.

Dear Madam, Dear Sir, I suspect I have a post-traumatic experience, are antidepressants a possible good medication?

Patrik Roser: Antidepressants can be useful to support the treatment of post-traumatic stress disorder, but the drug alone is usually not enough. First of all, the experience you have described should be examined in detail and the diagnosis confirmed. However, the means of choice is then trauma-specific psychotherapy, which can at best be supported with medication.

40 years old, 6mg Temesta daily, and 25mg Nozinan swallowed in the evening for existing depression and unfortunately I still take these tablets today. I'm afraid that I might get dementia or that all of this speaks against my health, please give me an answer (thank you!) I'm 70 years old.

Matthias Hilpert: Temesta and Nozinan are not antidepressants. However, due to their anti-anxiety and calming effects, they can be used to aid in the treatment of depression. These drugs do not cause dementia. Long-term use should, however, be discussed regularly with the attending physician in any case; the reasons for further prescribing should be checked in detail.

Hello - I have been prescribed antidepressants for vegetative dystonia / anxiety disorder for about 10 years; because of insufficient effect, I tried a total of 3 medis. The symptoms never really went away; so I slowly sneaked out the Cipralex (I've been at 0 since mid-January 17). After a few weeks in the summer without symptoms, I now have tingling scalp, muscle twitching, etc. Question: Can these still be symptoms of withdrawal? If not, would an SNRI help?

Patrik Stephan: The described symptoms could in principle fit with a so-called withdrawal syndrome. The time course (appearance of symptoms now months after tapering off Cipralex) makes this very unlikely. Therapy can only be recommended after a medical examination. SNRIs are also used with success in anxiety disorders.

am 65, in great health. To sleep better (sleep through the night and, if applicable, have positive dreams) I take 7.5 mg Remeron (1/4 of the 30 mg tablet, so an extremely small dose) every day before bed. I have only had positive experiences with it. What could be negative side effects since I intend to take medi indefinitely. Thanks for your answer

Patrik Roser: The relevant and most common side effects of Mirtazapine (Remeron) include an increase in appetite and body weight, drop in blood pressure, dizziness and fluid retention, especially in the legs. However, these side effects depend on the dosage and are rare at 7.5 mg.

I had antideppresiva for 19 years, how long has it been in the body, thanks

Patrik Stephan: None of the antidepressants on the market are stored in the body. Most antidepressants have a half-life of approx. 12 hours (maximum 3 days), which means that the blood concentration is halved during this time. After a few weeks, the active ingredients have completely disappeared from the body.

I suffered from depression for the first time on Jan 65, 2009. Treat. Setralin and Remeron. n

Patrik Stephan: Depression can also appear new at your age. The combination of sertraline and Remeron is not uncommon and is generally well tolerated, even by the elderly.

Many doctors give the wrong feeling that antidepressants can be tapered off without any problems even after a long period of use. Massive withdrawal symptoms are denied by these doctors as well as by the various manufacturers. Why do you find thousands of reports in various forums such as ADFD etc. from those directly affected, who describe their monthly and sometimes long-lasting symptoms as "hell on earth" even when slowly sneaking out

Patrik Roser: I agree with you that after taking antidepressants for many years, withdrawal phenomena can occur, but these must be clearly differentiated from classic withdrawal symptoms in the context of addiction disorders. However, I cannot confirm the severe symptoms you described after tapering off the medication from my everyday clinical practice. I often found myself in slightly more pronounced states of increased sensitivity to stimuli, depressed mood and inner restlessness. Nevertheless, I do not want to deny the cases you have described, but I would rather assume individual cases.

According to the German Medicines Commission, there is no superiority of antidepressants over placebo in around half of the studies that have been carried out, provided that the studies not previously published in specialist journals are also considered. How can one have confidence in antidepressant medication when study results are published so selectively? Due to unpublished studies, the reimbursement of reboxetine was prohibited in Germany

Patrik Roser: You are addressing a very important and political issue here. I also take the view that all results from clinical studies, even if they are negative, should be published. Here, health policy is called upon to implement a corresponding code in a mandatory manner.

Quotation from "Compendium of Psychiatric Pharmacology", 2017, Springer. In the chapter "General Therapy Principles" you can read: "Since the placebo response rates have increased significantly in the last few decades, the placebo-antidepressant difference is currently no more than 20%". In other words: at most one in 5 patients who believe they feel an improvement really benefits from antidepressants. A risk-benefit assessment is actually negative. Or not?

Matthias Hilpert: Patients who take part in placebo-controlled studies are each very carefully selected. This means that many patients are not allowed to participate due to exclusion criteria. Reasons for exclusion can be, for example, age, concomitant illnesses, the use of additional medication or the severity of the illness. For this reason, results from such studies cannot simply be transferred to average patients. It should also be noted that patients with severe depression are more likely to respond to treatment with antidepressants than those with mild depression. This fact is now taken into account in current treatment recommendations, in that psychotherapeutic treatment is recommended as the therapy of first choice for the treatment of patients with milder depression. After appropriate advice from the attending physician, the patient should be able to participate in the decision-making process, so that the benefit-risk assessment is made jointly.

2013 for 2 months Efexor EF 150 mg / d, extreme diarrhea, replaced by Cymbalta, stopped after 2 months of a lot of blood in the urine. Today I still have problems with extreme sweating in summer temperatures, soaking wet polo shirt, urinating every 1.5 hours at night, dry oral mucosa, sleep disorders with anxiety are gone. Effect on depression zero. This rat poison is supposed to be a drug? Can you name an expert who can help me? The manufacturer would probably deny that.

Patrik Stephan: The physical symptoms you are suffering from today have nothing to do with the drug therapy in 2013. Efexor can cause diarrhea (during therapy), Cymbalta can increase the bleeding tendency (during therapy). It seems important to me that you also have a physical examination. The first point of contact would be your family doctor.

Good evening. I suffer from MS and I inject Rebif in addition, I take 12.5 mg Surmontil in the evening. Can I become dependent on this dosage?

Patrik Stephan: No, definitely not.

How can I stop taking antidepressants because of my schizophrenia? I have put on a lot of weight and feel hungry in many ways. It's not always fun.

Patrik Stephan: Feeling hungry and weight gain are unfortunately a common side effect of certain (not all) antidepressants, but also of certain (not all) antipsychotics (drugs against schizophrenia). Weaning is not always the way to go. First of all, all of your medications and also your mental health must be examined. Ev. the situation can also be improved by changing the therapy (switching to a different active ingredient).

I've been taking 2.5 Temesta every day for the past 38 years, without that nothing works. What else can you do there, I managed to reduce it by half myself 4 years ago, but since my cancer last year I've been back to 2, 5 expidet Temesta. Thank you

Patrik Roser: Lorazepam (Temesta) belongs to the group of benzodiazepines and is not an antidepressant. Benzodiazepines have anti-anxiety and calming effects, among other things. Long-term use of benzodiazepines can lead to habituation or even dependency; accordingly, pronounced and severe physical withdrawal symptoms can occur when discontinuing or reducing the dose. If you want to end the treatment with this medication, a slowly tapering approach under close medical supervision would be recommended. In terms of the risk-benefit assessment and taking into account the intake for 38 years, however, the termination of treatment should be examined carefully and critically.

Antidepressants such as fluoxetine should not be used under the age of 18. be dispensed according to the instruction leaflet, as suicidality increases. Why is that done anyway? Why are depressed people not treated entirely without antidepressants? Namely with good psychotherapy. After all, it has been known since the 1980s that psychotherapy is primarily helpful.

Matthias Hilpert: Antidepressants are generally prescribed very cautiously for patients under the age of 18. Symptoms that occurred during treatment with the drug must be indicated in the package insert. However, this does not have to mean that these symptoms were also triggered by the drug. Suicidality often occurs in the context of depression, even in people who are not taking any antidepressants. Suicidality very often subsides under treatment with antidepressants. It has also been scientifically proven that psychotherapy helps against depression. In the case of moderate and severe depression, however, psychotherapy alone is often insufficient and effective quickly enough, so that additional medication should be prescribed.

I (f, 31) have been taking escitalopram (10 mg / day) for anxiety for three months. The effect came on quickly, but unfortunately I am struggling with some side effects, above all with sleep disorders (no more deep sleep and constant fatigue) and permanently inflamed eyes. Increasing it to 15 mg only made symptoms worse. What would you advise?

Patrik Stephan: It is gratifying that the anxiety symptoms improved quickly, which is not always the case. In my opinion, this speaks in favor of continuing therapy with escitalopram (perhaps at a dose of 10 mg daily). It may or may not be that the sleep disorder is a side effect. Whs. it makes sense to treat sleep temporarily with an additional medication that promotes sleep. Sleep better -> eye irritation better and less daytime sleepiness. I suggest that you discuss this with your doctor.

I take half a tablet of "Citalopram Helvepharm 20mg" (prescribed by the family doctor) daily against my strong emotions and rapid excitement. I've been taking this drug for many years. I have more and more the feeling that it has no noticeable effect on me! Could it be that the body no longer reacts?

Matthias Hilpert: It is quite possible that you no longer react to this drug. There can be different reasons. The dosage may (by now) be too low to treat your symptoms. In the case of long-term treatment, the prescription should always be checked regularly by the attending physician.

Panic attack / anxiety disorder without hospital stay: After a long period of successful cognitive psychotherapy with previously 20mg Fluctine twice a day now once a day, it is now slowly tapered off. Question: It is difficult to get pregnant with Fluctine resp. Can Fluctine be taken during pregnancy?

Patrik Roser: Antidepressants in pregnancy are a complex topic and require careful consideration of the pros and cons. On the one hand, the drug can have negative effects on pregnancy and the unborn child, on the other hand, a new outbreak of the disease also poses a risk. The group of selective serotonin reuptake inhibitors (SSRIs) is a relatively safe treatment option in pregnancy, but it is Fluoxetine (Fluctine), a representative of this group, is not recommended here because an increased risk of malformations has been described. I would discuss with your psychiatrist and your gynecologist whether further drug treatment is necessary, and if so, whether they should then be switched to a different SSRI.

I've been on antidepressants for years. How do I know if I can take it off again?

Patrik Stephan: We cannot judge that from here with the information available. Assessment criteria include the diagnosis, the course of the disease and also the assessment "from the outside" (treating doctor, relatives, etc.).

I have been taking Saroten 25mg every other day for about 1.5 to 2 years for pain in MS and would like to stop taking it. Whats the best way to do this?

Patrik Roser: The dose of 25 mg you have taken is comparatively low. Taking into account the duration of the intake, a dose reduction to 10 mg and discontinuation in a second step is recommended. Please allow a few weeks for this. However, you should first discuss with your treating doctor whether discontinuation is actually indicated in view of the pain symptoms and which alternatives can be used if the pain increases after discontinuation.

Good evening. I, 65, have been taking Deprivita for some time. How does it work and how is my body likely to react after discontinuation?

Matthias Hilpert: Deprivita is an extract of St. John's wort and is prescribed for the treatment of mild and moderate depression. The exact mechanism of action is still unclear. It is impossible to predict how your body will react to weaning. Withdrawal reactions have been described for a wide variety of antidepressants. For example, sleep disorders, unsteady gait, dizziness and nausea can occur.Discontinuation should always be done in consultation with the attending physician. In addition to possible withdrawal symptoms, a renewed increase in depressive symptoms could occur. This should also be avoided or at least noticed and treated in good time.

Good evening. In a German medical program on the subject of "Depression" it was said that, contrary to popular belief, antidepressants are not addictive. Is this blanket statement true?

Patrik Roser: Yes, that is correct. Antidepressants do not cause addiction in the strict sense of the word, as they do not affect the addiction-relevant circuits in the brain, unlike alcohol or drugs, for example. At most, symptoms can occur when discontinuing, but these must be differentiated from classic physical withdrawal symptoms in the context of addiction.

Good evening everyone. I have been taking various psychotropic drugs (including anti-depressants) for many years. now I was able to find out that I am pregnant. :) What do I have to watch out for with regard to medication and are there any where are compatible with pregnancy?

Patrik Stephan: With the information available, it is not possible to provide advice in this forum. Inform your psychiatrist and your gynecologist immediately (= tomorrow).

Good evening. I have been taking Seroquel since a stay in the clinic for several days in 2010. Initially 100 mg, since 1 1/2 years 50 mg. A year ago I stopped taking the drug altogether. Within a day I was again in an unbearable depression. Then I took the usual dose again and it slowly got better. What do you suggest?

Patrik Roser: I can very well understand your wish to give up the drug altogether. On the other hand, the drug helped you then and now to contain your depressive illness. Weighing up the advantages and disadvantages of the treatment, there would be nothing against continuing to take the drug, especially since the dose of 50 mg is relatively low.

Good evening, I've had massive sleep problems for over 30 years. For years I took half a seresta or temesta in the evening and later a whole seresta or temesta - and slept well. A few years ago the doctor switched me to Trittico on the grounds that it was less addictive. I should now increase from 50 mg to 100 mg so that it works again. How do you see the problem? Are antidepressants really better in this case, or should I stick with sleeping pills? Thank you for your reponse!

Matthias Hilpert: Your doctor's justification is quite understandable. Seresta and Temesta are benzodiazepines, these can be addictive. Even after several weeks of use, the effect can wear off, so that an increase in the dose is necessary. Elderly people can also react paradoxically to these drugs; instead of calming them, they can aggravate restlessness. On the other hand, antidepressants, which include Trittico, do not lead to addiction. It would therefore be more beneficial if your sleep problems could be treated without benzodiazepines.

Since the burnout in January 2015, I have been prescribed 125mg Sequase and have gained a lot of weight. What can I do? My doctor is against discontinuation.

Patrik Stephan: Unfortunately, weight gain is a known and common side effect of Sequase, even in low doses. If the drug has to be continued, there are still certain ways to lose weight. It is important that these activities are linked to a program (diet advice, regular sporting activity in a group, possibly medical training). Your doctor can advise you on this.

After several years of taking 10mg of Cipralex, I slowly tapered it off. After that I had the same symptoms as before. Irritability, nervousness, depressed mood. What to do?

Patrik Roser: The symptoms you described can initially be seen as withdrawal phenomena, which usually subside after a few days. However, if the symptoms persist, you should check with your psychiatrist whether it is a relapse of the depressive illness that may require continuation of the medication.

I have been taking paroxetine, 10mg per day, for 7 years. Had severe withdrawal symptoms so far. That's why stopping canceled again and again. What do you recommend?

Patrik Stephan: Taper paroxetine in small steps over 6 months using the suspension (1 ml = 2 mg). Discuss this suggestion with your doctor.

I take Trittico because of my insomnia. It works quite well, why should I stop using it at all? You're not talking about specific side effects.

Patrik Stephan: If Trittico works well and is well tolerated, you can take it for years without it being harmful.

+++ In the title of the program and also in the content of the same, the wrong impression can arise that antidepressants are addictive. It would be important to point out very vehemently that these are withdrawal symptoms (thanks Dr. Hell!). Fear of addiction has deterred many sufferers from taking antidepressants. More education is needed. +++

Good evening, I have a social phobia and am taking sertraline. Is this a good choice and are any long-term consequential damages known or possible? Thanks and best regards

Patrik Roser: Sertraline has been shown to be effective in the treatment of social anxiety disorders in clinical studies and is therefore also approved for this indication. It is a well-tolerated antidepressant with a relatively low side effect profile. Harmful consequences of long-term use are not described, however, as with other antidepressants, discontinuation symptoms can occur when the treatment is stopped, but these usually subside after a few days.

Good evening, at the age of 19 (am now 57) I suffer from attacks of depression again and again and have already experienced various antidepressants, with and without success. Now I'm slipping into exhaustion = really physical fatigue and psychological fatigue (towards burn-out). Now my family doctor just wants to prescribe antidepressants for me again. However, I sense that it is not a depression. Are there any other drugs besides antidepressants?

Patrik Stephan: Before a therapy can be recommended, a diagnosis must first be made. Talk to your family doctor again. It may be useful to do certain physical exams. I am thinking primarily of blood tests (blood count, iron and thyroid values, etc.).

Good day. My mother has been on anti-depressants for over 15 years and is 80 years old. Is there a way to get rid of it despite the age?

Matthias Hilpert: Antidepressants are usually well tolerated by older people, taking into account the choice of preparation, the dosage and the general state of health. Regular medical checks of the reason for the prescription and tolerability are essential. In principle, any antidepressant could be discontinued or tapered off even after long-term use. However, the possible risk of relapse must be taken into account. As long as the drug is working and tolerated well, there may be no need to stop using it.

Good evening. After a stay in the clinic almost 2 years ago, I took the following medications for another year: 10mg Cipralex, 100mg Lyrica, 15mg Remeron. I stopped Cipralex and Lyricia 1 year ago without any side effects. I take Remeron in the evening - I can't get away from it. Either I can't fall asleep and after 4 hours I'm wide awake. I often consume alcohol in the evening. Without alcohol, the sleep problem is greater. What do you advise?

Patrik Roser: In your case, the cause of your sleep disorders would certainly have to be clarified. Alcohol is usually not recommended as a sleep aid, as it can disrupt the sleep architecture and does not bring restful sleep. The alcohol can also affect the effectiveness of Remeron.

Good evening. What does a sensible course of the withdrawal phase of an antidepressant look like or how do you treat the withdrawal symptoms mentioned in the program?

Patrik Stephan: Unfortunately there is no such thing as a "universal recipe". The procedure depends on the clinical picture, the drug, the duration of the therapy and other factors. If the withdrawal symptoms need to be treated, it is advisable to use an antidepressant that inhibits the reuptake of serotonin, preferably in liquid form (drops, suspension). That can then be sneaked out very slowly.

What can be done about the withdrawal symptoms discussed or are there alternatives to avoid taking antidepressants again? How long can or should one "endure" such withdrawal symptoms?

Matthias Hilpert: Withdrawal symptoms after stopping treatment with antidepressants can be very unpleasant, but from a medical point of view they are usually harmless. Withdrawal symptoms also subside on their own, this can be the case after a few days, but it can also take several weeks. If the person concerned cannot bear the withdrawal symptoms, then taking the previously prescribed antidepressant again will help. If the treatment is then to be ended without discontinuation symptoms, the dose must be reduced very slowly over weeks, i.e. tapered off.

I'm 70. I had problems sleeping up to my retirement and afterwards. Average only 2-3 hours. At that time the doctor prescribed Quetiapine and Zoldorm. Because quetiapine is an antidepressant, I wanted to know what that means. He said that it simply protects my brain from constant study and that I can therefore sleep more relaxed. The Zoldorm should help me to fall asleep better. Today I still take 1/4 Zoldorm every day to fall asleep and never come back

Patrik Roser: Quetiapine is actually one of the antipsychotics, but it also has antidepressant properties. In fact, depending on the dosage, quetiapine can reduce evening or nighttime brooding, thus contributing to better sleep. Zolpidem, on the other hand, is a hypnotic that only promotes the sleep phase. Long-term use can lead to habituation, which makes it difficult to stop taking the drug. Since the dose of 2.5 mg has remained relatively low and has remained stable over a longer period of time, it should be considered whether the medication should actually be discontinued after weighing the advantages and disadvantages. However, you should definitely discuss this with your doctor.

Good evening, I've been taking Deanxit for 3 years. I wanted to stop this twice, each time reduced to half. Unfortunately, I didn't make it both times and again take 1 Deanxit per day. Excessive withdrawal symptoms. Since the tablets are not good for crushing, I cannot stop taking them more specifically. Unfortunately, I am not supported by my doctor, they just say you shouldn't take any more. do you have any advice on how I could better sneak it out.

Patrik Stephan: Deanxit is a combination preparation (2 active ingredients). The Tbl. Or Drg. are actually not divisible. But you could cut it in half. Both active ingredients have a long half-life (approx. 3 days). My suggestion: 1. Go back to 1/2 tablet a day, 2. after 4 weeks only take 1/2 tablet on Mondays, Wednesdays and Fridays, after another 4 weeks only take half a tablet on Mondays and Thursdays and then after another 4 weeks of therapy to stop.

I stopped my AD (venlafaxine 150mg) two months ago. After a month I had to fight again with massive symptoms that indicate depression (load increased during this time). For a month now I have been taking Escitalopram 30mg (desire to have children), unfortunately with moderate success. Now my psychiatrist recommends me to continue taking escitalopram (20mg) and also to start again with venlafaxine (increase to 150mg - last effective dose). What do you think of this station wagon?

Matthias Hilpert: If only insufficient improvement was achieved with escitalopram, then it can make perfect sense to prescribe the previously more effective venlafaxine again. If one of the two drugs alone does not work sufficiently after several weeks of treatment, given a sufficient dose, there is always the possibility of a combined treatment with both drugs.

Good evening, I had sertraline for 2 years and have now reduced the dosage for over 1 month and finally stopped it completely last week. As mentioned in the program, I also have symptoms similar to those at the beginning of the depression / anxiety states. I have gained 15kg in the two years, which does not exactly contribute to my well-being. My question: will the kilos (automatically) go down again? Or will I just take a stroll now?

Patrik Stephan: Unfortunately it is often the case that the kilos do not "automatically" go down again. You have to actively do something about it: increasing physical activity, dieting (possibly also diet advice). It is important here that the first goal is not set too high. Realistic would be z. E.g. "minus 3 kg until December 31, 2017".

After a heart operation in the hospital, I was given the drug Quetiapien 25mg to be able to sleep better and it works very well. At home I now take half a tablet of it. I've been told that I can take this regularly without hesitation. Can I continue to take this without hesitation? Or is there an alternative?

Patrik Roser: Quetiapine can in fact continue to be taken regularly without any major concerns, especially since the dosage of 12.5 mg is comparatively very low, the effect on the heart activity is correspondingly negligible and the effectiveness is satisfactory.

I have been taking 30 mg of Remeron for a year. Sleep well with it. In the morning, however, I feel very badly and throughout the day. I have now also been prescribed venlafaxine 37.5. A doctor says I shouldn't add another one. Another

Patrik Stephan: The combination of Remeron and Venlafaxine is used frequently and is actually well tolerated. It may be that, despite therapy with Remeron, there is no improvement in mood during the day. Then it makes sense to combine it with a so-called "drive-increasing" antidepressant such as venlafaxine. Venlafaxine can also be dosed significantly higher.

R.A. w / 68. I took Escitalopram Helvepharm 10 mg for a short time and unfortunately no longer had an orgasm, then I switched to floxyfral 100 mg. The same thing there too. Now I take Trittico 50 mg 1 tablet / day. Is it possible that you get dizziness, headaches, weight gain and leg pain at night (possibly from the back). As a widow I feel very lonely and have sometimes wondered why I am still there. Thanks for an answer.

Matthias Hilpert: Dizziness is more common at the beginning of treatment with Trittico. This usually improves by itself after a few days. An improvement often results from switching to the retarded form of Trittico.

Good evening. Since I have had a history of cancer and then went through menopause, my mood is sometimes dramatically up and down accompanied by anxiety. Besides St. John's wort, is there anything else on a natural basis? Many Thanks

Patrik Roser: No other natural active ingredients are known within the group of classic antidepressants. Plant-based lavender oil, which is approved for the treatment of restlessness and anxiety, as well as valerian or hop preparations for calming and as a sleep aid can be found at best.

Hello. After taking mirtazapine for a year, I developed a pulmonary embolism. It could not be determined why and why this came about. It could be that mirtazapine triggered this. Thank you for your answer.

Patrik Roser: I am not aware of any connection between the use of mirtazapine and the occurrence of a pulmonary embolism, nor is it described in the product information.

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