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Mental health

Advice about mirtazapine

14 replies

Minisoksmakehardwork · 13/05/2015 22:11

Due to feeling rubbish and not sure if the 40mg citalopram I was on was not working, or everything else was too much to deal with on 'just' 40mg citalopram plus not sleeping overly well (can fall asleep on a washing line but waking up and staying awake for hours), my NP has changed me to 30mg Mirtazapine.

I now feel, for want of a better description, like I've got a hangover but without the nausea and headache. I'm really foggy. I feel like I must surely be slurring my words (I'm not). I'm getting really painful pins and needles which doesn't fully go away. I'm permanently exhausted, like I've been running on no sleep. Yet I'm sleeping like the dead and could cheerfully go to sleep when the kids do. I'm having a nap on the sofa while the dc are at school otherwise I don't think I could function to get them meals. I'm also hugely grumpy and irritable, I'm overreacting to silly things and have barely any tolerance towards dh and the children. I'm barely able to contain it as I feel really aggressive.

I'm seeing NP in about a fortnight and have been taking these for a week now. The first morning after I took one, I had the worst, most painful one and needles in my hands, I couldn't bear to clench them and even cleaning my teeth was hugely painful. Now I can't hold anything for prolonged periods.

Is this normal and if anyone else has experienced this, how long did it take to settle down? I'm seriously considering making an emergency appt to go back as I don't know if I can last until my scheduled appt.

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FlyingPirate · 13/05/2015 22:33

I'm afraid I don't know if it's normal however I'm suffering from the same side affects, I.e. Feel foggy and hungover, very irritable, snapping and intolerant, exhausted all the time etc. My pins and needles are quite mild (usually in my hand) but I'm on half the dose so that could be why.
I've only been on them for 2 weeks so don't know when it settles down. I know it's not very helpful but just letting you know that you're not alone.
Hopefully someone with more knowledge will come along shortly

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hiddenhome · 13/05/2015 22:37

What time of day so you take them? I administer them at work and they're always given at night as they do cause a great deal of tiredness.

The side effects from these drugs do diminish after about two weeks. Some side effects do remain, but can be liveable with providing they're not debilitating. The antidepressant effect often doesn't appear until about 6-8 weeks, sometimes sooner.

Mirtazepine does make you put on a lot of weight. That's the main side effect we notice. It is sometimes prescribed as an appetite stimulant in the elderly when they're off their food due to depression. I don't know if this would bother you.

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mamadoc · 13/05/2015 22:44

How fast did you stop the citalopram? Sounds like SSRI withdraws to me rather than mirtazapine side effects. They should have been cross-tapered.

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fantasmasgoria1 · 13/05/2015 23:04

Hi I have been taking Mirtazapine for 2 weeks now for BPD ( stabilizing moods). At first it increased my appetite but i brought extra fruit for snacking. It has made my health anxiety quite bad but i know i will need to take for a few more weeks to see if it is beneficial. It does cause tiredness but that does lessen as does the fogginess of thought. As for the weight gain it is not in everybody and depends on whether your appetite increases. As i said just eat more fruit to stave off the hunger but that subsided after a week.

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Minisoksmakehardwork · 14/05/2015 07:46

I take them at night - usually between 7-9 as any later (I forgot one night, took it much later) and I'm completely wasted the next day.

I was told to swap straight over. So the day I was prescribed them I took one that night.

The weight gain does concern me, as I've been putting a lot of weight on lately and was already suffering with occasional pins and needles. Which I had put down to the extra weight as I weigh more than I ever have done. I'm supposed to be doing WW but I'm mentally in the wrong place at the moment so not been doing/going.

I'm ringing my GP today to ask for a telephone consultation. While the feelings aren't completely debilitating on the whole, I'm much more snappy with the DC and finding it takes me so much longer to do anything. I've 4 young DC and it's having a huge impact on them with regards to what I'm now not doing, being snappy and constant tiredness.

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mamadoc · 14/05/2015 08:05

If you straight stopped 40mg of citalopram overnight having been in it a while you will almost certainly get withdrawal effects.

You should have been told to cut the dose of citalopram gradually over a few weeks eg 10mg per week and start a lower dose of the mirtazapine eg 15mg (you can take both at once, they work in different ways)

Definitely talk to your GP. I bet if you restarted a lower dose of the citalopram the symptoms would go away.

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NotAJammyDodger · 15/05/2015 21:16

I have never experienced what you are describing while taking Mirtazapine. However, if I forget to take (or when I have reduced) another AD I am on I do get terrible pins and needles as they wear off. I think mamdoc is right, it sounds more like withdrawal from the first AD you were on. See your GP.

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Pandora37 · 15/05/2015 23:31

Mirtazapine did make me feel extremely tired for the first couple of weeks but I also had terrible insomnia, possibly because I was withdrawing from sertraline. I've been withdrawing from mirtazapine recently and felt really shaky and horrible, like I was hungover as you describe. I also think it sounds more like withdrawal from citalopram. Have you got any citalopram tablets left that you could split in half and take?

Re weight gain, I put on about 10 pounds which isn't a huge amount. I also managed to successfully lose all of that weight again whilst on it (albeit mainly due to stress) so it is possible.

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Kittykat7 · 17/05/2015 03:44

The usual advice from switching is to stop one med without weaning & start the other. Some meds can't be taken at the same time especially if they both work on the serotonin. Pharmacists are usually good for advice re:medications. I would speak to your Dr again & don't start taking the first med as well as Mirtzapine as the advice to start & stop the other without weaning is correct.

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NotAJammyDodger · 17/05/2015 06:54

[kitty] it depends on the meds and dosage as to whether they are cross tapered. If done correctly they shouldn't cause a serotonin overload. Also Mirtazapine is a different class and not an SSRI like citalopram.

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mamadoc · 17/05/2015 09:31

Mirtazapine is not an SSRI (it's a NASSA) and it can be safely combined with mirtazapine as they work differently. This is often done as an augmentation strategy long term.

However I do agree that you should talk to your GP don't take random internet bods opinion. It happens I am a psychiatrist but there again I could just be saying that. I would only ever advise you to see your GP before doing anything with meds.

If you swop straight from one SSRI to another you won't get withdrawal but if you stop abruptly and go to a non-SSRI drug you will. The pins and needles sensation in particular is quite typical.

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FanFuckingTastic · 17/05/2015 09:36

I was on Mirtazapine briefly, and the side effects were such that after about four weeks I had to stop taking it.

I am not sure if that was the mirtazapine, or the fact that I am also on 200mg sertraline, 30mg amitriptyline and 400mg XR Tramadol.

GP assured me it would be fine, but I felt completely disconnected from my body, like I was watching myself.

Most medications like these I tend to get side effects for about two to four weeks and then as they kick in, the side effects lessen, but not with mirtazapine.

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Minisoksmakehardwork · 18/05/2015 12:53

Sorry for being a while getting back to this.

I have since spoken to my GP. She wants me to continue with it but reduce the dose by half. I've been doing that since Friday and still no real let up. I feel slightly less foggy but the pins and needles are crippling first thing and present in some form for the rest of the day. Tiredness is abating mid morning and back by early evening. So it does seem like it is the citalopram withdrawal more than the mirtazapine effects. She wants me to continue with it for another week, until I see her next.

I do appreciate all your advice. It has been very helpful and I have several points to raise next at my next appt.

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Minisoksmakehardwork · 26/05/2015 16:31

Soooo, I didn't realise my appointment is not for yet another week. It's half term. I'm spending it trying to stay awake and not snap at the DC. While managing crippling pins and needles for the first half of the day and whenever I do anything which needs a grip longer than 3 seconds.

I am also eating everything in sight still. So I'm going to make and emergency appt on Friday when dh is home. I wish I'd realised last week that my appt wasn't this week (although I doubt much would have changed).