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Original poster

Experiences of combining mirtazapine and sertraline for depression, anxiety and insomnia

4 replies

DollyMixture89 · 30/07/2026 14:55

I have treatment-resistant depression. I've struggled with depression and insomnia on and off for many years, but for the past five years I've had a constant low mood mixed with anxiety.

I've tried many antidepressants, including some that aren't available on the NHS.
I'm currently being supported by a great team, and they're arranging blood tests first to rule out any underlying deficiencies or problems, including vitamin D, B12, folate and magnesium.

If everything comes back normal, they'd like me to try a combination of mirtazapine and sertraline. I've never taken mirtazapine before because I've always been worried about the potential weight gain. I have taken sertraline in the past, and while it did help my mood, I experienced apathy and sexual dysfunction.

I've been told that higher doses of mirtazapine may be less likely to increase appetite and weight, although they may not be as effective for sleep.
One of my biggest concerns is the risk of serotonin syndrome.
I'd really appreciate hearing from anyone who has experience with this combination or with mirtazapine in general. How did you find it? Thank you.

OP posts:
minecrafter · 30/07/2026 18:59

Hi @DollyMixture89, I had fluoxetine instead of sertraline, and took mirtazapine.
I didn’t have any weight gain, and mirtazapine is amazing for sleep.
The only side effect I would say, or the mirtazapine can make you feel groggy the following morning, so make sure you don’t take it too late at night, especially if you need to drive the following morning. It puts you in a very deep sleep.

The combination really helped my anxiety!

Original poster
DollyMixture89 · 31/07/2026 09:19

minecrafter · 30/07/2026 18:59

Hi @DollyMixture89, I had fluoxetine instead of sertraline, and took mirtazapine.
I didn’t have any weight gain, and mirtazapine is amazing for sleep.
The only side effect I would say, or the mirtazapine can make you feel groggy the following morning, so make sure you don’t take it too late at night, especially if you need to drive the following morning. It puts you in a very deep sleep.

The combination really helped my anxiety!

Thanks for reply & advice. Fluoxetine is one i haven't tried, think it was mentioned for the combo.
I am currently on Trazadone which is also great for sleep, but I am groggy on it & a little forgetful but not helping depression or anxiety.
Are you on a lower dose of mirtazapine?

OP posts:
LuckyManifestations · 03/08/2026 20:25

Mirtazapine user here.
I have never had trouble sleeping, so cannot comment on that.
It does make me terribly groggy in the mornings no matter how early I take it the night before.

The plus sides are though that it worked instantly on my anxiety, and within a fortnight for my depression.

I have taken every anxiety and depression medication previously, most of which either havent worked for me, or the side effects have been more than I could deal with.

Mirtazapine has definitely given me a lift, although the drowsiness has been a problem as I start work very early in the mornings.

I havent had the side effect of increased hunger either.

Bluebellsintheforest33 · 03/08/2026 22:07

I don't have experience of this, but can I ask how you got a diagnosis of treatment resistant depression? Was it through the NHS or did you go private?

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