Dd has been prescribed Mirtazapine and is refusing to take them in case they make her gain weight - anyone around who can advise?

[PaperScissorsRock]

After years of mental health stuff - anxiety, depression, ocd and more recently an eating disorder (currently lower end of healthy weight range), dd (18) has been prescribed Mirtazapine.

She’s googled it and has found that this is the most likely to make her gain weight as it’ll increase her appetite (which is probably why the gp prescribed it), so she won’t take it.

Does anyone have experience with Mirtazapine? Any reassurance?

Is it worth her talking to the gp about it?

Obviously I can’t force her to take it, but I do think she needs something. Are there other options which she might more easily consider?

Thanks

@PaperScissorsRock ok did they say start off on 7.5mg? Talk to a MH doctor about this but why not start of on 7.5mg and if it does her any good stay on that but if her issues persist you can move up? She might feel happy on 7.5 that’s the dose they give to children anyways

@Butterfly3105 the gp said to start at 15mg and double it in 2 weeks if necessary. The tablets don’t look like they’d split easily.

Something is underlying her mental health problems and it would be far better to try to get to the bottom of that rather than giving her drugs which cause weight gain. Is there any suggestion from her mental health team as to what that might be?

I ask because ocd and eating disorders are common in girls with neurological disorders such as ASD, which are often hopelessly under-diagnosed in young women.

@Cailleach she is on the waiting list for an ASD assessment.

Over the last few years she has seen so many people (camhs, young carer mentors, school pastoral teams) who have helped for a very limited time then dismissed her, so she now doesn’t engage well.
Her GP and the adult crisis team and the primary care team all agree that right now antidepressants are likely necessary to help get dd to a place where she can function and can accept help and do stuff to help herself.
Right now she is so entrenched in her mentally ill self that no one can help.

I was prescribed it as an anorexic and I am still (7 years later) cross that my treatment team could be so cruel. It made me so bewilderingly hungry that I was just terrified all the time. I ate a jar of syrup with a spoon as I just craved sugar and was so distressed afterwards DH nearly took me to A&E. At the time I think I was in a similar place to your DD as I was refusing the calcium supplements as I had to eat them - they were chewable - and I didn’t know the nutritional information.

I was changed onto agomelatine. It didn’t affect my appetite and it made my anxiety much easier to manage. I’m now in recovery - not recovered as it’s still a conscious act every day to ignore the ED voice - but the agomelatine supported me in getting here.

I’ve made a note of that antidepressant @broccolibush, thank you.
I hope you do feel recovered one day 💐

I’m waiting for a gp to call back.
I’m hoping it’s ok to discuss different antidepressants with them.

It should be Paper - I spent a long time talking such things with them as I have taken most in my time (am drug free now though). Good luck. And well done on supporting your DD with this as it really isn’t easy

awful drug. it wasn’t that it made me more hungry, it’s that it made me literally unfillable, totally ravenous and I just couldn’t stop eating. I can imagine that hunger would be torture for someone with an eating disorder

I gained 6lbs in 5 weeks on mirtazapine. And I tracked calories for much of the time so I'm not sure how it happened.

Different meds are effective for different people. It would appear unhelpful not to try the first prescribed (in case it might be the most effective with fewest/least debilitating side effects) and give it a go but if she is adamant then she should return to the clinic and explain her reasons. It might be helpful to rehearse the reasons she engaged in the first place and her current quality of life.

Good luck.

Suggest she asks for Trazodone instead. It works for anxiety and depression is a similar way but does not stimulate the appetite like Mirtazapine. Trazodone has its own issues, of course, brain fog and tiredness probably the worst.

Hateful drug. I put on a ton of weight.

Ask for agomelatine ( no weight gain, lots of sleep) or Lofepramine.

I’ve been on pretty much every drug. Those 2 were the best for not eating.

Yeah, or Trazadone

@PaperScissorsRock no advice re the mirtazapine but I hope you make progress with the GP and with the ASD assessment. How has the transition to adults been for you & DD? There are a few of us on the ED thread with teens approaching that transition point - as ever it seems so variable across the country...

@myrtleWilson I think I posted once on that thread, but I’m really crap at keeping up with threads like that!

The eating disorder is recent. The other stuff has been ongoing for years.
As a child/teen we got nowhere. She was accepted by camhs 3 times then dropped, they wouldn’t consider anything as she masks and looks fine.
I rang the gp 2 weeks after her 18th birthday and he immediately referred her for assessment to the clinic that diagnosed me. In my experience of ds’s diagnosis and mine, adult services were far better.
As for MH services, it’s too soon to tell.

I take Mirtazapine to help me sleep, and I take Sertraline daily for anxiety. Before taking Mirtazapine, I was frequently unable to sleep until 4-5am, which wasn't great for my health conditions. I take the Mirtazapine at night.

I have ME/CFS and fibromyalgia and I've never had a problem taking Mirtazapine. I don't think it's necessarily helpful for people to warn others off a medication on anecdotal evidence only. And each person with ME/CFS is different, so it's very hard to know what will or won't work for someone. If you are struggling with mental health, please don't let comments here put you off trying medications that could be so beneficial to you. If you try it and it doesn't help, you can try another medication.

tofu, well said. I just hope that when people read posts that says 'X didn't work, X had this side effect, X is evil' that everyone adds 'FOR ME'. I can't think of any medication in this treatment field that works for everyone. Many people have to, as you say, try something different or sometimes combinations.

An issue we’re having is that if anyone says something in the wrong way dd will completely spin out and meltdown. She spoke to our lovely gp who pointed out that DD’s eating disorder isn’t bad enough for the ED clinic (will only accept patients when they need hospitalising). The only thing dd took away from the conversation was that she had to eat even less to prove how bad she is.
I’ve ended up looking like a controlling mother because I tend to vet phone calls and what will be said, because the slightest thing triggers her, and on top of other family stuff going on, no one can cope.

I’m on sertraline, I read horror stories about it which made me terrified of taking it - I’m fine on it, no issues apart from some early side effects that lasted a few days.

Tbh the thought of increasing her appetite felt like a good idea, but I hadn’t considered how this would conflict with the ED at all.
Mirtazapine at this stage isn’t an option as dd simply won’t take it.

Good luck, OP.

It’s not anecdotal evidence on Mirtazapine and weight gain.

It was invented to stimulate the appetite of elderly people and anorexics. Someone on here once said it had an extra glucose molecule. It’s has a rightly deserved fearsome reputation for increasing appetite. It is listed as a side effect.

NHS info on it
www.nhs.uk/news/medication/antidepressant-use-linked-weight-gain/

Will the doctors prescribe an older antidepressant? Some of them don't make you gain weight as easily. Mirtazepine isn't usually the first one prescribed so she might have tried them already.

Could you get her a counsellor privately? I got nowhere with mental health services and paid privately for counselling and honestly his support has been invaluable.

I’ve spoken to the dr, she has prescribed a low dose of fluoxetine, with strict instructions to keep a close eye on her (which I have to do anyway).

@nothingcanhurtmewithmyeyesshut she recently had some sessions with a private counsellor, which was disastrous. She is open minded to trying again, but wants to wait a while.

[quote TheEmojiFormerlyKnownAsPrince]It’s not anecdotal evidence on Mirtazapine and weight gain.

It was invented to stimulate the appetite of elderly people and anorexics. Someone on here once said it had an extra glucose molecule. It’s has a rightly deserved fearsome reputation for increasing appetite. It is listed as a side effect.

NHS info on it
www.nhs.uk/news/medication/antidepressant-use-linked-weight-gain/[/quote]
I was referring to the claims that Mirtazapine should be avoided if you have ME/CFS and or Fibromyalgia. I was not saying that weight gain was anecdotal, it is a known side effect of Mirtazapine.