Mirtazapine - how do you lose the weight?

[hatemirtazapine]

GP prescribed mirtazapine under psychiatrist’s guidance two years ago for anxiety complicated by OCD and PTSD . It helps me sleep, I feel drugged up most of the time and ever so slightly less anxious . GP won’t allow me to come down on it, says it’s essential I take it - no safe alternative as I’ve had a serious reaction to sertraline, citalopram and duloxetine - they don’t want to change it again .

Dose was increased in September to 30mg as I was having panic attacks . Also put on beta blockers and threatened with an antipsychotic too if things didn’t settle . Since then I’ve gained a stone in weight . I was morbidly obese to begin with .

I’ve also got PCOS which is going untreated (no meds) as
as told there isn’t any nhs help . Best friend is a GP and has pointed out dozens of times they should be prescribing metformin and checking for T2DB but my GP has said not needed .

My family continually point out how fat I am - in a horrible way, call me the ‘elephant in the room’ and say it’s my fault for taking medications - ‘if you stopped them you’d feel much better’ .

GP has said to religiously control everything I eat, calorie count every meal, track steps daily - says that’s the only way I can start to lose . I’m scared if I start it’s going to get to being an OCD ritual .

My diet isn’t great, I eat a takeaway once a week (more out of tiredness and lack of motivation to cook) and eat far too many biscuits, sweets, cakes and mayo . I comfort eat and hoard food .

Being so fat and anxious exercise is a nightmare too - I can walk about 3 miles but end up in agony with knees and ankles afterwards . I usually do 1.5 miles a day which probably isn’t enough . I’m thinking about trying to swim when the pool opens next week but I’m scared - too many ‘beached whale’ comments as a child .

GP said there is no NHS help - it’s a case of me being much stricter and forcing myself to walk more . I’m getting some therapy for the mental illness side of it, and she’s encouraging me to do gentle walks for enjoyment and eat for fuel rather than for comfort - but I don’t know if that’s enough?

Op I'm really sorry it sounds like you're stuck in a vicious circle...its really very difficult to moderate diet when you're coping with the things you are.

Please see a different gp, kick up a fuss if you need to. I'm just starting investigations into pcos and if diagnosed my gp has said that metformin is the treatment.

It sounds like you need a helping hand to give you a breakthrough in this cycle so that you can tackle the others things. I think being taken seriously by a gp will give you the confidence you need to tackle your diet.

Mirtazapine is a beast for weight gain, I know from personal experience. If it helps, my body responded well to normal weight loss tips once I came off it so hopefully when you can start reducing the meds you'll be able to adjust your weight too.

Have you tried therapy? With your comments about hoarding and comfort eating, I wonder if cbt would be helpful to you alongside the anti depressants.

Do you feel happier working out at home? If you're able to do so undisturbed then there are some great workouts on YouTube. Someone here recently mentioned The Body Project on YouTube (and online) which I've looked up and they seem great - really encouraging and positive.

I don't know the dynamics in your family, but if they don't respond to a strong communication of 'shut up and drop it' then I would do my best to minimise contact and attempt to ignore them. It's ignorance talking.

Given the exercise you do, you're clearly a very resilient person (however little you feel it) and I don't think you're being given enough credit by your gp for how hard you're trying in the face of such difficulties.

You have a gp problem, please find another. Preferably one with some understanding of OCD. Some surgeries declare gps special interests and if you can find one with a special interest in mental health or pcos ask to be registered with them.

Youre doing brilliantly, don't go around feeling like you're not. And you will get there. Listen to your friend, help is available (on the NHS for you).

P.s. I meant to say as well that support for the comfort eating and how you utilise food sounds key here too, hence why I suggested cbt. Therapy could be really useful in helping you address this.

Your GP is a twat. Get another one. Can you afford to pay privately to see a psychiatrist. I gained weight on mirtz despite religious calorie counting and loads of exercise. I see a private psychiatrist now.

Mirtazapine is well known for weight gain. I certainly gained weight on it. I’d lost weight before, due to anxiety and depression, so it didn’t matter to start with, but it soon did. The only thing that stopped it was when I was able to come off it.

I really don’t think that it’s just a question of comfort eating and stopping that and increasing exercise. It also makes you feel very hungry which doesn’t help. Mirtazapine doesn’t, in my experience, allow you to use food for fuel. I agree with osbert. If you could see a psychiatrist , you might have more support.

My GP outright lied and told me mirtz doesn't cause weight gain. It's actually in the leaflet that it's a common side effect. So after that I changed GP because I don't trust lying gits who will say anything just to get rid of you rather than listening.

Currently on mirt for a year. Was always a size 6/8 and now I'm a 12/14. I don't over eat and I exercise yet I've put on so much weight! I have a private psych but as I've tried so many anti depressants and this is the only one that works. Basically I'm fucked. I have a well mind and a poorly body or the other way around - I'm on a Facebook support group and every single person can't shift the weight until there off. Sorry x

@missw1987

Currently on mirt for a year. Was always a size 6/8 and now I'm a 12/14. I don't over eat and I exercise yet I've put on so much weight! I have a private psych but as I've tried so many anti depressants and this is the only one that works. Basically I'm fucked. I have a well mind and a poorly body or the other way around - I'm on a Facebook support group and every single person can't shift the weight until there off. Sorry x

In the US mirtz is often combined with bupropion to counter the weight loss. Bupropion is only licensed for smoking cession here (we're really behind medically in a lot of ways) or refractory depression (which you appear to have) but a private consultant psychiatrist can prescribe it to adults off-license if mirtz is all that works for you but is causing obesity as that's a health problem, too.

It's a shame we're so behind in the game because mirtz can work well but making people obese has serious ramifications, too, and yet there's a way it can be mitigated.