Newbie to antidepressants. Can’t believe it. Given choice of sertraline or mirtazapine. Please help

[Marmitemarinaded]

I can’t go in to details
But back from GP and he has all but insisted I go on anti depressants

Phenomenal dr. This is not a quick decision. It’s been going on for years.

Anyway he’s said I can decide.

Please help me decide
Thanks so much

No, not daft. Impact of feeling like you're doing something to help yourself feel better can make a difference.

@colouringindoors

No, not daft. Impact of feeling like you're doing something to help yourself feel better can make a difference.

So you don’t think actually sertaline?

It's not impossible, but usually takes a bit longer.

i think it might have started to work by now; I definitely felt an effect quite soon, but just keep taking the pills 😀

One week in
Absolutely no side effects
Does this mean I should make the jump to 50?

Yeah I would. Glad to hear no side effects. Mine were minimal too on Sertraline (theres a reason GPs prescribe itvto each other!). Hope it helps.

@colouringindoors

Yeah I would. Glad to hear no side effects. Mine were minimal too on Sertraline (theres a reason GPs prescribe itvto each other!). Hope it helps.

Thanks How did you stagger? Start on 25?

I actually changed from fluoxetine to Sertraline under psychiatrists advice so actually started on 50mg and then about 3 weeks later went up to 100mg with no side effects. I would imagine if you've had no side effects on 25mg you're very unlikely to have anything significant side effects going up. I had slight nausea and headache for a few days going from 0-50mg but that was nothing compared to starting fluoxetine (bad).

It can work almost first day with some. I know its working because intrusive thoughts piss off, i can speak whats actually in my mind and my whole brain and imagination sharpens up. Reading becomes really enjoyable again

Mirtazapine is not an older antidepressant. It's newer than SSRIs like Sertraline. It's a noradrenergic and specific serotonergic antidepressant (NaSSA).

Different people respond differently to different antidepressants.

I didn't do well at all on SSRIs - I practically had every side effect on the list! Tricyclics (which are the older antidepressant) made me sleep for 16 hours a day.

Mirtazapine worked for me - it's a strange drug that has different effects at different levels (eg it works well to help sleep at lower doses, but not at higher doses). I found it helped my depression at a lower level but my anxiety only at the highest dose which I've been on for over 10 years.

Mirtazapine doesn't make you gain weight in and of itself, but in the early weeks it massively increases your appetite. I was very careful to try not to overeat but put on a small amount of weight anyway but the hunger pangs wear off and I lost the weight again easily when they wore off.

However, it's completely personal. The only way to find out is to trial them and keep in contact with your GP. If one doesn't work for you, try another.

V odd to offer mirtazapine as a first-line option.

Usual first-line options would be:

-Sertraline
-Citalopram
-Velnafaxine (potentially)

Don’t be nervous about trying SSRI’s / SNRI’s. Might sound flippant but they’re ten-a-penny and the majority of people will try/be on them at some point. Really not a big issue.