To ask for experiences of mirtazapine?

[struggling26]

Hello. Long story very short: I am having a very tough time at the moment due to an experience last year which left me with PTSD. I’m awaiting trauma therapy and I’ve had a few short term prescriptions of diazepam from the GP in recent months to help manage acute distress and panic. I get really good short term relief from Diazepam, but it doesn’t seem to be agreeing with me anymore due to heavy sedation and a very unsettled feeling the next day. As a result my GP wants me to try mirtazapine instead as a more longer term solution (rather than using diazepam in the shorter term to manage acute crisis periods). I have IBS too and cannot tolerate SSRIs such as sertraline - GP said this is less likely to cause anything like that as a side effect.

anyway, does anyone have any anecdotes about mirtazapine? Either good or bad? Especially in terms of reducing anxiety/panic and improving sleep / mood etc, but also in terms of GI side effects? Is it a good alternative to diazepam? Thanks 🤞🏻

It’s helped me enormously. I’ve not put on weight but it does give me restless legs, which I’m susceptible to.

If you have someone to help you with your child it might be worth trying, but I would not risk it if you're a single parent without support. DH missed seeing DD for entire days at a time, missed work, etc. due to sleeping for up to 18h a day. And that was the starter dose.

I put on a LOT of weight with mirtazipine, outweighed any benefits from it.

My friend who was on it ended up putting on quite a lot of weight. I certainly think you'd need to be aware of it.

Has the GP looked at options for an SNRI? I have IBS and a consultant I saw suggested that SNRIs can have a significant positive impact on IBS. I'll go hunting and see if I can find the scientific article/s supporting it.

I am not on mirtazapine but it was the next try for me if my current meds didn't work (escitalopram, an SSRI), especially as my depression was manifesting with loss of appetite. My friend is on mirtazapine, and said it really helped with depression, anxiety and sleep. You get sleepy soon after taking it, so need to take it in the evening, and it does increase appetite. I struggle getting off to sleep which is why it was the next thing for me, but the escitalopram is working really well so I don't want to make a change now.

Replying to myself:

https://pmc.ncbi.nlm.nih.gov/articles/PMC8378448/

Here we go.

Thanks all, lots of useful info here to consider.
I’m not a single parent, I do have a partner who is around for practical support with parenting however he works very long, unpredictable shifts and lots of antisocial hours, so I’m often the default parent. This would worry me for being overly sedated. I do also have a high pressure, mentally demanding job 4 days a week, so need to factor that in, in terms of needing to be alert etc.

does anyone know if 15mg is a typical starting dose? This seems high to me if others have been on 7.5mg?

Thank you @Ineffable23

I think (counterintuitively) the sedative effects are meant to be lower at a higher dose. So if you have expressed concerns about sedation, they might have done a higher dose for that reason?

BNF suggests 15mg is a normal starting dose:

bnf.nice.org.uk/drugs/mirtazapine/

My DD was on it for two years following a traumatic withdrawal from other ADs. It did sedate her so at least she was getting some sleep, but there were no other beneficial effects unfortunately.

The weight gain is real, it gave her a voracious appetite and she put on at least two stone which was a lot on a tiny frame. She’s lost it all but had to work hard at it.

The good news for her is that coming off it has been easy with minimal side effects.

DFIL is on it for OCD and it has been enormously effective for him at 30mg a day. Totally life transforming. It sedated him slightly at first but only in that he drifted off to sleep at night quickly, not sleeping for many hours of the day sedating. That's worn off now and whilst people say increased appetite is one of the main drawbacks, my DF is a large man and he's actually lost some weight on it. It does increase appetite but I guess for those whose mental illness might exacerbate over eating/weight challenges, a calmer clearer mind might allow for weight loss.

Magnesium muscle spray. Home bargains sell it, spray it on your feet and rub it in and it dulls the sensation so you can sleep.

I have been on it a few times. I found it helped with my sleep (avoided the 5am wake ups lying awake thinking about things) but wasn’t overly sedating for me. I understand it is the antidepressant of choice if you are having issues sleeping. I had no issues with eating, put on and lost weight on it but no different to eating more and then choosing to lose weight.

That doesn’t touch my restless legs. I have to take Pramipexole.

I cant stand it. Been on it twice. Makes me need to have things in my mouth all the time, even made me wish items around me were edible. Weight gain was rapid and awful. Really badly affected my M.E and fibromyalgia - both became very very very bad, in constant flare for months til I stopped. Made me permanently drowsy. Utterly awful.

Everyone will have different stories but I've never met someone who didnt have the food and weight issue with it.

Vivid dreams were a thing.

Absolutely not for me.

made me do hungry I wanted to eat the contents of the fridge and the fridge itself - so made me gain weight rapidly - was just constantly ravenous on it .

made me sleep / but far too much and too deeply - didn’t hear the baby crying as was practically in a coma.

then the next morning I woke with what felt like the worse hangover ever .

everyone reacts differently but this definitely didn’t suit me as could barely function on it as was so tired and when I was awake all I did was think about food.

have friends who found it really helpful and didn’t find the side effects as bad as I did.

I guess you’ll have to try it and see how you go as everyone has a different response.

I remember buying tea and cake, and then buying and scoffing a whole box of chocolates before going to McDonalds immediately afterwards. Another time I bought four chocolate muffins and wolfed them down. I went back to normal very quickly. I don't eat any more than I did before I started on them fifteen years ago. The weight gain still continued and I can't shift it. I won't stop taking them for any reason as they give me mental stability (with other drugs).

wellbutrin?

DD started on 7.5mg and went up to 15mg. At 7.5mg she was bone tired all the time, was told this would ease with the increased dose.

I’m the exact same. Do you mind if I ask what you were diagnosed with?

My experience is it’s great if other things don’t work/ aren’t suitable but best alongside at least one other med.
It doesn’t really increase my appetite as I have a big appetite anyway. I’ve lost weight while on it before.
It is great for sleep but you can spend too much time in rem sleep on it so that’s why you can get vivid dreams/ nightmares and not feel as refreshed as regular sleep.
It makes you pretty drowsy in the day. I couldn’t function if i wasn’t on Venlafaxine as well. Venlafaxine alone makes me jittery and sleepless but they seem to balance each other out somehow.
Being on it is akin to being constantly mildly stoned ime. It depends whether you’re ok with that feeling, if it suits your lifestyle, and on whether that’s overall better than your current situation. For me it is, at the moment.
People experience it differently though and that’s my experience of it.
I've been on it for 20 years with a break of 4 years (during which I relapsed).

Venlafaxine is one of the most difficult ADs to come off because it has a very short half life. From experience, doctors are quick to tell you that any symptoms you experience are a relapse, when in fact they are more likely to be the effects of withdrawal.

It was a relapse. The relapse happened slowly months after I was physically clear of all medications.

Obviously you know your experience but withdrawal doesn’t kick in immediately, it can take months, years to be clear of the effects of ADs.

I was off all meds for nearly five years.
The withdrawals were very unpleasant but my mood was stable at the time.
My mood was fine for about three years after I stopped the meds, then a few things happened that triggered a major depressive episode.

I hope you’re much better now.