Mirtazapine experiences?

[AwakeCantSleep]

Hello all. Thanks very much for reading this. I've been suffering from bad depression and anxiety for quite a while. (I got signed off work for 8 months last year.) I've got better since, but I'm really struggling with the anxiety to the extent that even opening work emails stresses me out beyond belief. I am constantly exhausted from being so anxious. I just cannot go on like this.

I've been taking sertraline (100mg) for over a year, and it does help, but I also feel that it makes me very very tired and thus even less likely to cope with work.

My GP suggested to reduce the sertraline to 50mg, and introduce Mirtazapine (15mg) which should also help me sleep at night.

Reading the leaflet in the Mirtazapine package however has freaked me out (and I really don't suffer from health anxiety....!). Problems:

• these days I often start work very early (7:30-ish). The drug can apparently make you very sleepy in the morning.
• I worry about weight gain (I've not put on weight on SSRI medication).
• If the stuff zonks me out, I can't drive and that means I can't attend my yoga classes which have been a life saver. Also getting to work much more difficult.
• I don't really want to have to rely on drugs. It appears that withdrawal can be more difficult with mirtazapine than with SSRI.

Thus far I've not taken a single tablet of mirtazapine for the above reasons. However I have reduced the sertraline. Not sure this is a clever idea.

(By the way I have had CBT and counselling, both very good but not touched the root cause of the anxiety. I'm now paying ridiculous money to see a clinical psychologist as I've exhausted all options on the NHS.)

Any wise words/experiences on the effect of mirtazapine and/or sertraline would be much appreciated. Thank you.

Mirtazapine seems to be the drug of the moment. I know three people (including myself) who've been put on it.

It did nothing for my depression, made me horrendously sleepy to the point I couldn't drive at all for the first few weeks, and I put on a fuck ton of weight.

Its primary use is as an appetite stimulant. If you're not happy, say this to your GP and ask them to reconsider.

I came off it as the side effects made me feel so much worse. I'm very slowly losing the weight, and that's with no appetite.

I'm on the maximum dose of fluoxetine as sertraline stopped working for me. Perhaps a different SSRI will be of more benefit.

Thanks Hug, that's really interesting. From what you have described, I don't think Mirtazapine will be any good for me. I'll have to phone the GP about it (appointments are like gold dust).

I've ended up on Sertraline after trying Fluoxetine (which made me feel like a zombie; plus I struggled to get any sleep on it), and citalopram (which didn't touch the anxiety and gave me the most horrendous nightmares - think being chased by a serial killer etc). I might have to re-consider fluoxetine.

I'm on mirtazapine and love it.

But I have dangerously bad insomnia. (Think getting 4 hours sleep in a 90 hour period)
I also have a personality disorder.

It's not that bad detoxing off of it.

Venlafaxine was far worse.

What about a Try-Cyclic one? One of the oldies.

Or a mix of ammytriptaline and an SSRI? Combat the anxiety with a seperate medication, may mean a lower dose of AD is needed.

Venlfaxine (Effexor) is good. Don't get me wrong. Probably do the job quite well. It's an SNRI.

But I'd warn you: coming off Venlafaxine is the hardest thing I've ever had to do in my life.

Alternatively, what about going herbal and trying Red Clover? I've heard positive things about that.

(I've tried every type of AntiDepressant there is!)

Hi,

I am a mental health nurse and have actually seen many patients have a very positive response from mirtazapine. You will be started on 15mg and this can be increased to 45mg if needed. It is taken at night time because yes it can cause some sedation but many people report their sleep is much improved which in turn can improve mood and anxiety in itself! It is the drug of choice at the moment but that's also because It can be very effective. Every person will have a different response to each medication and therefore I would not be put off trying because others report over sedation or no therapeutic effect on mood. Unfortunately finding treatment that suits is a bit of trial and error which is incredibly frustrating. If side effects are unacceptable then of coarse you must tell your GP no one should have to suffer with unwanted side effects. But do give sufficient time for mediation to take effect and sedation can wear off after the initial period of starting treatment.

DH had it. Made him tired, he piled on weight and did nothing for the depression. Ended up back on sertraline.

I was on mirtazapine for 3 months, hardly got out of bed and put on 2 stone. I have friends who have loved it though, give it a go and see how it is for you.
I found venlafaxine is much better for me (side effects are awful at first and withdrawal worse), but once I'd stabilised my dose it was great.
Good luck OP

Venlafaxine will only be used if you have no problems with blood pressure as it can cause high BP. Sertraline is often particularly good for anxiety, you weren't on a very high dose but if you had bad side effects it may not be for you.

I was prescribed it for severe insomnia which it did help with. However, i did pile on weight and suffered badly with constipation.

Weirdly DH also got diahorrea.

I didn't get on with it. It made me a zombie because I was so tired, crave carbs and really angry when I wasn't shattered. I didn't stick with it. I also didn't get along with fluoxetine (vivid, terrifying dreams) or sertraline (just numb) and now I'm on Agomelatin, which is fairly new and manages my anxiety well unless I drink alcohol. It also has very few side effects for me which is great. Most doctors don't seem to have heard of it though, as it's quite new.

Wow, so many replies. Thanks very much, your responses are incredibly helpful.

From people's experience on here, how long does it take for the intended effects of Mirtazapine to kick in? And the side effects too. Would 2 weeks be an adequate time frame to try this drug?

I really don't want to be a permanently shattered food craving zombie for much longer than that, given that I have to work! It's hard enough as it is.

Agomelatine sounds very interesting, and I shall definitely ask my GP about it. He may not have heard of it.

No two weeks isn't enough time for any A.D.

It took about 8-12 weeks for me.

I'm on it. It hasn't been as bad as some for weight gain. I found Prozac worse. It is meant to make you sleepy, but it didn't with me. I'm not convinced it is any goos against depression or anxiety. It wasn't for me, when I was only on the mirtazapine.

The worst thing for me was restless legs. I couldn't take it over 30 mg.

It is normal to combine mirtazapine and another AD though

You wouldn't use two anti depressants together. Too much risk of Seratonin Syndrome....
You may use it with another mood altering drug such as a mood stabiliser/anti psychotic.

The side effects aren't that bad. Honestly.

I've lost weight on it!

Mirtazapine is often combined with another Ad. I'm on Paroxetine,as well as Mirtazapine. It's often combined with Venlaflaxin and that combination is known as Rocket Fuel.

I also take a low dose amitryptiline for pain.so I'm on 3 Ads...

I was on mirtazapine for a while, the highest dose actually. In terms of sleepiness, it did make me feel zonked for the first 2-3 days but that quickly went. I actually had terrible insomnia for about a month, although I was coming off sertraline for the first couple of weeks so that may have been why. I also had a few nightmares/weird sleep paralysis type things but they went after a couple of weeks. My sleep eventually improved and I never had problems getting up in the morning. I'm on venlafaxine now and I find it harder waking up on that than I ever did on mirtazapine.

It did increase my appetite and I put on about 10lbs which isn't terrible but depends how much you weigh in the first place I guess. I do think a bit of weight gain is inevitable unfortunately, I think that's the most common side effect there is.

In terms of depression and anxiety, it worked okay. It got me out of bed and functioning but I never felt truly 'right' on it. I was on it for 6 months and for the last 3 months my depression got worse and worse. The withdrawal was actually okay - I only felt awful for one day and that's because I got a bit cocky and reduced quicker than I should. Only took a month to come off it, if I remember rightly.

In terms of side effects, venlafaxine has been the best AD (as well as sertraline and mirtazapine, I've also been on fluoxetine.) Other than occasionally finding it a bit hard to wake up in the morning (and to be honest, I'm a bit like that anyway) I haven't had any side effects. Might be worth discussing all of the alternatives with your GP before going for mirtazapine.

I love mirtizipine but I came off them as I put ALLOT of weight on x

I started on 15 mg of Mirtazapine just almost 4 weeks ago. I have depression/anxiety (with panic attacks) and my sleep was destroyed by 4 weeks on sertraline - which had me climbing the walls and worsened my anxiety.

Initially the 15 mg really helped with my sleep - taken before bedtime, I fell asleep quickly and slept well for about 6 - 7 hours. I didn't feel especially zombie-like during the following day either. It didn't do much for the panic attacks or the anxiety . BUT, after a couple of weeks the 15 mg bombed, the anxiety increased and my sleep deteriorated.

Yesterday my GP increased the dose to 30 mg before bedtime and I slept better last night. Today is the first day in a couple of weeks when I have not had to take a Diazapam to help ease the anxiety. (On 1st October my GP gave me 28 x 2 mg tablets to take the edge off the anxiety, and I have been very reserved about their use - only taking them when absolutely necessary - I still have 5 left some 6 weeks since they were dispensed). This has meant that sometimes the anxiety has been absolute HELL.

I hope I am not being overly-optimistic about the Mirt - but so far to date they have not been a bad experience; no side effects and NO weight gain. I think the weight gain thing can be controlled if one just accepts it might be a problem and uses extra will-power. I try not to have in the house any of the high carb sweet things which will pile on the weight.

Fingers crossed the Mirt works - I cannot bear to feel as bad as I have felt.

I'm also on Agomelatine (& two other meds, I'm bipolar). It's been an excellent med for me. However, it has come out from tests as not especially effective. I think it's a case of it either works brilliantly for someone or not at all.

To prompt reflection on the absence/paucity of longer term withdrawal success stories. To suggest that even if you are currently in the blissful throws of early Mirtazapine addiction you may benefit from a little research beyond statements made by those with a vested interest in this drug. I am dying of organ failure one and a half years into the peaks and troughs following cessation. That is not my only health inconvenience. I have known four others on this drug. Two are dead. One due to reasons that likely preclude anecdote being re-categorised as data and the other from dementia which followed significantly unusual course in a protracted late stage. Best wishes to you all, especially to those who happen to be someone's mother.

I've refused Mirtazipine for those same reasons and insisted on a tricyclic so watching with interest.

hi at the moment im on 100mg sertaline for depression and insomnia i have been on this about a year now works really good for my depression and most of the time my sleep ive recently been put on mirtazpine im still within the first week at the moment , im defiently sleeping first day i slept 13hrs it has reduced slightly , im just hoping that once it gets in my system i wont want to sleep so much as its making me drowsey during the day and partner has noticed it takes my brain awhile to respond to questions on a morning at the minute. im using a sleep chart at the moment to record how im feeling and how its going with both tablets

I suffer with anxiety which if prolonged leads to depression and have been on and off ADs for many years, having tried most of the popular choices.

My GP prescribed Mirtazapine after a period of acute anxiety about 3 years ago where I was effectively living in a continuous panic attack to the point I could barely function. Sleep was out of the question.

Everyone's experiences of Mirtazapine will be different, however mine were as follows.

Firstly, it was amazing for getting me to sleep. Ironically, the smaller the dose, the greater the sedative effect. I've tried 15, 30 and 45mg doses.

I'd take a pill at 10pm and barely be able to keep my eyes open 45mins later and would have a great night's sleep.

In the morning though, unless I (or someone else) forced me to get out of bed, I could fall back to sleep very easily. I remember one weekend literally lying in bed all day, half awake and having a second full night sleep without ever really waking up properly. You have to force yourself to get up.

before my body got used to it, the first few days were difficult in that my head was very foggy, my mental processing inhibited and all my creativity restricted. I remember at one point actually slurring my speech slightly such was the level of background sedation.

Whilst this was a real problem from a work perspective, it was a massive and hugely welcome relief from the panic attacks and anxiety, and to be fair, it was the Mirtazapine that broke the cycle for me.

Once I've levelled out on the drug, the sleep and getting up in the morning situation remained, however the day time alertness did improve, albeit not fully - I was always conscious that I was under the influence and never quite felt natural.

My panic attacks and anxiety had stopped me from eating and I;d lost about 2 stone in weight, so the carb cravings that came with the Mirtazapine where initially welcome and I put the weight back on, but then it became a challenge to not over do it. I am well disciplined so this was not a big challenge, but I can see how so many put weight on with it. There are times when you are desperate for bread, cake, cereal etc and no amount of food satisfies.

What I will say is that Mirtazapine did nothing for my depression, in fact it made me a lot more irritable and short tempered. I tried all three doses but they were all the same. Brilliant to relax and go to sleep, but no good for me as an AD.

I still have a few boxes left of the various doses and reach for them in an emergency if panic has gripped me, to ensure I get a good night sleep and don't lie awake in the night with my heart pounding out of my chest uncontrollably for hours and hours. I always regret it in the morning when I'm groggy all the next day.

The only other thing I will say about Mirtazapine is that they were the only anti depressant that didn't give me sexual dysfunction.

ive not been on mirtazipine for a week the first few days were hard but now its really good im actually sleeping , they do make me eat a little but i never had breakfast previously now i do, so far so good my moods are good and im sleeping, i keep a sleep chart to see how im doing day today