Advice/experiences of mirtazapine

[TheValeyard]

Hi there,

After having a couple of major depressive episodes due to work stress, my doctor prescribed mirtazapine - I'd had severe bouts of insomnia, and this was thought to be the best AD for that particular symptom.

I've been on 15mg for the last couple of months, and have just gone up to 30mg. I'm unsure whether to stick with it, as:

I have visibly put on quite a bit of weight;

I still feel extremely down in the mornings, despite sleeping, to the point where I'm having to suppress crying jags on the train;

I've developed skin problems on my face (possibly unrelated, but no other cause identified);

Still feel anxious and disconnected all the time;

Although I am sleeping better, I rarely feel rested, and lack energy almost constantly.

Does anyone have any advice or experiences on this drug? Is there any chance this will get better, or - as I'm thinking - should I just come off of them?

I was on these for 3 months and had similar experience, like you I was not sleeping because of work stress. I did sleep better but put on a ton of weight and felt very disconnected. I don't remember still crying or skin problems though. I came off because of the weight gain - a common side effect the GP didn't mention - this drug is actually prescribed as an appetite stimulant. I mentioned I had a history of being bordering on eating disorder in the past, and that significant weight gain was not something I could tolerate. When I mentioned the feelings of disconnect and being muffled my GP said that was what they were meant to do.

Have you tried any other AD'S ? There are several others commonly prescribed. If you aren't happy then go back and ask for something else. they may offer Sertraline, or another SSRI. You can look at profiles of the AD's on the MIND website and it might be an idea to have a look through before if you are thinking of trying something else. I found I just accepted the mirtrazipine without asking any questions at the surgery because I was so stressed and desperate.

Hope you find some peace.

I tried a few before I settled on my current AD's and I remember feeling the worst , mentally, whilst I was on mirtazapine. Makes me shudder to think how low I was on them although I'm sure they've been a huge help to some x

I've tried citalopram before (managed my mood ok, but didn't do much for sleep) and sertraline (which made my sleep worse).

Might just have to accept that the stress is what it is...

You may need an increase in dose. Often the weight gain is better in the higher dose apparently (something I don't understand). The weight gain with mirtazapine is due to being more hungry and this should wear off.

I have been on mirt (45mg) for many years and found it extremely helpful. I tried SSRIs and tricyclics first and had horrible side effects and they didn't work.

What works for me will not work for others. It's trial and error and you need to give them a good try.

I was on 15 and then 30 first. I felt like it was working but was left with some anxiety. This went when I increased to 45.

I resisted ADs fir many years. I was in a place when I went on them where I had really run out if options. They saved my life.

Hope that helps.

Sertarline and citalopram don't agree with either and citalopram made me seriously ill. I take mirtazapine out of desperation - to counteract the effects that citalopram have left me with (which I didn't have before I took them) namely poor sleep, nocturnal diarrhea (lovely!) and anxiety on waking which is so extreme it makes me retch and shake. I find mirtazapine lovely for sleep (many hours good quality sleep) and helps with anxiety but it does make me pile on weight. I don't have severe cravings on the drug like some, and I don't tend to overeat but I still put on weight (particularly on the tummy) and this occurs when I cut calories too. The drug may change the way insulin behaves in the body (from what I have read). I am trying to wean myself off the mirtazapine, but when I do the severe anxiety comes back. I think MiniMum is right though, Mirtazapine may work better at higher doses with less weight gain.
I've spent a lot of time reading user reviews on the drug and some people have found they can control the weight gain with a low-carb, low GI diet and plenty of exercise. Also I think it helps spreading your calories evenly throughout the day.
Are you trying any other therapies apart from anti-depressants? I feel for you not been able to sleep well, that is horrible.

I did get a referral to a counsellor through my company's welfare office, but am at the end of my sessions. I did look into hypnotherapy for sleep problems, but wasn't convinced by the sessions I had.

I've asked about higher doses of mirtazapine, but apparently as the dosage gets higher it becomes less effective for sleep.

Sorry I didn't respond sooner! Things went a bit pear-shaped this week. I didn't know that the higher doses of mirtazapine were not effective for sleep, if that is the case its obviously not worth upping the dose, particularly as the mirtazapine does not seem to be giving you restful sleep in the fist place. If sleep is the main issue, I am surprised that the doctor would prescribe mirtazapine when it is primarily an antidepressant and can also cause weight gain and be difficult to come off. Perhaps its worth going back to your doctor and asking about an alternative? Perhaps beta-blockers as they can be taken as and when you need them. It might also be worth getting on the NHS waiting list for some kind of counselling to help with the work stress. That might be the key to overcoming the insomnia. Myself, I am back on the mirtazapine at the moment (just 7.5mg) so I'm expecting to grow out of my trousers sometime soon!

No personal, experience with it, but my dad took it for a while and reported feeling a great deal worse whilst on them.

I was on it for 4 weeks and had to come off it - I was sleeping 14+ hrs/day and piled loads of weight in, and felt really quite spaced out. I didn't get in with it at all, sadly.

I've been on it for years now. Yes the weight gain isn't ideal but better than the alternative

Hi all

Thanks very much for your replies. I've decided to stick with the 30mg dose for the time being. My sleep hasn't been great this week, but it's not terribly bad either.

I'm going to watch what I eat very closely and get some more exercise to mitigate the weight gain (got the dumbbells out on Weds and ran 7k last night!). Got some treatment for my skin and that seems to be working.

It's not ideal, but I'm in a better place than I was before. Was in quite a bit of trouble in Feb so not keen to go back to that.

I'm on the same dose as you OP, and have been for about three years. I have found the weight gain managable in the long run, but then I only ever gained about 0.5 stone on it (Sertraline is another story!). I like Mirtazapine as it doesn't give me the groggy feeling that SSRIs do, nor the sexual dysfunction. Not everyone gains lots of weight on it (although clearly many people do!).

I’ve been on 30mg mirtazapine for about 4 months now. I had been on sertraline and citalopram before that, but came off them due to side effects. It took a full 7-8 weeks of taking it before it really started to work for me, so persevere with it. Like most ADs, things get worse before they get better.

The sleepiness was difficult at first, but by about the second month I was back to sleeping normal hours. I just sleep a lot heavier than before taking them, though not heavy enough that I don’t hear the littles ones if they wake.

It’s been a real help with my GAD and depression. I used to get so anxious in the mornings that I would make myself sick, but I feel like I’m getting back to my old self on Mirtazapine.

The only thing that I’d say that caused issues was the night sweats on the first 2 weeks. I had to change my PJs twice a night and the bedsheets each day. It didn’t last long, but was tiring having to do so much additional washing!

To combat the weight gain I use a free calorie counting app (MyFitnessPal) so that I can see how much I’m eating and when, I’ve also started running which studies have shown can be as effective as ADs for depression.

I understand Mirtazapine won’t be for everyone, but I’m a lot happier on it than I have been in the 9 months I was taking sertraline/citalopram.

Well this is interesting.... OP thank you for starting this thread. I hope you don’t mind me jumping on? Iv been on loads of diff anti d’s And I hated how I felt on them, sort of I’m a fog all the time. I was put on mirtazipine 2 years ago now. I have no side effects and it helps me fall asleep beautifully. HOWEVER, after a year I really struggle and lost a lot of weight quite quickly. I got well again and put weight back on. For the last year I can not shift Hal a stone that I have never had! I’m short so that doesn’t help as low tdee. No amount of excercise or diet is getting me down below the extra half stone... I wonder if this has caused it.