Mirtazapine can anyone help?

[OldGrinch]

I'm currently signed off work with anxiety and depression. I'm on Venlafaxatine 35 mg tablets which are helping a little but suffering from bad insomnia. I asked my GP if she could prescribe a low dose of Mirtazapine to be taken at night to help with this and she said that GPs are not allowed to prescribe these two medication together and you have to be under a specialist mental health services team to get these two medications prescribed at the same time. Does anyone know if this is correct? I'm sure that Ive had colleagues that have been on both via GP. Grateful for any advice. GP saying she can only offer Amitriptyline which already tried and doesn't work 😡

I don’t know the answer to your question, but I think doctors are being cautious with Mirtazapine. I’ve been on it for several months now, and I have asked for the dosage to be increased, but my doctor is extremely reluctant, even though I am struggling a lot.

Thanks, so is the Mirtazapine the only antidepressant you are prescribed through GP then? Would you mind me asking what dose you are on?

I couldn't get any mirtazapene last week. It was out if stock in all my local pharmacies. I don't know if there's a shortage which is making doctors reluctant to prescribe it.

I was taking both together (45mg mirtazapine and 150mg venlafaxine) but they were prescribed a psychiatrist and not my gp. I think your gp is right as I was referred over when I’d hit 45mg and there still wasn’t any improvement (this doesn’t mean it wouldn’t work for you, my mh is rather complex).

I've been on mirtzapine via the GP - it's bloody awful stuff. I crashed my car in the first, and last, week of taking it. I'm not surprised they're reluctant to prescribe it along side what you already have.

Have you tried promethazine? I find it very effective.

What's promethazine is that the stuff in Phenergen?

It is yes.

Oh Ok thanks. Will give that a try. My GP said that as a compromise she will give me 7 days supply of sleeping tablets but after that "no more". What the hell do they expect me to do after that? It makes me mad as I bet old folk in homes are allowed sleeping tablets, just to keep them quiet and docile, but if you actually need to sleep as you've a home and family to keep your just supposed to get on with it

I’m only on 15mg, and not on anything else at the moment. I used to take Citalopram.

We can't get Melatonin here over the counter, in UK. I don't know if the Draconian GP might prescribed that one, it's worth asking. My only worry about trying the Phenergen is that I thought there was a link between that and Alzheimer's disease? Or is that the case with any sedating med?

Have you considered just switching to mirtazapine by itself?

That may suitably replace the low dose of venlafaxine you're on.

"GPs are not allowed to prescribe these two medication together and you have to be under a specialist mental health services team to get these two medications prescribed at the same time. Does anyone know if this is correct?"

According to the NICE guidelines, antidepressant combinations should normally only be given by mental health specialists. So I think there is some truth to what your doctor told you. However, that may not be a strict rulejust guidanceand it's not clear to me why your doctor thinks it's OK to give amitriptyline in combination but not mirtazapine.

Personally I'd never go sleeping tablets again. You should be able to use one of the over the counter older style antihistamines. You could talk to a pharmacist or your gp to check re safety. Your gp is right about combining anti depressants, that needs to be done by a specialist as there can be dangerous interactions like seretonin syndrome.