Mirtazapine, sleep, weight gain... don’t know what to do any more

[Killerpinkflamingo]

I am so, so upset tonight, and I just wondered if anyone had any advice.

In September 2015, I began suffering from insomnia. At first, I thought it was just a bout that would last a week or so (I’ve suffered from short bouts over my lifetime that, whilst unpleasant, always resolved themselves eventually). Only, this one, didn’t stop. I was back and forward to the GP, trying antihistamines, lavender, meditation, yoga, getting short courses of sleeping tablets, trying different antidepressants that never worked. I ended up buying sleeping tablets online and getting hopelessly addicted. This carried on until September 2017, when I left my job and had a nervous breakdown. It was horrific.

In October 2017, the doctor prescribed me Mirtazapine. And it was a miracle. I slept every night, a deep, refreshing sleep, and my mental state got better every single day. Since then, my life has improved dramatically - I got a new job, I have a place on a Masters course in September to train for a whole new career, I’ve met a wonderful new partner and moved in with him - I’m not being melodramatic when I say that Mirtazapine allowed me to completely change my life for the better.

But of course, there is a downside. Weight gain. I knew when I went on this medication that it had weight gain as a side effect, but back then, I was such an exhausted, anxious wreck that I didn’t care. But two and a half years later, I’ve gained two stone and I seem to have developed a very unhealthy relationship with food. I’m terrified of putting more weight on so try my hardest not to eat, and then end up binging. I feel like a fat lump and I’ve had to buy all new clothes. I’m constantly worried that I’m not really “hungry”, and that it’s just “Mirtazapine hunger”. Now, in the lockdown, these thoughts have got worse, and seem to be consuming me.

I’ve tried a couple of times over the past year to come off Mirtazapine, but I end up not sleeping again and getting in a state, terrified that I’m going to go back to what I was like before. But I can’t stop upsetting myself about my weight when I do take it. I feel so stuck.

I’ve been to my GP who says that I am so much better, I’m sleeping, it suits me so well, she wants me to keep taking it. My partner wants me to keep taking it because he sees how upset I get when I can’t sleep. But now I’m sat here sobbing because I feel so stuck - I can’t carry on like this, the weight gain is upsetting me so much.

Do any of you wise MNetters have any thoughts on this situation? I don’t really expect any answers, but it’s just nice to get it all out - I feel like my GP, my partner and my friends are completely sick of hearing me go on about this

I have a very similar story! Although I’m currently embracing the weight gain as I know I look and feel better. I like that I don’t feel numb as I have with other medication.

I had counselling along with medication and I think that really helped. Would that be an option for you?
I had an eating disorder so the weight gain is sometimes hard but counselling helped to change my thinking towards food.

I can't really offer much advice. All I will say is your story is incredibly similar to mine. I've put on a stone and although I'm not large (a size 12) I'm so used to being a size 8 that I feel huge. Everyone keeps saying the weight suits me but it's ALL ok my belly so I look slim with a big belly and I hate it.
I too have had the same convo with my gp but I'd rather have this belly than go back to how I was.
Hope you get some decent advice shortly

Thank you both so much for your kind words, I’m sorry you have both been struggling too. It’s so hard, isn’t it? @Yankathebear counselling may actually be a good idea - I’m so struggling with the weight, and I feel like my thoughts about it are really negative and all consuming. Did you access counselling through your GP?

Hi @killerpinkflamingo

I didn't want to read and run, I'm not familiar with Mirtazapine but I thought chatting to someone may help. Has your GP suggested counselling? Do you think your GP could change you medication?

Have you thought about keeping a food diary? Are there any triggers that you can think of? Time of the month, stress, anxiety?

I've gained quite a bit of weight over the last few years mostly due to stress and anxiety when my mum wasn't well, but now I think it's just become a habit!

I need to lose weight as my back and joints are now being affected as well as being diagnosed with T2 diabetes!

I'm sure we could help each other, bounce ideas, words of encouragement etc

I hope that you find a way of dealing with your weight gain, I'm always here if you want to drop me a line

Take care and stay safe xx

Have you only seen your GP so far? Your GP sounds good, but for other medication options could you ask her to refer you to a psychiatrist?

I know mirtazipine is really problematic for weight gain. What dose are you on? I was on quetiapine for a while, which is similar but not quite so bad for weight gain, my psychiatrist said. I think I was on 50mg and I put on about half a stone. I also had pregabalin, and promethazine. I know you said you’d had antihistamines, but maybe a combined approach would help. A psychiatrist would be able to help with this more easily than a GP.

I hope you can get some more advice on here, I do understand that this is a very distressing problem. Sleep is so important and it’s lovely to hear the progress you have made. Take it one day at a time and don’t assume that you won’t resolve this in the longer term.

I was on Mirtazapine for maybe 4-5 months. I had to come off it because the weight gain made me feel so dysphoric.. I found the 15mg really helped with sleep but once you go up the sedatives get overridden by the antidepressant/anxiety so it's less effective. I think doctor prescribed me zopiclone for sleep instead - but they are very careful to give you it as it's highly addictive.
It sounds like you need to see another doctor. There must be so many other sedative medications that won't make you eat your feelings like mirtazapine did to me!

I've been on mirtazapine for 12 years. I've discovered that if I count calories and don't eat more than I burn, then I don't gain weight. However, the carb and sugar cravings are still there.

My choice is to stay on it to stay mentally well, and monitor what I eat. My weight fluctuates depending on how obedient I am being

So you have three choices- stay on it and eat what you want and get bigger but try not to care, stay on it but watch what you eat, or stop taking it and be slim but not sleep.

The sleep is SO AMAZING.

Can you increase the dose? The weight gain appears to be at lower doses.

Sorry to hear of your weight worries.
Mirtazapine worked really well for me too and really helped massively was asleep right from the start. I did out on loads of weight on it as well so I had to stop in the end because I gained about two stone. As an alternative I'm now on sertraline and taking amitriptyline to help with sleep. If you are really worried about the weight gain I wonder if your GP would consider you switching to something like this?

Just another one saying I hear ya! It changed my life in such a good way.. regulating sleeps it was like a miracle. But the hunger! Found myself once literally eating slices of bread, just plain out of the packet to get rid of that starving feeling 😑 all I can suggest is keep loads of low cal snacks to hand so you can dip in and out when you need. I know it's not great advice but, I'd choose that over the anxiety that comes with sleeplessness anyday! Xx

Hi @ValleysGirl72, thank you, yes I feel like I’ve got so much going on in my head, I really need to talk it out!

For a long time, I was trying to change my medication, and my GP was happy for me to try. But I have tried so many now - all SSRIs did nothing (too activating and made the insomnia even worse), trazodone didn’t work, with amitriptyline I was awake all night feeling dizzy, hungover and with a dreadful dry mouth. My GP is now trying to get me to accept that I do need the Mirtazapine. And I feel like I do accept it - until a day or so later, when I end up sobbing yet again about my weight

I do think counselling could be a really good idea, and I’m going to ask my GP about this. I haven’t kept a food diary, so that may be a good idea too. I think I just keep careering around, one minute thinking “I must take this medication, it’s good for me!” And the next minute, “I have to stop it, I’m getting bigger and bigger, I can’t cope!” Its really exhausting.

Thank you so much for your kind words, it really means a lot

How much are you on? I've found that the effect of a good night sleep still works at a really low dose. I've taken 7.5mg for long periods of time, which is not even a therapeutic dose, but still works to help me sleep.

I've been on it for 18 years, a whilst I'm about a stone and a half heavier than when I started, I've also quit smoking, I'm in my mid 40s and I've had 2 children -so I might have gained weight in that time anyway.

I find at a low dose it doesn't make me any hungrier than I was before. I make sure I eat 3 meals a day anyway as part of looking after my mental health, and I generally don't feel the need to snack otherwise.

Oh, more messages while I was typing the last one! It’s reassuring to hear that other people are going through similar, I have felt so dreadfully alone with this problem, because I don’t know anyone in RL who also takes Mirtazapine. Lots to think about. I have thought about pushing to see a psychiatrist, but I was feeling so worn down and defeated by it all that I just accepted what my GP said about staying on Mirt - maybe I should go back and be more assertive.

I’m on 30mg - interesting comments about the doses. I know some people say the weight gain is better at a higher dose, and some say at a lower. It seems very individual - a very strange drug in that sense! But that could be something I discuss with my GP too

I’ve been on mirtazapine for 7 years, for anxiety and insomnia. At first I was ravenous, gained quite a bit of weight, but was never overweight as I exercised obsessively and counted calories. I’m not sure when my hunger and relationship with food got back to normal, but I haven’t had issues with excessive hunger or over eating for years now, so in my experience you do go back to normal after being on it long term.

In regards, to coming off and insomnia, I had similar issues, what massively helped me was tapering down very very slowly and using antihistamines to help me sleep. I would take half a tablet one day a week, then after a week, if I felt fine I would take a half tablet two times a week spaced out by a few days, then three times a week etc etc until I was on half a tablet all week. I still slept extremely well and have managed to cut my dose in half over the course of a few months. I will be tapering down again once my masters course is finished as I do get quite anxious when reducing my dose, normally it’s manageable for me unless I’m really stressed.

Should add I was also on 30mg for about 6 years, now on 15mg.

With regards to tapering off, you can even get liquid mirtazapine and reduce your dose even more gradually i.e. 15mg one month, 14mg next month, 13mg next month etc

I came off both times I got pregnant and used the liquid form. However, just to warn you some GPs are reluctant to prescribe it as it's more expensive so you might have to really push for it.

Hi OP
While on a trial break from my long term antidepressant I experienced a bout of stress and insomnia, my GP suggested I tried a different kind and I took Mirtrazipine for a short while and put in a stone in a month. That was too much for me and I agreed to try something else. sertraline was a disaster for me making me really anxious and after 2months I went back on my old style Tricylic AD which is quite sedative and actually suits me.
The guidance seems to be very much toward SSRI’s but I find that the old type suit me better, would your GP consider that?

@Killerpinkflamingo I had it through occupational health at work. They were great.
At the moment I don’t even want to think about coming off of them.

Does anyone else get the really vivid dreams?

I really sympathise. I had similar issues with Citalopram. It was a life saver but I put on two stone and ended up sleeping all day as well as all night.
My suggestion is that you wean yourself off it incredibly slowly. If it is in pill form, buy a pill cutter. Take your usual dose one day then chop the pills and take 3/4 of it next day. Do this for a week, then move to 3/4 dose every day for a week. Then 3/4 one day, 1/2 the next etc, until you are down to 1/4 tablet every other day.
If it's not in tablet form but capsules with powder inside, that's harder and you might need to ask if it could be given in liquid or pill form, or get some micro scales and weigh the powder, which would be a faff, but worth it. GPs might tell you this srt of very slow titration doesn't work. But lots of people coming off ADs find this is the most effective way to do it. I was on them for about 12 years and coming off this gradually was the only method that didn't cause a relapse.

While you are titrating, get into good habits that help support sleep - very comfortable bed, correct room temperature, maybe a weighted blanket, blackout blinds etc.

If you do get insomnia, I find it helps to do all the things you think you shouldn't - get up, make a cup of tea, read for a while (but not TV) until I feel tired again.

The weight is really tricky. Certain ADs make you crave carbs incessantly. I found the only way to get past this is to cut out white flour and processed sugar in all forms. I don't stick to it all the time, but I know the cravings will vanish when I do.

I also gained weight on mirtazapine, at least one whole dress size in less than 3 months! I did sleep, but still felt like a zombie in the morning when I needed to be switched on for work. Switched to sertraline in March, but when I needed a repeat prescription there was a massive delay to get it, so am now on citalopram. I don’t sleep so well, but it’s manageable, and I do feel like my face has slimmed down a little even if my thighs haven’t yet. Could you try something else? My doctor agreed to try whatever I needed until we found something that worked because I knew if I didn’t stop the weight gain I would probably stop eating, and that’s not a good place to be.

My sleep patterns improved when I sorted out my vitamin and mineral levels. The tests were and are done at the GPs but I access my results and have bought appropriate supplements to get my levels into at least the 75%ile. As far as I can tell, getting D3, B vitamins (and B12 particularly), iron and magnesium levels sorted have had the best effect on my sleep patterns and enabled me to wean off anti depressants. Been off them now for 4 years after being on them most of the previous 20.

I realise this isn't the answer for everyone but it is worth doing some reading around - avoiding sites that just want to sell to you.

Thank you so much everyone, lots of things to think about! I really appreciate hearing from those of you who take Mirtazapine, it really helps me to feel less alone (sorry if I sound a bit dramatic, I’m a bit of a wreck at the moment!).

@Elsiebear90, it’s reassuring to hear that your appetite went back to normal after a while. I feel like at the moment I can’t tell if I have a normal appetite or not - I’m so busy second guessing myself and thinking, “am I really hungry? Or is it just the Mirtazapine?” It sounds totally crazy, I know! Were you able to lose the weight that you gained initially?

I’ll definitely be taking all your advice on board, and I think my first step is going to be asking my GP to refer me to a psychiatrist. Thank you all for your kind words and advice, it has really helped

Oh and @Yankathebear, yes to the vivid dreams! Sometimes they can be a bit unsettling, but most of the time they are fun and a bit bonkers My partner has even said that I laugh a lot in my sleep now I really enjoy the dreams - when I first went on Mirtazapine I was overjoyed to remember a weird and wonderful dream, because dreaming meant that I had actually slept - and I don’t think that novelty will ever wear off!

V interested. My gp just prescribed mirtazapine.

My god sleep is good. Only taken twice and appetite has been high afterwards. Last night I did not take it and had the wierdest lucid dreams.

Still undecided and trying to avoid, but my insomnia is terrible. I feel for you op. A private psychiatrist might be willing to explore options but obviously there is the cost. At end of day no one can force you to continue, but do not do anything sudden without discussing with doctor.

For me, I need a really solid routine. Wind down and lights by 10. Best natural sleep time is 10-2. Also sleep cycles in 1.5 hours. So aim for 6, 7.5 or 9. Track it either with a fitbit type wrist device or manually. Loads of apps you can download.

In past I used my fitness pal or chronometer to count calories. It is singularly best thing for watching weight imho. Lost more pounds when did that than anything else. We underestimate calories I think but it is simple science. Eat 200 cals less than you need to sustain current bmi. Once you get into it its quite fun. Really recommend. Also protein snacks fill you up more.

Agree with pp about taking magnesium, b vits. I have v low dose zinc sometimes too. All of these good for anxiety associated with insomnia. I take vit D in day ascwakes me up.

I dunno, essential oils are nice too. A diffuser with lavender. Clean bedsheets, no phone in bedroom etc. Not that I always do these. I hope the counselling helps too.