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

The old style tricyclic antidepressants are sedating whilst not having weight gain as a side effect. I wonder if a psychiatrist would be valuable for an opinion as the GP may not be as experienced with all drugs available?

OP what a shame as it really sounds like you've found what suits you in all other aspects just a shame about the weight gain. And I know it's really hard to constantly be fighting your appetite all the time.

I did think about the tricyclics, but I tried amitriptyline and it didn’t work at all, even going quite high with the dose. I was awake all night feeling hungover and dreadful. I think my sleep problem is so ingrained, that it takes a lot to sedate me! I think a psychiatrist is the way to go. I have a telephone appointment with my GP this week, and will ask for a referral.

@MaxNormal, I agree, it really is a shame - Mirtazapine suits me perfectly in all other aspects. I have no other side effects at all, it just makes me feel completely better and 100% like me again. If only it didn’t have the weight gain side effect, I would very happily take it for the rest of my life!

If you are not depressed as such but insomnia is an issue, there is Trazadone which is an anti-depressant but not really in vogue now but which is often used to help insomnia and is taken every night so no issues with only taking them occasionally that you have with the Z sleeping tablets. Start on 50mg omg fantastic nights sleep, be ready to get into bed within say 20 minutes. I have found it works really well if you have something in your stomach at night when you take it eg a hot milk and digestive biscuit. It has not caused any appetite changes or weight gain in me.

"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 have found that giving up wheat (although not easy, as it's a lot of a Western diet), will change your appetite if you give it a month or two.

Also, dark chocolate is less addictive than milk chocolate, and can be eaten in something approaching moderation.

It was a really good antidepressant for me as well, and I loved the sleep. To some extent I was able to counteract the increased appetite, because my head was so much more with it, and I had more energy and motivation, but there was a slow weight increase through the couple of years I took it.

I ended up coming off it, and not replacing it with anything else. SSRIs never did anything for me, and my GP wasn't keen on anything else. I couldn't get a psychiatrist to review my meds, despite asking for it a few times.