Changing from venlafaxine (Effexor) to mirtazapine

[HelloMist]

Has anyone done this? venlafaxine/Effexor XR -> mirtazapine. I also want opinions on how fast I can do it and whether it should be tapering (reduce V and gradually introduce M). I'm worried the GP has told me a way that's too fast and will make me feel awful!

Only been on it a month at 75mg, maybe that means reduction can be faster? GP says 1-2 weeks with a 75mg alternate days (ie 0 the rest!) Meant to be rough to come off. NICE guidelines say to taper onto the other drug. I did question it but he thought at this low dose it wouldn't be necessary.

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Background, can skip if too long, sorry

Am taking V for anxiety, been on other SSRIs for moderate depression in the past. Mirtazapine made me gain weight but the 2 others I tried stopped/hugely hindered my ability to orgasm. Neither is great but said no to Sertraline as I feel from studies I've read, in all probability it'll have the sexual problems in my case like the other SSRIs. Wish bupropion was licensed for it here! I asked about that and vortioxetine (suggested on another thread) but told latter is newer and can only be prescribed by Psychiatrist.

Mirtazapine weight gain - does worry me as will make me more self conscious etc but hoping 1) my body/metabolism might not react the same as years ago, pre-pregnancy, and 2) knowing about it from day 1 might make it easier to be aware of what I'm eating. I don't want to cut out what I enjoy or be unable to snack at all though, hope I can find a balance. Think I was generally ok on it otherwise though my memory of it is fuzzy. Less tiredness than venla I think.

Just be careful that you go onto mirtazapine with your eyes wide open. The weight gain can happen, even without any dietary changes. It made me quite fat and made me feel quite sedentary. Sleep wise, it worked for me as I suffer from insomnia, but I could sleep at a drop off a hat- and it annihilated afternoons on a weekend where I'd be comatose on the sofa for hours.

People find it very difficult to wean off it too.

It is a drug that gains very mixed opinion, so do lots of reading about it before you decide.

I came off it after being on it for 8 months. Dropped the stone that I'd put on. I did find it hard to come off it- and was emotionally very up and down for a good few months afterwards. Which was tricky for me, as I'd gone on it for insomnia, not anxiety so the change in moods really threw me.

Good luck with whatever you choose.

Apologies- just read properly your thread and seen that you've taken it before- so some of the stuff about Mirt. you'll already know!

Don't worry, thank you for responding. It was quite some time ago so it's only the weight thing I remembered, so your other points are useful. I've looked at my NHS app records and I was on it a few years, hoping this means I overall found it manageable and it was helping! Can't really remember but prepared to try it for a few months and see due to lack of other better options.

Anyone know whether taking 75mg venla every 2 days is likely to make me feel really awful? Or be manageable. After talking to pharmacist, I'm going to try a few days of this then go back to GP if it does! To ask for a slower way.

I think 75mg is a low dose so coming off it should be easier than it would be on a higher dose. Best just to try it and see how you get on, it usually takes a couple of days for withdrawal to start so taking it every other day should help with that.

Side effects wear off. You’ve only been on it a month. If keep trying with Venlafaxine first. I’ve been on millions of different ones.

Mirtazapine was the worst of all of them.

@GreenTeaBlackCoffeeAndRedWine thanks for the reassurance :)

@ArseInTheCoOpWindow I take your point, but studies I've read indicate this side effect only goes away in a low proportion of cases and could take a long time to do so. For me that will add to my anxiety and low mood rather than let me improve. Glad venla has been the one for you.

There is a liquid form of venlafaxine, (it tastes absolutely disgusting). But it might be useful if you want to taper the day on/day off a bit slower, as you can take tiny amounts of the liquid, which might just prevent the withdrawal side effects being too horrific. I 'd caution you that even missing a single dose of venlafaxine is very likely to make you feel awful. Good luck though.

If you're on 75mg a day then it's the extended release formulation?

You can switch to the normal twice daily dosing and take 37.5mg in the morning if you want to withdraw slowly.

If you're cross tapering to switch to mirtazepine (taking both at the same time) you might find you feel really good while on the both. It's a really good combination for depression and anxiety

I was on a similar dose for a couple of weeks and came off cold turkey with absolutely zero side effects. I pretty much immediately transitioned to mirtazapine (although that didn't suit me either).

Thanks for the replies and suggestions, all. :) Might update how I'm doing in a few days, not too bad currently.