Mirtazapine on top of Venlafaxine?

[Notgettingbetter]

I've read about this combination. The mental health team are now suggesting it to me. I currently take 225mg venlafaxine only. I've been very depressed for more than five months now. I've seen a little improvement - when I think back to how I was a few weeks ago - but I'm still very low.

For me the hardest parts are that I don't enjoy anything - there is absolutely no pleasure or joy in my life. And I struggle with my daughter. She's very full-on.

I'm also wondering if I am going through some delayed grief - a lovely friend of mine died under horrific circumstances four years ago. Would it be a bad idea to take more drugs in this situation? I really don't know...

I am seeing a counsellor but I can't tell if it's helping. Though I do like her and I feel comfortable with her.

I wish someone could just tell me what the best thing to do would be, but obviously I know no one can.

Anyone?

Apologies I can't advise but didn't want to read and run. My only experience with mirtazepine was an insatiable appetite, brain fog that made me sound pissed and ridiculous thirst oh and gaining a stone in a month. GP confessed she prescribed it to little old ladies who were down and very thin so it got them eating again 😳 it wasn't for me at all.
Hopefully someone more knowledgable will reply soon

I had a major depression and it does take time and effort to turn things around but your stable/slightly improving so that good.

I found exercise really key to me getting better. I’m not much of a gym bunny or team sport player, so I did fitness videos, palates etc. It took about a week, but one day after daily morning video I felt a mild high. From then on I was motivated to keep going and found the morning best as it got me up and ready and it felt like I was wiping the slate clean for a bit.

It can be really hard when you have a child - adults find depression hard enough to understand. Hopefully you have support and can draw on her to motivate you do more than you would otherwise.

Thank you both.

Walking lots really helped with my last depression. I have been meaning to do more walking this time but struggling to get myself going.

I've taken lots of antidepressants, found Sertraline good but had a headache a lot. I've been put on Mitrazapine 30g for about 6 weeks. I think its amazing. I take it at night and it's the first time in years I'm getting a decent sleep so I'm not a utterly exhausted in the day. I haven't had a change in appetite or weight so far, but again I think I'm moving more as I'm not so tired and I don't feel so overwhelmed with life. I don't have the raging thirst and headaches like I get on other antidepressants. I haven't noticed brainfog or slurred speech, again I was so wiped out before I couldn't think straight. Still get panicky anxiety but I know what it's causing that now and try to avoid the triggers. I'm still low but I'm getting more periods of happiness and humour. People have commented that I look more relaxed. I'm worried they will take it off me and I won't give them up without a fight now! It's worth a try. I hope you find something that works and you find that can help you be happy.

I was on both for a few years. I wasn't sleeping so the mirtazapine helped with that, and the anxiety. I was put on both at the same time.
I think it helped. I went from completely not functioning to functioning. I was going through an extremely awful time with various things going on so its difficult to gauge. Thing is, you can always try and if it doesn't help, you can stop. I found it pretty easy to come off the mirtazapine (I went from max dose to nothing by accident), whereas I just have to miss a dose of venlafaxine and start feeling really ill. I know lots of people find it sedating but I found that it got me to act a bit more normal. I started to exercise and do stuff again. I hope it works out for you if you try it.

I hit a very low patch around 15 years ago just after my medication was changed to one that made things worse so was then started on Cymbalta after about a year on that, things still wasn't great.

So then psych added Mirtizapine at night which went up to 45mg over time, between both of them and other meds it enabled me to get through some very tough years with my physical health and out the other side without hitting the same lows as before.

Psych added a mood stabilizer and an antipsychotic to even other things out and help me sleep. I was wary of mirtizapine as I had been on it a few years before for a short time and had a bad experience with it.

In combination with cymbalta which is chemically like effexor it has helped a lot. If I have to miss a dose of either for any reasons (not often but fasting or if unexpectedly away from home for a night), I feel down as a result.

So I see it as cymbalta to help in the morning and then need to top up on antidepressants at night with another dose which is mirtizapine. I take my blood pressure meds morning and night to keep the levels right in my system and this is essentially the same thing.

It's worth a try and if it doesn't help, remember that it means your team can rule that out and try something different. Mental health medication is a bit of trail and error in my experience as what helps one person might not be useful for another

How long have you been taking the venlafaxine for? It doesn't sound as if it's working very well for you, so why aren't they thinking simply about swapping it out rather than adding in a second drug?

FWIW, I have taken a lot of different anti-depressants over the years and I hated venlafaxine. I was prescribed it again last year because bupropion became unavailable. I was entirely undepressed when I started it (had been stable for years after a major depression) and was a mess two months later. This isn't particularly a recommendation for bupropion, although it works for me and is thankfully in stock again now, but have you tried sertraline or fluoxetine? They also have far fewer side effects. I found the nausea on venlafaxine appalling and the discontinuation syndrome is unpleasant too.

I've been taking venlafaxine a couple of months now. I don't get any side effects. I think it's possibly helped a bit. It's hard to tell.

I used to take sertraline. It seemed to help at the beginning but it stopped working hence the switch to venlafaxine.

I had Fluoxetine last time I was depressed, years ago. Don't think it did anything for me. Nor citalopram.

Bump

I'm currently on Venlafaxine (75mg) and mirtazapine (30mg) for postnatal anxiety & depression. They have both helped me massively. I take the mirtazapine in the evening & from the first day I took it, I was able to sleep (this was after almost 3 weeks of not sleeping at all due to terrible anxiety). I have gained a few pounds, but nothing major. Plus I had already lost so much weight due to a combination of loss of appetite & burning calories due to the high level of anxiety. It was my perinatal doctor who picked up that I also had depression as well, which is why she prescribed the mirtazapine. I would say give it a try - hopefully it will work as well for you as it has for me x

Ps. I have also been on fluoxetine in the past for anxiety, but it didn't work for me this time around.

Hi, I know this post is a little old now but I was just wondering if they added venlafaxine after you started mirtazpine? I’m on 30mg of mirtazpine at night it’s been 6 weeks today and I still don’t feel right. Anxiety is really bad I’ve got twins that are 11 months old and they want me to go to 45mg of mirtazpine but I really don’t feel comfortable taking that. And I was just wondering if the venlafaxine helped you? X

I was taking Venlafaxine before the doctor added Mirtazapine. I've been taking 225mg venlafaxine and 30mg mirtazapine for a few months now. The mirtazapine is making me very tired even with sleeping a lot, and it makes me really hungry. I don't think either really help with my depression, especially as I feel even lower when I'm depressed. Yesterday my doctor reduced my mirtazapine dose to 15mg and upped my venlafaxine to 300mg. Hopefully this change will make a difference.

I'm sorry you're suffering with anxiety - while my depression is still bad I find I hardly suffer with anxiety at all these days so I think one of the drugs must be helping in that regard. Sertraline used to really help with my anxiety too.

It's so different for everyone and unfortunately such a slow, trial and error process to find the right meds for each individual. I hope you find something that works for you.

*that should read "especially as I feel even lower when I am tired.

I’m just on mirtazpine it’s been 6 weeks at 30mg I’m exhausted with the constant anxiety but I’ve read that it can take 8 weeks to work. I’ve just come off the phone to doctors I was hoping they would add in venlafaxine but she would like me to go to 45mg if mirtazpine for another 4 weeks along with propranolol 40mg x3 a day. But I’m worried about taking 45mg although they say higher the dose the less sedative. Do you mind me asking if it took a while before your anxiety settled?

I'm afraid I can't be much help - I haven't really suffered with anxiety for a long time. I switched from sertraline straight to venlafaxine about a year ago and anxiety wasn't really a problem before that. I have a friend who has been taking a higher dose of mirtazapine than yours for years - she says it really helps her. I would expect it to have some effect by six weeks but like I said, we all react differently.

Hi @Kimmi2021

Sorry to hear you’re struggling with anxiety at the moment. I was on fluoxetine when my perinatal doctor prescribed mirtazapine. I took it in the evening (still do - 30mg) and it really helped me to sleep. However, the anxiety was still there when I woke up. We then made the decision to taper me off fluoxetine & start Venlafaxine. It took a few weeks for the Venlafaxine to settle down, but it really has helped me. I’ve been on both of them almost a year now & my perinatal doctor said I will stay on them for 2 years, minimum.

I was told that the mirtazapine was for my depression & then Venlafaxine for anxiety. Like you said, my perinatal doctor was reluctant to up the mirtazapine as it can have less of a sedative effect & the guaranteed sleep that it gave me was the only thing getting me through at the time.

Keep going - brighter days are ahead. I know it doesn’t feel like it at the time, but it will get better x