Mirtazapine not working

[FloridaGirl90]

Hi - please excuse the long message
Late 2016 I had a breakdown following a serious case of insomnia that lasted about 3 months, ending in me being hospitalised for 3 weeks. I managed to stop taking medication in 2017 but in August of 2017 I started to suffer with insomnia again. I went to the doctors and he prescribed 15mg Mirtazapine which I have been taking ever since. It worked from day one, it was like a miracle, I slept and felt refreshed and so much calmer. Since then I have had the odd night where I haven't been able to sleep, this results in me panicking and feeling anxious all the next day that I won't be able to sleep but it usually just rectifies itself. However, in November 2021 just a week before my 50th birthday, I had a rough night where I woke at 2.30 am and couldn't get back to sleep, I then didn't sleep at all for the next two nights. I was then anxious about not sleeping and anxious about being ill as we were going away for my 50th birthday. I rang the doctor that day and he suggested I upped the Mirtazapine to 30mg and gave me 14 2mg Diazepam tablets to take if I needed them. I took the 30mg that night and 1 Diazepam, I slept through but did feel jittery the next day, I put this down to the Diazepam. I took the 30mg for the next few nights but then reduced this back down to 15mg as my normal sleep pattern returned, mainly due to the fact that I have read so many things on the internet about higher doses of Mirtazapine not working as well for insomnia. Anyway to cut a long story short, I couldn't get to sleep on Saturday night so I took one 2mg Diazepam, I did get to sleep, not a great nights sleep but I felt spaced out the next day. Sunday night I couldn't get to sleep so I cut a tablet in half and so had 1mg Diazepam, and the same Monday night. I have slept about five hours the last two nights. I think what I am trying to ask really is do you think if I increase my Mirtazapine back up to 30mg a night this will help. I do not want to keep taking the Diazepam, it scares me to be honest, and I worry that even on such a low dose over the last three nights I might have issues if I don't take it. I have read so many things about the higher dose of Mirtazapine not working as well for sleep, but this is what the doctor suggested. I also wanted to ask other people who do take Mirtazapine for sleep - how long before bed do you take it? If I do take 30mg tonight should I take one an hour before bed then take another when I get into bed or take them both at the same time? For example - last night I took 15mg at about 9.30 and I kept nodding off on the sofa, I went to bed about 10.30 but then couldn't nod off again, so I ended up taking the 1mg Diazepam at about midnight then went to sleep till about 5.00 am, it might sound daft but I don't feel refreshed as I worry it is just the Diazepam that made me sleep rather than the Mirtazapine. I normally feel great after just taking the Mirtazapine. I am so sorry for such a long post but I find it hard to talk to anyone about this stuff, I just feel people don't get it when you say you can't sleep

I really feel for you - I am struggling with chronic insomnia and awaiting a prescription for Mirtazapine. You're right - other people don't get how utterly debilitating not being able to sleep is. I can't really suggest any advice but just wanted to let you know you're not alone.

Thanks Austin7
Does anyone else have any helpful hints

I think you need to listen to your doctor and also look at some sort of counselling to get rid of anxiety about non-sleeping. Do not fiddle with the drugs yourself.

In case it's useful - you might have already done the below already.

I notice you mentioned your 50th birthday. Are you taking HRT? Disrupted hormone levels can make it really difficult to get a good night's sleep. If you do take it, it's worth getting a review in case the dose you're on isn't working.

Also do you drink alcohol? This can cause early waking.

I'd definitely get some blood work done to check thyroid/blood sugar etc to determine if there is a medical cause behind the insomnia if you haven't already. Definitely worth seeing/talking to your doctor and also getting some counselling for the anxiety. I hope you feel better soon.

It is possible that your initial bout of prolonged insomnia coincided with the onset of your perimenopause. I had something similar happen to me, was prescribed 15 mg of mirtazapine, then got on HRT and was able to reduce my mirtazapine use to one quarter of the pill. I wish someone could give insight on long-term use of low dose mirtazapine. I posted a question about it here and got no answers. Longer term because the reality is that perimenopause lasts for years and my sleep is not 100% fixed on HRT alone. As for you, I think you should go up to 30mg per your doctor's advice for a few months and then see if you can go back down to 15. Also investigate getting on HRT.

Try 7.5 mg mirtazapine

I never even considered the menopause
My periods have become irregular over the last year, but I don’t think I have any other symptoms
sorry I don’t know much about HRT
Would the doctor send you for blood tests etc before prescribing?
Funny the doctors never considered it could be menopause ?

I am on 30mg mitazipine and find it still helps me to sleep, I had the same worries as you.
I take it 30 minutes before bed but make sure that I take it as part of sleep hygiene so get my body and mind ready for bed.
I rarely have trouble sleeping now but obviously everyone is different.

As other posters mention - definitely consider the menopause.
I have no personal experience of mitazipone, but was under the impression the higher dosage does not promote sleep. It is a lower dosage, so the suggestion of 7.5 mg is valid.
Suggest first port of call is GP for some blood work. For sleep, I’d recommend Phenegan tablets for a short term fix.

Until last month I was taking 7.5mg Mirtazapine to help with sleep. I am the same age as you and never had any sleep problems until these last couple of years. I am now taking HRT because I think the menopause has affected my sleep more than any other factor. It has helped a bit but still not perfect.
The thing that worked the best for me is Magnesium Glycinate. I take it just before bed and from the first night it definitely helped me get to sleep and stay asleep. It doesn’t work for everyone but maybe worth a try.
What I have noticed is that just because I might have had a bad night doesn’t always mean I am tired the next day so I try not to stress about it.
Without trying to seem unkind, your op does sound like you are very anxious about your sleep habits. Given your history I can understand why but the more you worry and stress about sleep the more elusive it is. If you’re struggling with getting to sleep, maybe try listing to an audiobook. Nothing too exciting but something to distract you from thinking about not sleeping. Good luck!

Thank you for all your very helpful replies, I now have another question :)
Last Tuesday I increased my dose to 30mg and my sleep returned, I slept great for the next four nights.
As I dont really want to stay on 30mg a night, my intention is to hopefully in time taper off the 15mg. So on Saturday I decided to decrease the dose to 26.25mg, I found I was struggling to get off to sleep so ended up taking the last remaining 3.75mg of tablet and got off to sleep. This was the same for last night (Sunday).
My question is - after increasing the dose from 15mg to 30mg for four nights should I really need to taper down, would the 30mg have had such an effect that I would be reliant on that dose?
I am going to speak to the doctor if the menopause could be a factor but would be grateful for any advice in the meantime if I should really need to taper down the dose after only four nights
My plan for tonight was to take 22.5 mg then if I cant get off take another 3.75mg. I want to get off the 30mg and at least get back to 15mg a night as normally I am ok on the 15mg, my thinking was if I have another bout of insomnia to up the dose again to 30mg till it passes
Thanks again for any advice

You are me l think. I’m the same. Sleep obsessed, in my 50’s and with severe insomnia.

I never found mirtazapine that good for sleep tbh.

I take Amitryptiline in quite a high dose. That works. Trazadone is another one to consider.

Can you take Magnesium alongside Mirtazapine?