Mirtazapine: how was it for you?

[StrawberryTheCat]

I've just completed day 3, and honestly, I think I maybe feel worse than before. I'm getting irritated, angry and snapping at my husband and kids, which is only making me more depressed. I feel dreadful. I'm taking it for perimenopause/PMDD, and for these few days on my cycle, I normally feel fine, good even. But having started the mirtazapine, I feel utterly dreadful... very depressed, irritable and generally rubbish.

So I guess I'm just hoping that will go away, and the antidepressant effect will begin.

Those who have taken it, did you feel like this, and did things improve?

I actually think I might stop taking, because I'm not at all happy about the weight gain side of things. I've just been reading here khealth.com/learn/antidepressants/mirtazapine-weight-gain/

Apparently it makes your body store more fat, because it increases your blood leptin levels. I'm not happy with that at all. I'll maybe take it for another week, and see what's happening to my weight, but if I'm getting fatter, I'll stop, and ask for the HRT. After all, being overweight also increases your cancer risk, and I was trying to lose weight so... 🤷🏼‍♀️

Hi again OP - yes it also slows down or alters your metabolism too which makes it harder to lose any weight bcos you have to reduce your intake substantially (like to crash diet levels to see any effects) which is not sustainable long term.
I would try to get off it but have found all antidepressants to have equally unpleasant side FX (SSRI’s & sexual dysfunction for eg) so it’s a hobson’s choice for me - plus I suffer with adverse withdrawals which makes it really difficult to stop or change them.

HRT on the other hand is natural - body identical (if you ask for micronised progesterone) & has no unpleasant withdrawal. Side effects are really minimal in comparison & can be managed (eg progesterone can make you sleepy - which is a bonus &/or have bad dreams - which you can negate by taking in the a.m or vaginally so as to avoid it being broken down by the liver).

It’s definitely worth a try - even just as an experiment. It helps with sleep too & negates anxiety. I read that our bodies need estrogen to be able to produce serotonin so it’s no surprise it can cause depression when we’re losing it in peri/meno. Also progesterone affects GABA receptors (neurotransmitters implicated in sleep, mood balance & acts like an anti anxlytic.) Excuse my cod understanding of the science lol but it really stacks up as to why it can be responsible for mood changes in peri/meno or if like me, exacerbate pre existing anxiety & depression.

Good luck!

PS Menopause Matters is a goldmine of info & support btw. It is an experimental thing & affects everyone differently so before you ask your GP make sure you know what type you want (body identical is best as it causes less side FX) & are a bit clued up b4 you go in as GP’s are not great still & you don’t want to be out on one that is known to have more side FX & that will causes you to give up at the first hurdle).

I was on mirtazapine at maximum dose for many years. If I can try and put the weight gain in perspective for you - yes, I put on a stone and a half in weight initially, but that was due to eating takeaways, cakes, junk food due to the insatiable appetite... This DOES wear off and over time I cut out the junk and easily lost the excess pounds. In other words, don't give into the cravings and you will find the appetite does dial back to normal levels . It can be a really effective antidepressant so give it a chance!

That was only a study with 7 women . I have definitely put on weight with it and my appetite is much better than it was when I went on it. I had near enough stopped eating. I was so anxious.! I can see that it would go up very easily now I'm back to my normal healthy appetite but I have just been calorie counting and it's fine ! I think it's settled down now though because I've been on it a few weeks.
Just bear in mind , HRT will take a few weeks to work fully , I hope you find the right thing for you .

@ShortEndOfShittyStick thank you, I'm definitely trying to stick to the same diet I was on before I started it, but had a few slip ups this week. To be honest, I don't think my appetite has massively increased, and I think I can probably manage to keep my calorie intake at the right amount, it's just if I end up gaining weight regardless of that, then I'll come of it. It's not worth doing that damage to my body, I don't think, when there are other options I can try. I do need to give it another week and if my weight doesn't increase, then I'll stick with it a while longer.

My DH has taken it for years. He had an initial weight gain but this is because he couldn't stop eating!! He's still on it but is now at his slimmest ever. He no longer craves carbs, he eats healthily. He's looking great. It's not inevitable that you'll pile on the weight.

I just wanted to add that although my experience with it has been ok (apart from weight) , I started it when I was having anxiety and panic attacks- was 40 and with what I know now, I think I didn't need an AD, but just HRT!! So in a way, if this had happened now, I would try HRT as that's made a massive difference, the mirtazapine only does so much, the hrt was the missing piece of the puzzle for me. Now I'm 3 stone heavier, partly due to mirtazapine to

Yes, I'm totally aware that my hormones are the problem. I have PMDD which seems to have been brought on by perimenopause (I have several other symptoms of that too). I just wanted to try another AD before I try HRT, because I'm not massively bothered by the other symptoms, it's the mental health aspect that needs addressing. When considering the increased cancer risk from HRT, I decided to try another AD first, in case that helped enough. Today, I haven't had any issue with increased hunger, so I'm hoping I won't gain weight 🤞🏻

I had PMDD until I went on HRT. It was a game changer for me. The increased cancer risk is absolutely minimal, look into it some more to ensure you are educated. It's a game changer as HRT can help with so many things at this stage in our lives 👍

I was prescribed it for sleep and anxiety as a result of lack of sleep, many years ago. It was a good relaxant for me, however the hunger pangs were humongous. I'm a big researcher and I've yet to read of anyone who has taken it and not piled on the weight. I've always been petite so couldn't accept the way the extra weight was making me feel.

I took it for a few months a few years ago, and my mum also took it for a while.

I put on so much weight, my weight has been very stable throughout my life but I put on nearly 2 stone on mirtazapine. I did find it helped my mood much more than other antidepressants I've been on, but it also made me feel really groggy in the mornings, almost like a hangover without drinking (and hangovers worse when I did have a drink). However, if I was really struggling with sleep and mood, it would be the one i would gravitate toward going back on for a few months to get myself out of that hole. I came off it primarily because of the weight gain, I really struggled to lose the weight as well but as soon as I came off it I lost it no problem.

My mum found it helpful for sleep as well. She didn't gain any significant amount of weight, but she found it much harder to lose weight (she already wanted to lose a bit before she started it). She came off it because she was genuinely feeling much better (she went on it because of stress) and hasn't needed it since.

I should add that I am a long way off the menopause, so that wasn't a factor for me, but I have heard so many women say that HRT massively helped their mental health. Hormones can have such an impact I think more than we realise, and stabilising them can make a huge difference.

I am glad I saw this post as I was just about to put one up about Mirtazapine.

I recently cross-tapered from Escitalopram (10mg) to Mirtazapine (15mg) and was experiencing weird dizziness. That has improved and I am not sure if it was because of brain zaps coming off of Escitalopram or from side effects starting Mirtazapine. Occasionally, I will get a really violent dizzy spell for a couple of seconds and then be fine again so I am not concerned about it really.

However, I am having a terrible time with my mental health. Soon after I went 100% on mirtazapine, I noticed intrusive thoughts trying to nudge their way into my consciousness again. Just brief things and I put it down to post-Christmas fatigue, etc. But they have got gradually worse and distressing. Changing from Escitalopram to Mirt was to try to stop these things but by God when they hit it's bad.

I mentioned this to my GP two weeks ago on a phone consult to review the meds. He sounded totally disinterested and said, "Well, you could just stop taking Mirt because you've not been on it for long" - but offered no other solution. Like he'd just given up treating me. When I said I wasn't necessarily saying I wanted to stop it (my sleep has been excellent on it and I have had more energy in the day - never realised how fatigued Escitalopram was making me feel) he then said I could just "experiment" with halving the Mirt to 7.5mg to see if that worked better and then told me to book another review when I felt like it and that was that!

The next day I had a massive panic attack. I was upset because I was on new meds and felt I had no medical back-up there. I ended up calling an online GP service for a second opinion. The GP was kind and told me that the dosage I was on for Mirt (15mg) was the equivalent of being on 5mg of Escitalopram and that it was likely that I needed an increase. My GP the previous day refused that - said he didn't think we should go up. So the phone GP said I could try a little longer to see if things levelled out because it's hard to know at the moment if I am still getting withdrawal effects from the Escitalopram or side effects from the Mirt. But he was pretty sure I'd need to go up to 30mg.

I am just so exhausted. I am getting really terrible anxiety and then depression and am struggling to cope now - veering between such dreadful anxiety that I feel I cannot go on and get urges to hurt myself and then crushing depression that makes me feel I can't bear the sadness of life. Equally I cannot face trying to call for a GP appointment as it's a nightmare with my practice anyway and I can't face the disinterest I experienced last time - made me feel like a hypochondriac or a nuisance. I don't want to feel this way - if I could be drug-free and happy I would obviously take that!

I just don't know what to do - I keep trying to tell myself I will feel better once I get used to the meds but I've been just on Mirt now for 5 weeks and I am not feeling better apart from sleeping. I don't know who to talk to either.

This recent worsening of my depression happened after TWO consecutive cancer scares within 2 months - one while I was on HRT and had a bleed that turned out normal but the GPs messed it up and referred me for a hysteroscopy I didn't need (but thankfully showed all was well) and then my first mammogram, where I was recalled because of uncertain results - which was because the radiographer did it wrong. Since then, I worry obsessively about getting cancer whereas previously I had not experienced this. I know that I should probably get some kind of counselling - can't really afford it at present but will be looking into it. But I won't take HRT again - the risk (I know it's small) is still too much for me to even think about. Every day though I just wake up and panic.

I am on it and it helps me sleep - though was unaware of the weight gain issue - thought it was just menopause pounds. But being able to sleep is priceless. I am adhd and was suffering from periods of insomnia.

Sorry you are going through such a tough time - I’ve been there & with equally unhelpful & useless GP’s. Is there any way you can google your local MH team & call them to escalate your concerns & request a medication review with a MH professional?
Unfortunateky IME they are so overwhelmed & only seem to take you seriously if you are suicidal but you have already tried one AD & are being trialled on the 2nd line one Mirtazepine & now need input. It may be that you’re still not over the switch onto Mirtazepine that cld be screwing you up still - not sure how long been on it? For the GP to suggest you half your dose of mirtazepine when you’re still struggling is really bad practice & I can’t see why he won’t increase you up to 30mg?? That’s ridiculous. Mirtazepine is most hypnotic or sedating at low doses so 7.5mg is most helpful for sleep alone but we need it for the MH side of things too! 15mg still is sedating but still good & 30mg is much less so (I don’t get any benefit & am on that dose) but certainly more effective with anxiety & mood. Obvs we all respond differently - so may affect you differently. I was really annoyed I was given no option but go on Mirtazepine because of its renowned sleep benefits - when it knowingly is only sedating at lower doses & my depression & anxiety is severe & therefore needs more than 7.5mg.

This is why I hate how GP’s are given free rein to dole out AD’s with no expertise in how to manage a patient when they’re on them or deal with withdrawal sensitively.

Or cld you ask to see a different GP & really show the distress you’re in - ask if any have an interest in MH? Failing that see same GP & demand a referral to MH. Imo I don’t se why you can’t trial the higher dose of 30mg Mirtazepine. It’s helping me - but the life saver & most powerful mood stabiliser & anti anxiety drug I’ve ever had is HRT! Don’t know if you’re in peri or menopause &/or with cancer risk it’s been ruled out for you. I’m on it (& have cancer unfortunately but it’s not a hormone driven one thankfully so am ok to be on it).

Good luck

Thank you so much for your input on this. I am waiting for the call and dreading it - if I get the bored tone of voice I will break down. But maybe that's not a bad thing.
Yes, I was surprised that he said to go down instead of up. I have no idea why he thought going up was bad! I don't know if it's possible, too, to stay on both at low doses (SSRI and Mirt). Because that felt OK when I was cross-tapering.
I am sorry to hear about your cancer and hope your treatment is going well. I was on HRT for a while but, again, the GPs messed up the dosage, and a whole situation developed which I won't go into now, but it made me terrified of taking it again. I am menopausal, definitely.
Sending you all the best x

@dunant173 - thank you yes latest scans are showing no changes so all good so far!! 🤞 It's ridiculous isn't it how GP's can play so fast & loose with our health esp meno health & MH. Hope they listen & you get more support. I was on both Escitalopram & Mirtazepine 15mg each & found it the best combo I've ever tried but they won't prescribe until you've trialled Mirtazepine etc separately. ICombubation therapy carries a higher risk of serotonin syndrome & was told I had to come off one of them bcos I cldnt have stronger pain relief while on both bcos morphine is a serotonin agonist as well (which is not actually the case but nobody was prepared to manage the risk) It was a psychiatrist who prescribed them together tho & generally they won't do combination AD therapy unless you've exhausted all other AD's & getting no relief. But then again who knows as it's literally like the Wild West out there when it comes to what we get prescribed!! All the best.

Just to update on where I am with this... I decided I'm not happy with mirt and that I'm going to come off it. It has certainly made my depression worse and I just feel like a bit of a zombie on it.

So for the last two nights I split the day 15mg with a pill cutter and took 7.5mg, and I'll do that until the weekend, then I'll stop, and fingers crossed, as I've not been on it for long, I will be okay with that.

Hi, I've been on Mirtazapine since 10th Jan. It made my depression worse but I do feel like it's lifting a bit. I was really bad on Tuesday but yesday was better & today better again.
I am grieving after a bereavement on the 8th so it could be that aswell tbh.

Hi everyone I started this med on Friday but I'm worried because I was on 30mg of citalopram before this which doc said I could just switch straight to. I felt great first morning, but then had some dizziness. It felt a bit like the brain zaps you get coming off citalopram but I doubt it could be that after one day, did anyone experience that?

Anyway going to contact the doctor tomorrow to check about cross tapering as I don't want to make myself feel worse.

I'm off this completely now, and feel 1000 times better! The irritability completely gone, and I don't feel 'drugged'. Going to try HRT instead.

Good luck with the HRT OP . Just to mention might be worth getting testosterone checked too - I'm going on the gel .

@StrawberryTheCat I've just come back to find how things were going and have seen your update.
I hope HRT helps you🙂
I'm going to give Mirtazapine a longer try as my HRT days are behind me.
I'm struggling waking up in the mornings, so after reading several of this thread's posts, will take it earlier in the evening.

Day 4 for me and I'm 80% better today, so much less anxiety. I switched from citalopram so I'm not sure if that's affected how quickly I've adapted. Having said that I felt pretty rubbish yesterday so every day is different and it's still early days.

How is everyone getting on now? I am on escitalopram but not getting on with it at all. My doctor is suggesting switching to mirtazapine.