Nightmares

[Apudebeaumarchet]

I’m on 15mg of mirtazapine at night for sleep. I had been on a higher dose for a very long time but I came off it for a few years and went back on over a year ago. When I was off it I had dreadful insomnia (as I did before I started taking it years ago). Now I’m back on it and sleep like clockwork which is a massive relief.
However, I have really bad nightmares all the time. At best I have strange, fitful kind of dreams, extremely vivid and wake up exhausted. At worst I have really really terrifying nightmares (like take the scariest movie you can think of, multiply by a hundred and imagine you don’t know it’s not real), wake up confused, disoriented and so tense and tired presumably from being absolutely petrified in my sleep.
At first I was just so glad to be sleeping again and I thought the nightmares would get better but they’ve got worse. I’m tired all the time and very irritable as a result. I have a five year old who still wakes once a night most nights which doesn’t help as it’s broken sleep.
I have been diagnosed with Persistent depressive disorder and am also on Venlafaxine in the morning.
Has anyone else on mirtazapine found that they have nightmares on it? Is there anything I can do?
Anyone that has nightmares, any tips on how to cope with them?
Or anyone have any thoughts on what might cause someone to have nightmares so much? I’ve had them since childhood and they are now seriously affecting my life to the point that I just don’t know what to do anymore.

Speak to someone about getting your meds changed, it's obviously not working for you. Have you had any therapy for nightmares? If not, maybe you should. Since they've been going on your entire life, so not totally related to meds. If you bring whatever is trying to come out during sleep, into the open during waking hours, maybe it'll go away. Keep a notebook by your bed and write the nightmares down while they're fresh in your mind, if you can remember them. Then practice imagining a different ending/outcome, thinking it through a few times to try to reset your brain. Maybe a therapist might know what the nightmares mean. You can also buy dream analysis books and have a go at decoding them yourself.

Thanks for the reply.
I went to the GP to get my meds changed a couple of months ago but he said no.
I asked to be referred back to a psychiatrist but the referral has been rejected multiple times.
I have had therapy. Not specifically for the nightmares as they have only gotten out of hand since I went back on mirtazapine.
I don’t think there’s any point analysing the dreams. My parents were emotionally abusive and I grew up with constant arguing/ violence/ chaos, so presumably that is the “root” of most of my problems. I know this but it doesn’t seem to help or resolve anything by talking about it.
Maybe I will look up about dream analysis though. I suppose it can’t hurt. It’s just not very nice thinking about the dreams. I usually forget them pretty quickly and am relieved because they’re so awful.
They are usually very crazy, about things like being tortured/ being murdered/ being chased/ often ghosts or monsters or serial killers so imagining a different outcome doesn’t really apply as they don’t have any linear sort of story so to speak and don’t have an outcome- except that I usually die but that doesn’t stop the pain/ fear.

I forgot to say I used to be on the lowest dose of olanzapine (anti psychotic) and this seemed to help. I wanted to go back on it but the GP said they are not comfortable prescribing this and the psychiatrist won’t see me.

Since you know there's another solution out there I'd save for a private psychiatrist appointment then. Seems your GP doesn't know much about MH. Once you've got the ok from a psychiatrist for the olanzapine the GP will probably be happy to continue prescribing it.

I had the exact same problem its the dose you are on, I increased mine slightly and the nightmares are a lot better

the side effects of Mirt are worse at lower doses

I can’t afford to go private. They won’t just let you do an assessment and refer back to GP.
The GP was reluctant about the olanzapine largely because I’m already lethargic and the side effects are awful so I think they’re probably right about that.

Thanks so much.

I used to be on a higher dose and that seemed to work better.
The GP said they wouldn’t put it up because then it would lose the sedation and the insomnia would probably come back but I used to sleep fine on 45mg and my general form was better too.
I think I’ll book a different gp and get it increased. Thanks so much.