Mirtazepine - positive and helpful stories please

[Sunshinebea]

Hello, I was prescribed Mirtazepine for severe anxiety GAD and panic recently. I took citalopram before and lasted six days before being admitted to A&E with horrific anxiety attacks. I’ve since been on Mirtazepine for a week at 7.5mg and almost three weeks at 15mg. I wake in the morning with awful anxiety in my stomach and butterflies throughout the day. My mood is low and I feel very on edge. The doctor wants me to increase to 22.5mg then 30mg but I have read that it can increase your anxiety so I am too afraid to do so. Has anyone had any similar experiences? I just don’t know how I would cope if it heightened my anxiety - the awful stomach drops are persistent as it is. I had a week on this dose where I actually didn’t feel anxious much but now it’s back and I just don’t know what to do.

Anyone?

It was the first thing that helped my anxiety. Eventually I switched to a different medication which was better suited to me, but mirtazapine made a positive difference to my mood.

Have a support plan. Keep in close contact with your gp so you an reach out to them if you do experience a dip and do you have family of friends you can lean on if your struggles get worse?

Remember that any dip will be short-term because your gp will tweak your medication to respond to it.

Anxiety is a b*tch. Don't let it paralyse you by making you too scared to kick it's arse. X

I took it for a few years for anxiety, but I took lamotrigine at the same time to increase the sedative effect. It worked very well for me, it also made it easier to get a decent nights sleep which I hadn’t had in decades. I take it occasionally now, and my doctor trusts me to know when it’s needed. For me it works best when taken with lamotrigine, even at a low dose. Hope you start feeling better soon, anxiety can be so debilitating.

Thank you so much. Did either of you experience anything going up in dose? I think as I am on 15mg and have felt somewhat better but still have anxiety I am unsure about increasing and being worse.

How old are you op? I got fobbed off by the doctor with entirely unsuitable meds including mirtazepine. It turns out that HRT for perimenopause was what was actually needed. The difference in mental and physical health is incredible now, including anxiety, and it's not even been that long.

I've been on it for a long time (20 years on and off).
Is it a GP prescribing it?
Mirtazapine is known for being more sedative at a lower dose.
Most people find with increasing the dose, you can lose the sedative effect.
Personally, I still slept heavily and was more tired on 30mg, but I was on other medications at the same time.
Have you problems with sleeping/ insomnia?
It’s fairly unusual to be on mirtazapine on its own. It seems to work best alongside a different antidepressant.

@LamonicBibber1 Im 41 and I have asked about hormones. I have the Mirena coil but it’s 4 years old so perhaps needs changing? The GP said I could try HRT but not until I’m more stable on Mirtazepine. What do you take?

@Onlyinthrees I had a bad reaction to citalopram so they put me on this instead

Mine was kept at a low dose, I think it works better that way. It started to work quickly as well, I didn’t have to wait weeks for it to start helping.

@rowanrome did it help your anxiety at that dose? And do you know how long before it really did?

I am kinda in the same boat as you with regards to Mirtazapine. I've been taking 15mg at night for about a year now. It worked great at first, slept well, ate (too) well, and did alleviate most of my anxiety. Recently tho my anxiety has crept back. As always, the GP's first suggestion was to up the dose to 30mg. Like you I was terrified of upping the dosage due to all the reports of it being less sedating at higher doses and possibly making anxiety worse. My biggest fear was not being able to sleep as I have tinnitus.

I couldn't get the GP to give me an intermediate dose of 22.5mg so I ended up just splitting the 30mg tablet into 22.5mg with a tablet splitter (after lots of googling to make sure it's safe).

So, I took 22.5 mg last night(4/11/25) for the first time and here is my experience.

Fell asleep no problem (maybe even faster than 15mg, possibly from the pill being cut??). I did wake up twice in the night to pee which is unusual for me but did fall straight back to sleep no problem.

Woke up, slightly early , did feel a bit odd/jittery with slightly nervy tummy (probably anxiety), had a drink of water and lay back down, then....I had a really nice calming feeling that lasted for 2 hours.

It's now 3pm and my anxiety levels are pretty much the same as yesterday when on 15mg (obviously its too early to tell much) But.. I'm not feeling any worse, maybe slightly sleepier than usual but not bad. I will be definitely taking 22.5 mg again tonight and hope things start to improve over the next weeks.

I'm a very anxious person generally so it can be difficult for sometimes to differentiate between a genuine side effect and the symptoms that anxiety can make you feel at times (especially with the horror stories you see online).

It's entirely possible that you will experience no negative effects at all with the increased dosage and feel only positive ones, everyone is different.

BTW its taken me 6 weeks to try and work up the courage to try the increased dosage. So don't beat yourself up too much about stressing about it.

Good Luck.

@blunderwood thank you for your message and great work on being able to take the 22.5mg! My GP told me to split a pill and do the same. I am also not yet able to work up the courage to do so…. But you have encouraged me. Do let me know how you get on. I still have a nervous feeling in my stomach most of the time so I think I’m worried it will get worse. I usually wake up with this awful feeling of fear and it’s hard to shake off. I was hoping the 15mg would help but my GP thinks I need more. Like you I can’t always tell what’s my own nervous system and what’s a response to medication, and I have had such an awful time with citalopram that I’m terrified!

but well done, that’s sounding super positive. How long are you planning to stay on the 22.5mg for do you think?

@Sunshinebea Glad my post was of some help to you. I'll keep you posted on any major updates good or bad.

I have some morning panic too, its not a great start to the day! I'm happy your GP told you its fine to split a pill (I was sooo worried about that) I even felt panicked after I swallowed it.

It's very difficult to start these things while you're anxious. I just told myself I can sit and hope it will get better on its own (possible, but very unlikely, sadly) or I can try the increase. If the increase goes badly, then I'm gonna have a really shitty day....but its only one day..and hey Ive had loads of really shitty days and survived.! Plus, I'll definitely know that Mirtazapine isn't a long term answer and can explore other avenues.

I would say try and avoid googling about side effects ( like me you probably wont :) but googling helped me find this site). But there is plenty of positive stories out there too.

I'm gonna try stay on the 22.5mg for at least 4 weeks and if all goes well then try the 30mg depending on how I feel (probably take another 6 weeks to convince myself to do it tho).

@blunderwood how are you today? Hope it’s going well x

My dh found it good in a crisis situation due to the sedation at low dose. He eventually changed to venalflaxine.

Its great. Helps you sleeps too. I take it with sertraline as its the only things that will actually make me sleep.
never had any side effects.

@Sunshinebea Hi again, all is well so far, thanks for asking Took a bit longer to fall asleep last night but eventually dozed off and slept through the night (yay!). Didn't have any problems of waking up early again or the nervy stomach again. Still early days (literally), I'll keep you posted. Hope you are well.

@blunderwood thanks, glad to hear you’re doing good. It’s hard isn’t it. I’m 3 weeks into 15mg and my GP says to go up. But I am starting to feel a bit better and I don’t know whether to wait. But she said it’s not a therapeutic enough dose.

@Sunshinebea You are correct it's very difficult to know what to do at times. You said that you are only 3 weeks into taking 15mg, from what I've read (I'm not a GP or medical expert) that the usual waiting time is 4-6 weeks to see if the medication is improving symptoms. If you are starting to feel a bit better then perhaps waiting another week is fine and then see how you feel then. The 15mg worked great for me for about a year (until it didn't :() but that most likely wont be your experience, 15mg MAY be your ideal dose but you wont really know till you go up etc.

She is right in saying that 30mg and upwards is a therapeutic dose but everyone reacts differently to medications.

I'd always advise you to take the medical advice of your GP rather than some random person on the internet.

I do understand your reluctance to up your dose, even the thought of things getting worse is enough to put you off. But you seem to be taking to the medication pretty well so far.

The trouble with anxiety is that you feel that you have to make an instant judgement on this but, you have time to consider it and make a decision when you are calmer etc. Perhaps writing a list of pro's and con's may help.

Just take your time and be kind to yourself and make the right decision for you.

@LamonicBibber1 i am wondering what HRT they have put you on as I’m trying to decide between medication and HRT for anxiety. Sorry to jump in.

@blunderwood thanks so much that was a thoughtful response. Yes I agree I need to make sure I don’t feel rushed or pressured and I have time. I’m feeling a lot better today again so I’ve decided to give it another week and then reassess. I don’t mind putting the medication up if I need to but I want to be sure I’ve understood the full affects of this dose first.

my doctor made it sound like the 15mg wouldn’t ever be enough so I was getting anxious about it.

@blunderwood hope you’re doing ok x

Another ex-mirtazipine-taker here. I started on 15mg and later went to 30mg. Did the job. Very glad it existed and that the clinician thought of putting me on it.

@MairOldAlibi thanks so much how did you find going up to 30mg? Did you get many side effects?

Not really, other than a slightly spaced out feeling for a few days, but actually the side effects were a bit less in terms of the sedation. And I was thirsty on both doses but that was good because usually I don’t drink enough.

@MairOldAlibi thanks. Did it help anxiety more at the higher dose? I have had a few really good days but now I am feeling super anxious again. I’m not sure why. I’m on 15mg