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.

@Sunshinebea Hi again, I'm doing okay, thanks for asking. I had a couple of wobbly hours on Friday night and Saturday morning but they passed (whew). It's impossible for me to tell if this was caused by the increase in dose or it's just my normal anxiety. I tend to go into hyper-vigilant mode when I take medication, so it is probably just that.

Started feeling a bit better on Saturday afternoon and still feeling relatively okay now, as MairOldAlibi said, I too feel a little bit more spaced out. So apart from a few bumps in the road the increase has been not too bad so far.

They tend to say "you might feel worse before you start feeling better" (which is the last thing you want to hear) when starting/increasing anti-depressants so, I was kinda mentally prepared for any major changes but mercifully it hasn't been too bad so far.

I'm trying now to distract myself by keeping busy rather than sitting about worrying possible side effects

Sorry to hear you are feeling a bit more anxious now, it will pass though. Getting better isn't a linear process you can be doing fine and then out of nowhere you can be hit for 6. Just don't let the dips stop your progress though. You were starting to feel better, you can get back to there again and even better.

@blunderwood thank you. So glad you are doing ok - well done, sounds like you have a good attitude toward it all. I wish I could get myself into a better headspace. I had an awful reaction to citalopram just before starting Mirtazepine so I feel like I’m much more hypersensitive to it all.

had quite a few headaches today and just felt tired so I think I am just getting myself all worked up. My family think I should increase dose to tackle anxiety but I’m so afraid of another sharp anxiety response.

might go back to the GP for some reassurance tomorrow.

@blunderwood how you getting on?

I’ve had a few days where my mood has dipped and my anxiety spiked. I sort of feel a bit afraid and have some sense of dread but it’s not attached to anything. I’ve managed to convince myself it’s the medication so I’m now completely afraid of taking any more. What a mess I am. I keep crying and I just don’t feel like myself at all. The GP says my dose isn’t high enough but I’m terrified from all the bad reviews I’ve read of people getting worse on mirtazepine.

@Sunshinebea Hi again, I've been okay-ish, felt a bit panicked yesterday for a few hours. It's hard to tell if it's the medication or just my anxiety. I was feeling pretty anxious before I upped the mirtazapine so its probably 'just' anxiety. I think I'm just gonna stick with it though, it's only coming up to a week so its still early days.

It's still putting me to sleep and any 'jittery' feelings tend to pass quickly, although the jitteryness could be my own anxiety.

Sorry you aren't feeling too great. From an outside perspective that sense of dread is very common in anxiety. I know for one that I get it a lot, its pretty horrible.

GP's tend just to parrot the lines about "therapeutic doses" etc but they aren't the ones that have to go through the side effects. It's hard to take comfort in them saying "you'll feel better in a few weeks", when you find it difficult to get through the next few hours.

Perhaps you could ask your GP for an emergency/short course of Valium as a safety net if you up the dose.. Although some GP's can be a bit reluctant to prescribe benzodiazepines.

I know it's hard but try and stay away from the bad reviews. The trouble for reviews about anything whether it be medication or bikes or whatever are always mainly negative because people who have positive experiences don't tend to post about it. There's probably millions of mirtazapine users at 30mg who have had an overall positive experience at that dose. They wouldn't feel the need to post about their experience.They are out living their lives.

Hope you feel better soon

@blunderwood thank you. Have you found that it has helped with sleep at all? The problem I have is that I am woken with a shot of adrenaline every morning and I just can’t seem to shake it. I can’t work out if it’s because of the sedative effect and then we waking and somehow reacting to that. But I never used to wake with such anxiety in the morning. It’s not been my usual pattern. Oddly when I started mirtazepine I didn’t have it, it’s just started this last couple of weeks.

@Sunshinebea At 15mg I actually found the opposite where I would wake up and I'd still be sleepy for about an hour and had to really force myself to get up. To answer your question...I found it really helped with sleep. I have tinnitus that it keeps me awake, but the Mirtazapine 90% of the time sends me to sleep within an hour.

At 22.5mg a couple of mornings I too have woken with a shot of adrenaline but I've found I can get back to sleep after a drink of water. Also I find it takes a bit longer to fall asleep now but that too could be the anxiety. I've read plenty of reviews where people say that they fall asleep just as easily at 30 and 45mg.

It could be the body getting used to the medication but more likely its probably the increased anxiety from worrying about increasing the medication.

I read something earlier about morning anxiety called the cortisol awakening response (CAR), which includes a natural spike in cortisol and adrenaline to help you wake up.

So it could be like you said, your body's response to the sedative nature of mirtazapine or because you feel more anxious at the moment.

I've also noticed that if I avoid anything sugary for a few hours before bed, I sleep much better. If you read more about the cortisol awakening response it might easy your mind a bit.

@blunderwood oh the morning cortisol is really interesting I didn’t know about that. Had a really bad night last night but I think I’m just super anxious. Trying to work up to increasing the dose. I’ve read too many stories about it activating and being more anxiety inducing. I hope you’re doing ok!

@blunderwood hope the increased dose is helping you x

@Sunshinebea Hi again, I'm doing okay , I hope you are well too . I'm pretty much the same since the increase, no better , no worse really. I was hoping to feel a bit better by now but it's still early days. I'm still in that hyper-vigilant mode that anxiety puts you into so I'm trying my best to distract and calm myself.

From the last week I can say that my fear of waking up and being totally wired and over activated or even worse in a full blown panic has been unfounded. Sleep and waking up have been pretty much as per usual. Daytime has been a just bit more foggy headed.

I have had a few panicked moments and even a full panic attack yesterday (albeit short lived) but I was like that before I upped the meds. As I said earlier I'm attributing the panicked moments to my anxiety in general plus being in the hyper-vigilant mode.

The trouble with getting reviews online about anxiety medication is that they are written by people with chronic anxiety (myself included) who tend to attribute everything and anything to the medication rather than the most likely culprit...anxiety itself. Of course there are horror stories but these do tend to be rare but our anxious minds will always focus on these. Keeping perspective on these things is difficult with anxiety.

I'm still going to give it at least another week.

You could be super cautious and split up a 30mg pill into 8ths You can get a pill splitter for a few pounds , a razor blade would do at a push. Assuming you have 30mg pills take half of one of those 30mg pills with an 8th and this would give you dose of 18.75mg. Take that for a night and see how you feel.

I'm still going to give mines at least another week.

@blunderwood you’re so right it’s impossible to tell what’s anxiety and what’s side effects. I have health anxiety and panic disorder so I suffer a lot from this. Unfortunately I just can’t trust my own judgment at times.

I am into week four of 15mg and I feel quite a bit better but am still getting episodes and days where the anxiety is high, I also seem to have constant feeling of butterflies in my stomach which is really tiring me out and I am not sure if that’s my own anxiety or not. I didn’t have it to such an acute degree before the citalopram fiasco but I can’t seem to shake it now. I also get moments where my head feels really tingly and fuzzy.

did you get this and did it settle down if so? Also I am still very lethargic in the day and feel like I have zero fitness levels anymore. Does that get easier over time? I’m worried the sedation is just making me very slow and unfit!!

@Sunshinebea I also have health anxiety and panic disorder with agoraphobia thrown in for good measure. I was on 15mg of Mirtazapine for about 1 year. The initial stages were tough I was completely zombiefied for the first week or so but it does get easier. I didn't think I'd even be able to stay awake the first day, I was zonked!

My anxiety also seems to live in my stomach (probably because the brain and the gut are so closely linked in emotional responses.) My stomach is the first thing that feels off when I'm anxious. The butterflies is probably adrenaline rushes because you are in an anxious state.

Sometimes (well most, If I'm honest) I just need to read about a possible side effect for me to feel that side effect or be convinced its gonna happen.

In my experience of mirtazapine the anxiety won't just turn of like a switch, it just slowly fades little by little over a period of time.

The anxiety after the initial period (I'm not too sure how long this took exactly) just seemed to be dialed down once I had been on them a while. The mirtazapine also gave me the ability not to give a shit about the anxiety after a while. I could feel the anxious thoughts but I just had new found ability just to not care about them anymore. I was doing things and going places I never thought I could before the Mirtazapine. I wouldn't have said I was anxiety free or anything at this stage but it was certainly much more manageable. This is probably why I'm sticking with the increase in dosage in the hope I can get back to that level.

I think the citalopram fiasco as you put it is just putting you into an anxiety spiral (totally understandable it must have been hellish) but I think that bad reactions to medications usually happen early on in treatment. Your on week 4 and your still doing okay(ish). All the symptoms you are describing sound like classic anxiety symptoms.

Regards to fitness and lethargy, you can get over it...I actually lost a stone in the summer even on mirtazapine! and exercised 6 days a week. It took a while to build up to that but it can be done. Try to make yourself do some light exercise, usually for me just by starting the exercise was enough to lift the lethargy. The lethargy in general will pass.

Hopefully for you the anxiety will lessen and the calmer feelings will grow day by day.

I must say tho the only (bad) side effect for me outside the initial month or so was that Mirtazapine made me a bit tetchy/grumpy at times. I'm usually quite chilled out and non-confrontational but I could be raging (not in a out of control sort of way) with some people at times if they annoyed me.

Apparently this is a known side effect but on the other hand if you are an grumpy, argumentative sort,they do the opposite and chill you out.

@blunderwood thank you that’s encouraging to hear. Do you recall how long it took for you to feel able to go about your life again with less anxiety?

im seeing improvements but they are small and slow. I will get a few hours a day where I feel fairly ok then my anxiety hits again. Almost when I remember it. I still get these weird head rushes and feelings of doom.

Im due back to the GP Monday and I think I’m slightly anxious about her wanting to increase my dose. I just feel like I don’t want to go backward with the anxiety. Still waking in the early morning with adrenaline rushes though which is frustrating. And I seem to get two or three good nights sleep then one or two where I’m tossing and turning and can’t drift off, or like my brain is overactive and won’t be quiet. So annoying !!

I hope the increase works well for you soon.

@Sunshinebea

Thanks for your encouragement.

I can't really give you an exact timeline on when i felt the anxiety was manageable, it was within a couple of month tho. It happened sooner rather than later if that makes sense. I wasn't grinding along with anxiety for like 6 months kinda thing.

It can take me slightly longer to drift off at nights especially if I have something on my mind. So I think drifting off taking longer for you some nights is probably normal especially when you are still pretty anxious.

I think if you explain your concerns about upping the dose to your GP they may be able to offer something else. It is possible to take mirtazapine along side other anti-depressants. You can use mirtazapine for sleep and something else for daytime etc. Although, I think you may be reluctant to try another anti-depressant after your citalopram fiasco.

Alternatively, ask for some benzodiazapines for "emergencies" if you do up the dose. It can be reassuring to have some as a safety net e.g. in case you up the dose and you feel totally wired or panicky. Most GP's should understand that there's a bit of a "breaking in" period when you start/up anti-depressants.

I think you are making progress (maybe not as fast as you like) but progress it is. You are getting treatment and making steps towards recovery. With anti-depressants in can take a while to find the right fit for you. Just stick in there, the level of anxiety you are feeling won't last forever, it will go down.

Interesting reddit thread on this very subject, perhaps you can get a few more views on the dosage.

https://www.reddit.com/r/Mirtazapine_Remeron/comments/1bvufmp/15mg_vs_30mg_of_mirtazapine_for_anxiety_and/

@blunderwood thanks. I’m getting really upset and frustrated. Since taking the medication I’ve been able to sleep, but my head feels fuzzy and slow and I keep getting this awful thing where sounds or music loop round and round my brain nonstop and i never had it before. I’m starting to get very anxious that the mirtazepine is changing my brain or making me worse. I feel so lost today. And afraid to go up incase all these symptoms get worse and worse.

@Sunshinebea Sorry to hear you are not feeling so good. The fuzziness and foggy headiness will lift in time. The musical/sound loop thing is common in anxiety, it's annoying but it will pass. I get it as well, its usually a song a dislike which makes it doubly annoying. Its something to do with your brains response to stress and anxiety causing repetitive thoughts.

You probably know this already but mirtazapine can't permanently change your brain, it can only increase and decrease certain neurotransmitters and this is only temporary, that's why you need to keep taking medication everyday for it to be effective. So try not to worry on that front

You could always phone the non-emergency NHS number on 111, there is a dedicated mental health option. They may be able to offer you better reassurance than I can. They have access to your medical records so they can offer an emergency prescription etc.

Take care

@blunderwood thanks so much. Did you feel like your brain was a bit slow, and you struggled to focus on things? Has the increase helped with the sedation at all? x

When If first started taking it at 15mg everything was a bit slowed down yes. To me that was more preferable to the racing anxiety thoughts at the time. First week, I struggled to stay awake and was spaced out, but over time it gets better and pretty much non-existent. During the year at that 15mg I was fine during the day with energy levels and focus etc, getting up in the mornings tho was still a wee bit of a struggle but manageable (I'm not a morning person at the best of times).

@ 22.5mg the spaced out feeling has come back a wee bit BUT to a much lesser degree than when I initially stated on 15mg. I'm assuming its because the dosage has went up.

22.5 not heavily sedating during the day either (I didn't find 15 sedating either during the day outside of the first month or so). Its also easier to get up in the morning on 22.5mg, I'm not bouncing out of bed with bags of energy or anything it just doesn't take as long.to come out of the drowsy/half-asleep stage. Appetite and sleep length has been exactly the same. Anxiety levels, in general haven't really changed. There's been some good hours and days were I've actually felt pretty good.

If you're worried its a completely drastic change...for me, it wasn't.

Hope this helps.

@blunderwood thank you. Yeah it’s tricky because the anxiety at night is less and through the day panic doesn’t escalate like it used to. The slow brain fog is hard because I feel like I can’t find things in my head to talk to people about like I’m just a bit blank. And it’s hard to process stuff and I feel like I’m under a foggy glass pane. Surely this should have lifted by now?

I’ve got an appointment with the doctor on Monday so I’ll see what she says but I expect she will say I need to increase the medication.

can you say if you’ve had any increase in anxiety symptoms since doing so?
or any difficulty sleeping?

@Sunshinebea I've certainly had 'spikes' of anxiety whilst increasing but mercifully they are short lived. That could just be me monitoring for any changes and increasing my own anxiety rather than the medication. Sleeping wise, its taking slightly longer to nod off but nothing major. I'm not tossing and turning for hours on end.

Mirtazapine can be strange sometimes in regards to sleeping in my experience anyway. There's been times when I could have sworn that I hadn't even fallen asleep but suddenly its 4am and I remember the dream I just had. It's not frightening or anything, I just think "well I guess I must have slept" then fall straight back to sleep.

If your panic is less at night and not escalating during the day then that certainly seems like good progress. It could be just a waiting game at this stage. Medications effect everyone differently and at different rates.

With regards to brain fog, that too could be anxiety. It's hard to tell. I can just zone out and mind goes blank even before I was on mirtazapine.

I would definitely raise your concerns about increasing mirtazapine with your GP. The increase in anxiety at higher does seem to be a factor for certain people. GP's are well aware (at least should be) of the initial bumps in the road when starting/increasing anti-depressant meds. There could be a different treatment plan or like I've said in a previous post, a Valium safety net to mitigate any risk.

It's not like you have to stick with mirtazapine if you feel its not really helping or the thought of increasing the dose gives you too much anxiety. There are other options available, just ask your GP to outline some alternatives, they won't take it personally if you don't want to increase the mirtazapine dosage.

Having said all that, it's entirely possible that 30mg of Mirtazapine is the perfect dose for you.

@blunderwood thank you so much for taking the time to reply. Feeling a bit better today. Had a better sleep - some nights I wake up two or three times to go to the loo which is really annoying me but last night I didn’t. No idea why.

Took my five year old to a birthday party and by the end realised I’d gone two hours without feeling anxious or thinking about it. Of course the realisation then made me think about it but seems like progress!!

maybe I will just stick it out two more weeks to see if the improvement builds.

how are you - have you noticed any improvement in mood or anxiety yet?

From my own experience, I’m currently on 15mg myself, at this dose it’s primarily used for sleeping, and it’s the higher doses which aid more with depression and anxiety (or at least that’s what my gp told me) but for obvious reasons they can’t just start us on the higher dose x

Mirtazapine has literally changed my life.

I started on sertraline then when that made my anxiety ten times worse moved on to Citalopram which had the same problem.

Switched to low dose Mirtazapine combined with Propranolol as needed to manage the anxiety symptoms. Honestly after about 3 months adjustment time my anxiety is so, so much better. I was in the panic attacks multiple times a day can't go out of the house without feeling anxious level before I started my attempts to medicate it. I've recently got a new job in a highly competitive area that I'd never have been able to even walk into the interview for prior to this.

Medication can be finicky and it can take a while to find the right one and right dose but I'd urge you not to give up on Mirtazapine, it's honestly been a complete game changer. Maybe speak to your doctor about taking it in conjunction with propanol which helps manage the symptoms of anxiety while your body gets used to the new medicine? Worked for me!

Good luck and sending all the positive vibes 💐

I also get the morning anxiety rush, the best way to overcome this for me is to get straight out of bed and into the shower and start my day rather than lying there ruminating. I take 7.5mg mirtazapine (have taken 15mg in the past). My only note of caution is that when I tried to stop it, I couldn’t sleep, at all. I gave it 6 weeks and it was unbelievable how long the insomnia went on for. So I caved and went back on 7.5 and don’t think I can ever stop it now due to this. I also put on 2 stone and can’t shift it.

@JudgeBread this is so encouraging thank you. Can I ask what dose you have found to be beneficial for anxiety? I have suffered with panic attacks all my life and really empathise with you. They’re so debilitating. I’ve also had periods where I’ve been house bound due to them. I am really hoping that I settle into this medication. I still feel very up and down emotionally and a little fragile.

@Trashracoon yes I have heard that it’s more sedating at lower doses but I suspect this is what’s stopping me from going up as I am already so anxious I don’t want to increase the anxiety further !