Mirtazapine

[lorisparkle]

I am currently on 4 pumps of oetrogel and 2 progesterone tablets (continuous) and still feeling incredibly anxious, depressed, having intrusive thoughts, not sleeping etc. The GP suggested trying sertraline but I think that hasn't helped. He has suggested mirtazapine.

For those who also take it - what time do you take it? I have taken it at 9pm but can not wake up at 6.30am. I am worried that if I take it earlier I will be too tired to drive etc when I need to in the late evening.

Any advice...,,

What dose are you on and how long have you been on it?
The lower doses can be very sedative for the first week or two but it usually settles.

I ended up taking a week off work to sleep but now I take at 10 and get up at 5.

Thanks so much @Gnomegnomegnome I have only just started taking it on a low dose and have been signed off work as well. Hopefully by the time I am due back to work it would have all settled down.

I am currently on 4 pumps of oetrogel and 2 progesterone tablets (continuous) and still feeling incredibly anxious, depressed, having intrusive thoughts, not sleeping etc.

@lorisparkle Can you clarify why you are on 200mgs of Utrogestan every day?

I know it's new guidance that when using a high dose of gel, some women need more progesterone, BUT that can come at a cost- often all the symptoms you describe.

Utrogestan is a depressive / sedative type of drug. It can also cause anxiety and mood swings.

Many women hate it (I was told I'd love or hate it, and to try it for 3 months.)

There are many options that you could try with HRT before trialling other drugs.
Medical advice to to get HRT right, not introduce ADs or similar.

I'd advise you to speak to your GP and discuss dropping down to 100 mgs a day, and perhaps reducing the gel to 3 pumps. (You can have an ultrasound scan to check the womb lining if there are any concerns there.)

If you carry on with 4 pumps of gel, the other option is to use Utrogestan vaginally at a lower dose (which is supposed to be effective and avoid side effects.)

OR you could use it on a 3-month cycle with is 12 days x 200mgs for 2 weeks out of very 12 weeks. (This is in the NICE guidance for women who are intolerant to progestogens.)

@JinglingSpringbells thank you for the information. I had been on 1 progesterone tablet for a year (and 2 then 3 pumps of oestrogen ) before the horrible anxiety started. The GP suggested an extra oestrogen but I said that I still had some bleeding. She said to try the extra progesterone. That extra tablet has not improved or worsened my mood/anxiety etc and it is too early to see if it has stopped the bleeding.

I started on sertraline about 2 months ago when the anxiety/depression started but again do not feel any better. So that is why GP suggested changing to Mitazapine. I certainly feel better but that could be because I am actually sleeping better. My only problem is getting up in the morning!

I tried mirtazipine and put on a lot of weight, I was better with amytrptiline for sleep

The GP suggested an extra oestrogen but I said that I still had some bleeding.

What kind of bleeding?

Were you post menopause when you started HRT? You should be at least 12 months with no natural period or over age 54 to use continuous combined.
If it's started too early/ soon, then bleeding can occur at odd times.
This means you/women should change to sequential, on a monthly cycle.

Obviously I don't know all the history but there are many posts here from other women where GPs have initiated HRT as continuous far too soon then there are issues with bleeding, they increase progesterone, and it all gets in a muddle!

ADs are contraindicated in women who do not have a history of depression or anxiety before menopause. NICE guidance
https://www.nice.org.uk/guidance/ng23/chapter/Recommendations#managing-short-term-menopausal-symptoms

Psychological symptoms

1.4.5Consider HRT to alleviate low mood that arises as a result of the menopause.

1.4.7Ensure that menopausal women and healthcare professionals involved in their care understand that there is no clear evidence for SSRIs or SNRIs to ease low mood in menopausal women who have not been diagnosed with depression (see the NICE guideline on depression in adults).

I started on sertraline about 2 months ago when the anxiety/depression started but again do not feel any better.

There is a lot of information on the website of Dr Newson on this. ADs etc do not help if the underlying cause is lack of estrogen.https://www.balance-menopause.com/menopause-library/antidepressants-and-menopause-factsheet/#:~:text=For%20some%20women%2C%20these%20medications,levels%20of%20estrogen%20and%20testosterone.

Your GP should be considering something else with HRT before prescribing ADs.
If they aren't , can you self-refer to a private specialist?

I was put on Mirtazapine for depression as previous tablets stopped working. The most immediate side effect was anger ... could have killed people for breathing. The advice says may cause agitation, but looking at Mirtazapine forums other people have said that they had to come off, it was wrecking their family life and relationships. There is a whole forum about how hard and how long it takes to get off this medicine.

I'm sure GPs think they are helping but the way they reach for ADs when NICE says not to, is very odd.

For the majority of women who have these symptoms, and are on HRT, it's the HRT that needs tweaking rather than adding in other drugs (all of which have side effects) .

I too wondered whether I had been put on continuous too quickly hence the bleeding. I am speaking to the GP again in a couple of weeks so it will be interesting what she says about the progesterone. However when I first started taking it, I missed one dose and felt awful so if she suggests not taking it continuously it will be interesting how it effects me.

When I was in mirtzapine for depression I fell asleep 30 mins after taking it. No way I could drive after taking it. I had problems to get up in the mornings but with time that got better.

It helped my anxiety amazingly but made me put on weight when I was already struggling with this. My anxiety still causes issues but I am reluctant to return to this or any other medication.

11pm usually.

Mirtazapine saved my life long before I hit perimenopause, but it isn't for everyone and it does sound as though some GPs reach for anti depressants when it looks as though the HRT needs tweaking instead.

And yes, it can interfere with the signals that tell you that you are full after eating a meal which is why some people put on weight on when on it.

@JinglingSpringbells I'm 37 so not quite there yet but your posts have been so informative, thank you.

@lorisparkle my dh takes mirtazipine as a insomnia treatment where nothing else works. Takes it at 9pm and he's done at 9.30, 10s bedtime here. Its not helped the insomnia yet but he's always wide awake at 6am(does lunch boxes etc then) and absolutely sleeps 90% of the 10-3 and 7-10 period.

I take it at 10 and am out like a light by 10.30. My alarm goes off at 6 and I'm fine to be awake then. If the alarm isn't set I can sleep til 8 happily.

Insomnia was my last peri hell.

I’ve been on it 2yrs. Totally agree it’s tricky to know when to take, am actually thinking of trying to stop after Christmas because of this. If I take it earlier, say 8pm ish I fall asleep on the sofa before 10, if I take closer to 9pm really struggle to get up the next morning 🙄 It has worked amazingly though after a lifetime of anxiety I’ve never felt more mentally well and sleep brilliantly and am nervous of losing this when I come off

Mirtazapine is an appetite stimulant so if putting on weight is going to be an issue for you I would go back and ask for something different. Even my skinny sister ended up chubby and this made her more miserable.

I was started on mirtazapine early December. Unlike everyone else it does not sink me out or make me hungry 🤷‍♀️ I was put on it for anxiety and increased to 30mg after 7 weeks on 15mg. I’ve now been on it almost 11 weeks and still wake a few times a night and don’t sleep past 5am when I take it at about 9:30pm, goi g to bed at 10:30-11:00. I still feel anxious, but not as low as before. I’m exhausted and have no appetite at all. Does this mean I need to try something else. I’ve already tried Sertraline and escitalopram and neither worked. Any advice would be gratefully received as I’m back at the doctors in February. I feel so fed up as I have been dealing with this anxiety/low mood for a year now and nothing is helping.

I had to stop taking it because it gave me horrible back pain. So now I can't sleep again.

Mirtazipine is notorious for piling weight on. My GP won't prescribe it for this reason as patients then hate it down the road and it can also be difficult to come off.

It's an atypical antidepressant so doesn't have the same actions as antidepressants in the SSRI/SNRI classes or the older tricyclics

Try another SSRI. I took Mirtazapine years ago and felt constantly drugged up and hungry. I gained 5 stone which really didn’t help the depression

I am very progesterone intolerant, it causes the symptoms that you have described. Anxiety, suicidal feelings, depressed as soon as I stopped the progesterone they went. Utrogestan was the absolute worst for me, horrendous!!, I did not want to live and cried constantly, also the 200mg dose is very high, I used 100mg. I’ve tried them all, I’m now on the last progesterone 🥴, it’s dydrogesterone along with the estrogen in tablet form Femoston 1mg/5mg. Medroxyprogesterone and dydrogesterone are the lesser androgenic of the progesterones.

Tridestra is also a good regime, you do have a bleed by taking medroxyprogesterone for 2 weeks, but the estrogen part is for 3 months. I may go back to this if Femoston doesn’t work as the only reason I stopped is due to being lactose intolerant and the tablets include it. But I’ve just seen an advert for a product called milkaid that could be a game changer and enable me to use it without getting tummy ache, that also goes for the Femoston tablets, they all have lactose in them.

Failing this it’s back to my menopause Dr to trial a regime that is off license but is done under supervision. Whatever you do don’t take St John’s Wort for low mood like I did, it causes break through bleeding 🤦‍♀️

@JinglingSpringbells is the patch better?
Is utrogestan that bad for you?

I had to stop Utrogestan last year as it made me terrible. Couldn’t stop crying, although I was already a hot mess so hard to know if it made me worse but it felt like it did. I had the Mirena coil fitted in the summer and have to say I feel like my sleep, which was already terrible, got worse 🤷‍♀️ I just so desperately want to feel like me again. I’ve never had any MH problems before so I’m finding this all very scary, especially when nothing is working for me.

I have found mirtrazapine to be great although I am really struggling with my weight. It took a week or so for the inability to get up in the morning to improve. However as soon as I went back to work the horrible feelings came back. I was also getting breakthrough bleeding. I am now on evorel conti and 30mg mirtazapine and feel OK. It is such a struggle to find what works for you.