TCA to Mirtazapine

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19-03-22, 14:03
Librella

TCA to Mirtazapine

I had an appointment with my doctor yesterday and we discussed either increasing my dose of nortriptyline or switching to mirtazapine. The past few weeks the pain relief of nortriptyline has faded and the sleep benefit definitely wore off a while ago, so I added hydroxyzine for insomnia. I actually suggested mirt because I heard it’s great for appetite and weight gain (I’ve been underweight for 2 years unable to gain anything partly due to early satiety), and I’ve done great with the hydroxyzine with is also an antihistamine. She was open to switching right away and said I would taper by taking nor every other day for a week and then starting mirtazapine at a low dose. I got scared of the side effects of withdrawal and decided I would wait until adjusting a few other of my meds (might need to do another round of antibiotics for h pylori test), but I was wondering if anyone has experience switching between these? I saw some rough starts to mirtazapine here which makes me worried.
20-03-22, 10:24
panic_down_under

Re: TCA to Mirtazapine

Quote:

Originally Posted by Librella

I had an appointment with my doctor yesterday and we discussed either increasing my dose of nortriptyline or switching to mirtazapine. The past few weeks the pain relief of nortriptyline has faded and the sleep benefit definitely wore off a while ago, so I added hydroxyzine for insomnia.

Are you still on 25mg nortriptyline for pain, or on a higher antidepressant dose?

Quote:

She was open to switching right away and said I would taper by taking nor every other day for a week and then starting mirtazapine at a low dose.

It would be better to halve the nortriptyline dose than skipping days as it has a relatively short half-life so you could experience a yo-yo effect with missed dosing which can be disturbing.

Quote:

I got scared of the side effects of withdrawal

If it becomes an issue then you could switch to a slower taper. There are no significant drug interactions between nortriptyline and mirtazapine.

Also, not all withdrawal symptoms are necessarily triggered by the med. An anxious mind is quite capable of producing the full range of symptoms if given the chance.

Quote:

I saw some rough starts to mirtazapine here which makes me worried.

Support groups like NMP can give a distorted picture as usually only those who have problems seek input from them. The millions who don't rarely post about it. Despite the 'antidepressant' label, mirtazapine is mostly just a potent antihistamine so usually doesn't produce AD type side-effects. The most frequent are sedation and powerful carbohydrate cravings both of which are positives for you. Maybe start on half a 15mg tablet for the first week to build some confidence.
21-03-22, 13:34
Librella

Re: TCA to Mirtazapine

Still on 25 mg of nortriptyline. If the other options don’t work we’ll increase the dose. It’s for the pain, I just have rescue meds for anxiety.
22-03-22, 10:29
panic_down_under

Re: TCA to Mirtazapine

Quote:

Originally Posted by Librella

Still on 25 mg of nortriptyline. If the other options don’t work we’ll increase the dose. It’s for the pain, I just have rescue meds for anxiety.

I don't know if mirtazapine will prove better at easing nerve pain, there are promising studies, however, I don't recall it mentioned for that purpose in anx/dep support groups. Fingers crossed.