Could the Mirtazapine be making me worse?

I am currently taking 30mg Mirtazapine along with 10mg Ciprlex. When I started Mirtazapine about 3 months ago it helped for a short time and then the depression started creeping back. A Psychiatrist has now added Cipralex which I am happy to take as I used to take Citalopram (similar drug) and it kept me well for a number of years until last year. I am at my wits end feeling anxiety and low and worry that I am never going to get well again. I am beginning to wonder if Mirtazapine is doing anything for me apart from helping me get off to sleep although I have now started waking through the night. I know tablets will not make all my problems go away (grief), I am doing everything I can to help myself but I'm steadily losing the will to fight this anymore. Is it possible I am on too much medication?

Dear Katy I'm sorry that you are feeling so unwell. I can only comment on my experience of both mirtazapine and lithium. Doctors often augment another anti d with mirtazapine so there isn't any danger there. It was my psychiatrist that added mirtazapine to the lithium. I was also taking dothiepin 175mg at the time so definitely over medicated. If your anxiety is still very bad then I would suggest that you ring your GP or psychiatrist's secretary in the morning. Mirtazapine does stop working and sometimes it can increase anxiety. If you have suffered a bereavement then maybe ask your GP about some counselling. My Dad died in 2011 and I still feel upset about it but managing to cope with it. Take care and keep posting. Sleep issues can be a problem. I have an emergency supply of zopiclone but I cannot recommend anything - let your GP decide. EJ.

Hello EJ and thanks for answering my post; I knew I could rely on you. I do think Mirtazapine helped for the first few weeks, I couldn't believe how much better I felt, however I think it did stop working as I could feel my mood deteriorate again and I was doing everything I could to help myself. I got referred to a psychiatrist who added Cipralex which I have been taking for nearly a couple of months now. I had previously taken Citalopram and this had always kept me well until the bereavements. I don't feel like the Mirtazapine is doing anything other than make me sleep a bit better. I am beginning to wonder if it is making the anxiety worse as the Cipralex has improved my mood. It's awful feeling like this and I know the grief plays a big part (I am having counselling). I would have expected the anxiety to be improving by now rather than getting worse. Have you come across this happening before with Mirtazapine? I will ring psych tomorrow. Thanks again x

Hi Katy I experienced severe anxiety whilst withdrawing from mirtazapine. I know that for many others they have needed something else to tackle the anxiety. My problem has always been severe depression although I'm 90% cured. You might need something in the short term or your psychiatrist might take you off mirtazapine? This is always done very slowly as it can be a beast to withdraw from. Serotonin syndrome occurs when there is too much serotonin in the blood (I think this is what you were hinting at taking mirt and cipralex together). It is very rare. I believe that I am more at risk taking lithium and mirtazapine together. It is always worth being aware of the risks though. EJ

Hi EJ, I'm not worried about Serotonin syndrome just the fact that my anxiety is worse. Can Mirtazapine make anxiety worse? I haven't reduced the dose, I'm still on 30mg but was thinking of taking 15mg tonight. I take 10mg of Cipralex which is supposed to help anxiety; I feel all the side effects from the Cipralex have subsided. I just don't know what to do and just want to function properly again and I know you can't tell me what to do, I just feel like I'm searching for answers. Thanks for caring x

Increased anxiety is a listed side effect of Cipralex, but not mirtazapine. Maybe the new drug is the culprit?

Hi Mark, thanks for your input. I really don't know what to think; I lost confidence in the Mirtazapine when it seemed to stop working after 3 - 4 weeks; there was a definate improvement quite quickly at first. Because I have taken citalopram successfully before and Cipralex is a similar drug it seemed sensible to try it. It has helped my mood lately and I did have increased anxiety at first. It's just these last couple of days it has got worse. I'm just sick of feeling like this really; just taken 2mg diazepam and it has hardly touched it. Maybe it's just me getting anxious about anxiety!!!!

All SSRIs can cause increased anxiety, that's one of the reasons I couldn't tolerate citalopram, fluoxetine or fluvoxamine for long.

I agree that common sense dictates that if the 2 drugs are chemically related you'd expect your tolerance to the side effects to be broadly similar.

However, I've been on citalopram on 3 different occasions and suffered slightly different side effects each time. No idea why.

Hi Katy sorry to see you are struggling. When I switched from Cipralex to Mirtazapine the first few weeks were fine, probably because I still had Cipralex in my system. When I went up to 30mg of Mirtazapine and stopped Cipralex, the 30mg Mirtazapine done nothing for me at all, I did feel that it was making me worse but my GP said that it was more likely that it wasnt working rather than making me feel worse, or if we had gone up to 30mg sooner then it may have worked. I only gave it 5 weeks. In the end went back onto Cipralex 20mg and take 15mg Mirtazapine as an add on. I think that the Mirt just helps me sleep but they do say that it can augment/boots another anti d.

Im not sure in your case what it could be. Maybe if you feel Cipralex is working then you could possible increase it to 20mg which is the max dose. Also when I stopped the 30mg Mirtazapine after taking it for 5 weeks, I just stopped and I did not get withdrawal but then after a week I was taking 15mg again alongside the Cipralex.

I feel alot better than I did but am not by any means cured. I am not sure if that is down to 20mg on its own or in combination with 15mg Mirtazapine.

I hope you get to speak to your doc or psychiatrist and they can help you.

Take Care xxx

Hi Faye, I feel the same about Mirtazapine ie at first it helped then it seemed to stop. I have read many similar experiences about it not working for long. I tried to go up to 15mg cipralex but I think it was too soon. Gonna stay on 10mg for a bit, i was always on 20mg Citalopram and that worked for years. I cut down the Mirtazapine to 15mg last night as I didn't see the point in taking 30 if it was not doing anything and maybe making things worse. I just don't know anymore and I'm fed up of feeling like this and I've just taken 5mg diazepam as the anxiety is doing me in. Are you at work? xx

Hi Katy I didn't realise you was on Mirtazapine as well as Cipralex. I went on it for 8 months and it worked after a day for me but 3 weeks later I woke up more anxious than ever and started feeling sucidal on it. I mentioned this to my doctor and they just upped my dose to the full 45mg's but I just never got any better on it, I felt worse and worse and couldn't sleep at all anymore on it apart from when I inititally took the pill and I'd drop right off for an hour or 2 at most then be up half the night having to take diazepam or zopiclone because my panic was so bad. I eventually took myself off to the hospital and they let me come off the Mirtazapine, it was really hard as I was very poorly withdrawing but it soon passed and I have never looked back since going on Cipralex, though I'm not 100% there yet havig ony been on it a couple of months but I am practically better. Mirtazapine just didn't agree with me at all though but I know other people who swear by it (:

Hi Karen, I was the same with the Mirtazapine after a couple of days I felt great, it was like a miracle. Then I started to feel not as good so it was upped to 30mg, again felt better at first then decline again. That's when Cipralex was added and stayed on 30 mirt. I feel the only benefit I get from mirt is it relaxes me a bit when I've taken it on an eve. My anxiety has been getting worse so last night I cut the dose to 15mg. Spoke to my psychiatrist and she said it's ok and can increase cipralex to 15 if I want. I'm going to stay on 10mg and see how I go. I have felt really nauseous this morning but just trying to put one foot infront of the other. I'm glad you are improving it gives me hope!!!! xx

Hi Katy , yes im still back at work and doing "ok". Im only just starting to have more good days than bad, and it has taken a long time. I have marked on my calendar and it has been 66 days not sure how many weeks that is 9?? I never thought it would take this long as previously on Cipralex first time around 2-3 week mark I was feeling better. Although I very quickly went up to 20mg Cipralex after being off them for 5-6 weeks the doc said I could go back straight to 20mg as I had tolerated them before but I had never STARTED on 20mg before I started on 10mg then went up to 20mg a few years later. Never had ANY problem with the increase at the time but this time well although I said to myself I want to get the 20mg in my system as quickly as possible, I DEFINATELY this time had the case of "feel worse before better" which I never quite understood before now I do.

Maybe you could ask your doc to go up on Cipralex and reduce to 15mg Mirt as you felt ok on this but havent felt ok on 30mg ?

***HUGS***

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Hi Karen P I felt the same kinda on Mirtazapine 30mg on its own. I felt it made me worse but doc said possibly wasnt working or didnt go high enough soon enough, who knows. Would explain why I felt ok the first few weeks as I was tapering off Cipralex so I was taking both and felt ok. I think for me Mirtazapine does nothing on its own or maybe it would have done in another 6 weeks ! But I always thought if your not getting progressively better by the 6 week mark then you should change.

Faye, when you reduced Mirtazapine did you have any side effects? I have felt a bit sickly on and off today and a bit of a headache. You never know if it's your own anxiety or the meds. Anyway not too bad today only had 1 diazepam this morning infact anxiety okish at the moment, just feel a bit spacey!!! xx

Hi Katy, no I didnt have any side effects when I stopped taking 30mg Mirtazapine after being on it for 5/6 weeks. I just stopped and the GP said I could just stop. I went a whole week without it, no withdrawal, then saw a specialist who said take 15mg Mirt with the Cipralex. Whether I would have eventually have got withdrawal had I not gone onto 15mg who knows. But I definately didnt get any going from 30-15 with a week break in between.

So have you now reduced to 15 mg Mirt ?

Hi Faye, I reduced it to 15mg for 2 nights and last night I had the worst night in a long time; woke up at 3.30am feeling really low mood. The psychiatrist did say if I reduced it at this stage I could see the depression come back. I took the other 15mg this morning and although it made me feel zonked I feel a bit better now. I will take the 30mg tonight and leave things as they are for now. It's too early really to keep changing things, I'm just getting so fed up of not being 'me' and I'm questioning things all the time. I think I will have to try to just accept things as they are for a while. My friend say's she can see improvements in me, it's just so difficult to see it yourself. Are you still seeing specialist?