Mirtazapine and flu like symptoms

[Belleblue]

Hi, I took mirtazapine about 5 years ago for approx. 10 months. It did help but around the 9month mark I began to experience flu like symptoms. I know that mirt can lower white blood cells which can make you more vulnerable to infections so I began to withdraw from them and felt much better. When I tried to reintroduce them again I got the same flu like feelings and malaise, so I knew without a doubt it was the mirt

I am now experiencing stress related anxiety and some depression once more and need to take something. I cannot seem to tolerate the SSRIs as they give me dreadful agitation and insomnia, so I was thinking of going back on mirt once more. I feel this cycle of anxiety/depression I seem to go through regularly now requires me to be on some form of medication for a longer period of time to give myself some breathing space and rest from it. However I am fearful of going back on mirt as the same thing may happen and I will have to come off it again and then what?

I've considered agomelatine as well, but that can affect the liver and as I am 66 don't want to harm my physical health. Also thought of pregabalin, but am fearful of the build up of tolerance some experience. That sound like a lot of fear doesn't it?, but I really don't know where to start at this stage
Any advice or suggestions greatly appreciated.

Belle x

[Belleblue]

Well I went to the docs earlier in the week as I had another episode of anxiety followed by some depression. You'd never guess to look at me that I'm in a right old state underneath as I'm a bit of a swan, serene on the outside but paddling furiously beneath.
But I guess a lot of us are like that.

Anyway we discussed various options re which antidepressant would be best. I said that although I had tried various SSRIs in the past and couldn't tolerate them due to their insomnia/agitation side effects, I would be willing to give escitalopram another go if I could be prescribed some diazepam in the kicking in period. To my surprise she told me that they no longer prescribe escitalopram as it is more or less the same as citalopram and that they don't prescribe diazepam during the initial kicking in period with ADs. So if that is happening in my surgery, it must be happening elsewhere too.

The upshot was that I am going to retry Mirtazapine. When I told her about the flu like symptoms she said that if I experience that again I should come in for a blood test. She said the side effect of agranulocytosis doesn't even come up on the information they have, but is probably on the packet insert as they have to report all side effects however rare.

I should be starting mirt next week pending a positive outcome to an ecg on Monday.

[anxiousjomo]

Good luck Belle! Hopefully the mirt will work better for you this time round. I wonder if there are any supplements/diet things you can do to help keep your immune system strong? It is a weird side effect (and one I am trying not to worry about at the moment, as you know!) as it is impossible to know really if we are feeling ill because we have a bug, or if it is the drug...

I wonder if you start to have the same problem, could you get a blood test done to check your white blood cell levels? That would at least help make clear if that is what is going on or not...

At least when you start the mirt you will get to have some nice long sleeps!

[Belleblue]

Thank you Jomo
I will certainly get a blood test if the same symptoms recur.

All the best.