Mirtazapine success but side effects tough - advice needed

[Asha1979]

After citalopram stopped working after 5 years I ended up trying lustral (didn't work) and seroquel (didn't work) then cymbalta which weren't kicking in until mirtazapine 15mg was added to the cymbalta. After 5 days the anxiety had disappeared. However I am always hungry and am having awful bad dreams every night. I don't know whether I should stop the mirtazapine (after speaking to my psych of course). I will tell her at my next appointment on friday about the bad dreams and the excessive hunger. Are these good enough reasons to stop the mirtazapine which has helped lift me out of the dark place I was in. I'm on them over 2 weeks now. Advice anyone???

[Dubai]

Hey Asha,

I'm on Mirt for 9 weeks now, and I feel great, the dreams became occasional and even at their peak weren't very disturbing to me. As for the hunger I gained a stone the first 4 weeks and lost a pound the next 4. I felt the appetite issue is something I could control and I try to time my dinner closer to my dose time, If I have dinner in the early evenings then the hour I'm waiting to sleep I get very hungry. The benefits of Mirt in my humble opinion outweigh the side effects. I wish you a speedy recovery.

[hanshan]

I find it easier to resist hunger earlier in the day, particularly work days when I am busy doing things, so I don't eat much during the day - just a few mandarin oranges at lunch-time and no-sugar tea or coffee (some milk with the tea). This means I can eat reasonably well in the evening, but I still try to add lots of raw salad vegetables to bulk things up without adding too much energy.

It's harder to resist food during the day on weekends. I've found some instant vegetable soup that is definitely not a gastronomic delight but which swells up into all sorts of unidentifiable vegie bits and pieces and helps quell hunger pangs for only 23 kcal per serve.

[Asha1979]

Okay I'm going to stick with it as its a great ad, I will just go easy on the food

[Mark13]

Asha

I'm on exactly the same combination, although the other way round so my SEs are different.

I'd been on mirtazapine for 5½ years before adding duloxetine (Cymbalta) and I find the two work well together.

I never got nightmares with mirtazapine, maybe it's interacting with the duloxetine and causing this.

I take duloxetine at lunchtime and mirtazapine at night-time (60-90 minutes before bed) BTW.

[Asha1979]

Asha

I'm on exactly the same combination, although the other way round so my SEs are different.

I'd been on mirtazapine for 5½ years before adding duloxetine (Cymbalta) and I find the two work well together.

I never got nightmares with mirtazapine, maybe it's interacting with the duloxetine and causing this.

I take duloxetine at lunchtime and mirtazapine at night-time (60-90 minutes before bed) BTW.

Good to talk to somebody on the exact combination. I'm on 120mg cymbalta and 15mg mirtazapine. I'm quite hopeful as I was in such a bad place when the mirt was added and it did lift me out of the depression, the anxiety disappeared like a light switch turning off. I asked my psych doctor today could we maybe up the mirt dose to 30mg but she prefers me to stay on 15mg for now, not quite sure why. I take the duloxetine in the morning and the mirtazapine at 10pm.

[Mark13]

I asked my psych doctor today could we maybe up the mirt dose to 30mg but she prefers me to stay on 15mg for now, not quite sure why. I take the duloxetine in the morning and the mirtazapine at 10pm.
It's probably because you're on the max possible dose of Cymbalta. My GP won't go above 60mg, it's not shown in trials to have any greater benefit above that, but if it works for you it doesn't matter what other's experiences are.

Mirtazapine at 15mg is not considered a therapeutic dose, but at that amount is does help you sleep better usually, which certainly benefitted me for years before I needed something extra.

With any two anti-depressants or similar acting drugs or supplements (St. John's Wort) for example, increase the risk of serotonin sydrome, so your GP is just probably playing it safe.

[Asha1979]

Yes she is playing it safe I would say. I don't know why she upped the dose to 120 as I also did read that about it not being recorded as any better than 60mg. I've been on cymbalta since 5th june and not sure if it has worked yet or not. It must be as 15mg mirt is not enough to lift anxiety and depression on its own. I still wake up feeling anxious but it passes. I'm not back to where I was before but hopefully getting there. How long did it take you to feel 100% again? with the two together? I'm 6 weeks on cymbalta and 3 weeks on mirtazapine.

[Mark13]

How long did it take you to feel 100% again? with the two together? I'm 6 weeks on cymbalta and 3 weeks on mirtazapine.
I don't think I'll ever be 100% as I've had GAD / depresssion for too long, but I do feel a lot better now than I have for a few years.

I think it took about 4-6 weeks of 60mg to really kick in for me. That's when I stopped waking up with anxiety (although it used to ease during the day).

I found duloxetine side effects the worst - I can say how it works when already being on mirtazapine.

Obviously when I started mirtazapine I was on no other related drug, so it helped me sleep straight away with few side effects (mainly just drowsiness, dry mouth).

[Asha1979]

Upping dose to 30mg tonight

[Bonnibelle]

I have been on Mirtazapine for about 10 weeks now. The first couple of weeks I felt awful, very drugged up, weak, exhausted and hungry. It wasn't nice at all and I honestly wouldn't want to go through that again. I am now fine, I have the odd groggy morning but it usually wears off.

I would say it is very early days. The dreams do settle as does the hunger. I have gained about 8lb since being on them which I needed to gain but I know that has been just due to me giving into the cravings.