Prescribed Mirtazapine due to Anxiety over short term Insomnia problem

[xrachykinsx]

Hi, I was hit with a viral infection about a week ago which prevented me from sleeping due to sinus pain- completely normal and not out of the ordinary but for some reason I then began to feel anxious about not being able to get to sleep even after all my viral symptoms had vanished... In total I had about 7 nights of no sleep. I just made myself panic in bed and then towards the end of the week it had taken over my mind and was the only thing I could think about 'would I be able to sleep tonight.' My pressure to be able to sleep was made worse because I have a 2year old son to look after.

I finally hit breaking point yesterday and went to the doctors who although said he didn't think I was depressed, said I could become depressed should my problem carry on and therefore prescribed me with 30mg Mirtazapine to tackle the anxiety and insomnia. I took my first tablet last night at around 8pm and fell asleep within the hour, I woke up about 9am the next day and have felt quite sleepy most of today. I am a little wary of being on this medication as I feel I would be myself should I be able to get to sleep normally again but on the otherhand am not sure if I've possibly just triggered off some anxiety that I've always had. I have always been an anxious person but not to the extend where I would feel I need help. Will it be easy to come off Mirtazpine or is it likely that I will find some dependance on it for going to sleep? I'm worried because the main component in my cycle of anxiety..is the sleep, so would hope that once I've finished and decided to come off Mirtazpine..I will be able to and will be able to continue sleeping properly.. I'm only 22 and have never ever been on antidepressants before, and it just worries me that I don't really need them..

[ElizabethJane]

30mg seems a little high if it is just for sleep. Mirtazapine is usually sedating in the lower doses such as 15mg. Unfortunately mirtazapine can increase anxiety in some people. If you remain on 30mg it might not help you to sleep after a few weeks. I have found mirtazapine very difficult to come off and it is not recommended to come off it 'cold turkey' it is better to do it very slowly or cross-taper onto a different med. I have been on mirtazapine 45mg for about five years now. I have come off it twice and found that very difficult. Could you suggest to your GP that you try a lower dose first ? EJ

[fallula]

Hi xrachykinsx, I've also been prescribed Mirt for sleep anxiety. It's worked wonders but like you I'm worried as to how I'm going to come off it. I was told to take 30mg and the first time I took it I could hardly get up the stairs because I just came over all tired and my legs felt shaky. I slept for around 12 hours and the day after I felt so tired and worn out. I just couldn't get motivated. I took 30mg for around a week and although I was getting lots of sleep I felt so knackered and out of it the day after I decided to come down to 15mg. I've now been taking 15mg for about three weeks. Some days I'll feel wiped out the day after but those days are few and far between now. I've spent a lot of time trying to work out if I have severe anxiety in general or if it's just sleep anxiety and I've come to the conclusion that although I do suffer from social phobia and get het up about things the main thing in my life that stresses me out and has become a massive issue to me is sleep and atm Mirt is working wonders for that so I'm going to stick with it. I also have a toddler and when I wasn't sleeping I felt suicidal and very depressed and like a right rubbish mother, it was all due to serious sleep deprivation. Now I'm on Mirt those feelings have gone and I'm on the right path to getting back to my old self. Yes I'd prefer to be able to sleep without the help of any medication (I used to be the queen of sleep, I bloody loved it!) but atm that's not possible so I'm just having a bit of a helping hand. Perhaps you could just try and see it like that and worry about coming off it etc when you've been on it a bit longer and are feeling stronger in yourself? If in a few days if you're still feeling like you are I'd suggest talking to your doc about decreasing your dose. I was worried about talking 15mg instead of 30mg, I was panicking that I wouldn't get to sleep and it'd all kick off again but that dose still got me sleeping x

[hanshan]

15 mg is the usual dose for sleep - you might want to try that, as you can always top up if it doesn't work. As always, consult with your doctor about any change in dose.

I suspect that doctors may be prescribing mirtazapine for sleep because of the great benzodiazepine / z-drug addiction fear epidemic. If your problem is short term, a BDZ or z-drug might have been a more suitable choice. Nevertheless, if you only need to take mirtazapine for a month or less, it's not so likely that you will have any major discontinuation problems, particularly if you taper down.

For the moment, it's helped break your insomnia cycle, so that's a plus. If it helps stop any anxiety or depression, that's also a plus. Good luck with it, and hope all works out well.

[xrachykinsx]

I am so sorry I didn't reply sooner. I completley forgot about this forum which was a shame as you gave me some lovely replies. Unfortunately my sleep problem turned into more of a problem. It was just the trigger for all my stresses to bubble over. I've been suffering with depression and anxiety for qutie a while now as a result..so the 30mg dose was probably correct as I did get myself into a state. I deneied I had a problem for a long time thinking I could sort it out myself so I'm actually only 8 weeks in to taking 30mg now. It doesn't force me to sleep anymore which is good..I can stay up for about 1hour and a half after taking at 10pm and I wake up with no problems, only isssue is..my anxiety isn't completley gone. I still feel very uneasy most of the time. I've just posted a new thread as I didn't realise I'd posted on here already...but it's regarding my next query anyway xx

[keggsy]

Hello all,

Like Rachy I had insomnia probs which got worse and worse. Was given zopiclone initially but was very anxious about taking it.
Tried citalopram but side effects were very bad and lost my thinking completely.
Became obsessed with lack of sleep.
Was depressed and anxious and given mirt 15mg which was okay, but the sedative effect did not really help with the sleep anxiety.
6 weeks ago went up to 30mg mirt which has helped with my mood,
Sleep is a bit better but I'm still worried as each night comes and have zop for emergencies.
What has helped me is great friends and family, CBT, educating myself about sleep good book on amazon by Colin Espie which is a superb tool for insomniacs. Adjusting to the situation , accepting it and realising a poor nights sleep means that I have a better chance of sleeping better the next night through being more tired. I can still do most things after a poor night even if feeling a bit grotty.
These longer and sunny days help with mood too.
Still v much a work in progress and likely to be on 30mg mirt for a few months yet at least.

[hanshan]

Hi Rachy,

I take pregabalin with mirtazapine, as I found that mirtazapine alone wasn't enough to deal with anxiety. It is something to keep in mind if current medication and therapy aren't fully working.

[xrachykinsx]

Hey, thanks for your replies. I don't have the sleep problem now I have been taking my 30mg dose for a few months now but I just have this general anxiety about 'not feeling completley at ease' I don't really want to start adding other meds into the mix. I've been given an increase to 45mg and haven't started taking yet...but thinking I will tonight as I'm still not feeling 100% great. Overall the mirtazapine 30mg has helped me to be more stable but i'm still feeling pretty urggh at times.

[loreen]

The best thing about mirtazapine for me is the ability to sleep. Having had very bad sleep for months I am now able to sleep for 7 hours.

Unfortunately mirt hasn't got rid of the anxiety,but I think I am able to deal with it better because I am not so tired.

As for increasing the dose, you have to try it to see if it benefits you. When I increased my dose it just made me too drowsy during the day. Everyone reacts differently,so it is worth a try to see if it helps you. Good luck x

[xrachykinsx]

It is good for the sleep :) my sleep is now perfect...but unfortunately I'm not comforted enough by this as I still feel quite uneasy during the day. I just can't relax or feel completley fine. It's weird really as this anxiety only started as anxiety for going to sleep! I have decided i'm going to give the 45mg a go...I'll only keep wondering if I don't!

[hanshan]

Hi Rachy,

I'm like you - the mirtazapine fixed my sleep and night-time anxiety, but I still had anxiety during the day. I added pregabalin, and it worked wonders in clearing up the day-time anxiety. If you want to go down the extra medication road, it's worth trying - it doesn't work for everyone.

[xrachykinsx]

It's something I could keep in mind. I don't think my anxiety is as crippling as it is for some people...or atleast it's not as crippling as it was before I started taking mirtazapine. I was literally in a pit of despair at the beginning...so I'm hoping that the new 45mg dose that I started last night will just help push everything along that little bit more. I have waaaay too much time on my hands which isn't helpful for my anxiety... I function absolutely fine day to day...I just have moments where I feel quite upset and jittery xx

[keggsy]

More crap nights sleep for me. Could not get off last night so took half a zopiclone reluctantly.
Am tempted to try and reduce my 30mg mirt to 15mg to try and get the sleep benefit associated with the lower dose.
Having said that, when I was on 15mg originally, my sleep was still not good. Also being on the orodispersable tablets mean splitting them is not easy.
My brain just does not seem to have an off switch and as soon as I get sleepy it clicks back into gear. Tried meditation and relaxation but nothing really works.
Really do not want to take zop regularly.

[xrachykinsx]

I'm suprised that the 30mg doesn't send you to sleep...even more suprised that the 15mg doesnt give you perfect sleep either! I know what you mean about the zopiclone, I had a funny reaction the last time I took it...but that was when I was struggling on citalopram! I started burning all over my body..I literally felt like I was on fire..it was weird

[keggsy]

I think the mirt is helping me deal with the next day effects of poor sleep.
Not getting too down about it, but do feel frustrated and sad and on the days where I have slept okay, feeling energised is amazing but not something I can take for granted anymore.
Good nights breed good ones and bad one breed bad ones I find.
Would love to know whether the depression causes the insomnia or other way round.

[sunshinevet]

I have never been on a SSRI for sleep. I was given Minipress for sleep and Effexor which is in the same class as mirtazapine for my mood/ PTSD issues. SSRI would keep me stable through the day and when I was having an anxiety episode I would take Aterax. < if I am spelling that correctly. Minipress is used to slow the heart rate down before I go to sleep to help me calmly go to sleep and stay asleep for at least 8 hours wearas I was lucky to get about 4 hours of sleep a night without being awoken with night terrors or alertness to any noise. If it is helping you sleep I would stick to it but if it keeps you tired throughout the day, maybe take it an hour or even farther out before you go to bed to not have the effects last the next day. I had to do this with Minipress in order from falling asleep the next day after taking it.

[xrachykinsx]

Keggsy...that's a good question because for me... the sleep problem no longer remains..and actually didn't before I started on the mirtazapine...I ended up taking the mirtazapine because I ended up feeling bad in the day. My anxiety and breakdown was triggered by insomnia which made it into a viscious circle...I wouldn't say I was depressed before the breakdown... the doctor told me that I was becoming depressed because of the lack of sleep, so I think it can work both ways.. xx

[keggsy]

Yeah rachy, it is the proverbial chicken and egg.
For me it is the insomnia that causes the anxiety and depression or certainly heightens it.
Always been a bit of a worrier but last 3 months have been so bad.
Need to focus on my sleep CBT stuff and consider the hard sleep restriction therapy.
X

[xrachykinsx]

I just find it all so weird how, I was absolutely fine.... and then suddenly I get poorly with a sinus infection- can't sleep..and for some reason I do not know..I panicked and got myself into the insomnia rut- the more you try to sleep..the worse it gets! I just find it bizzarre that even though I got my sleep sorted on my own without medication...I still ended up a anxious wreck everyday! I guess though...it was just waiting to happen with all the stress I've been under in the last few years..everyone has that line where it can all bubble over. I was starting to feel a bit better on my new 45mg dose...had felt the most normal I have done in the whole 6months since it started..but I went out last night- had a few glasses of wine and although it had no affect on me last night or this morning...I have felt noticeably more anxious today! Hoping it's just the alcohol..I'll be happy if that's the reason! lol xx

[hanshan]

It might be rebound from the wine. It's a matter of trial and error to find out how much you can drink and be okay, but it's likely to be less than before when combined with mirtazapine.

[xrachykinsx]

I very rarely drink anyway. I certainly wouldn't miss it if I didn't drink for the next 6months. I guess it's always nice to be able to have a couple on special occasions though. Felt a bit iffy today too...but i've only been on my increase for a week today so plenty of time to feel good again xx

[keggsy]

Went up to 45mg last night, took a third of a 3.75mg zopiclone also - a tiny amount.
Slept a full nine hours - first time for ages!
Remember being zonked when first taking 15 and when I moved up to 30 so I hope better sleep continues and not to obsess about it.

[xrachykinsx]

That's great :) I'm having a bit of a wobbly day! Have been a bit dodgey ever since I went out on Wednesday night. I've been on the 45mg dose for a week today. Feeling a bit urghh about my anxiety again but hoping it's just a tiny blip xx

[keggsy]

Yeah hopefully a blip for you rachy. Just taken second dose of 45 mg.
Hope I get a similar result to last night, though am wide awake at mo. Will report back tomorrow!

[xrachykinsx]

How are you doing keggsy? Although I've had an 'Okay' day... as in 'okay...I've pushed through', I just feel a bit unsettled again..not sure if this is to be expected only a week into my increase.. I'm hoping so because I'm starting to get disheartened everytime I have a serious of good days and then start wobbling again which lasts 3-4days. My doctor has made it clear 45mg is the highest he will go on mirtazapine (I know some people are on 60mg-90mg) but it's not generally prescribed unless a doctor really believes in it will be good.

I'm really hoping this is all normal in terms of recovery..as I get really disheartened by the bad days- I know I shouldn't but you can't help it xx

[keggsy]

Evening rachy.
Had a decent night sleep again last night on 2nd night of 45mg.
Still been a bit worried and anxious which tells me it cannot just be the insomnia causing my low mood, though it def makes it worse.
Hopefully the 45 mg dose will in next few days boost my mood, though not convinced it will.
Doc said he would consider sertraline instead but as mirt is supposed to be one of the most sedating AD's I'm not sure switching would be the best idea.
Sun nights often dodgy for me with work the next day. Wish I could relax about sleep!
X

[xrachykinsx]

Yes, you see..that's my fear..I would be quite happy and willing to try something else IF it didn't stop me from sleeping and I'm not willing to start popping zopiclone's alongside another antidepressant, so really really hoping I start to stop having these downhill days xx

[keggsy]

I think we need to try and focus on the here and now, I'm a terror for predicting the worst which often never materialises.
I'm sure there are other options if mirt does not work for us.
I've got my 45mg in tablets now instead of the dissolvable tabs and doc said he is happy for me to experiment with splitting the dose - I.be got 15mg and 30mg tablets, so could take the supposedly more sedating 15mg at night and the 30mg in daytime.