View Full Version : SSRIs nonresponders have success with mirtazapine?
Hello,
I have been suffering from severe physical anxiety symptoms for around 10 months now - generally I feel fairly panicky and restless (almost like a form of akathisia). I believe that it was partly caused by medication changes and stress in the past.
I have tried a number of SSRIs which mostly just made my restlessness worse. I'm currently taking a tiny dose of citalopram (5mg) which helps slightly with my OCD intrusive thoughts, but doesn't do anything for my physical agitation. I'm waiting for CBT as well - until I get my intrusive thoughts under control I'm reluctant to drop the medication completely.
My question is therefore: have any of you who experienced worsening of panic and agitation on SSRIs experienced relief of physical anxiety symptoms on mirtazapine? If so, what kind of dose did you need to take? I would continue to take the 5mg citalopram and hope that the mirtazapine takes care of the panic/agitation.
Thanks :)
Hi. I couldn't get on with ssri s at all. They made me extremely agitated it was so horrible I will never forget the trauma. I am on mirtazapine now and they helped me a lot. They really calmed me down and got me out of the hole I was in. I started on 15 for about a month and then 30. I didn't notice much difference with the increase so with hindsight probably should of just stuck with the 15. They worked really quickly even the next day a felt a bit brighter but really really tired. I quite enjoyed that but I know others don't.
They never entirely took the anxiety away but they did really help.
I'm coming off them now, slowely but surely I'm feeling better. I hope they help you too if u decide to go for it
I too had a traumatic time on SSRIs. Mirtazapine has done nothing for my anxiety and after a month of being on it, my anxiety was getting worse. I'm now tapering off.
Side effect wise it was a walk in the park compared to SSRIs and they do really help me sleep well so might be worth a try though?
I've been taking 7.5mg for a week and last night took 15mg. My anxiety has been really bad recently - hopefully the 15mg will help in this area. Until I'm stable I'm continuing to take my 5mg citalopram though - I've had too many drug changes and most of them have made me worse, so if the mirt does the same I still have the cit to cushion the blow...
If this doesn't work - maybe the next step is a mood stabiliser...
Good luck. I'm starting Trazodone tonight. Similar to Mirt but hopefully better with the anxiety.
Thanks Teej. Just be aware the trazodone can increase anxiety in some people due to the effects of its active metabolite.
Why can't someone come up with a drug which helps take the edge off agitation yet has no addictive properties/ weight gain/blood pressure "extras"?
Hi Pulisa,
I think all the research effort went into SSRIs and related drugs for some time, particularly when it was found they could also help SOME people with anxiety. However, side effects and non-response cases make them less than perfect.
Fortunately, research has now returned to specific anxiety drugs, and several are currently in trials. With luck, one might be more effective to more people with fewer side effects.
That would be a huge step forward, Hanshan. Thanks for your response.
I've been on the mirt for around 2.5 weeks in total. While my mood has lifted my anxiety has still been as bad as ever - maybe even slightly worse? Though I did have some alcohol a couple of days ago which may have contributed to this latest blip.
For those on mirt, how long did it take for you to feel a substantial decrease in anxiety/panic? And what dosage were you on? I'm just taking 15mg but I've read that higher dosages can be more stimulating - which is the last thing I need.
My anxiety never decreased with Mirt,I started at 15 and then onto 30.
It worked well for depression though for me.
I also have to say that although mirtazapine worked beautifully for stopping nighttime panic awakening (often several times a night), it never really did much for daytime general anxiety. I'm now taking mirtazapine combined with pregabalin, which together keep me okay day and night.
Hmmm...so far I have experienced a brightening of mood with mirtazapine. However, I don't feel that it has done anything for my anxiety. I feel the same old constant tension, agitation and restlessness. In fact the mirtazapine may have given me some restless leg syndrome. So for anyone who took/takes 15mg mirt - how long did it start to work for panic/general anxiety and how long did it take for any side effects to dampen down?
Hmmm...so far I have experienced a brightening of mood with mirtazapine. However, I don't feel that it has done anything for my anxiety. I feel the same old constant tension, agitation and restlessness. In fact the mirtazapine may have given me some restless leg syndrome. So for anyone who took/takes 15mg mirt - how long did it start to work for panic/general anxiety and how long did it take for any side effects to dampen down?
It never worked for me with regards to my anxiety, if anything it made it worse at 15mg. 7.5mg seems to have less anxiety and even more sedation.
I'm still on 15mg - think its been around 3 weeks on that dosage, and 4 weeks in total.
Good points - I sleep better, I have less restless legs (though that may have been because I've cut out alcohol) and feel brighter.
Not so good points - some increase in intrusive thoughts, still an overall sense of panicy restlessness. I'm also eating a lot of sweet carbs (I have a sweet tooth at the best of times!). Trying to get out on a daily walk to prevent me from gaining weight.
Still, 3 weeks at 15mg isn't long. I'll give it another 3 weeks before reconsidering whether to continue taking it.
Not a great day today. Lots of intrusive thoughts and a general feeling of jumpiness/agitation. I'm starting to wonder if Mirtazapine will help. Had to take a 2mg diazepam tablet earlier and burst into tears in front of one of my friends. I'm really sick of this constant agitation/restlessness/akathisia whatever it is - nothing seems to help and I still haven't heard about getting my intensive CBT.
:(
Hi Emphyrio,
Sorry to hear things aren't going so well.
I don't want to write mirtazapine off as an-anti anxiety drug, but there do seem to be quite a few people that it doesn't help, at least on its own.
Have you tried pregabalin? This is the drug that has worked best for me as a long-term medication for anxiety.
I think that the fact that mirtazapine works on norepinephrine is working against me. What I could do is cut my dosage to 7.5mg a night and see if that helps. Either than or come off it. I did try pregabalin but not to the max dosage of 600mg a day. Maybe I should try that again?
Hi Emphyrio,
You could try cutting the mirtazapine to a very low dose. That is supposed to cut out the norepinephrine element.
I don't know what dose pregabalin you were taking. If it's not working by around 400 mg per day, it probably won't have any effect at 600 mg.
I think that the fact that mirtazapine works on norepinephrine is working against me. What I could do is cut my dosage to 7.5mg a night and see if that helps. Either than or come off it. I did try pregabalin but not to the max dosage of 600mg a day. Maybe I should try that again?
I don't think mirt will help at such a low dose - even sleep. I think you'd be better off on another med like Pregabalin. Good for GAD and sleep so there would be no need for mirt. How long were you on Pregabalin? It works for me at 300mg but you have to give it a couple of weeks for side effects like dizziness and feeling spaced out to settle. It's also worth trying max dose, then gradually reducing if you start to feel better.
I was on it for 3 weeks at 75mg twice a day. I'm going back on it but will work my way up to 600 - I believe I need a higher dose if it will work for me at all.
I've stopped taking mirt completely - it was exacerbating my intrusive thoughts and I felt extremely agitated whilst taking it. Good for sleep though. If I start getting insomnia I can go back to it at 3.75mg or something - though I'm guessing withdrawal shouldn't be a serious issue given that I only took it for 4 weeks? (I week at 7.5 and 3 weeks at 15mg).
Goodbye Mirt (for now at least) - you helped me sleep but I've now realised that antidepressants and me don't get along too well.
Not sure whether stopping mirt will cause you any issues - although at that low dose you have reduced as far as you can go really. I found Pregabalin helps with sleep and quite sedating. Hope it works for you Emphyrio.
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