View Full Version : Mirtazapine and Pregabalin for anxiety and nausea
Hello. Reaching out for advice as losing faith in AD medications. I have had nausea for 18 months and 7 months ago was finally diagnosed with anxiety related illness even though I had never felt anxious. After trying Trazadone with Diazepam the nausea disappeared instantly so problem solved right? Wrong; as my tolerance to diazepam increased I found myself needing a higher dose of Diazepam so stopped and stayed with Trazadone for a few months but nausea persisted. Also growing Anxiety symptoms appeared so I was moved to Mirtazapine starting with 15mg. This had an instant positive effect on anxiety symptoms but nausea persisted. Increased to 30mg which I stuck with for almost 3 months with gradual slow improvement in anxiety and nausea symptoms. During this time I have not been able to work and desperate to return I asked to see my psychiatrist for a review. He upped my dose to 45mg which I was reluctant to go with but agreed. The increased dose did hit me hard at first but seemed to improve my nausea and anxiety further. However today after 2 weeks on the 45mg I suddenly have very high anxiety and flu like symptoms (fever, chills, aches). Will stick with it for a few days but difficult to accept these awful side effects. Psychiatrist has said that if 45mg does not work then we will try pregabalin alongside. Have read many good reviews of this and interested to hear how Mirtazapine and a Pregabalin work together?
SmilingAlbert
29-03-15, 16:42
Hi Hipha,
I had nausea for a long time - had a load of stomach tests (incl endoscopy) and nothing really found.
Nausea proved to be all mental due to enormous work stress - I was literally worried sick. I was on Mirtazapine already, but adding Pregabalin (150mg, moved to 225 after a while) zapped the nausea within 24 hours. They don't have any negative indicated interactions, and seem to work well together. Quite a few on these boards are on both.
I would strongly suggest giving it a try, as it *should* give you your life back (I know exactly what it's like!) - let us know how you get on.
Albert
Hi Hipha,
If you have flu-like symptoms, with fever, chills and aches, don't discount the possibility that you have actually caught a virus going round - none of those sound like common side-effects of mirtazapine, particularly after taking it for a while. A virus can also set off mood problems.
As for mirtazapine and pregabalin, I take both, and find they work really well together, so it's worth a try if mirtazapine isn't fully effective for you.
Thank you for your replies.
I am now realising that my problems are more likely to be anxiety based than depression and so am hoping pregabalin will give me some relief. I am desperate for some relief from nausea and am looking forward to being prescribed pregabalin (assuming Mirtazapine 45mg does not suddenly relieve symptoms in the next 7 days)
My current symptoms whilst flu like are almost definitely not due to a virus. These symptoms have occurred a few times in the last 7 months usually when I am increasing dosage or coming off a medication. I did not mention that I had a severe reaction to sertraline 50mg with severe fever and nausea for 24 hours. Seems that I am sensitive to these meds.
I feel that Mirtazapine has helped improve my mood but apart from the first few days has not helped with my anxious symptoms and if anything has established anxiety where it did not previously exist.
My psychiatrist has prescribed pregabalin as the next medication so I do not expect any issues getting it. I asked my psychiatrist why this had not been prescribed at the beginning when diazepam had such an immediate positive impact removing my nausea overnight. He suggested that it is better to use a single drug rather than mix drugs, however I suspect that pregabalin is a 3rd or 4th line option after trying SSRI and SNRI options which is clearly based on price. Hopefully now that the patent has expired on pregabalin the price will drop and it will become a 1st line treatment for anxiety in the UK.
I will let you know how I get on in the coming weeks and months where I will hopefully finally find some relief from this horrendous situation.
Thanks
SmilingAlbert
30-03-15, 00:54
Good luck with it - as I said, my experience is that it should help a lot. And yes, when Preg comes off patent it should make things a lot easier and GPs etc. will be more willing to prescribe it.
As Hanshan has said, the combination with Mirt can often be a good one. Please let us know how you get on - fingers crossed for you, as I know how awful persistent nausea can be...
Albert
Hello
After having a good day yesterday, today I have anxious thoughts, feelings and symptoms (tight chest and sickly). Decided to try and see my GP early via the walk in clinic but after waiting for 1 hour gave up. I actually woke with anxious thoughts about going to see my GP and the day ahead which is new for me. My psychiatrist is clear that Mirtazapine could not be causing my anxiety but there seems to be lots of others on forums that have experienced anxiety especially when increasing dose. After 3 weeks on 45mg I am ready to drop back down to 30mg as I felt less anxious and sleep was much better on 30mg. I see my my GP at 2pm today but she is clueless and will not know what to do. I think the safest option is to introduce Pregablin alongside 45mg and 'see what happens' (3 words that I am now so familiar with!). Any thoughts?
I agree with Hanshan that nausea is likely due to high anxiety levels. I also agree that bumping up dose of Mirt to 45mg might actually be exacerbating it. I think Mirt is better for anxiety due to depression.
I take Pregabalin alongside Venlafaxine and find it helps with GAD. Perhaps ask to lower dose of Mirt to 30mg and introduce Pregabalin slowly?
Thanks for your reply. I have been diagnosed with moderate depression back in November by my pschyiatrist although I did see him when I was coming off Trazadone 200mg and felt at my lowest point with extreme nausea and very low mood. I am thinking that my condition (and nausea symptoms) is similar to GAD or at least this was my original condition. After taking Trazadone and coming off it, the focus for my psychiatrist was my mood which I understand as I had depressive symptoms when I saw him. My mood is ok considering what I am going through. If the anxiety that I am experiencing now on 45mg is as a result of depression then what is Mirtazapine doing for me? Feeling lost. I will update you after seeing my GP.
Quick update; saw my GP yesterday and we agreed to drop back down to 30mg of Mirtazapine from 45mg as this higher dose was making me feel very anxious for no reason and was finding it difficult to sleep. My GP also took the guidance of my psychiatrist and prescribed me 75mg of Pregabalin twice daily. Will start on Pregabalin once I am settled again on 30mg.
---------- Post added at 14:16 ---------- Previous post was at 14:05 ----------
I agree with Hanshan that nausea is likely due to high anxiety levels. I also agree that bumping up dose of Mirt to 45mg might actually be exacerbating it. I think Mirt is better for anxiety due to depression.
I take Pregabalin alongside Venlafaxine and find it helps with GAD. Perhaps ask to lower dose of Mirt to 30mg and introduce Pregabalin slowly?
Thanks KK2613. I agree with you. 8 months ago my friend suggested that my persistent nausea might be due to GAD and not due to a physical issue. My GP agreed and my journey began. Somewhere in the next 8 months I think we have lost sight of that first diagnosis as depressive symptoms have arisen as different meds were tried and discarded. Before taking these meds I was not aware of worrying about anything specific apart from the persistent nausea and finding and solving the root cause. Is it common with GAD to not be worrying about anything specific? My Psychiatrist mentioned that some anxiety sufferers are not aware of specific worries but that the brain is over thinking sub consciously resulting in anxiety. What is your story with GAD?
Hi Hipha,
My take on GAD is that it is anxiety that comes out of nowhere, then actually looks around to find something to be anxious about. Most people have many things that they could be anxious about, but they just put them out of their mind. But for people with GAD, they are "anxiety magnets".
Hipha I have never thought of it like that but how true you have hit the nail on the head.
Hipha I have never thought of it like that but how true you have hit the nail on the head.
Hello Jane
Which bit is true?
The bit about most people can put things they are anxious about to the back of their minds but people with GAD are anxiety magnets , so true.
The bit about most people can put things they are anxious about to the back of their minds but people with GAD are anxiety magnets , so true.
Ah can't I take the credit for that. Hanshan's words. Think this is true and can be described as mindfulness. For many people living in the moment and not worrying about the past and the future comes naturally. For the rest of us it is a challenge every minute of every day to live in the moment. Now that I am more mindful I realise how much thinking I do much of it completely pointless as my thoughts never predict what will happen or prepare me for challenges ahead. The way I see it wishful thoughts about the future is as pointless as worrying and fearing the worst will happen although at least wishful naive day dreaming does not cause anxiety. We should all live in the present but easier said than done
Started pregabalin today for the first time and 30mg Mirtazapine at night. 75mg with breakfast and 75mg with lunch 3.5 hours later. Felt slightly sickly after taking the first tablet and then pretty spaced out and dizzy through the afternoon and especially after eating dinner at 7pm Not sure what to expect tomorrow and for the week ahead. Just go with it and hope the nausea disappears. Does Pregablin take time to have a positive effect on anxiety (unlike a Diazepam)?
SmilingAlbert
05-04-15, 23:03
For some, it will start working very quickly (like within 24 hrs). For others, a few days, but stay in there if it doesn't work immediately.
I really hope it helps you.
Good luck!
Albert
Hello
Really struggling with the drop down from 45mg to 30mg of Mirtazapine. Feel sick through the day and having anxious thoughts and symptoms. This happened when I increased to 45mg where I persevered with this increase for 3 weeks but had to give in as anxiety symptoms were very strong. Also taking pregabaliin 75mg after breakfast which is knocking me out. Feel dizzy and have a headache through the day so have stopped taking 75mg in the afternoon. Not feeling any benefit from the Pregablin although feel that the change down to Mirtazapine 30mg is obscuring the recent introduction of pregabalin (1 week). It is clear that I am very sensitive to AD meds. I will continue with Mirtazapine 30mg hoping that my symptoms settle down. If not I am through with AD meds. Any encouragement or views are appreciated.
SmilingAlbert
10-04-15, 19:04
Keep going Hipha; it is often difficult to change med levels and sadly you just have to live through it - you will find your equilibrium soon!
Thank you smiling Albert. I am becoming inpatient as I am desperate to return to a normal life and work. 8 months is not a long time in finding a medication and dose that helps but I feel that I feel worse now after starting these meds 8 months ago. I have never felt depressed or anxious until taking AD meds. I only know what depression feels like after withdrawing from Trazadone and now reducing dose on Mirtazapine. My thought is that if Mirtazapine can make me so unwell after dropping down from 45 to 30 after only 3 weeks then can I allow my body to become dependent on this drug making future withdrawal unbearable? Arriving at the conclusion that AD meds are not for me. Will continue through April and then review my progress back to stability of symptoms. Big step to decide to stop and put faith in therapy but want to regain control before it is too late.
SmilingAlbert
11-04-15, 23:33
I appreciate your concerns; I was desperately ill for many months last year and was desperate for answers; even with private medical insurance I went through several doctors to find one that could help.
As Hanshan and others have shown, Mirt + Preg can be a very effective combination for anxiety and the nausea that comes from it. Don't worry about future withdrawals - the key thing now is to get something that works NOW; if you need to be on it for a while, then so be it. It is medicine, designed to make you better: in the olden days, people like us had sweet jack zip to turn to, so we are lucky (hard to believe in your difficult situation, I appreciate). Churchill had all this and more, with no drugs (apart from drink perhaps), saved the world, and died in his bed at 90...
150mg Preg/day is a pretty low dose; some assert that 400mg is what is general considered good for anxiety. I would definitely consider talking to your doctor about upping it. 30mg Mirt and 400mg Preg would I think be a very calming combination, for the majority of people.
In addition, look at your wider situation; try and live a normal life, don't obsess too much about your illness, do the things you enjoy most, see the people who you are glad to see, avoid the people who you aren't. Get out there, do walks, read good books. Books were one of my saviours, and public libraries are your friend there.
Best wishes,
Albert
Thank you for your advice and kind words smilingalbert. I admit i have lost faith in AD meds but will persevere. I truly appreciate your support and advice especially as you have suffered a similar illness and symptoms to myself. It helps to know that I am not the only person who has suffered from persistent nausea for many months. I will persevere with Mirtazapine and hope that my symptoms will settle down on 30mg of Mirt. I am only taking 75mg of Pregabalin whilst waiting for my withdrawal symptoms to settle so not expecting any benefit yet. Will add a 2nd 75mg dose going forward. I find pregabalin side effects are as documented with headache and generally feeling dizzy and fatigued. Did not realise that Pregablin would have such strong side effects. Hopefully I can build up the dose over time. I read that I should aim to increase 75-100mg per week but will find my own path. Thanks again for your advice. I will let you know how I get on.
SmilingAlbert
13-04-15, 00:21
Great stuff Hipha - Pregabalin is must better to handle than older drugs, from what I can see, and once your body is used to it, these should ease significantly.
I found 225mg Preg and 30mg Mirt worked for me for what sounds like a similar situation; you may need more, may need less - but I promise you, you will get your life back, sooner or later, hopefully on this - but perhaps on something else.
There are a lot of intelligent and dare I say it experienced users of both meds here so please come back and ask for advice - good luck!
Albert
Hi Hipha,
The problem with ADs is that all of them have side effects to some degree or other, but only some of them will work for any specific person (and it varies from person to person). This means that with some (but not all) ADs, you just get side effects with little benefit. Furthermore, even for the ones that work, you need to find the optimal dose (which again varies from person to person!).
But don't give up on ADs and other drugs for anxiety. It is possible with some persistence to find one that works at the right dose for you. Generally, starting up and changing dose levels can be the worst time for side effects, but they do subside in time, and then you can make a reasonable assessment as to whether the drug is beneficial for you.
I don't know Albert's age, but I am over 60 and I agree with his statement about the choice being very limited way back when, compared to today. Furthermore, research is continuing into new medications with fewer side effects.
Thank you both for your reassuring words
Albert- what was the pattern of your nausea? My symptoms started in August 13 with nausea on a morning easing to virtually nothing by evening. Since taking AD meds this has changed to low nausea on morning and nausea on afternoon. Looking back this pattern is typical with anxiety based nausea through a dread of the day ahead. Distraction does help keep the nausea away but it's got to be doing something physical even walking. I find I cannot watch TV or read during the day so this does not distract. One question does pregabalin stay in your system overnight so that anxiety is dampened down when waking? This is key for me as need to nip anxiety in the bud immediately before it affects my stomach. I don't have anxious thoughts just anxious symptoms so hoping pregabalin will dampen down my negative sub conscious thoughts 24*7
Pregabalin has a short half-life of around six hours (although, again, this varies from person to person). If early morning anxiety is a problem, it may be an idea to take a dose just before bed, and another immediately on waking.
SmilingAlbert
13-04-15, 17:33
hi guys
FYI I'm 43 now.
Yes, the nausea was worse in the AM with dread of problems ahead, and made worse by stressful situations. Often better in the evening, when I would usually manage to east something. But back on again in the AM, reliably.
I did have occasional glimmers of light, usually when I had been in stress-free environments for a day or two, which served to show to me that this was stress rather than any dire physical illness.
I concur with Hanshan; take one just before bed (for most it helps restful sleep), and then another first thing in the AM.
Albert
I take Mirtazapine at night before bed. Taking Pregablin together with Mirtazapine will knock me out. I fall asleep within 5 minutes and stay asleep with Mirtazapine so don't need to add anything for sleep. However if taking Pregabalin last thing at night is needed to prevent anxiety on waking then I will try this at some point. What do you think I should do next with dose? Currently 75mg with breakfast and then 75mg after lunch. Feel that I am ready to increase dose soon. Should I take 150mg instead of 75mg twice a day? My GP is clueless and suggested I start at 25mg so I need to take the initiative. Been told that I should to take Pregablin with food which dictates when I take it.
SmilingAlbert
14-04-15, 11:38
hi hipha
no as Hanshan says it has a low half life so much better to spread the does into 2 or even 3 times a day
so you could do do 75mg morning, noon, night each
or if too difficult, do 75 at night, 150mg in the AM
225mg is a good amount to move to, I'd have thought
but please ensure you don't run out as that may cause more problems
Hi Hipha,
You should be taking somewhere in the range 100 mg to 400 mg per day for at least two weeks to decide if pregabalin is having a positive effect.
If morning anxiety is a problem, you can load at night before bedtime. In this case, pregabalin is working to stop wake-up anxiety, not increase sleep. However, I find I do tend to sleep longer with combined mirtazapine and pregabalin.
Thank you both for your replies
I have an appointment with my community psychiatric nurse today and will discuss with her although ultimately it is up to me how I approach an increase in dose. I do find that the afternoons I my worst time with nausea symptoms so need to either build up the required effect through morning and early afternoon doses of 75 or consider taking a higher dose (150) in the morning and 75 in the afternoon? Only one way to find out.
Hi Hipha. I spread Pregabalin out 150mg x3 daily. Obviously, I would build up to required dose gradually but I agree with above post that you need to be on +150mg daily. In fact, I personally think anything below 300mg is pretty much ineffective for anxiety. I was initially on max dose of 600mg but found this too much as it was causing dizziness and drowsiness during the day. Higher doses at night will help in the morning if that's when anxiety hits, because although it does have a short half life, our metabolism slows down when we're asleep, reducing drug elimination. It really is a process of trial and error and most GPs will have little to no experience prescribing this drug so your input and knowledge will be needed.
Hope that helps.
Thank you KK2613
I have just seen my CPN who suggests increasing to 150mg in 3 days on the morning dose and keep to 75mg for the afternoon dose then increase the afternoon dose to 150mg also after 1 week. Will see what 225mg does for me if anything but hopeful that 300mg will stop my brain thinking thinking thinking. What is your illness and symptoms if you don't mind me asking? How has Pregablin helped you?
I take PRG primarily for pain Hipha but find it also helps GAD associated with depression. I took Gabapentin for a long time but switched to PRG as it is supposed to be more effective for chronic neuropathic pain, which I suffer with. I've been on various SSRIs and antidepressants over the years but always find they stop working after a while. I tried Mirt as well but it didn't help depression/anxiety much.
300mg is a good dose but it's just getting the time you take individual doses right. How has your mood/anxiety/nausea been today? Are you seeing an improvement? PRG is not like antidepressants which take weeks to work - you should know fairly quickly whether it is helping.
Thank you for the reply kk2613.
I have had a day with anxious sickly feeling from waking which has stayed with me all day especially after eating lunch. Tried to burn off the adrenaline by going for a bike ride with a challenging route. The helped whilst I was on the bike but now back at home still have anxious symptoms (I have nothing to worry about at this moment). I have taken 75mg with breakfast for almost 2 weeks and introduced a 2nd dose with lunch on Sunday. Have felt no noticeable benefit for anxiety but was not expecting any until I increased to 300-400. My anxiety symptoms begin after waking and peak after lunch and then decrease after 5pm and always have during this illness. I feel that I am taking pregabalin at the appropriate times according to symptom peaks. I will increase to 150+75 on Saturday and then 150+150 when side effects have settled. Slightly concerned that I have felt no benefit as you say effect is immediate. Here's hoping....
SmilingAlbert
15-04-15, 21:33
Hi Hipha,
It should have an affect, when on the correct dose! Don't give up hope for a bit, and take one day a time...
Albert
Thanks smilingalbert. I should stop looking for reassurance on the web but can't help myself. Many experiences of pregabalin posted on the web with wide variety of experiences mostly good with successful outcomes. Will stick with it. Looking forward to increasing dose
How have you been feeling Hipha?
Although I said Prg doesn't take weeks to kick in, like SSRIs, you still need to give your system time for the new dose to settle, so don't be tempted to pass judgement just yet. It may take a week before you feel any benefits so be prepared for a few minor blips on the way.
All the best.
Hello
Update on progress
Increased dose yesterday to 150mg in morning and continued with 75mg after lunch. Was expecting to be hit hard by this increase but experienced hardly any side effects. Anxiety symptoms of nausea and avoidance were present but seemed to lessen during the day especially after taking the pm dose. Had a relatively good day. One marked change was sleep where I slept in until 9:30 for the first time in over 1 year! Key change is that I did awake but was able to drift back off which never happens as my mind starts thinking as soon as I am aware. Coincidence? I will persevere with pregabalin and increase to 150+150 soon and then review. Mood is quite low at the moment as tired of this illness which is eating away at my life and those closest to me. Desperate for some relief from nausea and these growing anxiety symptoms. Thank you for your advice and kind words.
SmilingAlbert
19-04-15, 19:11
>>One marked change was sleep where I slept in until 9:30 for the first time in over 1 >>year! Key change is that I did awake but was able to drift back off which never >>happens as my mind starts thinking as soon as I am aware. Coincidence?
This is a very good sign!
I found when i was anxious I could never 1. sleep for long 2. go back to sleep after waking
Both of these are signs your system is much more relaxed, and hopefully this is because the meds are helping. In theory, the meds should start alleviating the nausea soon.
Incidentally, you might want to know that the NHS website specifically says that pregabalin is much less likely to CAUSE nausea than more conventional drugs:
http://www.nhs.uk/Conditions/Anxiety/Pages/Treatment.aspx
So this is worth bearing in mind too...
Albert
Thanks. I don't want to get my hopes up as I have had many disappointments in the last 8 months. However any difference in symptoms is unusual and very noticeable for me and sleeping in felt very different to me. I have felt quite dizzy and stoned today with nausea not too bad. My nausea symptoms have changed several times over the months and now feel more vague although getting some acid reflux lately. Change in symptoms is welcome as hopefully one day the change will be NO NAUSEA. Looking forward to increasing to 300mg daily although feel that after waking and rising I need to take my dose immediately as there is 19 hours since taking previous dose. May need to introduce a night time dose to boost my levels when waking. Will continue with pregabalin and update you on progress
When my anxiety was at its worst I was waking constantly from about 2 am onwards. Once I had woken up at about 4 am, there was no way I could get back to sleep. Now if I wake about 4 or 5 am, I can actually go back to sleep. Problem is, I can now sleep 10 hours in a night!
I take most of my pregabalin in the evening as my anxiety was worst in the early morning. However, as I now seem to be in a holding pattern with minimal anxiety (and adjusting better every day to moving to Japan just over four years ago), I may go back to spacing the pregabalin dose throughout the day, which may help reduce excessive sleep. If I'm really brave, I may experiment with reducing the dose, but it's been so good for me I don't want to upset things.
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