Advice please - Mirtazapine failing to help with sleep

[sandie]

GP diagnosed depression with anxiety some 7 weeks ago. Awful Palpitations, terrible anxiety, chest tightness, adrenaline surges, struggling for breath etc - everything. Initially prescribed sertraline which led to the most awful side-effects and I weaned myself off after 4 weeks, I started Mirtazapine 3+ weeks ago - the GP said this would also help with my sleep.

Initially, the sleep was so much better, - I even managed 7 hours on one night ! However, now that the meds seem to be helping with the depression, and the anxiety, palpitations, etc are significantly reduced, my sleep is wrecked.

My GP gave me some very low dose (2mg) diazapam to take the edge off the anxiety. I have only taken a few for this, but have started to take one at night with my 15 Mirtazapine, in the hope that it will help with my sleep .... but it hasn't. Last night I manage a total of around 4 hours in 2 different sessions.

I'm seeing my GP on Thursday but have absolutely no idea of a way forward. I had understood that as an aid for insomnia, Mirtazapine was more successful at a lower dosage. Is it likely therefore that he will increase the dose, or could he even decide to reduce it ?

Any ideas, advice would be so very welcome.

[MyNameIsTerry]

Hi Sandie,

I think you need the guys on the Mirt board, you may not get many responses on here. I know hanshan, SmilingAlbert and others talk about the best dose for sleep so I'm sure they can help you.

It might be an idea to move this thread on there so they see it, they are on most days.

[sandie]

Hi MyNameIsTerry - I posted yesterday on the Mirt board but had no responses.

Could really do with some advice.

[MyNameIsTerry]

It could be they weren't on. Hanshan is in Japan so is on more when it's night-early morning over here.

I hope you get some soon. MrAndy is on more at the moment and I know he's offered advise on Mirt about sleep so hopefully he will spot it.

[MrAndy]

It usually takes about 3 weeks to settle on a med and you will have some bad nights sleep on the way.i still have bad pacthes and ive been on olanzapine for 3 years
It is true though that mirt is more effective for sleep at lower doses a bit like quetiapine also works.Speak to your GP and tell them your main trigger for anxiety is sleep and you want to get that sorted 1st
http://www.crazymeds.us/pmwiki/pmwiki.php/Meds/Remeron

[sandie]

Thank you MrAndy. Do you think that perhaps tonight I should just take 7.5 and see how that works ?

[MrAndy]

15mg is what is usually used for sleep,Personnaly I wouldn't go up and down doses I would try and get stable on one dose and stick with it for a few months
Sleep will sort itself out in time,I know its frustrating believe me I've been there

[sandie]

Last night I took a 2mg diazapam with my mirtrazine, but it didn't help with the sleep. I do have some 1mg Loprazolam(NG Not L which my husband takes to counteract jet lag. I wonder if perhaps taking one of these with the Mirt might help?

Failing that, I also have some Phennergen tablets (which are an OTC sleep aid). Do you think the might be okay to take with the Mirtrazine ?

[MrAndy]

You need to speak to your GP about drugs interactions,remember sleeping tablets and benzos should only be used short term

[sandie]

Purely by chance a newly-retired GP friend, has just called me for a chat.

Her thoughts are that as the Mirt appeared to be working for the first couple of weeks and has only just bombed out, I may now need to up the dose to 30 mg. I spoke about perhaps upping to 22.5 and her opinion is that generally speaking it was only when a specific dose is working would you then think about altering the dose by small amounts, ie, downwards, until a person felt consistently 'normal'.

I am not due to see the GP until 16th November - another 9 days. I have just enough tablets to last until then, but my friend advised I have a telephone chat with the GP asap to update him on how I am feeling and the fact that my sleep is now back to almost non-existent again and see how he responds. She also feels that if I take 30 mg tonight and tomorrow and it definitely helps, then it will mean less of a potentially difficult week; her view is that the GP won't have a problem that I took the decision into my hands.

I have taken a diazapam to help with the increased anxiety today. In fairness, my use of these has been very sensible. I was prescribed 28 x 2 mg on 1st October. Here we are some, 38 days later, and I still have 8 and half tablets remaining.

Oh well, I shall have to middle through the rest of today as best as possible.