Mirtazapine poop out

[Benjammin69]

Hi all,

I'm hoping someone can help me. I have been taking mirtazapine for approx 6 months now because I had my first bout of major depression. I have been on 15,30 and 45mg. I'm currently taking 30mg and 100mh quetiapine ... my issue is I am getting signs and symptoms of my depression returning and I am so scared. Anyone have any advice on what to do to help myself? Should I go up to 45mg or wait it out and hope it's a blip.

Kind regards

Ben

[panic_down_under]

I have been on 15,30 and 45mg. I'm currently taking 30mg and 100mh quetiapine

Ben, was the quetiapine added because mirtazapine wasn't working even at 45mg, or was it prescribed earlier?


Should I go up to 45mg or wait it out and hope it's a blip

I'm not a fan of mirtazapine as it is by far the most poop-out prone antidepressant on the market too often failing within a few months, tends to cause large weight gains and it isn't that effective either. It's only saving grace is that it is relatively free of side-effects, but then so are M&Ms!

I think you would be better switching to a SSRI. Citalopram (Celexa) and escitalopram (Lexapro) are the two SSRIs with generally the best side-effects profile. They share the same active chemical so it wouldn't matter much which is chosen.Sertraline (Zoloft) would also be a good choice.

[Benjammin69]

Hi panic down under, the quetiapine was added due to anxiety not depression. The depression has been under control on all 3 dosages but the anxiety has been running wild but now I remember how evil the feeling of depression is it's making me think the mirt has pooped out, but not sure if blip and I'm over thinking it or is it a full blown relapse :-(

[panic_down_under]

Hi panic down under, the quetiapine was added due to anxiety not depression.

So instead of putting you on an effective antidepressant which could have controlled both anxiety and depression (they are both expressions of the same underlying biological deficit), your GP's answer was to prescribe an antipsychotic? :ohmy: Have the breakfast cereal makers been putting junior doctor kits in the packets again? :weep:


The depression has been under control on all 3 dosages but the anxiety has been running wild but now I remember how evil the feeling of depression is it's making me think the mirt has pooped out,

If the depression responded to even 15mg then I suspect the mirtazapine wasn't responsible, but the placebo effect, maybe extended by a fortuitous waning of the depression.

[Benjammin69]

OMG - so I downloaded an app called push doctor and they gave me a video conferencing appointment, they have said I'm showing signs of a relapse and issued me a prescription for citraprolam and signed me off for 4 weeks. Al in all cost me £50 but what a great service to be seen at 8.30am on a Sunday!

[panic_down_under]

what a great service to be seen at 8.30am on a Sunday!

Did they explain how to transition from mirtazapine to citalopram, are you still supposed to take the quetiapine and what starting dose was prescribed?

[Benjammin69]

They have given me 10mg of cit alongside the mirtazapine and quetiapine, he didn't say to change my medications. He just added it alongside it. Now shitting myself cause of start up side effects :-(

[panic_down_under]

Now shitting myself cause of start up side effects :-(

They shouldn't be as bad as when starting from a clean slate as mirtazapine will have prepared the way to some extent.

BTW-a not infrequent initial SSRI side-effect is diarrhoea (conversely constipation is also possible). If you do start literally "shitting" yourself, otc diarrhoea remedies containing loperamide should help.

[Benjammin69]

Yeah to be honest I took my first one yesterday and other than dry mouth and a dodgy belly (shitting me self lol) that was mainly it on the side effect front. Hopefully 10mg cit, 30 mirt and 100 quetiapine will stabilise my depression and anxiety.

[panic_down_under]

Hopefully 10mg cit, 30 mirt and 100 quetiapine will stabilise my depression and anxiety.

The plan should be to take at least 20mg citalopram and once it begins having a positive affect weaning off the mirtazapine and quetiapine.

[Benjammin69]

Panic down under are you a doctor lol as I just been to see my usual doctor and that is their plan. To reduce the quetiapine and slowly remove the mirtazapine whilst increasing the cit to 20mg they also booked me in for a blood test to check thyroid and wanted me to take some propranolol which I stupidly left the prescription in the doctors surgery! :doh:

[panic_down_under]

Panic down under are you a doctor

Nope. I'm now long retired, but my profession was the opposite of the healing arts.


lol as I just been to see my usual doctor and that is their plan.

Ah, great minds! :winks:


To reduce the quetiapine and slowly remove the mirtazapine whilst increasing the cit to 20mg they also booked me in for a blood test to check thyroid and wanted me to take some propranolol which I stupidly left the prescription in the doctors surgery! :doh:

Sounds like a good plan.

[Benjammin69]

I've stopped the quetiapine with little problem so far.. bit edgy when first wake up but that's as I'm used to taking 'something' so just getting in to a new routine really. Not been that bad except dodgy stomach and a bit of insomnia (early awakenings)