Pregabalin with mirtazapine?

[PixieP]

After some advice please!
I'm currently on day 10 of 30mg mirtazapine for GAD. Had a few good days but last 2 have been pretty tough again. I'm due to see my GP again in 10 days and just wondered what peoples' experiences of mirt combined with pregabalin are?
I've run the gamut of SSRIs and SNRIs so options are starting to get limited. Thinking of asking the GP to augment the mirt with preg. Anyone had any experience of these 2 together?

[panic_down_under]

I've run the gamut of SSRIs and SNRIs so options are starting to get limited.


Imho, the older tricyclic class antidepressants (TCAs), maybe even MAOIs, would be a better long-term bet than playing around with the mirtazapine+pregabalin combination. They are both very much third/fourth tier meds.

[Cherryade]

I take both. 15mgs of Mirt and 150mgs of Pregabalin. I feel better now than I have felt in years and years. Its a good combo for me. Was on 45mgs Mirt and cut down to 15mgs over a period of a year then added in the Pregabalin.

[SmilingAlbert]

There are quite a few here on both, including me. I think it is a good combination for promoting calm, and it seems to be safe in combination with no interactions that I know of.

While it is true that these items are down the list, they are on 'the list' for a reason: for folk who can't tolerate and/or respond to SSRIs etc. higher up the list.

[hanshan]

I take pregabalin and mirtazapine and the combination works very well for me - I wish it had been available years ago.

Part of the reason for "lists" is that older drugs higher up on the list are often much cheaper to prescribe, not better. It is only recently that generic pregabalin became available. Even if you don't take the generic, the competition limits the patent holder from charging as much as possible. Also, older drugs are more familiar to doctors, and they are more comfortable prescribing them than newer medications.

[PixieP]

Thanks for the replies. Out of interest what dosage of each meds are people on? I'm currently on 30mg mirt. 15mg helped for about 6 weeks and then the anxiety crept back. I've been on 30mg for just over 2 weeks and have had some good days but equally some pretty horrendous ones. Not sure I want to increase to 45mg of mirt if the GP suggests this next week so thinking the pregabalin might be a good option to augment my current dose. Did anyone have to "fight" to get this or were the doctors quite open in prescribing it?

[hanshan]

I take 45 mg mirtazapine and 600 mg pregabalin, which are the maximum doses, but many people are happy with less than that (body size and other factors, some of them genetic, will affect blood plasma concentration).

You could try 45 mg of mirtazapine, or suggest pregabalin. Even though pregabalin has been available since 2006, not all doctors are up to speed with prescribing it for anxiety, however.

However, the mirtazapine/pregabalin combination has worked well for me. I started on mirtazapine, and it wasn't fully effective, but once I added pregabalin, the background anxiety disappeared. It still doesn't fully eliminate anxiety related to stressful events, but it's normal to experience anxiety in those cases.

[akb]

Imho, the older tricyclic class antidepressants (TCAs), maybe even MAOIs, would be a better long-term bet than playing around with the mirtazapine+pregabalin combination. They are both very much third/fourth tier meds.

Nothing personal, but I found this comment unhelpful and inaccurate.

Did you have problems with these two medications?

I tried mirtazapine but the side effects were horrendous for me so had to trash after 3 days. With pregaba I had no side effects at all. As we all know, they all affect people differently.

akb

[braindead]

3 day trail is a bit poor , i take mirt at 15mg 45 mg made me suicidal but i didn't ditch it i dropped to 15mg and 150mg pregabalin , 5mg olanzapine and 6mg lorazepam my shrink nurse says what ever puts you in a safe place :wacko::wacko::wacko:

[PixieP]

I was on 30mg mirt for 2 weeks but after a few good days my symptoms just got worse again so last night I dropped back to 22.5mg. I am going to ask for Pregabalin when I see my GP this week as I have had this anxiety for 6 months now and it's not getting any better. I'm not even anxious about anything other than the way I feel! I have propranolol to take the edge off the physical symptoms but my mind just does not want to be calm. I really don't want to try more ADs as I've now been on 6 different ones and none has made any significant difference. I'm struggling to carry on with normal life right now so I hope the GP doesn't fob me off with another AD to try. I've had enough!

[hanshan]

Hi Pixie,

If you have tried six different ADs without success, that is a good reason to try pregabalin (and follows NHS guidelines). Good luck with your GP.

[akb]

Hi Hanshan

Following your good advice, I am much improved after increasing pregabalin back to 200 from 150.

Although I was surprised to hear that you still get the occasional surge of anxiety on such a high dose, I think the same applies to any medication. The occasional blip due to unsavoury external events is to be expected, but it rarely lasts a long time. We can just look at it as a temporary setback and try not to get too upset by it.

akb

[hanshan]

Hi Akb,

Thanks for your friendly comment. I'm willing to have some anxiety at times, just to know how nice it is when it is gone!

[PixieP]

Thank you all for posting about your experiences and providing much-needed support and advice. I don't ever expect to totally eradicate anxiety but it would be nice to experience it as part of a normal range of emotions again and not exist in the constant state of extreme agiation that I am at the moment! I'm seeing my GP tomorrow so fingers crossed she will be open to switching or augmenting meds as my current mirt alone is definitely not doing anything.