Mirtazapine 45mg &a seroquel XR 150mg, when do they work!

[Benjammin69]

As above really... been taken by mirtazapine 45mg for 3 weeks and seroquel 150mg for 8 days... I have noticed a rapid decrease in depression/suicidal thoughts are gone etc.. but my anxiety and ruminating thoughts are still quite high... when can I expect them to reduce? Anyone got any experiences to share?

Thanks

[Mermaid16]

I take Mirtazapine and found that it hasn't ever done anything for my anxiety. It did however lift my depression. I have been on Mirtazapine since July last year, mainly for sleep and depression. I take Olanzapine 2.5mg at night, it hasn't really helped my anxiety, but I have just last night increased the dose a little. I work, so can't afford to be sleepy in the morning. Today, so far has been better than yesterday anxiety wise. I also take Clonazepam but think my body is use to it now so it isn't really doing much. Once I stabalise I will start reducing it, but am still trying to find the right combination of meds so that it is possible.

[panic_down_under]

As above really... been taken by mirtazapine 45mg for 3 weeks and seroquel 150mg for 8 days... I have noticed a rapid decrease in depression/suicidal thoughts are gone etc..

That is probably down to the Seroquel (quetiapine).


but my anxiety and ruminating thoughts are still quite high... when can I expect them to reduce? Anyone got any experiences to share?

It can take a couple of months for mirtazapine to kick-in, but it is one of a number of meds which seem to work well for some, and not at all for most with anxiety (OTOH, it is one of the best meds for pulling the very severely depressed back from the brink). It can become fairly activating at high doses which while often a positive for depression can be a problem for many with anxiety.

[Benjammin69]

That is probably down to the Seroquel (quetiapine).



It can take a couple of months for mirtazapine to kick-in, but it is one of a number of meds which seem to work well for some, and not at all for most with anxiety (OTOH, it is one of the best meds for pulling the very severely depressed back from the brink). It can become fairly activating at high doses which while often a positive for depression can be a problem for many with anxiety.

Thanks for your reply as always :-)

I've been on mirtazapine (15,30,45) since august but only 3 weeks on 45mg mind you!

Also the quetiapine XR 150mg - is an increase too am on my 9th day of 150mg. To be fair my depression has subsided been t I'm left with this awful anxiety and constant panic. Gone and got myself some propranolol today to throw in to the mix to calm some Of the physical symptoms down :-)

I'm hoping that 45mg mirtazapine, 150mg quetiapine and 120mg propranolol will knock this depressive anxiety episode on its head quick!

[panic_down_under]

I've been on mirtazapine (15,30,45) since august but only 3 weeks on 45mg mind you!

Ah, okay. I would therefore expect a positive response fairly soon if it works.


I'm hoping that 45mg mirtazapine, 150mg quetiapine and 120mg propranolol will knock this depressive anxiety episode on its head quick!

That is a lot of medication for what sounds like moderate results. I'm a med minimalist. While multiple meds are sometimes needed, this is very much the exception, not the rule. This relatively recent idea of just throwing more and more meds into the mix hoping to strike some combination that works is nutz, imho.

And this is even more so with your med regime as none of these is what I consider a first or second line anxiety med, and two of them, mirtazapine and quetiapine, can trigger long-term problems. I'd be getting a second opinion, preferably from a psychiatrist.

[snowghost57]

I'm with Panic, that sounds like a lot of medication. I don't have a lot of experience with medication, I used them for 20 days and with CBT I am now anxiety free. I was on 25mg Zoloft. I understand that doctors try different types to see what works, but three different kind at the same time? I'm surprised your physician is prescribing over 300mg to "knock out" a depressive anxiety attack. I would get another opinion.

[Benjammin69]

I'm with Panic, that sounds like a lot of medication. I don't have a lot of experience with medication, I used them for 20 days and with CBT I am now anxiety free. I was on 25mg Zoloft. I understand that doctors try different types to see what works, but three different kind at the same time? I'm surprised your physician is prescribing over 300mg to "knock out" a depressive anxiety attack. I would get another opinion.

Hi thanks for your reply.

I agree with the meds - I have tried so many tho so I reckon they are lost with me they don't know what to prescribe - they describe my case as treatment resistant... nothing sedates me no lie. Seroquel, mirtazapine, diazepam, antihistamines the lot none of it works. I've tried various ssri's, pregabalin, benzos, the lot and nothing calms my anxiety down. My depression goes but leaves me with a high state of anxiety. I do have therapy weekly as well been going since October.. I also exercise... whilst I write this I'm at a kids party and my panic mode is stuck on 6 out of 10 so it's not at the highest that it could be but not that comfy either... grrrr. I'm hoping the seroquel will work more and more the more I take it. My hope is in the seroquel as I really don't believe the mirt will help anxiety at all if I'm honest.

Anything else I could be doing/considering?

[panic_down_under]

I've tried various ssri's, pregabalin, benzos, the lot and nothing calms my anxiety down.

...Anything else I could be doing/considering?

My first choice would be either sertraline or nortriptyline and if the chosen one didn't work on its own adding some of the other to create in individual SNRI. However, I understand UK GPs can't mix antidepressants so you'd need a psychiatrist to supervise this.

Therefore, clomipramine (Anafranil) would probably be your best option. It is arguably the most potent antidepressant made. And be prepared to go up to the maximum dose.

If clomipramine doesn't work, then the MAOI class antidepressant tranylcypromine (Parnate) should be considered. Your GP would likely have an attack of the vapours at the suggestion because of past food restriction issues. But modern food processing techniques have eliminated almost all the risks. Imho/e MAOIs are the most effective antidepressants ever made. Most of the old time psychiatrists with experience of all antidepressant classes I've asked have nominated tranylcypromine as the med they'd take if they needed an antidepressant with the others mostly picking clomipramine. Few mentioned a SSRI, or SNRI.