Chronic fatigue

[Bonnibelle]

I started Mirtazapine 7.5mg in May 2013 due to insomnia and because I weighed less than 84lbs. I had severe anxiety and agoraphobia after my brother attacked me 8 months previous. It helped and I felt much better until November 2013 when my extended family got intouch and hurled abuse at me which led to a huge anxiety setback. In December 2013 I went onto 15mg.

Again this dose helped me and I felt much better. I was out living life again and in March 2015 I was working out daily and in general really happy away from stress of my extended family violence.

In autumn 2015 I started with fatigue issues, my son was struggling due to bullies and by November he told us he was wanting to take his own life. My world fell apart. I had no support other than my husband but he couldn't take any time off work so I was coping alone with a very unwell son and my daughter had a bowel infection and then croup which caused 2 hospital admissions that winter. It led to me one day just collapsing with stress. I was bed bound for 2 weeks but still had no support and had to keep getting the children to school, taking care of my ill son and trying to get him support in school and with CAMHS. Horrific stress. My GP saw me twice in a month, did bloods and tests and said it was acute stress and he thought another trauma had re triggered my PTSD and anxiety.

My son had therapy from me and then later CAMHS when they finally saw him, and he is now the happiest child. I am so proud. I though have never bounced back. It was early last year that my fatigue just got so bad I then had a huge relapse with my anxiety and agoraphobia. I had agoraphobia after the attack but I overcame it, now it's worse than before as I can't attend appointments or take the children out alone. All due to how fatigued I am.

My GP has done many tests and nothing was found other than last spring an underactive thyroid which showed my TSH had been climbing since the January and by May it was high and I needed treatment. I am on thyroxine the last 11 months. I still have chronic fatigue issues so bad, daily I am exhausted to the point I struggle to do day to day chores, going out is hard and I'd say I get out twice a week for a walk or to a shop. It's led to severe social anxiety being this housebound and unwell.

Last year I had daily fatigue but also huge energy crashes similar to CFS/ME, where I'd wake in a crash. My legs feel weak, shaky, unable to walk around my house and i have to stay in bed on a crash day. I say a crash day is 10/10 on the fatigue scale, day to day it's a 7. Today for example is an 8 so I feel I could crash I feel that bad. I seem to crash usually after any contact from my extended family so my GP thought stress was a huge cause of my crash episodes.

On Saturday night I took Mirt late around midnight, I usually take it about 10pm. I woke feeling so ill at 7am the next day, I couldn't lift my head off the pillow and all day I felt in a drugged up daze. Today I feel the same despite taking it earlier. It has now made me concerned that Mirt is a huge reason I have chronic fatigue issues. I spoke to my friend and she doesn't think Mirt can cause that and as the first 2 years I just had the odd fatigue day, not a constant daily chronic fatigue, then it can't be mirt. I was always tired on it but no not to this degree, this is just the last 18 months.

I am just concerned as I have felt so ill since taking it late Saturday night. Can Mirt cause chronic fatigue? should I be concerned? I have been on it 4 years almost since starting 7.5mg but just over 3 years on the 15mg.

Sorry this got long, I just wanted to describe how I am feeling. I am desperate as I am 37 and just want to make memories with my children, not feel this drained daily and dreading the next crash.

B

[panic_down_under]

Can Mirt cause chronic fatigue?

Probably not, but it can cause fatigue. Mirtazapine is basically just a potent antihistamine so is often very sedating, especially at low doses.

I suspect your GP is right in believing your issues are stress related and it appears to be manifesting as depression which can seem a lot like chronic fatigue. In extreme cases people may become almost catatonic.

I think your best option is to take a real antidepressant, not what is mainly a sedative. The SSRIs citalopram (Celexa) and escitalopram (Lexapro) generally have the best side-effects profile, but sertraline (Zoloft) would also be a good choice. Also ask your GP to refer you for CBT.

[Bonnibelle]

Probably not, but it can cause fatigue. Mirtazapine is basically just a potent antihistamine so is often very sedating, especially at low doses.

I suspect your GP is right in believing your issues are stress related and it appears to be manifesting as depression which can seem a lot like chronic fatigue. In extreme cases people may become almost catatonic.

I think your best option is to take a real antidepressant, not what is mainly a sedative. The SSRIs citalopram (Celexa) and escitalopram (Lexapro) generally have the best side-effects profile, but sertraline (Zoloft) would also be a good choice. Also ask your GP to refer you for CBT.

Thank you for your reply

Unfortunately I cannot take SSRI meds as I have had 2 nasty reactions and the older ones effected my heart. I had little choice, hence the mirtazapine prescription.

I do wonder if depression plays a huge part as it's symptom of an underactive thyroid too. I just wasn't sure whether depression could cause such fatigue.

I was feeling less fatigued a few weeks ago when my mind was feeling less anxious and more positive.

I am having CBT currently.

Thank you.

B

[panic_down_under]

Unfortunately I cannot take SSRI meds as I have had 2 nasty reactions

What happened?


and the older ones effected my heart

How so? Do you have heart disease?

Also what other medications are you taking, including supplements, vitamins, etc.


I just wasn't sure whether depression could cause such fatigue.

People with severe depression can find it hard to summon the energy to get out of bed. In extreme cases they can become virtually catatonic.

[Bonnibelle]

What happened?



How so? Do you have heart disease?

Also what other medications are you taking, including supplements, vitamins, etc.



People with severe depression can find it hard to summon the energy to get out of bed. In extreme cases they can become virtually catatonic.

I had an allergic reaction to both.

Dothiepin caused chronic palpitations and one night I woke up at 4am with my heart rate so loud and fast we thought it was a boy racer driving past the house with loud music thudding in his car lol! I had to call 999 for the first time in my life so I was taken off it cold turkey and told never to touch the old school drugs again.

[panic_down_under]

I had an allergic reaction to both.

Which SSRIs did you take?


Dothiepin caused chronic palpitations and one night I woke up at 4am with my heart rate so loud and fast we thought it was a boy racer driving past the house with loud music thudding in his car lol! I had to call 999 for the first time in my life so I was taken off it cold turkey and told never to touch the old school drugs again.

That was bad advice on three counts. Firstly, dothiepin, aka dosulepin, is by far the most cardio-toxic antidepressant made and other meds should not be judged by it.

Secondly, palpitations are not just an issue with tricyclic class antidepressants (TCAs). All antidepressants may trigger them, including the SSRIs. They are a fairly common mirtazapine side-effect too.

Thirdly, the TCAs are not really a specific class of meds all having the same basic properties as is the case with SSRIs which all do much the same thing, so if one causes an adverse reaction it doesn't mean they all will.

The TCAs range from doxepin which is just a powerful antihistamine to serotonin reuptake inhibitors as effective as the SSRIs, through to arguably the most potent SNRI made, clomipramine, and to nortriptyline which has almost no affect on serotonin, but inhibits noradrenaline/norepinephrine reuptake. There is also a wide range of impacts on the heart ranging from potentially very severe with dothiepin/dosulepin to lofepramine (Lomont) which usually has no more impact on the cardiovascular system than the SSRIs do, and significantly less than the SSRI citalopram (Celexa).

Lofepramine may be worth a shot, as would the SNRIs milnacipran (Savella) and levomilnacipran (Fetzima) which are both stronger noradrenaline than serotonin reuptake inhibitors. Levomilnacipran is still in patent and thus expensive so I'm guessing the NHS probably hasn't approved it, but milnacipran has been around for quite a while. Their affect on the cardiovascular system is about the same as most SSRIs and less than citalopram.

[Bonnibelle]

I took Cipralex and Citalopram and had nasty reactions and was told never to try again.

Dothiepin i was on 10 years ago with no issues but this time I took it I had a heart arithmia, not just palps. Hence why I am not to touch it. I have tried Lofepramine, Colipramine and Amantryptaline and I had very low BP, sickness etc...

Trust me they tried a lot before deciding on the mirtazapine.

I would rather just come off them because I suffer from anxiety and it's something I'd rather deal with without medication. At the time I had PTSD and had been attacked. I am now out of any danger, I have health issues to deal with that causes me anxiety but I'd rather cope with that alone without meds because Mirt isn't helping that at all.