View Full Version : Citalopram to mirtazapine
Hi all, new to the site so hope this is the correct place to post... Anyway, about a month ago I moved from 40mg citalopram (which I'd been on for many years) to 15mg mirtazapine to treat my ongoing anxiety problems. I changed as, frankly, the citalopram was doing nothing for me and was suffering badly from anxiety and depression. I withdrew from the citalopram over a two-week period, as directed by my gp. The first thing I noticed when I quit the Citalopram and started the Mirtazapine was the fact that in the mornings I could barely get out of bed I was so exhausted (previously I was always an easy early riser). As the weeks have passed this has not changed; in fact it's worse. Some days it takes me most of the day to gain any energy. Also, over the last days I am struggling to stay asleep and having very weird dreams (more like visions actually). Moreover, my limbs are heavy and I have a general lassitude and weariness. To top it all I am having profoundly depressed - almost suicidal -periods, And spikes of deep anxiety. Yet I also have moments of hope, and the stomach problems I had for years have virtually gone. Can anyone offer any insight? Are these symptoms normal at this stage? Is it Citalopram withdrawal perhaps? Is it worth persisting with this regime? Any help is much appreciated
Certainly sounds like the swap to mirt has been difficult, especially since you say you were on max dose of cit and for a long period. I think it might be time to increase mirt, as at higher doses it is more activating, and this appears to be what you need right now. Speak to your GP: you can go up to max dose of 45mg if need be over a period of 4-6 weeks.
All the best and welcome to NMP.
i would have thought your doc would have swapped to another SSRI then you wouldn't have to detox you could just swap overnight. Unless you tried all the rest. mirtazapine at 15mg make you sleepy for about 2 days so it interacting with your detox, that why i cannot understand your DOC another SSRI was always favorite after so long on one already :wacko::wacko::wacko:
My daughter was on Sertraline for a couple of years and it stopped working. She had to go through three meds, including all the cross taper side effects until they found one that's working for her. It was a bit rough on her but in the end she's doing great.
Hang in there, it does get better. One thing to ask your doctor about is a chill pill to help in the mean time until thinks settle down again.
Positive thoughts
MyNameIsTerry
15-09-17, 03:07
Hi and welcome to NMP :welcome:
Mirt at low dose is used to help with insomnia. This is because the med has antihistamine effects that disappear once the dose is raised and the serotogenic effects come into play.
I'm confused why your GP has left you on this dose to be honest.
https://bnf.nice.org.uk/drug/mirtazapine.html#directionsForAdministration
For Adult
Initially 15–30 mg daily for 2–4 weeks, dose to be taken at bedtime, then adjusted according to response to up to 45 mg once daily, alternatively up to 45 mg daily in 2 divided doses.
He should be pushing you up by now, if starting you on that dose at all. Perhaps he wanted to start low due to the possibility of side effects? GP's are getting more cautious due to the struggle many of us have getting onto antidepressants.
TERRY If your daughter was on sertraline, she could if the doc was wired up , staight taper overnight no side effects to ESCITALOPRAM, PAXIL, PROZAC.CITALOPRAM ////ALL SSRI. so no need to wash out, just straight taper overnight to the equivalent dose of ssri she ,was on and away you go.What med did she finish up on terry:shrug:
---------- Post added at 10:06 ---------- Previous post was at 09:58 ----------
THE doc would put you on mirt so you could get some sleep and start to eat well , i dont no why you have all the hassle its usually a cool med for a short time, the use mirtazapine more in combos , my sister is on mirtazapine her first ever med at 73 year old, she is on just 15mg and it got her out a big big hole, it took mt 3 months to persuade her to take an AD now she is fine, she may go to 30mg but her age keeps the mgs down :wacko:
TERRY If your daughter was on sertraline,
Terry certainly has his followers but not sure about daughters :roflmao:
You'll scare the poop out of newbies with that green-eyed monster avatar :scared15:
terry certainly has his followers but not sure about daughters :roflmao:
You'll scare the poop out of newbies with that green-eyed monster avatar :scared15:
toxic boy in graveyard HE IS CARRYING A BIT OF RADIATION
---------- Post added at 18:07 ---------- Previous post was at 17:59 ----------
Terry certainly has his followers but not sure about daughters :roflmao:
You'll scare the poop out of newbies with that green-eyed monster avatar :scared15:
http://www.nomorepanic.co.uk/attachment.php?attachmentid=3188&stc=1&d=1505495129 HEAR IS TOXIC BOY
toxic boy in graveyard HE IS CARRYING A BIT OF RADIATION
Perhaps N Korea would be interested in hiring him :wacko:
Perhaps N Korea would be interested in hiring him :wacko::sofa:
---------- Post added at 09:50 ---------- Previous post was at 09:28 ----------
IN England if you see a gp about mental illness 9 time out of 10 he will start you of sertraline or citalopram because the are told to in the NHS bible ,If those 2 dont work he will proceed to try 2 more ssris. If still no go then its EFFEXOR a NSRI , Thats just the way the GPs have been programmed they may put you on a waiting list to see a shrink, nurse who if thinks bad enough will put you on the shrink 2 year waiting list , THERE is nearly always an ssri that works at you first breakdown its only years later they fail you not just 1 but the hole lot . i bounced from sertraline to escitalopram for years when 1 failed i overnight tapered and away we went. Then these 2 pooped out , and i started the med go round , 8 meds in 14 month :wacko::wacko::wacko:
A lot of GPs will put you on mirt after an SSRI poops out, especially if the patient has sleeping and eating problems too.
A lot of GPs will put you on mirt after an SSRI poops out, especially if the patient has sleeping and eating problems too. VERY TRUE , Its not a med that seems to last long , when i was on pregabalin and getting nowhere the shrink comboed me with mirtazapine, i slept the first morning till 12 am then back to normal 4am after that. He raised me to 30mg for some time all for nothing. i had to taper off pregabalin has it was has good to me has rocking horse shit , that left me with mirtazapine and i was slipping into hell. I had to be dragged out with olanzapine a last resort if ever there was, if your given antipsychotic meds and you no your ill. I am off mirtazapine now and nearly off olanzapine. leaving me on Cymbalta and lorazepam:wacko:
Do meds always stop working after a period of time? This concerns me because I've been on Citalopram 20mg for 17 months now and I'd consider myself 95% better than I was before starting them. I'd never had anxiety or depression before my first incident (which happened at the end of 2015 when I was 54 years old. I'm terrified now that they are going to stop working and I'll be plunged back into that awful abyss. I'd rather be dead than go back there....
Do meds always stop working after a period of time? This concerns me because I've been on Citalopram 20mg for 17 months now and I'd consider myself 95% better than I was before starting them. I'd never had anxiety or depression before my first incident (which happened at the end of 2015 when I was 54 years old. I'm terrified now that they are going to stop working and I'll be plunged back into that awful abyss. I'd rather be dead than go back there....
YOU COULD GO ON FOREVER ON CITALOPRAM:yesyes: if not its in a group of meds that will be easy to swap to , at your age and your first bout of mental illness you have a great success rate on any ssri DONT WORRY your fine.:shades:
Oh thank you! I think mine was related to the menopause too and I'm also on HRT now so fingers crossed :yesyes:
Is that true that you can just switch over from one SSRI to another without any changing or tapering. I never knew that. Can you give me some more information on it.
Thanks
Jo
MyNameIsTerry
16-09-17, 19:18
Is that true that you can just switch over from one SSRI to another without any changing or tapering. I never knew that. Can you give me some more information on it.
Thanks
Jo
Not quite, there are some extra considerations:
http://www.gpnotebook.co.uk/simplepage.cfm?ID=1651179592
Going from a high dose of one to a low dose of another may mean tapering down unless you want to feel withdrawal. The doctor can try to match the new med dose but slamming you straight onto that means the side effects of the new med can be much worse for obvious reasons so they will build you up to a matched dose.
Since SSRI's also vary in their impact on adrenaline it's not as simple as saying they all work the same. Therefore testing how the patient responds is important. They also vary in how they act on liver enzymes. Some people can tolerate one and not another.
When toy consider this you can see how slamming someone from one high dose to another has a potential for a very unpleasant failure.
Going from the lowest therapeutic dose is where switching is much simpler. A stop-start or cross-taper is much easier to manage. They still may do some tapering of doses but it's much quicker and the drugs are impacting us at similar levels so it smoothes out as one drug leaves & another enters since drugs don't go through a 50% elimination reduction per half life. Because half lives differ you can have one drug eliminating quicker or slower than the new one is getting in.
Which brings me to Fluoxetine. It's half life is so long that it builds up far slower than the others. This means it's usually less harsh to get onto. It also means it takes a lot longer to start working.
Switching from Fluoxetine is the only exception in how they do it because it's half life is so long that any new med introduced will quickly build up on top of it giving you two meds at once. To combat this they use a "washout period" of a week where got stop taking it altogether. That week allows for a far chunk of the drug to be eliminated and when introducing the new med it won't build up on top of much of what's left as the half life of the other SSRI's means they take around a week to reach their steady-state in your blood plasma.
Obviously if you are on a higher dose of Fluoxetine you may need to taper down first. But with some of the drug still in you for the month it takes to be eliminated, the switch might be smoother as the new drug is being propped up for longer so there is more time to settle you in before trying to increase til a matched dose.
AN AMERICAN DEFUNK FORUM PYHCO BABBLE . learned me how to taper SSRIS without any problems, why to wash out and put yourself through hell then hell starting up a new SSRI hell again , Take SERTRALINE when i was on 100mg i would change overnight with my GP blessing to the equivalent ESCITALOPRAM ie Lexapro 10MG the med then crossed the blood-brain barrier together 1 going in and 1 coming out. WITH that particular tapper i have felt better even on the next day with NO yes NO side effects, another would be 20mg citalopram to 10mg escitalopram its younger brother and superior med , more money of course. I am not telling anyone else to try this is just what me and half America do. Some doctors follow the nhs bible that stopping the sssri med your on slowly to nil. then starting up another ssri when washed out taking about 10 week that is if the new med works,. Different classes of meds the best you can do is GROSS TAPPER thats add a low dose of a new med to you existing med then over time raise you new med while lowing you old. THE ARE some meds that need a complete wash out ocourse, my main thread is SSRIs :wacko::winks:
Not quite, there are some extra considerations:
http://www.gpnotebook.co.uk/simplepage.cfm?ID=1651179592
Going from a high dose of one to a low dose of another may mean tapering down unless you want to feel withdrawal. The doctor can try to match the new med dose but slamming you straight onto that means the side effects of the new med can be much worse for obvious reasons so they will build you up to a matched dose.
Since SSRI's also vary in their impact on adrenaline it's not as simple as saying they all work the same. Therefore testing how the patient responds is important. They also vary in how they act on liver enzymes. Some people can tolerate one and not another.
When toy consider this you can see how slamming someone from one high dose to another has a potential for a very unpleasant failure.
Going from the lowest therapeutic dose is where switching is much simpler. A stop-start or cross-taper is much easier to manage. They still may do some tapering of doses but it's much quicker and the drugs are impacting us at similar levels so it smoothes out as one drug leaves & another enters since drugs don't go through a 50% elimination reduction per half life. Because half lives differ you can have one drug eliminating quicker or slower than the new one is getting in.
Which brings me to Fluoxetine. It's half life is so long that it builds up far slower than the others. This means it's usually less harsh to get onto. It also means it takes a lot longer to start working.
Switching from Fluoxetine is the only exception in how they do it because it's half life is so long that any new med introduced will quickly build up on top of it giving you two meds at once. To combat this they use a "washout period" of a week where got stop taking it altogether. That week allows for a far chunk of the drug to be eliminated and when introducing the new med it won't build up on top of much of what's left as the half life of the other SSRI's means they take around a week to reach their steady-state in your blood plasma.
Obviously if you are on a higher dose of Fluoxetine you may need to taper down first. But with some of the drug still in you for the month it takes to be eliminated, the switch might be smoother as the new drug is being propped up for longer so there is more time to settle you in before trying to increase til a matched dose.
TERRY is all this research from manuals and the NHS bible. I am talking breaking the mold of 70tis style med taken. All my med changes have been done by real people and me who experiment with our bodies to pass on to other people that need help faster than 10 week change over if your lucky . Have a few week in mental hospital all reason flies out the window the will have you on 375mg Effexor in 2 weeks 1 law for them and 1 for us.they carnt afford to have you sitting round hospital washing out meds and starting low doses in the ZOO :wacko::wacko::wacko:
MyNameIsTerry
17-09-17, 18:30
TERRY is all this research from manuals and the NHS bible. I am talking breaking the mold of 70tis style med taken. All my med changes have been done by real people and me who experiment with our bodies to pass on to other people that need help faster than 10 week change over if your lucky . Have a few week in mental hospital all reason flies out the window the will have you on 375mg Effexor in 2 weeks 1 law for them and 1 for us.they carnt afford to have you sitting round hospital washing out meds and starting low doses in the ZOO :wacko::wacko::wacko:
No, it's my understanding of meds. Only that link is from doctors.
I believe your average GP doesn't have a clue about pharmacokinetics and from things I've seem some do on the Meds board it only backs up my belief.
Even if you are doing fine, they want to ramp up the dose because they are told too. In many physical issues they wouldn't do that, they would be listening to the patient.
I agree with you about dose ramping. They are used to throwing meds at you that start to work quickly and don't want to spend months tapering while the patient is struggling.
I started on 20mg Citalopram as my first med. Two days later I was under the Crisis Team not knowing what was wrong with me. If I had been started at 10mg I wouldn't have been so drastic.
No, it's my understanding of meds. Only that link is from doctors.
I believe your average GP doesn't have a clue about pharmacokinetics and from things I've seem some do on the Meds board it only backs up my belief.
Even if you are doing fine, they want to ramp up the dose because they are told too. In many physical issues they wouldn't do that, they would be listening to the patient.
I agree with you about dose ramping. They are used to throwing meds at you that start to work quickly and don't want to spend months tapering while the patient is struggling.
I started on 20mg Citalopram as my first med. Two days later I was under the Crisis Team not knowing what was wrong with me. If I had been started at 10mg I wouldn't have been so drastic.
I to was started on 20mg Citalopram Terry years ago , my wife was in tears i was picking fights for no reason with her i came straight off. 20 years on they still tried me again on citalopram made me worse, they never think to look at your old notes, i was way out in the planets has a space cadet at the time i didnt no what i was getting, but i had a light bulb moment and went ape shit at the shrink :wacko:
MyNameIsTerry
18-09-17, 14:58
I to was started on 20mg Citalopram Terry years ago , my wife was in tears i was picking fights for no reason with her i came straight off. 20 years on they still tried me again on citalopram made me worse, they never think to look at your old notes, i was way out in the planets has a space cadet at the time i didnt no what i was getting, but i had a light bulb moment and went ape shit at the shrink :wacko:
I had never felt depression until those first days, Brian. I was new to anxiety back then and my GP just didn't prepare me for how the side effects could be.
Years later when I relapsed I ignored him when he trotted our the same BS about side effects and prepared myself for a tough few weeks. I didn't ask for help because I knew there wasn't much so if I couldn't make through to the other side it was worth trying since any of the others might have meant the same rough ride.
I think it's good to learn from others in places like this. I always believed my GP back then but listening to people on here might have saved me a couple of very tough years where this med turned me into someone far more anxious than when I went to my GP.
RandomGeeza
18-09-17, 20:27
Hi all, new to the site so hope this is the correct place to post... Anyway, about a month ago I moved from 40mg citalopram (which I'd been on for many years) to 15mg mirtazapine to treat my ongoing anxiety problems. I changed as, frankly, the citalopram was doing nothing for me and was suffering badly from anxiety and depression. I withdrew from the citalopram over a two-week period, as directed by my gp. The first thing I noticed when I quit the Citalopram and started the Mirtazapine was the fact that in the mornings I could barely get out of bed I was so exhausted (previously I was always an easy early riser). As the weeks have passed this has not changed; in fact it's worse. Some days it takes me most of the day to gain any energy. Also, over the last days I am struggling to stay asleep and having very weird dreams (more like visions actually). Moreover, my limbs are heavy and I have a general lassitude and weariness. To top it all I am having profoundly depressed - almost suicidal -periods, And spikes of deep anxiety. Yet I also have moments of hope, and the stomach problems I had for years have virtually gone. Can anyone offer any insight? Are these symptoms normal at this stage? Is it Citalopram withdrawal perhaps? Is it worth persisting with this regime? Any help is much appreciated
Long term Mirt user here: What you describe is exactly how it is at first. I'm surprised that you haven't commented about hunger and carb cravings... if they haven't caught you up then they will.
I take 45mg a day, split over a single morning dose (15mg) and then 2 at night just as I get into bed (2x15mg). The dreams and sleepiness are to be expected given the histamine profile of Mirt. Personally, I love the dreams and being a terrible sleeper I also enjoy the chilled, sleepy feelings I get on these. If you get up in the morning and fight it a little, the grogginess soon lifts. You have to work them a bit.
I found 15 worked for a few months but then pooped out. They upped me to 30, that did nothing so within a few weeks it was upped again to 45. And I have been here ever since. TBH, it has taken almost 12 months to stabilise my anxiety. And to find my rhythm with them, finally. But as it is, I would encourage you to do what you feel is best. You are still early doors and given how long it has taken me, you might have a little further to go, before you exhaust this option.
Long term Mirt user here: What you describe is exactly how it is at first. I'm surprised that you haven't commented about hunger and carb cravings... if they haven't caught you up then they will.
I take 45mg a day, split over a single morning dose (15mg) and then 2 at night just as I get into bed (2x15mg). The dreams and sleepiness are to be expected given the histamine profile of Mirt. Personally, I love the dreams and being a terrible sleeper I also enjoy the chilled, sleepy feelings I get on these. If you get up in the morning and fight it a little, the grogginess soon lifts. You have to work them a bit.
I found 15 worked for a few months but then pooped out. They upped me to 30, that did nothing so within a few weeks it was upped again to 45. And I have been here ever since. TBH, it has taken almost 12 months to stabilise my anxiety. And to find my rhythm with them, finally. But as it is, I would encourage you to do what you feel is best. You are still early doors and given how long it has taken me, you might have a little further to go, before you exhaust this option.
WE DONT TALK ABOUT WEIGHT GAIN, because its been cover many times, thats why i and many others dont take mirtazapine long term. The weight it puts on you is depressing in itself , BUT YOU SEEM OK :yesyes:
RandomGeeza
19-09-17, 09:41
WE DONT TALK ABOUT WEIGHT GAIN, because its been cover many times, thats why i and many others dont take mirtazapine long term. The weight it puts on you is depressing in itself , BUT YOU SEEM OK :yesyes:
Hmmm... not particularly. At first I wasn't aware of the weight gain potential, and over the first months it wasn't an issue. However, as my dosage increased so did my appetite. And my waistline. And yes, my anxiety over this new worry.
For the last five months and with my Dr's awareness I follow a strict eating regimen and I stay active. No simple carbs, sugars or sweet foods. I eat greens, veggies and wholewheat foods. TBH, I actually enjoy what I am eating nowadays and can attest that it is the healthiest I have eaten in my entire life. And I have actually lost almost a stone (14lbs). The same stone of weight that I put on.
So, with control and an awareness to the weight issues Mirt can induce. I am managing the potential weight caveat of Mirt.
I haven't swapped over to an SSRI for fear of a relapse, reintroduction of side effects and the unknown. I did read somewhere that if an AD works for you, it's best to stick with it.
Hmmm... not particularly. At first I wasn't aware of the weight gain potential, and over the first months it wasn't an issue. However, as my dosage increased so did my appetite. And my waistline. And yes, my anxiety over this new worry.
For the last five months and with my Dr's awareness I follow a strict eating regimen and I stay active. No simple carbs, sugars or sweet foods. I eat greens, veggies and wholewheat foods. TBH, I actually enjoy what I am eating nowadays and can attest that it is the healthiest I have eaten in my entire life. And I have actually lost almost a stone (14lbs). The same stone of weight that I put on.
So, with control and an awareness to the weight issues Mirt can induce. I am managing the potential weight caveat of Mirt.
I haven't swapped over to an SSRI for fear of a relapse, reintroduction of side effects and the unknown. I did read somewhere that if an AD works for you, it's best to stick with it.
Your diet would not suit me . i have near on given up drinking you wont take my fish and chips:wacko:
RandomGeeza
19-09-17, 14:13
Your diet would not suit me . i have near on given up drinking you wont take my fish and chips:wacko:
LOL. I don't drink either... Again because of the Mirt. For me it seems to heighten the effects of alcohol, almost doubling its strength. It makes for a cheap night, but I become very maudlin on it... so best to steer clear.
As for fish and chips... once in a while is OK, just not every night. ;)
And I did not know of Mirt's use with eating disorders etc. And had I have been made aware when first prescribed, I would have steered clear. However, I was in to deep to change when the weight issue became apparent, and as mentioned earlier, things had settled mentally. I felt it best to continue with the treatment. It was that or take my chances with SSRI's which carry a higher potential for insomnia and stimulation. Both things I needed to avoid.
LOL. I don't drink either... Again because of the Mirt. For me it seems to heighten the effects of alcohol, almost doubling its strength. It makes for a cheap night, but I become very maudlin on it... so best to steer clear.
As for fish and chips... once in a while is OK, just not every night. ;)
And I did not know of Mirt's use with eating disorders etc. And had I have been made aware when first prescribed, I would have steered clear. However, I was in to deep to change when the weight issue became apparent, and as mentioned earlier, things had settled mentally. I felt it best to continue with the treatment. It was that or take my chances with SSRI's which carry a higher potential for insomnia and stimulation. Both things I needed to avoid.
I have actually been on mirtazapine twice , first time i went up a jean size every 2 weeks you only have to look at the box and you put on weight.: wacko: 2nd time not to long ago so i could get some sleep in a combo med set up , didnt do it for me and was a bleeder to come off. and yes i no anorexics are given mirt . i am coming of olanzapine that is 3 times worse but saves your life in a crisis
RandomGeeza
19-09-17, 17:59
I have actually been on mirtazapine twice , first time i went up a jean size every 2 weeks you only have to look at the box and you put on weight.: wacko: 2nd time not to long ago so i could get some sleep in a combo med set up , didnt do it for me and was a bleeder to come off. and yes i no anorexics are given mirt . i am coming of olanzapine that is 3 times worse but saves your life in a crisis
Yes I know the feeling of just walking past a biscuit and ballooooooooooning!!!! Even on my diet I still bloat a lot, with water... which can be very uncomfortable.
Other than, it's not tooooooo bad. I would rather it be this way than debilitating anxiety and depression.
MyNameIsTerry
19-09-17, 18:16
Yeah, it turns you into Pac Man :biggrin:
They even use it to treat cats & dogs to get them to eat. So, perhaps if you can't walk past a dog biscuit either...:winks::woof
Yes I know the feeling of just walking past a biscuit and ballooooooooooning!!!! Even on my diet I still bloat a lot, with water... which can be very uncomfortable.
Other than, it's not tooooooo bad. I would rather it be this way than debilitating anxiety and depression. I would have to agree with you there buddy,:hugs: bbbbut, I no Olanzapine helps me but i cannot stand how fast the weight gain is it doesn't matter if i just ate snow i would still be a very fat snowman with type 2 diabetes i am down to half tab 1.25mg ,:wacko:
RandomGeeza
21-09-17, 15:53
I would have to agree with you there buddy,:hugs: bbbbut, I no Olanzapine helps me but i cannot stand how fast the weight gain is it doesn't matter if i just ate snow i would still be a very fat snowman with type 2 diabetes i am down to half tab 1.25mg ,:wacko:
My mental health nurse mentioned that anti-pysch med and the guaranteed weight gain on them and said I should count myself lucky as to have not been prescribed them. Such helpful professionals in the NHS..??..!!
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