Anyone had success increacing?

[Dandan182]

Hi everybody. Just looking for some advice as I'm struggling with depression and anxiety. I was put on 20mg of citalopram a few years ago and it worked wonders for me. Then a few months ago it just seemed to poop out so I was upped to 30mg and still didn't help so my doctor prescribed me mirtazipine 15mg and then 30mg alongside the citalopram, drop the citalopram to 20mg, and keep taking the mirtazapine. after being on the 30mg of mirt for over a month my mental health just seemed to get really bad. My anxiety had reached an all time high and my depression is the worst its ever been. I'm really not coping. My doctor decided that I should come off the mirtazipine so I'm currently taking 15mg now and stopping them next week. I still feel terrible. The plan is to up my citalopram to 40mg once I'm off the mirt......... I've reached a point where I can't force myself to go out I've had to cancel having my son this weekend which has really upset me and I'm worried my partner is struggling with all of this now. She's very supportive but I can tell its taking a toll on her now.

Has anyone had any success in increasing a dose of antidepressant.?
Is it normal for mirtazapine to make me feel that bad if its not right for me?
Has anyone dealt with something similar? Thanks guys

[nomorepanic]

Hi

This is just a courtesy reply to let you know that your post was moved from its original place to a sub-forum that is more relevant to your issue.

This is nothing personal - it just enables us to keep posts about the same problems in the relevant forums so other members with any experience with the issues can find them more easily.

Please also read this post:

http://www.nomorepanic.co.uk/showthread.php?t=213239

[Aho]

Hello Dandan

Sorry to hear of your struggles with medication. It won't help you to know you're not the only one.

I'm speaking from experience here although not of the medications you're taking. Antidepressants do poop out, that's an unfortunate fact. Increasing the amount may help some people but in your case I'd say the citalopram is a waste of time. Mirtazapine can be taken with other antidepressants. It will be interesting to hear what others have to say but I think you need to change from citalopram. Escitalopram would be one alternative but I'm no expert, you need to discuss with your doctor. It's all trial and error right now. I am in the same position as you. Try and be patient and draw encouragement that there is an antidepressant out there that will work for you. Hope this helps.

[panic_down_under]

my doctor prescribed me mirtazipine 15mg and then 30mg alongside the citalopram, drop the citalopram to 20mg, and keep taking the mirtazapine. after being on the 30mg of mirt for over a month my mental health just seemed to get really bad.

Is it normal for mirtazapine to make me feel that bad if its not right for me?

I think the problem is that you're essentially unmedicated. The citalopram wasn't doing much at 30mg, so dropping the dose back to 20mg has ensured it is almost certainly not effective. Mirtazipine is a very effective antihistamine and sleep aid, but in the opinion of many, a poor antidepressant, although I understand the NHS is a fan for some reason.


Has anyone had any success in increasing a dose of antidepressant.?

If increasing the dose from 20mg to 30mg didn't work then upping it to 40mg seems like a long shot. Even if you get a response it may not last long given your history.

Alternatives to consider include supplementing the citalopram with buspirone (Buspar). There are many studies showing that it can rejuvenate pooped out SSRIs and generally increase their effectiveness. It also often reduces some of their typical side-effects.

However, my past experience is that many UK GPs don't know about this and sometimes baulk at prescribing an SSRI with buspirone because of a misplaced fear of triggering serotonin syndrome/toxicity (SS/ST). Buspirone can't induce it as it isn't a serotonin uptake blocker. I suspect that your doctor will be one of the unwilling prescribers given s/he reduced the citalopram dose before prescribing mirtazapine and now wants you off it completely before increasing the citalopram to 40mg, I'm guessing because of the mistaken belief that mirtazapine can trigger the syndrome when added to a SSRI.

Firstly, mirtazapine is, at best, only an extremely weak serotonin reuptake inhibitor so can't increase SS/ST risk by addition to any significant degree. But more importantly, mirtazapine is a moderate serotonin 5-HT2a receptor antagonist, i.e. it blocks that receptor. The recommended treatments (http://www.psychotropical.com/treatment-of-serotonin-toxicity) for serotonin syndrome are the potent 5-HT2a receptor antagonists cyproheptadine and chlorpromazine. 5-HT2a antagonists prevent the body temperature spike which does the damage in SS/ST.

The other option would be to switch to another antidepressant, either a SSRI, with sertraline being my pick, or a SNRI, or TCA. Personally, I'd pick a TCA.

[Scarra]

Anyone struggling with mirtazapine dosage , any advice would be much appreciated ����

[panic_down_under]

What is the problem, Scarra?