Do the initial side effects of Mirtazapine go away?

[Gilla999]

Just over 3 weeks ago I had a severe bout of insomnia which triggered quite a steep decline in my mental health (I literally didn't sleep for 2 weeks). After about 2-3 days of being treated with Zopiclone and Diazepam I wasn't getting any better - it felt like my brain chemistry had got all out of whack and all I could do from lunchtime onwards was uncontrollably shake and cry, with feelings of severe exhaustion still overwhelming me. It was like the fight or flight mode in my brain couldn't switch off.

Four days ago I started taking Mirtazapine as prescribed by my psych. Since then there I have to logically say there have been improvements - I am no longer shaking or crying uncontrollably and I am back within my own mind again. However I am really struggling with the side effects of the Mirt and I'm desperately hoping that they dissipate over time, and I'm looking to hear from anyone who has experience of this.

I take 15mg at about 8pm - the first 3 nights it made me drowsy, last night it did not. This is partly due to a rapid and irregular heartbeat that has started, which I've had previously when increasing or being put on any kind of SSRI (it eventually faded after a couple of months). Either way, I do eventually drift off but contrary to what I've read from other people, I don't feel like I get a restful night of sleep. It feels like I spend 95% of my time in what I can only describe as "wakeful dreams" where I'm sort of half aware I'm not asleep, but dreaming at the same time. The next day I feel like I've been hit by a brick. Groggy and very tired and a real derealisation problem when I go outside. This seems to eventually clear at around 4pm, and I have 4 hours of feeling more in my own mind before I need to take the Mirt again.

Do the initial side effects like the crazy drowsiness for most of the day get any better? I should add that I'm not drowsy that I can nap during the day either, so it's literally just feeling very tired and drowsy and rubbish for most of the day.

I am loathe to already ask to switch as I know these things take time for your body to adjust to... I'm just interested to hear from other people and whether their initial side effects did improve or not?

Thank you x

[panic_down_under]

Four days ago I started taking Mirtazapine as prescribed by my psych.

Is this the only med you've been prescribed, and do you only take 15mg just once per day at around 8pm? If it is the only med then how is what seems like full blown anxiety being treated?

Like most antihistamines, mirtazapine is usually a pretty good sleep aid, but not everyone gets the benefit. If your doctor okays it you could try lowering the dose. The sedative properties diminish as the dose is increased. If that doesn't help then maybe low doses of the antidepressant trazodone may. At doses below 150-200mg it too acts only as a very sedating antihistamine. It has a much shorter half-life than mirtazapine so you're less likely to experience sedation 'hangover' in the morning.

[Maca44]

At startup I was out of it for the first week but the groggy feeling does fade so you do need to give it time so 12 weeks is about the time it took for it to settle with me but the groggy feeling passed after the first week.

[Gilla999]

Thank you Maca - this is really helpful to know. 12 weeks seems like a million years away but my previous experience with Sertraline does tell me it takes time for your body to adjust, so I'm just praying that it is also the case with Mirtazapine.

Frustratingly last night it did not help me to sleep. This is possibly because I decided to take it earlier (7pm) in order to try and get over the grogginess a little earlier today. Clearly a mistake as it didn't make me sleep and I ended up taking melatonin, diazepam and phenergen on top, none of which worked. Eventually I took another 15mg Mirt at 2am and that did the trick for about 5 hours. Obviously felt exhausted and terrible all day today :(

panic_down_under - I have also been prescribed 5mg of Escitalopram but at the moment I am only taking half a tablet (2.5mg) in the morning as I always find the side effects of starting an SSRI very strong at first (I previously used to take Sertraline) so I'm trying to taper myself 'up' to the 5mg dose. As it is, I feel that 2.5mg kick in at around 5pm and give me initial SSRI side effects I get of a racing/irregular heartbeat and a kind of manic, fake happy feeling. (As I mentioned, I know from previous experience of Sertraline that this does eventually pass/settle down). And you are 100% correct - it is full blown anxiety, panic, phobia - I'm not sure it fits perfectly into any of the boxes, but it is definitely anxiety based.

Do you think this combination of Escitalopram/Lexapro and Mirtazapine sounds like a reasonable one to try? (I know there are no one-size-fits-all answers). I am also practicing daily mindfulness and trying to be patient. It's just very hard when you consistently feel so very horrible - every hour feels like a day.

I really appreciate all your feedback and experiences!

[panic_down_under]

initial SSRI side effects I get of a racing/irregular heartbeat and a kind of manic, fake happy feeling.

I just got the mania with every SSRI I tried without the happy feeling, fake or otherwise. :sad:


Do you think this combination of Escitalopram/Lexapro and Mirtazapine sounds like a reasonable one to try? (I know there are no one-size-fits-all answers).

There is a good chance it will work, but the only way of knowing is by trying it. Unfortunately, despite claims being made about DNA and other tests, there is still no reliable way of determining the best med beforehand. Whoever cracks that code, if it is in fact crackable, will make a fortune.

[Maca44]

Yes I know its frustrating but honestly its worth the wait for Mirt to kick in. I would say that its best to stick at the dose and time you take it, I take my 30mg at 9pm but its no guarantee of sleep. I found the worse thing to do is get into a panic and mess with the dose but I also know that its not that easy when you feel crap, you just want it to stop.

I hope this helps

[Gilla999]

panic_down_under - that mania is a horrible feeling :( The only way I could ride it out was to start on a half dose. And yes you're right on the determining the best med. I think I just need to have patience but it is so hard when you are feeling SO shit all day and every hour feels like a month.

Maca I really appreciate the reassurance on the Mirt side effects and I also agree that messing about with the dosage or the time in a panic is the worst idea. I think my body doesn't know if it's coming or going at the moment. Hopefully things will improve in a few weeks.

Thanks again for your replies x

[Maca44]

People who care about me always say, it will pass, its been worse than this, but as you know when your in the middle of it those words don't help because we feel it is the worst and feel it will never go. I know it does pass it always does but I do know how horrible it is and how blinkered we are when in it.

Hope you get comfort soon.

[Gilla999]

Maca you have described it so perfectly. When you're in the depths of it there is nothing, literally nothing, that will help. All I have learned to cling on to is "today is just a day". Sometimes just getting through the day is all you can do. Sometimes even just the hour. I've discovered the human being (thankfully) has a very strong will not to cease to exist, even it its darkest moments. And so we go on. And then it gets a little better after a few hours, or a day, or two days . And I try to just enjoy those moments and remember that everything comes and everything goes.

Thanks for the good wishes, sending lots of them back at you x

[Maca44]

Yes even an half hour of feeling ok is still feeling ok. When I started Mirt I was like you but it does fall into place and you suddenly find a day was ok and your kind of surprised, if that makes sence.

[Sober2000june]

Hi Guys, I was put on Mirt in feb 8th after giving Prozac 3 weeks. anyway I saw a private shrink who id seen in past. and she said Prozac wouldn't have been her 1st choice for me, so she gave me the mirt and the 1st night I slept 11 hrs. we had to drive to England the next day and afet 2 lots of diaz I was quite upbeat and enjoyed 4 days in a log fired cottage. bearing in mind the day before I was in the priory thinking not being here any more. anyway the 1st 11 days I slept like a baby. then I would wake bolt upright out of dreams at 4.30 every morning my councellor told me to use the diazepam I was given. but I felt it was lowering my mood. anyhow I started taking and actually had a few days where I felt positive. a bit manic at times. however I had an argument with my wife the same night I had a great evening in wasn't sure if I took 7.5 or 22.5 mg. so next day not good and the following. then I suggested to my counsellor who was liaising with private consultant could I drop it to 7.5 to see if it would help. anyway that just meant the next 2 weeks going down and back upto 15mg and wanting not to be here again bottom line is I only stuck 15 mg for 3weeks consistently. so te private shrink said no med will work im frightened of them. I ended up seeing another nhs shrink through crisis team. she suggested proxotine. I have stuck it fr 12 weeks 10upto 20m nd back down again. the est I eer got was mnic nd insane on it.
Macaho long didi ti takethe mirtto settle for you?

Kind regards

[panic_down_under]

so te private shrink said no med will work im frightened of them

They won't if you don't take them consistently at a therapeutic dose, plus antidepressants typically take 4-12 weeks to kick-in. All the ADs you've taken had a good chance of working and you would likely be much improved by now if you stuck with any of them. Unfortunately, antidepressants can sometimes produce unpleasant side-effects, but they rarely cause any physical harm, indeed ADs can have health benefits beyond the anti anxiety/depressive response, such as reducing the risk of heart attacks, ischaemic strokes and dementia.

My advice is to start on a low dose of whatever med is prescribed and increase the dose by the same amount every 2-3 weeks until you reach the initial target dose, having first gotten your doctor's okay to follow that regime. And you need to take them consistently day after day without fail, irrespective of how you feel. If you can't do that then is therapy and option?

[Maca44]

Yes you gotta stick with regular med times, I always take my Mirt 9pm everynight. It took about 12 weeks for it to change my mood, it kind of creeps up on you and you start to get good days. Its never going to completely change your mood but I can function day to day and most importantly, for me, hold onto my job. I recently found out that messing with the dose can cause real problems as I thought I didn't need it and started to come off, I pretty much went back to square one so reinstated, it was working better than I thought.

[Sober2000june]

thanks for the responses guys

[Sober2000june]

macca i had good days within 1st 3 weeks. I think the night i wasnt sure if i took 7.5 or 22.5 really rattled me

[Sober2000june]

meant to say macca what dose you on?

[Maca44]

meant to say macca what dose you on?

Started at 15mg about 3yrs ago that knocked me right out for first week, really out of it but that passed. After about a month I went to 30mg and was stable on that, 30mg is the sweet spot for me because I did go upto 45mg after a bad spot but found 45mg raised my anxiety, it made me very agitated.
You have to give it time to settle then you can tweek dose with your GP to find the right strength. I found keeping dose and time you take it helps but taking extra on bad days just makes things worse, believe me I have tried that 😀 and it doesn't work.

[Stephanie22]

Hi, how are you doing now on this med now? I literally took my 1st dose last night and I feel dreadfully groggy today. I know it’s only been one day & it seems normal, I just need to know there’s light at the end of the tunnel. X

[Maca44]

Hi, how are you doing now on this med now? I literally took my 1st dose last night and I feel dreadfully groggy today. I know it’s only been one day & it seems normal, I just need to know there’s light at the end of the tunnel. X

Sorry for delay I don't visit here much now as I have changed meds but still take 7.5mg of Mirt which will soon stop. I can tell you the groggy feelings will go just give it a week and you should feel less groggy.

[Deans]

Hi I am new on here but had terrible anxiety for a long time wich eventually lead to hospital and crisis team this week.
They confirmed depression and severe panic anxiety .
I am on 3rd day of 15mg Mirt and 75mg pregabanol
I have Larazapsn if panic gets too much.
I am so scared and frightened sad and feel like I cannot cope with anything anymore.
I am praying I will start to feel better soon as days are so long and I am really struggling can anybody give me any positive feedback or there improvements please.
Many thanks

[panic_down_under]

Hi I am new on here but had terrible anxiety for a long time wich eventually lead to hospital and crisis team this week.
They confirmed depression and severe panic anxiety .
I am on 3rd day of 15mg Mirt and 75mg pregabanol

I have Larazapsn if panic gets too much.

An SSRI is usually the first choice med for newly diagnosed patients. Was that suggested, if so do you know why one wasn't prescribed?


I am so scared and frightened sad and feel like I cannot cope with anything anymore.

This is how most feel at the beginning, but this is not a hopeless situation. The overwhelming majority of people recover and go onto lead mostly anxiety and/or depression free lives.


I am praying I will start to feel better soon as days are so long and I am really struggling can anybody give me any positive feedback or there improvements please.

Unfortunately, there is no quick 'cure,' either by meds or therapy. These disorders are often long in the gestation and don't give up easily, although spontaneous remissions are quite common. However, as per above, they most often do respond well to medication. It just takes time.

[Deans]

Hi, how are you doing now on this med now? I literally took my 1st dose last night and I feel dreadfully groggy today. I know it’s only been one day & it seems normal, I just need to know there’s light at the end of the tunnel. X
Hi Stephanie
Still feel a little groggy on day 4 morning but slightly less anxious.
I also take low dose of Zopiclone sleeping tablet do that probably worsens the feeling.
Keep going as the days will improve I am sure for both of us
Take care