Citalopram and mirtazapine for anxiety

[Windywel]

Hi there is anyone on both citalopram and mirtazapine for anxiety? I am on cit for the second time -5 weeks in with 3 of those on 20mg. It’s not helping the anxiety at all, fact it has made it worse and therefore the depression. Was wondering about talking to the doc about adding in mirtazapine. Is anyone else doing this? Does it work for anxiety and is it safe? Many thanks

[Windywel]

Other option is I just carry on with lorazepam until the meds kick in whenever that is - which is a better option?

[panic_down_under]

I am on cit for the second time -5 weeks in with 3 of those on 20mg. It’s not helping the anxiety at all, fact it has made it worse and therefore the depression.

Which is unfortunately typical with ADs, and especially the SSRIs and SNRIs at the beginning. It was probably also what happened the first time you started citalopram.


Was wondering about talking to the doc about adding in mirtazapine. Is anyone else doing this? Does it work for anxiety and is it safe?

At low doses mirtazapine is a very sedating antihistamine, indeed a more potent antihistamine than most of the meds sold as such. It eases anxiety by sedation which might be a good thing for you atm. At higher doses it may act as an antidepressant, but the citalopram is likely to kick-in before it does so taking it for this reason is probably pointless.

As for safety, you're unlikely to keel over from taking both it and citalopram despite drug interaction sites issuing dire warning about *serotonin syndrome/toxicity (SS/ST) which are simply male bovine excreta. However, mirtazapine can induce very powerful carbohydrate cravings which may produce significant weight gain if taken for extended periods.


* To quote arguably the world's leading SS expert, Dr Ken Gillman (http://scholar.google.com.au/citations?user=ea6KeD0AAAAJ&hl=en):
"As I have pointed out before, drugs like bupropion and mirtazapine, that have no significant serotonergic activity, are no more likely to cause ST than is vitamin C." PK Gillman, 2010 (PDF (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3550296/pdf/13181_2010_Article_84.pdf))


Moreover, mirtazapine is a serotonin 5-HT2a receptor antagonist (blocker) which can prevent (https://www.ncbi.nlm.nih.gov/pubmed/20655983) the body temperature spike which does the damage in SS/ST although in humans the recommended treatments (http://www.psychotropical.com/treatment-of-serotonin-toxicity) for serotonin syndrome are the more potent antagonists cyproheptadine and chlorpromazine.

PS:

Other option is I just carry on with lorazepam until the meds kick in whenever that is - which is a better option?

Imho, mirtazapine.

[Windywel]

Thanks PDU - still mirtazapine over diphenhydramine then? I do have some of that as unisom sleep gels but haven’t taken any yet as I’ve never tried them and scared of side effects

[panic_down_under]

Thanks PDU - still mirtazapine over diphenhydramine then? I do have some of that as unisom sleep gels but haven’t taken any yet as I’ve never tried them and scared of side effects

Diphenhydramine is likely to produce fewer issues so try that before going down the mirtazapine path. It is a milder antihistamine than mirtazapine.