Amitriptyline and mirtazapine

[SnowyGreen]

Can you take amitriptyline with mirtazapine?

[panic_down_under]

Can you take amitriptyline with mirtazapine?

Yes, but what is the reason for doing so?

[WiseMonkey]

Two different types of AD's ... could work against one another?

[panic_down_under]

Two different types of AD's ... could work against one another?

Mirtazapine is really only a powerful antihistamine, not an antidepressant despite what it says on the label, having little impact on serotonin and noradrenaline/norepinephrine pathways. It mostly works by sedation. But it can be useful at small doses as a sleep aid to counter AD induced insomnia. However, insomnia isn't usually an issue with amitriptyline because it is itself a fairly potent antihistamine.

[SnowyGreen]

Yes, but what is the reason for doing so?


Well, I've been on mirtazapine 30mg for 6 years now, mainly only use it for sleep nowadays, as I like the sleepy effect. However, I am in surgical menopause atm, and the fall of estrogen has triggered vestibular migraines, which makes me dizzy all the time, as well as other weird head symptoms, and I was reading that 10mg of amitriptyline can help vestibular migraines, so I was wondering if you could take both at the same time. I am currently trying to balance my hormones with an estrogen patch, so I'm hoping in time the dizziness will go away just with the balancing of hormones.

[panic_down_under]

Well, I've been on mirtazapine 30mg for 6 years now, mainly only use it for sleep nowadays, as I like the sleepy effect. However, I am in surgical menopause atm, and the fall of estrogen has triggered vestibular migraines, which makes me dizzy all the time, as well as other weird head symptoms, and I was reading that 10mg of amitriptyline can help vestibular migraines, so I was wondering if you could take both at the same time. I am currently trying to balance my hormones with an estrogen patch, so I'm hoping in time the dizziness will go away just with the balancing of hormones.

Mirtazapine and amitriptyline can be taken together, although your GP's computer may flag a supposed potential for serotonin syndrome/toxicity (SS/ST). The computer will be wrong. Not my opinion, but that of arguably the world's leading SS/ST 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. This scenario has already been enacted, over a decade, with the antidepressant mirtazapine, which was claimed, erroneously, to have serotonergic activity. Many poor quality case reports of ST with mirtazapine were published. This probably led to misdirected treatment of overdoses, some of which may have caused morbidity. It took several reviews to correct this error and establish that mirtazapine cannot cause ST

PK Gillman, 2010 PDF (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3550296/pdf/13181_2010_Article_84.pdf). See also: A systematic review of the serotonergic effects of mirtazapine in humans (https://onlinelibrary.wiley.com/doi/abs/10.1002/hup.750)

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) are the more potent 5-HT2a antagonists cyproheptadine and chlorpromazine.

10mg amitriptyline is only a small dose so may not have much of a sedating effect, but you might be able to cut back the mirtazapine dose a little. Clear it with your GP before trying this, however.

[SnowyGreen]

Thanks so much for your help panic down under.