Starting on Mirtazipine and diary

[Deedee33]

Hi all, I’ve just recently posted about being on fluoxetine and before that venlafaxine but both of these tablets caused immense side effects - venlafaxine caused severe feelings of dissociation and and frightened me. Fluoxetine caused insomnia - incredible shaking that would last for hours at a time and surge like despair throughout the day. I’ve tried other things like natural remedies- St. John’s wort - cbd oil - ashwaganda and now here I am after a frantic phone call with the doc on Friday morning, starting mirtazipine. I’m in need of help as I’ve been struggling with GAD and somatic symptom disorder for over two years and crippling health anxiety on top of it all. I’ve had two psychiatric teams involved in my treatment as well as cbt therapy and yet I’m still struggling. Everyone on this forum is brilliant - panic_down_under especially. I felt like it was time to put a post on here and ask for support as I really struggled through with the other tablets - so I’m on day one of mirtazipine and I will write down My experiences With and if anyone is at a similar stage or has any advice, encouragement and support to other - it truly would be greatly appreciated. Thank you so much fellow folk of no more panic

[Deedee33]

Day one

Took my 15mg tablet way too late- 11pm. Fell asleep within 20 mins and then slept through until 11:30 am. Felt groggy but managed to get washed which is a positive. I know in my heart it is way too soon for any improvements but at least it’s a start.

[SnowyGreen]

Hi, I've been on mirtazapine twice. This time I've been on it for 7 years. I have never had side effects from this drug, except being sleepy at night time, which is awesome :) I think you'll be fine on this drug.

[Deedee33]

Thank you so much snowygreen for your post and encouraging words.

[Deedee33]

Day Two

Must admit that I was incredibly thirsty and ate a lot more than usual yesterday. Took 15 mg tablet about 11 pm - probably too late again as found it impossible to get up out of bed this morning. Have had breakfast though which is a positive- as both anxiety and depression have seemed to rob me of my appetite. Will keep posting as I hope it may help someone else who is starting on these tablets but also it’s helping me to keep a diary and gain support too.

[Deedee33]

Also snowygreen what dose are you on?

[SnowyGreen]

Also snowygreen what dose are you on?


I am on 30mg

[Deedee33]

Thank you for replying - the tiredness thing is quite full on

[Deedee33]

Day Three

Dry mouth. I knew that this was one of the side effects but it’s been quite bad on a morning so note to self - need to drink more fluids. So very hard to get up out of bed this morning - slept 12 hours and still feeling knackered. It actually feels like I’m waking up after having a massive binge on alcohol the night before - so I’m really not sure how I’m going to cope if that’s a side effect that’s consistent.

Made the horrendous mistake of falling down the rabbit hole and reading lots of mirtazipine horror stories on glorious google. Urgh. I’m starting to wonder whether the fear of antidepressants and their side effects and already scuppering the chances of them working in my favour. I know they are not the magic fix but I’ve been struggling for so long now that I had been keeping the antidepressants route as the last route to go down. Not sure whether sleeping too much is better than sleeping too little? If anyone is reading this - thank you - and will keep posting.

[panic_down_under]

Dry mouth. I knew that this was one of the side effects but it’s been quite bad on a morning so note to self - need to drink more fluids.

Sip, don't drink as the dry-mouth will continue even if you drink gallons. It isn't caused by dehydration. If it becomes a major issue there are products such as moisturising gels, mouth sprays, mouthwashes and toothpastes which can make a significant difference. Biotene is one popular international brand and there are probably some local ones too. Your chemist will be able to guide you on what's available.


So very hard to get up out of bed this morning - slept 12 hours and still feeling knackered.

Mirtazapine if pretty much only a powerful antihistamine, in fact more so than many of the meds sold as such and blocking histamine H1 receptors produces mostly sedation. Mirtazapine usually becomes less sedating as the dose increases and tolerance to the sedation may develop after a while.


Not sure whether sleeping too much is better than sleeping too little?

It might be just what you need atm.

[BrokenGirl]

Hi there,
I'm just wondering how you're getting on with Mirtazipine? I hope the side effects are settling down and it's starting to work for you.
I'm in one of the worst HA spirals I've ever had. It's come to the stage where I really can't take it anymore.
I think the only option I have is to go back to my doctor and ask for medication. I was thinking of asking her about Mirtazapine because I can't tolerate any SSRIs - have tried many of them but the side effects were too much for me.
Anyway, would love to know how you're finding this medication?

[panic_down_under]

I was thinking of asking her about Mirtazapine because I can't tolerate any SSRIs - have tried many of them but the side effects were too much for me.

A TCA like amitriptyline might be a better bet. The TCAs tend to produce fewer initial side-effects than the SSRIs anyway, but they are also available in very low dose tablets compared to their therapeutic dose range which makes it much easier to start at a low dose and ramp it up by the same small amount to limit the severity of any initial side-effects. The trade off may be some ongoing side-effects such as dry-mouth and constipation which can usually be well managed.

[BrokenGirl]

A TCA like amitriptyline might be a better bet. The TCAs tend to produce fewer initial side-effects than the SSRIs anyway, but they are also available in very low dose tablets compared to their therapeutic dose range which makes it much easier to start at a low dose and ramp it up by the same small amount to limit the severity of any initial side-effects. The trade off may be some ongoing side-effects such as dry-mouth and constipation which can usually be well managed.

I'm actually on amitriptyline, have been for about 10 years. But it's a very low dose, 10mg a day. I'm taking them for migraine prevention.
Severe migraines is one of the major side effects I've had with SSRIs.
I remember my doctor upped my dose a few years back so it would work as an anti depressant. I stuck with it for a good few weeks but eventually brought the dose down again due to the side effects. I think it was the tiredness got to me in the end. I was a complete zombie all day every day. Was hoping it would wear off but it didn't.
But maybe I could talk to the doctor about it again (different doctor this time).
Thanks for suggesting it - it had totally slipped my mind that amitriptyline is also an AD in a higher dose.

[KK77]

I'm actually on amitriptyline, have been for about 10 years. But it's a very low dose, 10mg a day. I'm taking them for migraine prevention.
Severe migraines is one of the major side effects I've had with SSRIs.
I remember my doctor upped my dose a few years back so it would work as an anti depressant. I stuck with it for a good few weeks but eventually brought the dose down again due to the side effects. I think it was the tiredness got to me in the end. I was a complete zombie all day every day. Was hoping it would wear off but it didn't.
But maybe I could talk to the doctor about it again (different doctor this time).
Thanks for suggesting it - it had totally slipped my mind that amitriptyline is also an AD in a higher dose.

There is another AD similar to Amitriptyline but without such harsh side effects called Lofepramine. Not sure whether a GP would prescribe it but worth looking into and discussing with your doc anyway.

[panic_down_under]

I remember my doctor upped my dose a few years back so it would work as an anti depressant. I stuck with it for a good few weeks but eventually brought the dose down again due to the side effects. I think it was the tiredness got to me in the end. I was a complete zombie all day every day. Was hoping it would wear off but it didn't.

Mirtazapine is likely to be far more sedating than amitriptyline, although some do have paradoxical reactions.

Arguably the best med to try for HA is clomipramine (Anafranil) as it has a good track record for OCD (HA is in the OCD spectrum), but it is a very potent serotonin reuptake inhibitor so might trigger some of the same issues you've had with SSRIs, although this isn't necessarily a given. It would definitely be worth trying if you and your GP are willing to experiment. If not imipramine might be the better bet. Usually much less sedating than amitriptyline (I've taken up to 350mg and no issues), but a little more potent as an AD, thought not as potent as clomipramine.

Alternatively, you could try lofepramine, as KK77 has suggested, or nortriptyline which is the active metabolite of amitriptyline. Both primarily inhibit noradrenaline, aka norepinephrine, reuptake having only a modest effect on serotonin and histamine H1 receptors so are unlikely to prove sedating.

[Deedee33]

Hi BrokenGirl - I have I only just seen your message on this post and have sent you a private message - really hope all is well and panic_down_under always offers some excellent advice

[Sober2000june]

HI Deedee33,

Just wondering if youre stll on Mirt and how you are doing?