Any advantage in going up to 45mg?

[ElizabethJane]

I have been to see my psychiatrist today and he wants to up my mirtazapine does from 30mg to 45mg. I have resisited this for various reasons: I am afraid that an increased dose would lead to increased sedation and increased weight problems. I do have problems in the morning with low mood and irritability but it is not as bad as when I was really ill with depression. Then I would be crying and feeling panicky and not want my husband to go to work. I am obsessed with my weight at the moment so Dr J has limited my weigh ins to once a week. He has said my BMI must not fall below 20. I am not sure whether the increased dose will affect my concentration? It might relieve my depression (of which I suffer from chronically) but at what price? I would be interested to hear from anyone who is taking 45mg of mirtazapine and whether it has affected their weight/concentration/irritability. Thanks in anticipation. Jane.

[ElizabethJane]

Anybody?

[suzy-sue]

Hi Jane ,im not taking Mirtazapine but will tell you what I know ..45mg if im correct is the max dose for Mirtazapine ? It is common to feel extra tired or thet sedated feeling when a dose has been upped ,the higher the dose more so ..It does affect people differently ..if it doesnt settle to a more unsedated effect after 8 weeks it probably wont ..I was still very sedated on 40mg of my tabs after this time ,so I reduced just a little bit 5mg and found I felt fine ..Apart from the morning ..I still feel really tired and groggy after several months .The hunger you feel usually eases off too .But you have to watch what you eat and cut down on sugar and carbs ..Hope this helps a bit and someone else replies ..All the best Sue x

[ElizabethJane]

thanks Sue it is what i expected although the psych says that 60mg is the maximum dose. Although I am well now I have experienced very bad suicidal depression ikn the past It is too much like recent history for him to take me completely seriously.. I think that he is just covering himself. I need to stay alert at work and for the many singing engagedments I have coming up. If I feel worse I will up the dose. I can just about cope with the mornings although I nearly went back to bed this morning. thanks once again

[suzy-sue]

Its a difficult choice I agree ,but you have to think about the consequences ..You obviously will know if you need to up ..Lets hope you will be ok .Fingers crossed for you Jane .x Sue :hugs:

[sunshine-lady]

Hi Jane

I am taking mirtazapine 30mg (alongside other medications) at the moment, but have taken 45mg in the past when I my depression increased. I felt a little 'heady' and had a slightly sickly feeling for the first few days, but it soon passed and the extra 15mg really helped. I stayed on 45mg for several months and reduced back down to 30mg with no real adverse effects.

Hope this helps and good luck:hugs:

[NoPoet]

A lot of people from the citalopram forum tell me that increasing their dose helped massively, even though they didn't want to do it at first. In fact PoppyC posted the other day to say that she went up to 40mg and her anxiety is all but gone. When she was still on 20mg, she was suffering terribly.

The point is, if you are still suffering on your current dose, there is nothing to lose by increasing the dose. Someone once said to me, "If you had a headache, would you only take one paracetamol and still have half a headache if you know that two paracetamols would fix it?"

[jo61]

I've been on 45mg for a few years now. I take lithium too. My experience on increasing was that I was no more sleepy and the weight gain was no more on the higher dose. The lithium is what has affected my waistline lately.

[ElizabethJane]

Thanks to everyone for replying. I really appreciate that. Interestingly the lithium (I am on it too) has made no difference to my waistline. I was feeling fine yesterday really upbeat. Today I fell over in D Street. I felt really giddy and someone helped me up. I got as far as M&S to spend my raffle prize and burst into tears. They managed to locate one of their first aiders who put a cold compress on my knee and had a look at my elbow. Apart from bruises I am ok. I did attract a bit of attention all highly embarassing. They offered me tea and helped me even though I hadn't fallen in their store. Well done M&S. I'll leave it a few days and see if I feel less vulnerable before upping the dose. Thanks everyone for your help.

[ElizabethJane]

the depression is really hitting hard at the moment and I have almost decided to contact Dr J tomorrow with a view to going up to 45mg of mirtazapine. I am feeling very low and day to day living has become a struggle. I'm thinking morbid thoughts and I'm not sleeping very well. I also think that people are talking about me (which they probably are) It is all to do with those old feelings of self doubt and I think it is obvious where those feelings lead to. I've written a lot about birds and music in the daily diary and it is that I can hear the birds singing but I can just not see them at the moment. I can listen to the music but I can't feel it.I'm sorry to be feeling like this again and I feel as if I have let everybody down on here as I feel as if I am one one of the more senior members now and I should know better/ have all the answers to get well. I don't.

[jo61]

You're not letting anyone down. We all get dips and blips and hard as it may seem to believe, you will get through this and will feel better. It's a horrible illness. Are you seeing a therapist at all? I changed to a CBT therapist last summer and it was like a lightbulb switching on in my head - it's really turned me around, along with the medication and increasing exercise.
:hugs:

[KK77]

the depression is really hitting hard at the moment and I have almost decided to contact Dr J tomorrow with a view to going up to 45mg of mirtazapine. I am feeling very low and day to day living has become a struggle. I'm thinking morbid thoughts and I'm not sleeping very well. I also think that people are talking about me (which they probably are) It is all to do with those old feelings of self doubt and I think it is obvious where those feelings lead to. I've written a lot about birds and music in the daily diary and it is that I can hear the birds singing but I can just not see them at the moment. I can listen to the music but I can't feel it.I'm sorry to be feeling like this again and I feel as if I have let everybody down on here as I feel as if I am one one of the more senior members now and I should know better/ have all the answers to get well. I don't.

I wanted to reply because I've been feeling the same EJ. Like you I suffer mainly with depression (hence Melancholia - and I'm all male BTW!). Although it's not as severe as it's been in the past I've still felt it slowly creeping up on me and reluctantly I've had to increase my dose of sertraline because I know that if I don't do anything about it it'll get worse.

Depression has nothing to do with age, experience or seniority, and you haven't let anyone down by being depressed. It happens EJ.

Coming to your medication, I feel you should think of increasing your mirtazapine, purely to prevent your depression from getting out of hand. Later you could then reduce to your current dose again. (I don't think WG is any different on higher doses.) Perhaps you should see "Dr J" again and discuss your options. I think it's best that we take action, even if it means increasing our meds. I hate taking it. But despite my best efforts it's been creeping up on me, so for now I'm resigned to taking 50mg sertraline. The alternative is far worse I think.

Hope you feel better soon.

[ElizabethJane]

I saw Dr J last Friday and in the end it was a relief to be getting some help as I was feeling extremely low and disjointed and not sleeping. Since going up to 45mg my sleeping has improved ie I'm not waking up too early although I still wake up at six but that is better than four. I'm still experiencing quite low mood but I'm hoping that will improve. I have to report back to Dr J in three weeks. My threshold for any sort of stress is low and I'm just saying 'no' to anyone who oversteps the mark. I'm still very irritable but slept loads over the weekend. I haven't noticed any undue increase in appetite and have tried to keep active and occupied. The only unwanted side effect was on Monday morning. I looked out of the garden and there was a man standing in old fashioned clothing. He clearly wasn't 'there' but I had 'seen' him. He seemed like an old sepia print. My stomach turned over. I blinked quickly and he was gone. I have thought about this and I'm not sure what conclusion to make. I haven't 'seen' anything else so my guess is not to take it seriously but I can't explain it..

[ElizabethJane]

I've been taking 45mg at night for twelve days now and I am to report back to Dr J in three weeks. I would go to see him again sooner but can't afford to do so as BUPA has run out for psychiatry. I still don't feel much of a difference but I am making a tremendous effort as I dont want to sink any further. I can't say that my mood has lifted much. I am working and looking after my son and home so I'm still functioning. I'm still as irritable as hell. I have a GP appointment next week so I'm hoping for a real improvement before I see her. I have tremendous difficulty going off to sleep. My latest thing is to try to meditate. I used to read the 'Metro' or a novel and would go to sleep quickly. My life seems to be some sort of waking horror (some of the time) I do so want it not to be like this. I know I'm ill as I have started to muddle appointments. I turned up with my son wrong date right time to an orthodontic appointment. I just wanted to cry and give up go home for the day but I went to work and somehow just carried on. I'm not sure what to tell Dr J as his response will be more drugs. Lovely as he is I dont want any more drugs. Sometimes I just want to retreat and hide under my duvet all day. Pathetic isn't it.

[pacman]

Hey, hang in there ElizabethJane, the tablets will work soon enough and lift your mood and this (as you say yourself) is just a blip. I know exactly how you feel and much like smudger, I have been waiting for the tablets to take an effect. If you read his comments then it should give you hope, he didnt start feeling any noticable effect until day 40ish ...

I have good days and bad, so you have to take them as they come.

Hang in there ! Things will get better ...

Kind regards
Pacman

[KK77]

I'm sorry you feel so bad EJ but 12 days really isn't long enough. I know you're probably fed up of meds - so am I - but we have to carry on regardless. By the time you see Dr J you might feel a lot better. I'm still very up and down on my increased dose and some days don't want to get out of bed either, I can assure you. It's not pathetic, it's the nature of depression. But I'm sure you're a fighter and won't let it beat you. I certainly won't!

Hope you feel better soon.

[ElizabethJane]

Thanks Guys no I haven't given up yet but I have been down this path many times before. The lack of sleep is the worst thing so I might start taking the zopiclone again at least until I have seen my GP. Thanks once again.

[ElizabethJane]

Still not right although I have added stress of my Dad in hospital awaiting a procedure tomorrow and if that doesn't work then an op a major op probably next week. I have seen my GP and she thinks that three weeks on 45mg isn't long enough to be past the side effects and feeling better. I also spoke to Dr Js secretary who I think expected me to make an appointment to go in to see him but because I am a private patient and we are self funding I can't do at the moment. My GP is very supportive and she will see me in a fortnight. sleep is still an issue as I don't want to take zopiclone but will tonight. It is horrible not being able to sleep feeling tired going to sleep for a few hours then waking up. I still have to get up early in the morning when I want to sleep. I'm hoping that someone else will read this and find some help with their journey. I'm not sure what way I want things to take right now. I think that I will print out some of my entries that are here and show them to Dr J. then he can see how up and down it has been for me. But I'm not giving up not just yet. There is more to life than this.

[suzy-sue]

You poor thing Elizabeth ,,:hugs:You certainly have an awful lot to deal with at the moment ..I hope everything goes well for you Dad tommorow ,its very worrying when elderly parents are in hospital .Im sure they will do their very best for him .All you can do is take one day at a time ..I think considering how bad you feel with your depression & Medication you are doing extremely well . Many would not have coped so well .. I hope you get some sleep tonight and tommorow you find the strength to get through yet another day ...Lack of sleep always makes every thing feel worse ..You take good care of yourself hun and hope everything turns out well tommorow .Luv Sue :hugs:xx

[Ed09]

Hi. I can say that when I upped my Mirtazapine from 15mg to 30mg it took probably two weeks before I noticed an improvement. Even then I still get daily lows, they're just nothing like as bad as without the medication. Some anti-depressants take months to work regardless of what the leaflet says, and some do nothing for one person yet work for someone else and vice versa with each drug.

If you don't get much relief you always have the option of changing medication. Because Mirtazapine is a unique class of anti-depressant, it can be taken alongside an SSRI (Citalopram, Sertraline, Prozac) and I believe SNRI (Venlafaxine), so that's another option. Upping your dose may not help with sleep because at higher doses Mirtazapine has a more stimulant and less sedative effect. You can always split a tablet and take half in the morning, half at night as well.

Worrying that people are talking about you doesn't surprise me. I actually take Mirtazapine partly for social anxiety and it at times makes it worse - depending on the day I sometimes get a degree of paranoia. Unfortunately a lot of these meds are a double edged sword and they have a lot of side effects. On the other hand it helps me greatly with depression and I only need think back to what it was like before and I'm still happier to be on it than not.

I hope things improve for you. Just remember that you're not alone and depression is a condition that millions of people suffer from. Like you they ride out the low points and suffer the same fears about medication. :)

[ElizabethJane]

Thanks Ed I have only just got around to replying to your post. I was aware that mirtazapine an snri can be augmented with another anti depressant. I did not want to go up that route as my psychiatrist Dr J had suggested that as another option. I had previously been on dothiepin for sixteen years and also take lithium. Any more pills and I'll rattle! I can look at it all from a more objective point of view. My sleeping patterns are still not brilliant but they are better than they were. I find it difficult to go to sleep. If I do go off then I have a series of nightmares usually about two or three before I go to sleep properly then wake early. I am having some hypnosis in April which I think will help plus I have low dose zopiclone 3.75mg tablets for the really bad nights. I am still paranoid but as I am feeling better I just press the 'overide' button in my brain when I know people are talking about me. It is as if some are jealous of me and see me getting more attention than them they want me not to be 'special' to certain people. I'm a dreadful flirt when I am well but this causes all sorts of problems especially in my singing groups. I have always been like this I can't help it. I'm not sure if splitting the dose of mirtapine would help me. I would ask Dr Js permission first.