Another mirtazapine diary

Hi everyone,

I have mostly been a lurker here but thought I would share my experience with Mirtazapine. I see a lot of bad posts about this drug and my experience with it has only ever been positive, or neutral. We'll see if that holds as I go on.

I have GAD, and about 20 years ago I had my first issue with it. I have severe somatic symptoms of anxiety upon waking, which last through the day and trail off at night. I also have terrible insomnia. And then once this starts, I worry about worrying, and not sleeping.

After some bad experiences with trying Paxil and Effexor, I was put on Mirtazapine, 15 mg. Within 4 days, my anxiety was completely gone, I was sleeping well and I was back to my old self. I stayed on the drug for about a year and then weaned off. I did gain 40 lbs on it, which wasn't good, but everything else about it was great. I ended up on 22.5 mg for the duration of my time on it, and weaning off was no issue.

15 years passed and I didn't have any issues with anxiety or insomnia. Then my husband had a heart attack and it sent me into a relapse. Insomnia, all day long anxiety, etc. I immediately tried mirtazapine and again, within 4-5 days, it was all better. I stayed on 15 mg for a year and then weaned off with no issues. I gained 10 lbs this time. I regret weaning off this second time. I should have just stayed on it.

Four months ago, I had another relapse. I'm not sure what triggered it but it was the same debilitating anxiety from the time I opened my eyes until early evening. Insomnia was crazy. I reached for the mirtazapine and after 4 days on 15 mg, the anxiety stopped... but the insomnia stayed. Then 7 days later the anxiety came back. Mirt had pooped out on me. :huh:

I stayed on the 15 mg for about 2 more weeks with no effect. Disgusted, I went down to 7.5 mg and stayed there (hoping it had SOME sleep benefit) and tried Zoloft instead, which was a resounding disaster. Insomnia got worse and my anxiety went through the roof. Doc tried amitriptyline, which also took anxiety away in about 4 days and I was very encouraged, but within 10 days I developed a condition called Postural Orthostatic Tachycardia Syndrome (POTS). No more TCAs for me.

I've tried zyprexa (meh), then gabapentin (double meh) and still no relief. I was at my wits end as this has been going on way to long and now I feel a deep depression settling in as well, and still the anxiety and insomnia.

So, the doc and I decided since I tolerate Mirtazapine well, to try a higher dose than I've ever tried before, at 30 mg. I need some depression help this time as well, and hope it will also reduce my anxiety. I don't seem to tolerate SSRIs well as they make the insomnia and anxiety worse at first and I fall apart when that happens. Fingers crossed that I'll get some relief, but I'm not gonna lie... I'm skeptical since the initial poop out!

Here is how it is going so far:

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Day 1 - 30 mg knocked me out! I didn't expect this as 15 mg didn't make me sleepy at all and I thought the higher doses were more activating, but no so much for me. I slept really well, longer than I had in months, but was very groggy until 1 pm the next day. Anxiety still present but blunted a bit I suppose as compared to usual. Stayed in bed all day.

Day 2 - Not nearly as groggy this morning. Slept well. Still had anxiety in the morning upon wake up. Mood today was terrible. Very depressed and worried I am not going to get better. Had anxiety most of the day. Stayed in bed all day wallowing in depression.

Day 3 - Grogs are pretty much gone. Slept well. Some anxiety in the morning but the type of anxiety is different. Instead of an all-out onslought of physical anxiety, I feel jittery, like too much coffee. Still unpleasant but not as bad as usual. I did take 1/2 Ativan to settle down. Mood was better today. I forced myself to get out of bed and went on a walk, went to my kid's soccer game, went to the mall and out to dinner. This is a big deal for me because the depression has been paralyzing the past week and I've had trouble even leaving the bedroom. Anxiety came back in afternoon. Tried propanolol as I don't want to take benzos too often, but it fell pretty flat. Just white knuckled it until evening.

Day 4 - Slept well. Woke up pretty anxious. Took some Ativan. Really don't want to make a habit of taking these but they are the only thing keeping me functioning until this anxiety lets up. Mood is okay so far. At least I'm not in bed. I plan to take another walk today as it helped yesterday. Feeling a little disappointed as Mirt has always eradicated my anxiety within 4 days or so and I was hoping the same would be true on this higher dose. I'm impatient. :weep:

Day 5 - Had trouble falling asleep last night. I'm trying not to blame this on the mirtazapine and hope it's just a fluke. The lack of sleep and anxiety over lack of sleep has made my mood pretty iffy today. I'm trying to stay positive. I see my pdoc today so we'll see what he has to say. Anxiety was bad this morning but more managable this afternoon.


Anyone with positive stories about Mirt or who is just starting please share your stories!!!

So sorry to hear you are having a rough time. Lack of sleep is a real killer, isnt it? I find that once I get into that cycle of anxiety/lack of sleep it is really really hard to get out of it.

I hope the Mirt does start to work again for you - it may be that it just needs some time to settle down into your system. Hopefully you can keep going for a week or two as you are and see if things improve.

Thank you! Yes, insomnia is a big anxiety trigger for me. I fall apart pretty quickly without decent sleep which makes sticking through pretty much any SSRI impossible since they nearly all cause insomnia to some extent.

Day 6 - I did sleep marginally better last night. Anxiety was also better in the morning than usual. Depression was really bad today though. I really don't understand the depression. There is no reason for it! This all started with anxiety but in the last few weeks, the depression crept in, and I'm finding that even harder to deal with. Trying to distract myself with walks, a lunchtime drive and work today. I find that distraction is best for the depression because I am terrible with ruminating!

I am very much the same - ruminating and dwelling on how I am feeling is my worst habit - sometimes I am sure I could feel absolutely fine if I could just snap out of the cycle of thinking I have got myself into. The slightest twinge of feeling off gets a big overreaction, instead of just ignoring it as irrelevant.

At the end of the day, none of these symptoms are medically important. Distraction and keeping busy is key - that is certainly why I am struggling at the moment I think. Have had the whole day at home at my in-laws, not doing much but playing with the kids and hanging out. I should enjoy the fact that I am not at work, but apparently not!

My only advice to you would be to try and keep busy until the meds get settled down, and try and remember that this is early days and your body is just adjusting. Things will not be like this forever.

I was thinking the same today... I thought I'm not getting better because I won't allow myself to. I'm too worried about if I'm going to get better, if the medication will work, etc. Sigh.

I'm also at my in - laws! We are living here until our new house is built (only a few more weeks!) but's very stressful to be having a breakdown while living with your in laws and trying to put on a brave face.

I settled down a bit this afternoon with the doom and gloom and focused on working from home which distracted me a bit. Hoping tomorrow is a better day!

Day 7 - Woke up with very little anxiety! Still feel it hanging out under the surface but I guess that's improvement. Mood is okay today. Less desperate than the last few days but I'm not doing cartwheels. Feel sort of flat. I know it's early days but I can't wait to actually feel pleasure and enjoyment in things again! The flatness in an of itself is distressing.

Onwards and hopefully upwards!

Glad to hear you are feeling a little better today - any improvement is something to celebrate! The flatness is certainly partly exhaustion from the lack of sleep etc, so once you have recovered a bit I am sure that will ease off.

I am 8 weeks in to 15mg now, and have managed to lose the 5lbs I gained in the first couple of weeks through exercise and watching what I ate, so am pleased about that. Feeling a little better today emotionally, and just trying to remind myself that these negative thoughts or feelings are all totally meaningless and irrelevant!

Good luck!

Day 8 - Day 14

Had a few good days, a few bad days. Overall, I think the mirtazapine is helping my physical anxiety somewhat, though not fully. I can't tell on mood. I've had a run of a few really bad days and then today has been decent.

Doc wanted to add Luvox to the mix as he thinks I am having some ruminating/obesssing thoughts, which is probably true. I just noticed that mirt and luvox have a serious interaction and they shouldn't be taken together, so I'm a little miffed at my pdoc. He spent time telling me to trust him today and then prescribes a combination my pharmacist could make me very sick. *sigh*

Will keep at it a bit more and hope the mood improves more!

Not sure if anyone is still reading but just in case!

Day 15 - Day 18

Day 15/16 were just days I was trying to survive. Doc prescribed some seroquel (25 mg 3x day) for anxiety, but they were way too sedating to take in the day and still function. Plus they didn't really help the anxiety. I was just super sleepy and anxious.

Day 17 (yesterday) was okay. I was anxious in the morning as usual. Managed to go out to lunch with the family and attend a family event for a few hours. Felt decent at night but I am usually calmer at night.

Day 18 - Started out rocky with some ugly anxiety but it went away by mid-morning. I actually feel HUMAN today! This is the most "like me" I've felt in about 4 months. Maybe the mirtazapine is finally kicking in. Hope this mood and productivity holds!