Considering Mirtazapine - need advice

I have suffered from GAD for over 10 years now. I also suffer from moderate tinittus and have done nearly all my life. In the past I have taken Citalopram which helped greatly with the anxiety.
Two months ago I felt I started back on Citalooram again but then came off it as it increased my tinnitus to unbearable levels. This didn't happen the last times took it in past. I know this can be a side effect of SSRIs and read that sometimes the increase can be permanent so was glad I stopped.

I have tried unsuccessfully managing my anxiety since without medication and the anxiety has increased to a point that it becoming unbearable and desperately need help. I finding it difficult to function.

I researched Antidepressants which have low chance of increasing tinittus and only one I found was mirtazapine.

I understand this can help with sleep but also with anxiety. I just want advice from anyone who has taken it who have generalised anxiety disorder and experiences from anyone who has tinittus and taken it.

I would really appreciate any help at all anyone can give me. I am desperate for solutions. I haven't found any other medications that could help with the anxiety but not raise my tinittus.

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Originally Posted by StressedEric

I researched Antidepressants which have low chance of increasing tinittus and only one I found was mirtazapine.

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But tinnitus is a listed potential side-effect so there are no guarantees.

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I understand this can help with sleep but also with anxiety.

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Mirtazapine is more a very sedating antihistamine than antidepressant which eases anxiety mainly by sedation.

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I haven't found any other medications that could help with the anxiety but not raise my tinittus.

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Just because citalopram worsened your tinnitus doesn't necessarily mean all SSRIs will and they are likely to be a better long term bet for anxiety than mirtazapine. So would the older TCA ADs which are often prescribed to treat tinnitus triggered anxiety/depression.

I have been given script for 15mg mirtazapine from GP. If I do decide to start it, I was thinking of starting 7.5mg then go up to 15mg. Is it safe to half the 15mg tablets. I am very sensitive to med changes so just want to ease myself in.

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Originally Posted by StressedEric

I have been given script for 15mg mirtazapine from GP. If I do decide to start it, I was thinking of starting 7.5mg then go up to 15mg. Is it safe to half the 15mg tablets. I am very sensitive to med changes so just want to ease myself in.

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You could halve the tablet, but you probably don't need to as mirtazapine's main side-effect is sedation and you will probably won't feel much difference between taking 7.5mg and 15mg. It could even be a little more sedating at the lower dose as sedation usually decreases as doses increase.

I have been reading more on Mirtazapine and reports that it one of the most difficult AD meds to come off in terms of the severity of the withdrawal syptoms? I am nly thinking of if I find it not working for me what would be the safeest way to come of it and what period of time should the tapering be and peoples experiences of the withdrawal. I am just getting as much imformation before I start it or if I consider another AD first before considering it.

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Originally Posted by StressedEric

I have been reading more on Mirtazapine and reports that it one of the most difficult AD meds to come off in terms of the severity of the withdrawal syptoms?

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I urge you not to go down that rabbit hole as such reports are highly biased. They represent the relative few who do have issues, not the majority who don't and thus have no reason to post about it. Plus withdrawal isn't always down to the med. Psychology is at least as potent a generator as chemistry and probably more so for those with anxiety. Convince yourself that you will suffer greatly and an anxious mind is very capable of delivering your worst nightmare.

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I am nly thinking of if I find it not working for me what would be the safeest way to come of it and what period of time should the tapering be and peoples experiences of the withdrawal.

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Mirtazapine is more a strong sedative than antidepressant and the main withdrawal symptom is usually rebound insomnia. Cutting back the dose in 7.5mg steps every couple of weeks will usually minimise this and any other symptoms.

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I am just getting as much imformation before I start it or if I consider another AD first before considering it.

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You shouldn't need to wean off it completely before switching to another AD as there are no significant interactions, even with MAOI class ADs which do require a washout before switching to/from them from other ADs. Mirtazapine is sometimes prescribed to ease SSRI induced insomnia, although, imo, immediate-release trazodone is the better med for this.

Took the first 15mg Mirtazapine tablet last night. Within about 15 minutes r so of taking it felt groggy (which I expected) but my tinittus level increased suddently and quite dramatically. I was surpised how quick the tinittus level increased as imagine it woud take longer for the drug to make any of an effect. It has remained loud since. The only reason I wanted to go on this med was that it not reported to incudce tinittus and it is not listed as a side effect in the patient leafet.

I called GP this morning and basically got two choices: stop it now and see if the level goes down to base level or stay on it for a few more days and hope it goes down. I undertand that the longer I stay on it there could be withdrawal symptoms coming ff it and even make the raised level permanent. I would imagine if stopped it after a few days I dont need to taper off it.

This is the quandary that I am in now. Anybody got advice?

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Originally Posted by StressedEric

Took the first 15mg Mirtazapine tablet last night. Within about 15 minutes r so of taking it felt groggy (which I expected) but my tinittus level increased suddently and quite dramatically. I was surpised how quick the tinittus level increased as imagine it woud take longer for the drug to make any of an effect.

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If the tinnitus flared in 15 minutes or so I don't think it was the mirtazapine as it typically takes 30-60 minutes for plasma levels to begin building, longer if taken with food. On an empty stomach peak plasma level is reached in around 2 hours.

I'm wondering if there isn't a significant psychological component to it. Did the ringing diminish after a while, or is it continuing?

The tinnitus stayed at that level all day. I persevered and i took another 15mg tablet last night and when woke up, the tinittus was louder still than previous day and so far it has remained at that level. I am still thinking of stopping the med and hope that the level goes back down. If i stop after just 2 days I assume that I will not have to taper off it before stopping. I know this particular med gets into the system quickly. I want to avoid any withdrawals.

It will takes some weeks to develop dependency so there won't be any issues quitting after 2 days.

After 4th tab had massive tinittus spike that lasted all night and also sound distortion in right ear. Phoned docs. My doc not there but spoke to another doc at surgery said it might settle down and keep on taking it. Took 6th tab last night, massive spike again. The distortion worse. Worried this med is damaging my ear!!!. I was going to ENT dept in hospital today for my hearing aids. They checked my ear while there- no wax or anything. Phoned doc, no appointments but left msg. doc replied said stop the Mirtazaprne. No advice given on tapering or anything! Cant phone her. Even only taken it for 6 days worried if go cold turkey I will suffer horrible withdrawal? I don't want more ear damage. God, so scared and can't get hold of any docs and a&e would mean an all night wait...

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Originally Posted by StressedEric

After 4th tab had massive tinittus spike that lasted all night and also sound distortion in right ear. Phoned docs. My doc not there but spoke to another doc at surgery said it might settle down and keep on taking it. Took 6th tab last night, massive spike again. The distortion worse. Worried this med is damaging my ear!!!. I was going to ENT dept in hospital today for my hearing aids. They checked my ear while there- no wax or anything. Phoned doc, no appointments but left msg. doc replied said stop the Mirtazaprne. No advice given on tapering or anything! Cant phone her. Even only taken it for 6 days worried if go cold turkey I will suffer horrible withdrawal? I don't want more ear damage. God, so scared and can't get hold of any docs and a&e would mean an all night wait...

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Anybody got advice on coming off it after 6 days on 15mg?

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Originally Posted by StressedEric

Worried this med is damaging my ear!!!.

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The ringing/noise is being generated in your brain, not the ears so mirtazapine is not going to harm them. I suspect anxiety is a contributor, possibly more so than the med.

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Even only taken it for 6 days worried if go cold turkey I will suffer horrible withdrawal?.

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You're unlikely to suffer withdrawal after only 6 days, at least physically. People take antihistamines for much longer without developing dependency. However, if you convince yourself you will suffer then an anxious mind is very capable of delivering your worst nightmare.

I going to taper 7.5mg (half 15mg tab) for a few days. First 7.5mg tonight. Will see how I go.

Had 7.5mg (half tab) last night. Today got very loud tinittus which has lasted all day. Maybe its worse if thinking of it but it SO hard not to as so loud. Surely I wouldn't have such withdrawal after only 6 days????

I have been taking 15mg of mirtazapine for over six months for anxiety. They are working ok for me. Not for tinittus as far as I know
Some medications don't work unless they are taken for more than six days.

As for the tinittus, maybe there is another medication???

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Originally Posted by StressedEric

Had 7.5mg (half tab) last night. Today got very loud tinittus which has lasted all day. Maybe its worse if thinking of it but it SO hard not to as so loud. Surely I wouldn't have such withdrawal after only 6 days????

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I doubt it is withdrawal, both because of the short time you've been taking mirtazapine, but also it has a longish half-life, up to 40 hours, so there will will have been little change in plasma levels yet.

Tinnitus being may worse if you think about it suggests psychology is a factor. Just about any side-effect is possible when taking an AD, but it would be very unlikely to occur with all of them as they have wildly different modes of action. Mirtazapine has little in common chemically, or in the receptors it targets, with SSRIs, for example.

I took another 7.5mg half tab last night (2 tabs now of 7.5mg) i still worried that it is withdrawal the tinittus is still constant very loud it not going down it very loud white noise in both ears. I really really scared. Ive had no sleep it so overpowering. I read reports that tinittus is a withdrawal symptom of mirtazapene and that the tinittus it causes is permanent. I don't know what to do if I go completely off the tinittus could be worse I don't think i can cope if it does. I am so frightened. Anybody experience of mirtazapeme withdrawal? Should I go back to 15mg and come off more slowly? I am in the dark with this. Please please I am desperate.

You are not in withdrawal, Eric. You weren't on mirtazapine long enough and the tinnitus began while there would have been almost no decrease in plasma levels. What you have in rampant anxiety with has taken over. Please get in touch with your doctor asap as you need to get it under control.

I have spoken to doc this morning and she said no more tapering at7.5mg and take no more tablets i.e. come off it completely. This means it been 8 days total (15mgx6 and 2x7.5mg)

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Originally Posted by StressedEric

I have spoken to doc this morning and she said no more tapering at7.5mg and take no more tablets i.e. come off it completely.

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Did you tell her about how high your anxiety levels are? If so, what was the response?

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This means it been 8 days total (15mgx6 and 2x7.5mg)

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People take antihistamines for longer for hay-fever, etc, without suffering withdrawal. Stop reading nonsense online about meds, especially about their side-effects and withdrawal. Most of it is nonsense and all you're doing is getting yourself wound up for no reason, Eric.

I started Mirtazapine again just over a week ago after my anxiety worsened. I was told it won't cause tinittus increase. I was on it only for 6 days and my tinittus increased and it def not related to my anxiety. I tapered off 3x7.5mg and after advice from Dr stopped it.

When I came off it last time, my tinnitus returned to base level.

This time however after 3 days of stopping this drug my tinituus has got very very loud now and stayed there. It is definitely mirtazaprne which is causing this dramatic increase. It is a withdrawal symptom. If this does not go down then thanks to mirtazapene as well as trying to manage my anxiety I may be faced with a life of continuous very loud white noise in my head which I will find very difficult to cope with.

I have suffered tinittus for the majority of my life and was able to cope with the base level which I hardly pay any attention to. I cannot distract from it now it's impossible which means it always going to be there forever in whatever I do and to be honest I not sure how I am going to cope.

From similar posts in this forum I get the impression this is not a temporary symptom that will simply go away.

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Originally Posted by StressedEric

This time however after 3 days of stopping this drug my tinituus has got very very loud now and stayed there.

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The tinnitus became worse 3 days after you stopped taking mirtazapine? It has a half-life of up to 40 hours so there's probably still a fair amount in your system at 3 days.

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It is definitely mirtazaprne which is causing this dramatic increase. It is a withdrawal symptom.

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Withdrawal is very, very unlikely after only 6 days at a low dose and as per above, you still have some of it in your system, however, just about anything can trigger, or worsen tinnitus and this can continue long after the trigger is removed. Plus there is much evidence that anxiety/stress can be a driver of tinnitus. A large percentage of those with tinnitus report being under stress when the symptoms began or worsened and up to 45% have a diagnosed anxiety disorder according to a recent study. It may be as high as 60% with depression. There has been a noticeable spike in tinnitus cases in recent years linked to the stresses of coping with the Covid pandemic.

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I have suffered tinittus for the majority of my life and was able to cope with the base level which I hardly pay any attention to. I cannot distract from it now it's impossible which means it always going to be there forever in whatever I do and to be honest I not sure how I am going to cope.

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Therapy would probably be your best treatment option, both for the anxiety disorder and the tinnitus.

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Originally Posted by panic_down_under

The tinnitus became worse 3 days after you stopped taking mirtazapine? It has a half-life of up to 40 hours so there's probably still a fair amount in your system at 3 days.



Withdrawal is very, very unlikely after only 6 days at a low dose and as per above, you still have some of it in your system, however, just about anything can trigger, or worsen tinnitus and this can continue long after the trigger is removed. Plus there is much evidence that anxiety/stress can be a driver of tinnitus. A large percentage of those with tinnitus report being under stress when the symptoms began or worsened and up to 45% have a diagnosed anxiety disorder according to a recent study. It may be as high as 60% with depression. There has been a noticeable spike in tinnitus cases in recent years linked to the stresses of coping with the Covid pandemic.



Therapy would probably be your best treatment option, both for the anxiety disorder and the tinnitus.

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It was 6x15mg and then 3x7.5mg so 9 days total. I am well aware of my base level tinittus as have had it for 40 years and have no problem living with it. This new level of tinittus is way beyond anything I have experienced before and its constant and has only occurred since withdrawing from this drug. My existing tinittus does vary in volume but it never remains constantly loud like this. This is unbearable. Please this is not my anxiety as it never gets this loud it never has done. Agreed stress can increase tinittus and it does go up slightly whrn I am anxious but I promise its never been this loud.
I know of other people have experienced exactly the same thing that I am experiencing when withdrawn from this same drug.