7.5mg and 10mg Cit - should I up dose to 15mg Mirt?

Hiya

I have been struggling with anxiety for many many years with regular visits to me drs. Eventually I was referered to see a p/doc - who i saw on 24th June.

He diagnosed me with GAD and, as I already take citalopram, put me on 10mg of cit and 7.5mg of mirt. ((I previously had tried upping the cit to 20mg but had bad side affects - my p/doc said that i am most likely sensitive to meds as 20mg should be easy for me to tolerate after the inital 2 week start up)).

From 24th June for a month I have felt wonderful - life has been a total joy and pleasure....in this month I was on holiday in Greece for 2 weeks without a care in the world. Hooray, I have been 'cured' and am now back in control.

HOWEVER, I am now back from holiday and since sunday night (back to work monday) my anxiety has come flooding back with avengence. I have had a really bad few days (mon / tues / and so far today).

so in the month since seeing p/doc I have felt fantastic for 4 weeks - but horrendous for the past 3 days.

is this because the 7.5mg of mirt has pooped, or just because coming back to work after hols is generally stressful and i have worked myself up to my bad thinking habits again...

should i ride it out and stay as I am - or up the mirt to 15mg....my d/poc said up the dose to 15mg if 7.5mg of mirt isnt working - but the thing is, is that the 7.5mg has been working - right up until the past 3 days (where I have come back to work after being on holiday).....tricky!!

Been bad all week and this week hasn't started much better. Come on guys - 58 'reads' and not one reply!

Not all the replies are "real" people - just so you don't feel you are being ignored.

Hi, I didn't want to read and run. Got no real advice for you but just wanted to say only YOU can make the decision!
It may well be that you have had a wonderful stress free time because of going on holiday and that the reality of going back to work has hit you with avengance. Why not see if you can ride it out for a few more days and if you're still really anxious see about uping to 15mg. You can always go back down to 7.5mg if you find 15 to high!

I am also on Mirt (15mg) and my Doc recently said about increasing it to 30mg as i felt they had stopped working for me which i did for a few days and they made me feel so bad (probably the side affects like when you first start taking them) so i have gone back down to 15mg! Am seeing my Doc tomorrow so will discuss with her what to do now!

Hope this helps you a little!
Remember you are not alone in this. There is lots of help out there. :)

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Originally Posted by Devonchap

I previously had tried upping the cit to 20mg but had bad side affects - my p/doc said that i am most likely sensitive to meds as 20mg should be easy for me to tolerate after the inital 2 week start up.

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I don't have experience with it so I don't know how realistic it is to keep upping the mirt, but that doesn't seem like a long term solution. Obviously you could go up to 15 on the mirt, but the question is how long before that poops out too? I would try to look at this is an opportunity to plot a long-term course with no fear of mirt pooping ;)

How about trying 10 mg escitalopram, rather than cit? Some people find that easier and it is sort of equivalent to 20mg cit, with fewer side effects for some people. I just transferred from 20mg cit to 20 mg escit and... so far so good.

thanks all

As the Mirt seems to poop quite quickly, I think I am going to try to increase the cot to 15mg - which hopefully I will tolerate better than the 20mg (which was awful last time i tried)....and stick on 7.5mg of mirt for sleep.

Does that sound sensible?

i am also trying to get step 3 CBT for longer term resolution!

Hi there. I'm on mirtazapine 30 mg. I think it did help me a lot to begin with. It brought me out of my low mood and quietened me down a bit if that makes sense. I was so agitated to begin with and it helped. I do want to just say though it didn't cure my anxiety and I do still have to work on myself. I think when you came back from holiday and felt bad again that was in a way to be expected. A lot of anxiety is memory and coming home probably brought past suffering back. Keep trucking on, bad days always pass. You are on a very low dose so maybe u could up it a bit. I couldn't tolerate ssris so I can't offer any advice there

Mirt doesn't poop quickly. Many people take mirt for years and continue to have real benefit.

It is common for people with anxiety to have blips of high anxiety even when taking medication. They may jump to the conclusion that the medication has pooped out. This is not necessarily the case. When you go through a blip you have to ride it out, it could last a day or several weeks.

Mirt can be taken as a high dose 30mg / 45mg or a low dose 7.5mg / 15mg.

The low dose works completely differently to the high dose.

Low dose: Sedating / calms you down

High dose: Stimulating / picks you up

Combined with an SSRI a low dose of Mirt will calm your nerves and the SSRI will improve your mood. A good combination.

Talk to your doctor, a higher dose is not necessarily better as it causes a different effect eg. from calming to stimulating.

CBT is the best long term solution

I take 45mg mirtazapine and 1,000mg lithium at night. I find the two in combo extremely sedating. I had always believed from my psychiatrist that the mirt was still sedating even at 45mg. It certainly helps me sleep. If the lower dose is helping with your anxiety then I would stick with that. I'm not sure whether the mirt is stimulating but I do work part time and also have a fairly hectic 'other' life. It keeps the gremlins at bay but I do not feel over sedated. I was taking 175mg of dothiepin as well at one time. That was really sedating!! EJ