Fluoxetine and Mirtazapine

Hi All

I've been on and off ADs for about 20 years. Last September I moved from Mirtazapine to 20mg of Fluoxetine because I didn't feel the Mirtazapine was working as well as it should have been. Fluoxetine was the first AD i ever used and it worked really well, which is why i wanted to go back to it.

Over the following weeks and months my Fluoxetine dosage was increased and now I'm currently on 60mg of fluoxetine and 45mg of mirtazapine and I'm still not feeling as well as i know i should be.

There was a 2 week period at the beginning of February when i actually felt 'normal'. This was when the doc added 15mg of mirtazapine into my 60mg of fluoxetine for the second time. I felt 100% better but slowly, over the days and weeks, my mood has subsided. Subsequently my doc has increased the mirtazapine to 30 and now 45mg. I've been on 45mg for a week and my anxiety level is very high.

My doctor is a lovely man but i do feel as if he doesn't know what to do with me. I've asked if my surgery has a mental health specialist and they said "no".

Does anyone have any suggestions as to what might help me?

Any help would be very much appreciated. I am hopeful that i can find a medication that helps me, given that 2 week period of feeling fine, but i really don't think I'm there yet.

Incidentally, i've also started to practice mindfulness meditation and started running. I am very optimistic that both of these will be great as preventative measures but I need to feel well before i am able to embrace them wholeheartedly.

Thanks for your time.

Hi!

At what date did you increase your fluoxetine last? It might be that the last increased dose has not got into your system yet. I am on 17 weeks of fluoxetine with 9 weeks one day of that on 40mg. I also take 30mg mirtazapine. I feel awful. Deeply depressed, jittery, can't keep my eyes open, sick.

Hi Peachypips

My Fluoxetine was increased back in November so it's had plenty of time to work. I don't think it's working as it should, given that i'm maxed out on two separate pills.

Probably time for a change of tablet which is where i need advice if possible.

I hope things turn around for you. It's a delicate balance between cutting your losses and trying something else and seeing if it gets any better.

You're right- it should have worked by now. Have you seen any improvement at all? Im getting to the point where I think my meds aren't working too.

I had most success on Sertraline- stupidly I stopped it because I thought I was better, then couldn't take it the second time as it gave me chronic diarrhoea. Sertraline with Mirtazapine were my wonder-combo. Citalopram also worked for me but I was very lathargic on it. I may yet have to go back to it if this doesn't work.

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Originally Posted by jimmy_coma

Hi All

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Welcome to No More Panic, :welcome:

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I've been on and off ADs for about 20 years.

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Which antidepressants have you taken in the past, and are you taking anything else atm, including supplements?

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Last September I moved from Mirtazapine to 20mg of Fluoxetine because I didn't feel the Mirtazapine was working as well as it should have been.

Over the following weeks and months my Fluoxetine dosage was increased and now I'm currently on 60mg of fluoxetine and 45mg of mirtazapine and I'm still not feeling as well as i know i should be.

There was a 2 week period at the beginning of February when i actually felt 'normal'. This was when the doc added 15mg of mirtazapine into my 60mg of fluoxetine for the second time. I felt 100% better but slowly, over the days and weeks, my mood has subsided. Subsequently my doc has increased the mirtazapine to 30 and now 45mg. I've been on 45mg for a week and my anxiety level is very high.

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So an 'antidepressant' which had previously failed was added to the one that replaced it which also isn't working at the current dose? What could possibly go wrong...Sigh.

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I've asked if my surgery has a mental health specialist and they said "no".

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Is a referral to a psychiatrist not an option?

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Does anyone have any suggestions as to what might help me?

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The first thing I'd do is dump the mirtazapine. It is a very good antihistamine, more potent than many of those sold as such, but not a great antidepressant, imho. One of its biggest problems is that it is very prone to quitting, often within just a few months, and once it does it is rarely effective thereafter. It can also be quite stimulating at high doses which may be making things worse, especially as fluoxetine is also usually stimulating.

The second thing would be to up the fluoxetine dose to the recommended maximum 80mg/day. Some of us, e.g. me, just need a big dose to get the best out of a drug. And I'd be pressing for a referral to a psychiatrist.

Final point, it seems clear that your anxiety is chronic, so once you're stabilized on an effective med I suggest you stay on it permanently as there is growing evidence antidepressants become progressively less effective every time they are stopped and restarted, often requiring higher doses to achieve the previous level of control. They may also produce more severe, and/or different, initial side-effects. Two studies, Amsterdam JD, 2016 and Amsterdam, 2009 found the likelihood of antidepressants working after each restart drops by between 19-25% (see also: Amsterdam JD, 2009; Leykin Y, 2007). This applies whether returning to a previously taken antidepressant or a different one.

Thanks for your reply. I have briefly moved from fluoxetine to sertraline and citalopram in the past ( a few years ago) but the reason for that was mainly due to me trying to negate some of the fluoxetine side effects.

I will ask about a referral to a specialist on Friday when I see my doc.

I agree with you - I intend to stay on whatever medication ends up working for me this time.

The thing I don't get is the fact that I genuinely felt 'fine', 'normal' whatever you want to call it, for a good couple of weeks. It's so frustrating because it seems as if feeling better is simultaneously within my grasp as well as being tantalisingly just out of reach.

I feel exactly the same. I had two really great weeks on 20mg, and then it disappeared, after which I increased my dose to 40mg at 8 weeks. I'm just hoping that at 16 weeks on the increased dose I will be better. I'm on 9 weeks at the mo.

Fingers crossed for you.