Mirtazapine and/or pregabalin

[mickonz]

I am in one of those med quandaries. Had major anxiety crisis earlier this year and , for reasons which are too dull to put here, i ended up on mirtazapine 30 and pregabalin 20. my side effects were insane, hallucanagenic dreams, terrible muscle cramping, forgetfulness, clumsiness, intense feelings, depressive/suicidal thoughts. I also wanted to eat everything. Having said that my anxiety did eventually go and my mood lifted.However because i took them both at the same time i did not know which effects to attribute to which.

Recently ( after about 6 weeks of being) on the full dose the eating, 'living dead feeling' , cramps were worse and people at work were noticing i was not functioning properly- kept losing things, forgot how to do simple tasks etc. Therefore my doctor lowered mirtazapine to 15.

Three days later and I had flu symptoms, vomitting, shaking and suicidal thoughts- generally very vulnerable and unstable sensation..

I dont really know what is going on or what to do for the best. i know Mirtazapine withdrawal can be pretty bad, and if so i would prefer to get off it before i become too dependent . having said that it may be the pregabalin that is the issue---i have no idea. Gp, though means well, seems to treat me a bit like a chemistry set.

So in summary i wonder if anyone has had similar experience and can confirm what is doing what. And also offer some advice on what they feel would be best to do. x

[karenp]

Hi, you def sound like you had Mirtazapine WD to me as I went through exactly the same symptoms coming off it. Each time you go down a dose the wd comes back but it does pass quickly.
You could see how you feel once you are totally off the Mirtazapine which made me much worse than before I ever went on it. Maybe the Pregabalin will be enough for you (:

[mickonz]

thanks Karenp. today the flu symptoms have gone but i deffo feel quite agitated and been having bad thoughts and have that horrible worry that it will never go. I suppose the dilemma is always 'is this WD or is this the symptoms the drug was keeping at bay'. could you let me know roughly how long, for you, it took before you felt settled again each time you reduced, and which increments you in dosage you took coming off. How long should i give it before deciding it is WD or relapse? i know it isn't the same for everyone, but it is good to get feedback from someone who has been through it. Its a shame really because I had high hopes for it as going on was way easier than SSRIs -and it did reduce my anxiety -it just makes me physically feel quite rough- and continued to after 6 weeks so...its always a dilemma. really appreciate your feedback at this time.

[ElizabethJane]

Pregabalin and mirtazapine work in different ways. Mirtazapine is primarily an anti depressant and is not so good as an anti anxiety drug. Pregabalin works in a different way and needs to be built up gradually in the body. It's off label use is to treat anxiety. I am on mirtazapine 45mg and have withdrawn from it twice. Pregabalin would not help with suicidal thoughts and is not an anti depressant. If you have only been taking the mirt for six weeks then the withdrawals will be short. I needed diazepam to get through mine. It did feel like the illness returning so if you can get through it you'll do just fine. If you are feeling really bad then see your GP ASAP.EJ

[mickonz]

thanks elizabethjane. part of the reason i am on both is because of a muck up in the system meaning i had two diagnoses from two different psychiatrists. One diagnosed GAD and prescribed pregabalin, the other depression with anxiety and prescribed mirtazapine. in the end they persuaded me to go on both. I didnt have any suicidal thoughts until i was put on the meds, then when i did i kept being told it was a side effect. This has made me understandable confused as to what is doing what, how much me, how much drug, how much WD. I suppose discoverng this is part of the journey. Thanks for that differentiation. Really helps. Could i ask how long you were on the drug for and how long your WD took.

[ElizabethJane]

Hi I am still taking mirtazapine 45mg and I am on it long term. I appreciate that mirtazapine does not suit everyone. I am also on lithium. I am going to have a meds review with my psychiatrist when I come back from my hols. I am currently stable. I have been told I will never be able to come off the lithium. I also took pregabalin briefly for pain relief. It worked but I felt numb and out of it. I would definitely take it again. I have diazepam for emergencies but I don't get many of those! I was also confused as to what was withdrawal from mirtazapine and what was not. It can cause horrendous withdrawals. I had no problems with withdrawal from pregabalin. Mirtazapine can cause suicidal thoughts but only if you are young. It alleviated my suicidal thoughts and primarily sorted out my low mood and insomnia. It does take four to six weeks to have any effect though.EJ

[hanshan]

With anxiety disorders, it's always difficult to know if you are getting either a recurrence of original symptoms, or withdrawal effects, when stopping or reducing a medication.

It's always best to go very slowly if you suspect withdrawal effects (or as suggested have a short-term back-up like diazepam).

Withdrawal effects will subside, but a recurrence of original symptoms will persist.

You say you are on pregabalin 20. Is that 20 mg a day? If so, that is a low dose and could be increased.

[mickonz]

yes, sorry that should have been 200

[karenp]

Mirtazapine never helped my anxiety at all apart from the first couple of weeks when it just took it totally away and I thought it was a miracle drug as it made me sleep so well too. But then I started just feeling totally depressed and cried every single day, the depression got so bad I used to have to go and walk every morning for an hour just to feel a it better and then the anxiety came back really bad. I stayed on it 7 months at different doses as my doctors kept saying it would eventually kick in but it really did not do for me, I too had the suicidal thoughts though I knew they were only ever that. I ended up contacting the crisis team to get me off the thing and my Wd used to last about 3 or 4 days each time I dropped a dose and I went down very slowly, like only a quater of a pill each week. I wasn't good when I was totally free of it but was so much better without it and wen ton Escitalopram in November which I was terrified to do as I'd had a hard time on Citalopram and other SSRI's before and after the nightmare with Mirtazapine, I was totally scared of ad's but I have wonderful doctors who have given me Lorazepam and sleeping pills to help get through any side effects and personally for me, Escitalopram has been much kinder to start up, I'm not there yet and upping my dose at the mo but most days I feel 95% normal again, it's just early mornings for me now, where a son Mirtazapine I never had ay good days and don't know how I got through those 7 horrible months. My doctors wouldn't prescribe Pregabalin so I've never taken it. Really hope you feel so much better soon and the Mirt WD is soon forgotten I promise xxx

[hanshan]

Hopefully you can cycle down from the mirtazapine, and see if pregabalin is working for you.

It's possible to increase pregabalin up to 600 mg a day, though you should be noticing an improvement by around 400 mg a day.