Mirtazapine and Pregabalin for anxiety and nausea

[Hipha]

Hello. Reaching out for advice as losing faith in AD medications. I have had nausea for 18 months and 7 months ago was finally diagnosed with anxiety related illness even though I had never felt anxious. After trying Trazadone with Diazepam the nausea disappeared instantly so problem solved right? Wrong; as my tolerance to diazepam increased I found myself needing a higher dose of Diazepam so stopped and stayed with Trazadone for a few months but nausea persisted. Also growing Anxiety symptoms appeared so I was moved to Mirtazapine starting with 15mg. This had an instant positive effect on anxiety symptoms but nausea persisted. Increased to 30mg which I stuck with for almost 3 months with gradual slow improvement in anxiety and nausea symptoms. During this time I have not been able to work and desperate to return I asked to see my psychiatrist for a review. He upped my dose to 45mg which I was reluctant to go with but agreed. The increased dose did hit me hard at first but seemed to improve my nausea and anxiety further. However today after 2 weeks on the 45mg I suddenly have very high anxiety and flu like symptoms (fever, chills, aches). Will stick with it for a few days but difficult to accept these awful side effects. Psychiatrist has said that if 45mg does not work then we will try pregabalin alongside. Have read many good reviews of this and interested to hear how Mirtazapine and a Pregabalin work together?

[SmilingAlbert]

Hi Hipha,

I had nausea for a long time - had a load of stomach tests (incl endoscopy) and nothing really found.

Nausea proved to be all mental due to enormous work stress - I was literally worried sick. I was on Mirtazapine already, but adding Pregabalin (150mg, moved to 225 after a while) zapped the nausea within 24 hours. They don't have any negative indicated interactions, and seem to work well together. Quite a few on these boards are on both.

I would strongly suggest giving it a try, as it *should* give you your life back (I know exactly what it's like!) - let us know how you get on.

Albert

[hanshan]

Hi Hipha,

If you have flu-like symptoms, with fever, chills and aches, don't discount the possibility that you have actually caught a virus going round - none of those sound like common side-effects of mirtazapine, particularly after taking it for a while. A virus can also set off mood problems.

As for mirtazapine and pregabalin, I take both, and find they work really well together, so it's worth a try if mirtazapine isn't fully effective for you.

[Hipha]

Thank you for your replies.

I am now realising that my problems are more likely to be anxiety based than depression and so am hoping pregabalin will give me some relief. I am desperate for some relief from nausea and am looking forward to being prescribed pregabalin (assuming Mirtazapine 45mg does not suddenly relieve symptoms in the next 7 days)

My current symptoms whilst flu like are almost definitely not due to a virus. These symptoms have occurred a few times in the last 7 months usually when I am increasing dosage or coming off a medication. I did not mention that I had a severe reaction to sertraline 50mg with severe fever and nausea for 24 hours. Seems that I am sensitive to these meds.

I feel that Mirtazapine has helped improve my mood but apart from the first few days has not helped with my anxious symptoms and if anything has established anxiety where it did not previously exist.

My psychiatrist has prescribed pregabalin as the next medication so I do not expect any issues getting it. I asked my psychiatrist why this had not been prescribed at the beginning when diazepam had such an immediate positive impact removing my nausea overnight. He suggested that it is better to use a single drug rather than mix drugs, however I suspect that pregabalin is a 3rd or 4th line option after trying SSRI and SNRI options which is clearly based on price. Hopefully now that the patent has expired on pregabalin the price will drop and it will become a 1st line treatment for anxiety in the UK.

I will let you know how I get on in the coming weeks and months where I will hopefully finally find some relief from this horrendous situation.

Thanks

[SmilingAlbert]

Good luck with it - as I said, my experience is that it should help a lot. And yes, when Preg comes off patent it should make things a lot easier and GPs etc. will be more willing to prescribe it.

As Hanshan has said, the combination with Mirt can often be a good one. Please let us know how you get on - fingers crossed for you, as I know how awful persistent nausea can be...

Albert

[Hipha]

Hello

After having a good day yesterday, today I have anxious thoughts, feelings and symptoms (tight chest and sickly). Decided to try and see my GP early via the walk in clinic but after waiting for 1 hour gave up. I actually woke with anxious thoughts about going to see my GP and the day ahead which is new for me. My psychiatrist is clear that Mirtazapine could not be causing my anxiety but there seems to be lots of others on forums that have experienced anxiety especially when increasing dose. After 3 weeks on 45mg I am ready to drop back down to 30mg as I felt less anxious and sleep was much better on 30mg. I see my my GP at 2pm today but she is clueless and will not know what to do. I think the safest option is to introduce Pregablin alongside 45mg and 'see what happens' (3 words that I am now so familiar with!). Any thoughts?

[KK77]

I agree with Hanshan that nausea is likely due to high anxiety levels. I also agree that bumping up dose of Mirt to 45mg might actually be exacerbating it. I think Mirt is better for anxiety due to depression.

I take Pregabalin alongside Venlafaxine and find it helps with GAD. Perhaps ask to lower dose of Mirt to 30mg and introduce Pregabalin slowly?

[Hipha]

Thanks for your reply. I have been diagnosed with moderate depression back in November by my pschyiatrist although I did see him when I was coming off Trazadone 200mg and felt at my lowest point with extreme nausea and very low mood. I am thinking that my condition (and nausea symptoms) is similar to GAD or at least this was my original condition. After taking Trazadone and coming off it, the focus for my psychiatrist was my mood which I understand as I had depressive symptoms when I saw him. My mood is ok considering what I am going through. If the anxiety that I am experiencing now on 45mg is as a result of depression then what is Mirtazapine doing for me? Feeling lost. I will update you after seeing my GP.

[Hipha]

Quick update; saw my GP yesterday and we agreed to drop back down to 30mg of Mirtazapine from 45mg as this higher dose was making me feel very anxious for no reason and was finding it difficult to sleep. My GP also took the guidance of my psychiatrist and prescribed me 75mg of Pregabalin twice daily. Will start on Pregabalin once I am settled again on 30mg.

---------- Post added at 14:16 ---------- Previous post was at 14:05 ----------

I agree with Hanshan that nausea is likely due to high anxiety levels. I also agree that bumping up dose of Mirt to 45mg might actually be exacerbating it. I think Mirt is better for anxiety due to depression.

I take Pregabalin alongside Venlafaxine and find it helps with GAD. Perhaps ask to lower dose of Mirt to 30mg and introduce Pregabalin slowly?

Thanks KK2613. I agree with you. 8 months ago my friend suggested that my persistent nausea might be due to GAD and not due to a physical issue. My GP agreed and my journey began. Somewhere in the next 8 months I think we have lost sight of that first diagnosis as depressive symptoms have arisen as different meds were tried and discarded. Before taking these meds I was not aware of worrying about anything specific apart from the persistent nausea and finding and solving the root cause. Is it common with GAD to not be worrying about anything specific? My Psychiatrist mentioned that some anxiety sufferers are not aware of specific worries but that the brain is over thinking sub consciously resulting in anxiety. What is your story with GAD?

[hanshan]

Hi Hipha,

My take on GAD is that it is anxiety that comes out of nowhere, then actually looks around to find something to be anxious about. Most people have many things that they could be anxious about, but they just put them out of their mind. But for people with GAD, they are "anxiety magnets".