Mirtazapine good for depression ?

[Lan69]

What dosage of Mirtazapine works best for depression?
I've been on 30mg since may last year. Improved greatly from the citalopram which was tapered off over a week after 10 weeks of hell. Found I was still struggling so my GP increased it to 45 mg. went downhill and crisis team psychiatrist introduced sertraline . I lasted 4 days I think and ended up back in hospital. The sertraline was tapered off and mirt reduced back to 30mg. The hospital psychiatrist introduced pregablin. After discharge the crisis team psychiatrist added quetiapine into the mix. So from September last year I have been taking a cocktail of 3 meds ( pregablin, mirt, quetiapine).
My anxiety has greatly improved I can get out and do things and the physical symptoms have nearly all gone. The problem is the mornings, I've struggled for a year with mornings at first it was anxiety related ( physical symptoms, shaking, hyperventilating, fast heart rate, churning stomach ) but now my psychiatrist thinks my morning difficulties are due to depression, my fear of the day ahead and feeling overwhelmed. She has increased my mirt back to 45mg so I'm currently taking
45 mg mirt
600 mg preg
100mg quetiapine
I know I'm waffling but I guess I just want to know if mirt is the one that will lift my depression as last time the increase made me worse

[Istherehope?]

I can't honestly say I know....like you I felt worse on the higher levels of Mirt. I suppose the only way to find out is to try but that really sucks when you're not feeling great already and worried about getting worse. After ten weeks on Mirt I had Venlafaxine added which made a huge difference to anxiety and depression. For me Mirt only really helped with sleep and if anything it made my mood worse.

Sorry to not be more helpful.

[Lan69]

I've read about that combination is it not referred as ' California rocket fuel' ?
I'm pleased it's working for you
I think I mentioned it to my GP last year but she said a psychiatrist would have to prescribe it and then I forgot all about it
It's awful all this trial and error when your not in a good place and having to wait weeks to see if it's going to work or not. If I could sort these mornings out I'd be good to go and get back to work

[Istherehope?]

Yes it is known as Californian Rocket Fuel and it has made such a difference for me. It was prescribed by a crisis team psychiatrist after I became suicidal on Mirt alone.

You're so right, the trial and error aspect is a nightmare. I used to get those terrible mornings too, overwhelming, relentless waves of dread and panic...it's truly horrible and I really feel for you...I really hope the mornings improve for you soon.

[Lan69]

Thank you
Can I ask did it take long for you to notice improvement ?
The increase in mirt also made me suicidal last time so that thought is in the back of my mind. I wasn't on pregablin or quetiapine then tho so they might make a difference.
Next time I see my psychiatrist I will mention 'rocket fuel' and see what she thinks of it as an option for me

[Istherehope?]

I went from 45mg Mirt to 30mg Mirt and 75mg of Ven. I noticed an improvement between 2-3 weeks but when it plateaued I increased to 150mg Ven. Again I noticed the improvement between 2-3 weeks and two months on I feel pretty much "normal". The Ven didn't seem to produce much in the way of side effects for me which was also a relief as I have also reacted badly to Citalopram in the past.

I can see why you're wary about increasing Mirt again, but I really hope the other meds make it a different experience for you. If it doesn't help though the rocket fuel might be another option.

[Lan69]

Oh I had a terrible time on citalopram... A nightmare infact. 10 weeks of hell, no sleep, not eating, constant adrenaline rushes. I couldn't leave my bed and needed diazapam to get me to doc appointments. Ended up in hospital for 2 weeks
It's so strange though as I had been on citalopram for a few years previously and they worked great but this time was a big no no
I know one thing when I do get sorted I will take whatever cocktail works and never come off them again

[Istherehope?]

Sounds like we respond in a similar way to some of these drugs - like you I had taken Citalopram previously and it had worked, but I couldn't go back on them - I think I only managed five weeks of hell before a crisis team psychiatrist took me off them. She won't prescribe SSRIs for me at all now.

And I agree, I don't ever want to come off my current combination and I really hope you find the cocktail that works very soon.

[Lan69]

I've been checking through the mirt threads and it seems a lot of people struggle at 45mg which isn't giving me much hope !
I hate it when I feel like this because I become obsessed about my medication, googling looking for other people's experiences and reassurance.... It does my head in

[Istherehope?]

Yes, the endless search for something that will tell us it's going to be ok...I was the same a few months ago...wish I could make it better for you