Ever increasing venlafaxine, plus mirtazapine

[panic_down_under]

I know it acts differently at higher doses

Mirtazapine is mostly a very potent antihistamine at low doses blocking histamine H1 receptors which produces most of the sedation. It is also an antagonist (blocker) of serotonin 5-HT2a and 5-HT2c receptors which lengthens REM and slow brain sleep duration. At higher doses it enhances noradrenaline, aka norepinephrine, neurotransmission which is activating. The higher the dose the more activating it becomes.

[Dying_Swan]

Mirtazapine is mostly a very potent antihistamine at low doses blocking histamine H1 receptors which produces most of the sedation. It is also an antagonist (blocker) of serotonin 5-HT2a and 5-HT2c receptors which lengthens REM and slow brain sleep duration. At higher doses it enhances noradrenaline, aka norepinephrine, neurotransmission which is activating. The higher the dose the more activating it becomes.

Thank you, panic down under. That's really interesting. Is it also true that the lower the dose, the more sedating it is? And the longer REM sleep I guess is responsible for the weird and wonderful dreams?

I'm doing ok thanks. Up and down and feel a bit like I've reached a plateau, but it's a better plateau than the one I was stuck on a few weeks ago. I've been more anxious but in a strange way I feel like that's a good thing, as on 150mg I felt like I had no emotions. A bit of anxiety is more normal for me, if that makes sense

[panic_down_under]

Is it also true that the lower the dose, the more sedating it is?

Yes, mirtazapine is usually most sedating at the low end of the dose range as it doesn't need much med to saturate the histamine receptors, becoming less so as the dose increases and noradrenaline activity becomes stronger, however, antidepressant side-effects can be different from person to person so your mileage may vary.

And the longer REM sleep I guess is responsible for the weird and wonderful dreams?

Not sure if it because dreaming lasts longer, or because REM may not be as deep as before so dreams might intrude more into consciousness. I can't say whether the dreams are really more vivacious than before, or only appear so because we remember them in greater detail. Enjoy the ride as it can be temporary.