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Thread: Ever increasing venlafaxine, plus mirtazapine

  1. #21
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    Re: Ever increasing venlafaxine, plus mirtazapine

    Quote Originally Posted by panic_down_under View Post
    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.
    I was just about to say that, honest 😉

  2. #22
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    Re: Ever increasing venlafaxine, plus mirtazapine

    Quote Originally Posted by panic_down_under View Post
    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
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  3. #23
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    Re: Ever increasing venlafaxine, plus mirtazapine

    Sounds posative' I know what you mean about having anxiety in a different way' I can get really anxious at work due to the stress but kind of like it as once the work is calming down I get a feeling of relief and that relaxes me. Its different from the pure panic anxiety.

  4. #24
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    Re: Ever increasing venlafaxine, plus mirtazapine

    Quote Originally Posted by Dying_Swan View Post
    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.

  5. #25
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    Re: Ever increasing venlafaxine, plus mirtazapine

    Thank you panic down under. You know so much about this stuff and it's really helpful. I'm quite happy for the dreams to be temporary, I just hope the sleep effect of the mirt isn't. I'm terrified of it stopping working!
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  6. #26
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    Re: Ever increasing venlafaxine, plus mirtazapine

    Ok, I'm having some pretty wild mood swings. I feel like I can switch from high to low to high minute by minute, but I'm finding a really noticeable dip in my mood about 5pm. Tonight is the worst that dip has been, to the point I was scared and almost called 111. I take my 75mg immediate release Ven about 6pm (150mg XR in the morning). I told the psych about the 5pm decline which I think is why he said to take the mirtazapine every day, but I have done for almost a week, and it's getting worse. Anyone have any ideas?
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  7. #27
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    Re: Ever increasing venlafaxine, plus mirtazapine

    When you say scared do you mean scared of your low mood or something else ?.

  8. #28
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    Re: Ever increasing venlafaxine, plus mirtazapine

    Quote Originally Posted by Dying_Swan View Post
    Anyone have any ideas?
    You would probably do much better taking 3 x 75 XR daily, one when you get up, the second around 2-3 pm and the third just before bedtime. I found people do so even with the longer half-life ADs. I certainly do. Doctors don't like prescribing them this way because the more times folk need to take a med the more likely they are to stop taking it altogether - nine out of ten doctors agree medicine is an enjoyable occupation except for the $@#*%~^ patients (the other one has prescribed himself too much Haldol to care!).

  9. #29
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    Re: Ever increasing venlafaxine, plus mirtazapine

    Sorry Maca, yes I mean I was scared by my low mood. It lifted in a couple of hours but was horrible. Maybe aggravated by the hot weather :/

    Thanks panic down under. I will ask about it. I'm not sure why he put me on the XR at all and I really hope this 5pm business doesn't last. What would you think about 150mg in the morning and 75 in the evening, but all immediate release? Or do you think three times daily would be better?
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  10. #30
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    Re: Ever increasing venlafaxine, plus mirtazapine

    Quote Originally Posted by Dying_Swan View Post
    What would you think about 150mg in the morning and 75 in the evening, but all immediate release? Or do you think three times daily would be better?
    The trick with ADs is to keep plasma levels as constant as possible and 3 x 75mg XR would be more likely to do so, especially in your case where even the morning XR dose seems to be running out of steam by 5pm. It will likely to be even worse if you switch to 150mg immediate release which has a half-life of only 3-7 hours.

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