Page 1 of 2 12 LastLast
Results 1 to 10 of 11

Thread: Really struggling with sleep- any advice welcome

  1. #1
    Join Date
    Mar 2011
    Posts
    11

    Really struggling with sleep- any advice welcome

    Hi - I've been taking 15mg mirt for 10 days on top of 150 venlafaxine. Night waking has been an issue from some time and in the past this combination has worked well. But last night I woke at 2.30 with pounding heart and struggled to sleep again. Woke fully at 5am. Feel really awful today and somewhat despairing about mirtazapine sorting out sleep problem.
    I'd appreciate any words of encouragement or advice from anyone with similar experience.
    I've been off work for 4 weeks and meant to be going back next week but this now feels unlikely 😢
    Thank you x

  2. #2
    Join Date
    Jan 2017
    Posts
    1,686

    Re: Really struggling with sleep- any advice welcome

    Quote Originally Posted by biba View Post
    ...last night I woke at 2.30 with pounding heart and struggled to sleep again.


    ...I've been off work for 4 weeks and meant to be going back next week but this now feels unlikely 😢
    Waking with a pounding heart suggests you were woken by anxiety, or maybe a venlafaxine side-effect, not a mirtazapine failure. Mirtazapine is only a sleep aid, not an anaesthetic which will keep you under no matter what. Could concerns about returning to work be the trigger?

    Also I see your venlafaxine dose is double what it was when you last posted in 2016 and that back then heart pounding was also an issue. How long have you been on 150mg/day and do you take it as a single extended/slow release dose, or 2 x 75mg immediate release?

  3. #3
    Join Date
    Mar 2011
    Posts
    11

    Re: Really struggling with sleep- any advice welcome

    Thanks very much for your response and for cross-referencing with my last post. I have been taking 150 XL (single dose in morning) for roughly 7-8 weeks and slerp disturbance has been more pronounced since I increased. Maybe I should reduce ven to 75 and increase mirt to 30. Pdoc seems very sure that I shoukd remain on 150 and does not perceive this as the potential cause of night waking.
    I tried trazadone before and this got to to sleep but did not keep me asleep.
    Do you have experience of these meds?

  4. #4
    Join Date
    Jan 2017
    Posts
    1,686

    Re: Really struggling with sleep- any advice welcome

    Quote Originally Posted by biba View Post
    I have been taking 150 XL (single dose in morning) for roughly 7-8 weeks and slerp disturbance has been more pronounced since I increased.
    Sleep disturbances when first taking antidepressants or increasing their dose is fairly common. Fortunately, in both cases this side-effects usually diminishes after a while.


    Maybe I should reduce ven to 75 and increase mirt to 30. Pdoc seems very sure that I shoukd remain on 150 and does not perceive this as the potential cause of night waking.
    If 75mg wasn't effective before it probably won't be even with the addition of 30mg mirtazapine. Imho, mirtazapine is a reasonably good sleep aid (and great antihistamine), but a poor antidepressant. Nor does it boost the effectiveness of SSRIs much (despite the SNRI label, venlafaxine is just a SSRI). Buspirone (Buspar) would likely be a more effective booster. Also, the mirtazapine hypnotic affect drops as the dose increases so15mg is usually more sedating than 30mg.


    I tried trazadone before and this got to to sleep but did not keep me asleep.
    Trazodone is pretty good at initiating sleep, however, it has a much shorter effective half-life than mirtazapine so may not keep you asleep as long, although it compensates for this by being far less likely to be sedating into the next day. It is also often pretty good at easing some of the common SSRI side-effects, although doses usually need to be a bit higher than those commonly prescribed for sleep.

    Do you have experience of these meds?
    I have taken trazadone as an antidepressant at high doses, not a sleep aid, and found it too sedating even at 300mg. This was long before the extended release version became available which is much better at maintaining plasma levels above the sedation threshold. I wasn't on it long enough to draw any conclusions about its effectiveness, but should I need to switch from my current AD it is one of the two meds I'd consider as it usually produces few side-effects other than sedation.

  5. #5
    Join Date
    Mar 2011
    Posts
    11

    Re: Really struggling with sleep- any advice welcome

    Hi Panic_down_under - I found your previous replies really helpful and wonder if you can assist again. I'm trying to reduce the mirtazapine I've been taking for some months from 22.5mg to 15mg. I'm also prescribed 150 venlafaxine. I haven't been able to settle on this combination but when I try to reduce I feel awful after 3 days with reallt pronounced anxiety symptoms that seem disproportionate to the reduction. My doctor suggests it's the anxiety breaking through but I'm not convinced as I've coped well on much lower doses. Do you think it's likely the symptoms will ease over time or should I stick with current dose for longer?
    Thanks for your help.

  6. #6
    Join Date
    Jan 2017
    Posts
    1,686

    Re: Really struggling with sleep- any advice welcome

    Quote Originally Posted by biba View Post
    I've been taking for some months from 22.5mg to 15mg. I'm also prescribed 150 venlafaxine. I haven't been able to settle on this combination but when I try to reduce I feel awful after 3 days with reallt pronounced anxiety symptoms.My doctor suggests it's the anxiety breaking through but I'm not convinced as I've coped well on much lower doses.
    Although this is a significant 33% drop I'm surprised how quickly you're experiencing heightened anxiety given the mirtazapine longish half-life - 20-40 hours. It also has me wondering just how effective the venlafaxine is. How long have you been taking both meds?

    Do you think it's likely the symptoms will ease over time or should I stick with current dose for longer?
    Are you taking the 22.5mg as one and a half tablets? If do maybe try splitting the half tablet, i.e. taking ~18.75 mg, for 2 weeks and then if this goes well cutting back to 15mg. A pill cutter will make dividing the half tablet easier and more accurate.

  7. #7
    Join Date
    Mar 2011
    Posts
    11

    Re: Really struggling with sleep- any advice welcome

    Thanks for your response. I've managed to reduce the mirtazapine to 15mg without too many I'll effects. But now I'm waking very early and struggling to sleep again. I really don't want to increase the mirtazapine as again. Do you have any other ideas? Effective sleep aids? Melatonin? Ive been taking venlafaxine at 150 from around June this year.

  8. #8
    Join Date
    Jan 2017
    Posts
    1,686

    Re: Really struggling with sleep- any advice welcome

    Quote Originally Posted by biba View Post
    Do you have any other ideas? Effective sleep aids? Melatonin?
    Melantonin is worth a shot. The best treatment for SSRI/SNRI induced insomnia is small doses of the AD trazodone (Desyrel), however, I understand it is difficult to get a prescription for it via NHS GPs. It works the same as mirtazapine, but has a much shorter half-life so is less likely to still be sedating in the morning.

    Ive been taking venlafaxine at 150 from around June this year.
    Has the anxiety spike following the mirtazapine dose reduction subsided?

  9. #9
    Join Date
    Mar 2011
    Posts
    11

    Re: Really struggling with sleep- any advice welcome

    Thanks once again. Yes, anxiety spike was short lived but eatly waking is a problem. Do you think a sma'll increase in venlafaxine might help? Not sure GP would be happy to prescribe a third antidepressant! I'm wondering if sleep might improve once I've properly adjusted to lower dose...?

  10. #10
    Join Date
    Jan 2017
    Posts
    1,686

    Re: Really struggling with sleep- any advice welcome

    Quote Originally Posted by biba View Post
    anxiety spike was short lived but eatly waking is a problem. Do you think a sma'll increase in venlafaxine might help?
    Increasing the dose may worsen the insomnia so if the anxiety is being controlled then I'd hold off.

    Not sure GP would be happy to prescribe a third antidepressant!
    I meant replacing mirtazapine with trazodone if you can get it, not adding it. However, I've just realised you've tried trazodone before and it wasn't fully effective so it's probably moot.

    I'm wondering if sleep might improve once I've properly adjusted to lower dose...?
    Possibly. Mirtazapine ends to become less sedating as the dose increases, so could become more so as it decreases, but there are no guarantees.

Page 1 of 2 12 LastLast

Thread Information

Users Browsing this Thread

There are currently 1 users browsing this thread. (0 members and 1 guests)

Similar Threads

  1. Struggling need advice
    By Jem21 in forum Citalopram / Celexa
    Replies: 3
    Last Post: 06-04-15, 03:19
  2. Struggling and need some help/advice
    By Becbec89 in forum Symptoms
    Replies: 1
    Last Post: 03-10-14, 10:08
  3. Struggling with sleep
    By Cammy in forum Health Anxiety
    Replies: 3
    Last Post: 29-06-14, 05:55
  4. Anyone struggling to sleep
    By MissLady83 in forum General Anxiety / Generalised anxiety disorder (GAD)
    Replies: 51
    Last Post: 15-10-12, 20:18
  5. Advice please, really struggling.
    By rocklover in forum General Anxiety / Generalised anxiety disorder (GAD)
    Replies: 2
    Last Post: 13-08-08, 21:29

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •