Mianserin or Tolvon

[beautifulfreak77]

Hi my psychiatrist has offered me mianserin but I can’t find any reviews online it’s like it doesn’t exist, please has anyone here tried it? May of been called Tolvon in other countries....it’s making my anxiety high that I can’t find anything to do with this antidepressant, I know it’s an old antidepressant I just want some reviews....thanks for reading 🙂

[MyNameIsTerry]

There is a guy who posts on the Meds board called panic_down_under. He (Ian) knows tons about meds so I expect he can help you here. He knows a lot of TCA so I expect he can help with this.

[beautifulfreak77]

Okay thank you I will see if I can try and ask him then.

[beautifulfreak77]

Hi my psychiatrist has offered me mianserin or maybe known as Tolvon, I know it’s an old tetracyclic antidepressant but I can’t find any reviews online, i wrote on another thread and someone said to write here as a very nice man named Ian maybe able to help, but obviously if anyone else knows anything too It would be great to hear from you, thanks everyone....

[panic_down_under]

my psychiatrist has offered me mianserin but I can’t find any reviews online it’s like it doesn’t exist

Might be time to get a new psychiatrist. Mianserin is an old drug that was a mild sensation when first released until doctors, eventually, realised it was slightly less effective than sugar pills. The makers then slightly tweaked the chemistry and relaunched it as mirtazapine, which, imho, isn't that much better.

Is there a reason he's suggested this and not a SSRI, SNRI, or TCA? Have you tried them and not responded?

[beautifulfreak77]

Hi, oh right this doesn’t seem like it will be much help then. Psychiatrist offered these as I’ve tried a lot of antidepressants including mirtazapine, ssri’s Give me bad anxiety I have panic disorder with agoraphobia and GAD this was for my depression though as I have severe depression and no other antidepressants have helped a couple actually just made me feel very sick and numb, as if I didn’t even care or have feelings for people including my family. This is just getting more depressing as nothing is shifting this depression also I’d like the anxiety gone but at the moment I’m on diazepam for that. The last antidepressant I tried was Duloxetine can’t get passed the starting dose just made me ill. Thank you for your reply though someone said you’d be the man to know ��

[KK77]

Might be time to get a new psychiatrist. Mianserin is an old drug that was a mild sensation when first released until doctors, eventually, realised it was slightly less effective than sugar pills. The makers then slightly tweaked the chemistry and relaunched it as mirtazapine, which, imho, isn't that much better.

Is there a reason he's suggested this and not a SSRI, SNRI, or TCA? Have you tried them and not responded?

Which begs question as to why it's still on market and being prescribed, Ian

I think you should go back to psych and look at other options, OP.

Have you tried Venlafaxine as side effects are usually milder than Duloxetine? There are also Tricyclics like Clomipramine and Lofepramine which might be worth considering.

[panic_down_under]

Which begs question as to why it's still on market and being prescribed, Ian

Good question. I am surprised it still is. Haven't had anyone ask about it for years. If I remember correctly, most enquiries came from Italy and Cyprus for some reason.

Mianserin is better than mirtazapine in one respect, small supplementary doses - 15-20mg - may significantly diminish AD induced sexual dysfunction in about 60% of cases when taken daily. I don't know why, but mirtazapine is apparently much less effective as an adjuvant.

[panic_down_under]

Psychiatrist offered these as I’ve tried a lot of antidepressants including mirtazapine, ssri’s Give me bad anxiety

Unfortunately, antidepressants often worsen anxiety at the beginning. There is no real way of avoiding this, but it can often be kept at tolerable levels by starting at a low dose and ramping it up every week or so by the same small amount. I suspect you've been started on relatively high doses more suited to those with depression.

I have panic disorder with agoraphobia and GAD this was for my depression though as I have severe depression and no other antidepressants have helped a couple actually just made me feel very sick and numb, as if I didn’t even care or have feelings for people including my family.

Before SSRIs and SNRIs the 'gold standard' AD for panic disorder was imipramine (Tofranil). While the newer drugs soon replaced it this wasn't because they were more effective. Arguably they are less so. It is a pretty good anti depressive too.

This is just getting more depressing as nothing is shifting this depression also I’d like the anxiety gone but at the moment I’m on diazepam for that.

Diazepam may be worsening the depression. Anxiety and depression are symptoms of the same underlying biological disorder, atrophy of parts of the two hippocampal regions of the brain due to high brain stress hormone, mostly cortisol, levels which inhibits the growth of new brain cells. The hippocampi are one of only 2 or 3 areas of the brain where new cells grow (neurogenesis) and a constant turnover seems to be required to keep them functioning. Antidepressants and therapy turbo charge the growth of replacement cells. The new cells and the interconnections they forge produce the therapeutic response, not the ADs and therapy directly. This is why ADs takes weeks to become effective. There is good evidence [1] that benzodiazepines inhibit neurogenesis, however, at this stage this is of less importance than getting you onto an effective antidepressant.

The last antidepressant I tried was Duloxetine can’t get passed the starting dose just made me ill.

Duloxetine is often highly effective, but because it is inactivated by stomach acids there are no options for starting on a very low dose which I think is what you need to do.

Imipramine inhibits both serotonin and noradrenaline, aka norepinephrine, reuptake just as duloxetine does. The recommended starting dose for depression is 75mg/day, however, because it is prescribed at low doses for other indications such as diabetic neuropathy, it is also available in 10mg tablets and 25 mg capsules/tablets which makes it easy to start low and titrate up in small steps to the usual minimum therapeutic 100mg dose. While you would probably have few problems starting at 25mg I suggest taking only 10mg for the first 7-10 days if only to build confidence in the med.

[1]
Boldrini M, 2014; Nochi R, 2013; Sun Y, 2013; Song J, 2012;Wu X, 2009; Stefovska VG, 2008.

[MyNameIsTerry]

What dose of Duloxetine did you start on? For depression they prescribe 60mg but for anxiety they start at 30mg to reduce side effects. I found 30mg mostly caused nausea but 60mg was a nightmare to stick with so someone going straight onto that with anxiety could find it a bad experience.