Just Wondering

[Redsmum]

I’m on day 7 of Citalopram & my sleep is rubbish, woke at 4am shaking & constantly thinking & that was with the help of 0.5mg Lorazapam! I read on the Citalopram sticky that Mirtazapine is brilliant for helping you sleep, does anyone know if you can take that with Citalopram, should i ask Dr for that as well. Any thoughts/knowledge would be much appreciated. Thank you.

[panic_down_under]

I’m on day 7 of Citalopram & my sleep is rubbish, woke at 4am shaking & constantly thinking & that was with the help of 0.5mg Lorazapam! I read on the Citalopram sticky that Mirtazapine is brilliant for helping you sleep, does anyone know if you can take that with Citalopram, should i ask Dr for that as well.

Yes, mirtazapine can be taken with citalopram and it is a better 'sleeping pill' than lorazepam, imo. It is usually quite sedating at low doses <=15mg, becoming less so as the dose increases. I'd try half a 7.5mg tablet initially.

[Redsmum]

Yes, mirtazapine can be taken with citalopram and it is a better 'sleeping pill' than lorazepam, imo. It is usually quite sedating at low doses <=15mg, becoming less so as the dose increases. I'd try half a 7.5mg tablet initially.

Thanks so much for replying, will definitely speak to dr.

[panic_down_under]

Thanks so much for replying, will definitely speak to dr.

If your GP is not up to speed on ADs you might get a flat no because of nonsense like this NHS Guidance (PDF) warning about the risk of serotonin syndrome/toxicity (SS/ST) when combining SSRIs and mirtazapine.

That it is nonsense isn't my opinion, but that of one of the two leading SS/ST experts, Dr Ken Gillman who used to spend a large part of his semi retirement trying to correct this misinformation until the futility of it all became overwhelming (he details some of it here):

As I have pointed out before, drugs like bupropion and mirtazapine, that have no significant serotonergic activity, are no more likely to cause ST than is vitamin C. This scenario has already been enacted, over a decade, with the antidepressant mirtazapine, which was claimed, erroneously, to have serotonergic activity. Many poor quality case reports of ST with mirtazapine were published. This probably led to misdirected treatment of overdoses, some of which may have caused morbidity. It took several reviews to correct this error and establish that mirtazapine cannot cause ST

PK Gillman, 2010 PDF. See also: A systematic review of the serotonergic effects of mirtazapine in humans

And lest there be any doubt, the other leading expert, Ian M. Whyte, whose team at the Hunter Toxicology group wrote the SS/ST diagnostic criteria now used world wide to diagnose SS, agrees (note: 5-HT=serotonin):

In some cases this has led to reports of serotonin toxicity for drugs that, from well-defined receptor binding studies, are unlikely to cause increased levels of CNS 5-HT. Important examples include the 5-HT2A receptor antagonist olanzapine and the 5-HT receptor antagonist mirtazapine.

Dunkley EJC, et al, (2003), The Hunter Serotonin Toxicity Criteria, QJM, Sept, vol 96(9):635–642

Moreover, mirtazapine is a serotonin 5-HT2a receptor antagonist (blocker) which can prevent the body temperature spike which does the damage in SS/ST although in humans the recommended treatments are the more potent 5-HT2a antagonists cyproheptadine and chlorpromazine.