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Thread: Considering Mirtazapine - need advice

  1. #1
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    Considering Mirtazapine - need advice

    I have suffered from GAD for over 10 years now. I also suffer from moderate tinittus and have done nearly all my life. In the past I have taken Citalopram which helped greatly with the anxiety.
    Two months ago I felt I started back on Citalooram again but then came off it as it increased my tinnitus to unbearable levels. This didn't happen the last times took it in past. I know this can be a side effect of SSRIs and read that sometimes the increase can be permanent so was glad I stopped.

    I have tried unsuccessfully managing my anxiety since without medication and the anxiety has increased to a point that it becoming unbearable and desperately need help. I finding it difficult to function.

    I researched Antidepressants which have low chance of increasing tinittus and only one I found was mirtazapine.

    I understand this can help with sleep but also with anxiety. I just want advice from anyone who has taken it who have generalised anxiety disorder and experiences from anyone who has tinittus and taken it.

    I would really appreciate any help at all anyone can give me. I am desperate for solutions. I haven't found any other medications that could help with the anxiety but not raise my tinittus.
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    Re: Considering Mirtazapine - need advice

    Quote Originally Posted by StressedEric View Post
    I researched Antidepressants which have low chance of increasing tinittus and only one I found was mirtazapine.
    But tinnitus is a listed potential side-effect so there are no guarantees.

    I understand this can help with sleep but also with anxiety.
    Mirtazapine is more a very sedating antihistamine than antidepressant which eases anxiety mainly by sedation.

    I haven't found any other medications that could help with the anxiety but not raise my tinittus.
    Just because citalopram worsened your tinnitus doesn't necessarily mean all SSRIs will and they are likely to be a better long term bet for anxiety than mirtazapine. So would the older TCA ADs which are often prescribed to treat tinnitus triggered anxiety/depression.
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  3. #3
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    Re: Considering Mirtazapine - need advice

    I have been given script for 15mg mirtazapine from GP. If I do decide to start it, I was thinking of starting 7.5mg then go up to 15mg. Is it safe to half the 15mg tablets. I am very sensitive to med changes so just want to ease myself in.

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    Re: Considering Mirtazapine - need advice

    Quote Originally Posted by StressedEric View Post
    I have been given script for 15mg mirtazapine from GP. If I do decide to start it, I was thinking of starting 7.5mg then go up to 15mg. Is it safe to half the 15mg tablets. I am very sensitive to med changes so just want to ease myself in.
    You could halve the tablet, but you probably don't need to as mirtazapine's main side-effect is sedation and you will probably won't feel much difference between taking 7.5mg and 15mg. It could even be a little more sedating at the lower dose as sedation usually decreases as doses increase.
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    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

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    Re: Considering Mirtazapine - need advice

    I have been reading more on Mirtazapine and reports that it one of the most difficult AD meds to come off in terms of the severity of the withdrawal syptoms? I am nly thinking of if I find it not working for me what would be the safeest way to come of it and what period of time should the tapering be and peoples experiences of the withdrawal. I am just getting as much imformation before I start it or if I consider another AD first before considering it.
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    Re: Considering Mirtazapine - need advice

    Quote Originally Posted by StressedEric View Post
    I have been reading more on Mirtazapine and reports that it one of the most difficult AD meds to come off in terms of the severity of the withdrawal syptoms?
    I urge you not to go down that rabbit hole as such reports are highly biased. They represent the relative few who do have issues, not the majority who don't and thus have no reason to post about it. Plus withdrawal isn't always down to the med. Psychology is at least as potent a generator as chemistry and probably more so for those with anxiety. Convince yourself that you will suffer greatly and an anxious mind is very capable of delivering your worst nightmare.

    I am nly thinking of if I find it not working for me what would be the safeest way to come of it and what period of time should the tapering be and peoples experiences of the withdrawal.
    Mirtazapine is more a strong sedative than antidepressant and the main withdrawal symptom is usually rebound insomnia. Cutting back the dose in 7.5mg steps every couple of weeks will usually minimise this and any other symptoms.

    I am just getting as much imformation before I start it or if I consider another AD first before considering it.
    You shouldn't need to wean off it completely before switching to another AD as there are no significant interactions, even with MAOI class ADs which do require a washout before switching to/from them from other ADs. Mirtazapine is sometimes prescribed to ease SSRI induced insomnia, although, imo, immediate-release trazodone is the better med for this.
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  7. #7
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    Re: Considering Mirtazapine - need advice

    Took the first 15mg Mirtazapine tablet last night. Within about 15 minutes r so of taking it felt groggy (which I expected) but my tinittus level increased suddently and quite dramatically. I was surpised how quick the tinittus level increased as imagine it woud take longer for the drug to make any of an effect. It has remained loud since. The only reason I wanted to go on this med was that it not reported to incudce tinittus and it is not listed as a side effect in the patient leafet.

    I called GP this morning and basically got two choices: stop it now and see if the level goes down to base level or stay on it for a few more days and hope it goes down. I undertand that the longer I stay on it there could be withdrawal symptoms coming ff it and even make the raised level permanent. I would imagine if stopped it after a few days I dont need to taper off it.

    This is the quandary that I am in now. Anybody got advice?
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    Re: Considering Mirtazapine - need advice

    Quote Originally Posted by StressedEric View Post
    Took the first 15mg Mirtazapine tablet last night. Within about 15 minutes r so of taking it felt groggy (which I expected) but my tinittus level increased suddently and quite dramatically. I was surpised how quick the tinittus level increased as imagine it woud take longer for the drug to make any of an effect.
    If the tinnitus flared in 15 minutes or so I don't think it was the mirtazapine as it typically takes 30-60 minutes for plasma levels to begin building, longer if taken with food. On an empty stomach peak plasma level is reached in around 2 hours.

    I'm wondering if there isn't a significant psychological component to it. Did the ringing diminish after a while, or is it continuing?
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  9. #9
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    Re: Considering Mirtazapine - need advice

    The tinnitus stayed at that level all day. I persevered and i took another 15mg tablet last night and when woke up, the tinittus was louder still than previous day and so far it has remained at that level. I am still thinking of stopping the med and hope that the level goes back down. If i stop after just 2 days I assume that I will not have to taper off it before stopping. I know this particular med gets into the system quickly. I want to avoid any withdrawals.
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    Re: Considering Mirtazapine - need advice

    It will takes some weeks to develop dependency so there won't be any issues quitting after 2 days.
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    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

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