Dropping Mirtazapine Dose

[fishman65]

Just wondering if anyone has dropped their mirtazapine dose from 45mg to 30. I'm on venlafaxine too. I started having episodes of sleepwalking and put it down to the mirtazapine, hence the reduction.

While I'm having fewer bouts of the night time wandering, I've noticed some increased lows during the day. This morning's was the sharpest yet and scared me, so I think the dose will have to go up again.

[spectrum123]

I did drop from 45mg, but at the time I was using a 30+15mg tablet to get to 45, so I halved the 15 to drop to 37.5 then down to 30. I didn’t have any issues dropping the dose that way.

[fishman65]

OK thank you for that Spectrum. The tablets I've always been prescribed are 30mg, so I've always used another half tablet to get the 45. If I drop down again I'll do it more gradually.

[panic_down_under]

While I'm having fewer bouts of the night time wandering, I've noticed some increased lows during the day. This morning's was the sharpest yet and scared me, so I think the dose will have to go up again.

Despite what is says on the box, mirtazapine is not a true antidepressant, but a sedating antihistamine. It is usually most sedating at the lower end of its recommended dose range becoming less so as the dose increases. This may explain the low mood after dropping to 30mg/day. The lows should ease as the body adapts. If it doesn't increasing the venlafaxine dose may help. How much are you on?

fishman's advice to reduce the mirtazapine dose in 7.5mg steps is spot on.

[fishman65]

Ven is 150mg

[panic_down_under]

Ven is 150mg

Then you have considerable 'headroom' to increase the dose. Venlafaxine only begins acting as a SNRI, i.e. inhibiting noradrenaline, aka norepinephrine, reuptake at doses of about 225mg and up, albeit still only weakly. The maximum dose is 375mg/day for healthy adults.