Re: Time to switch?
Originally Posted by
mct
was on mirtazepine 15mg for 2.5 months without any effect apart from somewhat better sleep.
to NMP,
I'm not surprised that you failed to get a response from mirtazapine. Despite what it claims on the box, it isn't a true antidepressant (AD), but a potent sedating antihistamine, i.e. it mostly works as a sedative. Plus, 15mg is only the usual starting dose. Most need to take 30-45mg/day to get a good response. The other issue with this med is that it is very prone to stop working, sometimes within just a few weeks. All that said, it can be a useful med to stabilize a downward spiral as it works quickly as a sedative.
Escitalopram was added 3 months ago and I have tapered the mirtazepine slowly to currently 3.75mg.
Did your doctor tell you to taper off mirtazapine and onto escitalopram that slowly, or was this your idea? Have you had previous issues starting/stopping ADs?
I started the escitalopram slowly beginning with 2.5mg. Within a few days I had marked nausea, insomnia and greatly increased anxiety/agitation.I slowly increased the dose so that in total I have been on 2.5mg 2weeks, 5mg 2 weeks, 7.5mg one week, 8.5mg 3 weeks and then 10mg for the last six weeks.
Why were you on 8.5mg for 3 weeks? Side-effects?
The rule of thumb on increasing (or decreasing) AD doses is to not do so more frequently than 5 times the half-life of the med which for escitalopram is 8 days. Raising the dose sooner may significantly worsen the severity of any side-effects, however, delaying dose increases won't significantly lower their severity no matter how long the delay.
Overall I still feel worse than before I started. The insomnia has improved to some degree (with added zopiclone) but the panic attacks on waking are just the same. The increase in anxiety has reduced but I am still plagued by unfocused, unpleasant anxiety till about noon every day - this was not the case before I started.The mild feeling of depression is, if anything worse, as I am now downcast at the failure of two drugs.
So instead of using mirtazapine to aid sleep you're now taking zopiclone? How often do you take it?
Have I given escitalopram a decent shot or should I give it longer at 10mg (8weeks, 12 weeks?)? If so any suggestions for what next? Thanks for your thoughts.
I don't know. ADs typically kick-in at between 4-12 weeks on a therapeutic dose which for escitalopram is usually 10mg plus. You've only been at that dose for 6 weeks, but there is also the 3 weeks at 8.5mg which probably should count for something. It comes down to how quickly you metabolise it. Given the amount of time and effort you've put into it already, I'd probably give escitalopram another couple of weeks.
__________________
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.