mirtazapine alternatives?

[solitarymonkey]

to keep this short, i've been on mirtazapine since october, and was on citalopram before that. I've started to feel depressed alot again lately, and fed up of constantly wanting to eat because of the meds side effects. I'm due to see my therapist soonish, and was wondering what alternatives to mirtazapine people might be able to suggest me asking to get changed to? Thanks

[jim_morrison]

Were you put on mirtazapine because insomnia is a component of your depression/anxiety?

[solitarymonkey]

No, it wasn't for insomnia or anything. I had one of those "enlightenment" moments and fell hard into a bad depressive episode and they wanted to see if a change in meds would work. But my mum thought that the increased appetite and sedative effects would be a good thing (after I told her about the meds and moved back in with her when it all went down). I'm now on 45mg (and have been for a while now), so that side effect is long gone. I just don't want to keep putting on the weight because I just want to keep eating. I actually think that it's having a part to play in my depression cycling like this again. It's not good.

[jim_morrison]

Ok, well since your depression hasn't responded to citalopram or mirtazapine, I'd suggest asking your doctor if you can switch to Effexor since it's from a different class of antidepressants to the previous two that you've tried.

[solitarymonkey]

I'll have to jot that down and take that with me when I find out when my next appointment is. Thank you! Is there anything else you might recommend discussing with them?

[jim_morrison]

No worries, are the meds mainly for depression? or are there other problems like social anxiety, OCD, panic attacks, or anything else like that?

[solitarymonkey]

Mainly just depression. But I was diagnosed with social anxiety last year (which lead to my citalopram prescription), but I now believe it to be more accurately avoidant personality disorder. I believe there may be a slight possibility of bipolar (one of the less severe diagnosises like cyclothymia?) But doctors always seem to shrug that one off. Probably because I can't prove the hypomania (can never remember any examples). The anxiety and depression are really all I need help with, as everything else stems from them. Not sure if that answered your question as my concentration keeps bouncing about at the mo. Lol.

[Dr House]

Id suggest Cymbalta over Effexor XR, cause of the terrible withdrawals and short half life of Effexor XR. Both are SNRIs though Cymbalta can be pricey if you don't got insurance.

[Himi Jendrix]

I was on prozac after trying mirtazapine cause I gained 30 lbs in 30 days. Keelp in mind I tried every other SSRI to that point.

The prozac ended up giving me hypomanic or something to that effect and now I live independantly and have 4 jobs. Its pretty cool so I guess it works.

It seems like many docs regard prozac as the Atypical SSRI as it has different effects from the others.

[jim_morrison]

Originally Posted by solitarymonkey

Mainly just depression. But I was diagnosed with social anxiety last year (which lead to my citalopram prescription), but I now believe it to be more accurately avoidant personality disorder. I believe there may be a slight possibility of bipolar (one of the less severe diagnosises like cyclothymia?) But doctors always seem to shrug that one off. Probably because I can't prove the hypomania (can never remember any examples). The anxiety and depression are really all I need help with, as everything else stems from them. Not sure if that answered your question as my concentration keeps bouncing about at the mo. Lol.

Ok, yeah if it's primarily depression and anxiety (social/general) then I'd definitely recommend Effexor XR.

[jim_morrison]

Originally Posted by Dr House

Id suggest Cymbalta over Effexor XR, cause of the terrible withdrawals and short half life of Effexor XR. Both are SNRIs though Cymbalta can be pricey if you don't got insurance.

Personally I'd favour Effexor XR over Cybalta for the following reasons;

1. Cymbalta is potentially liver toxic, Effexor is not.
2. Effexor is stronger (probably due in part to the fact that it has an active metabolite desvenlafaxine which also acts as an SNRI) Cymbalta by contrast lacks any active metabolites.
3. The XR version should route out the half life problem, for me it takes approximately 30 hours for withdrawls to start kicking in. Cymbalta also has a short half life and comes as a controlled release formula, so it offers no benefit over this.
4. effexor has a more favourable drug-drug interaction profile, due to it's lack of inhibition of CYP enzyme system and it's low protein binding. Cymbalta by contrast is highly protein bound and is an inhibitor of certain CYP enzymes.
5. Effexor is cheaper due to the fact that generic versions are available.
6. Effexor has been around for alot longer, and hence there is alot more medical and clinical experience with it and it's possible long term outcomes and effects. Cymbalta by contrast is relatively new.

[crayzyMed]

Cymbalta is toxic garbage, mejay here got liver damage from it.

[solitarymonkey]

thanks for all the advice, guys! it's very much appreciated! as long as i have some thing to walk into my next doctors appointment with did some research into them, and the effexor definately sounds the least scary! lol. but it all depends on what the doc says.
thanks! ^_^

[sidekick]

FWIW, I was first put on Prozac for depression. It helped a bit. Tried Remeron/mirtazapine next... worst thing EVER. I will never take it again. Then I was put on Zoloft. Stayed on it for about a year and a half, then stopped taking it because I was "cured". Started back up on it about a year ago, after a 4 year lapse. Still works for me. It seems to have helped with SA a bit, although that may be at least in part because depression is a catalyst for SA, and if I'm not depressed SA isn't as much of a problem.

[lionheart]

Hmmm They say getting depressed after a meditation session can be seen as a good achievement. I was 4/5 years on mirt and yes you get depressed on it after a while, in my case even more so than your normal state, drug induced depression. i swithced to lexapro and depression is gone completely and im more social and talkative. The mirt drowsiness is just wrong, feel sleepy even with 9 hours sleep still!! that one is gone now but i got some libido problems on lexapro, its a choice to make what is more imoprtant now, feeling good for now sure is. Mirtazapine does help with meditation greatly i opened my 3rd eye in a couple of months and got in touch with the white bright light, awesome expirience. Now when i quit mirt and on lex i do get lot of pineal gland stimulation, i havent done meditation in a while but when i close my eyes my 3rd eye opens emmidiately, a little strange.

[jim_morrison]

Originally Posted by lionheart

I was 4/5 years on mirt and yes you get depressed on it after a while, in my case even more so than your normal state, drug induced depression. i swithced to lexapro and depression is gone completely and im more social and talkative. The mirt drowsiness is just wrong, feel sleepy even with 9 hours sleep still!!

Yeah, I also did find that when I used to be on a high dose of mirtazapine I felt more depressed, mostly I think because the sedation was too heavy & just made me feel crappy all of the time. I take a low dose now for insomnia, but I try to keep my mirt dose as low as possible.

[lionheart]

Originally Posted by jim_morrison

Yeah, I also did find that when I used to be on a high dose of mirtazapine I felt more depressed, mostly I think because the sedation was too heavy & just made me feel crappy all of the time. I take a low dose now for insomnia, but I try to keep my mirt dose as low as possible.

yes, anything above 7.5 mg made me drowsy, in my case the higher the dose the higher the drowsiness

[Dr House]

Originally Posted by crayzyMed

Cymbalta is toxic garbage, mejay here got liver damage from it.

I never got liver damage from it nor any other drug. I've taken over 14,500 pills in the past 5 years too and my blood tests show my liver is fine. I get blood tests on average 3 times a year. Liver damage is prolly a really rare side effect. Simple blood tests can check for liver problems.

[jim_morrison]

Originally Posted by lionheart

yes, anything above 7.5 mg made me drowsy, in my case the higher the dose the higher the drowsiness

Yeah I find the same, with mirtazapine higher doses give me more pronounced side effects. On higher doses I could easily have just ate and slept all day every day lol.

[solitarymonkey]

turns out that I've missed my appointment with the therapist I opened the Letter 3 days after the appointment was due. Damn phobia of letters! Thanks for all your advice guys! I'll Jot down all your suggestions for discussion with the therapist when to get it reshechuled. cheers!