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Discussion Starter · #1 ·
So I finally got my doctor to prescribe me another type of anti-depressant. The only other one left was Mirtazapine. I was a bit reluctant at first because the weight gain side-effect I've read about scares me a little, but in the end I decided that I'd rather just feel better, so I decided to go on it.

So my dose of Effexor has been dropped to 37.5 mg from 75 mg for 4 days while I take 15 mg Mirtazapine as well. For the first day doing this while only taking 37.5 mg from 75 mg of Effexor I felt pretty fine, no adverse effects, no withdrawals, nothing. So then in the evening I took my Mirtazapine like I was supposed to, and then for some reason I had the worst reaction I have had to any med ever. First I felt really sleepy, which was expected, then as I drifted to sleep one leg started getting restless while the other was fine. So at the point I couldn't sleep, but I needed to. Then, as I tried to get to sleep because my restless leg was preventing me, I had the weirdest, most drugged up type of feeling I have ever had. I felt like I was hallucinating, getting extremely bad negative thoughts (Horrible images in my head, that were terrifying). I was freaking out, but there was nothing I could do, I was too drugged up to do anything. In the end, I did fall asleep, and when I woke up it was 15hrs later... All day today since waking up, I have been feeling the most depressed, and suicidal I have felt in a long time. Everything I just seem to think and feel is negative, and amongst this I am irritable and bad tempered.

I just don't know what to do. Shall I keep taking the mirtazapine or do I just stop? This reaction is only after one dose, so I'm thinking for the sake of my sanity, about not taking it... But at the same time, part of me thinks it might all go away in a few days when I keep taking it and more of it is in my system. However I am struggling to rationalise taking it further while I feel so bad. I hope that makes sense.

So I'm in a tricky situation, and any advice about this would be greatly appreciated.
 

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since they are different types of antidepressants it seems you need an AD free wash out period of about 10 days to get the effexor out of your system

also the new AD starting dose may need to be lowered for a while

many anxiety sufferers have severe reactions or side effects to new antidepressants, which sadly some docs wont accept
 

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Discussion Starter · #3 ·
I've been on 5 different medications over the years, and never have I EVER had this type of reaction.

It isn't because I am anxious or whatever either. There is an actual DIFFERENCE. I went into starting this med very positive and actually happy at trying something else. Then I took it, and then I had this strange reaction. I could understand if I was anxious or apprehensive to begin with, but I wasn't. It's like it messed something up in my head. It actually induced depression rather than helping it.

Understandably I am reluctant to take it now because I don't want to risk feeling this way again.
 

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Discussion Starter · #5 ·
I didn't take it last night, and already then felt mildly better. However today, I still feel depressed and suicidal, so either mirtazapine just added the final touch and/or I am already feeling that way due to reduced dose of Effexor.

I tred to contact my doctor today, but I was told the earliest time I could be seen was next week. What a crock of ****.
 

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Those results are common with Mirtazapine. If you can't handle its effects then I would completely wean off of Effexor before restarting treatment.
Wikipedia said:
Mirtazapine has mild psychedelic effects which are occasionally encountered by some of its patients. Reports include vivid, bizarre, or even lucid dreams, and auditory and visual hallucinations. These effects tend to be most prominent upon first commencing treatment and usually dissipate with time.
Wikipedia also lists agitation and Restless Legs Syndrome as side effects, but after the list containing both of them it mentions that "Most of these side effects are generally mild and become less prominent with consistent dosing over time."

Your depression and suicidal idealization are being mediated by the Effexor tapering, at least that's the most likely rationale for them.
 

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Discussion Starter · #8 ·
It could well be the Effexor, but I felt that the Mirtazapine worsened the effect. I'm now on day 2 of the reduced Effexor (at 37.5mg) and I didn't take Mirtazapine last night, and already I feel better. I still feel depressed and suicidal but it slightly less extreme, plus I don't have other crazy effects from when I first took Mirtazapine.

Despite everything that's happened, I think I'm going to try and persevere with the Mirtazapine. I just hope, I get better. Tonight I'm gonna take it and I pray that things are slightly better this time round. I've never felt so bad on any medication ever before so this reaction is quite surprising.
 

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It's hard to say exactly what caused you to feel so bad; it was probably a combination of coming off Effexor and the side-effects of mirtazapine. You might want to try mirtazapine again once the withdrawal has passed, as then you'll get a clear view of its positives and negatives.
 

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Discussion Starter · #10 ·
Ok, so this may seem really weird, but on the second day of taking Mirtazapine I felt like I hadn't even taken it... I had no drowsy effects, no depressed or suicidal feelings, nothing. The only thing that is starting to kick in is the withdrawals, as today I'm getting brain zaps, dizzy spells, etc - all of which are definite signs of Effexor withdrawal.

Despite all that is happening or that has happened, today for the first time in what seems like ages, I'm starting to feel brighter and generally less apathetic towards everything. I actually enjoyed watching a movie today, which is something I haven't done in quite a while. Most of the time before, watching a movie felt like I was just watching a moving image onscreen and nothing more - this all while I was on SSRI/SNRI's. So that to me shows how much they affected my ability to enjoy and be engaged into things, which is something I was severely lacking. Either that, or I have been severely depressed for a long time and not realised it, and I'm just starting to feel better. Who knows.
 

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Discussion Starter · #11 ·
Also, I'm starting to notice a trend. I'm on 15mg which I take at night, and for the first few nights it knocked me out, but now it doesn't fully knock me out. I don't really get tired at all or anything. I still sleep sure, but I have no problems getting up in the morning or anything, which I was kinda expecting, since I had this problem on SSRI/SNRIs. Weird.
 

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I still sleep sure, but I have no problems getting up in the morning or anything, which I was kinda expecting, since I had this problem on SSRI/SNRIs. Weird.
Mirtazapine enhances REM sleep, while SSRI/SNRI's decrease it. So even though Mirtazapine can make you sleepy immedietly after taking it due to it's sedative nature, I find it makes you less tired/fatigued overall because you get a better and more natural quality of sleep every night.
 

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Discussion Starter · #13 ·
Yeah, I kinda figured that. But I still don't get why it doesn't knock me out like it's supposed to. Last night I took it at 12am and I didn't sleep until around 3am..
 

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Yeah, I kinda figured that. But I still don't get why it doesn't knock me out like it's supposed to. Last night I took it at 12am and I didn't sleep until around 3am..
You may have to up the dose to 30 mg, anything less than that doesnt knock me out.
Also it tends to take about 2 hours to kick in usually, so try taking it earlier in the night.
 

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Discussion Starter · #15 ·
Really? I thought 15mg was the most sedating dose.

Anyway, currently this med is really not doing anything for me at all, and I actually feel like I am getting more depressed... I'm gonna speak to my doctor about getting a higher dose, but I kinda feel inclined to just quit it. Would this be possible? I've only been on it a few weeks and as it's making me more depressed I just want to come off. I'm hoping that if I do quit I won't getting any withdrawals, but you never know for sure...

Edit:

I've just remembered by going through my old CBT diaries while I was on other anti-depressants, that for my depression side of things on Zoloft was actually getting better. But Zoloft didn't work so well for my anxiety so I'm thinking maybe Mirtazapine and Zoloft together might be more helpful rather than just increasing the Mirtazapine on its own.

The general feeling I get from Mirtazapine is not a feeling I get from any other anti-depressants - it doesn't feel like it's working on my mood in terms of stopping the darkness of depression... For my anxiety I think the sedation of the medication is doing something as I haven't had any panic attacks or problems with anxiety so far and I'd like to stick to the 15mg of mirtazapine for that. So I'm thinking a 25mg of Zoloft to start with might be something to try along side Mirtazapine.

What do you think?
 

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Really? I thought 15mg was the most sedating dose.

Anyway, currently this med is really not doing anything for me at all, and I actually feel like I am getting more depressed... I'm gonna speak to my doctor about getting a higher dose, but I kinda feel inclined to just quit it. Would this be possible? I've only been on it a few weeks and as it's making me more depressed I just want to come off. I'm hoping that if I do quit I won't getting any withdrawals, but you never know for sure...

Edit:

I've just remembered by going through my old CBT diaries while I was on other anti-depressants, that for my depression side of things on Zoloft was actually getting better. But Zoloft didn't work so well for my anxiety so I'm thinking maybe Mirtazapine and Zoloft together might be more helpful rather than just increasing the Mirtazapine on its own.

The general feeling I get from Mirtazapine is not a feeling I get from any other anti-depressants - it doesn't feel like it's working on my mood in terms of stopping the darkness of depression... For my anxiety I think the sedation of the medication is doing something as I haven't had any panic attacks or problems with anxiety so far and I'd like to stick to the 15mg of mirtazapine for that. So I'm thinking a 25mg of Zoloft to start with might be something to try along side Mirtazapine.

What do you think?
Yeah if your on 15 mg your probly not going to get any antidepressant effects, the threshold dose for that is 30 or above mgs.

As for the sedation, I know that some literature claims that lower doses are more sedating, but to be honest I found it to be more sedating at higher doses.

In relation to mood improvement, I see no problem with adding zoloft, many people have succesfully added Mirtazapine to an SSRI or SNRI in the past.
Just talk to your doctor about increasing the Mirtazapine dose and adding the zoloft first ofcourse.

Good luck.
 

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The general feeling I get from Mirtazapine is not a feeling I get from any other anti-depressants - it doesn't feel like it's working on my mood in terms of stopping the darkness of depression... For my anxiety I think the sedation of the medication is doing something as I haven't had any panic attacks or problems with anxiety so far and I'd like to stick to the 15mg of mirtazapine for that. So I'm thinking a 25mg of Zoloft to start with might be something to try along side Mirtazapine.

What do you think?
It's not the sedative effects that bring anxiety relief, it's the way in which mirtazapine blocks serotonin receptors that'd normally be producing anxiety.

Mirtazapine + sertraline? Go for it. These combinations have been reported to produce hypomania, which is always an indicator of efficacy. I'm actually using mirtazapine and an SSRI myself very shortly, along with some other stuff. If your doctor says there is any sort of risk combining them together, ask him to wipe the dust off the pharmacology books on his shelf.

Oh, and 15mg is way too small of a dose if you have significant problems. Keep in mind that up to 180mg has been used on inpatients without adverse reactions.
 

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Discussion Starter · #18 ·
Yeah I hear combinations work quite well. They seem to cancel each others side-effects but keep the positives.

Can I ask to what advantage does 180mg provide? I would imagine that it stops being more effective at a certain dose. I hear 45mg is the most effective dose, and anything higher doesn't do much.
 

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180mg is a bit ridiculous, yeah, but the effects would just be a much stronger version of what they're like at 15mg. At some point though, you would probably reach an upper limit on effects because (AFAIK) mirtazapine only has the ability to block serotonin on those receptors, and there's only a certain amount of serotonin at any given time. Of course, this limit would change if you were on sertraline.

Actually you'd probably be tripping balls at that dose, due to mirtazapine's weak effects on 5-HT2A (the psychedelic receptor).
 

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My bf Noca is on 45mgs of Remeron and says it works great for him with little to none side effects. He says the higher dose helps take away the drowsiness side effect but its still a long way from being anything like a stimulant.
 
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