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Experiences - Mirtazapine long-term effects, especially sleep

Discussion in 'Antidepressants' started by Troppo, Feb 17, 2011.

  1. Troppo

    Troppo Titanium Member

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    I'd like to ask if anyone knows of anyone who has personal experience with mirtazapine (Remeron, Avanza, Zispin) when taken daily over several months or longer?

    If so, does it CONTINUE to help with sleep when taken at night? I have found it helpful but have not taken it long-term for sleep due to it being an antihistamine, and tolerance to the sedation produced by other antihistamines can set in pretty quickly. Does mirtazapine have sleep-inducing effects that persist once a steady dose has been taken for weeks or months?

    Also has anyone here continued to benefit from the antidepressant effects of mirtazapine over several months or longer, rather than having it 'poop out' like is occasionally described? If needing to quit after months of daily use has anyone had severe withdrawal symptoms (or discontinuation symptoms if you prefer that term)? My impression has been that mirtazapine doesn't create the serious problems that some other antidepressants can when stopped but I'd be interested in knowing personal experiences from people.

    Thanks for any experiences anyone can offer.
     
  2. HeavyPlant

    HeavyPlant Newbie

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    just started myself. After abit of reading dont sound to bad. I have been on and off antidepressents for years and this is suiting more than most up to now. I still have sex drive which other med's have ruined in past. been taking 30mg each night for a couple of weeks and the knock out effect seems to have gone also feeling more awake and positive the next day now, not like the first week because i could not stay awake. but maybe that was the recovery from a drugs binge a few nights before, unsure!

    sorry i cant be more help been on them before but discontinued after a month due to crap Dr...
     
  3. OrbitalSPIN

    OrbitalSPIN

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    Mirtazapine is actually one of the better antidepressants in AFOAF's opinion because it's really effective in treating depression and AFOAF hasn't heard of any real complaints about it having any significant side effects. AFOAF's been taking Mirtazapine 45mg. h.s. "at bedtime" for about 4 years and it still helps with AFOAF's depression along with helping AFOAF get to sleep. AFOAF would like to note though that AFOAF's on a few other things as well. So, it not just the Mirtazapine alone that's helping AFOAF get to sleep.
     
  4. Roads

    Roads

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    SWIM has been on mirtazapine for over a year. SWIM has been at 15mg, 30mg and 45mg, and currently takes 60mg at night, and yes it still does help with falling asleep. Certainly not as sedating as the 15mg one starts off with in the first weeks, but it does consistently produce the urge to sleep a year+ past the initialization of the treatment.

    The anti-depressant effects havent seemed to poop out for SWIM, however SWIM has borderline personality disorder and has found that this medication keeps his emotions "stable" in a pleasant way rather than making you stupidly happy for no reason.

    Part of the elongated efficacy is because the 5-HT2a/2c receptor system mirtazapine acts on can be sensitized and down regulated by agonists and antagonists. Mirtazapine being a potent antagonist, suppresses 5-HT2a distribution which helps with sleep and anxiety, and also suppresses 5-HT2c distribution which disinhibits nor-epinephrine and dopamine in various parts of the brain. This allows the drug to induce long term anti-depressant and anti-anxiety changes over a long term treatment.

    If you feel it does poop out, get your psych to add an SSRI, as they synergize quite well together (SWIM takes Paroxetine as well); or have them raise the dose - emerging research is suggesting that mirtazapine at 90-120mg may be even more effective for depression and anxiety while still being side effect tolerable.
     
  5. Troppo

    Troppo Titanium Member

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    Thanks for the help guys, and glad to hear this drug can continue having beneficial effects. Interesting pharmacology too, sounds quite different to other antidepressants. It could be similar to mianserin, an earlier drug, both were also originally made by Organon from memory.
     
  6. Roads

    Roads

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    Yea Mianserin and Mirtazapine are virtually the same barring that mianserin antagonizes 5-HT6 and 5-HT1d and is also a decent Norepinephrine reuptake inhibitor and Mirtazapine doesn't share those properties except being a poor NRI.
     
  7. ChemDawg

    ChemDawg Newbie

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    I was on Mirtazepine for a year. I was taking 60mg. at night. I didn't notice any withdraw effects when i stopped it 2 months ago. In fact i didn't notice any difference in mood or sleep when I got off of it, but that's just me. Try it and see if it is beneficial to you, because the withdraw symptoms are non-existant. For me the benefit was just the sleeping part. Good Luck
     
  8. TooFastTim

    TooFastTim Silver Member

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    TIM Is currently taking 30mg at bedtime over the course of the last two years he has had the dosage adjusted from 15mg to 30mg he is 270 pounds and is 30 years old he takes it in conjunction with alprazolam 2mg

    At first the medication really seemed to knock him out. As he became more tolerant of the medication the sedition effect seemed to go away As for the antidepressent effects TIM never really knew what he was supposed to feel TIM does seem to ne more personable and has had people mention that he seemed more even. My own observed effects are After taking the 30mg tablet he is super hungry. Super hungry! He has also noticed a bit of water retention easily cured by prescription water pills Tim would also like to add that he gained a fair amount of weight in the first six months of use
     
  9. TheFakeBass

    TheFakeBass Palladium Member

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    I'm not sure how relevant this is (I know it's not what you're asking for) because my pet jellyfish has only been taking mirtazapine for six weeks, but these have been the best six weeks my pet jellyfish has had in a very long time.

    My pet jellyfish has problems involving general anxiety, social anxiety, depression, cannabis addiction and polydrug abuse, and posttraumatic stress. That he has sleep problems almost goes without stating.

    My pet jellyfish was prescribed mirtazapine six weeks ago and quit smoking cannabis at the same time (and quit consuming caffeine a few weeks ago), so I can't really say with a huge degree of accuracy that the mirtazapine has been the biggest pharmacological change in his life.

    BUT:
    I don't think my pet jellyfish has ever had such an easy time falling asleep. In that regard, it seems to keep getting better and better. Not once in the past couple of weeks has my pet jellyfish tried to get to sleep at the end of the day and failed. In fact, even before he takes his mirtazapine at night, he can feel a sense of sleepiness that he hasn't felt in months, if not years due to the stress and anxiety. He still wakes up in the middle of the night pretty often, and has rather difficult and shallow-feeling sleep when he gets back to bed, but all in all I'd say his sleep has been much more restful in general. He doesn't have much trouble waking up in the morning (in the past, sometimes it's taken him hours). His dreams have become much more pleasant, and he's very thankful for that. They've also become more vivid, but he doesn't mind.

    For my pet jellyfish, the hypnotic effect of 30mg seems less "involuntary" than with 15mg, but no less effective. (Mirtazapine has a weird reputation for being less sedating at higher doses due to the opposite effects of histamine antagonism and alpha-2 adrenergic antagonism.)

    He's feeling somewhat better in just about every other regard. Mirtazapine works for him like no other antidepressant he's tried (fluoxetine, bupropion, trazodone, paroxetine) works. He still feels sluggish and kinda broken in the head and has trouble feeling positive emotions (he felt pretty much zero before), but the relief from depression has amazed him. He didn't think it was possible.

    The anxiety has gotten much better too. His frequency of panic attacks has gone WAAAAY down. He no longer feels very anxious when he is alone, and he no longer feels overwhelmingly uncomfortable just by being anywhere near another person (he still has some trouble with talking to people, though).

    The side effects haven't been bad at all (a lot better than SSRIs for the jellyfish!). He's had a bigger apetite, but he's fine with this. He couldn't stop eating when he started the mirtazapine, but that got better.

    Anyway, as I understand it, "poop-out" can happen with any antidepressant, and can often be remedied simply by increasing the dose. If that doesn't work, switching to another medication or adding another medication may work.

    So yeah, I don't really have much to say other than "hope it works well for you" and "hope it keeps working well for my pet jellyfish," but it has sure worked damn well for my pet jellyfish for the past six weeks. And over the course of those six weeks, it has only gotten better. If six weeks is long enough for the purposes of this thread, then awesome.
     
  10. Troppo

    Troppo Titanium Member

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    Hey again guys, thanks for all your help with this one!
     
  11. Valseedian

    Valseedian Silver Member

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    lil late, but I'll also chime in saying that I'm with fakebass all the way herre.

    swim first tried remeron in jail, where his cellmate traded half of his 45 nightly for swim's help in completing his 'integrated learning' assignments (college in jail essentially). Swim had been in for 7 days before making this little arrangment, and it's the first time in the better half of a decade he has been wholey sober for more than 12 hours. Swim has minor social anxiety with major ADHD. Swim is unsure whether or not he can blame these on many many years of excessive ADHD treatments (from Yr 6, untill his junior year in highschool, he was prescribed every ADHD treatment under the sun. When he stopped his twice daily 30mg xr adderall script he was 94lbs soaking wet. this was obviosly counteracted by some sedative nightly.) he first truely realized he had insomnia in jail, when everyone else put their head down, they were out cold. Swim would take hours to fall asleep (tho, this isn't unusual for swim's 'free' lifestyle either, he uses cannabis to this day to acheive sleep).


    After being released, swim got himself a remeron script at 30mg and usually consumed 3/4 of his pill nightly, and another 1/4 in the morning or at lunch if he was feeling manic. His treatment lasted for 6 months before he discontinued it. He feels like the positive effects did last some months after stopping.

    swim's problem has never been depression, and this didn't seem to effect his emotional state past making him a more 'level' person.. swim is usually a huge sap, not one to hold back the tears, but remeron dulled this quite effectively.

    swim continued to use cannabis while on remeron, but required significantly less during those times, and didn't require smoking multiple times nightly just to get back to sleep.

    swim is in the process of aquiring health insurance, and will probably seek a remeron script when he does.
     
  12. Love Ragdolls

    Love Ragdolls Newbie

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    I like the part about the person taking three quarters of the pill at night and a quarter of it in the morning. I wonder why my doctor didn't tell me to do that since the bedtime dose only take me so far the next day.

    Love Ragdolls added 58 Minutes and 58 Seconds later...

    Hi, FakeBass,
    The following words you posted stood out for me and I had to ask about it.


    For my pet jellyfish, the hypnotic effect of 30mg seems less "involuntary" than with 15mg, but no less effective. (Mirtazapine has a weird reputation for being less sedating at higher doses due to the opposite effects of histamine antagonism and alpha-2 adrenergic antagonism.)


    Read more: http://www.drugs-forum.com/forum/showthread.php?t=155004#ixzz1ao71MaPN


    But first I'd like to ask how difficult it was for your pet jelly fish to quit caffine.
    Did he/she experience any headaches at first? Not sure if jelly fish come in both genders.

    Secondly, I'm trying to wrap my brain around the use of "Involuntary" in that sense. I'm on 15 mgs of Mirtazapine at this time and am supposed to double that on Sunday night. Is it possible I will notice a difference?

    Love Ragdolls added 7 Minutes and 25 Seconds later...

    Did Tim get really hungry right after taking a 30mg tablet in the evening or did Tim get really hungry after taking the new dosage? Not sure how to even ask this properly. Were you only hungry at night after a tablet?

    Sue's doctor told her that she would gain weight from taking Mirtazapine and she also told Sue that she would have to get active. Sue wonders just how active? Sue already has an icecream addiction. She and her husband have an icecream cone every night after dinner. Black Cherry... Hope they tire of it soon.
     
    Last edited: Oct 15, 2011
  13. Thetakishi

    Thetakishi Silver Member

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    I had been taking Mirtazapine for over a year now at a 45mg/day(bedtime) dose for insomnia/depression/anxiety/panic attacks. The "knock you out to the point of not wanting to even sit anymore" sleep effects pooped out for me after about 3 days at 15mg, but it does still continually (albeit barely) help with sleep (equivalent for me now to taking a benadryl or two), and I haven't had a single panic attack since I started, except when I tried to add an ssri to my regiment.

    I just came off of it too about 3 weeks ago, and several times took short breaks, during the course of treatment with zero withdrawal symptoms, no rebound effects, and I'm still panic attack free. I also never had any side effects, including the common never ending hunger. It was pretty much my miracle panic attack drug.

    Thetakishi added 1 Minutes and 0 Seconds later...

    Sorry to double post, but I meant to say it also didn't do anything for my depression or general anxiety though, although I have heard many reports say it worked wonders.
     
    Last edited: Oct 15, 2011
  14. AZ8990

    AZ8990 Newbie

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    Everyone seems to react differently to mirtazapine, especially depending on dose. I was on it for almost 6 years at 30mg/night mainly to help with insomnia. It stopped helping recently, so i stopped taking it. I noticed not so much an antidepressant effect, but more what I would describe as a deliriant effect during the day. This deliriant effect did feel slightly like being high, but in a weird/uncomfortable way. There was extreme emotional blunting noticed by everyone around me. My anxieties related to specific things went down because mirtazapine sapped the mental energy needed to worry about things, but general anxiety shot through the roof. I couldn't sleep before it, and now I can't sleep off of it, so I can't say there have been withdrawals or addiction.
     
  15. Synesthesiac

    Synesthesiac R.I.P.

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    Can't really believe what I'm reading here, don't think that I've ever seen a thread about a commonly prescribed anti-depressant/anxiolitic with no dependance issues spoken about so positively by so many people. Usually you get a horror story about side effects or bad withdrawals within a few posts. Not a single bad post about it yet in this thread. Makes me wonder if due to the nature of this forum is is an ideal anti-depressant for people that have been previous users/abusers of recreational drugs, or if it is just in general a very promising anti-depressant for anyone.

    I've tried 3 different SSRI's before. None of them work as I get instant anorgasmia from them. I asked my doctor today for an SNRI but apparently in the UK they wont prescribe them without consulting a psychiatrist first due to suicide issues. He's put me on my fourth SSRI now (fucks sake!), but said if this still did not work then he would try Mirtazapine. To be honest I cant wait to try it. Looks like it will help with my sleep to for the first week or so.
     
  16. C.D.rose

    C.D.rose Donating

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    Yeah, a third SSRI trial after three different ones consistently produced the same side-effect is really not very likely to turn out successful. Mirtazapine is really a somewhat odd drug that cannot be neatly placed into the big antidepressant classes (SSRIs/SNRIs, tricyclics, MAOIs). Some psychiatrists like to combine with other drugs, such as venlafaxine or bupropion, but that's usually for more severe or treatment-resistant cases of depression.

    Generally speaking, it sure is worth a try after SSRIs have failed, but it's not some sort of wonder-drug. Nothing is, of course. I do remember a study that concluded it was the most effective among the first and second-line treatment options though. So, as I said, worth a try, but not a silver bullet.
     
  17. Love Ragdolls

    Love Ragdolls Newbie

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    It's been a few months now on Mirtazapine. Still only 30 mgs at bedtime and it still is great for falling asleep within minutes of going to bed. Not waking up at all hours is a bonus and mornings are great. My depression only seeps in for short spurts now and then and my anxiety level is low. I've put on weight...an awful craving for sweets. My anger has toned down but my memory is still crappy. Case in point: I was ticked off at a bad driver the other day and instead of giving him the finger, I gave him a thumbs up.
     
  18. Mindless

    Mindless Gold Member

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    I have not tried Mirtazapine, but found this thread interesting and wanted to contribute the following.

    From reading this thread it seems that Mirtazapine is well-tolerated. Accoring to the British National Formulary (BNF 62 2011) it's most adverse effects are increased appetite and weight gain, as well as oedema. Mirtazapine "causes sedation during initial treatment" (BNF 62).

    However, some in this thread have found this benefit to be longer-lasting. Could this be due to improved mood? Depression does have an adverse impact on sleep.
     
  19. Troppo

    Troppo Titanium Member

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    Unfortunately, this was my mate's almost exact experience with mirtazapine. He has compared it to being in an alcohol-hangover type state that lasted all day, but one without nausea or headache. He gave up after this state went on without reduction for 3 days, since he had L-tryptophan as an alternative, and that has seemed to help with both sleep and depression (1.5 g+ being needed for sleep).

    However my friends major reason for not keeping on with mirtazapine was the fear that it would stop working for sleep, and at the same time render all antihistamines (eg. doxylamine, diphenhydramine) ineffective and also render trazodone ineffective as sleep aids. His fears were due to mirtazapine itself being a strong H1 and 5-HT-2A receptor antagonist, as are the antihistamines and trazodone respectively, as well as a very long acting antagonist (i.e H1 and 5-HT-2A function could theoretically take a long time to return to normal). He now rotates sleep drugs so he is only taking the same one for 1-2 nights in a row, for example L-tryptophan+melatonin then gabapentin then doxylamine then trazodone then possibly a benzo or Z-drug. He has to be careful not to use the tryptophan and trazodone too close together, due to risk of serotonin syndrome. All of the drugs he takes for sleep are short-medium acting ones, to avoid the type of all-day sedation seen with things like mirtazapine, other long-acting antidepressants, long-acting antipsychotics, and even long-acting benzos like diazepam. Using these long-acting drugs as sleep aids also seems to render them ineffective more quickly than using rotated short acting drugs.

    He also says beware not to use the same short-acting drug type many nights in a row, not just because of tolerance issues but also because they can start to cause withdrawal-type effects and general instability as they wear off during the daytime. Keep on rotating your sleep aids!! He has heard some stories that trazodone won't cause tolerance, and also that the Z drugs and triazolam aren't supposed to cause tolerance either (if used strictly at night only), but with the latter two drug types he has heard they will still cause rebound withdrawals during the day if used every night. He was going to try a small dose or two during the day if forced to use the same things every night, but this could just start promoting rapid tolerance, just as happens with alcoholics who drink to ward off daytime withdrawals.

    Having said all this, he would still tell people to give mirtazapine a try if other things have not helped. He read an article about it not working for depression the way it's officially supposed to (i.e. not being a serotonin-increasing drug and therefore not a dual action drug) by Australian psychiatrist Kr Ken Gillman, but other than that one opinion, other reports do indeed say it's as good or better than nearly all other antidepressants (MAOI's possibly excepted).

    He is also struck by how little people complain of withdrawal from this drug, and how satisfied people are in general with it. The only severe complaints he has read have been on benzo withdrawal forums, but the people there complain about almost every known drug, and even there mirtazapine seems to attract fewer complaints.

    Oh, my friend said he also tried mianserin, which is almost identical to mirtazapine, for many weeks some years ago. He found a diary he had from that time, in which he wrote that mianserin's sleep-promoting effect wore off for him quickly soon after starting. He had also written that even weeks on a regular, decent dose did not help his depression, so for these reasons also he did not persist with mirtazapine.
     
  20. AllAroundTheLight

    AllAroundTheLight Silver Member

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    SWIM's personal experience with the drug suggests otherwise. He was prescribed the drug for insomnia and deppression. It seems like there is a maximum amount of sedation he can get out of mirtazapine once he reaches 60mgs. Anything over that will not make him any more tired. Also, what's wierd is that at higher doses the side effects become a bit more pronounced. For example, SWIM gets really bad dry mouth and some very bad bodily itching as he lays in bed trying to get to sleep. The itching can be so bad that it prevents him from getting to sleep. For this reason, he can be quite uncomfortable as he tries to fall asleep, and when he wakes up, the grogginess, dry mouth, and general crappy feeling make him wish he didn't take the stuff to get to sleep. But I guess grogginess is an inevitable side effect of any powerful sleep-promoting drug. As for the long term effects, SWIM still feels pretty deppressed at times, but not as bad as before. He occassionally breaks down into tears but he is definitely no longer suicidal which is great at least. SWIM still has a very high amount of anxiety so he wouldn't say it has helped him much with that. The only reason he still takes it is because it generally has helped him sleep better. The bad part is that it also makes him very hungry. SWIM has gained about 20-25 pounds since starting the drug a year ago. Not sure if this is a common side effect of many Out of trazodone, seroquel, celexa, prozac, abilify, and zyprexa, only mirtazapine was worth continuing. SWIM wants to get some type of benzodiazepine to help with anxiety and sleep. He's really wanted to try xanax for the high alone, but thinks he will have a hard time getting a scrpit for that. In the mean time, he will stick with mirtazapine as it gets the job done in the short term with sleep.