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Re: Depression anger and ADs (Mirt and Esc)

Posted by linkadge on August 14, 2020, at 14:32:59

In reply to Depression anger and ADs (Mirt and Esc), posted by Mtom on August 14, 2020, at 10:21:24

My first antidepressant was citalopram and it was soon after augmented with mirtazapine. So, I know this combination well. I've had some issues with anger myself, but I can attest to two things:

1) SSRI withdrawal can definitely increase anger
2) Mirtazapine can also cause anger

Mirtazapine has a few effects which can increase anger. The first is the 5-ht2c antagonism. Activating this receptor tends to inhibit aggression and mirtazapine blocks the receptor (which can increase anger). The 2nd effect is the alpha-2 antagonism (which as you mentioned will increase norepinephrine output). Some other drugs which block this receptor can also cause this effect. The third property is the antihistamine effect. This can make you tired and less able to process feelings of anger. It can also increase appetite which can lead to being 'hangry' (hungry + angry).

I tried going off citalopram and onto mirtazapine only, but it wasn't quite effective enough (had feelings of sadness that wouldn't go away). Also, the irritability got worse during this transition. Theoretically it is possible you **may** notice an improvement in anger with a higher dose. Depression itself can cause anger and so if you get a resolution in your depression this may resolve. However, don't beat yourself up if you don't.

You have a few options which I would recommend:

1) take a very low dose of escitalopram (I'm not sure if you can get it in liquid form). Even 2.5mg of escitalopram can help offset some of the mirtazapine effect.

2) try a small dose of a mood stabilizer like tegregol. Even though you aren't bipolar, small doses of mood stabilizers can really take the edge off. I have a *possible* diagnosis of bipolar (like you I have found antidepressants very hard to tolerate anxiety wise). However, I have found that small doses of meds like tegretol, lamictal, or lithium to really help and are remarkably easy to tolerate (actually easier than antidepressants). Tegretol totally chilled me out. Anticonvulsants can calm the temporal lobes which tend to fire erratically when people get pissy. Gabapentin / pregabalin may also be worth asking about.

3) supplements like omega-3, magnesium, niacin or vitamin C can help buffer excess adrenaline release.

4) a bit of 5-htp may help both anger and SSRI withdrawal. I have taken 5-htp together with mirtazapine without any problems.





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