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Why do people not like Amitriptyline + Mirtazapine

Posted by mtom on June 9, 2019, at 9:55:30

I know when SSRI's were introduced, TCA'S lost popularity. Is this because SSRI's are truly better, or was it marketing?

A 2018 Review of 21 AD's published in Lancet found Amitriptyline highest for efficacy, but among lowest for acceptability. I know weight gain and sedation are problems - what else?

And Mirtazapiine (Remeron) ranked 2nd highest for efficacy, but in the middle for acceptability - and it also has same issues with somnolence and weight gain.

Despite their finding of both having higher antidepressant efficacy than other AD's, I can't find a lot of discussion from users supporting this for either. Lancet review included 522 trials, although there was a lot more data for some than others (e.g. Remeron seemed fairly low), some compared 2 (or more) AD's head-to head, some against placebo, studies from Pharma companies seem to be included, and they noted there was risk of bias and certainty of evidence was moderate to very low.

Still, it seems to be the largest study done to date.

Comments re Amitriptyline? And any others including Mirtazapine for efficacy and side effects? (e.g. why large drop outs for both).

Note: I've tried citalopram (Celexa) - huge anxiety/agitation and other SE's, then escitalopram (Lexapro, Cipralex) - similar SE's although slightly less intense. No efficacy from either, although Lexapro is often cited as one of most effective with least side effects.

Tried Amitryptiline many years ago and did have somnolence and weight gain issues. Not sure if it was effective for depression and anxiety, I did feel better but also had resolved some situational stresses in my life at the same time.

Right now weight gain issue is OK as I've lost a lot of weight. But sleep isn't a problem for me (in fact fatigue is) and somnolence SE is worriesome. And I've read anxiety can be an issue with effective doses of Mirtazapine (even though also prescribed off label for anxiety) - apparently the Norepinephrine effect kicks in at higher doses. Concerned about this as I get anxiety on other AD's. Have read at lower doses Remeron is mostly sedating and AD effect doesn't kick in until higher doses (which may then trigger anxiety).




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