Psycho-Babble Medication Thread 108552

Shown: posts 1 to 12 of 12. This is the beginning of the thread.

 

Mirtazapine

Posted by babak on June 3, 2002, at 16:25:00

Hi

Let me first explain that I live in UK and generally speaking it is very difficult to get UK doctors to change medication frequently.

I have been suffering fro GAD and depression for the last 12 years. In the first five of them I was taking Prozac which worked relatively well until I started having headaches and loosing my temper. I convinced my doctor to put me on Effexor. It helped with my temper but the headaches continued and I found it difficult to go to sleep and I was continuously tiered. My libido gradually disappeared too and after four years on Effexor I became impotent. I tried Reboxetine but I had to come off it after a week because of severe kidney pains. Last year my marriage broke down and I also went bankrupt. I asked my doctor to put me on Mirtazapine but instead he increased my Effexor to 375 mg per day. Finally after six weeks on 375 mg with no real improvement I was put on Mirtazapine.

So I started reducing my Effexor's dosage as I increased Mirtazapine from 15Mg to 45. Within four days I started feeling better; The transformation was miraculous; all the tension in my body disappeared and for the first time in twelve years I went out and bought myself some clothes because I felt like it rather than having to do it. I found out that I could actually pick my daughter up and carry her for more than twenty yards. My sleep became normal too and I felt refreshed the next day. People around me couldn't believe their eyes. I actually started planning to rebuild my life with some hope.

However after five week I got a cold. When I recovered I noticed that effects of Mirtazapine were wearing off. By then my Effexor dose was down to 37.5mg. Lower than that and my tinnitus would play up; getting unbearably loud and spread across my whole head. My doctor has now put me on 1200mg of lithium plus 45mg Mirtazapine. But things not getting better and I feel really angry now. Tiredness is back, apathy too as well tension which is still not as bad as before though.

I would like to know why did Mirtazapine stopped working and what should I try next because I don't think Lithium is doing much good apart from leaving a bad taste in my mouth. Could it also be that Mirtazapine was working so well because I was still taking Venlafaxine with at the time?

Thanks

Babak

 

Re: Mirtazapine

Posted by katekite on June 3, 2002, at 18:39:33

In reply to Mirtazapine, posted by babak on June 3, 2002, at 16:25:00

Condider this oversimplification: serotonin is the necessary ingredient for good sleep and empathy, and norepinephrine is needed for daily energy and confidence, shopping energy for example.

Mirtazapine's mechanism of action increases serotonin at lower doses and also norepinephrine at higher doses. 45 mg is probably on the edge of getting a little norepinephrine response but will not be enough for some people. Effexor is not too different in its basic mechanism, though the dose to achieve norepinephrine boosting is very high compared to the serotonin dose. During your good spell, you may have been experiencing a synergistic effect (neither by itself really helpful but together very good).

With respect to the lithium, if you have not found it to help, it is probably not useful for you and you might wish to stop it. Did your doctor think you are bipolar? or was it considered a treatment for the tinnitus? or was it just to try to augment the antidepressant action of the mirtazapine? If the last one, it sure doesn't sound like its having the desired effect.

When things stop working for me, I try to recreate the most recent drug environment that I remember feeling good on. It usually works at least partially.

So option one for you sounds like stopping lithium if that is feasible, going back to 45 mg of mirtazapine only and then slowly adding effexor until you feel ok again.

Option two would be stopping lithium if that is ok, then increasing the mirtazapine past 45 mg to try to hit the norepinephrine response again.

I would choose between the options based on how quickly you need a response: it is always better to take fewer drugs if you can (less side effects etc), so option 2 would be nice long term, but option 1 might be more reliable if you are feeling deeply depressed and need results.

My oversimplification is just that, oversimplification.... it seems to work for the responses some people get out of these drugs, but probably isn't really a good analogy for the nitty gritty details of how depression lifts.

Also you may possibly be having some withdrawal from effexor, even with tapering, that will pass in time. Clues that some of the depression could be effexor withdrawal would be associated withdrawal things like nausea or fuzzy head sensations or tingling, anything physical reported for effexor withdrawal. Treatment would be to reinstate effexor and taper more slowly.

Hope you feel better quickly.

kate

 

Re: Mirtazapine

Posted by babak on June 3, 2002, at 21:36:00

In reply to Re: Mirtazapine, posted by katekite on June 3, 2002, at 18:39:33

> Condider this oversimplification: serotonin is the necessary ingredient for good sleep and empathy, and norepinephrine is needed for daily energy and confidence, shopping energy for example.
>
> Mirtazapine's mechanism of action increases serotonin at lower doses and also norepinephrine at higher doses. 45 mg is probably on the edge of getting a little norepinephrine response but will not be enough for some people. Effexor is not too different in its basic mechanism, though the dose to achieve norepinephrine boosting is very high compared to the serotonin dose. During your good spell, you may have been experiencing a synergistic effect (neither by itself really helpful but together very good).
>
> With respect to the lithium, if you have not found it to help, it is probably not useful for you and you might wish to stop it. Did your doctor think you are bipolar? or was it considered a treatment for the tinnitus? or was it just to try to augment the antidepressant action of the mirtazapine? If the last one, it sure doesn't sound like its having the desired effect.
>
> When things stop working for me, I try to recreate the most recent drug environment that I remember feeling good on. It usually works at least partially.
>
> So option one for you sounds like stopping lithium if that is feasible, going back to 45 mg of mirtazapine only and then slowly adding effexor until you feel ok again.
>
> Option two would be stopping lithium if that is ok, then increasing the mirtazapine past 45 mg to try to hit the norepinephrine response again.
>
> I would choose between the options based on how quickly you need a response: it is always better to take fewer drugs if you can (less side effects etc), so option 2 would be nice long term, but option 1 might be more reliable if you are feeling deeply depressed and need results.
>
> My oversimplification is just that, oversimplification.... it seems to work for the responses some people get out of these drugs, but probably isn't really a good analogy for the nitty gritty details of how depression lifts.
>
> Also you may possibly be having some withdrawal from effexor, even with tapering, that will pass in time. Clues that some of the depression could be effexor withdrawal would be associated withdrawal things like nausea or fuzzy head sensations or tingling, anything physical reported for effexor withdrawal. Treatment would be to reinstate effexor and taper more slowly.
>
> Hope you feel better quickly.
>
> kate

Thanks Kate,

The Lithium is supposed to augment Mirtazapine effect. My tinnitus is one many psychosomatic symptoms which is part and parcel of my depression (well so I am told).

With regards to increasing Mirtazapine, I thought 45mg is the maximum and to Effexor withdrawal effect I reduced it ever so slowly and as I said I still take a small amount.

I think I would also prefer the option 2 and if I can convince my doctor, Iíll try that for couple weeks.

Thanks again

Babak


 

Re: Mirtazapine

Posted by katekite on June 4, 2002, at 21:49:57

In reply to Re: Mirtazapine, posted by babak on June 3, 2002, at 21:36:00

Here's a link with links of old posts, someone taking 60 mg.

Option 3 which I didn't mention before would be to try a more specifically norepinephrine drug like desipramine or reboxetine or wellbutrin.

good luck.

kate

 

duh, here's the link I forgot

Posted by katekite on June 4, 2002, at 21:51:14

In reply to Re: Mirtazapine, posted by babak on June 3, 2002, at 21:36:00

http://www.dr-bob.org/babble/20020425/msgs/104302.html

 

Re: Mirtazapine

Posted by allisonm on June 5, 2002, at 20:18:35

In reply to Mirtazapine, posted by babak on June 3, 2002, at 16:25:00

Mirtazapine and Effexor are said to be a very potent and successful combination. It has a nickname : "California Rocket Fuel". If you do a keyword search on this site you will find many posts on California Rocket Fuel.

Is there a way that you could continue to take both? IT sounded as though the augmentation was making a difference before the Effexor dose got too low.

Good luck.

Allison

 

Re: Mirtazapine Ľ allisonm

Posted by Babak on June 6, 2002, at 6:42:31

In reply to Re: Mirtazapine, posted by allisonm on June 5, 2002, at 20:18:35

Thanks everyone for your feedback.

Yesterday I finally gave up on Lithium. I was feeling sick and running a temperature. It might be just a cold but since I stopped taking it yesterday I feel a little bit better and that dreadful taste is gone too.

I havenít seen my psychiatrist but I have increased Mirtazapine to 60 mg and added 75 mg of Venlafaxine to see if can get anywhere near how I felt when I first started Mirtazapine.

When I started Mirtazapine id did feel really sedated but it wore off with three days and yes I did put on weight but I think that was because food tasted so good and I was eating a lot and to be honest I didnít mid that much as it was the first time I was really enjoying my food in 12 years.

As to trying other norepinephrine I have tried reboxetine which gave severe kidney pain. I am not too keen on Desipramine and other similar TCA and on whole I have never had good results with them.

I suppose, Iíll just have to wait and if "California Rocket Fuel" will work.


 

how's it going babak? is it working yet? (nm)

Posted by katekite on June 8, 2002, at 10:31:19

In reply to Re: Mirtazapine Ľ allisonm, posted by Babak on June 6, 2002, at 6:42:31

 

Re: how's it going babak? is it working yet? Ľ katekite

Posted by babak on June 14, 2002, at 17:28:00

In reply to how's it going babak? is it working yet? (nm), posted by katekite on June 8, 2002, at 10:31:19

No, and I am getting more and more frustrated over this now.

To some extent I wished I hadn't had that initial good reaction.

I increased the Mirtazapine to 60 mg and added 150 mg of Effexor and nothing has changed.

I still sleep well which I suppose is a blessing but the weakness and apathy is just as bad as before. I am seeing the doctor next week and I think he will suggest an anti psychotic drug now.

Thanks for asking anyway

 

Re: how's it going babak? is it working yet?

Posted by katekite on June 15, 2002, at 11:28:23

In reply to Re: how's it going babak? is it working yet? Ľ katekite, posted by babak on June 14, 2002, at 17:28:00

Hi, sorry its not working yet. You do sound pretty frustrated.... waiting sucks!
If you feel weak maybe you should also ask next week to do a check for low thyroid and low cortisol and a blood panel for anemia or glucose problems, if you haven't had those particular tests in a year or so. Just to make sure there is no medical component.

Take care,

kate

 

Re: how's it going babak? is it working yet? Ľ katekite

Posted by Babak on June 15, 2002, at 16:36:10

In reply to Re: how's it going babak? is it working yet?, posted by katekite on June 15, 2002, at 11:28:23

Thank you Kate for your kind concern. I have recently had my thyroid tested twice; once before going on Lithium and once after a week of starting on the same. I think the weakness is mostly due to Effexor. I just hadnít noticed it until I came off the drug and went on Mirtazapine.

Right now I am really confused because the old muscle tension is getting worse and again it could be because of Effexor or just the frustration I feel. Anyway I am reluctant to give up so soon on the combination of Venlafaxine and Mirtazapine.

Doctors say, as well as the labels on most of the antidepressants that it takes up two weeks or more before the drug starts to have an effect. However in my experience either a drug starts working within a week or it never gets going. So Iíll give it a few more days and see what happens.

Thanks again
Babak

 

Re: how's it going babak? is it working yet?

Posted by babak on July 3, 2002, at 18:56:07

In reply to how's it going babak? is it working yet? (nm), posted by katekite on June 8, 2002, at 10:31:19

Well this rocket fuel thing is not working although it must be said that when I told my doctor that I was taking 60mg Mirtazapine with 375mg of Venlafaxine, he said I could be risking serotonin syndrome. He has reduced the Mirtazapine back to 45mg and Venlafaxine to 75mg and said that if I didn't comply with his prescribed dosage, I would have to find another psychiatrist.

The reduction of Mirtazapine has brought the tinnitus back to its normal level but on 75mg of Venlafaxine my depression and especially headache is a lot worse.

I am loosing faith in Venlafaxine and am thinking of Zyperaxa but I have read a fair amount of bad press about it.

It is either that or ECT which is financially out of the question.

Any other ideas?


This is the end of the thread.


Show another thread

URL of post in thread:


Psycho-Babble Medication | Extras | FAQ


[dr. bob] Dr. Bob is Robert Hsiung, MD, bob@dr-bob.org

Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.