mirtazapine, woo hoo!

MistressTwist · Oct 17, 2014 at 06:44 AM

So, I went to the docs yesterday and was given mirtazapine, finally they listened to me about not being able to sleep! These things KO'd me for 9 hours straight, and I already feel calmer and my mind weeds aren't acting up today, which is great as the last few days have been really tough.

Fingers crossed there won't be as many physical side effects as there have been with citalopram and sertraline!

Altered Moment · Oct 17, 2014 at 10:59 AM

It has worked very well for me for sleep. I haven't had any side effects. The biggest one with it is weight gain that people complain about but i have not had it.

MistressTwist · Oct 18, 2014 at 04:39 AM

I'm on day 2 now with nothing negative so far, weight gain was mentioned when I got them so I'll be keeping my eye out.

The fact that you haven't had it gives me hope! My last 2 sets of meds gave me horrid side effects! So fingers crossed my metabolism is like yours and I get along with these. I feel so much more refreshed today its unreal! XxX

metamorphosis12 · 12:36 PM

I have heard the same. Weight gain seems to be a main reason why some people stop. I was on it for only 5-7 days but the lethargic side effects were too much for me. The dosing usually has a paradoxical effect in most cases. As you increase the dose, the less lethargic and tired you feel. One of those weird polar opposites. Usually the increase in amount of the med. will either level or exacerbate the problem. Where this seems to actually lessen that side effect. Though the weight gain can remain a consistent problem for many.
Short, free online summary from Stahl, of aspects prescribing mirtazapine:
https://stahlonline.cambridge.org/pr...e=Therapeutics

Page 5 on Remeron side effects:
http://www.ccjm.org/content/73/4/351.full.pdf

This is from a 2010 paper. It is very interesting and thorough. Covering the mechanisms, reasons, and symptomatology of MDD. Many classes of psychotropics and individual medications are covered. Also, the enzymes used for different psych. meds and the effects of combining them. It is pretty extensive :

Quote:

Mirtazapine
The antidepressant activity of mirtazapine is a result of enhanced serotonergic and noradrenergic neurotransmission through blockade of presynaptic α2-adrenergic autoreceptors and heteroreceptors and postsynaptic 5-HT2 and 5-HT3 receptors.71,72 No influence on serotonin or noradrenaline reuptake was observed.73,84 Mirtazapine has low affinity for central and peripheral dopaminergic and muscarinic receptors, and high affinity for H1 receptors.83,84

Following oral administration, mirtazapine is rapidly absorbed, but the absolute bioavailability is moderate (see Table 2).73 The drug is nonspecifically and reversibly bound to proteins and possess a high distribution volume.75,86 Metabolism is mediated by CYP1A2, CYP2D6, and CYP3A4.75,87 Demethylmirtazapine is the active metabolite, but its exposure in the human body is three times lower compared with the parent drug.74

Low inhibitory effects of mirtazapine on major CYP isoenzymes were reported in vitro.83,88 No significant interactions with the CYP2D6 substrates amitriptyline, clozapine, olanzapine, and risperidone were observed.90–92 In contrast, plasma concentrations of mirtazapine were reduced after concomitant administration of the CYP3A4 inducers carbamazepine87,90 and phenytoin.75 Moreover, mirtazapine disposition was affected by fluvoxamine and, to a lesser extent, by paroxetine.76,77 Coadministration of cimetidine (an inhibitor of CYP3A4, CYP1A2, and CYP2D6) increased mirtazapine plasma concentrations significantly, requiring dose adjustment.78 An additive sedative effect was observed with diazepam. Moreover, patients should be advised to avoid alcohol while taking mirtazapine.83,87

The drug is predominantly excreted in the urine and feces.87,89 The activity is prolonged by the circulation of the parent compound.87,89 High clearance values indicate renal tubular secretion.83,87,89 The elimination rate is strongly affected by CYP2D6 polymorphism.79,80 Steady state is reached in less than a week.81

In the therapeutic range, mirtazapine shows linear pharmacokinetics. 99 Nicotine may decrease plasma mirtazapine levels, and smokers may require increased doses.82 In contrast, mirtazapine plasma levels are increased in the elderly,91,100 as well as in patients with hepatic impairment,87 and dose reduction should be considered in both groups. Mirtazapine exposure in patients with severe or moderate renal insufficiency is increased compared with healthy controls.83 Although there are no differences in reported adverse effects,102 the drug should be used with caution in these patients.84 Gender affects mirtazapine plasma levels, but the changes are not clinically important (see Table 3).101

The efficacy of mirtazapine in treatment of patients with moderate to severe MDD was reported in several studies.104–106 Short-term studies revealed similar efficacy for mirtazapine and amitriptyline.107–109 Moreover, mirtazapine had a longer time to relapse than amitriptyline during the first 20 weeks (see Table 1).85

Furthermore, mirtazapine showed similar or greater efficacy than citalopram, fluoxetine, paroxetine, sertraline, duloxetine, fluvoxamine, and reboxetine.79,111–114 In a meta- analysis of 25 randomized, controlled trials, mirtazapine showed a faster onset of action than SSRIs and was superior for short-term (two-week) response and remission rates, but the differences were not significant at the end of acute-phase treatment (6–12 weeks).86 The efficacy of mirtazapine and venlafaxine were similar in patients with severe depression characterized by melancholic features.87

Mirtazapine was generally well tolerated in patients with MDD, with a lower frequency of side effects compared with placebo (see Table 1).84,96,105 Sedation, especially at low dose, and weight increase may be due to H1-receptor blockade.105 In a long-term treatment study, weight gain was the only more frequent side effect with mirtazapine than placebo, whereas blood pressure and heart rate were similar.83,110,117

Compared with amitriptyline, mirtazapine had fewer adverse events and less need for discontinuation of treatment due to an adverse event.83,110 Dry mouth, vertigo, and weight increase were as frequent as with TCAs, but seizures were less frequent.22,84

Discontinuation rates due to adverse events for mirtazapine and SSRIs were similar. Mirtazapine was associated with significantly less insomnia, sexual dysfunction, and nausea than SSRIs, but with significantly more weight gain, dry mouth, fatigue, and excessive somnolence.88 Adverse effects such as increased salivation and weight gain were more frequent with mirtazapine compared with venlafaxine but sweating, constipation, increased sexual desire, and weight loss were more common with venlafaxine.116

Mirtazapine is used as a single agent, or in combination with SSRIs or venlafaxine. The recommended dose is 15–45 mg/day, and it is generally given as a single dose in the evening.46

Getting the balance right: Established and emerging therapies for major depressive disorders

I assume your major issues are depression, insomnia, and maybe anxiety. Your OP didn't say specifically but you did mention sleep issues and using antidepressants before, anyway!

Menu

My Support Forums - Mental Health Support Groups

Get emotional support and friendship from others like you!

mirtazapine, woo hoo!

My Support Forums

MistressTwist Member Member Since Oct 2014 Location: West Sussex Posts: 33 9	Oct 18, 2014 at 04:39 AM #3 I'm on day 2 now with nothing negative so far, weight gain was mentioned when I got them so I'll be keeping my eye out. The fact that you haven't had it gives me hope! My last 2 sets of meds gave me horrid side effects! So fingers crossed my metabolism is like yours and I get along with these. I feel so much more refreshed today its unreal! XxX
	Reply With Quote