When Should You Not Take Mirtazapine
Mirtazapine may not be suitable for all people. You should not take mirtazapine if you have any of the following conditions:
Have low blood pressure
Have epilepsy or seizures
Are pregnant, or are trying to become pregnant
You should also take care if you have diabetes, as mirtazapine can make it more difficult to keep your blood sugar levels stable.
You should avoid drinking alcohol if you take mirtazapine as it can exacerbate the sedating effects.
A Better Solution To Fix Your Sleep
The major drawback of taking mirtazapine for a sleep problem is that itâs not a long-term solution. Firstly, the sedative effects of low dose mirtazapine tend to wear off after a few weeks, as the body becomes used to it.
This may lead people to think that they can increase the dose to get the same effect but, as we mentioned earlier, the sedative effects of mirtazapine are lost as the dose increases. So taking a higher dose may actually make you more alert.
Secondly, taking a sleep aid such as mirtazapine doesnât address the actual reason behind why youâre sleeping badly in the first place. It just covers up the problem and itâs well known that after stopping taking mirtazapine, insomnia usually returns.
The most comprehensive way to resolve a sleep problem is to identify the root causes. Ask yourself these questions:
- Is there anything that could be affecting your sleep?
- What are your daytime and bedtime routines like?
- What do you know about attaining healthy sleep?
Thinking about your sleep, addressing problems with your sleep hygiene and expanding your knowledge about sleep are all key components of Cognitive Behavioural Therapy for insomnia .
This is the gold-standard treatment for insomnia and at Sleepstation we use a modified version of CBTi, known as digital CBTi , to help people get back to sleeping well. We provide a scientifically proven solution to insomnia with results that are sustainable and which involves no use of medication.
What Other Treatments Can Help Manage Anxiety
Medications for anxiety are safe and effective and are good options for many people. But some people want to avoid medication, and some want to combine medication with other treatments. You can try:
- Psychotherapy. Cognitive behavioral therapy is a first-line treatment for anxiety, and phobias can respond to biofeedback and exposure therapy.
- Stress management techniques. You can learn breathing techniques and progressive muscle relaxation to reduce anxiety.
- Lifestyle modifications. Getting enough quality sleep, exercising, and avoiding alcohol, illicit drugs and excessive caffeine can help reduce anxiety.
- Support groups. Connecting with people who share your experiences can be valuable.
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Depression And Comorbid Medical Conditions
Treating depression in patients with general medical conditions can be done safely and effectively with antidepressants, including mirtazapine, with no additional adverse effects or tolerability burden.34 One study suggests that mirtazapine and venlafaxine are effective not only for the treatment of overall symptoms of depression, but may also be useful for the treatment of somatic symptoms in depressed patients.35
Postmyocardial infarction depression. Depression after myocardial infarction is associated with increased cardiac morbidity and mortality, while antidepressant treatment in patients with cardiac disease and depression may result in significant therapeutic benefit.36 Additionally, there is evidence that nonresponse to treatment of postmyocardial infarction depression may be associated with more cardiac events.37
Poststroke depression. Niedermaier et al40 found that prophylactic treatment with mirtazapine begun 1 day poststroke significantly reduced the rate of developing poststroke depression, with 5.7% of treated patients becoming depressed compared to 40% of nontreated patients. Mirtazapine was also shown to be effective in treating poststroke depression in the nontreated patients who developed depression in the first phase of the study.40
Urgent Advice: Call Your Gp Straight Away If:
- youve taken too much mirtazapine
Do this even if you feel well.
If you need to go to an emergency department , do not drive yourself get someone else to drive you or call for an ambulance.
Take the mirtazapine packet, or the leaflet inside it, plus any remaining medicine with you.
Symptoms of a possible overdose include:
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Selective Serotonin Reuptake Inhibitors
These include fluoxetine , paroxetine , sertraline , fluvoxamine , citalopram , and escitalopram . They tend to be the first line choice for multiple anxiety disorders and depression. They are technically classified as antidepressants .
Sertraline is FDA approved for multiple conditions including: Major Depression, OCD, PTSD, Social Anxiety, Panic Disorder, and Premenstrual Dysphoric Disorder. While not all SSRIs have this many FDA approved indications, we often use the other ones for the same conditions. Pharmacy companies do not always bother pursuing FDA approvals due to cost reasons and the realization that the meds will be used off-label. It is completely legal and ethical to use medications for off-label purposes, but ideally the patient and provider should have a discussion about this first.
While SSRIs can have an immediate effect, the full effect can take anywhere from 3-8 weeks depending on the person. They are generic and cheap. I tend to prefer generic meds b/c they have been around longer with a proven track record, and the risks are known too . This is my style, and there is certainly nothing wrong with those who do prescriber newer meds .
While they are overall fairly well tolerated and arguably with less side effects than older classes of antidepressants, some people may be more sensitive to side effects of this class and may do better with older classes like tricyclic antidepressants or MAOIs .
Fda Warning: Suicide Risk
- This drug has a black box warning. This is the most serious warning from the Food and Drug Administration . A black box warning alerts doctors and patients about drug effects that may be dangerous.
- Mirtazapine may cause an increase in suicidal thoughts or actions. This risk is higher in children, teenagers, and young adults. Its also higher within the first few months of treatment and during dosage changes. You and your family members, caregivers, and doctor should watch for any new or sudden changes in your mood, behaviors, thoughts, or feelings. Call your doctor right away if you notice any of these changes.
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How To Cope With Side Effects
What to do about:
- dry mouth try chewing sugar-free gum or sucking sugar-free sweets.
- increased appetite and weight gain mirtazapine can make you hungrier so it can be quite a challenge to stop yourself putting on weight. Try to eat a healthy balanced diet without increasing your portion sizes. Dont snack on foods that contain a lot of calories, such as crisps, cakes, biscuits and sweets. If you feel hungry between meals, eat fruit and vegetables and low-calorie foods. Regular exercise will also help to keep your weight stable.
- headaches make sure you rest and drink plenty of fluids. Dont drink too much alcohol. Ask your pharmacist to recommend a painkiller. Talk toyour doctor if headaches last longer than a weekor are severe.
- feeling sleepy do not drive or use tools or machinery if youre feeling this way. Try to avoid drinking alcohol as this will make you feel more tired. Talk to your doctor if this becomes troublesome as you may need to switch to a different medicine.
- constipationeat more high-fibre foods such as fresh fruit and vegetables and cereals, and drink plenty of water. Try to exercise more regularly, for example, by going for a daily walk or run. If this doesnt help, talk to your pharmacist or doctor.
What Are The Long Term Side Effects Of Mirtazapine
Long term use of mirtazapine is considered safe, with little risk of long-term side effects even when the drug is taken for months or years. Care must be taken, however, when deciding to stop taking the drug.
Like with many antidepressant medication, itâs not advisble to abruptly stop taking mirtazapine. This can lead to withdrawal symptoms, which may include:
- headaches and dizziness
- nausea and vomiting
- anxiety and agitation.
For more information on this drug, you can visit the NICE website, which is a trusted source of up-to-date drug information.
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Psychotherapy For Anxiety And Panic Disorders
Cognitive and behavioral psychotherapy can be used alone or in addition to pharmacotherapy. The combination approach yields superior results for most patients compared to either single modality.
Cognitive therapy helps patients understand how automatic thoughts and false beliefs/distortions lead to exaggerated emotional responses, such as anxiety, and can lead to secondary behavioral consequences. Specific patterns of cognitive distortions tend to respond best to specific techniques described in cognitive behavior therapy books . While intended for use in conjunction with therapy, patients can purchase these books and complete the course themselves.
Behavioral therapy involves sequentially greater exposure of the patient to anxiety-provoking stimuli over time, the patient becomes desensitized to the experience. Relaxation techniques also help control patients’ levels of anxiety. Respiratory training can help control hyperventilation during panic attacks and help patients control anxiety with controlled breathing. Other forms of psychological treatment, including psychodynamic psychotherapy for specific issues, are available but exceed the scope of this article.
Consultation with a psychiatrist is helpful to initiate longer-term therapy and to provide follow-up planning. Longer-term therapy currently consists of SSRIs, often with additional psychotherapeutic techniques.
Other Possible Therapeutic Benefits
Pain in advanced cancer. Interest in the use of mirtazapine as an adjuvant treatment in the palliation of advanced cancer was originally spurred by the hope that it could offer an alternative to tricyclic antidepressants in pain management. In fact, a double-blind cross-over trial demonstrated that a single dose of mirtazapine could significantly increase the pain threshold of healthy participants.84 A pilot open-label trial,85 which targeted advanced cancer patients who were experiencing moderate-to-severe residual pain despite opioid maintenance, identified only a small insignificant improvement in pain and pain relief scores with mirtazapine, although there were significant dose-independent improvements in self-rated depression and functional assessment measures.
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Important Things To Know About Mirtazapine
Mirtazapine is a medication regularly prescribed for those with major depressive disorder, anxiety disorder, or insomnia caused by mental health conditions. It is classified as a tetracyclic antidepressant, which affects norepinephrine levels. Mirtazapine is different than many other common antidepressants that fall under the category of selective serotonin reuptake inhibitors , which work by increasing the levels of serotonin, a neurotransmitter in the brain. Weâll go into more detail on how mirtazapine works later in this article.
As an antidepressant, Mirtazapine can take up to 4-6 weeks to start working. You might experience side effects that include headaches, dry mouth, weight gain, or nausea.
Signs Of Remeron Addiction
Like the majority of Antidepressants, Remeron is generally considered to be nonaddictive however, the drug can cause physical dependence. Those that try to reduce their dose or stop taking Remeron altogether will start to experience uncomfortable withdrawal symptoms, which can cause some people to keep taking the drug despite wanting to quit. Withdrawal symptoms include rebound depression, irritability, nausea, dizziness, vomiting, nightmares, headache, and paresthesia . These symptoms can lead to a cycle of addiction and dependence where individuals build up a tolerance and effectively take more and more of the medication in an effort to prevent the debilitating effects of withdrawal.
Signs that indicate someone may have a Remeron addiction include:
- Taking Remeron for longer than prescribed
- Needing more and more of the drug to elicit the same effects
- Spending the majority of the day thinking about Remeron: how to get more, the effects it produces, and when to use it
- Being unable to stop using the medication
- Faking symptoms to get Remeron prescriptions
- Sudden changes in physical appearance, hygiene, and behavior
Cannabidiol & Medical Marijuana
Lets address the skeptics here first, but also look at the big picture in an unbiased way. We clearly need more research on this topic. Marijuana can clearly be addictive for some. Our society has had a puritanical basis against marijauna research in the past. Its clearly safer on average than alcohol and benzos in terms of overdose and fatality. Typically, overdose on these products has not ever been described as fatal. Only very recently has a coroner said there may have been a fatal overdose on marijuana. Even if this is not an accurate report, with the legalization of marijuana and development of higher potency strains, it would not surprise me that this does occur in time. But for now, in the big picture, the #1 drug that kills in our society is nicotine, and alcohol is #2.
The mechanism of action here concerns the endocannabinoid system in the human body. Like the other classes of medicines discussed, the exact mechanism is not completely understood. This can have various different effects including reducing seizures, anxiety, and gastrointestinal symptoms. The first ever CBD product was approved last year for severe seizure disorders.
I tend to refer my patients to someone who specializes in medical marijuana and CBD when other classes of medications like antidepressants have failed them.
Low Sodium Levels In The Blood
- Risk factors: Older adults | Taking diuretic medications | Dehydration
Very rarely, Remeron can cause a decrease in sodium levels in the blood. You might need to have regular blood tests done while taking Remeron to make sure the sodium in your blood stays at a normal level. Tell your healthcare provider right away if you experience weakness, confusion, difficulty concentrating, headache, or memory problems while taking this medication.
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Warnings For People With Certain Health Conditions
For people with a history of mania or bipolar disorder: Talk to your doctor about whether this drug is safe for you. Mirtazapine may trigger a mixed or manic episode.
For people with seizures: Talk to your doctor about whether this drug is safe for you. This drug may make your condition worse. If you have a seizure while taking mirtazapine, talk to your doctor. They will decide if you should stop taking it. You may need to stop taking this drug right away, or your dosage may slowly be lowered over time to avoid withdrawal symptoms.
For people with heart problems: If you have a history of certain heart problems, talk to your doctor about whether this drug is safe for you. These heart problems include angina , heart attack, or stroke. Mirtazapine can cause low blood pressure, which can make heart problems worse.
For people with glaucoma or other eye problems: This drug may dilate your pupils. This may trigger a glaucoma attack. Before you take this drug, tell your doctor if you have glaucoma.
For people with kidney problems: If you have kidney problems or a history of kidney disease, you may not be able to clear this drug from your body well. This may increase the amount of mirtazapine in your body and cause more side effects.
For people with liver problems: If you have liver problems or a history of liver disease, you may not be able to process this drug as well. This may increase the amount of mirtazapine in your body and cause more side effects.
Does Mirtazapine Help With Anxiety
I was prescribed mirtazapine for anxiety, im not depressed but have anxiety and panic attacks, does this medication help with this?
1 like, 32 replies
Posted 4 years ago
James. It is not a case of abusing Benz’s but of Benz’s being so made that they result in dependence. One doesn’t have to abuse the dose to become dependent. The tolerance that Benz’s quickly produce means that the drugs need to be increased to have the same effect. This produces dependence.
The only way to avoid this dependence is to taper off the drug by substitution of the drug taken, in your case Ativan. For this Diazepam is used in a comparable strength. I have used it to stop taking Nitrazepam coming down from 10mg of Valium to zero in just on 10 months 1mg at a time every 1-2 weeks. I would not take any psychiatric drug now however I felt I would insist on CBT or a deeper type of therapy. Good luck with your own health.
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What Medications Are Similar
Remeron is an atypical antidepressant, meaning that it isnt among a group of similar drugs available on the U.S. market.
However, multiple other groups of antidepressant drugs are available. Your healthcare provider may make an initial suggestion for you based on your medical conditions and your personal preferences. However, finding the right one for you can involve some trial and error.
Some of the major groups of antidepressant drugs are:
- Tricyclic antidepressants
Several other types of atypical depressants also exist. These dont fit neatly into another drug category.
Remeron is more closely chemically related to tricyclic antidepressants than to these other groups. However, compared with tricyclics, it seems to cause fewer side effects like dry mouth and potentially fewer severe side effects related to heart problems. Compared with SSRIs, Remeron may be less likely to cause sexual dysfunction as a side effect.
Compared with some other types of antidepressant drugs, Remeron may have certain benefits for certain people. For example, some evidence suggests that it may be more likely to help people with any of the following:
- Anxiety coexisting with depression
- Depression that hasnt responded well to other treatments
- Geriatric depression
Please note, these groups of drugs are possible alternatives to Remeron. They arent usually prescribed at the same time. This is especially important for MAOIs, which you should never take at the same time as Remeron.