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Re: Need some advise

Posted by Hombre on July 16, 2010, at 1:17:21

In reply to Need some advise, posted by Conundrum on July 15, 2010, at 23:21:24

Hi Conundrum,

I started 15mg mirtazapine after 2 weeks of prozac. Granted, there were about 3-4 days between ending prozac (couldn't tolerate it) and starting mirtazapine. After the initial knockout, I felt better than I'd felt in a long time, each day getting better than the rest. After 10 days, however, it started to fade fast. I think this had a lot to do with smoking at the time, which increases one of the cytochrome enzymes that metabolizes mirtazapine.

I upped the mirtazapine to 30 then 45mg, but never got the feeling back. I even tried adding 10mg prozac a day, but that still felt crappy.

Adding 75mg venlafaxine really got things going. I had a strong if not somewhat rocky response to venlafaxine previously. We brought mirtazapine back down to 30mg, but it felt weird trying to bring it down any lower than that. Insomnia, some anxiety, and lack of focus were still a problem with this combo, but the depression was gone.

Every dose increase of mirtazapine resulted in a few days of higher energy, some anxiety/butterflies, and constipation. To me that suggests some NE-type action, but I'd get used to it in a few days. I finally stabilized at 30mg mirtazapine/150mg venlafaxine. A mild form of California Rocket Fuel. I started taking herbs for the side effects and got some nice effects in terms of metabolism and drive.

I suppose you could consider adding an SNRI or even buproprion, but as you know it's a game of roulette. Keep spinning that wheel, though.

Good luck,
Hombre

 

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poster:Hombre thread:954637
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