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Re: Why do people not like Amitriptyline + Mirtazapine

Posted by linkadge on June 10, 2019, at 14:54:28

In reply to Why do people not like Amitriptyline + Mirtazapine, posted by mtom on June 9, 2019, at 19:47:02

I never found that mirtazapine increased anxiety (took it as high as 30mg). On the contrary, SSRIs did increase anxiety.

If sleep is not your core issue, then mirtazapine or amitriptyline may not be the best choices. Nortriptyline (related to amitriptyline) tends to cause less sedation and may improve energy more.

I think amitriptyline is so effective because, it hits so many targets. As mentioned, it is not well tolerated, but it has several complimentary antidepressant mechanisms.

serotonin / norepinephrine reuptake inhibition
antihistamine effect (reduces anxiety)
anticholinergic (antidepressant effect)
calcium channel inhibition (reduce pain, anxiety)
anti-serotonin (blocks certain receptors which can increase anxiety)





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