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Re: Why do people not like Amitriptyline + Mirtazapine linkadge

Posted by mtom on June 10, 2019, at 19:42:57

In reply to Re: Why do people not like Amitriptyline + Mirtazapine, posted by linkadge on June 10, 2019, at 14:54:28

For some reason Mirtazapine seems to be frequently recommended as an add-on to SSRI's. SSRI's do increase my anxiety. Now taking a very low dose, have been reducing gradually (escitalopram). Going to try a low dose Remeron as an add on and see how it goes. Many say it helps anxiety (although some don't) and may boost effectiveness of SSRI's.

Why is amitriptyline not well tolerated? I know about the weight and somnolence issues, but Mirtazapine has these too. Are there other issues with amitriptyline?

> 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)
> Linkadge




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