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Mirtazapine-Remeron looking somewhat hopeful plenair

Posted by mtom on July 10, 2019, at 12:16:42

In reply to Re: Many comment Mirtazapine for sleep.But AD/anxiety?, posted by plenair on July 10, 2019, at 10:17:49

> Thanks for the update. Did you go up on the Mirtazipine?
>
> I still am in analysis paralysis between luvox and mirtazipine.

Plenair, well the nightmares faded over a couple of weeks, occasional vivid dreams remained but fewer. So late last week I upped the Mirtazapine just very slightly and reduced the Cipralex also very slightly. Had nightmares that night, but they seem to be fading again to vivid dreams which I remember some nights, not others. However I had similar dream experience with Escitalopram. I still have some Tinnitus but that was brought on by the Escitalopram, lessened when I reduced dose, and has not worsened since I started Mirtazapine.

I think my Anxiety is slightly better and I've had a few intermittent days where I felt more motivated and got some long neglected tasks done, but not every day. (Mirtazpine has been said to often take effect faster than other AD's). Maybe a bit groggy in morning (some say this lessens over time and also less on higher doses when the NE effect over-rides the anti-histamine effect). So I will increase slightly again in about a week.

There was a study published in Lancet last year comparing 21 AD's for efficacy and acceptability. They ranked Mirtazapine #2 for efficacy, Fluvoxamine #7. For acceptability Mirtazapine was #11, Fluvoxamine #16.

However they extrapolated this based on a bunch of other studies, some head to head AD's, some AD against placebos, and the evidence level for their findings was limited by the fact that many AD's had less published research than others (including these 2). They also commented on the modest effect sizes (i.e. none looked really outstanding vs placebo), and the possibility of publication bias in their source data. But it seems to be the best comparison out there right now. There just isn't a lot of good data comparing all of the antidepressants. Escitalopram (Lexapro-Cipralex) rated high for a weighted combination of "both" efficacy & acceptability together, yet I had a ton of side effects from Esc that but did not completely go away when I reduced dose. And it had little impact on depression, although I never was able to get up to the full recommended dose because SE's worsened whenever I increased dose.

Most people who stop Mirtazapine seem to complain about somnolence and/or weight gain both of which seem common but do not occur in everyone. Also the somnolence seems to dissipate over time with many. I haven't gained weight, and it's not making me sleepy other than the slight grogginess in a.m. (which may in part be due to sleep disturbance with the dreams), but maybe my dose still too low for side effects (although had lots on very low doses of other AD's I've tried).

So, so far, the worse side-effect for me has been the dreams, which seem to increase with dose increase but then seem to fade over time (at least have so far, have to see how it goes with higher doses). A little concerned that as I go up, the more activating NE effect could increase my anxiety again, can only try it and see if I can find a balance.

I've read that Fluvox seems to be commonly prescribed for OCD (as well as depression and anxiety disorders)? Do you have OCD?


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poster:mtom thread:1104640
URL: http://www.dr-bob.org/babble/20190513/msgs/1105237.html