Psycho-Babble Medication Thread 114137

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switch from venlafaxine to mirtazapine in Bipolar

Posted by swingsnroundabouts on July 29, 2002, at 8:25:16

Hi all

Advice needed. I can't find any literature giving advice on switching from venlafaxine to mirtazapine. As I have Bipolar 1 disorder I am concerned about the change over triggering a manic episode. My doctor discontinued 75mg bds of venlafazine (no taper off) and started 30mg mirtazapine the next day. The reason for the change was ongoing sleep problems on venlafaxine. My sleep is great - trouble is I appear to be suffering from what I think is venlafaxine withdrawal syndrome (dizziness / exhaustion / vertigo) and I'm not sure whether the venlafazine should have been stopped so abruptly. Should the mirtazapine prevent or help with any potential trigger of mania due to the efexor withdrawal? Does anyone know if any literature exists on this as I don't think it does.

 

Re: switch from venlafaxine to mirtazapine in Bipolar

Posted by Shawn. T. on July 29, 2002, at 21:29:48

In reply to switch from venlafaxine to mirtazapine in Bipolar , posted by swingsnroundabouts on July 29, 2002, at 8:25:16

The venlafaxine should definitely have been tapered down. Some people have warned about mixing it with mirtazapine (Remeron), so I don't know if I want to suggest that. You might see about getting some Prozac (which have a very long half life) to help withdraw from the Effexor. I doubt that the mirtazapine is going to create the level of serotonin availability in your synapses that your brain was accustomed to. You should not experience a manic switch because mirtazapine blocks 5-HT2 receptors which are involved in bipolar II. If you do experience a switch, you will need to drop your dosage down to 15mg/day to decrease noradrenaline levels.

Shawn

 

Re: switch from venlafaxine to mirtazapine in Bipolar

Posted by swingsnroundabouts on July 30, 2002, at 6:15:07

In reply to Re: switch from venlafaxine to mirtazapine in Bipolar , posted by Shawn. T. on July 29, 2002, at 21:29:48

> The venlafaxine should definitely have been tapered down. Some people have warned about mixing it with mirtazapine (Remeron), so I don't know if I want to suggest that. You might see about getting some Prozac (which have a very long half life) to help withdraw from the Effexor. I doubt that the mirtazapine is going to create the level of serotonin availability in your synapses that your brain was accustomed to. You should not experience a manic switch because mirtazapine blocks 5-HT2 receptors which are involved in bipolar II. If you do experience a switch, you will need to drop your dosage down to 15mg/day to decrease noradrenaline levels.
>
> Shawn


Thanks Shawn

I agree that the dose of the efexor should have been tapered. I spoke to my doctor over the phone yesterday and I don't think they are too sure what they are doing. I've found some literature now and it seems to suggest the same, but as it's now been a week it's too late to do much - I may as well sit tight and wait for the withdrawal syndrome to wear off. I'm bipolar 1 so hopefully I won't get a swing!!!!

I'm not on a mood stabiliser - I just use chlorpromazine as and when to prevent any threatening 'up'. Hope I won't have to add that or I won't wake up at all!!!!!!!!!


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