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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by TriedEveryMedication on March 22, 2021, at 14:06:13
I ended up getting pancreatitis from it (30mg/day at bedtime).
It just about completely erased my anxiety, kept me asleep and night. I was able to function better at work. Mood was significantly better, too.
But unfortunately my pancreas and liver freaked out from it.
Is there anything else similar that I could try? The usual SSRI suspects don't really cut it. Well, paxil erased my anxiety but also made me too drowsy all the time.I hope everyone is well here or well as can be.
Thanks
Posted by linkadge on March 22, 2021, at 16:09:04
In reply to Mirtazapine worked really well for anxiety, but, posted by TriedEveryMedication on March 22, 2021, at 14:06:13
What were the symptoms you had (i.e. pancreatitis). How did they diagnose this?
Mirtazapine helps me to some extent, but I'm still having bad insomnia.
Linkadge
Posted by TriedEveryMedication on March 22, 2021, at 17:08:53
In reply to Re: Mirtazapine worked really well for anxiety, but, posted by linkadge on March 22, 2021, at 16:09:04
> What were the symptoms you had (i.e. pancreatitis). How did they diagnose this?
>
> Mirtazapine helps me to some extent, but I'm still having bad insomnia.
>
> Linkadgepain after eating in the morning, right under the bottom of my sternum was the alert. I had pancreatitis in the past from an antibiotic, so I knew exactly what was going on.
confirmed with an amylase and lipase blood test.
Posted by Christ_empowered on March 22, 2021, at 20:04:01
In reply to Mirtazapine worked really well for anxiety, but, posted by TriedEveryMedication on March 22, 2021, at 14:06:13
neurontin? lyrica? surmontil?
Posted by linkadge on March 23, 2021, at 17:00:01
In reply to Re: Mirtazapine worked really well for anxiety, but » linkadge, posted by TriedEveryMedication on March 22, 2021, at 17:08:53
Hmm. You probably don't want to do a retest of this drug.
For anxiety, it's hard to get something exactly like mirtazapine.
Trazodone or amitriptyline could be similar. Actually, one that might be the most similar is an older drug called Trimipramine.
Get your doctor to look up (or consider) trimipramine. Like mirtazapine, it has a similar antihistamine, and serotonin blocking effect. It has no SSRI or SNRI effect.
It should be similar.
Linakdge
Posted by sigismund on March 23, 2021, at 22:18:05
In reply to Re: Mirtazapine worked really well for anxiety, but, posted by linkadge on March 23, 2021, at 17:00:01
Try trimipramine.
I was on a low dose, around 15mg at night. At that dose it was weaker than mirtazepine but much nicer.
Posted by TriedEveryMedication on March 24, 2021, at 10:45:50
In reply to Re: Mirtazapine worked really well for anxiety, but, posted by sigismund on March 23, 2021, at 22:18:05
Thanks for the suggestions. I notice mirtazapine has strong Ht-51a binding affinity. The suggestions above don't so much.
The only thing I could find with a strong HT-51a affinity is buspar.
What do you think?
Posted by linkadge on March 24, 2021, at 15:42:54
In reply to Re: Mirtazapine worked really well for anxiety, but, posted by TriedEveryMedication on March 24, 2021, at 10:45:50
Mirtazapine does not have a significant affinity for 5-ht1a.
See:
https://en.wikipedia.org/wiki/Mirtazapine
Keep in mind that larger numbers represent a LOWER affinity of the drug for that target. Mirtazapine exerts its strongest effect at the histamine 1 receptor. Hence you will notice that for the histamine receptor, the number is the smallest:
H10.141.6 (highest affinity)
5-HT1A3,3305,010 (quite low affinity)Linkadge
Posted by sigismund on March 24, 2021, at 16:54:56
In reply to Re: Mirtazapine worked really well for anxiety, but, posted by linkadge on March 24, 2021, at 15:42:54
Buspar didn't do anything for me.
Posted by TriedEveryMedication on March 24, 2021, at 19:04:13
In reply to Re: Mirtazapine worked really well for anxiety, but, posted by linkadge on March 24, 2021, at 15:42:54
> Mirtazapine does not have a significant affinity for 5-ht1a.
>
> See:
>
> https://en.wikipedia.org/wiki/Mirtazapine
>
> Keep in mind that larger numbers represent a LOWER affinity of the drug for that target. Mirtazapine exerts its strongest effect at the histamine 1 receptor. Hence you will notice that for the histamine receptor, the number is the smallest:
>
> H10.141.6 (highest affinity)
> 5-HT1A3,3305,010 (quite low affinity)
>
> Linkadge
>
>Weird - on this page
https://en.wikipedia.org/wiki/Pharmacology_of_antidepressantsit shows mirtazapine's affinity to be 18 for HT-51A
Posted by TriedEveryMedication on March 25, 2021, at 11:54:36
In reply to Re: Mirtazapine worked really well for anxiety, but » linkadge, posted by TriedEveryMedication on March 24, 2021, at 19:04:13
According to this article it seems it more activates it indirectly
https://www.nature.com/articles/s41598-020-77652-4
"Mirtazapine, a noradrenergic and specific serotonergic antidepressant (NaSSA), is known to activate serotonin (5-HT) 1A receptor."
...
"Mirtazapine inhibits 5-HT2 and 5-HT3 receptor on astrocytes, which leads to selective 5-HT1A receptor stimulation and MT induction in astrocytes."
Posted by linkadge on March 25, 2021, at 15:43:31
In reply to Re: Mirtazapine worked really well for anxiety, but » linkadge, posted by TriedEveryMedication on March 24, 2021, at 19:04:13
Hmm.
Most sources I have read indicate a very low affinity of mirtazapine for 5-ht1a. Often with these affinities, a range of different studies need to be combined to get an idea of the actual value.
Also, you need to determine whether the affinity is agonist (activating) or antagonist (blocking) affinity.
Linkadge
Posted by linkadge on March 27, 2021, at 7:46:49
In reply to Re: Mirtazapine worked really well for anxiety, but, posted by linkadge on March 25, 2021, at 15:43:31
Yeah, it certainly will act as an indirect 5-ht1a agonist. Trimipramine might share this effect, as it blocks similar receptors.
Linkadge
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