Mirtazapine need some help please

I find it helpful to try and understand what is happening to the brain in order to figure out what is likely to be the best way forward in terms of medication.

   The latest research shows that at least three of the major categories (mood disorders [e.g. depression, bipolar], the personality disorders [e,g. schizophrenia] and the impulse control disorders [e.g. ADHD and ADD]) of mental health problems all appear to be related to the cells in specific parts of the brain not functioning as effectively as they should. For example, ADHD is associated with under activity of the pre-frontal cortex which is the part of the brain which inhibits and modifies the more basic instincts particularly the "fight or flight" response which is located in the amgydala which is an "evolutionary older" part of the brain. The most effective treatment for ADHD is therefore to essential wake up the pre-frontal cortex using stimulants (ritalin in children and modafinil in adults). This at first seems a bit strange that to improve poor behaviour we give people stimulants and strong stimulants at that (both ritalin and modafinil are also used to treat excessive daytime sleepiness as well as used by the forces to help keep troops alert during night time exercises). However, the research is very solid, where poor behaviour appears to be rooted in a reduced ability to control your impulses, these drugs give great results and if taken early enough in the day will not disturb your sleeping as they wash out your bloodstream quite quickly.

  When it comes to mood disorders such as depression and anxiety disorders and personality disorders the reduced brain cell functioning appears to be concentrated in different parts of the pre-fronrtal cortex. Unfortunately the stimulants don't have anywhere close to the same level of benefit in these conditions. The most effective approach with these disease is to improve the communication between cells. The cells in the brain and nerve system are called neurones and they are relatively complicated cells when compared to other types of cells in the body. The key thing about neurones is that each neurone is wired in to hundres of other neurones. Essentially the more connections neurones have with each other, the better they work. The "wiring" in this case is not a metal wire but is a chemical wire. Among the key chemical compounds that act as "chemical wires" in your brain that carry the electrical signal are serotonin and norepinephrine. The technical word for thses chemical wires is neurotransmiters, Most of the common anti-dpressants work by increasing the amount of these drugs in youer brain (SSRIs make more serotonin and SNRIs make both more norepinephrine and serotonin available).

   Many SSRIs and SNRIs including Mirtazapine make you more drowsy in the first month or two  of taking them  (technically Mirtazapine  is neither an SNRI nor and SSRI but works largely by making more serotonin  and norepinephrine available). If you are becoming more drowsy after two months, it is likely that the depression may be getting worse and the dose you are on is not big enough to stop the depressiopn getting worse. You really need to see your doctor but don't be surprised if they suggest a large dose of Mirtazapine. If you are not already on Modafinil again this is a discusion with your doctor. If you are being treated by your GP get a referral to see a proper doctor (i.e. a consultant) as you have more than one mental health condition and you need to be working out the best treatment option with someone who deals with this everyday and can spend at least 30 minutes each time versus the poor old GP who just have 11 minutes to see you each time. Try not to worry about having multiple conditions as given that the conditions all relate to the same basic problem of various parts of your pre-frontal cortex not functioning at 100% and as a consequence it is very common for people to have multiple mental health conditions .

  The one thing that a GP can help with though is that they often can get you a referral to CBT (the one talking therapy that actually helps) quicker than a consultant.

  In summary:

1) Get an appointment to see your GP.

2) If you do not have one already, ask your GP for a referral to a consultant given the complexity of having both ADHD and depression.

3) If you are not already on ritalin or modafinil for the ADHD, ask whoever you end seeing about trying it out to see it it helps.

4) For the depression don't be surprised, if they suggest a larger dose or a combined approach (e.g. adding in venlafaxine). Remember that tiredness at this stage is more likely to be due worsening depression rather than to the medication.

5) If you are not already on a waiting list for CBT ask to get a referral. Talking therapies are not the wonder treatment that the media make out but they do help particularly with reducing stress levels