12 weeks 15 mg then 22.5mg anxiety still high should i increase
Posted , 3 users are following.
Hi All
A little history
I have suffered anxiety and depression previously.
about 4 years ago, i was prescribed venlafaxine 75 mg (i think), after 1 day on sertraline, induction was horrible (Restless and trouble sleeping and other typical side effects) and on going side effects weren't great . I was on them for about 8 months and withdraw by tapering slowly.
About 2 years ago i went on to Citalopram for about 8 months 15 mg. I suffered with pretty bad side effects for the first 3 months and come off again by tapering.
I have been on mirtazapine for 12 weeks due to depression , anxiety and not sleeping. The depression and anxiety started again mainly from work stress, but then i get anxiety from things in my past which come around again when the anxiety and depression start again.
I realise that i am going to have to be on these for quite a bit longer this time.
I went on mirtazapine due to them being good for sleep and the length of side effects from citalopram the last time. I went on cit the last time due to the venlafaxine start up side effects which were horrid.
I think that I am pretty sensitive to AD side effects.
My anxiety increased when i first went on them, 15 mg, for a couple of weeks and then seemed to get better, but not resolved. After about 5 weeks i increased to 22.5 as the anxiety was still there and mood was not improved. I sleep ok and definitely get to sleep ok ( about 10pm) but am now waking at about 5 am and am taking longer to get to sleep. I don't feel too groggy, but don't feel great during the day but have no appetite and anxiety is increasing again.
I am wondering what to do.
Is it worth increasing to 30mg , or is it likely that anxiety will increase further with a higher dose.
Should I decrease back to 15 mg but will that not be enough to beat the anxiety and increase mood .
Should I change to something else , maybe back to citalopram as it seemed to work last time but the side effects were pretty bad for 12 - 13 weeks, ( diarrhea and restlessness feeling foggy and some difficulty sleeping, i think i felt pretty fluey for a while too) I'm not sure i want to go back to that but realise that i may not have a choice.
The curent dose of Mirtazapine 22.5mg isnt doing what i want it to and am still anxious ( i am smoking a lot more cigarettes at the moment) .
Will i have to come off Mirt for a while before switching to something else or can a cross taper be done. Is that likely to horrid also.
I want to get myself settled and sorted out on something that I could take for a bit longer.
Thanks in advance for any guidance or thoughts.
0 likes, 2 replies
MT74795 G55055
Posted
You should speak with your doctor. Did your level of anxiety change at all when you went from 15 mg to 22.5 mg? If the anxiety didn't worsen at the higher dose (or any initial increase wore off), it might be worthwhile trying to increase the dose to get more effect, but speak with your Doctor.
Mirtazapine can be cross-tapered with "certain" antidepressants but you need to work with your Doctor for that. Mirtazapine is also sometimes used as add-on therapy to another antidepressant in addition to its use as a stand alone treatment.
I'm ultra-sensitive to antidepressant side effects also.
You said that Citalopram gave you bad side effects for the first 3 months but you stayed on it for 8 months and you also say it worked pretty good then. I assume you stopped it then because your issues had resolved?
Did you try Escitalopram (brand names include Cipralex and Lexapro) as an alternative to Citalopram? It's a similar drug but contains only the more active form of the molecules in Citalopram and I've read and heard that some people tolerate Escitalopram better and also find it more effective.
For me, I can't tolerate SSRIs - I've tried Sertraline and also Citalopram and Escitalopram, although of the 3, Escitalopram side effects were slightly more tolerable than the other 2. But everyone is different.
I cross tapered Escitalopram to Mirtazapine starting about 18 months ago. I've had only a partial response to Mirtazapine, but more than I had with SSRIs. I've thought about maybe adding back a very low dose of Escitalopram as I think my mood may have been better with the combination of low doses of both, although Escitalopram did increase my anxiety (more so when I was taking higher doses but less than Citalopram had). Again, I seem to be ultra-sensitive to things that increase Serotonin activity, at least in the way that SSRIs do. Mirtazapine has a different mechanism. Mirtazapine gives me side-effects also, although at low doses they're tolerable, but I feel worse (both side effects and mood) if I go above 15 mg. Yet I know many people take 30 and even 45 mg. Again, everyone is different.
Have you looked into Cognitive Behavioural Therapy or Mindfulness based Stress Reduction or Cognitive Therapy (MBSR and MBCT)? They're used a lot these days to help treat both anxiety and depression, with or without antidepressants. Offered at special Centres, by some private Therapists and also through some Hospital Medical Centres. Cost may be an issue - in some cases and places all or part of these programs is covered by Insurance, in some cases not. The Guided Mindfulness meditations of these programs are available free on the Internet from Trustworthy Sources (good to check that they're an accredited centre for MBSR/MBCT) - although those are only part of the full program. Still you might find practices like the Body Scan helpful if practised consistently over time (they're not quick fixes).
joshuapryce1987 G55055
Posted
Stick to a routine when taking medication. Sometimes the medication doesnt work straight away, give it time to work and stick to a routine. Going up in dosage requires more liability.