GAD - Mirtazipine and Sertraline Advice

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Looking for advice and similar experiences. Sertraline 200mg pooped out after 16 years of working brilliantly. with no life event triggers. I am normally a happy go lucky person (as most of us, the last person in a friends group that you predict would suffer from anxiety and depression). Initially, GP recommended through liaison with Mental Health specialist (pysch) to add Mirtazipine as it has a good track record working in combination and complementing with SSRI's (e.g. Sertraline) in kick starting them again.

Since September last year i have been on a roller coaster ride with doseage trial and error and it is completely obvious that my GP is unable to support as they just seem to agree with whatever i state based on my symptoms that i have been tracking through a spreadsheet.

I have been referred by my GP multiple times for an antidepressant medication review with a psych but i keep getting referred to the Wellbeing Team and talk based therapies. I am already undergoing online CBT calls with Wellbeing Team and using the online CBT Silvercloud service. However, despite repeated attempts from my GP to refer me to a Mental health specialist qualified to discuss medication, i am refrerred back to the same wellbeing team through their single point of access. I've now raised a complaint through PALS (Patients and Liaison Service) to intervene and arrange a session for me to meet with a qualified specialist to discuss my medication as i feel like i am going round in circles and the current system / referral process is failing me.

My latest self medication has been to gradually reduce Sertraline and maintain Mirtazipine at 30mg. I am at a point now where i am not sure whether to continue with Sertraline reduction, e.g. move down to 25mg Sertraline or reduce Mirtazipine. The evidence suggests i should reduce the serraline as i had a significant bad reaction for a number of weeks the last time i went below 30mg Mirtazipine so my gut feeling is to reduce sertraline. I have also suffered no signficantly bad reaction at all since reducing from 200mg sertraline through 150, 100, 75 and more recently 50.

I'm thinking of reducing the 50 to 25 this week and then see how i go on 30 Mirt and 25 Sert combined. I get the feeling it's still going to be a while before i get to speak to a pysch on the NHS.

All i can say is thank god i have loving family and friends to support me. God only knows what it must be like to navigate our underfunded / underresourced alone without any support. My GP told me that the triage lisaison decision making progress above is all due to underfunding for mental health support. The quick fix is drug and talk based therapies but you never seem to be able to speak to anyone with a specialist background in medication (e.g. psych)

Thanks X

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  • Posted

    hello jon, im pretty sure the mirtazapine is too high. above 22.5mg, it can be too activating, and less sedation. youve almost gone from a combination of anti depressants, to a full switch to mirt. i would drop mirt to 22.5mg, and increase sert to 100mg. thats going to increase seratonin effect ( happy feeling) and reduce noradrenalin (motivation). you are mostly anxious now, it would give you a 50/50 split, of each maximum dose. i dont think old anti depressants that poop out stop working as such, its more to do with what they do, is no longer sufficient ie, sert is still doing a job, that along with mirt, will work for you. i had mirt of 15mg added to ven 6 weeks ago. worked very well. i wanted more, dont we all, and tried increasing mirt to 22.5 3 times. once for 5 days. anxiety shot up immediately each time, couknt stand it, dropped back down to 15mg, and quickly felt much better. im on a high dose of ven, so cant take more than 15mg of mirt, even when i reduced ven. on 100 of sert, 22.5mg i think will do it for you.

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    • Posted

      Thanks Nigel. I think you are right about the Mirtazapine and i'm dropping down to 22.5mg from tonight. As i've managed so well coming down on the Sertraline, i'm going to keep that at 50mg for now and see how i go. I really believe they should have some sort of NHS anonymous database tracker online where people can record their symptoms, improvements etc on these medications. We all have extremely valuable experiences and i just thank god that there are helpful people like yourself. Thanks again

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    • Posted

      i would recommend going back up on sert. it will increase seratonin, which will increase hapoiness and calm feeling. its the noradrenaline being too high in 30mg of mirt thats causing anxiety. if you drop mirt, you drop noradrenaline, but you will also drop its seratonin, which is why you need sert going back up. going back up on sert, should help anxiety, not make it worse. sert doesnt have a noradrenaline effect, so poses no issues. get too low on seratonn, you may start getting down.

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