Go to 15mg mirtazapine for a week, then straight to 20mg fluoxetine?

Hi, thanks for the advise. I have an action plan set in motion to get me doing things again. I tend to be always googling things lately and i can see how that would make any problem worse because you could be convinced you have multiple things when in reality its all in your head. I will carry on with the fluoxetine and just wait for it to go into my system. Worse case scenario is i go back on mirtazapine, but it would feel like I've put myself through hell for nothing if i do so.

hi beezwax,

sorry to hear you're not feeling better.

it's a good idea to talk it through with a psychiatrist with a good knowledge about psychotropic drugs. although i'm wondering when you actually going to have an appointment since your therapist agreed to refer you!?!

regarding your symptoms i think that although they may also have another origin such as infection it is very much likely they are side effects of fluoxetine, at least they are all listed in the potential side effects of these types of drugs. it is also possible that some of these are emerging due to lack of sleep.

in general one has to outweigh the benefits and the side effects when taking meds. yet in my opinion if a drug makes someone feel more ill, than i don't see a point in continuing a medication.

in your case one could argue that the time you're taking it is still too short so although they show effects normally within 2 - 4 weeks they may take longer with you. everybody is different and statistics say nothing about individuals yet only the general population.

i am guessing the symptoms got worse after you upped the dose to 40mg?

and you did not take any mirtazapin and/or diazepam in addition to the fluoxetine?

and you did not change anything substantially in your life such as your diet or starting to run marathons etc.?

in my previous replies i came up with a few hypotheses and i think we can discuss them as follows:

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1) your symptoms are related to your body now beeing without mirtazapine (not withdrawal yet the state you're in without the effects of the medication) plus fluoxetine has not yet reached its full effectiveness (it is too early to tell since you take it only about 2 weeks).

Seems still a valid hypothesis except for the fact that fluoxetine shows no effect yet annoying side effects.

2) you're actually facing withdrawal from mirtazapine

Could still be the case although withdrawal symptoms usually subside within the first weeks of discontinuation there are reports and meta analyses (giovanni fava et al.) they may persist for longer in some individuals.

-- If it were actual withdrawal, a reinstatement of the original drug normally provides relieve of symptoms. I recall you discussed with your therapist to use the mirtazapin in case symptoms get unmanagable. Have you tried that?

3) you're a non responder to fluoxetine

It seems you are a responder but not on the intended effects.

4) your dose of fluoxetine is too low

Looks like we can cross that out since you upped the dose to 40mg and clinical trials also showed no significant effects for doses greater than 20mg (highest administered was 80mg yet without significant effects). Plus since your symptoms got worse (correct me if i am wrong), it seems unlikely it would get better with an even higher dose.

5) fluoxetine has not started working yet

As stated above, after 2-4 weeks it normally shows efficacy. since you're not getting the effects yet side effects it seems the drug is doing something yet not what is intended.

6) fluoxetine is generating your symptoms

Since you felt worse after starting the fluoxetine and state your symptoms increased it seems plausible this is the case.

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in my opinion i would discontinue the fluoxetine, bypass the time with diazepam or lorazepam and start either a new med. or reinstate the mirtazapin.

how would i do that:

- since fluoxetine has a half-life of about 96hours / 4 days, it will take about 40 days to have it out of your system to a percentage of 99.%. hence you could either not take it anymore and see how you're doing or reduce to 20mg first for about two weeks and then go to 0 if you don't feel any withdrawal symptoms.

since you are taking it for only a short while and since it has about the longest half-life of the SSRIs it would seem highly unlikely you develop any form of discontinuation symptoms.

if fluoxetine causes your symptoms it would only be logical that they lessen once you decrease or stop the drug. if not they were probably not from that.

- in order to have a powerful working solution in place for the case you face increased symptoms you could rely on diazepam or lorazepam and take it as necessary or for a few days in a row.

- after you are off fluoxetine you could instate a new drug or reinstate mirtazapin. depending on the type of drug you could start instating when you're not 99% off fluoxetine.

Regarding you mentioning SSRIs are not working for you i can think of a few drugs that may work better for sleep and anxiety due to their sedative effects such as trazodon or trimipramin. although they also work as serotonin reuptake inhibitors they work as receptor inhibitors too and have more calming effects. Trimipramin also comes in liquid form which makes it very easy to individualise the dose.

that's what i could come up with today.

kind regards,

d

PS:

please note that all i'm saying are just my opinions based on my personal experience, scientific knowledge and logical sense and i trust you to talk and take actions in cooperation with your therapist.

and sorry for the essay yet i figured you're a quick reader ;-)

hey there!

I went to my therapist and we agreed to see if the fluox would work after giving it a little more time. I am doing slightly better in the past few days, but definately not great! If I don't get any relief over the festive season, I will take the Psychiatrist route and hopefulkly get sorted for the next year.

You have a good point there about weighing the side effects and if its even worth taking the drug if you get so many negative/unwanted effects. I've often considered ditching the meds all together, but the anxiety just sky rockets through the rood whenever I try... but I guess one could argue its already gone through the roof even after just switching onto fluox. So maybe I should just grin and bare it for a few weeks and be rid of them all together?

I've not taken any Mirtazapine in over a month and have also not taken any DIazepam in a while because I've just heard so many negative things about Benzodiazepines. In regards to changing things in my life. I stopped eating for a while so I was having no where near the amount of food I was having, and also I stopped going to the gym so my lifestyle has been suffering as of late and I've just been doing as many pleasurable hobbies as I can. 

Out of your list, my honest opinion is its a mixture between 1,2 and 5. I'm am 100% sure Mirtazapine has generated a lot of these effects because last time I tried to quit it, the same thing happened. My body just went into shock. I'm just happy that I have a plan laid down with my therapist so I have a goal and back up plans set up in place if Fluoxetine ends up not working. 

The reason I came off Mirtazapine was mainly because I always felt like I was in a cloud, lost my clarity of thought and generally felt like I'd lost some IQ. People could be talking to me and I'd easily lose track of what they were saying, I couldn't even comprehend what they were trying to express most of the time. (especially when I drank alcohol). I felt so down that I relied on alcohol for sleeping and just as a sense of escape for a limited amount of time, but obviously knowing in the back of my mind that it would make the problem worse for the next day. I also put on a lot of weight because I was literally never full. 

Its like with SSRI's you have a nessasary evil that you have to put up with if you want relief for anxiety ect. Whether that be not sleeping or whatnot. I will definately keep them sedating meds in mind for the future, thanks. I just feel determined to get the lifestyle changes underway now that I'm feeling slightly better. Thankyou again for your continued support and I will discuss this with my therapist. I feel this site can help as much as a therapist ( well it does for me at least). 

Sam.