Long term mirtazapine stopped working

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I have been taking mirtazapine at 60mg per day for over 10 years now - I know that's a whopping big dose but due to chronic treatment resistant depression it was the only dose that actually worked. For over 8 years it worked brilliantly - lifted my depression, eased my anxiety and most importantly, enabled me to sleep. With it i got my life back, managed to hold down a full time professional job. I'd still get my down days and times where my mood was ultra low but generally I'd get over it fairly quickly. It numbed me out I guess and I didn't really cry anymore, the tear ducts seemed incapable of working! I figured this was the trade off for functioning and playing an active role in life after many years of not being able to work with debilitating acrophobia and social anxiety.

However, around two years ago things started to slide - I was working in a hugely stressful target driven environment and bullying was rife from other colleagues and middle management. I was getting more and more responsibility dumped on me and being the people pleaser and perfectionist I was, took it on without complaint. I started to get ill again - avoiding conversation at work, tearful, increasingly anxious and stressed. The biggest factor in my mood was the start of a terrible bout of insomnia where I just couldn't function. I couldn't get to sleep no matter what I tried - reading in bed, exercising, herbal teas, switching off TV, drinking malt drinks - nothing worked. Obviously this then led to a vicious circle - the lack of sleep made me feel more depressed and anxious and stressed and so it continued. Where I had always been used to going to bed around 10pm and falling into a deep sleep around an hour later without waking until my alarm went off at 6 - this literally stopped overnight. I would just lie there hour after hour counting down the clock until I'd have to get up. Or if I did finally manage to sleep I'd be awake an hour later going through the same countdown routine. Now obviously I put this down to my hugely stressful and by now loathsome job keeping me awake and making me depressed so I decided enough was enough and quit. I was fortunate to find another job very quickly with a huge pay increase and a management role. Ideally or so I thought, I had friends that worked there and the company was supportive of its staff - tada! Everything would be great - new job, great environment, I'd start sleeping again my depression would lift and everything would go back to normal...how wrong could I be...

The insomnia continued and my mood continued to plummet I became a wreck. Whereas I'd take enormous pride in my work, staying late completing projects to deadline I just gave up. I sat there every day in a complete haze - couldn't focus, tearful, shaking with anxiety, unable to deal with the smallest of jobs because my sleep deprived brain just couldn't function.. I was lucky to get 10 hours a week sleep in total, a walking zombie is the only way I could describe it. So I walked out - gave up on what could have been my dream job. I now believed I was burnt out from my previous job and I just needed time out to rest, take the pressure off, relax... Not once did I question the mirtazapine - how could I believe this was to blame when it had worked so wonderfully for all these years? It must have been me, I'd had a total breakdown but with time I'd be better surely?!

I didnt visit my Dr - the practice is next to useless and frankly I'd had enough of pych help. But nothing has improved at all - its been a year since I left work and I can not sleep at all - I'm getting more and more depressed by the day, more tired, more stressed, more hopeless. However, one day - two years too late- I had an epiphany- was the mirtazapine to blame? Had it stopped working? I had never been told this could happen. So. Here I am, this site has become my refuge, my only place of solace to know that others are going through similar things. Which finally led me to the conclusion that mirtazapine can actually poop out. I decided to start tapering off mirtazapine - its clearly not working anymore and has led me to believe that it actually may be causing me more harm than good. Seven weeks ago I dropped to 45 mg with few withdrawal effects apart from nausea in week 3 and daily headaches. Something strange happened at this drop - for the first three weeks I actually slept!!!! Three weeks of complete heaven uninterrupted blissful 8 hour sleep. It was absolutely wonderful but alas, short lived. The insomnia abruptly kicked in again and that's where I am right now again. I have since dropped to 30 mg a week ago, hoping that this may trigger another episode of sleep but nope, nothing. I've also been to my gp since then who basically advised he has no idea why the mirtazapine stops working and offered me nothing for my insominia . he advised I should carry on with the reduction and be off them altogether over the next three months or so. But, now what? I'm depressed and have chronic insomnia - do I try something else? Is there another anti depressant which could help me? Because I can't carry on like this, I have no life and no future if I can't get something sorted soon.

Thank you for reading this, I so hope someone can offer some advice.

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  • Posted

    Wow!  That was hard to read.  You sure sound desperate....understandably so.  Have you been to a psychiatrist?  If not, please consider doing so.  If you have seen one please consider seeing another one.  Your issues with sleep deprivation can be quite dangerous to your heart and brain in addition to the problems you currently experience.  Psychiatrists are experts in medications for anxiety, sleep, and depression.  A good psychiatrist has the medication answers you need...much more so than your regular doctor.  Generally speaking have you tried melatonin (otc drug) as a sleep aid?  Have you been prescribed a sleeping pill or sedative?  Please do your best to see a psychiatrist as soon as possible....it's very important!  Please keep us up to date with your progress.  We are concerned for your health.  Best of luck?

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    • Posted

      Hi Tanney thank you so much for your response and kind words - it helps immensely to know I'm not alone in this struggle - I have good friends and some supportive family members but as they've never had depression or been on ADs they don't often understand exactly how bad things are.

      I'm in the UK ( not sure where you are from) so all referrals to psychiatrists have to go through your gp. I've held off asking for this as 1, I really don't have a good gp surgery and see a different locum doctor every time and secondly, I wanted rid of all mental health intervention after being stuck in the system for so many years during my twenties. However, I do see your point and I know I can no longer cope with this on my own without proper medical help. When I last visited my gp it was during the very short period when I had reduced to 45 mg of mirt and had a brief spell of sleeping for three weeks so he didnt prescribe sleeping pills. I have another appointment booked for may where I will be telling him how desperate I am.

      I don't think we can get melatonin OTC here? I have tried phenegran though which is supposed to work for insomnia as well as being a strong anti histamine but it did absolutely nothing apart from giving me very restless legs. I have also stocked up on lots of supplements - magnesium, vit d, b complex etc but to no avail despite taking them religiously.

      I just feel so stuck, lost and alone. In an ideal world I'd take no medication ever again but this looks increasingly unlikely. Right now I'd take an arsenal of sleeping pills/ sedatives just to sleep...

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    • Posted

      Hi again.  I'm in the USA so access to professional help is somewhat easier than UK.  Nevertheless please do whatever is necessary to see a psychiatrist so that all the meds you are on can be evaluated for efficacy.  You may be told that you are over prescribing meds (otc and scripts) and need to come off some/most of them to clean out your system.  Seeing a psychiatrist often has bad connotations to some people, and that's usually do to a misunderstanding of what this type doctor does.  Psychiatrists are regular medical doctors who have highly specific training in meds that are best suited for curing the mind/body of anxiety, depression, sleep deprivation, and other emotional issues.  They are an especially appropriate source of care for those of us who have the struggles that you are going through.  before adding or deleting any more drugs please discuss with doctor.  I know from experience that your struggles can be overcome once your meds are appropriately managed.  best of luck!!  Let us know what happens.

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    • Posted

      Thanks Tanney - I have my Dr appointment on the 11th may so will keep you posted on what happens. What you're saying certainly makes sense to me. Wishing you well with your own health

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  • Posted

    Hello, just read your comment and must say folks like us need to get back to basics. I like you I was working in a very stressful environment. Once I got better, I got back down to earth and got a job as a gardener, low stress, low logistics, it got me back out of the fog of life..Too many people follow the sheep without thinking.. Baaahahaha!!

    Get well soon...

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    • Posted

      Thanks for your response - all advice is much appreciated. I do agree that stressful working environments can be a contributing factor in depression which in turn can lead to insomnia and so forth. However, I'm past this stage and I've removed these stress factors believing them initially to be the cause of my insomnia and anxiety. what I believe I am now struggling with is a medical issue due to long term mirt usage at a massive dose - it's somehow caused the very thing which it helped with for many years.. And so the cycle continues.

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    • Posted

      Hi Pauljdme - I totally agree with you. Simplifying is the best medicine. What a world we have created where life is an endless race to consume, gather more and more clutter, and the messaging that if we don't do that we are losers, missing out, twisted, etc. etc. If only everyone stood up and said "enough!" Good on you for being real.

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  • Posted

    Hi.I live in the US as well,but beside have a psy.,I also go to a counseler to discuss my problems.The psy. doctor is really for meds not much else.I don't know if you have Counsolers or psychologists who you can go to.Mine is a counsoler who is a nun with a double masters in psychology.She doesn't live in a convent or where habits,etc.,but is a counsoler at a hospital full time and has her own patients after hours.I've seen her off and on for 10 years and just to talk to her for an hour really helps.She can't prescribe meds but she steered me toward my psy. thru working with her at the hospital.good luck and God Bless You,Bob

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    • Posted

      I'm really pleased that the help you are getting with counselling is working out for you. I did have some CBT type therapy many years ago when my depression was at its worse but talking therapy isn't really helpful for me. Different strokes for different folks! Whatever work's...

      I don't think I'm in a place where talking would help anyway right now, I need to get this meds situation sorted first so I can sleep again and once I have this foundation of rest I can work on rebuilding my life. As I've been plagued with depression most of my adult life fortunately I do know what I need to do but in order to do it I need to have a continuous sleep pattern!

      God bless to you too bob , I do find having a faith helps give comfort

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    • Posted

      Your 100% correct about every person having a different way of dealing with depression.Every time I talk to someone they give me a different suggestion about what to do.I know they mean well but only I can figure out what works and what doesn't.It's hit or miss and can be really frustrating.Hang in there!God Bless You,Bob

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    • Posted

      Too true Robert, I understand exactly what you're saying. If I had a pound for every single time someone has offered a solution to my problems I'd be a very rich lady by now! People are always telling me that I just need to exercise, walk more, eat better etc etc and I'd be soon be able to sleep. It gets exhausting saying over and over again that it's just not that simple! But they are well intentioned just misinformed about depression and associated symptoms. We can't get too cross with them. At least you've found a good counsellor and she seems to be helping you. That's a good start. Go with whatever helps you, you'll find your way. Are you on mirt as well?

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    • Posted

      Yup.Started at 15mg 7 weeks ago,then up to 30mg 2 1/2 weeks ago.I take 15mg in the morning and 15mg at night.Besides the aniexty/depress. I also have IBS,which causes me pain.So I take 400 mg of Gabapetin as a nerve block(200 am,200 pm) and Tramadol for pain.Right now they are also weaning me off Paxil(20 mg twice a day for  20 years),so it's hard to tell how the chips will land yet! Bob

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  • Posted

    Hi Normal-again. I am so sorry for all the misery you have had in the last two years. I was diagnosed with treatment resistant MDD with psychosis almost two years ago and had never suffered from clinical depression before. I live in Canada where we have access to medical care regardless of our financial resources. My doctor started me on low dosage antidepressants and saw me every two weeks to monitor my progress. He also referred me to a psychiatrist who committed to the hospital so he could monitor my progress while he found the medications and dosages that would work for me. Since July 2015 I have been taking 15mg mirtazapine and 300mg venlafaxine and I am happy and sleeping well. I deal with upsetting things more calmly too. One of my biggest fears is that one day the meds may stop working for me and I will be where you are now. Maybe you need a combination of meds like I do.  I have heard that the lower the dose of mirtazapine the more it helps you sleep. That was why my doctor prescribed it with the venlafaxine. Keep in touch. We are always here to listen and offer support and any advice we can. We all understand because we have been there. 
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    • Posted

      Hi phyllis11904 thanks for sharing your story, weirdly enough its really helped me sharing my post today because its forced me to face my situation in all of its entirety and realise that I need help...its lovely to get some insight and advice from fellow depression sufferers.

      I agree that mirtazapine is a wonderful drug for helping when you're in the depths of despair and can see no light at the end of the tunnel so to speak. The problem starts when you stat on them for such a long time and then they can start to have a paradoxical effect, in my case mainly crippling insomnia. I never really had my meds reviewed in all of these 10 years, I just got a repeat every month. A couple of times various Dr's did remark that I was on an extremely high dose but given my previous mental health they thought it best I remain on them. Besides, I wouldn't have given them up without a fight as why change something that works and did a great job of freeing me from the constant depression I felt for so long. They were literally a life saver.

      In regards to your worries that the same thing happens to you with prolonged use, can I offer a suggestion? Please please please don't stay on them for as long as I have. When the times right and with your Dr's approval taper off them - very slowly. Or if you start to exhibit signs that they aren't working anymore, again look to your Dr for support with switching meds instead of increasing dosage. I wish I had taken my own advice and withdrew from them when I was in a happier place and they had done their job. I wouldn't want anyone else to end up in this horrible situation.

      I do believe that the lower dose helps with sleep but I'm too far gone on this med now. I will be asking my Dr at my next appointment for other treatment options, today's replies have given me the courage to finally ask for proper help. If only I could find a solution to this insomnia I know I could with time get back to the person I once was. I will let you all know what happens.

      Best of luck with your own health and that you continue to keep well.

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    • Posted

      Thank you. I'm 68 now, so if they continue to work for me as long as they did for you I'll consider myself very lucky. Your advice about talking to my doctor as soon as I feel the aren't working as well is very good advice. I wish you all the best. Keep in touch and take care.

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    • Posted

      Hello Phyllis.I came across this site because my son (in his 40s) has been suffering really badly with depression and all the anxieties and the worst is his social anxiety which has meant he isolates himself. I had a real meltdown 7 years ago even though I was taking Venlafaxine. My Gp arranged a home visit for me with a community phsyciactric nurse as my anxiety was so bad I wasn't going out. To make things worse I was diagnosed with cancer. On her first visit of many she rang my gp and asked for a prescription for mirtazapine 45mg. My gp Was a little reluctant to add that to the Venlafaxine but was assured that it was the answer. Thank heaven for that decision ! It levelled me out and I slept well for the first time in months. I no longer fret over things and anxiety is a thing of the past. I also deal calmly with things and and am able to function normally.  Seeing my son suffer so badly was was prompted me to look up Venlafaxine . He's taking sertraline 50mg and I wondered if I should suggest he change his meds To Venlafaxine and mirtazapine as I desperately want to see him live his life as I know he can with the right medication. I have been fortunate enough to not have had any side effects at all. I wish all of you signed into this forum could feel as I do . I feel comfortable with myself now. I have survived the cancer but still live with the side effects and people are amazed how I don't let it get me down. Well now you all know how it's been possible. It's all been down to the right mix of medication. I feel very lucky and truly wish you all the best of life. Just don't give up .

       

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    • Posted

      The combination of mirtazapine and venlafaxine work that well for me too. I haven't had serious health issues to deal with like you did, but I do deal with things much calmer than I used to. Take care and good luck with your son.

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    • Posted

      sorry i understand this is a couple of months old now im currently talking 45mg of mirtazapine and tried propranolol for 2 weeks but they made me ill i think my mirtazapine has stopped working too but i cant cut them out! was hoping to find a medication to take alongside it? what dose of venlaflaxine do you take phylis? smile
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