Mirt and citalopram together? Seratonin Discontinuation withdrawl? Can I use both together? x

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Hi,

Was wondering if anyone has had similar experience / could advise...

I tried Citalopram (upped from 20 to 30mg) for 3 months and while I had some good days, I was very up and down and had a few big meltdowns near the end. 

I also wasn't sleeping so my doc changed me to 15mg Mirtazapine.

This happened 4 days ago and for the first few days I was ok and it has helped me sleep. He told me to stop the Cit (all this was done over the phone as no time for appointments) but after internet research I didn't stop the cit and decided to taper off (going from 30 mg straight to 10mg cit in the morning while taling 15mg mirtazapine at night). 

Last night I had the most terrible pains and was rollling around, sweating and vommiting all night (never had anything like it and can only imagine it would be similar to heroin withdrawl) and today I am feeling completley dazed and achey. 

Not sure if I made a mistake and should've come off Cit like he said. Worried might have seratonin syndrome or discontinuation syndrome. The symtoms seem to be similar.

Doc is ok but don't think they listen / care / know what they doing and I also feel embarrassed as I can feel he is exhausted with me and my depression and will be angry that I didn't follow his advise. The bits that I did find on the internet was 50 / 50 on tapering off  / mixing mirt and cit / stopping cit. Anyone had similar experience of taking mirtazapine and citalopram together?

Also sleeping ok but bloody hell so groggy / tired during the day. Does this wear off?

Also been suggested hormonal problems (as well as depression), which sounds probable as my meltdown often (though not always) coincide with the time before my period. Any experience with hormonal imbalances and depression (particularly suicidal behaviors) citalopram / mirtazapine

Sorry lots of information there and questions. Advice on any of these points much appreaciatted

x

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  • Posted

    Yes you should be able combine mirtazapine with any of the ssri's. They work differently and in fact complement each other. However you most likely will not need a normal dose for your citalopram so start on half your normal dose when/if combining with mirt and go from there. That said you should go back to your GP to discuss the problems you've had since switching.

    Mirt will make you very groggy the next day and will probably increase your appitite so be aware of that as well. For me it took a couple of weeks to adjust but it never fully wore off for me and I stopped mirt after a month but for you it may work out well as it has for others.

    My wifes depression and anxiety is always a lot worse before her period, in fact I can tell when she is due on just by her temperment lol

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    • Posted

      Thank you for your reply Tony.

      I was worried that I cut my 30mg to 10mg to quickly as last night was horrendous and one of the most ill I can ever remember feeling, but I'm hoping it was a one off.

      My partner is the same with guessing if I'm due on smile You sound understanding, as in mine which is a real gift. 

      Are you completley off meds now? How is your depression (if that's what you took Mirt for?)

      The thought of another 4  - 8 weeks readujusting to a new medication (after 3 /4 months trying the citalopram is crap, half wondering if I should just come off (or taper off) everything and hope for the best. I seem to be in a pretty bad way with or wthout them. 

      x

       

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    • Posted

      If you had problems from reducing citalopram to 10mg then you should not come off.tbh I think taking mirt for sleep problems is a bit like using a sledge hammer to kill an ant. 

      Anyway you'll know if mirt is for you or not by week 4. For me it worked but the side effects I could not tolerate, I had way to many problems.

      Sleep wise there is lots you can try without meds. Heres a post I wrote for someone else here that also had sleep problems and i think it may also help you.

      I used to suffer bad insomnia. The first thing to do is not to worry about not sleeping. The worry will tire you out the next day much more than the not sleeping to the point that if you got 4 hours sleep but were stressing over it at night you will feel worse than if you got only 2 hours but didn't worry about it.

      Secondly consider moving any clocks so that you cant see them. This stops the clock watching. I always found myself looking at the clock and working out how much sleep I would get and stressing over it- 7 hours, 6 hours, 5 hours (oh I'm gonna feel rough now), 4 hours (how can I work on 4 hours sleep?!) and so on.

      Finally, just go to bed later. I always found going to bed later and not worrying about it was a lot better than going to bed on time and laying awake staring at the ceiling stressed out. Also because I went to bed later I was often more tired and fell to sleep quicker.

      Other tips,

      No tv in the bedroom,

      Leave a light on! I know this sounds odd but I found that when I turned the light off I was suddenly under pressure to fall asleep which made it harder to sleep but with a lamp or side light on I didn't feel that pressure and found I could more easily just relax and doze.

      No electric devices the bright screen stimulates the brain. Maybe just read a book or magazine.

      I hope this helps. Goodluck! 

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    • Posted

      Hi Tony

      Thanks, that is good tips. TBH I think I came of Cit too quick and not sure I can go through another 4 weeks of trying mirtazapine. Back to the drawing board I think. Thanks for your replies x

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    • Posted

      Hi, Tony. Hope no one minds me butting in and hijacking the conversation, but you sound quite knowledgable and I would really appreciate some advice as I feel as if I am running out of options, having suffered from depression all my life, I feel like I have hit a dead end.  I am taking Mirtazipine, which I have just reduced from 30 to 15. My brain is mush and has been for a while, but I need to sharpen my thinking for a new and demanding job, but also my mood is at rock bottom. I wake up every morning wondering what the point is and wishing I wasn't here. I am very isolated and as I don't enjoy anything at the moment, can't do anything to make myself less isolated.  I have been on Sertralinr for past five weeks, didn't get above 50mg because anxiety through the roof and cognitive function severely impaired.  Not good when trying to hang on to your job. Doctor has switched me straight over to Duloxatine 60 from today, with Mirtazipine 15 at night.  I am hoping this might pick my mood up a bit, but without the crashing effects on anxiety levels and memory/ thinking. Wondered if you might know something about it?
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    • Posted

      Hi Gillian, Duloxatine is an SNRI and different to Sertraline which is an SSRI. Duloxatine will increase the level of noradrenaline as well as Serotonin (which sertraline already did). I cannot say what will help you as these things really are hit and miss. It is trial and error with many people having to try a variety of drugs to find the one (or combination) which works for them. After 5 weeks of sertraline and mirt its clear that was not for you. Mirt will be the one causing the cognitive function problems I doupt it was sertraline.

      Why was you put on Mirtazipine? Because of sleep problems, thats the normal reason GP's go with it. Have you tried propanolol (beta blocker) to help with anxiety attacks? It may not help the mental feeling but could help with the physical symptons like the shakes etc.

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    • Posted

      Hi Tony. Had depression all my life. Peaked about five years ago. Eventually settled on Mirtazipine 45 and Venlaflxine 375mg. As you can imagine, pretty damped down. Didn't.'t feel great, but got through and still here. Started weaning off Venlaflaxine over a year ago. Took six months, then on just Mirtazipine 30 for six months, but crashed and burned. Didn't want to go back on anything, but really low and felt I had no option. Really desperate. I week on 25 Sertraline, 4weeks on 50 and anxiety very high for me. Psychological, the physical symptoms are very minimal. Took last 50 Sertraline yesterday and first 60 Duloxetine today. Have read high risk of Seratonin syndrome so keeping Mirtazipine to 15mg for sleep. Seeing a counsellor, and just marking time. Very frightened about losing my job if can't get anxiety down and thinking a bit clearer. Have 5 days off so hoping to be a bit more settled by Wednesday, just enough to get through my shift . 
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  • Posted

    Don't worry it's not serotonin syndrome, that only happens when you take too much serotonin not cutting down. It takes time for the nervous system to find it's old self again. These drugs do change things in our system, it's no mystery.. get well soon : )
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  • Posted

    i am also on mirtz and quetizapine , the mirtz 30mg i take knocked me for six to start with ,felt like crap for 4 weeks , then it started to kick in and it has really lifted my depression , my anxiety is still there slightly easier , i would stick with the mirtz for at least 6 to 8 weeks if it has not worked by them i would see your gp and try something else , but give it time i know how hard it can be wanting to feel better now . i have hit rock bottom and been in a dark place and was ready to give up be patient and dont be hard on yourself ,and allow time for the meds to work , your not alone , if you have another night of pain i would see your gp striaght away . you have a right to a life and you need help to achieve that , if your gp cant help get him to refer you to someone who can , take care
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    • Posted

      Hi Terry

      Thanks for your reply, it's great to hear your feeling better and they have done their job smile Thanks for your advise too, much appreaciatted. It took 10 weeks for citalopram to start working for me and I went through bad anxiety to get there and still had massive dips when it started working. 

      I really don't think I can go through all that again.

      I figure I feel awful on or off meds so am going to keep my 10 of cit and try leave the mirtazapine for now. Maybe giving it a proper go if this doesn't work.

      Thanks for your kind words and reply, all the best.

      x

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  • Posted

    Hi Caramax

     SSRIs are commonly prescribed, though it depends what you are being treated for?

    Depression? Anxiety? PTSD? I would listen to the doctors advice.From experience SSRIs are not the option for every person, espically depression asscoiated with other mental disorders.Myself and other reports have indicated increased anxiety and emotional imbalance when taking SSRIs.To answer your question, yes hormones play a major role in emotional health.The endocrine system and CNS are linked.The hypothalamus connects the two, which is responsible for certain behaviours such as sleep, stress and emotional responses.The hypothalamus controls the release of hormones from glands in the endocrine system.

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    • Posted

      Just to add and clarify, the hypothalamus is part of the endocrine system....NOW its possible that if a hormone inbalance is present it may not react as wanted when taking certain medication.Keep in mind the edocrine system is responsible for the release of hormones in the blood.When taking medication, lets say for instance and SSRI- you are not taking  serotonin, you are taking a medication that helps build up/collect your own serotonin in the synapse .When taking this medication it is secreted into your blood system, the measurement of medication can be detected in the blood, but not so much in the brain and sometimes people become itchy as such smile I think, in theory, that its possible to have a combined reaction to various amounts of substance in the blood combined with an edocrine imbalance (hormones levels)
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    • Posted

      This is one of the problems with mental health medications. The affect on the brain is 'assumed' based on the drugs effect within the body. So taking an ssri does increase serotonin in the body, as seen in blood tests but due to the blood brain barrier etc you never really know what affect its had on serotonin in the brain. Except when the chop up those poor rats and take a look of course! But you have touched another point, I have seen that men with low testosterone are prone to depression which resolves once they start hrt which is just one example that mental health issues is not always caused or solved my adjusting the monoamines.
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    • Posted

      Hi Tony

      very much agree with hormone levels being a big problem when it comes to mental health, though as mentioned they are linked for communication for the body to respond in a healthy manner...I am not to sure if the ssri produces serotonin in the body, as to my knowledge a ssri is not actually serotonin but works to build the persons own serotonin in the brain, this is done by blocking to build up a persons own serotonin in te synapse...SSRIs are not a synthetic serotonin as to some other medications. Some medications are formulated to match as closely as possible to the chemical we have in our brains,actual synthetic chemicals, so in theory they will operate the same as the chemicals we produce naturally..You are correct about the hormone in men and women and how we function differently because of our gender..naturally...Measuring the chemicals in the brain is once again difficult, some chemical levels can be seen via brain scan.Other ways to detect abonormalties in brain are also done by brain scans that show abnormalites due to chemicals related imbalances....interesting subject really...

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    • Posted

      I know ssri are not serotonin lol I was making the point they increase levels of serotonin in the body as well by inhibiting its uptake in the body as well as the brain. But I think our understanding of depression has a long way to go.
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    • Posted

      Hi Tony

      I didnt know that ssri increase serotonin in the body, only the synapse- but good to know smile I agree that we have a long way to go with depression and treatments, all the better for great minds to share ideas and experience smile

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    • Posted

      Hi australia2014

      Thank you very much for your lengthy reply. 

      I am on for anxiety and depression. The citalopram did eventually make me feel good but I would get massive crashes / wobbles on them that left me contimplating suicide and I ended up in a&e. They have put me on Mirtazpine but I don't think they agree with me either and have an inkling it is hormone related for me.

      Thanks for passing on your knowledge. TBH I will have to re read a few times as these have got me so zoned out I can't make sense of much at the moment. 

      xx

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    • Posted

      Thanks for your reply Tony, it is such an interesting field and it's great to hear your thoughts and interesting about low testosterene in men.

      I want to try for a child soon (clock ticking) so I'm not sure I can go on HRT. I am hoping to see an endrocoligist  / hormone  / mental health expert (if there is such a thing), but looks like I may have to go private, which I can't really afford so just researching that at the moment.

      Thanks again for sharing your knowledge, as I said earlier to Australia my head is so fluffy at the moment form the Mirt I can barely take it in but I will be looking into this further.

      Warm wishes 

      x

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    • Posted

      Mirts dumbing down of the mental faculties was the reason I stopped mirtazapine. I work in i.t. and needed to be able to think.

       

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    • Posted

      Hey Tony

      Do you take anything else and did you taper off? I'm thinking of stopping them tomorrow and just put up with the side effects. Only been on 15g for a week and I know people say to wait but even with citalopram where I had horrible anxiety I still felt like myself. Feeling very zombie and uncompforatble on these.

      I would miss the sleep sedating though as I had bad insomnia for almost a year.

      x

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    • Posted

      I tapered off mine by halfing the dose every 2 days. so it took me 4 days to come off 15mg. It can often take a few trys before finding the right med. 

      You should go back to the gp and tell him/her that mirts not for you so you can try something else.

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    • Posted

      Much welcome Caramax

      I had the very same symptoms with ssri- suicide thoughts are a side effect..they did help but with non-helpful symptoms- Another suggestion is asking your dotcore to be refered to a psychiarist- The reason being doctors are limited to what they can prescribe, psychiarist have more medication and knowledge available to patients..It doesnt mean that some people are crazier than others, it just means the medication doctors have at their disposal are not the right medication for you..Its common for people to have negetive reactions to meds- best of luck- you will find a solution and you will win the battle smile

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