Mirtazapine changing dose, advice please.

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Hello, I've been on mirtazapine for around 2 years for high anxiety and sleeping problems. I've been on 15mg for most of this time and it's done amazing for sleep and not too much for anxiety although I thought it was working on anxiety until I do something out of my comfort zone which can be as little as driving to an unfamiliar place or using public transport which makes me feel terribly sick like I can't swallow and get waves of intense anxiety feeling really sick upset tummy and really tight chest. The chest tightness I seem to get nearly every night even on days I have next to no anxiety? Anyhow around 5 months ago I started taking 22.5mg per night and to be honest it feels no different to taking the 15mg. Over the last few weeks I've started to feel a little more anxious sort of hungover feeling I get a very tight chest and very often when I'm driving I get panicky and feel very sick and feel like I'm going to chock when I swallow which gives me like a adrenaline panicky rush along with a delicate stomach and hot chest. I've been challenging myself recently and have been going out of my comfort zone and been experiencing the anxiety again which I think I slowly coming back again . So a few day's ago I decided to take 2 tablets 30mg every night but the last few day's my anxiety has got worse. I'm even feeling anxious sat at home and out whilst working which I don't usually experience. So my question is should I keep taking 30mg as I have been for the last few day's, or go back to 22.5mg and just hope I was just experiencing a few bad days. And is it possible that changing from 22.5mg to 30mg over the last few days has made my anxiety worse? I'm just worried because the longer I'm feeling this anxiety again the longer it takes me to feel better and fight it off again. Sorry for the long story and thank you for your response.

Much appreciated smile

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  • Posted

    Hi Jamie.

    Upping your dose can definitely cause increased anxiety for a brief period. For me, it usually lasted a week or so, then the benefits kick in. So the trick is to stick with it for a week or two before you decide to stay on the higher dose. But yes, I went through adjustment periods going from 15 to 30mg, then from 30 to 45mg. (45mg would up being my sweet spot, and I remained on that dosage for more than a decade.) My doctor gave me a few benzos to easy my anxiety during those transitional periods, and that helped immensely. 

    Of course you shouldn't really change your dosage on your own without speaking to your doctor, especially if you're taking any other medications—not just ADs and anxiety meds, but any meds or supplements at all. Mirtazapine can interact with other drugs, even food (grapefruit juice!) so it's better to be safe than sorry and have a conversation with your doctor.

    A few months ago after taking mirtazapine for 12 years, I started experiencing more side effects than benefits, so I spoke to my doctor and we upped my dose of 45mg to 60mg. I was less tired but my anxiety got worse. After two weeks it still didn't get better so I went back down to 45mg. Then we decided to try going off mirtazapine altogether, which wound up working for me.

    Let us know how it goes!

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    • Posted

      Thank you mud93433. Sorry I forgot to mention the doctor told me when I last had a chat with her a few months back to take 15mg one night and the next take 30mg and alternate. I didn't do this as every time I change dose even by the smallest amount I have dreams and feel a little fuzzy the next day. So I've been on 22.5mg the last few months but recently been feeling a little panicky, agitated, nauseous and a little like I'm going to have a panic attack so this is why I've tried taking 30mg the last few days. The doctor Is happy as long as I don't go above 30mg without talking to her. But I'm not feeling any better so would you say I should keep at the 30mg for a few more days ? Or drop back to my usual 22.5mg I'm not sure if I was just having a bad few day's and that's why I'm anxious. Or if the 22.5mg just isn't working anymore? I'm just worried because if I keep upping the dose and every few months my body gets use to it then I'm in trouble as I think this is the only tablet I can tolerate. And have had all the cbt and tried all other options. I don't take any other tablets although I have some diazapam 2mg but have never taken one yet.

      I really appreciate your reply, thank you!

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    • Posted

      Glad I could help!

      Mirtazapine is not addictive so you do not build a tolerance to it, like you would with a benzo (xanax, klonopin, valium, etc) or alcohol or heroin or vicodin. You don't have to keep upping your dose. Once you find your sweet spot, you can stay there. This is why mirtazapine does not cause a true withdrawal—because it's you don't need more and more to produce the same effect like you would with those other drugs. So don't even worry about that.

      ADs can poop out after a while, usually after years, but you don't have to be concerned about that yet. Mirtazapine stopped working for depression for me after about 10 years, so we had a pretty darn good run togther smile

      My anxiety wasn't really under control until I got to 45mg of mirtazapine, but then again I was around 190 pounds and 6 feet tall when I started, so you might not need as much.

      I would stick with 30mg for two weeks. Religiously. Take it an hour before you want to be asleep, whch minimizes the munchies and helps you sleep like a baby, as well as making it easier to get up in the morning.

      Also, please keep in mind that if you were diagnosed with depression or anxiety, your symptoms will ebb and flow seemingly without reason, which is frustrating but totally normal. You could be experiencing a surge of anxiety whish is completely unrelated to upping your dose of mirtazapine. That's why it's good to keep a daily journal so you can keep track of how you feel every day, what meds you take, what you eat, how much alcohol you drink, if there's anything stressful going on in your life, etc. 

      Hang in there Jamie!

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  • Posted

    I agree with mud; a few days is not long enough to know whether 30mg is right for you.   Keep with it for at least 2 weeks.   Best wishes.
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  • Posted

    Hi, mirtazapine didn't work for me Jamie1988, I suffered terribly with chest pains and swallowing problems, heightened anxiety, I have now changed to citalopram, I hope you find something that suits you. All the best.

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