Mirtazapine - Muscle Spasms And Nerve Pain Worse

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An Internal Medicine specialist placed me on 60 mg's of Mirtazapine @ bedtime as a sleep aid as I have been experiecing muscle cramps and nerve pain that came on suddenly about fourteen months ago. The specialist's diagnosis; "Fibromyalgia." Since then I have had an MRI that showed I have spinal stenosis, disc bulging and bone spurs located primarily along my cervical and lumbar spine. Mirtazapine has helped me sleep quite well at night. Therefore, I have continued to keep taking this medication. After dosing before bedtime, my spasms and nerve pain calm down. During waking hours my spasms and nerve pain get much worse as the day progresses. A lot of rigidity as well that was not there before taking what appears to be a large daily dose of this medication. Could the elevated muscle spasms, nerve pain and rigidity during waking hours be a side effect of only taking the Mirtazapine at bedtime and none during the day? Kind of a hangover effect?

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  • Posted

    Hi Campaigner, 

    That is a very high dose of mirtazapine.  Is it supposed to control the pain, or is it just to help you sleep?  For the latter, mirt as low as 7.5 mg can knock you out since it is primarly a histamine  block at that dose.  I feel like 60 is overkill for your situation.  Docs go up that high for depression since it supposedly works better for that at higher doses, with anxiety being dosed at 15 - 30.

    How long have you been on it?  These drugs are not without their own cost.  Side effects can eventually outweigh benefits which is why these drugs were really meant for short term treatment, not for long term usage.  Unfortunately they began being dispensed chronically, yet reearch was never done on any of them for longer than 6-8 weeks.  There simply isn't any data on long term usage.

    I know amitriptyline was used for chronic pain issues.  My husband had two levels of fusion in his neck for stenosis and refused to take amitriptiyne for pain.  Instead, he has found that the pain fades away when he stops thinking about it, while thinking and worrying about it makes it worse!

    I found this doing a quick web search for mirtazapine side effects.  It says call your doctor at once if you have:

    severe nervous system reaction - very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out.

    Have you discussed this with your doctor?  I'd seriously consider backing off on the dosage with your doctor's agreement.

    Mirt can be a brute to back off of for some, causing withdrawal, so you may need to taper more gradually than is convenient.  If your tablets are in 30 mg, then backing off by a quarter tab rather than halves would be better.  Let's see what your doc says, first.

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    • Posted

      Thanks for the info. and replying to my post. I was put on the Mirtazapine about six months ago strictly for sleep. I figured out that it was a very high daily dosage when the Pharmacist questioned whether the 60 mg's per day was correct. I looked Mirtazapine up online and sure enough, I have a myriad of the listed side effects. On this high dose, I sleep very well at night. The problem is during the day. I'm not tired during the day. As the day passes, my muscle spasms and nerve pain gets much worse. I take my Mirtazapine dose around 7:30 in the evening and within two hours, I am feeling somewhat better and ready to go to sleep. I suspect that during the day, the Mirtazapine is wearing off. That would explain why I 'crash' as the day advances. I am seeing my GP this coming Wednesday and I will bring up my concerns with her. Tapering off of this medication seems prudent.  Of course the Internal Medicine specialist who prescibed the medication in the first place is no longer following my medical status. Frustrating that you can't even trust the so called 'specialists!'

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  • Edited

    WOW, 60 mg is beyone any recommended dose - 45 mg being the supposed highest.  I wonder what your Internal Medicine practitioner is thinking about here.  

    Excellent reply Betsy, 7.5 mg is more than enough to help with sleep.

    And just to back up, should you wish to lessen the dose, do so carefully to avoid any discontinuation syndrome, do your research or ask here first.

    Wishing you well smile  

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  • Posted

    Hi Campaigner8.I started on 15 mg at night about 4 1/2 months ago for IBS and anxiety depression,upping to 30mg about 2 1/2 months ago.When the doc upped me to 30mg she wanted me to take it all at night,but I told her I wanted to take 15 am,15 pm to help during the day.Maybe you could split 30/30 or 45/15.See what your doc says.God Bless You.Bob
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    • Posted

      Thanks Bob, I hope your anxiety and depression are lessened by whatever maeans available. Physical or emotional suffering... all the same in my opinion as, 'Pain is pain!' God bless you too! I've split it up the dose before quite a while ago with mixed results. Will try it again to see if it helps. Looking forward to my GP appointment tomorrow. Will post again to apprise anyone following this as to the results.

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  • Posted

    I am the original poster and am submitting an update on my situation.

    I am down to 15 mg's of Mirtazapine at bedtime for sleep. I have been on this reduced dosage for at least three months with my above listed symptoms getting much worse.

    ?When I take the 15 mg's of Mirtazapine at around seven in the evening, I am asleep by ten. I wake up around four in the morning, get up at five and the whole nightmare starts all over again.

    When I stand up after waking, I can feel my muscles start to go into spasms. It only has gotten worse over the months to the point that I am having a hard time walking due to the spasms and rigidity which is extremely painful.

    A Neurologist ordered an MRI of my brain. Wait for an MRI was going to be eight to ten months, so I opted to pay for the test myself. I read the report and all looked normal. Waiting another month to see the Neurologist to interpret the findings of the MRI. Scheduled for an EMG shortly after my Neurologist appointment. 

    ?I'm wondering if I am having a bad side effect from the Mirtazapine. I have found several sites on the internet that say muscle spasms are a side effect of Mirtazapine. 

    ?My question(s):

    ?1. Why do my muscle spasms get much worse the further away I get from my next evening Mirtazapine dose?

    2. Could this be a muscle disease such as ALS or Parkinson's disease?

    Thanks for your input,


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    • Posted

      Just wondering what your current situation is?have you had any further investigations or diagnosis? I have been on 45mg mirtazapine around 6 years for major depression with anxiety,worked well,but last 18 months developed severe night terrors,vivid dreams etc,decided to wean down,have gone from 45mg down to 15mg since May ( and will taper off rest after new year,as still nightmares and vivid bizarre dreams) unfortunatley the lower dose I come down to my severe pain from spinal ruptured prolapsed disks has got much worse,also back muscle spasms too,think this must be related to lowering dose somehow,such a shame as had it not been for awful nightmares and bizarre vivid dreams,I would have been prepared to stay on this med for ever,despite the two stone weight gain that I could really do without.feel between devil and deep blue sea as they say !
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    • Posted

      Hi Chrisy,

      Sorry I had not replied earlier, as I'm just seeing your comment now.

      My situation as far as the panful muscle spasms, general rigidity of the upper torso and symptoms as mentioned previously have gotten much worse since last entry. Unfortunately, still no diagnosis. Keep in mind that I haven't found a Physician invested in getting to the bottom of my problem.

      I am currently taking 15 mg's of the Mirtazapine at bedtime. I would say that the Mirtazapine is somewhat effective in calming down the pain and muscle spasms at night. The larger dose of 30 to 45 mg's is not more effective than the smaller dose I currently take. During the daytime, the Mirtazapine doesn't help control the spasms and pain to where I can be more active. I am on the couch most of the time. It is far too painful to walk a distance further than ten yards at a time.

      I'm waiting to see a Neurologist who specializes in muscle diseases. I suspect that I am suffering from one of the many muscle diseases.

      I hope and pray they find a medication that helps you with your muscle pain and spasms. Please update if and when you read this reply to your questions.

      All The Best,



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