Mirtazapine need some help please

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Hi everyone really embarrassed to even ask a question this is my very first time asking the public for help, ok so basically I am taking amphetamines every single day for my ADHD I have lost my appetite and also I don't sleep and feel a bit low, so the psychiatrist came up with mirtazapine to combat all those 3 I have been now taking it for almost 2 months and it has worked excellently I have added a lot of weight which is excellent since I am a bodybuilder I need as much weight as possible and that has worked great my mood felt a little bit up and my anxiety has been dramatically reduced I also slept like a king for the first 3-4 weeks the sedating effects where excellent better than any medicine I tried for sleeping, now 2 months in my anxiety has came back with vengeance I don't sleep anymore but the appetite is ok still I find my self waking up at 3-4 am and eating some ridiculous amounts of food, but lately I haven't slept at all I take 15mg prescribed and it feels as it does absolutely nothing no sedation no nothing and I have now started feeling worse then before I just don't want to go out I feel exhausted all the time for no reason even when I sleep at 4 am till 2 pm the next day, I just feel like I want to sleep all the time and comes night nothing, I don't even want to go out anymore and the gym feels exhausting and boring this medicine feels like it has taken the love out of everything, has anyone else experienced that? I don't even feel excited to do something anymore I feel like I'm numb and I don't want to be bothered I keep putting on a fake smile but deep down I feel rotted I don't want to sleep in the night the sedation isn't working I don't go out and when I do I am awfully quiet and not my bubbly happy little self as usually has anyone else experienced this? Does it go away or will I sadly have to put a stop to this medicine? Many thanks George 

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  • Posted

    Dear Greekgod,

    I find it helpful to try and understand what is happening to the brain in order to figure out what is likely to be the best way forward in terms of medication.

       The latest research shows that at least three of the major categories (mood disorders [e.g. depression, bipolar], the personality disorders [e,g. schizophrenia] and the impulse control disorders [e.g. ADHD and ADD]) of mental health problems all appear to be related to the cells in specific parts of the brain not functioning as effectively as they should. For example, ADHD is associated with under activity of the pre-frontal cortex which is the part of the brain which inhibits and modifies the more basic instincts particularly the "fight or flight" response which is located in the amgydala which is an "evolutionary older" part of the brain. The most effective treatment for ADHD is therefore to essential wake up the pre-frontal cortex using stimulants (ritalin in children and modafinil in adults). This at first seems a bit strange that to improve poor behaviour we give people stimulants and strong stimulants at that (both ritalin and modafinil are also used to treat excessive daytime sleepiness as well as used by the forces to help keep troops alert during night time exercises). However, the research is very solid, where poor behaviour appears to be rooted in a reduced ability to control your impulses, these drugs give great results and if taken early enough in the day will not disturb your sleeping as they wash out your bloodstream quite quickly.

      When it comes to mood disorders such as depression and anxiety disorders and personality disorders the reduced brain cell functioning appears to be concentrated in different parts of the pre-fronrtal cortex. Unfortunately the stimulants don't have anywhere close to the same level of benefit in these conditions. The most effective approach with these disease is to improve the communication between cells. The cells in the brain and nerve system are called neurones and they are relatively complicated cells when compared to other types of cells in the body. The key thing about neurones is that each neurone is wired in to hundres of other neurones. Essentially the more connections neurones have with each other, the better they work. The "wiring" in this case is not a metal wire but is a chemical wire. Among the key chemical compounds that act as "chemical wires" in your brain that carry the electrical signal are serotonin and norepinephrine. The technical word for thses chemical wires is neurotransmiters, Most of the common anti-dpressants work by increasing the amount of these drugs in youer brain (SSRIs make more serotonin and SNRIs make both more norepinephrine and serotonin available).

       Many SSRIs and SNRIs including Mirtazapine make you more drowsy in the first month or two  of taking them  (technically Mirtazapine  is neither an SNRI nor and SSRI but works largely by making more serotonin  and norepinephrine available). If you are becoming more drowsy after two months, it is likely that the depression may be getting worse and the dose you are on is not big enough to stop the depressiopn getting worse. You really need to see your doctor but don't be surprised if they suggest a large dose of Mirtazapine. If you are not already on Modafinil again this is a discusion with your doctor. If you are being treated by your GP get a referral to see a proper doctor (i.e. a consultant) as you have more than one mental health condition and you need to be working out the best treatment option with someone who deals with this everyday and can spend at least 30 minutes each time versus the poor old GP who just have 11 minutes to see you each time. Try not to worry about having multiple conditions as given that the conditions all relate to the same basic problem of various parts of your pre-frontal cortex not functioning at 100% and as a consequence it is very common for people to have multiple mental health conditions .

      The one thing that a GP can help with though is that they often can get you a referral to CBT (the one talking therapy that actually helps) quicker than a consultant.

      In summary:

    1) Get an appointment to see your GP.

    2) If you do not have one already, ask your GP for a referral to a consultant given the complexity of having both ADHD and depression.

    3) If you are not already on ritalin or modafinil for the ADHD, ask whoever you end seeing about trying it out to see it it helps.

    4) For the depression don't be surprised, if they suggest a larger dose or a combined approach (e.g. adding in venlafaxine). Remember that tiredness at this stage is more likely to be due worsening depression rather than to the medication.

    5) If you are not already on a waiting list for CBT ask to get a referral. Talking therapies are not the wonder treatment that the media make out but they do help particularly with reducing stress levels 

     

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    • Posted

      Wow where to start first thank you for taking the time to explain a few things, I think I did miss a few of my key points out everything you highlighted I already knew you see I am training my self to be a doctor so I know a lot about the brain it self, I am taking stimulants as amphetamine, I did try Ritalin, concerta, equasym and medikinet they're all the same just different release which sadly didn't help, now I didn't highlight enough I am not actually depressed I just had a little bit of low mood, and since being on Mirtazapine it has actually worsen it rather then fixing it, it just seems that Mirtazapine has made things worse rather then fixing them. That's where I needed help seems like Mirtazapine has lost all its effects, but nonetheless thank you for taking the time to answer back. 
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    • Posted

      The things you are mentioning is just how i am, I used to love getting up and going out on my bike, to motorsport events etc, Now I too just feel like staying indoors all of the time
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    • Posted

      My money is still on worsening depression rather than the meds. The symptoms sound very much like diurnal mood variation in which case the depression is likely to be clinical (edogenous) and severe. I went for months undiagnosed going to bed feeling completely OK and waking up feeling like I had just been bereaved and then the mood would just lift mid-morning with no apparent rhyme or reason. If you are on the downward slope it is almost impossible to distinguish whether the fatigue and the psycho-motor retardation are due to the meds or the illness. Nine out of ten times it will be the illness.

      I really hope I am wrong on this.

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    • Posted

      But you see that's what I really don't understand I don't actually feel depressed, I just don't feel right if that makes sense I just don't want to do anything just sit at home all day but when I am at work everything is perfect I don't feel sad or anything but having a week off and what not I just feel tired and a bit on the low side
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    • Posted

      Depression which has a more biological basis rather than a psychological basis often manifests itself at first as lack of energy, lack of drive, lack of any zest for life before the low mood really kicks in. The technical term for this mood state is anhedonia (which translate roughly to be unable to experience any joy, any pleasure any real kind of up.This form of depression is the most severe and most damaging. I strongly urge you to get a referral to a consultant. If you have one already in the pipe line, I think it would be beneficial if you asked to pull it forward as an urgent appointment, The earlier you can treat this type of depression the better. If I am wrong, that is great and you would be welcome to public berate me for being an idiot if after a consultation the consultant tells you I was talking rubbish.
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    • Posted

      I personally think you are completely wrong this is the very first time I just beleave its just low mood u know my job etc etc but as promised I will make an urgent appointment tomorrow and tell them to refer me to a consultant smile nothing to lose see the thing is I was perfectly fine before taking the Mirtazapine absolutley fine then take it for 2 months and feel like I have lost my self completely I just don't understand it.
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    • Posted

      Johnnyboy

      If you say you used to enjoy all these activities why are you taking mirt, if you don't mind me asking.

      I would have assumed that you took it if you werent enjoying these and other activities.

      Regards

      Nick

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    • Posted

      I started taking it when I realised what was wrong with me, I was talking about all of my activities being previous to my depression, I thought it was going to be the wonder ending to feeling worthless, unhappy, Uninterested, But it has done quite the opposite, I now hardly go out on any social occasion, Bought a new bike last summer to try to get me out, but now due to low use am trying to sell it as it hasnt worked and I have been out possibly 5 times.  Hope this explains it a bit more
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    • Posted

      I bought a mountain bike 3 years ago. The shop was near the MIND place where I went for counselling. I haven't been on it many more times that you. I still like looking at it in my hall wink

      I discovered when I came off Lithium and probably when I came off mirt that they were effecting my balance ie when I was sedated I didn't have the sense of balance that is required for getting on a bike, and maneouvring slowly.

      Nick

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    • Posted

      Interesting comments about ADHD, taking stimulants. After some difficulties, I've settled with a daily 72 mg dose of Concerta. Focus and productivity have improved.

      But there have some other epsiodes and my GP has intervened. He's now prescribing me Olanzapine and my daily dose is 5 mg. I've noticed a signifigant reduction in my mood swings and fewer manic momoment. 

      For the last year, I've also been taking Mirtzapine 30mg. I started taking this sometime before the other two sets of pills above.

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