mirtazapine panic attack

Posted , 5 users are following.

Hi I started mirtazapine 15mg 7 days ago and didn't really experience many side effects. I felt a minor mood lift after the first tablet then today around lunch time I felt a strong lift in mood with negative thoughts almost totally disappearing.  This continued to increase until 8pm when I suddenly felt a panic attack ( fast heart rate, feeling of anxiety, fear of this feeling increasing) coming on I took 2.5mg valium straight away and seemed to calm down within 5 minutes. My pulse remained at about 115 for 30 mins after. Is this normal? serious? I feel relaxed again now but the feeling all afternoon was like a really strong sense of wellbeing coming over me. 

Should I reduce the dose to 7.5 or continue on at 15? or stop all together?

thanks in advance for the replies smile

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20 Replies

  • Posted

    Perhaps because I experience tiredness around 90 mins after taking mirtazapine, I was advised to take my dose (30mg) at 8pm. The effect of it around 30 mins after taking it is an improvement in mood, but when I feel tired I usually go to bed.

    When I wake up in the morning around 7, the improvements gradually disappear over the next hour.

    It takes some effort of will then to do anything like go out shopping or for a walk.

    I usually find a benefit after making the effort to go out and so try to do something every day.


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  • Posted

    Hi Mike

    It sounds like the panic attack (not full blown?) ceased, as you say, after 5 minutes - the Valium was not responsible for that ceasing, which to me says you could have done some relaxation and got the same result, as Valium takes more than 5 minutes ... Valium itself when leaving the system (look up how long the effects last) can bring on anxiety itself and should be spaced out during the day I figure, i.e. if you take 5 mg a day it should be spaced out over the 24 hours - just a thought.

    If you are thinking of lowering the Mirt dose do it a little slower than the 50% decrease to 7.5 mg ... so take 3/4 of the dose for say a week see how you feel (12.75 mg) and then if need be drop to 7.5mg (to avoid further agitation).

    Hope you feel well soon smile

    Mirt is a very powerful AD with sedation included, 

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  • Posted

    I think the panic attack was definitely caused by the mirtazapine, I took 7.5mg last night and feel fine today although not as amped up as yesterday. I might try 15mg again for a few days and see how I go
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  • Posted

    Well I hope you get the dosage that is right for you.  Best to just remind you that swapping the doses or upping and downing the doses can cause havoc to the CNS.  Best of luck, hope it goes ok for you.
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  • Posted

    I guess that is what the experts would expect then.

    I'm glad for you that you seem to get a lasting benefit throughout the day. I seem to lose the effect as I wake up.

    Maybe you need to focus on the period 8 - 10p.m. and follow some relaxation methods in that time. So has to reduce the symptoms you get just before you take your next tablet.

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  • Posted

    Things they seem to recommend for us sufferers is mindfulness.

    Which I am only just learning, but it is an attempt to focus the mind onto simple things, ideally just one, such as your breathing.

    Trying to exclude all those other thoughts that seem to crowd in and distract you.

    It takes an effort and your mind will keep wandering. But just focus again and eventually your mind will be able to concentrate on what you have chosen as your focus.

    It seems that depression brings on a host of thoughts that are either worries or problems, jobs to do etc. It is that confusion of so many thoughts that is so uncomfortable.

    So having a session of mindfulness when it all gets too much, seems a good idea.


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    • Posted

      Great plan Nandrews ... getting Mindfulness strongly in place before coming completely off Mirt is so mind strengthening & reduces any depression 😊

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    • Posted

      That is encouraging.

      I am due to start a 5 day (over 5 weeks) course tomorrow and I do hope to get there.

      Just by chance this morning I felt particularly bad and couldn't even get into a mindful state, which was rather distressing. But I have a supportive doctor who advised me and around midday things improved.

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