Mirtazapine paradoxical effect?

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I have been on Mirt since November starting on 30mg. I started to have nightmares, nausea, anxiety, diarrhoea after about 5 months. The doctor reduced it to 15mg and all was ok for a while but have started feeling awful again. I saw Dr this morning and he is going to ween me off it over 2 weeks. I also take Fluoxetine which I tolerate well. My question of anyone is: has anyone had this experience on Mirtazapine? Did reducing/coming off help? My Dr mumbled something about Mirt having a 'paradoxical effect'. ?

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  • Posted

    Hi Jean sorry you are suffering.  If you look over this forum for other discussions about mirtazapine it might help you.  I think there have been a few people, including myself who felt rough on the 30mg and once reduced to 15mg have felt better.  As for the paradoxical effect well to me that doesnt make sense for this particular drug.  A good example of paradoxical effect is prolonged use of codeine which causes headaches, hence the "codeine induced migraine" which some people suffer.  I think this can happen with paracetomol over a time as well.  I am surprised that you are taking fluoxetine at the same time, but then I don't know much about anti depressants except I know they have horrible side effects and I want to get off mirtazapine as soon as I can.  I hope you feel better soon but as I say take a look around this forum as there are many posts about mirtazapine.  Regards Elaine
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  • Posted

    Hi Jean,

    Mirtazapine is more sedating at lower doses. At 7.5 or 15mg, it really knocks you out. 30mg is a bit less dedating, 45mg is much less. That's the "paradoxical effect."

    It might be that the two ADs you are taking are too strong for you, causing your brain to build up too much seratonin, which can cause the symptoms you describe. It's called Serotonin Syndrome.

    Can you talk to your doctor about that?

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    • Posted

      Good reply. It personally seems madness to me to be taken one ssnr and one ssri.  For me the lesser dose was less sedating even though I felt unwell on 30mg during the day.  Today I am trying 7.5mg so not expecting much sleep in the next few days but will persevere.
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    • Posted

      Thank you for your answers. Elaine let me know please how you get on with 7.5 smile and I will look into serotonin syndrome.
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    • Posted

      Hi Jean,

      I will. I took the 7.5mg last night but then I got stuck on the computer which is fatal as it was gone midnight and then I don't sleep very well anyway.  I have a few other problems going on like the anxiety of severe osteoporosis, one of the reasons I would like to get off the mirtazapine as these type of anti depressants taken long term can cause osteoporosis.  I also have suspected primary hyperparathryoidism and currently nursing a molar extraction that has left me with a lot of discomfort so I feel a bit like something the cat has dragged in this morning (I have four cats lol) so will be difficult to know whether it's the tapering of mirtazapine or just me generally feeling rubbish.

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    • Posted

      Hi Elaine

      Sorry to hear are not feeling great at the moment sad

      I also started 7.5mg last night so fingers crossed.

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    • Posted

      Fingers crossed for you too.  I am sort of okay, didnt help hearing an Enya song earlier on as it's the first Father's Day I dont have my dear old dad. I think I felt odd for about 4 or 5 days when I dropped from 30mg to 15mg but felt so much better afterwards.  I could probably stay on the 15mg if I thought it was safe to do so but I want to get off it altogether if I can.  Take care xx
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