Mirtazapine (Remeron) help me understand this drug and how it can affect the cardiovascular system.

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Hello, I need help to understand how this antidepressant work for anxiety. I am suffering from severe anxiety (suspected hyperadrenergic postural orthostatic tachycardia syndrome - hyper pots) which causes my heart rate to increase by 30-50 beats per minute upon standing along with blood pressure increase, and so it's hard for even to even stand because of heart palpitations, fatigue, dizziness etc, and so i lay in my bed for 22-23 hours daily for 8 months, my muscles are GONE, i am only existing. Medicine history story in few sentences: after more than several heart tests year ago, they found nothing except mentioned sinus tachycardia episodes and high blood pressure when anxious, for example it was 170/90 with the heart rate of 120 just sittting and talking to cardiologist cuz of anxiety and body many posture changes, but it's in 40s when i sleep and it varies from 50s to 140s every hour during the day, which cardiologists think relates to anxiety. I decided to go to psychiatrist and so she saw severe anxiety and gave me ssri antidepressant escitalopram which made me a lot worse, my heart rate was 90-100 even when i wanted to go to sleep. Now she wants to put me on mirtazapine and i just can't understand how it can work because its serotonin and norepinephrine reuptaker, so how it will reduce my anxiety if i will have more norepinephrine in my blood, i thought they will block it, not increase it. This is a paradox that i fail to understand, what kind of treatment is that? I am scared that this will increase my anxiety/panic attacks/heart rate/blood pressure just like escitalopram. What were your experiences with it? Thank you!

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  • Posted

    Hi , Mirtazapine isnt Ssri, Mirtazapine is a noradrenergic and specific serotonergic antidepressant (NaSSA) . Mechanism of how it works isnt fully understood. Like with every other antidepressant. Its good for anxiety as its more sedating. Lower dose- more sedation. Like with every antidepressant its a lottery, what works for others might not work for some. Mirtazapine is an atypical antidepressant with noradrenergic and specific serotonergic activity. It blocks the α2 adrenergic auto- and heteroreceptors (enhancing norepinephrine and serotonin release), and selectively antagonizes the 5-HT2 serotonin receptors in the central and peripheral nervous system. It also enhances serotonin neurotransmission at the 5-HT1 receptor and blocks the histaminergic (H1). Mirtazapine is not a serotonin or norepinephrine reuptake inhibitor but increases serotonin and norepinephrine action by other mechanisms. I was on it for 3 months for my anxiety on 15mg. It helped me a lot with sleep on a night time but it made me depressed, made me feel numb and detached from reality. Doctor took me off it cold turkey 28 days ago and I still suffer with withdrawl. Insomnia is the worst. Altough anxiety is better than on mirtazapine. It was somehow changing my thinking. I wasnt myself at all. Been put on Prozac 20mg and that made my anxiety worse , I felt like I was getting brain wash, so I stopped ADs and I feel like myself again.I was on prozac before for 7 years for OCD and never ever had side effects. It just didnt agree with me this time. When I look back at myself I know it was antidepressants making me worse. Mirtazapine is really hard to come off, even when tappered. One lad on this forum was addicted to heroin for 20 years and he said it was easier to stop heroine than mirtazapine. But like I said everyone is diffirent. What didnt work for me can work for somebody else. Thats my story and expierience with mirtazapine. I wish I never laid my eyes on this drug. Instead of looking for miracle pill, I rely on myseld with handling anxiety. Healthy life style, meditation, keeping busy. Also take food suplements like L-theanine, valerian root for sleep or wild lettuce extract, vitamin B, C and D sumplements. Thats my story and expierience with mirtazapine.
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    • Posted

      Thank you for responding, I appreciate that. What I fail to understand is that this medication mirtazapine prevents noradrenaline and serotonin from becoming bound to the nerve cells. This enhances the mood-lightening effect of free noradrenaline and serotonin that is released from nerve cells, and helps relieve depression - which means I will have more noradrenaline in my blood - which will result in more anxiety, higher heart rate etc etc. I just don't understand how it may help my anxiety by increasing the actions of norepinephrine. 

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    • Posted

      I know what you mean about being confused. Like I said before mechanism of antidepressants isnt fully understood. Ive read so many things about it . Its an experimental drug thats why it works with some people and with some it doesnt. It cant be fully explained. Science suspect how it works but they not sure about it.
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    • Posted

      I fear too much, cuz it doesn't make any sense. It enhances noradrenaline, and wiki says: The general function of norepinephrine is to mobilize the brain and body for action. Norepinephrine release is lowest during sleep, rises during wakefulness, and reaches much higher levels during situations of stress or danger, in the so-called fight-or-flight response. So, without swearing, i cannot describe this.. How can u heal my anxiety and too much norepinephrine feeling by enhancing it. Thanks for responding mate, i appreciate it a lot

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    • Posted

      I totally understand your frustration. Wish I had the answer to your question. Now it made me wonder and I keep reading about hahah
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  • Posted

    I think you will find that most people on this site taking mirtazapine including myself say that it is not very good at managing anxiety. Great for sleep and that's about it.

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