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

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kestonyyou
kestonyyou

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!

0 likes, 10 replies

10 Replies

  • aga02916
    aga02916 kestonyyou

    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.
    • kestonyyou
      kestonyyou aga02916

      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. 

    • aga02916
      aga02916 kestonyyou

      Posted

      Dont you mix noradrenaline with adrenaline? These are two diffirent things.
    • aga02916
      aga02916

      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.
    • kestonyyou
      kestonyyou aga02916

      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

    • aga02916
      aga02916 kestonyyou

      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
  • james87669
    james87669 kestonyyou

    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.

  • GotPots
    GotPots kestonyyou

    Posted

    Do not take SNRIs with hyperadrenegic pot. SNRIs such as Wellbutrin and Remeron increase norepinephrine levels which is already increased in hyperadrenegic pots patients. This will make your POTS worse increasing heart rate. It also can lower your blood pressure from the extreme drowsiness it causes.

  • CherrieLuv
    CherrieLuv kestonyyou

    Edited

    mirtazapine will lower heart rate and blood pressure. and norepinephrine in the mirtazapine will not have an effect on heart rate only mood. I did lots of research on it. I also have hyper adregenic pots. I was normal just a year ago...and for a year I've had pots and dont know why but I blame covid. always do lots of research before asking others. some of the answers on here are incorrect and will make u worry more. also the way mirtazapine works is complicated. even though it raises norepinephrine it blocks adrenaline. which means that only mood will be elevated and not heart rate or anxiety. norepinephrine only causes those issues if the adrenaline is not blocked. which it is with mirtazapine. so it would work out in a way that help you feel better hopefully. and lots of people have had a positive reaction with mirtazapine and hyper adregenic pots. I hope you're doing better since 2014. please let me know how you are now! many prayers and blessings to you and your health. 💗🙏🏼

    • 1Juan316
      1Juan316 CherrieLuv

      Posted

      hello Cherrie,

      you mentioned mirtazapine will lower your HR and BP. if my HR runs low ~34-36 at night, I wonder if this will further lower it. the dysautonomia I have actually increases my BP, so I am on a Beta blocker, but the doctor just prescribed mirtazapine, but have not started the treatment, I am always eerie about adding meds.

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