mirtazapine side effects or fluoxetine withdrawal? please help :/

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Hi i have been on mirtazapine since around december. I started at 15mg and also was taking 20mg daily of fluoxetine. After 2 weeks i went up to 30mg mirt and 10mg daily of oral fluoxetine. After another 2 weeks the mirt was upped to 45mg and i finally stopped fluoxetine at 2.5mg 3 weeks ago.

I manage to fall asleep fine but still wake up few times through the night. I wake up at 7am everyday as im a single mum with a 7 year old daughter. As soon as i wake up i feel this horrible feeling of dread, and like my skins trying to crawl away. I also keep getting a bizzare vertigo like feeling and all of my joints ache to the point where i feel like i cant walk up my stairs. Im only 26 and im not overweight. Ive always been physically healthy. The only positive thing ive had is weight gain. I was underweight up until recently. Since starting the mirtazipine i have put on 2 and a half stone. I think my go and mental health team are getting fed up with me but im limited as to what medication i can take because im on my own with my child. I tried quetiapine once and refused to take it again because i couldnt function atall the next day. I just really need some advice as im running out of options. Im on the medication for emotionally unstable personality disorder and general anxiety disorder which i habe struggled with for 6 years. Any advice or suggestions will be greatfuly recieved. Thank you x

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  • Posted

    Bless you Kayleigh.  Sounds like you have a lot to cope with. The horrible feeling of dread on waking is very common with many people who suffer from anxiety and/or depression.  The weight gain combined with your other symptoms does sound like mirtazapine isn't agreeing with you however you have been moved up very quickly to 45mg with very little time for each dose change to settle down.  You may find that if you leave it a little longer the symptoms may calm down/go away.

    Have you seen a psychiatrist? There are many non sedative antidepressant medications that you can still try so lots of options left.  I have been on mirtazapine for 5 months.  I have not gained weight or experienced your side effects.  It has helped my anxiety and sleep but not my depression.

    Well done for coping with your issues and looking after your daughter, it must be very hard.

    I would recommend seeing a psychiatrist if you haven't already.  I would also highly recommend Dr Claire Weekes book 'self help for your nerves'.

    Take care, Gen x

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    • Posted

      Hi Gen.

      Thank you so much for your reply.

      Yes i have seen a psychiatrist and ive tried CBT.

      I just really hope after another couple off weeks it settles down.

      Im reluctant to change meds or change the dosage as i think my bodys had enough to deal with lol.

      Xx

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  • Posted

    Hi Kayleigh

    I have been on Mirtazapine for a little over a year now. I have found it very effective, but 2 things strike me about what you have told us. I dont know about fluoxetine or how it interracts with Mirtazapine.

    Firstly, you havent been taking Mirtazapine for very long at all. In general it takes at least 8 weeks to be effective and in my own case it was more like 3 months before I started to feel better. And initially I actually felt worse like you, and wanted to give up. But hang in there!

    The second thing is that they seem to have increased your dose very rapidly. I took 15 mgs for 8 weeks then upped to 30 mgs after 10 weeks.

    They upped your dose after only 2 weeks which really isnt long enough to know if it was working, and then again to 45 mgs after only 2 weeks. You may well not need that much. I found that I fell off to sleep well on just 15mgs whereas on 30 mgs I felt hyper and couldnt relax enough to sleep.

    I am now down to just 7.5 mgs per night and very close to coming off entirely, but the whole process has taken over a year.

    So do try to be patient (easy to say I know!) and if the Mirtazapine is making you feel worse ask your GP to consider reducing the dose or building up more gradually until you get used to it.

    You will feel better, but it takes time.........your mental health team are there to help you.

     

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    • Posted

      Hello Jane. Thank you for taking the time to read and reply to my post.

      I too thought the same about the rapid changes in the dosages.

      I also meant to say that i am prescrived phenergan tablets(25mg) up to 4 times a day when required for the anxiety but i very rarely take them. But if i do its only when my daughter is staying with her father.

      But i want to try and avoid becoming dependant on loads of different tablets.

      Ive been a darn sight worse than how i am now but i can feel myself getting worse.

      I felt that the 15mg mirtazipine worked fine.

      Its been the last few weeks that i have noticed that my mood changes rapidly. And i feel like i need to cry but it just wont happen. And a part of me feels if i did cry it might help!

      I just assumed that the mental health people thought it was best for me to change meds quickly even though i didnt feel it was.

      Im not one to speak up and just kind of go with things.

      i think maybe i should speak to them about maybe coming down to 30mg as i do feel as though 45mg is quite high and maybe to high for me.

      Hopefuly that will help.

      thank you again smile

      Kayleigh x

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    • Posted

      Hi Kayleigh

      i was interested that you were on Phenergan at 4 x 25 mg.  that's a huge dose and I used to be prescribed one at night for hay fever which would send me off to sleep.  I'm currently on 45 mg mirtazapine and although it doesn't have any effect on the anxiety during the day, at least I sleep.  I take 15 mg about 10 pm and the. 30 mg,about half an hour before I go,r the bed.  8 don't know how you manage to function with 4'x,25 mg phenergan as well.  Ii would be a complete zombie with that amount and certainly couldn't drive and would. Be,frightened that it would affect my balance because the combination is so strong.  You might be better with something like Proprananol which is a beta blocker and would slow down your heart rate without the same side effects.

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    • Posted

      Hi Nessie91

      With regards to the phenergan im reluctant to take it specifically because of the reasons you mentioned.

      I only ever take 1x25mg in a worst case scenario.

      I have read reviews about beta blockers for GAD and it seems promising. So will definately mention it to my doctor.

      Ive also just found out that i have low iron levels and im also on the contraceptive implant which low and behold can worsen anxiety! Im booked in to have it removed on monday. It was only fitted to control the heaviness of my monthlys not actually needed for contraceptive purposes.

      Im hoping that the anxiety will decrease once its removed.

      It also ties in with when my anxiety flared up again.

      How do you manage your anxiety throughout the day? Do you find that the mirtazipine has taken the edge off atall or is the day anxiety the same?

      Kayleigh x

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    • Posted

      Also, meant to say about the implant. I don't know anyone who has got on with it and have had them removed for that reason. I was initially put on the pill for that reason too so that can be done and again there are many different types for different symptoms. Mirt has definately mellowed me even though I've had bad bouts recently but have had diazepam for those times.
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  • Posted

    I second everything Jane has said. I will add that Vertigo and achey joints are both known side affects of Mirt. Try taking it as early in the evening as possible (obviously leaving time to sort the little one) and this may help the after affects in the morining. BUt as Jane said jumping up a dose after only 2 weeks is very unsual and leaves very little time for the drug to take real affect and for any side affects to subside before upping the dose.
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    • Posted

      I completely agree. It is a very rapid increase.

      I stuggled to come off the fluoxetine which is why i had to have the liquid form so i could get down to the lowest dose .

      This may sound silly but i felt almost like i was being told off by the mental health doctor for not being able to do things as quickly as they expected. Which has kind of put me off talking to them and telling them how i feel. Which is why i would rather go to my gp (i have a psych doctor as my assigned gp at my surgery) he is fantastic and i feel that im not just a number to him but a real person.

      I do definately feel that 45mg is probably to much but ive been on 45mg for just over a month now so should i just wait another couple off weeks to c if i improve as i should b settled on that dose after about 8 weeks if its going to work?

      Kayleigh

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    • Posted

      You'll know by 4 weeks if its working for you or not.

      Another point to remember is fluoxetine take around 6 weeks to clear your system fully. Normally people are less likely to get withdrawel from fluoxetine because of this but some people still will. It's and odd jump to go from fluoxetine to mirt without trying something else first. I assume they gave you mirt to help with the sleep problems though?

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    • Posted

      If im completely honest i was on 40mg fluoxetine and 7.5mg zopiclone and then they tried me with 25mg quetiapine which i took in a friday eve. I refused to take it again because of how sedated i was the next day. Luckily my daughter was at her dads. She is a very independant child and shes never any trouble bless her but obviously i still need to be alert and in a fit state to take her to school everyday. Its a 10 minute walk to school and i find that the brisk 10 minute walk does reduce the anxiety for me and the same in the afternoon.

      I thought they would have put my fluoxetine up to 60mg first but they were almost obsessed with changing me to a different medication.

      It is easier only having to take the one tablet that claims to manage sleep,mood changes and anxiety rather than a cocktail of medication and i just hope that i feel the full effect very soon.

      My anxiety is manageable at the moment and its bearable and touch wood it doesnt seem to have become any worse in a couple of days so hopefully its settling down now with my body adjusting to the absence of the fluoxetine and the presence of the mirt

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  • Posted

    Hi Kayleigh - What you describe is very similar to what has happened to me so I will explain my story and what my amazing doctor has told me. I was on fluoxetine on 60mg a day and my previous doctor just said that there was nothing they could do until I changed my job and lifestyle rather than help me cope with it. My boyfriend, who also suffers with anxiety and depression advised me to change to his doctor and so I did. He is amazing - very old school and none of this 10min appointments only or come back if you need to. I've been in there for up to 45mins before and at the end he tells me when to come back and see him. I understand I am very lucky with this. Anyway, getting back to the point - he said it was hard to change to any other AD's from fluoxetine partly because of its long half life, meaning it stays in the body for much longer than other meds. Pretty much the only option was to change to mirtazapine. Also, fluox is known to be the drug that docs use when they hear depression and its known as the 'happy pill' heightening your emotions. However, my doc was concerned that it was also heightening my anxieties as it heightens everything.

    He looked into the best way to change drugs and the two week change was advised going from 60mg fluox to 40mg fluox and 15mg mirt, then 2 weeks 20mg fluox and 30mg mirt. Again I started in December and the first 4 days of each day was horrible - having flu like symptoms with dizziness, nausea etc. I have missed fluox before so I thought it was the lack of this in my system. On this dose I then had 2 very good positive weeks in January and thought all was well and on the road again. However, I then suffered badly, feeling very low and not knowing why.

    I was always a very emotional person, crying over everything - once changed to mirt this stopped until recently again. I have another doctors appointment next week as well as intitial stage 3 CBT appointment to see where to go from here.

    I'm not sure how much help this will be but I wanted to stress to you that you are not alone and if you feel you are not getting support from your doctor then ask to see another one or move practices. Don't think they are fed up of seeing you - that is their job and probably part of your anxiety for overthinking what they think of you.

    I have struggled for 8 years now with good times and very low times but there is support. Depending on how money is there are other ways too - private counselling or hypnotherapy. I have not gone down this route yet but I have started to go to yoga classes which have been amazing, just to have that hour of relaxation. It must be hard being a single Mum to take time for yourself but maybe when your daughter has gone to bed you could look on the internet for some yoga video's for mental health.

    All the best and I hope you can draw some help from my ramblings!

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    • Posted

      Sorry everyone had no internet.

      Thank you all so much for your replies and advice.

      Im having a chat with my mental health doctor tomorrow and also having the implant removed which i believe could be paying a huge part in the anxiety problem.

      Will let you know tomorrow of any updates ect.

      Thank you all again

      Xx

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  • Posted

    Hi, its sort of odd that you needed to reduce fluoxetine slowly cos it stays in the body for weeks after stopping so generally you dont need to go down slowly and usually there are no withdrawal effects because it very slowly leaves the body.. I guess they've tried to overlap them.. I would see your doctor and talk through your concerns. Also you should try psychological therapy which will help if you are on medicine or not.. but give it some time.. You can take a month or two to adjust to a new antidepressant. Hope you feel lots better soon!
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