On Mirtazapine for many years

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I've was on a combination of Venlafaxine 150mg in the morning and mirtazapine 45mg at night for many years. I'd started on Mirtazapine 15mg but over the years it was increased due to insomnia. My Venlafaxine was increased to 225mg last year due to a severe episode of depression. I never really picked up. I've experienced severe anxiety and paranoia recently. I'm now trying CBT. I comfort eat, big time. I was going to a gym but lost the will when despite exercising x3/week I still gained weight. I learned only recently that Mirtazapine stimulates the appetite. Does anyone know of any alternative to Mirtazapine that helps insomnia? My weight gain is so depressing but I have zero will power not to eat.

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  • Posted

    Hi Catherine. I stopped mirtaz because of the munchies, drowsiness esp in the morning, sore joints (I am a runner and I ran less because of that) and verbal agressivity. Not taken anything now and feel better. Sertaline is meant to have fewer of these symptoms (it cut my appetite when I took it). Or zoplicone at night to sleep. 

    anything but Mirt

    Good luck! 

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    • Posted

      In terms of treating my insomnia it's been great, but I had no idea it was the Mirtazapine causing my increased appetite, until a patient was prescribed it by one of the dr's where I work, to stimulate the appetite. This made me think how I used to be so good at dieting, but now I have no willpower to diet. I've been more depressed of late but I think that's the menopause, I think if I could lose weight I'd feel so much more positive about myself. The drawback will be that I don't want to harm my mental health, also on the odd occasions when I've forgotten to take it I have had real trouble getting off to sleep. I haven't had any other side effects.

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  • Posted

    Hi Catherine,


    ?I am on 150 mgs of Venlafaxine in the morning, and on 30 mgs of Mirtazapine at night. Mirt is thought to be less effective for insomnia at higher doses, i.e. at 30 mgs or above, so I was surprised when you said your Mirt was upped to help the insomnia.

    ?I have had a rough couple of years, with several episodes of severe depression and anxiety. I very much sympathise with you.

    ?As you have been on Venlafaxine and Mirtazapine for a long time, I would doubt if they are the main cause of your weight gain.

    ?I'm no expert, but I would be very, very careful about coming off Mirt; if you do decide you need to come off, then you'd need to come off very, very slowly. Betsy and Calmer on this forum are extremely knowledgeable here.

    ?I would suggest adding a low dose of Trazodone at night for insomnia: my psychiatrist added this to my meds cocktail at the end of last year, and it has certainly helped. Zopiclone is the only sleeping med that works for me - Temazapam conked out on me after three nights, and I've also tried Phenergan and Benadryl, which did nothing - but I can't stand the side-effects, and GPs are extremely reluctant to prescribe it these days, as they fear addiction.

    ?I would say that your mental health and sleep should take priority over your weight: I've put on three stone since going on anti-depressants 18 years ago, and I know how depressing and anxiety-provoking weight gain is, but I'd rather be fat than extremely anxious and depressed. Once you're in a better place with the anxiety, depression and sleep, then you can work on the weight.

    ?Really hope this helps.


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    • Posted

      Thank you Amanda. In the last year my mental health has deteriorated. Unsure if this is exacerbated by the menopause. My wt gain has been slow but constant for many years. My dress size has gone from 14 to 20/22!! I felt much as you said that it was ok if I felt better, but now my depression is brittle and I suffer daily mood swings. I agree that changes should only be made under advice of medics. But my size and shape are adding to my negative moods. I won't do anything without guidance. I only found this forum as I was searching alternatives for mirtazapine. I must say that it's been an eye opener reading peoples' experiences.

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