Sertraline and Mirtazapine Dose changes...

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Had a week of ups and downs with recovery on the horizon and then snatched away. Feels like i am almost at my optimum dose combination of Sertraline and Mirtazapine but as close as i get to normality, the anxiety them washes me back again. It feels like i am getting caught in a rip tide and i’m being dragged further out to sea each time. If i am going to get back on my surf board and ride to recovery i think i am going to have to make a change. The 30mg Mirtazapine seemsto be doing good but its a very complicated and contradictive medication in terms of its many effects on brain chemicals/hormones.. e.g. serotonin, norepinephrine, dopamine histamine, cortisol etc.

I’ve been thinking that the 30mg is too activating and so i’m going to reduce down to 22.5mg and increase the Sertraline from 175mg back to the maximum dose of 200mg. This feels like the last throw of the dice on this medication combination as i have been going up and down the doses on each since November last year. However, despite recovery not lasting, i am in a much better place than i was in November.

This is when you feel so alone and don’t know which way to turn. I speak to my GP and they don’t really know what to do either. Even the psychiatrist seems to be incapable of directing me on an appropriate strategy. This is where social media despite its evils can be such a big help. There are lots of forums like this one where you can talk to people who are going through similar experiences and bounce your ideas off. I also find that helping others is one of the best distractions from your own mental health issues. There is a guy on this forum who has helped me so much and i will seriously owe him a case of beer if this pay dice roll pays off.

The key to any medication or doseage change is to give it time. This is so difficult when you are faced with days of uneasy feelings like you’re going crazy and all manner of symptoms obstruct your day. However, if i can just get back on the board, i might be able to catch that wave again to recovery. Happy surfing to all fellow Serotonin Surfers! Watch this space.....

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9 Replies

  • Posted

    Hi fellow surfer. I totally understand about being out there on your own and unfortunately this illness makes your mind go into over drive, should I do this, should I do that and when none of it instantly works,(because patience is not our friend), it feels like none of it is going to work and in this blame culture that we seem to have adopted no one professional is willing to give us a definite answer, also add to the mix that this type of medication is a slow acting not one size fits all kinda thing then we are most definitely in the wilderness. The only thing any of us can do is listen to our bodies, try something wait then wait some more then adjust. I know I am not giving you any definite answers either but just wanted to let you know you are not alone and with support, humour, time and patience we may all just make it through

    • Posted

      Thanks Sue for your kind words of support and empathy. This forum sure does have lovely and supportive people. #nevergiveuphope

  • Posted

    HI sorry to bother you my doctor has just prescribed me 50mg sertraline to go with the 30mg Mirtazapine i already take but the mirtazapine is making me more anxious terrible tension in chest on waking lasts all day dread to think what adding sertraline will feel like?

    • Posted

      How long have you been on Mirt for. These 2 AD's have a good track record in combination but my advice is to wait a long period of time, at least several months before dose changes. I'm currently on 30mg Mirt before bed and 100mg Sert in morning. Ive been trying to get the combo right for the last 12 months as my GP appeared to agree with whatever doseage change i suggested. It's taken all this time to realise that i should just stay on this dose combo now and try to manage anxiety through focusing on books, exercise. dog walks, work etc. I realised ive become so focused on searching for the magic dose that maybe it doesnt exist. Medication can only get you so far i believe now.

    • Posted

      Ive been on mirt for over 6 Months it dragged me out of a place where i had zero motivation just lied in bed depressed and anxious.I suffer from anxiety not depression but then the anxiety made me depressed.Started on 7.5mg 15mg after two weeks picked me up for a few weeks wanted to do things etc felt weird but better than i was.Felt it wasnt doing enough so went back to docs upped again to 30 for another few weeks no change then upped again to 45 no change for couple of weeks then Awful anxiety for next couple of weeks so went back down to 30 for last 6 OR 7 weeks anxiety still there dont feel its doing anything except for when i take it at 8pm rest of night feel relatively normal sleep well then when i wake up Awful anxiety which manifests itself as tension in chest area feels like something wrong with my heart all day until next dose couple of hours of feeling almost normal at night thats where im at thanks for replying.Dreading side effects of sertraline ive not started them yet as scared.Im 6ft 1, 17 Stone man(Was anyway zero appetite)and embarassed to be like this only couple of people know and they cant tolerate me constantly complaining Sorry for ranting.

    • Posted

      No worries my friend. Rant away. If you've been on Mirt for that length of time then your GP seems to be making a sound suggestion. I'm the same as you. I've got GAD rather than depression but feeling anxious 24/7 for months on end will obviously impact your mood. I was on 200mg SERT a day for 16 years and 100% recoverered all that time. They pooped out last SEP and GP added Mirtazapine as i always get bad

    • Posted

      insomnia when it starts again. MIRT cured my insomnia from day 1 but i still haven't managed to beat the anxiety after going up and down on both SERT and MIRT. Nigel is right when he states that some people find MiRT too activating above 22.5mg. I cannot stress the importance of exercise enough. I've felt like someone has been sitting on my chest all day. I went to the gym this evening and the weight has shifted now, thank god. Dont be afraid of SERT side effects. The combo will have a very good possibilty of working for you.

    • Posted

      I've DM'd you about a blog i stared that talks all about my experiences, particulary with MIRT and SERT combo

    • Posted

      Ive only tried ssri antidepressants once before and iim sensitive to side effects especially nausea and loss of appetite which i already suffer from dont think i can tolerate the side effects of sertraline also so for next week im going down to 22.5 Mirt and see if i can come off meds altogether this is first time ive tried anything properly.

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