I don't know how you keep all the different neurotransmitters and their respective function so well organized. I'm a newer psych provider (PMHNP) and have a pretty good grasp on psychopharmacology but your knowledge is quite impressive. I enjoy your videos.
Thanks for this interesting video! I take one 15mg Mirtazipine pill once a day at bedtime. Within 60-90min I am getting very tired and feel calm in a good way and sleep 8hrs through the whole night. I wake up very refreshed and well rested the next morning without any hangover. Anything else tried, never worked for my anxiety, so 8mg of a long acting Benzo added is the only thing that works in my case, 3 times a day 2mg. SSRI/SNRI/TCA or atypical antipsychotics never worked for chronic anxiety or panic attacks in any way for me. Mirtazipine replaced the addictive hypnotics, and no weight gain either over years now.
I've taken it in the past. The HORRIBLE(!!!!!) morning drowsiness never subsided. Good drug with terryfying zombie-effect every morning, that lasts half a day. What a pity.......
Brilliant - thank you. I’m just about to start cross-tapering from Venlafaxine (slow release) to Mirtazipine- with the aim of improving dsyregulated sleep. This video is v reassuring that it won’t cause risk of seratonin syndrome. Grateful to you. All good wishes
No serotonin syndrome is not a risk. But very important to not stop venlafaxine abruptly and of withdrawals occur to go slower. Ofcourse this is not advice but discuss this with your doctor. Mirtazapine can make the switch easier as it helps with sleep
@@PsychiatrySimplified I’ve already watched your very helpful & informative video on stopping antidepressants and learnt about hyperbolic effect. Thanks very much for that. Also since I’ve been on Venlafaxine 225mg for 11 years my intention is to go slower than the five week reduction plan that trainee GP initially recommended (think perhaps he may lack experience in the area so not his fault). Because I have severe ME/CFS want to keep any withdrawal symptoms to a minimum. I’m hoping that gradual, symmetrical cross tapering will work out ok though can’t find a lot of advice re cross tapering of Venlafaxine with Mirtazipine online. Perhaps you would consider creating a future video on the subject if you think it warrants it..? With many thanks and wishing you a good upcoming week.
I've had severe depression for ten years now. I'm 30. I had a severe breakdown in college. Each day my brain gets better but still years to go. No sexual desire, no relationships, sleep 16 hours a day, suicidal thoughts every second, can't be around ppl for ten years now. I've had every tx possible and nothing has helped even 1%. I've managed to get an advanced medical degree bc all I can do is read. I want to believe in these meds and you make it sound so easy but idk. My psych said there's no point in trying another med bc I've tried so many things. However this is one of the few I haven't had. Maybe I'll ask him to add it.
I had a severe breakdown in college too. I’m also 30. Word of advice if I can give one: eat clean, exercise, stay sober. Consider those the three pillars of mental health treatment. My abusive parents to mellow me out put me on at least five different classes of mental health pills by 15. It had lifelong consequences. I didn’t start getting better from severe depression and eventually off those drugs unless I combined my treatment of severe depression with radical changes in my unhealthy lifestyle and habits of living like eating junk food, isolating myself, binging Netflix, drinking, living a sedentary lifestyle. When I altered all of that, it was far more effective than any medication I had ever been on. Support groups are vital too. Any form of community or friendship is like an instant antidote to severe depression. Good luck friend. I hope you find the help you need.
Just back from the new to me clinic doc and went thinking would be starting something new altogether but he is suggesting this as an adjunct so will start low dose. This video is helpful as are comments. He mentioned weight gain (i am already overweight so not keen on that but cannot put a price on mental health really). But interesting to see full picture. Hoping for sleep.
I took 7.5 mg mirtazapine and it made me sleep for two days (day and night). I reduced it to 3.25 and slept well with fatigue the next day. I reduced it to 1 mg which helped me sleep but also with a feeling of fatigue during the day. The problem with this medicine is that its half-life is so long (20 to 30 hours long).
im on day 3 of 15mg of Mirtazapine , after 6 years on citalopram. I was told to do a straight switch so havent tapered and i have to say im feeling great. I no longer have insomnia and wake up feeling refreshed and energised for the first time in years. Time will tell.iv had a few nightmare and night sweats and abit of brain zaps but other than that pretty mild.
@@jrman413 wish i could say better. the first few weeks were great. iv now been upped to the 30mg dose. Im sleeping ok. but i feel very low. waiting to speak to my gp about it.
Thank you very much for your clarifications. Does this mean that at 15 mg mirtaza the noradrenaline and dopamine will NOT be affected? I am also interested in knowing your opinion Your opinion on valdoxan as opposed to mirtaza as far as the efficacy and side effects go especially withdrawal symptoms. I see lots of ppl complain about the withdrawal side effects!
I've suffered with long covid" brain fog, confusion, emotions, forgetting simple things, simlar to dementia. Vitimin levels low, serum folate. Mirtizapine has helped upto 90% of my condition? Somehow, it had helped!
What dose ? Yes many ‘psychiatric medications can help’ Infact in the most extreme cases there are many others that do. They are better thought of as neurotransmitter reuptake inhibitors - so for example Mirtazapine with its low dose antihistamine effect can help with mast cell stabilisation, arousal reduction and improved sleep. Higher doses improve dopamine and noradrenaline potentiation so improve cogntion , activity.
@PsychiatrySimplified yes improved cognitive function, I've gained some weight, and helped with my sleep pattern. My dose is 30 mg per day at night, still left with extreme tinnitus and stomach issues. Mirtazapine has helped 85/90 % still have little issues, cognitively and holding instant memory as to repeat 1st words spoken. I'm currently in work part-time, with a understanding employer. Thank you for answering my questions.
Thank you So much! I have generalized anxiety but through therapy and medicine ive been able to function well over the last year life. Recently my sleep has been impacted and taking my current medicine of 200mg sertraline and 50 mg of quetiapine. Of course i find taking new medicine horrifying but you put my worry's to rest. Just took my first tablet and hopefully I can get a solid 8 hours. Thanks Doc, clear and concise communication of what medicine does to the body is so incredibly helpful. Love from Ireland
Ive just moved from 15mg from January to 30mg in May. I have dry mouth all the time and have gained weight. Ive always been 10 stone and 5'11", so weight gain is a benefit. Im hoping the increased dose improves my mood.
@@saspirella09 My mood has plateaued at an ok level. I'm 11 stone and now and have been managing my food, which I have never had to consider before. It's going well I think.
@paulstockton7121 aw thanks for gettin back to me. That's good tho. The extra weight. I need some extra weight an I do try my best to get workouts In. My 30mg made me dizzy n hot I had to lay down quickly. Suppose I need to get used to it. Good luck with everything, hope u get what you need from this journey
Great video. One question I had regarding anti-histamine activity, which you mentioned. I've taken Amitriptyline before and it caused me to have a massive short-term memory problems, which I believe is due to anti-histamine. Do you think mirtazapine will function in a similar way?
At what dose? Amitriptyline and short term memory is more likely due to anticholinergic effects as we know anticholinergics are notorious with memory issues. Mirtazapine does not have anticholinergic effects. The antihistaminergic effects is why Mirtazapine is best prescribed at night. Not saying STM memory dysfunction can’t occur - but will be more due to antihistaminergic effects if excessively sedating ( high dose or not tolerated )
Hello Dr. Rege, I asked a question similar the one I'm about to ask now: While someone is using mirtazapine, not coming off the medication, can the H-1 receptor upregulate while it's being antagonized? I'm worried about this because blocking H-1 doesn't seem too favourable for learning and cognitive outcomes. Would love to know your professional take.
It depends on the level of arousal. Anti H1 is needed to reduce arousal. So at night this helps with sleep and reduction of anxiety . An analogy is to bring an excessive level to normalise . To downregulate excessive activation .
Hello, thank you for such a comprehensive and quality explanation. I have severe recurrent depression without psychotic symptoms (F33.2). The doctor prescribed mirtazapine 30mg/day and aripiprazole 15mg/day. Do you think this combination can be effective? Thank you.
It depends on what is being targeted as the medication is used and adjusted for domains of depression. So effectiveness is individual and based on your symptoms doses will be adjusted.
Hi Doc, great review of Mirtzapine. I started it 3 or 4 times and every time it worked fantastic for my insomnia, anxiety, low energy, low apetite and nausea. The problem was every time I started taking it,, my liver enzymes elevated (ALT twice the limit, GGT three times the limit). Never found any substitute for Mirtazapine to help with all 4 symptoms. Would you recommend something to look for? Thanks.
Improvement is not linked to drug only - it depends on 1. Desired improvement in patient - cognition, sleep, anxiety, emotion etc .. what is one targeting 2. Nature of illness Based on the above when Mirtazapine is used appropriately for the right targets in the right condition yes 60 mg leads to improving those specific targets
This has worked great for my autistic son with sleep. His psychiatrist has suggested increasing his dose to help mitigate his weight gain as it has less potential to gain weight at higher doses? I’m not sure if going up will help with weight but decrease the efficacy on help with sleep.
It’s best discussed with the psychiatrist as they would have a rationale. Responses are very individual so it’s difficult to say. Suffice to say that higher doses above 30 tend to more activating (I.e to improve cogntion and motivation but still have a certain sedative effect )
Hey, great video! For a case with a Mixed Anxiety Depressive Disorder, wherein the patient presents with difficulty focusing and anxiety-induced blurred vision, which doses would be more beneficial, and why? Thanks
@@PsychiatrySimplifiedthank you for the response. I was wondering if higher doses would be helpful with the derealization symptoms owing to its noradrenergic effects? And are there any noradrenergic effects at all at doses below 30mg? Thanks again
I have been on it for 30 years no one told me it was going to be a problem to get off of it every time I went to the doctor and there’s always doctors coming in and out so I always have a new doctor. I go to a physical once a year nobody has given me any problems until recently. A young doctor said this is going to be extremely difficult to get off of so I bought a milligram scale and now I’m going to try to cut back 10% or 5% every single month, I’m horrified now that this is going to be a huge problem and I’m 63 years old. Thank you for the information.
Not really - but we know that they are used to facilitate social contact in this context. For treatment however CBT is very effective as social anxiety as a construct is associated with fear of embarrassment or scrutiny hence addressing that is important. In terms of medications besides usual ADs - phenelzine is used for resistant social anxiety - it’s one of the agents that increases GABA in the brain. Having said that psychological therapy is most likely to give longer lasting benefits in social anxiety
🎯 Key Takeaways for quick navigation: 00:00 *🧠 Mechanism of Action of Mirtazapine* - Mirtazapine is classified as an NaSSA, affecting noradrenergic and serotonergic systems. - Dual effects at different doses: lower doses primarily act as serotonin antagonists, while higher doses increase noradrenergic activity. - Serotonin-specific antagonism: targets 5-HT2A, 5-HT2C, and 5-HT3 receptors, leading to various clinical effects like anti-anxiety, anti-emesis, and promoting sleep. 03:19 *🛌 Clinical Effects of Serotonin Antagonism by Mirtazapine* - By blocking 5-HT2A, 5-HT2C, and 5-HT3 receptors, Mirtazapine offers benefits such as anti-anxiety, anti-emetic effects, and increased appetite. - It can be used in conjunction with chemotherapy to alleviate anxiety and depression-related nausea and vomiting. - Mirtazapine's histamine receptor blockade contributes to sedation but may lead to daytime grogginess and weight gain. 05:34 *⚙️ Noradrenergic Effects and Serotonin Augmentation* - Mirtazapine's alpha-2 pre-synaptic antagonism leads to increased noradrenaline, beneficial for treating severe depression. - It also acts on alpha-2 hetero receptors on serotonergic neurons, mildly increasing serotonin without significant potentiation, making it safe for augmentation therapy. - Serotonin activation of the 5-HT1A receptor increases dopamine in the prefrontal cortex, contributing to Mirtazapine's overall benefits in depression treatment. Made with HARPA AI
Summary The video discusses the dual effects of Mirtazapine (Remeron) at different doses, highlighting its mechanisms of action and clinical implications in treating depression and anxiety disorders. Highlights 🧠 Mirtazapine acts as a noradrenergic serotonin-specific antagonist (NaSSA), primarily targeting serotonin receptors at lower doses (15-30 mg) for anti-anxiety effects. 🌙 At higher doses (>30 mg), Mirtazapine increases noradrenergic activity, promoting the treatment of severe depression by potentiating noradrenaline and dopamine release. 🔵 It antagonizes serotonin receptors (5-HT2A, 5-HT2C, and 5-HT3), providing benefits such as anti-anxiety effects, anti-emetic properties, and promoting slow-wave sleep. 🍽 Mirtazapine's histamine receptor blockade leads to sedation and can contribute to weight gain, while its noradrenergic effects can alleviate severe depression symptoms. 🧭 The drug's augmentation strategy involves combining it with SSRIs or SNRIs without significant risk of serotonin syndrome. 📈 By increasing serotonin through action on Alpha 2 hetero receptors, Mirtazapine indirectly boosts dopamine in the prefrontal cortex, aiding in depression management.
Hi. Quick question if someone is still having anxiety and depression at a dose of 30mg would a 45mg dose make anxiety worse but depressive symptoms better ?
No necessarily. The domains of depression consists of activity: slowing of activity or agitation. The second domain is cognition which is executive function planning sequencing decision-making etc and the cognitive appraisal of situations. For example depression the appraisal becomes more negative. There is a bias towards negative stimuli. More than positive stimuli and the third dimension is emotions. This includes emotional control but also the ability to respond to reward i.e. the Hedonic drive the ability to experience pleasure in activities that One generally would experience pleasure. with mirtazapine higher than 30 mg - 45 and 60 mg of cognition and activity are addressed to a greater extent due to Dopamine and Noradrenaline increase. however whilst Anxiety can improve ; hyper arousal and agitation may worsen. to understand this deeper. Please see the video between Please see the video for the differences between Anxiety vs hyperarousal vs agitation as can also include psychomotor activity changes. Often patients describe anxiety but this tends to be more hyper arousal and agitation. This can be part of a melancholic depression or even mixed features. The treatment simply does not include high doses of antidepressants as this can worsen the hyperarousal, agitation Becomes important for the clinician to be able to look at all of these domains and then utilise medication to target. This of course becomes clearer when medication is taken- if the anxiety worsens, Then it would be important to identify if this was because of hyper arousal or agitation and then treating that helps the antidepressant work better. This of course requires the diagnostic evaluation to identify whether this is more than just a Depressive syndrome i.e. whether there is a mixed state possibly present. This is not medical advice
Can you do something on Transcranial electrical stimulation (tDCS) and Transcranial magnetic stimulation (TMS) please. I would like to understand your opinion.
We’ve done a short video on TMS . th-cam.com/video/x5t8ht1wsnE/w-d-xo.htmlsi=xEmQCvutx5UHkYRA Not yet one on TDCS but this video will help understand the principle
Very interesting and helpful. My doctors dont take all my brain problems into there thoughts when trying to treat me in anyway. This med seems like it would help me so much better then the Xanax then have been given me for years with nothing but putting me to sleep.
Mirtazapine has destroyed my wellbeing when it's intention was to get me out and living again. Constant headaches,dry mouth,mood swings and body aches. I have tried to wean off it but the insomnia is unbearable.
Sorry to hear. Dose? Is this at higher doses. This insomnia can be addressed. The key is recognise if there were beneficial effects at any doses. Often low doses provide benefits - higher doses lead to effects you mentioned due to increases NA potentiation. Thus one strategy here is to keep the lower dose and address the remaining domains via synergy with other agent. This is illustrative example. Ps not medical advice.
Mirtazapine has antihistaminergic properties thus histaminergic rebound can occur. It is important to take into account the original condition characteristics that Mirtazapine treated. So of insomnia was a feature , even mild , this insomnia will rebound during Mirtazapine withdrawal . Similar with other aspects. When withdrawal symptoms are significant it’s usually due to rebound PLuS the rebound of the symptoms that were treated. This is not necessarily a relapse but a disruption of the homeostasis that was achieved with the medication.
It’s extremely individualised. Compounding pharmacies may help. But I would highly recommend one think of the factors making it challenging to taper beyond just medication.
Go slow and steady. One option would be using tapering strips or individualized capsulas from your pharmacy. Both has to be prescribed by your/a doctor. Reducing 5-10% per mounth is recommended und can be adapted. Also check out the work of Mad in America, Peter C. Gøtzsche, Mark Horowitz and "Medicating Normal" and "As Prescribed" here on yt. There is hope: my oldest pat. tapering M is 86 now, and she's doing amazing, in her words: "better than ever before".
I was just prescribed this med. But everyone says it causes weight gain, and I already struggle with that... Does the 'increased appetite' side effect go away, or does it persist?
Hello. Very interesting. I have important question. What is the influence of mirtazapine on narrowing or widening of blood vessels? Especially celebral? Should it widen them via blocking alpha2 noradrenaline repeptors? Or should rather narrow them by increasing serotonin (like SSRI and triptans do)?
Mirtazapine is unlikely to have a significant effect in that aspect - while it increases NA via alpha 2 antagonism - hypertension is not often a clinical issue hence the vasoconstriction potential is not significant. Similarly it does not have a hypotension effect - it may have indirect effects on vessels via reducing anxiety, treating depression and inproving vascular tone etc
Be very careful before taking this medication 💊 absolutely make sure to watch the videos of people trying to go off it. It can be hell for some people especially after prolonged use.
This medication caused serotonin syndrome for me which can be a life threatening condition. I took a 20 mg dose daily for about 3 months before it started causing problems for me.
That is very unusual . Was it jumpy legs or was it actual clonus and hyperreflexia. Sometimes activation phenomenon - sweating, , arousal , restlessness can be misdiagnosed as SS. Not in anyways minimising your experience but more trying to ascertain if it was SS or something else. As the mechanism of the agent significantly minimised the possibility of SS.
Yes that’s RLS - 28 % incidence with Mirtazapine . If this happens it could point to a few things and can point to potential treatment options 1. Mixed state 2. Iron deficiency 3. DA deficit so conditions like ADHD
@@PsychiatrySimplified thanks for your input,I appreciate it. Yeah my GP just attributed it to too much serotonin so I was taken off it. But then I was prescribed duloxetine-now that drug really messed me up. 6 weeks I took those little tiny white evil beads and I missed one morning and the side effects were horrendous ! It was worse than the mirtazapine side effects I had,so I weened myself off the duloxetine by slowly removing half a dozen beads each day until I was down to only a dozen in each pill,then I was able to just cut them out. Took about 8 weeks to get off that medication. That duloxetine is by far the worst prescription drug I’ve ever taken. Now 6 years later I’m not taking anything except one sleeping tablet ( survorexant / belsomra ) and melatonin. Thanks again for your information 👍
@@PsychiatrySimplified I had blood tests done and my iron was good,and there is adhd in my family. Plus I was diagnosed with drug induced psychosis from abusing marijuana and amphetamines when I was younger-35 years ago when I was in my early 20s I was a full blown marijuana user and took amphetamines weekly for many years.
Great video. Thanks. I am very interested to learn your thoughts on apparent tolerance of this drug when administered for sleep. Is it actually a thing? I hear on the one hand people taking it with the same sedative efficacy for many years and others who notice a diminished response after just a few months. I take it for around 15 months with mixed results. One trick is if I lower from 15 to 7.5 for a week or so and then titrate up to 15 it seems to work better again. I just wondered if there is In your view a psychological basis for tolerance
There are a few possibilities for this 1. True tolerance - tolerance of the antihistaminergic effect needing a dose increase ( doses 30 and less are more sedating than > 30 mg) 2. Insomnia is due to another mechanism - hyperarousal, agitation in which case Mirtazapine cannot address the true underlying condition 3. Comorbid medical conditions - OSA 4. Comorbid psychiatric conditions for Mirtazapine may not be effective in addressing the condition on its own.
I am gaining lots of weight, eating chocolate in the middle of the night. ....literally....losing teeth now 😢 But up to now has been the best anti depressant to suit me after being a guinea pig for many years I suffer with insomnia & i get 2.5hrs non disruptive sleep max even on 15 or 30mg Desperate to improve my sleep but i dont think increasing it will help Also healing from adrenal fatigue @PsychiatrySimplified
Hello, I'm curious about the cognitive effects of mirtazapine and guanfacine. Given that guanfacine, an alpha-2 agonist, is known to enhance cognitive function, could mirtazapine, an alpha-2 antagonist, potentially impair cognitive function?
@@PsychiatrySimplified Thank you for your response, though I am still a bit confused. In your discussion about guanfacine, you mentioned its role as an alpha 2 agonist, which reduces overall noradrenaline activity but improves neural network connections, particularly in ADHD treatment. While I understand that mirtazapine can enhance cognitive function by increasing noradrenaline and dopamine levels, as an alpha 2 antagonist, does it weaken the same neural network connections that guanfacine strengthens?
Clonidine is alpha 2 presynaptic agonist - Reduces NA and hyperarousal as presyanaptic > postsynaptic 2. Guanfacine post synaptic alpha2 - create impact on cognition and some possible reduction of hyperarousal but more activation of alpha2 receptors in PFC - cognition 3. Mirtazapine alpha 2 presynaptic antagonist ⬆️NA . 5HT1A partial agonist activity - ⬆️DA
Does Mianserin have the same properties, that is, at higher doses it blocks noradrenaline and at lower serotonin? Also, is Mianserin as effective as Mirtazapine for promoting sleep?
Yes Mianserin has similar properties. Both Mirtazapine and Mianserin do not block noradrenaline - they increase noradrenaline by blocking alpha 2 presynaptic receptors. They are serotonin receptor antagonists - so it doesn’t reduce serotonin but blocks specific serotonin receptors. Mirtazapine has greater antihistaminergic property
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@@PsychiatrySimplified do you know at which dose mianserin starts to affect the noradrenic level?
Dear dr sanil, I would like to ask something i didn't fully understand about this medication, if you take higher dosage does it help less with sleep or does the additional dosage just add additional benefits for depression for those who needs it? Meaning does the higher dosage counter react the effects of the low dosages like sedation or just give additional benefits for depression? If the higher dosages does counter react the effects of low dosages like sedation, how much time is required to take the lower dosages in order to have their effects like sedation? Meaning if you used to take 30mg how much time is required to take 15mg instead, until the sedation comes back if the serotonin and norepinephrine counter react the sedation effect?
At a general level - higher doses are activating so counteract sedative effect ( but initial sedation can still be present ) - but at 45-60 mg there is overall improvement in depressive symptoms. At an individual level it’s difficult to know as one has to take individual factors into account
@@PsychiatrySimplified thank you for the reply, i started with 30mg har great sedation at the first 4 days or so but after that it didn't do any sedation, i tried 15 mg for 3 days did nothing than i tried 45mg and 60mg but also didn't do anything for sedation, the thing is i took mirtazapine at the past maybe 2 years ago and i remember it worked for for at least couple of weeks or like 3 months the sedation and i took then 15-30mg so something is odd here, I wonder though if i take 30mg and try to lower to 7.5-15mg how much time until the norepinephrine and serotonin effects "turn off" So there will be hopefully more sedation? Of course i ask in general not looking for a medical advice just trying to understand how mirtazapine works and how much time required to take the lower dose after i already took the higher dose in order to see the possible sedation effects that maybe weakened because of the norepinephrine and serotonin...
No SSRI since the last few months. I did try a few they all gave me ED . Mirtazapine only . At 15mg helps like 50% but does not do much for my anxiety . I been trying for couple of days 22.5 less anxiety but ED is back . I wish to get rid of anxiety and fix ED . Shall I try 30mg . Thank you
Are the higher doses 45 and up also associated with even more 5-HT2a/c/3 blockade along with the increase in noradrenaline and serotonin? or does that effect top out at the 30mg dose?
I love taking mirtazapine for sleep and anxiety which I been on it for 2 years and it’s working great and it gave me my life back. I don’t get any side affects and I am on 15mg. Is it safe to take it for rest of my life?
I have to shave of a little from 30mg to reduce the noradrenaline but get the best of the histamine and serotonin. Depression. anxiety and PTSD results in sleep as a lotto win. I’m also on 75 mg of Amitriptyline also at night. I get 6 hours if lucky and wake up on fire. Then I use CBT therapy. Plus 2 Valium. For the day until the sleep anxiety is silenced by mirtazapine.
Hi doctor. I have a long history of depression and anxiety and have tried many antidepressants over the years. However, since 2011, I’m taking Fluoxetine 20 mg morning and Mirtazapine 15 mg night. The fluoxetine capsules however give me a heartburn problem occasionally, so I take Zactin, the dispersible tab. Recently however, the Zactin has been recalled and there is no other dispersable alternatives. So now I’m considering stopping the fluoxetine altogether and just take the mirtazapine. Do you think I’ll be okay ?
It’s really a question for your doctor. It depends on the specific symptoms , the severity etc. your doctor knows your history and hence can make an individualised recommendation.
@@PsychiatrySimplifiedthank you sir for your reply. The fluoxetine/ mirtazapine combo was prescribed by a psychiatrist in India, and the GPs here in Australia refill the script every six months, so I don’t really have a doctor, never seen a psychiatrist here in Australia.
Most GPs are able to manage this part in Australia. Have a discussion in detail and they can consider a referral to a psychiatrist if needed. If there are challenges consider a Gp with an interest in mental health. With side effects in general there are 4 options 1 wait and watch and rule out other causes of heart burn. 2. Reduce dose or cease 3. Switch agent 4. Augment . These options need to be considered for each person individually . For example if fluoxetine is stopped then withdrawal symptoms ( usually low risk as fluoxetine is long acting) need to be managed and Mirtazapine dose may need to be adjusted upwards. This is one example. Importantly it depends on the main symptoms that the medications are prescribed for. Ps not medical advice
I would like to continue 15 mg Remeron for mood and sleep yet my pa wants to start Pristiq? Can i take Remeron bedtime and Pristiq morning without problems? I am not feeling the side effect issues report w the Pristiq i have yet to try it because of what i read. Btw my dna says Remeron isn't really my best choice but i love it for me, go figure.
We can’t provide individualised advice. In general pristiq can be coprescribed and is a common combination. At higher doses of both this combination is called California rocket fuel used in the severe cases of depression. However Mirtazapine is commonly used at low doses with other ADs including pristiq to assist with insomnia and anxiety .ps not advice
@@PsychiatrySimplified Sir what about vortioxetine? I started vortioxetine 12 days ago. Now BP is always high (140+, 90+), I take olmesartan 10mg at night and bisoprolol 2.5mg and vortioxetine 10mg together after breakfast.
@@PsychiatrySimplified sir I think it's(vortioxtine) decreasing the efficiency of blood pressure medicines(olmesartan, bisoprolol). I'm also withdrawing Quetiapine XR 50(Day four off Quetiapine). I don't know which one causing high blood pressure 😞. Anyway thanks sir for your kind replies.
It’s likely a cumulative effect - increase in Vortioxetine increases noradrenaline which can increase BP combined with reduction of quetiapine which can also increase arousal and hendry indirectly BP. But theoretically this should not be sustained - however this depends on one’s risk factors and vulnerabilities . The doctor should be able to counteract this . Wish you well. Not advice
@@PsychiatrySimplified the zyprexa mostly worked for my depression.. now the mirtazapine is working for my anxiety but now my depression is creeping back .I have only been on mirtazapine a few weeks 15mg idk what to do. I see a nurse practitioner she does her best bet ehh could be better
Ceasing olanzapine can be associate with rebound insomnia or agitation so this has to be done gradually if a decision is made to reduce and cease - but also anxiety has to be differentiated from hyperarousal and agitation. Olanzapine treats agitation , Mirtazapine doesn’t. Ps not medical advice. We will be releasing a video in 3 weeks on anxiety vs hyperarousal vs agitation
Dr this is off topic but I was wanting to ask if it is possible to come straight off Quetiapine 25mgs as I have been on it for 9mths. It is the lowest dose and as it is not working in helping for anxiety for which was prescribes off label. Is it possible to come off it without any tapering? My Dr seems to think it will be ok but is there known to be any discontinuation syndrome?
Some can - some can’t . Rebound insomnia is a risk. A safer way of doing it is to drop to 12.5 mg and then wait for 2-3 weeks to ensure no rebound insomnia or anxiety . Then to cease. If rebound occurs it simply means one may have to wean slower or may need to counteract the insomnia with other meds short term. A lot depends on stressors, underlying control of Illness - hence why medical supervision is essential. Ps not medical advice
@@PsychiatrySimplified so BP doesn't actually cause anxiety? As my resting heart rate is always on the lower side resting 53. Only shoots up to about 110 in panic ,then I panic about the elevated heart rate.
@@karenpeart5997 it’s the autonomic nervous system arousal but this can be from both directions - so cognition / thought increasing anxiety or increased heart rate triggering off panic thoughts
I took this for the first time as my psychiatrist just gave it to me but bro, having taken it just once at 15mg, i feel like someone who's been drugged. I fell in the toilet, my speech slurred and my sentences need to be completed by someone else i feel awful on it. I was given a 2months worth but i cant
Study and individual patient is very different . Results for the averages are always likely to be ‘average’ while the same for an individual can have a significant skew - positive or negative. It’s the clinicians matching of the medication to the patient characteristics that makes the difference.
Doctor , with huge respect I have a question for you that have you people ever used any psychiatric medicines such SSRI ,SNRI ,Metazapine etc by yourself . These medicines causes a lot of damages to receptors and level of neurotransmitter than benefits to someone. I took SSRI Escitalopram for 6 months in 2020 and still struggling to achieve my mental energy and motivation till date.
@@pvn271 Great to hear from someone that it benefits you. In my case after using ssri , I could not be able to achieve my mental energy and motivation. Feels abruptions in natural level of neurotransmitters
That’s the reason why a clinical assessment is needed by a medical professional. Motivation , mental energy are targets that can be addressed but it requires an evaluation first
@@PsychiatrySimplified Sir How the mental energy and motivation can be addressed? Is there any solution for this issues specifically . I did many assessments with the psychiatrist but have not found any solution for it 😌
I took mirtazapine for just two nights in a row to combat insomnia. First I took 7,5 mg and then even 3,25 mg. It gave me horrible brainfog, drowsiness and derealization throughout the day, even though I took it at night. I felt like I was partly floating above my body. Still, I am now thinking about giving it another try for depression and panic/anxiety, mainly because it doesn't have the side effects that SSRI's have. Is the sedating feeling expected to go away once you get used to it? And is it different with different doses?
The antihistaminergic effect that leads to the grogginess is meant to ease as the receptor desensitises. But if it persists beyond 7 days to the same extent ( where intensity doesn’t reduce ) then it’s likely a side effect.
@@PsychiatrySimplified Alright, thank you for your answer. Couldn't hurt to give it another try I guess. I just hope I won't gain weight or get high cholesterol.
60mg made me faint and heartrate drop to 20bpm, 45 made it have lesser of those fainting effects. I'm now on 30mg now and a doctor recommended 15mg for my depression, as the med has been helpful
@PsychiatrySimplified Yes, so therefore, to say the drug "blocks" a receptor and then state what those receptors do as the effect on the patient is an unchallenged assumption. The brain may double the receptor density, or double another transmitter, in response. This is shown when SSEs (selective serotonin enhancing) drugs have exactly the same patient effect as SSRIs.
No its not necessarily as the clinical effect is seen with patients. Does one evaluate metformin in the same way? No - many medications have a multitude of effects. As a clinician one combines pharmacology with the clinical response. That is the aim. Molecular pharmacology isn't just about knowing the mechanisms - but rather the effect seen in different humans at the individual level.
Learned it was dose dependent before I knew what that meant . At 7.5 I have the best sleep I can recall in so many years I have slow MAOA (T;T) , which affects serotonin I have fast COMT (-/-) and VDR TAQ1 gene (+/+) which leads to really low dopamine. I take adderall in am for low dopamine effects. Wondering if I just took a higher dose of mirtazipine I would get both great sleep and less need for a stimulant .. 🤔 hmm
Worth discussing this with the doctor. The dopaminergic potentiation with mirtazapine is not as sognificant as with a stimulant but combinations are used to extract synergy.
Hi there, May I recommend prayer, faith and forgiveness. Be kind to yourself. Jesus saves. Be sure to not lose your salvation if you receive it. The bible clearly states who wont inherit the kingdom. Do not be any of those! You'd be better off not knowing the truth. I wish you well.
the histamine side effects are bad. great for my hay fever & anxiety induced insomnia, but it results in headaches, dryness & lethargy. compared to the countless SSRI & SNRI drugs I've taken in the past, Mirtazapine is far superior, though, particularly in terms of side effects. this includes less sexual dysfunction, no tachycardia, better sleep & decreased brain fog/confusion (i.e. more clear thinking & better concentration). having only been on them for 1 week, i cannot say if they'll reduce my depression significantly, but so far i do feel more positive. why any doctor would prescribe the newer antidepressants to these older tetracyclics is beyond me? pressure & lobbying from big pharma, i suppose?
Certain newer antidepresants have advantages - just like mirrazapine was once upon a time an improvement on SSRIs until it becomes generic. Each agent has its unique feature than when used well can make a difference
Blood concentrations is double in women according to the initial research of this drug and doctors does not care. Do not know. Coming of high dose of this drug is a Nightmare! Those who have trouble sleeping normally before mirtazapine risks extreem insomnia on any percentage reduction.
@@PsychiatrySimplifiedthanks for an amazing video.🎉 I was given mirtazapin against migraines but due to the very sedative effect I stopped after only 3,5 weeks. It’s months since I stopped and my sleep is still a big mess. Can you explain why or what to do about it? Can it have increased my cortisol levels?
If insomnia is an issue - watch the video we did on insomnia. The type of insomnia needs to be targeted . So there are few options but it depends on the nature, so please discuss this with a doctor .
From my own experience mirtazapine comes with sexual side effects. This is my second stint of being on mirtazapine was on it last year for 8 months and came off due to side effects. I was experiencing really bad sexual dysfunction thinking it was the finasteride I was taking along side with it which is a hairloss pill. I came off both meds at the same time and sexual functioning came back to normal (male 28 with a very high sex drive). I've recently gone back on only mirtazapine and now experiencing really bad sexual dysfunction again.... so really it was the mirtazapine all along. 30mg is the only dose that puts me to sleep at night and I honestly cant seem to sleep or function without them. I'm really stuck as ive had so much time off work due to severe mental health issues and insomnia and it's the only thing that is allowing me to function for work. The sexual side effects are unbearable...erectile dysfunction, gentle numbness, difficulty to orgasm the whole lot. Why is this not being mentioned anywhere??
Sorry to hear ! It is ‘rarish’ which also fits in with its mechanism so it’s unfortunate. It’s incidence is low that ofcourse doesn’t mean it can’t happen at all. There are several other options for treating depression that don’t affect sexual function
@@PsychiatrySimplified No it's not at all worthless. I regret that I wrote in that way. My question is more that you dont describe the drug for what it is. Mrtazapine are very versatile and also got effect on sleep and helps with anxiety symtoms. But, sorry for the plump words from me. I really like our channel, that's a fact
Thanks for that! I guess I was abrupt myself . I’ve got two videos on Mirtazapine - perhaps I’ve covered it there. But fair point 👍. And sorry if I was abrupt
Mrs Richards: "I paid for a room with a view !" Basil: (pointing to the lovely view) "That is Torquay, Madam ." Mrs Richards: "It's not good enough!" Basil: "May I ask what you were expecting to see out of a Torquay hotel bedroom window ? Sydney Opera House, perhaps? the Hanging Gardens of Babylon? Herds of wildebeest sweeping majestically past?..." Mrs Richards: "Don't be silly! I expect to be able to see the sea!" Basil: "You can see the sea, it's over there between the land and the sky." Mrs Richards: "I'm not satisfied. But I shall stay. But I expect a reduction." Basil: "Why?! Because Krakatoa's not erupting at the moment ?"
I’m so impressed how he wrote in reverse on that clear board
he can just mirror the video
😂😂😂🎉
@@CannyAnnie ?taht saw tahw
I don't know how you keep all the different neurotransmitters and their respective function so well organized. I'm a newer psych provider (PMHNP) and have a pretty good grasp on psychopharmacology but your knowledge is quite impressive. I enjoy your videos.
Thank you 🙏🏻 . I appreciate the feedback. Welcome to psychiatry - it’s amazing!
Thanks for this interesting video! I take one 15mg Mirtazipine pill once a day at bedtime. Within 60-90min I am getting very tired and feel calm in a good way and sleep 8hrs through the whole night. I wake up very refreshed and well rested the next morning without any hangover. Anything else tried, never worked for my anxiety, so 8mg of a long acting Benzo added is the only thing that works in my case, 3 times a day 2mg. SSRI/SNRI/TCA or atypical antipsychotics never worked for chronic anxiety or panic attacks in any way for me. Mirtazipine replaced the addictive hypnotics, and no weight gain either over years now.
That’s really good to hear! You got a good balance of efficacy and tolerability
So pleased for you. Did you experience and side effects at all like hair loss, increase chloesterol, blood sugar etc?
@@j-uk2189 Not a single side effect since years. God send. But of course every individual is different. Sleep quality is AMAZING!
Not a single side effect since years. God send. But of course every individual is different. Sleep quality is AMAZING!
I've taken it in the past. The HORRIBLE(!!!!!) morning drowsiness never subsided. Good drug with terryfying zombie-effect every morning, that lasts half a day. What a pity.......
Brilliant - thank you.
I’m just about to start cross-tapering from Venlafaxine (slow release) to Mirtazipine- with the aim of improving dsyregulated sleep. This video is v reassuring that it won’t cause risk of seratonin syndrome. Grateful to you. All good wishes
No serotonin syndrome is not a risk. But very important to not stop venlafaxine abruptly and of withdrawals occur to go slower. Ofcourse this is not advice but discuss this with your doctor. Mirtazapine can make the switch easier as it helps with sleep
@@PsychiatrySimplified I’ve already watched your very helpful & informative video on stopping antidepressants and learnt about hyperbolic effect. Thanks very much for that.
Also since I’ve been on Venlafaxine 225mg for 11 years my intention is to go slower than the five week reduction plan that trainee GP initially recommended (think perhaps he may lack experience in the area so not his fault). Because I have severe ME/CFS want to keep any withdrawal symptoms to a minimum.
I’m hoping that gradual, symmetrical cross tapering will work out ok though can’t find a lot of advice re cross tapering of Venlafaxine with Mirtazipine online. Perhaps you would consider creating a future video on the subject if you think it warrants it..?
With many thanks and wishing you a good upcoming week.
Supreme Teacher
🙏🏻
Thank you Dr Rege for this detailed and easy to understand explanation ❤
Glad it was helpful!
For me sir
It's mind blowing video
I am paramedics from Nepal
HA
Glad you liked it 🙏🏻
I've had severe depression for ten years now. I'm 30. I had a severe breakdown in college. Each day my brain gets better but still years to go. No sexual desire, no relationships, sleep 16 hours a day, suicidal thoughts every second, can't be around ppl for ten years now. I've had every tx possible and nothing has helped even 1%. I've managed to get an advanced medical degree bc all I can do is read. I want to believe in these meds and you make it sound so easy but idk. My psych said there's no point in trying another med bc I've tried so many things. However this is one of the few I haven't had. Maybe I'll ask him to add it.
I had a severe breakdown in college too. I’m also 30. Word of advice if I can give one: eat clean, exercise, stay sober. Consider those the three pillars of mental health treatment. My abusive parents to mellow me out put me on at least five different classes of mental health pills by 15. It had lifelong consequences. I didn’t start getting better from severe depression and eventually off those drugs unless I combined my treatment of severe depression with radical changes in my unhealthy lifestyle and habits of living like eating junk food, isolating myself, binging Netflix, drinking, living a sedentary lifestyle. When I altered all of that, it was far more effective than any medication I had ever been on. Support groups are vital too. Any form of community or friendship is like an instant antidote to severe depression. Good luck friend. I hope you find the help you need.
How are you doing?
Hang in there buddy. Something ought to
Work. I’m surprised your doctor has given up on you like that. You may want to switch providers
You need a new Dr. He may as well have said:" I don't know what to prescribe you but you can still pay me."
Just back from the new to me clinic doc and went thinking would be starting something new altogether but he is suggesting this as an adjunct so will start low dose. This video is helpful as are comments. He mentioned weight gain (i am already overweight so not keen on that but cannot put a price on mental health really). But interesting to see full picture. Hoping for sleep.
Excellent video! The only one I have watched on mirtazipine that I understand.
@@HooieBones3 thank you for the feedback. I appreciate it. I’m glad you found the video useful.
I took 7.5 mg mirtazapine and it made me sleep for two days (day and night). I reduced it to 3.25 and slept well with fatigue the next day. I reduced it to 1 mg which helped me sleep but also with a feeling of fatigue during the day. The problem with this medicine is that its half-life is so long (20 to 30 hours long).
im on day 3 of 15mg of Mirtazapine , after 6 years on citalopram. I was told to do a straight switch so havent tapered and i have to say im feeling great. I no longer have insomnia and wake up feeling refreshed and energised for the first time in years. Time will tell.iv had a few nightmare and night sweats and abit of brain zaps but other than that pretty mild.
Good to know and thanks for sharing.
How are you now buddy?
@@jrman413 wish i could say better. the first few weeks were great. iv now been upped to the 30mg dose. Im sleeping ok. but i feel very low. waiting to speak to my gp about it.
Thank you very much for your clarifications.
Does this mean that at 15 mg mirtaza the noradrenaline and dopamine will NOT be affected?
I am also interested in knowing your opinion Your opinion on valdoxan as opposed to mirtaza as far as the efficacy and side effects go especially withdrawal symptoms. I see lots of ppl complain about the withdrawal side effects!
I've suffered with long covid" brain fog, confusion, emotions, forgetting simple things, simlar to dementia. Vitimin levels low, serum folate. Mirtizapine has helped upto 90% of my condition? Somehow, it had helped!
What dose ? Yes many ‘psychiatric medications can help’ Infact in the most extreme cases there are many others that do. They are better thought of as neurotransmitter reuptake inhibitors - so for example Mirtazapine with its low dose antihistamine effect can help with mast cell stabilisation, arousal reduction and improved sleep. Higher doses improve dopamine and noradrenaline potentiation so improve cogntion , activity.
@PsychiatrySimplified yes improved cognitive function, I've gained some weight, and helped with my sleep pattern. My dose is 30 mg per day at night, still left with extreme tinnitus and stomach issues. Mirtazapine has helped 85/90 % still have little issues, cognitively and holding instant memory as to repeat 1st words spoken. I'm currently in work part-time, with a understanding employer. Thank you for answering my questions.
Thank you So much!
I have generalized anxiety but through therapy and medicine ive been able to function well over the last year life.
Recently my sleep has been impacted and taking my current medicine of 200mg sertraline and 50 mg of quetiapine.
Of course i find taking new medicine horrifying but you put my worry's to rest.
Just took my first tablet and hopefully I can get a solid 8 hours.
Thanks Doc, clear and concise communication of what medicine does to the body is so incredibly helpful.
Love from Ireland
@@shr_g9490 Hope you feel better soon. Wish you well
Question: Is there much 5ht1a activation at 15mg ? Thanks, incredible video !
No not really. At higher doses this occurs
Ive just moved from 15mg from January to 30mg in May.
I have dry mouth all the time and have gained weight. Ive always been 10 stone and 5'11", so weight gain is a benefit.
Im hoping the increased dose improves my mood.
Hey.. your comment was interesting to me because I've done the same today. Are u still one the same dose and has it helped?
@@saspirella09 My mood has plateaued at an ok level. I'm 11 stone and now and have been managing my food, which I have never had to consider before.
It's going well I think.
@paulstockton7121 aw thanks for gettin back to me. That's good tho. The extra weight. I need some extra weight an I do try my best to get workouts In. My 30mg made me dizzy n hot I had to lay down quickly. Suppose I need to get used to it. Good luck with everything, hope u get what you need from this journey
I've had mine in the cupboard for 6 months. I've been scared to use them, but I think I might have to.
Have you tried prayer, faith and forgiveness? I recommend that before these. I wish you well.
@@timeisforfindingGod I did join a church two months ago but a friend talked me out of going.
Great video. One question I had regarding anti-histamine activity, which you mentioned. I've taken Amitriptyline before and it caused me to have a massive short-term memory problems, which I believe is due to anti-histamine. Do you think mirtazapine will function in a similar way?
At what dose? Amitriptyline and short term memory is more likely due to anticholinergic effects as we know anticholinergics are notorious with memory issues. Mirtazapine does not have anticholinergic effects. The antihistaminergic effects is why Mirtazapine is best prescribed at night. Not saying STM memory dysfunction can’t occur - but will be more due to antihistaminergic effects if excessively sedating ( high dose or not tolerated )
Hello Dr. Rege, I asked a question similar the one I'm about to ask now: While someone is using mirtazapine, not coming off the medication, can the H-1 receptor upregulate while it's being antagonized? I'm worried about this because blocking H-1 doesn't seem too favourable for learning and cognitive outcomes. Would love to know your professional take.
It depends on the level of arousal. Anti H1 is needed to reduce arousal. So at night this helps with sleep and reduction of anxiety . An analogy is to bring an excessive level to normalise . To downregulate excessive activation .
next video mechanism of bupropion pls
Ah yes that’s missing from the list
Yes please and it’s use in chronic pain
Hello, thank you for such a comprehensive and quality explanation. I have severe recurrent depression without psychotic symptoms (F33.2). The doctor prescribed mirtazapine 30mg/day and aripiprazole 15mg/day. Do you think this combination can be effective? Thank you.
It depends on what is being targeted as the medication is used and adjusted for domains of depression. So effectiveness is individual and based on your symptoms doses will be adjusted.
Hi Doc, great review of Mirtzapine. I started it 3 or 4 times and every time it worked fantastic for my insomnia, anxiety, low energy, low apetite and nausea. The problem was every time I started taking it,, my liver enzymes elevated (ALT twice the limit, GGT three times the limit). Never found any substitute for Mirtazapine to help with all 4 symptoms. Would you recommend something to look for? Thanks.
Dear Dr Sanil.
Did your patients improve significantly After increasing the dose to 60 mg
Thank you
Improvement is not linked to drug only - it depends on
1. Desired improvement in patient - cognition, sleep, anxiety, emotion etc .. what is one targeting
2. Nature of illness
Based on the above when Mirtazapine is used appropriately for the right targets in the right condition yes 60 mg leads to improving those specific targets
This has worked great for my autistic son with sleep. His psychiatrist has suggested increasing his dose to help mitigate his weight gain as it has less potential to gain weight at higher doses? I’m not sure if going up will help with weight but decrease the efficacy on help with sleep.
It’s best discussed with the psychiatrist as they would have a rationale. Responses are very individual so it’s difficult to say. Suffice to say that higher doses above 30 tend to more activating (I.e to improve cogntion and motivation but still have a certain sedative effect )
Hey, great video! For a case with a Mixed Anxiety Depressive Disorder, wherein the patient presents with difficulty focusing and anxiety-induced blurred vision, which doses would be more beneficial, and why? Thanks
While I can't provide specific advice usual doses for anxiety disorders are 15-30 mg nocte
@@PsychiatrySimplifiedthank you for the response. I was wondering if higher doses would be helpful with the derealization symptoms owing to its noradrenergic effects? And are there any noradrenergic effects at all at doses below 30mg? Thanks again
Dr if we use mirtazapine as an augmention strategy for anxiety disorders, which dose should we consider 15 or 30 mg ?
Depends on response but usually 15-30 mg
I have been on it for 30 years no one told me it was going to be a problem to get off of it every time I went to the doctor and there’s always doctors coming in and out so I always have a new doctor. I go to a physical once a year nobody has given me any problems until recently. A young doctor said this is going to be extremely difficult to get off of so I bought a milligram scale and now I’m going to try to cut back 10% or 5% every single month, I’m horrified now that this is going to be a huge problem and I’m 63 years old. Thank you for the information.
How is it going
30 years?! Because someone told you to??? Or because you made your own executive decision to take a drug that long??? Either way, I’m so sorry.
@ doctor told me too continue if it was working so well. So I did
How are you dr?;)..I am in Australia too.
Dr. Rege, is it true that benzodiazepines and alcohol are the only substances that extinguish social anxiety?
Not really - but we know that they are used to facilitate social contact in this context. For treatment however CBT is very effective as social anxiety as a construct is associated with fear of embarrassment or scrutiny hence addressing that is important. In terms of medications besides usual ADs - phenelzine is used for resistant social anxiety - it’s one of the agents that increases GABA in the brain. Having said that psychological therapy is most likely to give longer lasting benefits in social anxiety
@@PsychiatrySimplified Great, thanks for the info!
@@PsychiatrySimplifiedIs Parnate ( Tranylcypromine ) also useful for social anxiety?
Not really - not mentioned specifically while phenelzine is mentioned for resistant social anxiety. Moclobemide also indicated
🎯 Key Takeaways for quick navigation:
00:00 *🧠 Mechanism of Action of Mirtazapine*
- Mirtazapine is classified as an NaSSA, affecting noradrenergic and serotonergic systems.
- Dual effects at different doses: lower doses primarily act as serotonin antagonists, while higher doses increase noradrenergic activity.
- Serotonin-specific antagonism: targets 5-HT2A, 5-HT2C, and 5-HT3 receptors, leading to various clinical effects like anti-anxiety, anti-emesis, and promoting sleep.
03:19 *🛌 Clinical Effects of Serotonin Antagonism by Mirtazapine*
- By blocking 5-HT2A, 5-HT2C, and 5-HT3 receptors, Mirtazapine offers benefits such as anti-anxiety, anti-emetic effects, and increased appetite.
- It can be used in conjunction with chemotherapy to alleviate anxiety and depression-related nausea and vomiting.
- Mirtazapine's histamine receptor blockade contributes to sedation but may lead to daytime grogginess and weight gain.
05:34 *⚙️ Noradrenergic Effects and Serotonin Augmentation*
- Mirtazapine's alpha-2 pre-synaptic antagonism leads to increased noradrenaline, beneficial for treating severe depression.
- It also acts on alpha-2 hetero receptors on serotonergic neurons, mildly increasing serotonin without significant potentiation, making it safe for augmentation therapy.
- Serotonin activation of the 5-HT1A receptor increases dopamine in the prefrontal cortex, contributing to Mirtazapine's overall benefits in depression treatment.
Made with HARPA AI
Summary
The video discusses the dual effects of Mirtazapine (Remeron) at different doses, highlighting its mechanisms of action and clinical implications in treating depression and anxiety disorders.
Highlights
🧠 Mirtazapine acts as a noradrenergic serotonin-specific antagonist (NaSSA), primarily targeting serotonin receptors at lower doses (15-30 mg) for anti-anxiety effects.
🌙 At higher doses (>30 mg), Mirtazapine increases noradrenergic activity, promoting the treatment of severe depression by potentiating noradrenaline and dopamine release.
🔵 It antagonizes serotonin receptors (5-HT2A, 5-HT2C, and 5-HT3), providing benefits such as anti-anxiety effects, anti-emetic properties, and promoting slow-wave sleep.
🍽 Mirtazapine's histamine receptor blockade leads to sedation and can contribute to weight gain, while its noradrenergic effects can alleviate severe depression symptoms.
🧭 The drug's augmentation strategy involves combining it with SSRIs or SNRIs without significant risk of serotonin syndrome.
📈 By increasing serotonin through action on Alpha 2 hetero receptors, Mirtazapine indirectly boosts dopamine in the prefrontal cortex, aiding in depression management.
Hi. Quick question if someone is still having anxiety and depression at a dose of 30mg would a 45mg dose make anxiety worse but depressive symptoms better ?
No necessarily. The domains of depression consists of activity: slowing of activity or agitation. The second domain is cognition which is executive function planning sequencing decision-making etc and the cognitive appraisal of situations. For example depression the appraisal becomes more negative. There is a bias towards negative stimuli. More than positive stimuli and the third dimension is emotions. This includes emotional control but also the ability to respond to reward i.e. the Hedonic drive the ability to experience pleasure in activities that One generally would experience pleasure. with mirtazapine higher than 30 mg - 45 and 60 mg of cognition and activity are addressed to a greater extent due to Dopamine and Noradrenaline increase. however whilst Anxiety can improve ; hyper arousal and agitation may worsen. to understand this deeper. Please see the video between Please see the video for the differences between Anxiety vs hyperarousal vs agitation as can also include psychomotor activity changes. Often patients describe anxiety but this tends to be more hyper arousal and agitation. This can be part of a melancholic depression or even mixed features. The treatment simply does not include high doses of antidepressants as this can worsen the hyperarousal, agitation Becomes important for the clinician to be able to look at all of these domains and then utilise medication to target. This of course becomes clearer when medication is taken- if the anxiety worsens, Then it would be important to identify if this was because of hyper arousal or agitation and then treating that helps the antidepressant work better. This of course requires the diagnostic evaluation to identify whether this is more than just a Depressive syndrome i.e. whether there is a mixed state possibly present. This is not medical advice
Can you do something on Transcranial electrical stimulation (tDCS) and Transcranial magnetic stimulation (TMS) please. I would like to understand your opinion.
We’ve done a short video on TMS . th-cam.com/video/x5t8ht1wsnE/w-d-xo.htmlsi=xEmQCvutx5UHkYRA
Not yet one on TDCS but this video will help understand the principle
I just realized Mianserin is not FDA-approved in the US.
Very interesting and helpful. My doctors dont take all my brain problems into there thoughts when trying to treat me in anyway. This med seems like it would help me so much better then the Xanax then have been given me for years with nothing but putting me to sleep.
If insomnia is an issue also look at the video on insomnia and the video on clonidine and guanfacine
Good video! 👍
Thanks
Does mirtazapine increase serotonin levels in the brain or does it only affect noradrenaline? thank you
No does not increase serotonin levels. Hence can be combined with Serotonergic agents with minimal risk of serotonin syndrome
Mirtazapine has destroyed my wellbeing when it's intention was to get me out and living again. Constant headaches,dry mouth,mood swings and body aches. I have tried to wean off it but the insomnia is unbearable.
Sorry to hear. Dose? Is this at higher doses. This insomnia can be addressed. The key is recognise if there were beneficial effects at any doses. Often low doses provide benefits - higher doses lead to effects you mentioned due to increases NA potentiation. Thus one strategy here is to keep the lower dose and address the remaining domains via synergy with other agent. This is illustrative example. Ps not medical advice.
Great video i tryed to taper of 7.5mg to 3.75mg i was doing ok but in the 3rd week i had brain zaps in my head and leg arm
Mirtazapine has antihistaminergic properties thus histaminergic rebound can occur. It is important to take into account the original condition characteristics that Mirtazapine treated. So of insomnia was a feature , even mild , this insomnia will rebound during Mirtazapine withdrawal . Similar with other aspects. When withdrawal symptoms are significant it’s usually due to rebound PLuS the rebound of the symptoms that were treated. This is not necessarily a relapse but a disruption of the homeostasis that was achieved with the medication.
Thanks for reply is there any safe way to taper from 7.5mg i am back on 7.5mg
It’s extremely individualised. Compounding pharmacies may help. But I would highly recommend one think of the factors making it challenging to taper beyond just medication.
Thanks docs i trying understand your message am not that clever with the big words
Go slow and steady. One option would be using tapering strips or individualized capsulas from your pharmacy. Both has to be prescribed by your/a doctor. Reducing 5-10% per mounth is recommended und can be adapted. Also check out the work of Mad in America, Peter C. Gøtzsche, Mark Horowitz and "Medicating Normal" and "As Prescribed" here on yt.
There is hope: my oldest pat. tapering M is 86 now, and she's doing amazing, in her words: "better than ever before".
I was just prescribed this med. But everyone says it causes weight gain, and I already struggle with that...
Does the 'increased appetite' side effect go away, or does it persist?
It's variable. In some it persists some it doesn't - same as with weight gain. Best to discuss it with the doctor as there are options to address this
Would you prescribe this to a person with co morbid alcoholism / depression/ anxiety
Considering gabba regulation
Yes it can be prescribed as part of a management plan to address comorbid alcohol use disorder
Sir does noradrenaline increase on taking 15 mg
Minimal if any. Occurs at 45 and 60
Can quiet xr 50 withdrawal cause high blood pressure?
Hello. Very interesting. I have important question. What is the influence of mirtazapine on narrowing or widening of blood vessels? Especially celebral? Should it widen them via blocking alpha2 noradrenaline repeptors? Or should rather narrow them by increasing serotonin (like SSRI and triptans do)?
Mirtazapine is unlikely to have a significant effect in that aspect - while it increases NA via alpha 2 antagonism - hypertension is not often a clinical issue hence the vasoconstriction potential is not significant. Similarly it does not have a hypotension effect - it may have indirect effects on vessels via reducing anxiety, treating depression and inproving vascular tone etc
@@PsychiatrySimplified Thanks for your reply
Sir I am from India, is it possible to make an online appointment with you
Sorry cannot due to medicolegal reasons
Took this for four days. 3 of the nights I didn’t sleep at all.
Dose? Rule out mixed state. Also RLS 28% with Mirtazapine.
I am weaning off of mirtzapine. I hated the weight gain and blunted feelings.
Would Mirtazapine have any benefit for tension headaches?
If they are mediated by anxiety then it’s possible
Have you used it for tension headaches and did it help?
Ive had to take mirtazapine for akathesia from benso withdrawal,,,will the akathesia heal while on the mirtazapine
Please see the video on akathisia on this channel - there is an algorithm - there are multiple agents - it depends on the nature .
Be very careful before taking this medication 💊 absolutely make sure to watch the videos of people trying to go off it. It can be hell for some people especially after prolonged use.
Speak for yourself
This medication caused serotonin syndrome for me which can be a life threatening condition. I took a 20 mg dose daily for about 3 months before it started causing problems for me.
That is very unusual . Was it jumpy legs or was it actual clonus and hyperreflexia. Sometimes activation phenomenon - sweating, , arousal , restlessness can be misdiagnosed as SS. Not in anyways minimising your experience but more trying to ascertain if it was SS or something else. As the mechanism of the agent significantly minimised the possibility of SS.
@@PsychiatrySimplified I had restless leg syndrome really bad,I couldn’t lay still,I had to keep continuously moving,it was absolutely horrible.
Yes that’s RLS - 28 % incidence with Mirtazapine . If this happens it could point to a few things and can point to potential treatment options 1. Mixed state 2. Iron deficiency 3. DA deficit so conditions like ADHD
@@PsychiatrySimplified thanks for your input,I appreciate it. Yeah my GP just attributed it to too much serotonin so I was taken off it. But then I was prescribed duloxetine-now that drug really messed me up. 6 weeks I took those little tiny white evil beads and I missed one morning and the side effects were horrendous ! It was worse than the mirtazapine side effects I had,so I weened myself off the duloxetine by slowly removing half a dozen beads each day until I was down to only a dozen in each pill,then I was able to just cut them out. Took about 8 weeks to get off that medication. That duloxetine is by far the worst prescription drug I’ve ever taken. Now 6 years later I’m not taking anything except one sleeping tablet ( survorexant / belsomra ) and melatonin. Thanks again for your information 👍
@@PsychiatrySimplified I had blood tests done and my iron was good,and there is adhd in my family. Plus I was diagnosed with drug induced psychosis from abusing marijuana and amphetamines when I was younger-35 years ago when I was in my early 20s I was a full blown marijuana user and took amphetamines weekly for many years.
Sir, will noradrenaline increase if mirtazapine 7.5 mg is taken?
Unlikely at this dose. Alpha2 presynaptic antagonism for NE potentiation occurs at 45 and 60 mg.
@@PsychiatrySimplifiedthank you so much sir 🙏🙏🙏
Great video. Thanks. I am very interested to learn your thoughts on apparent tolerance of this drug when administered for sleep. Is it actually a thing? I hear on the one hand people taking it with the same sedative efficacy for many years and others who notice a diminished response after just a few months. I take it for around 15 months with mixed results. One trick is if I lower from 15 to 7.5 for a week or so and then titrate up to 15 it seems to work better again. I just wondered if there is In your view a psychological basis for tolerance
There are a few possibilities for this 1. True tolerance - tolerance of the antihistaminergic effect needing a dose increase ( doses 30 and less are more sedating than > 30 mg) 2. Insomnia is due to another mechanism - hyperarousal, agitation in which case Mirtazapine cannot address the true underlying condition 3. Comorbid medical conditions - OSA 4. Comorbid psychiatric conditions for Mirtazapine may not be effective in addressing the condition on its own.
@PsychiatrySimplified thank you for answering. It seems to me ( through anecdotal reading) that there is tremendous personal variance to point 1.
I am gaining lots of weight, eating chocolate in the middle of the night. ....literally....losing teeth now 😢
But up to now has been the best anti depressant to suit me after being a guinea pig for many years
I suffer with insomnia & i get 2.5hrs non disruptive sleep max even on 15 or 30mg
Desperate to improve my sleep but i dont think increasing it will help
Also healing from adrenal fatigue
@PsychiatrySimplified
Hello, I'm curious about the cognitive effects of mirtazapine and guanfacine. Given that guanfacine, an alpha-2 agonist, is known to enhance cognitive function, could mirtazapine, an alpha-2 antagonist, potentially impair cognitive function?
No because it’s a alpha 2 presynaptic agonist. I cover it in the video - increase of NA and DA ( via 5HT1A)
@@PsychiatrySimplified Thank you for your response, though I am still a bit confused. In your discussion about guanfacine, you mentioned its role as an alpha 2 agonist, which reduces overall noradrenaline activity but improves neural network connections, particularly in ADHD treatment. While I understand that mirtazapine can enhance cognitive function by increasing noradrenaline and dopamine levels, as an alpha 2 antagonist, does it weaken the same neural network connections that guanfacine strengthens?
Clonidine is alpha 2 presynaptic agonist - Reduces NA and hyperarousal as presyanaptic > postsynaptic 2. Guanfacine post synaptic alpha2 - create impact on cognition and some possible reduction of hyperarousal but more activation of alpha2 receptors in PFC - cognition 3. Mirtazapine alpha 2 presynaptic antagonist ⬆️NA . 5HT1A partial agonist activity - ⬆️DA
Is Mirtazapine serotonergic at 7.5mg?
Yes it has a mild serotonergic antagonist effect 5HT2A and C and 5HT3 effects - sleep anti anxiety, anti nausea
@@PsychiatrySimplified thank you!
Does Mianserin have the same properties, that is, at higher doses it blocks noradrenaline and at lower serotonin? Also, is Mianserin as effective as Mirtazapine for promoting sleep?
Yes Mianserin has similar properties. Both Mirtazapine and Mianserin do not block noradrenaline - they increase noradrenaline by blocking alpha 2 presynaptic receptors. They are serotonin receptor antagonists - so it doesn’t reduce serotonin but blocks specific serotonin receptors. Mirtazapine has greater antihistaminergic property
@@PsychiatrySimplified do you know at which dose mianserin starts to affect the noradrenic level?
Higher range
It occurs at Low and High levels. Study shows that low levels via alpha 2 ; higher levels potentially NET inhibition ( animal study)
Dear dr sanil,
I would like to ask something i didn't fully understand about this medication, if you take higher dosage does it help less with sleep or does the additional dosage just add additional benefits for depression for those who needs it?
Meaning does the higher dosage counter react the effects of the low dosages like sedation or just give additional benefits for depression?
If the higher dosages does counter react the effects of low dosages like sedation, how much time is required to take the lower dosages in order to have their effects like sedation?
Meaning if you used to take 30mg how much time is required to take 15mg instead, until the sedation comes back if the serotonin and norepinephrine counter react the sedation effect?
At a general level - higher doses are activating so counteract sedative effect ( but initial sedation can still be present ) - but at 45-60 mg there is overall improvement in depressive symptoms. At an individual level it’s difficult to know as one has to take individual factors into account
@@PsychiatrySimplified thank you for the reply, i started with 30mg har great sedation at the first 4 days or so but after that it didn't do any sedation,
i tried 15 mg for 3 days did nothing than i tried 45mg and 60mg but also didn't do anything for sedation,
the thing is i took mirtazapine at the past maybe 2 years ago and i remember it worked for for at least couple of weeks or like 3 months the sedation and i took then 15-30mg so something is odd here,
I wonder though if i take 30mg and try to lower to 7.5-15mg how much time until the norepinephrine and serotonin effects "turn off" So there will be hopefully more sedation?
Of course i ask in general not looking for a medical advice just trying to understand how mirtazapine works and how much time required to take the lower dose after i already took the higher dose in order to see the possible sedation effects that maybe weakened because of the norepinephrine and serotonin...
Is 30mg better than 15mg for an erectile dysfunction ?
It can be but really depends on many other factors? Is this SSRI induced ? And is Mirtazapine added on?
No SSRI since the last few months. I did try a few they all gave me ED . Mirtazapine only . At 15mg helps like 50% but does not do much for my anxiety . I been trying for couple of days 22.5 less anxiety but ED is back . I wish to get rid of anxiety and fix ED . Shall I try 30mg . Thank you
Mirtazapine in general has a lower probability of ED - higher doses are less likely to due to dopamine and noradrenergic potenaition. Ps not advice
What does 30mg of Mirtazapine for sleep as I'm currently on 15mg
Also has antihistaminergic and 5HT2A antagonism so helps with sleep. But for some as dose goes higher it can be activating.
While tapering whats the guidance now you provide is it 10 percent method, orba faster method?
It should be individualised with mirtazapine as the antihistaminergic effect can lead to a significant rebound.
Are mirtazepine 30 mg ok for tinnitus please
Superb , thank you
Pleasure
Are the higher doses 45 and up also associated with even more 5-HT2a/c/3 blockade along with the increase in noradrenaline and serotonin? or does that effect top out at the 30mg dose?
The 5HT2 / 5HT1A particularly increases as that potentiates DA. But alpha2 is main receptor which is blocked at higher doses for NA potentiation
I love taking mirtazapine for sleep and anxiety which I been on it for 2 years and it’s working great and it gave me my life back. I don’t get any side affects and I am on 15mg. Is it safe to take it for rest of my life?
Good to know. Taking medication is a risk benefit analysis. Do benefits outweigh any risks- that’s a discussion to have with the doctor.
How many weight gained??
How many weight gained??
Does this mean that ant-anxiety effects are better at 15mg than 30?
I have to shave of a little from 30mg to reduce the noradrenaline but get the best of the histamine and serotonin. Depression. anxiety and PTSD results in sleep as a lotto win. I’m also on 75 mg of Amitriptyline also at night. I get 6 hours if lucky and wake up on fire. Then I use CBT therapy. Plus 2 Valium. For the day until the sleep anxiety is silenced by mirtazapine.
Hi doctor. I have a long history of depression and anxiety and have tried many antidepressants over the years. However, since 2011, I’m taking Fluoxetine 20 mg morning and Mirtazapine 15 mg night. The fluoxetine capsules however give me a heartburn problem occasionally, so I take Zactin, the dispersible tab. Recently however, the Zactin has been recalled and there is no other dispersable alternatives. So now I’m considering stopping the fluoxetine altogether and just take the mirtazapine. Do you think I’ll be okay ?
It’s really a question for your doctor. It depends on the specific symptoms , the severity etc. your doctor knows your history and hence can make an individualised recommendation.
@@PsychiatrySimplifiedthank you sir for your reply. The fluoxetine/ mirtazapine combo was prescribed by a psychiatrist in India, and the GPs here in Australia refill the script every six months, so I don’t really have a doctor, never seen a psychiatrist here in Australia.
Most GPs are able to manage this part in Australia. Have a discussion in detail and they can consider a referral to a psychiatrist if needed. If there are challenges consider a Gp with an interest in mental health. With side effects in general there are 4 options 1 wait and watch and rule out other causes of heart burn. 2. Reduce dose or cease 3. Switch agent 4. Augment . These options need to be considered for each person individually . For example if fluoxetine is stopped then withdrawal symptoms ( usually low risk as fluoxetine is long acting) need to be managed and Mirtazapine dose may need to be adjusted upwards. This is one example. Importantly it depends on the main symptoms that the medications are prescribed for. Ps not medical advice
@@PsychiatrySimplifiedThank you 🙏🏽
Thanks so much
Pleasure
I would like to continue 15 mg Remeron for mood and sleep yet my pa wants to start Pristiq? Can i take Remeron bedtime and Pristiq morning without problems? I am not feeling the side effect issues report w the Pristiq i have yet to try it because of what i read. Btw my dna says Remeron isn't really my best choice but i love it for me, go figure.
We can’t provide individualised advice. In general pristiq can be coprescribed and is a common combination. At higher doses of both this combination is called California rocket fuel used in the severe cases of depression. However Mirtazapine is commonly used at low doses with other ADs including pristiq to assist with insomnia and anxiety .ps not advice
Why/how some antidepressants cause high blood glucose/interact with diabetes medicine?
Mirtazapine can lead to increased glucose lipid levels and weight gain via antihistaminergic action
@@PsychiatrySimplified
Sir what about vortioxetine? I started vortioxetine 12 days ago. Now BP is always high (140+, 90+), I take olmesartan 10mg at night and bisoprolol 2.5mg and vortioxetine 10mg together after breakfast.
Vortioxetine does not affect blood sugar and is a metabolically friendly agent
@@PsychiatrySimplified sir I think it's(vortioxtine) decreasing the efficiency of blood pressure medicines(olmesartan, bisoprolol). I'm also withdrawing Quetiapine XR 50(Day four off Quetiapine). I don't know which one causing high blood pressure 😞.
Anyway thanks sir for your kind replies.
It’s likely a cumulative effect - increase in Vortioxetine increases noradrenaline which can increase BP combined with reduction of quetiapine which can also increase arousal and hendry indirectly BP. But theoretically this should not be sustained - however this depends on one’s risk factors and vulnerabilities . The doctor should be able to counteract this . Wish you well. Not advice
Thanks!
Appreciate it
Can you take mirtazapine and zyprexa together? I just chanted from that to mirtazapine but was wondering if taken together is safe ?
Theoretically yes. Please seek medical advice as olanzapine is prescribed for other indications that Mirtazapine may not be able to address.
@@PsychiatrySimplified the zyprexa mostly worked for my depression.. now the mirtazapine is working for my anxiety but now my depression is creeping back .I have only been on mirtazapine a few weeks 15mg idk what to do. I see a nurse practitioner she does her best bet ehh could be better
Ceasing olanzapine can be associate with rebound insomnia or agitation so this has to be done gradually if a decision is made to reduce and cease - but also anxiety has to be differentiated from hyperarousal and agitation. Olanzapine treats agitation , Mirtazapine doesn’t. Ps not medical advice. We will be releasing a video in 3 weeks on anxiety vs hyperarousal vs agitation
Can mirtazapine effect calcium levels
Dr this is off topic but I was wanting to ask if it is possible to come straight off Quetiapine 25mgs as I have been on it for 9mths. It is the lowest dose and as it is not working in helping for anxiety for which was prescribes off label. Is it possible to come off it without any tapering? My Dr seems to think it will be ok but is there known to be any discontinuation syndrome?
Some can - some can’t . Rebound insomnia is a risk. A safer way of doing it is to drop to 12.5 mg and then wait for 2-3 weeks to ensure no rebound insomnia or anxiety . Then to cease. If rebound occurs it simply means one may have to wean slower or may need to counteract the insomnia with other meds short term. A lot depends on stressors, underlying control of Illness - hence why medical supervision is essential. Ps not medical advice
@@PsychiatrySimplified Thank you so much!
Hi Dr Sanil.
I will ask my doctor to prescribe 60mg because 45mg is not doing much
Should I take it at night??
Yes generally prescribed at night. But i cannot advise specifically for you. Please discuss this with your doctor
Thank you so much sir
What does 15mg do to blood pressure please ? I can't find any information on this
Snyone ?
Not much. If anything if elevated BP is linked to anxiety this may slightly reduce. Unlikely to have any significant effect on BP.
@@PsychiatrySimplified so elevated bp can cause anxiety
It’s bidirectional . If elevated Bp results in tachycardia then an elevated HR can lead to anxiety - and anxiety itself increases BP and HR.
@@PsychiatrySimplified so BP doesn't actually cause anxiety?
As my resting heart rate is always on the lower side resting 53.
Only shoots up to about 110 in panic ,then I panic about the elevated heart rate.
@@karenpeart5997 it’s the autonomic nervous system arousal but this can be from both directions - so cognition / thought increasing anxiety or increased heart rate triggering off panic thoughts
I took this for the first time as my psychiatrist just gave it to me but bro, having taken it just once at 15mg, i feel like someone who's been drugged. I fell in the toilet, my speech slurred and my sentences need to be completed by someone else i feel awful on it. I was given a 2months worth but i cant
New studies shown a no further effect above 45
Study and individual patient is very different . Results for the averages are always likely to be ‘average’ while the same for an individual can have a significant skew - positive or negative. It’s the clinicians matching of the medication to the patient characteristics that makes the difference.
Doctor , with huge respect I have a question for you that have you people ever used any psychiatric medicines such SSRI ,SNRI ,Metazapine etc by yourself . These medicines causes a lot of damages to receptors and level of neurotransmitter than benefits to someone. I took SSRI Escitalopram for 6 months in 2020 and still struggling to achieve my mental energy and motivation till date.
I would recommend discussing this with your doctor
yes i have and it worked great lol...your condition is not due to escitalopram but more likely to be due to your underlying issues
@@pvn271 Great to hear from someone that it benefits you. In my case after using ssri , I could not be able to achieve my mental energy and motivation. Feels abruptions in natural level of neurotransmitters
That’s the reason why a clinical assessment is needed by a medical professional. Motivation , mental energy are targets that can be addressed but it requires an evaluation first
@@PsychiatrySimplified Sir How the mental energy and motivation can be addressed? Is there any solution for this issues specifically . I did many assessments with the psychiatrist but have not found any solution for it 😌
I took mirtazapine for just two nights in a row to combat insomnia. First I took 7,5 mg and then even 3,25 mg. It gave me horrible brainfog, drowsiness and derealization throughout the day, even though I took it at night. I felt like I was partly floating above my body. Still, I am now thinking about giving it another try for depression and panic/anxiety, mainly because it doesn't have the side effects that SSRI's have. Is the sedating feeling expected to go away once you get used to it? And is it different with different doses?
The antihistaminergic effect that leads to the grogginess is meant to ease as the receptor desensitises. But if it persists beyond 7 days to the same extent ( where intensity doesn’t reduce ) then it’s likely a side effect.
@@PsychiatrySimplified Alright, thank you for your answer. Couldn't hurt to give it another try I guess. I just hope I won't gain weight or get high cholesterol.
It can be picked up Early and managed if that happens in clinical practice
60mg made me faint and heartrate drop to 20bpm, 45 made it have lesser of those fainting effects. I'm now on 30mg now and a doctor recommended 15mg for my depression, as the med has been helpful
This all assunes that the brain doesn't respond to antagonise the receptor blocking and altered neurotransmitters. Which it does.
No it doesn't assume that. Upregulation / downregulation of receptors is implicit in any receptor modulation.
@PsychiatrySimplified Yes, so therefore, to say the drug "blocks" a receptor and then state what those receptors do as the effect on the patient is an unchallenged assumption. The brain may double the receptor density, or double another transmitter, in response. This is shown when SSEs (selective serotonin enhancing) drugs have exactly the same patient effect as SSRIs.
No its not necessarily as the clinical effect is seen with patients. Does one evaluate metformin in the same way? No - many medications have a multitude of effects. As a clinician one combines pharmacology with the clinical response. That is the aim. Molecular pharmacology isn't just about knowing the mechanisms - but rather the effect seen in different humans at the individual level.
Learned it was dose dependent before I knew what that meant . At 7.5 I have the best sleep I can recall in so many years
I have slow MAOA (T;T) , which affects serotonin
I have fast COMT (-/-) and VDR TAQ1 gene (+/+) which leads to really low dopamine.
I take adderall in am for low dopamine effects. Wondering if I just took a higher dose of mirtazipine I would get both great sleep and less need for a stimulant .. 🤔 hmm
Worth discussing this with the doctor. The dopaminergic potentiation with mirtazapine is not as sognificant as with a stimulant but combinations are used to extract synergy.
Thanks for replying
I just want to be happy again! I am 42 and not been happy since my late 20s , please somebody help me
Hi there, May I recommend prayer, faith and forgiveness. Be kind to yourself. Jesus saves. Be sure to not lose your salvation if you receive it. The bible clearly states who wont inherit the kingdom. Do not be any of those! You'd be better off not knowing the truth. I wish you well.
the histamine side effects are bad. great for my hay fever & anxiety induced insomnia, but it results in headaches, dryness & lethargy. compared to the countless SSRI & SNRI drugs I've taken in the past, Mirtazapine is far superior, though, particularly in terms of side effects. this includes less sexual dysfunction, no tachycardia, better sleep & decreased brain fog/confusion (i.e. more clear thinking & better concentration). having only been on them for 1 week, i cannot say if they'll reduce my depression significantly, but so far i do feel more positive. why any doctor would prescribe the newer antidepressants to these older tetracyclics is beyond me? pressure & lobbying from big pharma, i suppose?
Certain newer antidepresants have advantages - just like mirrazapine was once upon a time an improvement on SSRIs until it becomes generic. Each agent has its unique feature than when used well can make a difference
I dont stop eating
@@adpgreyarea8526 it’s a known side effect - have a discussion with your doctor as there are options
Blood concentrations is double in women according to the initial research of this drug and doctors does not care. Do not know.
Coming of high dose of this drug is a Nightmare! Those who have trouble sleeping normally before mirtazapine risks extreem insomnia on any percentage reduction.
Yes rebound insomnia is a risk when coming off.
@@PsychiatrySimplifiedthanks for an amazing video.🎉
I was given mirtazapin against migraines but due to the very sedative effect I stopped after only 3,5 weeks. It’s months since I stopped and my sleep is still a big mess. Can you explain why or what to do about it? Can it have increased my cortisol levels?
If insomnia is an issue - watch the video we did on insomnia. The type of insomnia needs to be targeted . So there are few options but it depends on the nature, so please discuss this with a doctor .
From my own experience mirtazapine comes with sexual side effects. This is my second stint of being on mirtazapine was on it last year for 8 months and came off due to side effects. I was experiencing really bad sexual dysfunction thinking it was the finasteride I was taking along side with it which is a hairloss pill. I came off both meds at the same time and sexual functioning came back to normal (male 28 with a very high sex drive). I've recently gone back on only mirtazapine and now experiencing really bad sexual dysfunction again.... so really it was the mirtazapine all along. 30mg is the only dose that puts me to sleep at night and I honestly cant seem to sleep or function without them. I'm really stuck as ive had so much time off work due to severe mental health issues and insomnia and it's the only thing that is allowing me to function for work. The sexual side effects are unbearable...erectile dysfunction, gentle numbness, difficulty to orgasm the whole lot. Why is this not being mentioned anywhere??
Sorry to hear ! It is ‘rarish’ which also fits in with its mechanism so it’s unfortunate. It’s incidence is low that ofcourse doesn’t mean it can’t happen at all. There are several other options for treating depression that don’t affect sexual function
@@PsychiatrySimplified is there any science behind it? what are the other options?
Some welcome that side effect as woman are absolutely crazy nowadays 🤠🥳
I was actually prescribed 90mg of this stuff. It was too much.
Weight Gain a Lot!!!
Constant zooming of the screen is a little annoying. Less of this would be welcome.
Shall I slap my psychiatrist who said mirtazapine doesn’t work depression, anxiety and sleep, but take seroquel instead!? lol
We don’t advocate for violence 😃
Worthless video only presenting all we already knew about mirtazapine
Thanks for the comment. Worthless to YOU. So while its worthless to you ; it may not be for everyone. 👍🏼
@@PsychiatrySimplified No it's not at all worthless. I regret that I wrote in that way. My question is more that you dont describe the drug for what it is. Mrtazapine are very versatile and also got effect on sleep and helps with anxiety symtoms. But, sorry for the plump words from me. I really like our channel, that's a fact
Thanks for that! I guess I was abrupt myself . I’ve got two videos on Mirtazapine - perhaps I’ve covered it there. But fair point 👍. And sorry if I was abrupt
Extremely interesting I thought
Mrs Richards: "I paid for a room with a view !"
Basil: (pointing to the lovely view) "That is Torquay, Madam ."
Mrs Richards: "It's not good enough!"
Basil: "May I ask what you were expecting to see out of a Torquay hotel bedroom window ? Sydney Opera House, perhaps? the Hanging Gardens of Babylon? Herds of wildebeest sweeping majestically past?..."
Mrs Richards: "Don't be silly! I expect to be able to see the sea!"
Basil: "You can see the sea, it's over there between the land and the sky."
Mrs Richards: "I'm not satisfied. But I shall stay. But I expect a reduction."
Basil: "Why?! Because Krakatoa's not erupting at the moment ?"