Mirtazapine - Mechanism of Action and Psychopharmacology By Dr. Sanil Rege
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- เผยแพร่เมื่อ 10 มิ.ย. 2024
- In this video, Dr Sanil Rege discusses in detail the mechanism of action and psychopharmacology of Mirtazapine. In addition, he provides insights in the use of Mirtazapine in clinical practice.
This information is not clinical or medical advice. Please discuss your medical needs with your doctor.
Discussion points:
• Mirtazapine belongs to the antidepressant class NaSSA (Noradrenergic and Specific Serotonergic Antidepressant).
• Mirtazapine works through α2 pre-synaptic antagonism and 5HT2A, 5HT2C, 5HT3 and H1 antagonism.
• Alpha 2 antagonism increases serotonin and noradrenaline release.
• Mirtazapine combined use with SNRIs is termed California rocket fuel due to its significant NA and DA increasing properties.
• Mirtazapine recommended dose range.
• Lower doses have a sedating property due to greater anti-histaminic effects, responsible for weight gaining properties.
• Clinical experience with Mirtazapine, managing side effects and principles of prescribing Mirtazapine.
Check out our simplified guide to antidepressants - psychscenehub.com/psychinsigh...
Don’t usually comment but this was an amazing video. Finally someone that explains without explaining every word as if to a child.
Thank you for your feedback
Ive been taking this medication for three years and it has been a lifesaver. I suffered from extreme anxiety, a sense of despair and gloom that no other medication had solved. It has helped enormously. It also helped me with debilitating insomnia. I take 30 mg every night and will likely be on it for the rest of my life. 54 year old male
Thank you for sharing! 🙏🏼
Wait till you start getting the issues! There highly addictive for one and I kept getting seratonin syndrome and nobody could tell me what the issue was!
@@EMPERORSPROTECTION-TERRA4LIFE no issues at all, nothing but benefits. I know about serotonin síndrome and that hasn’t been a problem. You may have taken something else in addition to mirtazapine to trigger that in the first place
@@pauls4923 😂 not at all! Read everybodies relies about the nightmare they are going through because of this addictive drug and how the doctor ignored the basic question to “explain why we need to wean off a non addictive drug?”.
It’s an addictive drug simple as that
@@EMPERORSPROTECTION-TERRA4LIFE it’s a drug that has been a complete and total lifesaver for me and for many others. I don’t care if it’s addictive if it’s going to relieve overwhelming anxiety and depression. Thank God I’ve found it! I’ll be on it til death.
Been on this medication for decades now for sleep. There is nothing else quite like it. I get regular and deep sleep with it and wake up refreshed.
That’s good to know. Thanks for sharing
I was prescribed this medication post army, it was great, then plateaued, the doc recently realised i was still on the 15mg, and now has upped it 45mg and i have to say. my everyday life has become SO much more releif for anxitey, focus, mood and apetite. Thank you for your referenece
That’s good to know!
Thank you for making this video. I’ve recently been prescribed this medication and you explained what the drug itself does, in a way I could understand
so informative! Thank you.
Thanks for these wonderful lectures Dr. Sanil, they are very helpful
Thank you for your feedback 🙏🏼
Great presentation!
You are a very inspiring teacher!!
I only wish there were more professionals and health care experts to your level
Thank you for your feedback 🙏🏼
For someone who is studying for his psychiatry boards, this was immensely helpful in understanding the receptor roles. Thank you.
Thank you for your feedback 🙏
You do know that there’s not any proof whatsoever that a chemical imbalance causes depression ,It’s a theory and a bad one at that before you start your journey into Western psychology via big Pharma read a book called toxic psychology you might even question going into this profession if you have any morals
Your passion for teaching is commendable !
Thank you 🙏🏻
Excelente presentation, thanks!
Thank you for your feedback.
Thank you for sharing your knowledge!! I used this for insomnia and severe postpartum depression years ago with great results. Years later I went back on for insomnia and night sweats during menopause. Again with great results, a good nights sleep is finally with no night sweats. Your explanation gave me a clear picture of how the medicine works which no one ever explained before to me. I am off of it now and no withdrawal issues. Thank you again for sharing.
Thank you for your feedback 🙏🏼
Can I ask how long you were on it and what mg? Thanks 😊
Anna if you dont mind answering, what was your plan for withdrawal and how long were you on Mirtazepine? I am having problems with insomnia and worry about taking an antidepressant just for it, but seriously considering Mirtazepine
I've learnt a lot from this video. Thank you.
Thank you for your feedback 🙏🏼
Thank you so much made it easy to understand
You are simply outstanding helping lay persons understand the complex science of psychiatric drugs. Thank you for your channel
Thank you for your feedback 🙏🏻
Super Awesome, I appreciate it, And learned so much from this short video, keep up the good work.
Thank you for your feedback 🙏🏼
Fantastic explanation, I found this drug ticked every box for sever insomnia except for one main flaw, the next day fatigue and confusion became unbearable after 3 weeks on 15mg, was even starting to slur words , pity as it gave me a great sleep.
Yes it's the antihistaminergic effect for some. Theoretically increasing the dose reduces it but increasing dose is indicated in anxiety / depression. There are other agents that can also address insomnia - we have done a video in insomnia. How to Evaluate and Treat SLEEP PROBLEMS and INSOMNIA? - A Quick Guide | Psychiatrist Explains
th-cam.com/video/Rrdx11rDa9o/w-d-xo.html
Thank you!! Very informative video 💯
Thank you for your feedback 🙏🏼
Excellent presentation. Antidepressants are in general hit and miss, and carry a lot of social stigma. Explanations like this are very helpful to patients and their loved ones. Thank you.
Thank you for your feedback. Really appreciate it 🙏🏼
Chemical imbalance in the brain is a theory for depression there is not one study that shows it causes depression these medication’s are evil if the doctor suggest some of them run don’t walk to find a new doctor
Great video thank u
Thank you for your feedback
Very nice information. You are a great professor sir ❤❤
I love you so much from my heart.
Lots of love from me and my India
Thanks a lot🙏
Finally someone that gone beyond the simple explanation that is an anthi histamine and in that way it help insomnia . Like this doctor explain it , also antagognice 5HT2C , like trazodone but without the QT alteration in the heart rytm like trazodone do. So it is really a good alternative to trazodone for that who cant stay asleep .
Thank you for your feedback. 🙏🏼
You are wrong my friend, on the contrary, it made a change in heart rhythm. Ventricular extrasystole is one of the most obvious side effects of mirtazapine, I experienced it.
❤
thank you!
informative
Thank you, cheers from Yekaterinburg
Thank you for your feedback 🙏🏻
Brilliant explanation as always Sanil..
Thanks you 🙏🏼
Excellent video Sir by the way. Any studies done if mirtazapine lowers cortisol by increase in dopamine?
Finally a clear and comprehensive explanation! Thank you so much for this ❤ is mirtazipine effective in the treatment of OCD alongside therapy?
Not effective for OCD compared to SSRIs / Clomipramine and other augmentor. It may provide benefits for secondary OCD worsening mediated by depression and anxiety
As mirtzapine is a 5HT1 agonist(like triptans), it can be benfecial for migraine prophylaxis too at low doses 🙏
Now I understand why I don't get bad headaches anymore...Thanks for sharing ❤️
Thanks!
Thank you . Really appreciate it
A comprehensive explaination! Thank you for this "quick video"! I wonder how your vids would do on Tik Tok!😁
Is that a recommendation to have tik tok. Not forayed there yet . Too much SM. 😁
Hi found this very helpful. Do you have similar video for citalopram. Benefits, Pharmacodynamics & Pharmacokinetics. Side effects
Thank you for your feedback. I’ve covered mechanisms overall - hoping it’s helpful Psychopharmacology of Selective Serotonin Re-uptake Inhibitors (SSRIs) - Mechanism of Action
th-cam.com/video/bXFbDFPoiXE/w-d-xo.html
Hi, I am starting mirtazipine next week, currently weening off sertraline after taking for 5 years. Can i ask what dose would be best to combat social anxiety and mild depression. My sleep hasnt been an issue. thanks
Thank you for this great video. I do have a question. You mentioned that with higher doses that "mixed states" should be ruled out. Does this only apply to bipolar disorder, or a can a mixed state also refer to anxiety and depression symptoms that are occurring at the same time? Also, what doses would the mixed states caution typically apply to?
Thanks for the feedback and good question. A mixed state indicates a bipolar trait - does not necessarily mean bipolar disorder. It indicates the propensity for activation phenomenon with antidepressants. Anxiety and depression occurring together is not usually what is called a mixed state - but anxiety can be a feature in mixed states. We cover mixed state here in this video where we go into more detail. th-cam.com/video/hVMObsNmnf4/w-d-xo.html
Usually doses of >30 mg but in some even lower doses can ‘activate them’. Hope this helps.
I’m on 30mg mirtazapine there is improvement, but not as much as it should. Do you recommend increasing the dose to 45 mg or should I add brexpiprazole ??
Can we just say that mirtazapine is reversible effect or process to some action of ssri
like sexual dysfunction, emotional blunting.
Usually drugs that make you feel this good come with horrible side effects like severe constipation/urinary retention and movement disorders but mirtazipine has week anticholinergenic effects the worst thing is how dry my mouth feels sometimes but that's not a massive issue for me really this drug is so much better than sertaline
Weight gain and increased appetite are well known side effects. Both me and my sister and a neighbour all piled on the pounds when on it. I came off them a few years ago but have occasionally had one for insomnia when it's been bad 🌼
has anyone gone from mirtazapine to agomelatine? im just about to this and would like to see peoples feed back if they have done this :).. thank you so much for your video too. ive watched both your mirtazapine and agomelatine videos and its helped heaps understand more and stopped my worries about changing from 1 to another. I suffer from huge anxiety and left rehab 3 years ago (after 1.5 years in there) for ice/weed and alcohol addiction. So getting these meds right is crucial to me. Im an aussie so thank you with all your info!! :)
Yes it is a shift than can be done after discussion with the doctor. Agomelatine is now also TGA approved for Generalized anxiety disorder. One important point is that the last 15-7.5 mg of mirtazapine should be done very, very gradually as if done quickly or suddenly can lead to rebound insomnia / agitation. So in practice low dose mirtazapine can be kept for longer while agomelatine is optimised and then attempted to stop. This depends of course on if agomelatine treats insomnia and if insomnia is a feature of anxiety in first place. Ps not medical advice
I will do this thank you so much ❤
What about deprel trazodone. Someone suggested me to after taper the mirtazapine 7.5 if I come on deprel trazodone it will help to come off from it then. I had really bad depression and anxiety and I have been using many different tabs and from last 1 and half year using mirtazapine 30mg and try to wean gradually but when I stopped after 5th night was hell 😢😢😢. I got reversed and again started to take back so now for 2 months I took 30mg and from last week taking 15mg. I hate taking these tabs or any tabs, doctors never help I made appointments for advice etc but nothing. I am not addicted to any drugs etc, my diet is healthy I walk support etc.
If you will reply me back it will be big help ❤
Thanks in Advance
@@motherofprincesses5032 I finally just went cold turkey and took agomelatine straight away (it sucked) took 2 weeks to finally feel okay again and omg im sleep was aweful but agomelatine wasnt strong enough for my anxiety also my sleep sucked even after 2 months of taking it it wasnt like mirtazapine. The problem is im trying to find a med that doesnt numb my feelings because atm yes i feel good with my anxiety but due to this meds (or any meds) my relationship is copping it due to me not feeling as much and the sex life is fucked! Fukn mental health.
Fantastic explanation! I'm on mirtazapine 15 mg for anxiety/depression only 1 week ago! I noticed a little improvement on anxiety but not in my mood. Should I wait a few weeks to see if it helps with mood? If I go up to 30 mg couldni have the risk that my anxiety got worse due to more noradreanline effects?
Thank you for your feedback. Can't give advice here. In general for mood and anxiety - 15-30 mg is needed - higher doses may be needed for depression. The anti histaminergic antagonism generally means that anxiety doesn't arisen - but can happen in some - dose adjustments then needed. Usually waiting 3-4 weeks for response is recommended before increasing dose. This is of course best discussed with your doctor who will individualise treatment for you.
Te fue bien? Tengo miedo de que me siente mal y me cree demasiada adicción, y me rompa las noches
@@javi.r.acosta lo siento. Trata de hablar con su doctor. Buena Suerte
I know 9 months has passed since this post for me this medication helped, although I put on 40kg I was wondering if you have had any symptoms like this. Thanks for sharing
@@deant6361 That's f up 40 kg oh nooooo
I got this for depression and to help me sleep. This makes me sleep perfect get atleast 10 hours but the next day when I'm at work I feel so tired and drained and feel like a zombie I'm only on 15mg
Yes, it has an anti histaminergic activity, which leads to sedation in the morning. Some people experience it more than others. In many cases, as tolerance to antihistaminergic activity increases with more prolonged use ( 3-4 weeks), this side effect should reduce. If it doesn't, and it affects daily activities, best discuss it with your doctor to consider the alternatives. Agomelatine is another agent that helps with sleep and is an antidepressant but does not lead to grogginess as it doesn't have antihistamine activity but instead has melatonin potentiation.
I had severe drowsiness when first taking it on just 7.5 mg. It was so bad that I had to cut it down to 3.75 mg. Now I’m up to 1/3 of a whole 15 mg tablet (5 mg). 😆
I increased from 15 to 30 two weeks ago and for the first time experience this side effect. I feel groggy and sleepy all day but at the same time feel more restlessness, especially in my hands.
Is it true that no doctor or psychiatrist can really prescribe any medication for a person unless a brain scan is performed to know the chemistry of the brain of their patients and not just throwing a medicine out hoping it works for the person? I was just on this medicine at 30 mg and it made me a slug and the night terrors was horrible but I have never been on medicine before and it was to treat my anxiety and depression but I stopped bc I don’t like how it makes me feel
Doctor i was prescribed mirtaz 15 for my insomnia but it dinot work. So steooed upto 30 mg after a week.. At 30 mg iam sleeping well but daytime drowsiness is horrible, i cant function at all
Hi I'm 58 and went on zoloft for panic attacks severe anxiety. I had awful side effects and horrendous withdrawal even tapering. I had a disassociation feeling which scares me to death. 5 months off still getting sweats chills. My gp have me mirtazapine 15mg for sleep and anxiety but .so scared to take because of the experience on zoloft and also prozac.
Should I try this ? I've heard side effects aren't like ssri. I don't want weight gain , can it be kept off with low carb diet and exercise ?
Mirtazapine has better tolerability and can help with sleep and anxiety. Weight gain is a side effect ( doesn't occur in all patients) ; however if it occurs, diet, exercise and additional strategies are treatments for weight gain. There are alternative medication like agomelatine that have similar effects like mirtazapine but no weight gain and no withdrawal. Evidence-based for anxiety and can treat insomnia. P.S not medical advice psychscenehub.com/psychinsights/agomelatine-mechanism-action/
Thank you for the video! I did want to put out a question to you. How similar does this drug potentially treat depression similarly to risperdal if they have any similarities? I was on risperdal for 3 months and it did help me quite a lot for depression but because of the side effects I had to come off and I wondered if this drug is a good alternative to risperidone in terms of treating depression though I am not schizophrenic or psychotic. If your wondering too I was on 0.5 on risperidone.
Risperidone is quite different from Mirtazapine. Risperidone has D2 antagonism and 5HT2A antagonism ( Mirtazapine also has 5HT2A antagonism). Mirtazapine has dose dependent effects as mentioned in the video - so there is a increase in DA & NA with higher doses - with higher doses risperidone reduces dopamine ( DA). Both can be used in depression but for different purposes. Mirtazapine lower doses mainly anti anxiety, higher doses to promote cognition , activity and mood. Risperidone is used in depression to reduce ruminative negative thoughts , agitation or over valued thoughts that are all consuming and negative. So it acts as an augmentation agent.
@@PsychiatrySimplifiedah okay that does make sense. That is probably why risperidone worked so well is because I do get ruminative negative thoughts and thought maybe this anti depressant would potentially do the same with those negative thoughts which have been a huge problem with my depression (my depression is persistent btw)
Thanks for the video starting on 30 mg I hope it works
Best of luck!
I started taking mirtazapine in rehab while I was tapering off methadone, it really helped with sleep. That was 4 years ago, since I started taking it I have put on 40kg. Now I’m stressing about my weight and wanting to get off this medication but I’m scared of any withdrawal symptoms that may have to face. I’m just lost as to what to do ?
There are multiple options here. Have you discussed ethics with your doctor. They will be able to develop a plan specific to your needs. In general options include - ruling out medical causes, reduction of dose , switch to agent that doesn’t lead to weight gain ( withdrawal symptoms can be minimised) and /or augmentation with agents that result in weight loss. Many options available. Wish you well.
While taking another NaSSA (mianserin 10 mg) + sertraline 50 mg in May last year, I developed severe sleep-onset myoclonus which hasn't resolved despite discontinuing both drugs. I'd shake awake the moment I'm about to transition from wakefulness to sleep. Didn't have any sleep problems prior to starting the psych meds.
Is there anything I can do to get rid of the myoclonus? Why does it persist this long? Any advice would be appreciated.
This is not an uncommon side effect. Mirtazapine another NASSA has a 28 % incidence of Restless legs . While we can’t provide specific advice in general - non cessation is usually due to a triggered sleep dysfunction which can be addressed by usually short term long acting clonazepam 1-2 weeks - which is also evidence based on rem sleep behaviour disorder and is usually the choice or clonidine which reduces rem sleep activation and increases deep sleep. However it is essential.l that underlying agitation is treated ( which may require longer duration of agents ) Here is a detailed review I wrote for references if needed. Please note this is not advice and any treatment should involve consideration of the underlying illness and an individualised risk benefit analysis. psychscenehub.com/psychinsights/neurobiology-sleep/
Pls explain clozapine , how to minimise widrawal systoms.🙏
Clozapine treatment is specialised treatment - please discuss with your doctor.
Can i take this with zoloft?
Can you take this medication with Clonazepam? I just got it prescribed to me today 15mg.
Can i take this as needed for sleep?
I've been taking 7.5 mg for 4 weeks and have recently started developing a tolerance to it for my insomnia. What would you suggest as a next step? I'm not sure if 15mg would help as it's been claimed that this dosage has less sedating effects.
It would be inappropriate to provide advice on this forum. There are several aspects to consider when treating insomnia. Your doctor is in the best position to answer this. Please view this video on evaluation of insomnia. th-cam.com/video/Rrdx11rDa9o/w-d-xo.html
Does the increase In dopamine through the two channels mentioned = antidepressant effect at least I think you mentioned two
Yes 5HT2A antagonism and alpha 2 presynaptic antagonism
Worked great except made my cholesterol/triglycerides go way up. Only gained 2-3 pounds on the four months I took it and slept great.
Is it safe to combine with 10 mg citalopram? II cant tolerate ssris well, but low doses are not enough ...
Ps - not medical advice. Mirtazapine can be combined with SSRI. Of course, this should be discussed with the doctor.
Should I be taking this medication for insomnia? I’m not depressed but cannot sleep. Was just prescribed this today.
Please discuss this with your doctor. Insomnia is not a single entity - there are different sleep phases - your doctor will be able to advise
how do i get out of it …needs suggestion
Does mirtizipine treat emotional blunting?
Can this medication can be taken with effexor?
It can treat it and it can be combined - however, this must be discussed with your doctor as it may not be suitable for all individuals. We will be releasing an emotional blunting video this weekend.
Hi Dr Rege , I have a question, does the Mirtazapine 5HT2A antagonism is responsible for increased DA and NE in prefrontal cortex or 5HT2C antagonism- Also activation of which one of them is linked to SSRI emotional blunting , kind regards Samuel Mansour GP , WA Perth
Thanks for the question. Both have effects in DA increase 5HT2 C and A but with Mirtazapine the DA increase also happens via a 5HT1A effect. 5HT2A is linked to emotional blunting. Hence Mirtazapine reducing this.
But 5HT2C is exploited by Agomelatine to reduce emotional blunting. Vortioxetine does it via increase in DA and NA via multimodal mechanisms . Hope this help. If you are a GP interested in detailed education that’s RACGP accredited 👉academy.psychscene.com as it helps with showing these aspects via case studies
@@PsychiatrySimplified thanks a lot
Thank you for providing a wonderful and informative video. I have been taking 3mg of lunesta for a few months for severe chronic insomnia for 3 years sleep hygiene, melatonin do not work.
My Dr says I can try 7.5mg for my insomnia.
Do you think Mirtazapine is better option for long term insomnia than Lunesta?
Just worried about weight gain and next day sedation
Thank you Sir
Lunesta works through GABA pathways. There can be a risk of dependence. Mirtazapine works through anti histaminergic action . Weight gain is a side effect. It also has anti depressant and anti anxiety properties. Newer agents for insomnia include suvorexant and lemborexant - orexin antagonist that are not associated with risk of dependence. In insomnia it is important to rule out other conditions and consider medication that is targeted. Your doctor will be in a better position to choose and explain. Wish you well.
@@PsychiatrySimplified thank you Dr may God Bless you
Hi i was prescribed by my doctor due to my bad insomnia 3mths now.. And along with that i also given lorazepam but only needed.Is mirtazipine stay longer in our body and does it addicted? Or make our eyes dry
Mirtazapine is not addictive. If there are side effects please discuss this with the prescriber as there are so many aspects to consider
Excellent video, thank you Doctor! I got this for depression, I don't have problem to sleep. This makes me sleep too much and a I feel tired during the day. I'm on 15mg and today is only my third day. Is this side effect gradually disappearing?
At low doses Mirtazapine has antihistaminergic effects and therefore can be sedating. This effect can reduce over time ( 1 wk) , or by increasing the dose where it be one’s more activating ( 45 or 60) . In some though this effect can worsen with increased doses. Your doctor should be able to explain the reasons for the choice and what to expect. Wish you well.
@@PsychiatrySimplified thanks for your prompt reply! :)
@@PsychiatrySimplifieddoes the drug still work for insomnia and increased slow wave sleep once the antihistamine receptors down regulate?
can mirtazapine at 15mg-30mg be used in conjunction with lithium and valprorate for bipolar disorder?
If indicated for treatment of depression as part of bipolar depression. Generally antidepressants are not indicated as along term treatment as it can lead to cycling. Mirtazapine at low doses is used for sedation. But it depends - should be a question for the psychiatrist.
would eating high histamine foods reverse the weight gain effect of Mirtazepine? I took Agomelatine that blocks 2c and didn't notice any weight gain or excess appetite so must be the antihistamines part that does it. I also had no activation/mixed symptoms unlike on ssri on that but equally no antidepressant effect after 10 wks. Why might that be? Am able to sleep okish and dr is only suggesting Mirtazapine for its 2a blocking effect for depression and anxiety(I had akathisia from Latuda so AP are out. Withdrawal of Abilify caused akathisia too years ago by different dr). I don't tolerate ssri, they cause anxiety/mixedness/akathisis not really sure what it is??!! There is bipolar in family and its well treated by VA+LAM+Prozac combo. My dr doesn't seem to understand mixedness can occur without being bipolar 1/2 yet the same bipolar meds are still used to treat it. She refuses to use mood stabilisers in me as saying its not bipolar. LAM with ssri did not stop mixedness and I want to try VA but she won't. She says my family member is likely being treated for a personality disorder rather than bipolar on that combo so I don't need those types of meds!! I have another psychiatrist lined up for a second opinion and will take your mixed features MDD info with me. This is all so frustrating....
I'm sorry to hear. Agomelatine is evidence based in bipolar depression and does not activate as it does not increase DA.or NA in the mesolimbic system which where the mixed features ( irritability ,Racing thoughts, hostility, anger dyscontrol etc occur). It does not have anti histaminergic action so no weight gain. eating foods with histamine does not reverse weight gain. In terms of antidepressant effect it is important to recognize that depression consists of 3 domains. Activity, cognition and emotion ( low mood and sadness - which is different from emotional lability - difficulty controlling emotions ( more related to mesolimbic). So when one wants an ‘antidepressant effect - the question is what specific symptoms are being targeted. Amotivation slowed movement ( activity dimensions - linked to dopamine and NA); cognition ( attention and concentration, decision making ) - linked to dopamine in the frontal lobe; cognition -Thoughts) - guilt, hopelessness, etc. - PFC - amygdala ( so here, one has to look at both intensity and severity as both frontal lobe and mesolimbic system to be addressed). Agomelatine is a mild dopaminergic agent. There is hierarchy.of dopaminergic and Norsdrenergic agents. Similarly - sleep - ruminations before sleep - frontal - limbic ; racing thoughts - mesolimbic ; waking up multiple times - hyper arousal ( NA driven) / nightmares - NA driven ; early morning waking ( mesolimbic). So essentially the symptoms provide better info to choose meds rather than a diagnosis which is a label that does not take into account individual symptoms. Importantly the fronto limbic system is also involved in trauma. In adhd also fronto-striato ( read movement area) - limbic - in females however the presentation can be with mood deregulation as the frontal lobe top down inhibition is not present adequately on the limbic system - hence can present like mixed states. Overall a history and formulation based on Sx provides a management plan
This is educational only and not medical advice.
I have severe and intense panic attacks. What dosage of mirtazapine would you recommend? My doctor recommended 15mg
We can’t recommend or provide advice. In general Mirtazapine doses for anxiety are between 15-30 mg nocte. Wish you well
I have recently tried 15mg, 30mg and now springing for 45mg. I heard that 45mg can reduce sedation and drowsiness. I did not know that this could be a combined with stimulants. I have ADD and so I have been prescribed stimulants in the past but they would trigger my anxiety too much and would have to stop. I am now wondering what is the optimal dose for me. If I could combine the two drugs together with a stimulants then maybe I could take lower doses and be able to manage the drowsiness that usually occurs next day.
You may want to look at the video on clonidine ad guanfacine which are used in combination with stimulants to manage or reduce anxiety. Ps not medical advice
th-cam.com/video/TioM9NymZXc/w-d-xo.html
Seratonin syndrome is a common thing with this drug especially if you mix with other drugs
Dear Dr,
I was prescribed 15mg of Remeron Soltab around August 2021. I have been taking it daily up till end of October 2021. Due to personal distress, I went cold turkey and stopped taking my prescription for the entire month of November 2021. However Ive decided to recontinue my course of medication in December 2021. As at 29/12/2021 today, I feel like my depression has taken a downfall and a sense of doom and hopelessness lingers on a daily basis. May I know if the Mirtazapine is still effective even tho I have skipped for a month? Is the medication readjusting itself thus I'm having the side effects as when I started the course in August? Your expert view is greatly appreciated.
Sorry but this is really difficult to answer without an assessment. Please speak to a doctor who can assess your situation. Antidepressants do not lose efficacy if stopped and restarted ; but the dose of medication needs to be adjusted according to the severity of the depressaion. Your doctor will assess and prescribe an appropriate dose. We wish you well.
I am talking 30mg of Mirtazapine for 9 months now. Do you have any experience with tapering off while fasting? Fasting could help for faster balancing of the neuro chemicals and easing of withdrawal symptoms. What do you think about that?
From an evidence based perspective this is not something that has been recommended.
Is it possible for mirtazapine to cause or exacerbate autonomic dysfunction (pots syndrome)?
No direct evidence - but if activation occurs - it is a possibility.
I ask one question i am depressed about my slept when i am sleeping my bed is smelling not good when i wake up in the morning peoples are separating for me i cant continue my life smoothing
Because of this reason even icant sleep very well because i have stress can mirtazapine minimizw my bad smell on my bed please help ne doctor
Mirtazapine helped me who ever created this medication I wanna say Thank You❤️
Good to hear .
I have a question - why exactly does it cause weight gain? Thank you.
Antihistaminergic action. Possibly 5HT2C antagonism also associated with increased appetite.
Thank you for your videos; you are a gifted educator. I was suffering from sleep issues and severe anxiety and 8 months ago was prescribed Mirtazapine. I am very sensitive and had a range of physical ( deep fatigue at lower doses, jumpiness / heart palpitations at higher doses) and mental side effects (flashing kaleidoscope like dreams) as I went from 15mg up to 30mg. Sleep improved somewhat, and physical effects of anxiety such as adrenaline rushes and panic subsided, however unfortunately my cognitive anxiety has increased dramatically with obsessive fear, heightened apprehension about everything to where I am now incredibly psychologically fragile. I have been offered other medication to try, such as pregabalin, but am apprehensive about adding another possibly addictive medication to solve anxiety which may have been amplified by the Mirtazapine. On two days where I forgot to take the Mirtazpine, I have noted that I am a lot calmer, and this has me thinking that Mirtazapine might be the cause of my current heightened anxiety. I have casually asked the doctors about how to come off Mirtazapine, and they have mentioned that in their experience people can just stop taking it with little withdrawal symptoms - they seem unaware of any tapering schedules. Perhaps it is my anxiety speaking but I am concerned with withdrawal effects, as well as side effects at the different dosages noting that at the lower the dose the greater the sedation and fatigue (and less adrenaline effects) - and hence also how to transition to normal sleeping (if the lower dose is more sleep inducing) but at the same time, willing to stop the drug as soon as possible if it is causing issues. I wonder if you might be able to kindly recommend some common / sensible tapering schedules for this as well as any other ideas that I can discuss with my doctor. Many thanks in advance!
While we can’t give individual advice : in general if one is experiencing SE from a medication reduction and cessation will ease or stop the side effects. So Mirtazapine can be reduced to 15 mg for 4 days and then to 7.5 mg . It is this 7.5 mg cessation that can give an antihistaminergic rebound. For some patients they may need to be on this for a week or two before ceasing ; for others shorter or longer . One can only now by trying. During this period of cessation the doctor can prescribe another agent to treat the insomnia. This is general only and not medical advice. In general the shorter one has been on Mirtazapine the ‘easier’ it is to come off. However it is also important to identify the condition being treated - for mixed features ( video done) can be associated with worsening with antidepressants and presents with anxiety , hyperarousal , agitation. We also have a video on insomnia on the channel. Ps not medical advice. General only. Wish you well
Hi there again, Thank you so much for your very kind and informative reply ❤! Apologies for this but I wonder if you could please kindly clarify what you meant by “....worsening with antidepressants and presents with anxiety, hyperarousal and agitation”. Does that mean that Mirtazpine can cause such a response (anxiety, hyperarousal, agitation)? Thanks again 🙏♥
@@lcy_123 Antidepressant treatment is meant to improve activity, cognition and mood (experience of reward) without activating anxiety, or arousal in an ideal situation. When antidepressants worsen anxiety and increase arousal (restlessness, racing thoughts), this can be due to a mixed state (which is important to rule out) as ADs worsen mixed states. Your doctor will be able to discuss this more. We have a video on this. Search for mixed features.Any antidepressant can do this.
@@PsychiatrySimplified Thanks once again for your kind and informative reply🙏
I've been on mirtazapine 45mg for roughly 8 months have been on votiixetine for five weeks had some bad side effects so tapering of that now started sertraline 50mg today how long will it take to feel benafit from the sertraline
Depends on what were side effects ? Usually combination of Mirtazapine 45 mg and Vortioxetine increases DA and NA , if underlying hyperarousal is present then this can be worsened. Therefore a history of what has improved and what has worsened helps understand what the next steps are. It’s a balance between calming hyperarousal and I improving cognition and activity . So it’s not possible to predict for an individual unless a detailed history of symptoms is taken . Your doctor should be able to explain the duration of response . Wish you well . Ps not medical advice
My psychiatrist said that he didn't think mirtazapine would have any more positive effect for depression or anxiety above 45mg, based on the studies he's seen. He also said at had to do with something being completely saturated. He has only ever had one patient on 60mg and he said it didn't help with the depression any more than the 45mg and it just Made him really hungry. In your clinical experience have you found doses of 45mg plus effective in different mental illnesses for people, if so what mental illness.
As mentioned in the video 45 mg and in some cases higher doses of 60 mg are needed for the dopaminergic effects. This may be the case in patients that have ultra rapid metabolism or rapid metabolism of the CYP enzymes that metabolise mirtazapine. Clinically 60 mg is used and in some rare cases 90 mg are seen in practice ( this is not recommended) as max doses are 45 or 60 mg depending on countries.
Also when thinking about doses it becomes more important to identify whvj symptoms are being targeted. If anhedonia and motivation is an issue then dopaminergic and NE enhancers are needed. Since mirtzapine is induced by 3 cyp enzymes - many patients being rapid metabolisers or smokers may need higher doses. A fixed dose of 30-45 mg in some patients may result in a sub therapeutic effect. psychscenehub.com/psychinsights/pharmacogenomics-drug-prescribing-psychiatry/
@@PsychiatrySimplified thanks for the reply really appreciate it also if your smoking and need you more what about vaping?????
@@jaydavis1673 unlikely to do so as no poly aromatic hydrocarbons. But change from smoking to vaping could change drug concentrations as.smoking induction has stopped.
Can mirtazapine cause problems to heart? I heard that is contributes to cholesterol level to go up as well sodium and potassium levels. Thank you
It is generally medication that does not affect the heart. It can result in weight again which can affect cholesterol levels. It does not affect sodium and K levels: in the elderly > 65 yrs there is a small probability of a drop in Na levels.
Interesting comment as my cholesterol level is up and so is my weight gain.
@@youknowcrimedontpay9257 this can be counteracted or an alternative metabolically friendly antidepressant can be considered. Your doctor will be able to advise.
First dose for sleep . Really ha e to look into sleep hrs and misreport happens .from parents too
Hey doc, great video. Question, I will ask psychiatrist. I take guanfacine 3mg for ADHD and Remeron 7.5mg for sleep. They work great. However is the alpha 2 effect canceling out the Intuniv? From my understanding.. At 7.5mg, probably not.. Too low of a dose for that effect. But I am not a doc. Thanks!!!
Thanks for the feedback. No it won’t. Mirtazapine is alpha-2 presynaptic anatagonist at higher doses ( increase NA and DA with potentiation on adrenergic and dopaminergic receptors . Guanfacine is more postsynaptic alpha 2 ( see video on Guanfacine - potentiates action on adrenergic receptors. So both will do the same potentiate. It’s because one is presynaptic other is postsynaptic. Presyanaptic receptors are autoreceptors ( inhibition) - so antagonism has opposite effect.
@@PsychiatrySimplified wow, that is brilliant. Thank you! I am a bit of a nerd (electronics engineer) but not in biochemistry or medicine, so it's all new to me. That pre/post explanation clears up a LOT of confusion. My experience so far is that they definitely do seem to work well together, at least with respect to 'turning down' the peripheral nervous system a bit it seems. I do also take Adderall. The guanfacine has virtually eliminated side-effects of the amphetamine, and really the only reason I'm on mirtazapine is sleep assistance. I really do feel like this is the first time in maybe 30 years in which I am on a drug combination that seems to be working. I have no side-effects. Guanfacine is a pretty interesting drug. I will check out the videos. Thanks again.
@@lisweetie1556 good to know that it’s working for you. Good luck and wish you well. Thanks for sharing.
@@PsychiatrySimplified thank you very much. I have subscribed to the channel. One thing that I think is interesting to note, simply because I've never seen it ever mentioned, is that the guanfacine also fixed my Raynaud's and acrocyanosis, something that I've had my entire life (before Adderall, too). The color of my skin would concern me, and I saw a vascular surgeon, who said, not to worry it is just a cosmetic condition (benign). He said it is from "sensitive nerves", which sounded like an over simplification lol. I didn't think much of it. But years later, when I added the guanfacine to my ADHD treatment, I noticed within just a few days that for the first time in my entire life, my skin was normal color, not red or dusky blue. It is still normal color. It would seem to me that the guanfacine must be doing something to help modulate/moderate the signaling in that system. Anyway I just thought I'd share that, because it was so profound. Thanks again.
@@lisweetie1556 you raise a very good point. Yes clonidine or Guanfacine both are treatments for this. Dexamphetamine or Ritalin are both associated with Raynauds or worsening of it. Because they act on alpha adrenergic receptors associated with vasoconstriction and increase in peripheral vascular resistance - also increase BP due to this effect. Clonidine and Guanfacine both treat this. It is a side effect that can be overlooked but many complain of this. I always mention this in teaching. Thanks for sharing
Any video on quetiapine?
Please view this video on antipsychotics as a whole - th-cam.com/video/3vLSMZObXqE/w-d-xo.htmlsi=9H4WCT0tejouIRW4
wonderful explanation. I was prescribed 7.5 mg for sleep, to switch from benzos that l was using for over a week. It worked great but after about 7 days l stopped cold turkey because l did not understand that there is a withdrawal (my GP told me antidepressants are much lighter and cause no addiction) and l thought l was cured - l felt good, slept well and thought - allright, time to switch to naturals. Keep in mind that l never used any medicine before and had issues. 4th day after stopping, l plunged into severe withdrawal - insomnia, crying, doomlike feeling, completely out of whack, walking around with a massive pressure in my chest and unease. I was pretty surprised and googled it - figured it is discontinuation. My GP said no way, you have been less than 2 weeks on it. Okay, so l went a month without this med and this has been a TERRIBLE month. I resolved to benzo (sleeping pill or anti-anxiety) here and there to get at least some hours of sleep. After a month, l tested the hypothesis of differentiating withdrawal and rebound symptoms. So l took only a 2mg Mirtazapine before sleep. Slept 7 blissful hrs. Woke up without anxiety. Took the next day - even though l haven't slept well due to some worries , l was still absolutely normal and fine the next day - no crying, no doom, no sadness, no massive pressure in the chest. The next day, fine as well. Actually first time l felt normal. Now, how can a dose of 2-3 mg restore my normal emotional state if it is not withdrawal? So, to test it further, l discontinued after these 2 days and exactly 48 hrs later, l plunged into severe insomnia and 'woke up' with a massive chest pain and unease. Also crying. So, now l can't decide if l should reinstate and taper down slowly (my GP will think l am a hypochondriac) or just cruelly not take anything and persevere another month to see if l will be clean of withdrawal. I am asking this because l took Mirtazapine less than 2 weeks incrementally so l have a feeling that my withdrawal shouldn't be severe.
lenghty, l mean. it is pretty hard to continue like this - oh and my tinnitus aggravated during withdrawal
Thank you for sharing. There is one aspect to consider. The original reason. The causality works in the following way. Insomnia present ➡️medication prescribed ( gaba initially) ➡️ stopped ➡️ mild withdrawal gaba ➕original insomnia ➡️insomnia severity ⬆️ ( gaba not addressed by Mirtazapine )
Step 2. Mirtazapine prescribed after swap( anti H1) ➡️ insomnia treated
Step 3 ➡️ Mirtazapine ceased ➡️ insomnia pre step 2 likely more in severity due to course and mild gaba withdrawal ➕antihistaminergic rebound ➡️ significant increase in severity ⬆️ ➡️ 2-3 mg addresing antihistaminergic rebound .
But the severity of the insomnia is the missing piece. This is a common scenario where associations are made between medication and what comes after . But the original condition usually increases in severity ( insomnia usually does) over time which when combined with rebound or discontinuation phenomenon leads to a significant increase .
The above is not set in stone and cannot be individualised to your personal situation. Also it is an hypothesis in general based on clinical presentations . Ps not medical advice.
I wish there was an alternative for sleep. This is nearly perfect for me however the food cravings make it tough.
There are many different options for sleep. Please check the video we did on Insomnia. th-cam.com/video/Rrdx11rDa9o/w-d-xo.html
Try exercise mirtazapine is garbage
your thoughts on combining with wellbutrin
Mirtazapine can be combined with Bupropion under psychiatric supervision for treatment of difficult to treat depression.
I use wellbutrin 150 for almost a month now. Remeron on and off for sleep. Is there better combinations?
If someone is already taking an SSRI at therapeutic levels (escitalopram), would adding a low dose of Mirtazapine, say 7.5mg, augment the AD effect? Or would you still need to use at least 15mg to see any anxiolytic/antidepressant effects?
Addition of mirtazapine at any dose is an augmentation strategy. the dose of mirtazapine will need to be adjusted to 'augment' the desired effect -e.g low doses - sedation / mild anti anxiety. 15 mg -30 mg - antianxiety / mild anti depressive etc. This is in general though ; different individuals may react differently.
@@PsychiatrySimplified Got it got it. In this case I'm wondering whether it would directly augment the anti-depressant effect.
A different way to put it would be whether or not Escitalopram would potentiate the Mirtazapine so that lower doses would be more effective?
@@Plink451 not necessarily as the mechanism of two agents is different. One possibility is that mirtazapine sedative effect can help in insomnia and hence can improve depression at low doses - 7.5 mg. But for symptoms such as a motivation, decreased pleasure, cognitive deficits ( poor attention/ conc/ decision making) higher doses are usually required. So it depends on the symptoms that are residual and being targeted.
@@PsychiatrySimplified Makes complete sense! Thanks so much. I have one more question, sorry!
So for a patient with ADHD on methylphenidate and an SSRI, theoretically a low dose of Mirtazapine could aid in reducing the crash anxiety and improve sleep hence improving depressive symptoms? I've tried low dose amitryptyline and it was not effective at all.
@@Plink451 for a patient with ADHD sleep disturbances are usually mediated through alternative pathways. Please have a listen to the ADHD lectures we did. Mirtazapine could help but both amitryptiline and mirtazapine have antihistaminergic effects leading to sedation. In ADHD agents such as clonidine which reduce arousal associated with ADHD can help anxiety and sleep ( we have done a video on clonidine on this channel th-cam.com/video/TioM9NymZXc/w-d-xo.html) ; milder ones include melatonin. It's a difficult question to answer on a forum. The important aspect us to identify the nature of sleep disturbance - early, middle or late and if it is due to depression, anxiety or due to the circadian rhythm dysfunction associated with ADHD. Hope this helps. P.S not advice
I'm now in a process of withdrawal from Mirtazapine and it's terrbile. After 48h from the last dose the insomnia is back, i sleep 2-3 a night also feel very edgy and agitated 😢. However I feel less fatigued now than when I took the drug. I just hate how Mirtazapine makes you feel drowsy and fatigued all the time.
Sorry to hear. Mirtazapine reduction should be done gradually (mainly the last dose) as the last dose ceasing can lead to a antihistaminergic rebound. This rebound insomnia can be managed with other options which can be discussed with the doctor. However, it's important not to leave the severe insomnia untreated. Wish you well.
@@PsychiatrySimplified Thanks for the answer. At this stage I'm considering psychotherapy.
Another thing that is I get very itchy skin rash in random places all over my body that comes and goes . It started when I quit Mirtazapine and gradually it's getting worse to the point my fingers are so swollen I can't grab any item. I already have a visit with my GP to try to fix the damn rash. It drives me nuts especially in the evenings.
Is there any way to combat the weight gain? Can or will it still happen if you eat mostly healthy and lift 2 to 3 times per week? May have to add this to my snri and the weight gain, the unhealthy kind is my concern. Excellent video
If looking at augmentation to an SSRI with options without weight gain - these include Agomelatine and bupropion which would provide the same rationale without the weight gain. We have done a video on Agomelatine. Thanks for the feedback 🙏🏻
@@PsychiatrySimplified I will look into that, thank you for the quick reply!
@@PsychiatrySimplified damn looks like you can’t get agomelatine in the US
@@kevinherron6051 wish you well. How is Agomelatine different from other Antidepressants? | A Psychiatrist Explains | Dr Rege
th-cam.com/video/bInN0nt4S2Y/w-d-xo.html
@@kevinherron6051 bupropion is an augmentation option.
Hi Dr. Rege,
If a patient has taken mirtazapine long term (6 years or more) and they begin to not feel the sedated effects of the mirtazapine as strongly as they once did during the first year of taking mirtazapine, have the h1 receptors been completely desensitized?
Yes the histamine receptors tend to downregulate reducing the sedation. In some this may not happen to the extent they want leading to residual day time sedation. But overall they tend to ddownregulate. This is also the reason why sudden cessation is not receommded due to rebound up regulation - histaminergic rebound.
Thanks Sanil! Is down regulation reversible with abstinence of the medication? If so can h1 receptors completely re-sensitize to their original state prior to the usage of the medication?
@@jamescullen-657 Yes. They can.
@@PsychiatrySimplifieddo the serotonin receptors that Mirtazapine block upregulate during long term treatment?
Dr if no sedating at all at 7.5mg what would be the odds of increasing to 10mg
The issue is that benzodiazepine withdrawal itself may be playing a part as mirtazapine, although helps insomnia is not a substitute for benzodiazepines which act via GABA. In contrast, mirtazapine helps insomnia through anti histaminergic action.
Hello, Doctor!
I was prescribed Mirtazapine (15 mg) specifically for chronic nausea, vomiting, loss of appetite and weight loss.
Had excellent results for all of those symptoms; my appetite is back, I haven't vomited since and I'm finally able to enjoy my meals again.
But I'm having trouble with excessive drowsiness during the day, even with + 8 hours of sleep. Sleep was never a problem for me before taking the medication. Could increasing the dose to 30 mg or 45 mg counteract the drowsiness without losing the antiemetic and appetite-stimulating effects?
Thank you so much!
This specific question is best answered by your doctor. In general however, if sedation is there but symptoms have settled - reduction of dose is one option. If symptoms return then a trial of increase may be considered.( here 30 mg can be significantly sedsting as well; 45 mg is meant to increase NA and DA to counteract sedation but this doesn't always happen) . Hence the steps above. Wish you well.
@@PsychiatrySimplified Thank you so much for your answer!
When you try and come off them you will regret ever taking them
@@EMPERORSPROTECTION-TERRA4LIFE I've taken Mirtazapine for literally 15 years - no exaggeration. 14 days ago I split my dose in half. 7 days ago I stopped completely. THE MOST severe effect I could report on is marginally less heavy sleeping/sedation and marginally less appetite. Anti Depressant witch hunt nutters are the absolute worst, most confounding, saddest life wasters I've ever seen on the internet.
@@goldmidwest ok so people who get wothdrawals are you saying they are lying?
30mg at night and next day I’m hyper and I’m on 25-50mg seroquel as needed throughout the day for anxiety
As the mirtazapine dose increases, the noradrenergic effect increases, which can be associated with the activation phenomenon. This usually occurs at 45-60 mg - and hence higher doses are used to treat anhedonia and psychomotor slowing.
A friend of mine has bad panic disorder. SSRI helps him but can't go on too high of a dose without having apathy issues. He's taking 15mg of Remeron as well... would increasing remeron have a potential positive effect on panic attacks without causing apathy issues? Why do SSRI's cause apathy syndrome at high dosages?
It's difficult to answer specifically as there are many aspects to consider. In general both SSRIs and mirtazapine are helpful in panic attacks. SSRIs lead to emotional blunting as they inhibit dopamine / NA in the frontal lobe, anterior congulate cortex. It is linked to sexual dysfunction as a side effect. Mirtazapine is not associated with emotional blunting / vortioxetine and agomelatine also are agents that are not associated with emotional blunting. We covered agomelatine in another video recently.
@@PsychiatrySimplified Thank you! Is Mirtazipine dosage above 15mg generally more helpful for panic, even with the norepinephrine/slight dopamine increase? My friend responds to ssri + low dose remeron very well but continues to struggle with panic.. stuck at a specific ssri dosage to prevent apathy. Perhaps this friend should consider asking their doctor about increased remeron? Additionally, do higher dosages dampen the night time histamine sedation (e.g. my friend uses for insomnia as well)? I understand not medical advice but questions to relay back to their doctor. Thank you for excellent content.
@@nodnarbalak1531 Mirtazapine 30 mg does not lead to as much NA and DA as > 30 mg does. Theoretically, as mirtazapine increases - antihistamine sedation is counteracted by the NA and DaA but this is not always the case and many individuals experience increasing sedation; others may experience improvement in depression and anxiety. It is really different for different individuals as there are so many variables at play.
@@PsychiatrySimplifiedthese side effects of blunting, sexual, nausea etc.. are they all because these receptors don't down regulate in some of us with ssri use? And is this why Mirtazapine augments to solve this? So what is the point of an ssri alongside Mirt then? for other serotonin receptors good for mood? Is 5ht1a the major anti-depressant/activating part of SSRIs? And does it down regulate, losing the benefit for energy eventually though like 2a c 3 7 etc...? is that the apathy after chronically taking ssri?
THANK YOU SO MUCH
Doctor, I have problem waking up at early morning at 2:30am every day. i go to bed at 10pm and wake up at 2:30 am always, is it ok to take tab mirtaz 7.5 mg middle of my sleep at 2:30am so that I coul 0:13 d go back to sleep after 2:30am. Kindly advice me. Thank you 🙏
We can't provide advice here. Early morning awakening needs an evaluation to rule out agitation etc ; please discuss this with your doctor. Wish you well
Does Quetiapine hit the same receptors? My psychiatrist prescribed it to help with my mirtazapine withdrawal taper im scared to take incase I kindle my nervous system more.
Antihistaminergic withdrawal is the main issue with Mirtazapine. Quetiapine is a valid strategy that can help with tapering as it has antihistaminergic properties and allows for smaller dose reductions this assisting with any withdrawal symptoms
@@PsychiatrySimplified thank you im down to 3mg from 7.5 over 2 years im hypersensitive. Anxiety bad even with little drops. She said I can take as needed. Thanks for replying!
@@scotscub76 hope things go well. Good luck!
It is however really important to differentiate between withdrawal and return of anxiety as the original illness if that was something that was being treated .
@@PsychiatrySimplified I took it for sleep. And subsequently gained 3 stone!
Is it possible that this medication can suppress or mask symptoms of suppressed or long term H. Pylori in regards to its effect of reducing gastric acid secretion and pepsin secretion?
Mask Symptoms it’s possible due to anti H1 and 5HT3 antagonism reducing GI effects.
@@PsychiatrySimplified so this could have a knock on effect on the efficacy and or behaviour of medications, example methylphenidates? SSRI's, in regards to absorbion, or hydrolysis?
@@joshuafuryon7874 No not in that sense.. Generally does not impact it to that extent like say a PPI would for some meds.
thank you :)@@PsychiatrySimplified
Does the side effect when on over 30mg ease off like the side effects on the lower doses do? side effect being sleep disturbance caused maybe due to more activation on residual 5ht2a not sufficiently blocked by Mirtazapine. It is dosed in the morning only.
Also, the high dose effect of raising pfc dopamine, is that dependent on a down regulatory process before that is felt or is it immediate due to the block of ht 2a and c of the drug?
1. The side effects of sedation and or weight gain do not always ease off. (esp weight gain) . 2. The effects of PFC increased NA and DA are seen in 1-2 weeks.
@@PsychiatrySimplified Thank you for your reply. Does the sleep disturbance side effect at 30mg Mirtazapine eventually go away? lowering the dose is not an option due to side effect of irritability in patient with no PFC improvement signs at the lower dose either.
No does not go away in all. It depends in the nature if sleep disturbance. Mirtazapine is known to be associated with restless legs for example. Similarly it can worsen rem sleep. In such scenarios the doctor may based on the nature of sleep dysfunction consider targeting the specific abnormality through a different approach
@@PsychiatrySimplified thank you
Helo doct, I have been suffering from panic attacks with mild depression for almost a year now, the psychiatrist gave me zoloft but in the first week I had severe insomnia I got worse! And I stopped it now I just fight it with exercise and I try to be in a good mood but I would like to ask why mirtazapine if you can answer me Can it help me?
It is difficult to give personal advise on here. A full assessment should be carried out before any advice. Mirtazapine has a sedative effect and is effective for depression and anxiety. However mixed features should be ruled out. Please have a look at the video on mixed features. You can discuss this more with your doctor. Wish you well.
@@PsychiatrySimplified thanks doct! And One more question, does it create a sexual problem?
@@MySasis mirtazapine is amongst the antidepressants with lower risk of SD. It is in fact one of the prescribed agents to avoid SD. psychscenehub.com/psychinsights/sexual-dysfunction-with-antidepressants/
Where can I download of copy of those images, they are very informative.
Thank you for your feedback. Sorry, they are not available for download.
I have been prescribed Mirtazapine 30 mg along with Agomelatine 25 mg. When I took them at the evening the next morning's experience was overwhelming. Then I took 7.5 mg mirtazapine and 25 mg agomelatine. This time also, I tend to dizziness. What should I do. I have been sleep disturbance for the last 6/7 years.
I am married but so far didn't enjoy the pleasure of intercourse.
Sorry to hear. It is difficult to answer this or provide individualised advice. Please discuss this in detail with your doctor. In general when SE's such as activation occur mixed states need to be ruled out. this is only one aspect. A detailed evaluation is needed to identify the causes of insomnia th-cam.com/video/hVMObsNmnf4/w-d-xo.html
Dr Sanil,
How is mirtazapine induced akathisia different from antipsychotic induced akathisia?
Mirtazapine typically does not lead to akathisia - it’s also a treatment for akathisia . Akathisia has a strict definition of a subjective compulsion to move. Mirtazapine can lead to activation phenomenon - and at higher doses can potentially also lead to akathisia. Usually 5HT2A activation leads to akathisia ( Mirtazapine is an antagonist) . One key mechanism is the NAc ( nucleus accumbens shell part being activated through noradrenergic dysfunction ) Antipsychotic induced akathisia is multiple mechanisms How to Diagnose and Treat Akathisia (Antipsychotic Side Effect) - A Consultant Psychiatrist Explains
th-cam.com/video/GBSTgSaLUsg/w-d-xo.html
Noreandrenergic dysfunction meaning an increase in norepinephrine? Would an alpha blocker be a suitable treatment. If one is already in an hypaepsusd state, would mirtazapine exacerbate they hyperaoused state even further ? Is there evidence of over stimulation of the locus coeruleus in akathisia?
@@jamescullen-657 Have a view of the video on akathisia. It's difficult to give yes, or no answers as symptoms have to be put in context of overall presentation.
Thanks for the reply Sanil. So it sounds like mirtazapine can cause restlessness due to activation of norepinephrine and dopamine? Can restlessness look similar to akathisia?
@@jamescullen-657 Yes absolutely it can
Some people feel better reducing their serotonergic activity if their epigenetics express too little SERT