What is the long term effect of mirtazapine?

[deadendgame]

I quit everything else. I just can't quit remeron because I need it for sleep. Is there any long term effects I should know about?

 

[serotonin2A]

It can cause a discontinuation syndrome. If you decide to stop taking it and you find that difficult, then you should taper slowly.

 

[Solipsis]

Mirtazapine is relatively safe and not really associated with serious long term effects, but some types of side-effect may perhaps become an issue after a while (though other side-effects are more typical to get only in the beginning). The main side effect that made me fed up with it was akathisia.

Taking meds is a tradeoff: you stay on them when you gain more from it than you lose. I don't think withdrawal / dependency is really a good reason to stay on a drug indefinitely. It seems more realistic to explore solutions for insomnia if it actually persists after you taper, than to keep using it the rest of your life - or taking it a long time and having to get off it just the same. Maybe there are other antihistamines you could substitute that have more selective effect, if other insomnia remedies don't help?

But I'm not trying to decide for you what your tradeoff is with taking the drug, possibly if you have very persistent insomnia that can't be treated by looking at the root cause of the insomnia, mirtazapine still has the most worthwhile tradeoff, sometimes your drug can turn out to be the last resort after exploring other options... My point is rather that it seems wise to explore your options instead of admitting defeat to dependency. Although in all fairness "quitting everything else" definitely sounds like you are making good progress. good luck -

 

[deadendgame]

I do gain more than what I lose. What I gain is a peaceful night of sleep every time. it is only when i try to quit this shit is when I start feeling the hurt

 

[deadendgame]

I don't want to carry around the secret that I cannot sleep without medication

 

[feedtheSoul]

i have tried taking it for sleep every night and it helped my mood but it made me too groggy. try taking every other night if your doctor is ok with it. i have managed to get down to two or three nights a week, and my sleep is gradually balancing itsself

 

[cr33py]

for sleep its given at a lower dosage that doesnt affect much but histamine. Youre probably needing something sedating to sleep. hydroxyzine gets a bit of use for that. As do some of the bp meds like prazosin and clonidine.

 

[palmanita]

Yeah, it's just about the H1 histamine antagonism that helps to sleep (mirtazapine acts also as a a1 antagonist in higher dosages, the opposite of clonidine, which isn't exactly what one wants with a sleep aid). Also it's so super potent at H1 that, without pre-existing tolerance and/or severe insomnia, 1mg of mirtazapine can be enough!

The same with quetiapine. Depending on how you react to (a tiny bit of) dopamine antagonism, it could be a better because shorter-acting choice at 25mg.

I do absolutely like clonidine as a sleep aid and anti-stress medication because it doesn't touch dopamine or other systems it shouldn't mess with. It doesn't make you hungry or clot the nose like quetiapine is prone to. As a plus, clonidine is helpful against nightmares (less noradrenaline means less stress, even when dreaming)
Just the dosage is very important here, a bit too much and you might end up lethargic but when you got to know it, it's very controllable. And the tablets (there's just one brand if I'm right and maybe some generics, those from India are exactly the same tablets as what I got here from the pharmacy) can be used sublingually, it's such a tiny amount of chemical that you can't taste it. To start I'd take 75 mcg, for use during the day 25-50mcg. 150mcg should definitely make you sleep. Takes around 20 min to kick in this way- can't say whether the sublingual route actually helps or if it's just psychological.

 

[deadendgame]

yeah. i'll try to take less. i am definitely fucked up in the head and i think it's from the remeron so i'll taper down to 30

 

[deadendgame]

thanks guys

 

[aced126]

Yeah, it's just about the H1 histamine antagonism that helps to sleep (mirtazapine acts also as a a1 antagonist in higher dosages, the opposite of clonidine, which isn't exactly what one wants with a sleep aid). Also it's so super potent at H1 that, without pre-existing tolerance and/or severe insomnia, 1mg of mirtazapine can be enough!

The same with quetiapine. Depending on how you react to (a tiny bit of) dopamine antagonism, it could be a better because shorter-acting choice at 25mg.

I do absolutely like clonidine as a sleep aid and anti-stress medication because it doesn't touch dopamine or other systems it shouldn't mess with. It doesn't make you hungry or clot the nose like quetiapine is prone to. As a plus, clonidine is helpful against nightmares (less noradrenaline means less stress, even when dreaming)
Just the dosage is very important here, a bit too much and you might end up lethargic but when you got to know it, it's very controllable. And the tablets (there's just one brand if I'm right and maybe some generics, those from India are exactly the same tablets as what I got here from the pharmacy) can be used sublingually, it's such a tiny amount of chemical that you can't taste it. To start I'd take 75 mcg, for use during the day 25-50mcg. 150mcg should definitely make you sleep. Takes around 20 min to kick in this way- can't say whether the sublingual route actually helps or if it's just psychological.

A1 antagonism would help sleep. I think you mixed up A1 and A2 receptors. The A2 adrenergic receptor is an autoreceptor which, when agonised, inhibits norepinephrine release from the presynaptic terminal. A2 autoreceptor antagonists like yohimbine and mirtazapine at higher dosages result in anxiogenic effects.