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Citalopram + Mirtazapine ??

ksralyv2mch

ksralyv2mch

Bluelighter
Joined
Jul 31, 2013
Messages
309
I hope this is the correct Forum to ask this in... I have been on 40mg of Citalopram (celexa) for a little over 3 years now, recently I relapsed on heroin and now getting clean again my insomnia is back and the depression from the PAWS is synergising with my chronic depression and it's not fun. I saw my Psych (who is actually a Psychiatric Mental Health Nurse Practitioner) and she added Mirtazapine 30mg for my insomnia and increased depression. Now knowing that both of these act on serotonin I was automatically worried about serotonin syndrome, I'm only suppose to take the mirtazapine to help with my insomnia when I can't sleep..

TLDR;; I'm just curious if anyone has had any experience taking both Citalopram and Mirtazapine at the same time?

Thanks in advanced!
 
I haven't seen any reports of SS caused by mirtazapine, in fact there's even a study suggesting it can alleviate SS (here)

Mirt with venlaxafine became popular in the US for a period, I don't think you're at risk (especially at these doses)

Good luck
 
Shit those all sound like what one would go through while detoxing off heroin (*cough cough me cough cough*) so how would one really be able to tell the difference between SS and just regular opiate withdrawals?

so far tho I have stopped my SSRI and just been taking the remeron, I sleep great but I'm coming up on having to detox from opiates... not looking forward to it...
 
Hyperthermia and hyperpyrexia is also a common feature of a serotonergic toxidrome
 
Mirtazapine works on some serotonin receptors, but as an antagonist/inverse agonist. It's believed to be effective in relieving depression by blocking serotonin receptors that appear to have little to no involvement with depression, thereby forcing the naturally available serotonin to bind to receptors that are being under-stimulated and causing depression. Mixing it with an SSRI will therefore not increase the risk for serotonin, but rather as Abject has stated help reduce it. Mirtazapine is also meant to be slightly more effective in treating depression than classic SSRI drugs.

I had two friends who were on mirtazapine. They both said that the drowsyness/sleepy effects went away after a few weeks of daily dosing. I'd stick to taking your SSRI as prescribed and keep the mirtazapine for days where you can't sleep as otherwise it'll lose it's drowsy effects due to tolerance. Best of luck!
 
I tried Mirt for over a month, taking stupid doses twice (once in an attempt to desensitise myself to it, the other to pass out)
I couldn't take mirt because it made me lethargic like nothing could..

Also, it's said to be more drowsy at lower doses and less so at higher doses, but this was not the case for me at all. YMMV.
 
Thanks for all your responses fellow lighters. I am currently taking my Mirtazapine (I am attempting, poorly, a heroin taper) for sleep right now and I'm weening myself down from my SSRI to see if, in fact, the mirtazapine works better. Because with the SSRI I had some negative side effects (lack of libido/couldn't orgasm and it blocked MDMA which I was a frequent user, amongst other things) so once again, thank you and God Speed.
 
ksralyv2mch said:
Thanks for all your responses fellow lighters. I am currently taking my Mirtazapine (I am attempting, poorly, a heroin taper) for sleep right now and I'm weening myself down from my SSRI to see if, in fact, the mirtazapine works better. Because with the SSRI I had some negative side effects (lack of libido/couldn't orgasm and it blocked MDMA which I was a frequent user, amongst other things) so once again, thank you and God Speed.
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Sorry to say but the Mirtazapine will probably limit the effects of MDMA as well, by blocking 5-HT receptors directly. Aren't you worried about the rebound depression from MDMA use?
 
Mirtazapine is no joke. I took some on a 2C-P overdose and it brought everything to a screeching halt and knocked me out cold (potentially saving my life in the process) with just a single 15mg pill.

I take 7.5mg at night to go to sleep and its been a godsend during this hellacious benzo taper that had me staying up days on end.

Citalopram and mirtazapine would actually probably be a great combination as mirtazapine would balance out the hypomania-inducing effect that citalopram tends to have (it appears to be significantly higher with citalopram than other SSRI antidepressants). You'll probably gain weight from the combo though, mirtazapine alone causes pretty severe munchies.

MDMA is not blocked by mirtazapine, usually requiring a 50% or so dose increase to get to the same level as you would without mirtazapine but the crash seems to increase proportionally with the dose so you'll end up crashing harder for the same roll. Its totally not recommended. Mirtazapine can have unpredictable effects when mixed with a number of drugs so be careful with it, there have been some pretty severe mirtazapine + psychedelic combo reports, for example. The general rules of pharms and drugs apply here - if you are on prescription medication, its not recommended to mix recreational drugs with it, especially drugs like mirtazapine.

Don't take mirtazapine by itself... it has a tendency to stop working and leave you with nothing. The only time I would recommend taking it by itself is if you are taking it on an as needed basis for sleep at a dose at or below 15mg at bedtime.
 
We should actually expect some synergistic activity. Mirtazapine increases synaptic NE and 5ht via antagonism of alpha-2 adrenergic auto-receptors. This should synergize with SSRIs' activity, but the risk of SS is partially ameliorated by mirtazapine's selective 5ht-antagonism (selective for 5ht2 and 5ht3 isoforms). Regardless, this combination is well documented in clinical use. Mirtazapine + an SNRI is actually known as "California Rocket Fuel" due to its anti-depressant efficacy.

MDMA is not blocked by mirtazapine, usually requiring a 50% or so dose increase to get to the same level as you would without mirtazapine but the crash seems to increase proportionally with the dose so you'll end up crashing harder for the same roll.
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I found no interaction of any sort, with 15-30 mg mirtazapine / day, with 100-200 mg / MDxx in a sitting.

Don't take mirtazapine by itself... it has a tendency to stop working and leave you with nothing. The only time I would recommend taking it by itself is if you are taking it on an as needed basis for sleep at a dose at or below 15mg at bedtime.
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The literature actually suggests similar efficacy to SSRIs...

ebola
 
ebola? said:
I found no interaction of any sort, with 15-30 mg mirtazapine / day, with 100-200 mg / MDxx in a sitting.
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Again pointing out that there is variance in individuals - there is actually an old thread here that has the 50% suggestion from back in 2002 and I found it to be true personally - but I can actually take 20mg of Celexa daily for a month and still roll so go figure.

The literature actually suggests similar efficacy to SSRIs...
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I'm speaking about long term usage. Users report that it just randomly stops working entirely far more frequently than any other antidepressant.

Google "remeron poop out", there's lots who report this. I experienced it as well when I was using it at 30mg/day as an antidepressant along with xanax for anxiety - when it pooped out on me, the doc bumped it to 45mg and the efficacy didn't return which is when we switched me to Celexa and then 60 days later the hypomania from the Celexa had me inpatient and now I use 7.5mg of Remeron at night to get sleep but won't trust it for anything else. It doesn't seem to be as common when in combination as it is when its by itself, hence my recommendation.
 
I'm speaking about long term usage. Users report that it just randomly stops working entirely far more frequently than any other antidepressant.
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This sort of thing is pretty common with anti-depressants in general. Did you try googling "prozac poop out" too? The trials establishing mirtazapine's efficacy likely went out to roughly 6 months or so (that's standard).

ebola
 
California rocket fuel is a goddamn sham!

Genuine question: how are so many a/d studies biased so badly?? what the fuck happens in a peer review
 
That's really quite a nonspecific question. You're basically asking, why do studies have methodological problems a lot of the time?

And yeah, california rocket fuel is really an anecdotal phenomenon that spread from doctor to doctor; not much evidence behind it. But the pharmacological potential for synergy is there.

ebola
 
St3ve said:
Mirtazapine works on some serotonin receptors, but as an antagonist/inverse agonist. It's believed to be effective in relieving depression by blocking serotonin receptors that appear to have little to no involvement with depression, thereby forcing the naturally available serotonin to bind to receptors that are being under-stimulated and causing depression. Mixing it with an SSRI will therefore not increase the risk for serotonin, but rather as Abject has stated help reduce it. Mirtazapine is also meant to be slightly more effective in treating depression than classic SSRI drugs.

I had two friends who were on mirtazapine. They both said that the drowsyness/sleepy effects went away after a few weeks of daily dosing. I'd stick to taking your SSRI as prescribed and keep the mirtazapine for days where you can't sleep as otherwise it'll lose it's drowsy effects due to tolerance. Best of luck!
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After a few days I get tolerant to the sleepiness now even 135mg doesn't even make me sleepy nor seroquel but the combo does.
I don't chronically take it, its just a good med to have around.
 
Lucky you; mirt turns me into a zombie and it doesn't give up (haven't lasted more than a month on the shit)
 
I take ethylphenidate and MPA everyday, without stims I might get apathy.
 
I also take 5 meo dalt and bk2cb daily on top of those, never take what I take I'd say he he.
I'm extremely educated about the risks etc of what intake, I like to take risks to completely thread my predromal shizo with extraordinary success but that has I'm well aware risks.
 
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