Mirtazapine causing aggression, should i change meds?

[pregabsandweed]

I got switched a couple weeks ago from 30mg promethazine (for sleep) and 20mg fluoxetine for anxiety to 15mg mirtazapine. Sleep has been great much better than the promethazine but I keep seeming to get angry other the littlest things and its causing me and my gf to argue all the time. I was wondering if this is a normal side effect that will go away the mirtazapine is in my system properly, or do you think i should go back to the doctor and ask for something different? I have tried trazadone, gabapentin, amytriptylene and sertraline and none of them are effective, some help with anxiety but not with sleep and vice versa. I wish I could get prescribed pregabalin but the doctors seem against this. What do you guys think?

 

[pregabsandweed]

I seem to have calmed down a bit more now, so maybe it was just while they get into my system. They want to up me to 30mg soon though so I hope it won't happen again. Has anyone else experienced this side effect at all? and does it permanently go away once mirtazapine fully enters my system? I hope it doesn't come back because on the bad days I get really bad. Last fit of aggression I had I smashed up my wooden dining chairs and flung my bedroom TV. Luckily only the frame around the screen and the power LED broke, and the TV is still usable but the chair is completely in bits, may as well be firewood.

EDIT: Would it maybe be possible to move this thread to mental health? it may get a reply in there?

 

[fermonos]

My friend was exactly the same on this medication. He'd constantly fight with me and his other friends, like real fighting. But this was also while he was on alcohol but even without the alcohol he was moody as fuck and very aggressive just it never came to fighting. I remember one time when he put a pint glass over his head out of the blue, head pouring with blood then picked up glass from the floor and tried to cut his neck. I think that was the last night he took Mirtazapine.

Oh and he was on them a good month or two and the anger problems didn't seem to get better over time. I strongly recommend Amitriptyline, what dosage were you taking when you found it ineffective?

 

[pregabsandweed]

That doesn't sound very promising I think I will have to ask to change to something else then. I was on 25mg amitriptyline but they didnt really help me much with my anxiety or my insomnia (the one thing the mirtazapine has been effective with), I don't know if they can do any higher doses than 25mg but if they did I would want atleast my promethazine back to help with my insomnia again because i found amitriptyline to be weak in forms of sedation compared to mirtazapine.

 

[fermonos]

Ahhh right... For me I got some amitriptyline from a friend. Believe it was 20 x 10mg and when I take even 10mg I'm pretty fucked up but 30mg knocks me out. For anxiety I don't really know, I get really strong anxiety and everything I've been given so far hasn't helped me but I've only been prescribed anti depressents, not benzos which are for anxiety mainly. Anyway you could try taking 50mg of amitriptyline I'm fairly certain it'll knock you out.

Honestly if you are struggling a lot to sleep and anxiety is effecting you that much it's getting in the way of your every day life. I think you should be telling your doctor this and s/he should be putting you on some type of benzo for anxiety and maybe even sleep. Don't get me wrong SSRI's do work wonders for a lot of people with sleep issues/depression/anxiety but it doesn't work for everyone.

 

[cduggles]

OP, it's not clear from your post if you tapered before/while starting mirtazipine. So you might also consider that you went through a bit of withdrawal. (I say a bit because your symptoms as described weren't typical of severe SSRI withdrawal and it's not clear how long you were on them).

You might give the mirtazapine a chance (and maybe avoid alcohol in excess!). Insomnia is awful and if you find something that works and also helps with anxiety, I think it's worth a try.

Imo, you're better off posting here in BDD because this is where people post about meds. MH is a mixed bag. Just my thoughts.
Good luck! CD

 

[pregabsandweed]

I wasn't tapered no, I was taken off fluoxetine due to having a seizure a couple of months ago (only seizure I have had in my life) and my GP thought fluoxetine was the most likely culprit, I went about a week with no meds then I was given mirtazapine. I would rather try and avoid benzos, as I seem to become aggressive on valium. I know a friend of mine gets Lyrica for anxiety an it works well for them but my doctor doesn't seem to want to prescribe them only gabapentin.

 

[cduggles]

Sorry about the seizure.
Definitely avoid long-term daily benzo use or high-dose benzo abuse. Particularly if you're seizure-prone (withdrawal significantly lowers seizure threshold).

Lyrica (pregabalin) is a stronger version of Neurontin (gabapentin) and is a schedule V drug, which might be why your doctor is hesitant to prescribe it. It has higher abuse potential than gabapentin.
Gabapentin has also been scheduled as a controlled substance (schedule V) in some states for potential abuse.

With both medications, you build up tolerance very quickly with daily use. There are multiple people on BL who post about using over 5,000 milligrams of gabapentin (not a typo) a day.
Some people can just quit, but other people here describe horrible withdrawals.
There's a pregabalin (Lyrica) and a Gabapentin megathread you might want to check out.
Gabapentin: http://www.bluelight.org/vb/threads/455090-Gabapentin-(aka-Neurontin)-Mega-Thread-and-FAQ-s
Lyrica:
http://www.bluelight.org/vb/threads/532741-The-Lyrica-(Pregabalin)-Mega-Thread-v-2-0/page65
I put it in these meds in the category of great for withdrawal or used in low dosages once in awhile (like benzos). Otherwise you will develop a sky-high tolerance just for symptom management and possibly have a horrible withdrawal waiting for you.
So for chronic insomnia and anxiety, not likely a good choice.
Best, CD

 

[T. Calderone]

You may be having some withdrawal effects from stopping the other medications but I'm not sure if that would be causing your aggression. The trouble with mirtazapine is the higher doses act more as an antidepressant than a sleeping medication. I was on mirtazapine for a few months but it gave me nightmares and caused excessive hunger so I discontinued. If your symptoms persist, definitely ask your doctor to switch you to something else.

 

[pregabsandweed]

I have a doctors appointment tomorrow morning so I will raise my concerns and see what he suggests. Problem is my main GP who I have used since I was very young retired last month so now they just give his patients to any available GP until they get a proper replacement for him. Problem with this is all the different GPs seem to think different meds will fix my problems and none of them really know much about me because they havent been my main GP for 25+ years. This is the same doctor who started me on the mirtazapine though so hopefully he will know what to do.

 

[spacejunk]

Yeah, you're going to have to work with them as best you can, but if you're being scripted something for sleep, and aggression is a side-effect, you shouldn't be taking it. Any doctor should respond to this - but don't hold out too much on being scripted benzos, because as has already been mentioned, having had a seizure may rule them out. I don't know - i'm not a doctor, and i'm just speculating - but tell the doc what's going on, and let them know that the side effects of the meds have been causing aggression which have been causing interpersonal problems - it's really not an acceptable side effect for a sleep medication, and the dr wouldn't want you to hurt someone, or yourself.

 

[pregabsandweed]

Well I saw the doctor yesterday and he told me to keep on with the mirtazapine for a while longer and its a common side effect at the start until the body gets more used to the mechanism mirtazapine uses to sedate you. Got another appointment in 2 weeks and if aggression and irratability haven't subsided by then I am defo going to ask for a change of meds.