Mirtazapine...why would they give this to a depressed person?

[JackiesBabyy]

I take Trazodone for sleep every night and it works fine, and I read a bit about Mirtazapine which is similar to trazodone but stronger. My friend takes them for sleep and I asked for one just to compare it. It did put me to sleep...but holy shit, the entire next day I felt very anhedonic, energyless, and nothing interested me. Everything seemed boring as all hell all day. It wasn't a high dose either. It was whatever dose they start people on when they take it for sleep. And this is used for DEPRESSION?

It has a similar mechanism of action to Trazodone, which doesn't give me any problems(Didn't take the trazodone the same night I took the mirtazapine) or next day energylessness/anhedonia. What do you think caused it with this? It's not an antipsychotic, so...

 

[cook]

I have used mirtazapine for years to sleep. Never had any problems next day for whatever dose I am using. Currently I take 30 mgs which is the highest I can go without reversing the effect (it starts to stimulate in the higher doses).

What dose did you take? It is a tricky medication to dose. Sometimes lower doses sedate more and higher doses need to be taken to not feel the next day negative symptoms. And sometimes vice versa, depending on person.

 

[JackiesBabyy]

I have used mirtazapine for years to sleep. Never had any problems next day for whatever dose I am using. Currently I take 30 mgs which is the highest I can go without reversing the effect (it starts to stimulate in the higher doses).

What dose did you take? It is a tricky medication to dose. Sometimes lower doses sedate more and higher doses need to be taken to not feel the next day negative symptoms. And sometimes vice versa, depending on person.

Upon texting him and asking, 15mg. For comparison, I take 100mg trazodone for sleep while most people only need 50, so it's surprising I got such anhedonia from 15mg.

 

[cook]

It seems that trazodone is also histamine inverse agonist which causes the sedation, though i'm not sure about the cross-tolerance. In my knowledge mirtazapine is the most potent H1 inverse agonist known.

For non tolerant 15 mgs would probably be way too sedating. Usually people start with 5-7.5 mg or less. When I first took 5 mgs it was like there was no possibility being awake, it was the most powerful sedation I've ever felt. Even greater than quetiapine's which I've also used. And as I said for some people lower the dosage the greater the sedation, but I won't confirm that since I found the sedation increases steadily with the dose up to the 30-45 mgs where it turns upside down.

Try a lower dose if you want to give it another try, perhaps your symptoms will subside. It's not supposed to cause lethargy etc. zombie like characteristics like for instance quetiapine since it's not antipsychotic but I guess everything is possible.

 

[ugly]

Mirtazapine produces sedative effects due to potent histamine H1 receptor antagonism, and orthostatic hypotension due to moderate peripheral alpha 1-adrenergic receptor antagonism. Trazadone also has the alpha 1-adrenergic receptor antagonism, so there's the possibility of an additive effect. Mirtazapine is never supposed to be taken with antidepressants, mainly SSRIs, but Trazadone has properties of an SSRI. The two are not specifically contraindicated. I read about them in Micromedex, an app I use for study.

Mirtazapine can't be used before or after a person has been on an MAOI because of serotonin syndrome, but Mirtazapine has been known to cause serotonin syndrome even when no other serotonergic drugs have been used, including life threatening cases.

I'm studying for the national test.

 

[cook]

Mirtazapine is never supposed to be taken with antidepressants, mainly SSRIs

This is not true, it is very often used in combination with venlafaxine and SSRI's as well.

 

[ugly]

This is not true, it is very often used in combination with venlafaxine and SSRI's as well.

Micromedex says venlafaxine is a major contraindicated for Mirtazapine.

I just want to get it right if it shows up on the test. That's all I'm sayin.

 

[JackiesBabyy]

This is not true, it is very often used in combination with venlafaxine and SSRI's as well.

That and Trazodone only blocks the SERT enough to have some sort of effect at 400+mg doses, which is the dose prescribed for depression. The 100mg sleeping pill dose makes it just function as a sleeping pill.

 

[cook]

Micromedex says venlafaxine is a major contraindicated for Mirtazapine.

I just want to get it right if it shows up on the test. That's all I'm sayin.

I'm telling you it is one of the most common combinations. Maybe the theory and practice contrast on this one .

http://en.wikipedia.org/wiki/Mirtazapine#Interactions

"Mirtazapine in combination with an SSRI, SNRI, or TCA as an augmentation strategy is considered to be relatively safe and is often employed therapeutically"

Btw. I've been on that "California rocket fuel" -combo and it did nothing for my depression back then. But however usually it's considered as an effective treatment.

 

[JackiesBabyy]

Wikipedia says it blocks d4 receptors. Could this possibly be why it causes anhedonia in some people including me?

 

[ugly]

I have no personal experience with mirtazapine but I was prescribed trazadone a few years ago by a psychiatrist. I didn't like it. We went through a few different pills before I found a good set that helped me get it together. (I had had what amounted to a nervous breakdown.)

I want to try everything I study. It's always been this way. My dad was an under cover narcotics agent, and I used to have to type his reports for him while he was getting his master's in Narcotic Law or whatever it was. (It was '74 I think. I had an electric typewriter. He would hand me his handwritten reports, yellow legal pads always, and I would type them up.) He had textbooks with color close ups of everything known at that time to be a substance. Under the nice color close ups were explanations of the effects and I wanted to try everything.

I didn't try everything but I made a valiant effort. %)

My textbooks have nice color closeups and explanations of the effects, and I still want to try everything. I can't, and I wouldn't if I could. It's just a weird curiosity I have had since forever. That is one of the benefits of Bluelight. I come here and read for days about what you are all taking and what it is doing. Bluelight is the most interesting place on the entire internet, imho.

 

[cook]

Wikipedia says it blocks d4 receptors. Could this possibly be why it causes anhedonia in some people including me?

Sure it's possible. But my experience is, having been long on the 30mg's, that it does not block dopaminergic euphoria (opioids) at all. But then again, quetiapine blocks whole lotta more dopamine receptors and even that won't cause anheodonia to me. I'm immune to everything.

 

[laCster]

IMO mirtazapine is the most effective drug of its kind at doing what it was made to do (anti-depressants, mainly SSRI's, and various SNRI's, ect..), IME. however, i gained 20pounds in the first month of taking it, no thanks...

 

[cook]

Well, my experience is that it's just good for sleep but that's it. When I started 30 mgs I remember feeling kind of hypomanic for a while but that was only temporary. No long term effect on anxiety/mood. But then again, no SNRI/SSRI/whatever has ever worked for those issues in me. Consider yourself lucky if it works for something else than sleep.

 

[shreddedlettuce]

IMO mirtazapine is the most effective drug of its kind at doing what it was made to do (anti-depressants, mainly SSRI's, and various SNRI's, ect..), IME. however, i gained 20pounds in the first month of taking it, no thanks...

This is what my doctor says too.
It's a "fantastic" AD, but weight gain is a huge side effect.
So if weight gain doesn't effect you negatively then at least give it a try.

 

[olab7]

Mirtazapine is an agonist/antagonist on 5HT receptors ,dopamine receptors as well as adrenergic receptors. Which is why it's suppose to help depression and anxiety. But usually if your not depressed, anti depressants will have the opposite effect on you. Although, the anti depressant effects arn't suppose to start working until like a week of taking it. Sooo after saying all that...I'm not sure why it made you feel like that,lol sorry.

 

[AlphaMethylPhenyl]

^You basically just profiled an anti-psychotic. And there are many kinds of clinical "antidepressants"; I can tell you that most not-depressed people would feel some euphoria off Bupropion.


Both drugs have complex pharmacological mechanisms that overlap, but one isn't just a stronger version of another.

 

[cook]

Actually I was somewhat hypomanic when i first started the mirtazapine on higher dose but that faded out quickly. There's no telling really what happens when person x takes medicine y first time, there's just too many variables.

 

[JackiesBabyy]

Actually I was somewhat hypomanic when i first started the mirtazapine on higher dose but that faded out quickly. There's no telling really what happens when person x takes medicine y first time, there's just too many variables.

Are you bipolar and not taking a mood stabilizer or an AP? Antidepressants have a tendency to do that to bipolar patients when taking alone.

 

[cook]

Are you bipolar and not taking a mood stabilizer or an AP? Antidepressants have a tendency to do that to bipolar patients when taking alone.

No, officially i'm not bipolar but antidepressants can cause hypomania basically to anyone. Mania/hypomania needs to be present naturally (not medically induced) in order to diagnose someone as bipolar. Just like drug induced psychosis vs. endogenous psychosis.