Paroxetine and Mirtazapine combo

[zzorg]

Hi there guys. About a month ago I had a 'bit of a moment, that lasted about 72 hours'. Anyway, to cut a long and not very interesting story short, I had the presence of mind to admit myself to the local emergency department where I stayed for about nine hours until I'd calmed down a little. I have reactive depression (diagnosed) but I'm also fairly certain I'm bi-polar or BPD. In combination with my depressive episodes I also, frequently, have episodes of anger (more like rage tbh).

Anyway, I've been on loads of MAOIs/SSRIs and so forth since the mid '80s. So, basically, no CBT type counselling in my area as there's a waiting list in excess of a year. In light of that the hospital prescribed Largactil to help me sleep as that is a major factor in my behaviour. Now, before that script runs out I have to make an appointment with my GP and ask to be prescribed Mirtazapine which I understand is an effective anti-depressant with sedative qualities hence I've been told to take it at night.

Now...I have an issue: I've been on Paroxetine for roughly five years now, and tbh, it probably isn't doing much (20Mg in morning). I've been on 30Mg which turned me into a zombie, then down to 20, then 10Mg. And you've probably guessed already: I'm back at 20Mg because I'm physically addicted, big time. I *can't* get off it. The most I've managed is a few days at 10Mg and then I get Serotonin syndrome to the point where I feel like I'm about to have a siezure. I'm resigned to being on it, well, forever.

Finally, my question: Paroxetine and Mirtazapine - what can I expect from that combination? Is it a well known combo? And what are the side effects likely to be?

Any info and/or experiences of these two together would be very much appreciated.

Many thanks

Alan

 

[pasha]

Mirtazapine combined with paroxetine showed good tolerance and significantly better response compared with high doses of either agent alone (Debonnel 2000). This is one of the most popular combinations and has been proposed on various grounds:

• rapid onset of effect is possible, owing to the receptor profile of noradrenergic and specific serotonergic antidepressants (NaSSAs) (see below);
  
• side-effects of the SSRI may be nullified by the NaSSA and vice versa;
  
• additive effects are possible because of different mechanisms of action;
  
• SSRIs can increase plasma levels of NaSSAs through CYP450 enzyme inhibition.

Hope this helps.

 

[fairyrn]

If u continue to feel "hooked" on the Paxil, ask your GP to switch to Prozac. Prozac has the longest halflife of any SSRIs out there and therefore if u have to lower or stop it all together, there is usually no side effects. From time to time patients need to switch due to tolerance or ineffectiveness of the drug in question. It just happens. I never prescribed Paxil to women, only men. This was because I saw a change in the women that was, to say the least, not good. Men, however, seemed to do great on 20 to 40 every night. Good luck.