Personal experience, patient feedback, combined with the fact that it reduces anxiety through serotonergic channels and alpha 2 agonism, just like clonidine, which effectively lowers the body's anxiety caused by sympathetic systems. Also, it's sedating qualities and short-ish Half life allow for proper restful sleep w/o suppression of REM as caused by benzos. It also acts to reduce pain like amitryptaline according to some patients. But the best part is no sexual side effects as is the issue with ALL SSRIs etc. the only downside is appetite is increased, but his can be controlled.... It's not a metabolic issue as is the case with olanzapine (Zyprexa) and other atypical antipsychotics. many studies show mirtazapine is beneficial in addiction to boot!
I'd really like to try mirtazapine, but the appetite part scares me. I used to be really fat, and now I'm at a relatively healthy weight, but I developed body dysmorphia in the process, and even though I'm 5'10 158 @ 11-12% BF, I still think I'm fat when I look at myself; so the thought of an orexigenic drug scares me. I've been on phenelzine, and bupropion, and I felt like both of them interfered with the quality of my academic work so I stopped eventually. Mirtazapine doesn't seem like it'll affect my cognition much, maybe. Phenelzine felt like I was trying to do my math homework on a small dose of MDMA (i.e. linear thinking was difficult)--most of my work was fine, but math/physical science work quality dropped significantly. I attributed that aspect of it to the increased serotonin. Bupropion was fine with math/physical science work, but I felt like I remembered nothing--I assume due to the nicotinic acetylcholine antagonism.
Both phenelzine and bupropion worked pretty well though...Phenelzine especially, no social or general anxiety, and I'd actually smile (friends were the first to notice that) and enjoy things again. Bupropion didn't really affect my anxiety (which isn't nearly as severe as it used to be, though it wasn't that severe when I went on phenelzine, thankfully therapy was enough for most of my anxiety problems). I also have a lot of sleep troubles (no trouble falling asleep, but always wake up after 4-5 hours incapable of falling back asleep, and then I overcompensate with caffeine so I can't nap throughout the day). Phenelzine actually helped a lot with that (though a lot of people complain of insomnia along /w the daytime drowsiness on it), I was always drowsy on it though, even with 100mg modafinil and 2 cups of coffee daily. Phenelzine reduced my drug cravings (for benzos and opioids) significantly too, and removed all suicidal ideation. Bupropion reduced SI, and didn't really affect drug cravings.
Psychiatrist is considering low-dose bupe after I showed him the harvard med school paper on it, though he can't prescribe it and has to refer me to someone who can. Partially because I'm afraid (i.e. certain) i'll eventually relapse with the way things have been going.
I've also thought about oral L-deprenyl, but I don't want to deal with the MAOI dietary restrictions again, though it seems like it shouldn't really matter. And I've thought about Moclobemide, but I unfortunately live in the U.S. where it's unavailable. Same deal with amineptine.
In general I'm convinced my depression/SA issues revolve around dopaminergic transmission. Though honestly, anything that doesn't affect my cognition and removes/significantly reduces SI is what I'm, (reasonably too, I think) looking for in a med (of course, the med shouldn't have orexigenic effects either...ideally).
I don't really have a question I guess, just ranting about antidepressants. I guess what do you think about mirtazapine for people with body-image issues--the orexigenic effects have scared me away from it.
![:\](https://bluelight.org/xf/BL_Images/Orig_Emoji/wrygrin.gif "wry grin :\")