Really appreciate the love, spread the word we have a great community here with answers to your questions.

@@ShrinksInSneakers definitly tbis is better then tbe Facebook forum will dpread.. ooo tbis med hard to ween

Thanks for sharing that’s given me a lot of reassurance as I am now on day 11 of taking 15mg mirtazapine, still feeling very groggy through the day and having wild vivid dreams but I’m actually now starting to feel brighter in myself ( after having a nervous breakdown with C-ptsd) still feeling quite anxious but not as bad as I was. I’m wondering if your dose was gradually increased over time and if that helped you more? And did it still help you sleep? As I’ve read the sedating lessens the higher the dose you go.

Remeron is a good medication that is slightly more effective than SSRIs based on meta analysis data. I've found it to be a great medication with the main downside being weight gain. Good diet and exercise habits will help reduce this risk. Hope this helps, if you haven’t subscribed to the channel please do and spread the word about what we are doing here.

Remeron is more sedating at LOWER doses so feeling groggy in the morning gets better as the dose is increased because more norepinephrine is released resulting in less sedation. The NE effect is balances out the sedation. Hope this helps, if you haven’t subscribed to the channel please do and spread the word about what we are doing here.

@@willow2290 So with my dose, they were 15mg, but I was told to start off by cutting them in half. So for a week it was just 7.5mg before bed and then afterwards I increased it to a full 15mg. I was told to give it a week before going to two tablets, but I waited until I was more comfortable with the medication so I stuck with 15mg for an extra 4 to 5 days on my own accord. I don’t exactly recommend doing that without speaking to your doctor first. I was just being cautious due to past experiences of immediately upping Anti-depressant dosages without feeling comfortable with it yet. One of the reasons I was prescribed it was for my lack of sleep and poor appetite due to anxiety. It’s improved both immeasurably. It’s different for everyone, but this is definitely the best I’ve felt mentally in a very long time. I really hope it works out for you!

@@willow2290 how are you doing on it?

Great, love hearing the positive stories because many people comment on my channel about negative experiences. I would not consider mirtazapine as the first line option for OCD but there is some data in open label trials that this medication can be useful in OCD. Hope this helps, if you haven't subscribed to the channel please do and spread the word about what we are doing here

​@@ShrinksInSneakersYou need to be in jail these are drugs not medication. Dr Peter Bregan and Profesor Ashston are true doctors

Why does it take so long to get into my system

I dont have trouble sleeping anymore since im taking magnesium glycinate and ashwagandha ,that's why im hesitant to take mirtazipine , cause my only problem is i feel so much fear in my head , everyday I woke up feeling nauseous and not feeling well.any suggestion or advise for me

very interesting i was totally numb on this meds like on ssri

thanks appreciate the support

Tapering medication is always a good idea. It's hard to predict who will have withdrawal symptoms from the medication. I agree with the other points, I think mirtazapine is slightly better than SSRIs in terms of efficacy and I think the side effect profile can be helpful as insomnia is a common symptom of depression. Hope this helps, if you haven't subscribed to the channel please do and spread the word about what we are doing here

Anhedonia can be difficult to treat, in general we look to more stimulating antidepressant medications like bupropion to target low energy and loss of interest. Some psychiatrists will even use stimulant medications but this is off label and comes with some risks which must be weighed out. I will cover this topic for you

@@ShrinksInSneakers thank you so so much for your answer :)))

@@cagan8796 no problem happy to help in any way I can

Most of these medications cause weight gain, an option is metformin for antipsychotic induced weight gain. I can make a video about asenapine specifically. Appreciate the comment

In theory the combination would cover all the main neurotransmitters and would offer a similar effect. I have not personally used all 3 in combination so I can't offer an clinical experience in this case. Hope this helps.

The antihistamine effects are basically leveraging a side effect for its sedating properties. It's not a long term solution for sleep problems and it has no effect on depression. The other mechanism including alpha-2 antagonism will provide those benefits. Appreciate the comment, if you haven't subscribed to the channel please do, and spread the word about what we are doing here.

Thats a lot of different medications which can make it hard to tell which ones are actually working. However, it sounds like the olanzapine was helping. I would also consider some psychotherapy if you are not already doing it. Also please talk with your doctor about your concerns

This is not medical advice and is intended for educational purposes only.I would dose mirtazpine at night and consider taking it earlier in the evening to avoid sedation in the morning. If I was combining medications I would prefer desvenlafaxine and mirtazapine because of the synergistic mechanism of action. Hope this helps. If you haven't subscribed to the channel please do and spread the word about what we are doing here.

@@ShrinksInSneakers Thanks 🙏

A good strategy with side effect is to wait, it may not be the most exciting advice but often side effects improve over time as receptors down regulate. With mirtazapine it's more sedating at lower doses. When you go about 15 mg the norepinephrine effects can counteract the sedating properties of the medication. Hope this helps, appreciate the comment

I think the idea that antidepressants make people zombies is not grounded in evidence based facts but there is emotional blunting that can occur with SSRIs. Mirtazapine is usually well tolerated with the biggest side effect being sedation which is largely mitigated by taking the medication prior to bed. Hope this helps, if you haven't subscribed to the channel please do and spread the word about what we are doing here.

Good luck, the lower the dose the better it is for sleep. I usually work with 7.5 mg initially and go from there as the dose gets higher the stimulating effects of norepinephrine increase. If you haven’t already please subscribe to the channel, and spread the word about what we are doing. Also check out the Instagram page as we now have daily content posted there.

I always stress diet and exercise as first line options for reducing the risk of weight gain. Most important is pick a diet and exercise routine you can stick with, it's not a given that all people crave carbohydrates or gain weight on this medication, certainly some do but I believe it's possible to maintain a healthy weight and use this medication. Hope this helps

I know aome people that haven't gained in it because they ar strict and exercise. It has helped them tremendously where ssris have been terrible.

The best advice for preventing weight gain is to use a low carbohydrate diet and start the diet and exercise program prior to starting the medication. By having the dietary habits in place prior, the behaviors will already be handled and the transition will be easier. Check out my video on weight management. If you haven't subscribed to the channel please do, and spread the word about what we are doing here. Also we have daily content on instagram that is separate and unique, check it out.

@@ShrinksInSneakers Thanks. I really appreciate your response.

@@hasiqinrasnin2383 no problem

I can't give you any medical advice but I can offer some education on this medication combination. I'm not a big fan of venlafaxine because of the side effects and withdrawal symptoms. What we see is there is not much norepinephrine activity when the dose of venlafaxine is lower than 225 mg. The theory is by combining venlafaxine with mirtazapine you will get a considerable norepinephrine effect which will improve mood symptoms. I made a video a while back that showed doses of venlafaxine at 150 mg was a good balance between efficacy and side effects. I tend to use lower doses. With mirtazapine I usually like 30 mg as a good dose because the sedation associated with mirtazapine improves as the dose increases. When I have situations like this I would usually attempt to lower the venlafaxine and if symptoms worsen I would consider increasing the mirtazpine. Hope this helps, if you haven't subscribed please do and spread the word about what we are doing here

I’m prescribed Wellbutrin and this medication also. My dr said it’s ok to take both and I googled it and it said the same thing. My dr only prescribed me this medication because I was an increased appetite.

Nope

I will sometimes use metformin in these cases. I did a video on weight gain and steps to avoid it which may be helpful. If the depression is well controlled lowering the dose or even tapering off is something you can talk with your doctor about. The foundation for weight control is diet and exercise but I appreciate how hard it can be in these cases.

How quick did you gain that weight

Thats not how weight gain or loss works. Mirtazapine causes increased appetite and carb cravings. That's where the weight gain comes from, it's not some pill magically causing you to gain weight, it's because you are consuming more calories. Simple as that. Count your calories.

Are u still on it?

@@NirajPoudyal yes nothing like a good night sleep !

@@zanewoodward4822 wish u a good health and better life ahead. Me ,I,ve been taking it, 7.5 mg for 40 days and the doc improved the dosage to 15 mg , it,s been 15 days . I,m trying to stick with it for 1 month.what positive effects have u found about it beside good sleep?

It will still have sedating properties just not as much as it would at 7.5-15 mg because the norepinephrine effects will start to counterbalance the sedation but overall should still help with sleep. ope this helps, if you haven't subscribed to the channel please do and spread the word about what we are doing here

@@ShrinksInSneakers thank you. Already subscribe. Will 30mg be good for appetite stimulation. That’s what I am wanting

@@stevensicherman4101 It should still stimulate appetite.

I always recommend talking with your doctor about side effects. Each medication has established efficacy, there is no reason why fluvoxamine would need to be taken in combination with the others. Hope this helps, appreciate the comment

Anyone?

I don't think so the 7.5 mg should be fine to take advantage of the sedative properties of the medication. Appreciate the comment, let me know if I can answer any additional questions

@@ShrinksInSneakers reports are 3.5mg knock ya out...also reports that it 8s HELL TO COME OFF you never addressed that Sir.

​@@garysimone4977 People have come off this medication without issue if you taper off over time. There are many variables so it’s impossible to make a blanket statement about who will have a difficult time and how difficult it may be for an individual.

This is very hard to answer. I don't know enough about the case and can't really comment on a specific case like this directly. I do not think the symptoms described here are side effects from the medication if anything these are the opposite of the common side effects. I appreciate the comment, if you have not subscribed to the channel please do, and spread the word about what we are doing here.

This is a difficult place to be, mental health services are always backed up and never seem to have enough spots to fill the need. I can’t provide direct medical advice and there are many factors that I do not know about this situation so I will speak only about the medications/interventions I know of that are proven to reduce suicide. First are evidence based measures to reduce the risk of suicide, removing all lethal means from the home. This includes medications, sharp objects, and in the U.S. most notably guns. The next step is to create a safety plan, you can find a PDF with a quick google search. This will be a process the person runs through when feeling suicidal of engaging their support system and using other resources like crisis hotlines. The next thing I can say is DBT which is a form of CBT combined with mindfulness. This has been shown help reduce suicidal thoughts and often used on borderline personality disorder. Although it’s best to have a therapist to guide the persons there are several workbooks available that are self guided and could be useful. The next thing to consider is electroconvulsive therapy ECT, I’ve performed this procedure on acutely suicidal patients and seen significant improvement. I’m not sure about regulation or how the referral process in the UK works. The last part is medication, there is one medication proven to reduce completed suicide in RCTs, the medication is lithium. It can be used in depression with chronic suicidal thoughts, I’ve personally used it in this manner. The next medication is clozapine this has been proven to reduce suicidal thoughts in patients with schizophrenia. It might not apply here but for completeness I’m including it. The last medication is ketamine which has an approval in the U.S. For acute suicidiality. I hope this helps. If you haven’t subscribed to the channel please do so and spread the word about what we are doing. I also have daily Instagram posts to educate and reduce mental health stigma.

I also heard of shock treatment ECT for patients with resistance depression. I might try it soon .

@@tonima4784 try TMS instead of ECT. Less invasive. Gentle and you just go to your drs office each day for a month

Ketamine under medical supervision its expensive tho

How are you now?

It's the best kind of fuel

@@ShrinksInSneakers is remron abd preztiq

anxiety may be increasing due to increased norepinephrine activity at higher doses. I'm not aware on impaired circulation as a common side effect. Hope this helps

In rare cases we would increase past FDA approved limits. The most common reason is OCD where doses of SSRIs are routinely increased past FDA approved maximums. In clinical practice I would usually consider combination therapy. See my video on California Rocket Fuel in the playlist it will give you an idea. Hope this helps if you haven't subscribed to the channel please do and spread the word about what we are doing here.

@@ShrinksInSneakers thank you

@@Sentenza483 no problem

Yes, Mirtazapine can help with benzo withdrawals. I used Xanax for a long time and Mirtazapine helped me a lot with that. I hope you feel better soon.

Talk with your doctor about but for education purposes, I have used it as an as needed medication with some patients. In the case you are describing it would probably be fine but still check with your doctor, because it's not being used to treat a primary depressive disorder the option to discontinue the medication all together is reasonable. All the best

@@ShrinksInSneakers thank you unfortunately the doctors are not very helpful.

Did you come off it ok?

emotional blunting can occur with antidepressants like sertraline, in all cases I always like to make sure one medication is optimized before adding another one. In my experience I've seen less emotional blunting with mirtazapine, as always please talk with your doctor about the concerns. Hope this helps

@@ShrinksInSneakers how’s sexual sides on remeron

@@EE-ie9gm Less likely to occur, this is a better option if sexual function is a concern. If you haven’t subscribed already, please do, and spread the word about what we are doing here.

The higer the does makes it harder to sleep. 15 mg is the best. I am now on 45 mg which is good for depression and anxiety but it doesn't help you sleep..

Oh no. This is not what I wanted to read

@@jamesmorris7420 i feel abit better now mate tbh, i think it was part of the tapering down off it.

@@mrc.p8423 how are you now? I want off

@@giuglianavaselli5463 completely off it now for 3 months. Got insomnia though and dpdr from anxiety is back again like before i started taking it. Heart palpitations too. Bit of a catch 22 mate because i didnt like being on it, but i also dont feel right off it. Nightmare pal

@@mrc.p8423 oh sorry, do you still have insomnia?

There is more risk of weight gain than some of the other antidepressants. Side effects will vary on a patient by patient basis, if you are prone to gaining weight easily and this is a major concern mirtazapine may not be the best option. Hope this helps, if you haven't subscribed to the channel please do and spread the word about what we are doing here.

The medication is often used on a long term basis to treat depression. After 3 episodes of depression medication treatment is generally recommend long term. If the main goal of using the medication is to improve sleep, this is basically taking advantage of the side effect profile of the medication so like trazodone it could be taken on an as needed basis. Hope this helps, appreciate the comment

@@ShrinksInSneakers Thank you much appreciated!

@@ShrinksInSneakers does this med lose its effect on sleep 7 5 after a few weeks.. I am hearing conflict reports As the H1 ADJUST ??

@@garysimone4977 Everyone will have a different response, because you are using the side effect profile to achieve adequate sleep there may be some tolerance and that is certainly the case at higher doses because NE will offset the H1 activity. I would not think of any of these medications as alternatives to healthy natural sleep. These are symptom management to get you through difficult periods and if depression is the cause of the insomnia then treating the depression should be the target and 7.5 mg will not be an adequate dose for that purpose. Alternatives include melatonin, CBT for insomnia, and sleep hygiene

@@ShrinksInSneakers thank you for the reply... no they gave this to me for short term use as I am weening off a benzo.. I have .5 mg left to go so figure a month or so .. so I guess a better question a better question is this a decent med short term to help get over the hump of benzo wd and is this a difficult ned to get off yes we are all different but before I get to deep in this med * at 5mg would enjoy your opinion.

Some people have had a better response on doses above 15 mg as the norepinephrine effects counteract that sedation. However, it's not a go to medication for me if a patient has anxiety. I always believe anxiety responds best to psychotherapy with a much longer lasting effect. For anxiety I like medications like escitalopram better. As far as the shivering goes it's hard to say. It could be related to the medication, but it's not a common side effect. I would talk with your doctor about the symptoms. I appreciate the support and the comment

Yes it certainly does. The higher the does the less it helps you to sleep. It has been a life saving drug for me.

This medication can be used on an as needed basis. At 7.5 mg there is very little antidepressant benefit and at doses between 7.5 mg and 15 mg sedation is much greater so you are taking advantage of the side effect profile. In general if medications are not continued long term there is a lower risk of a withdrawal syndrome (does not mean it cannot happen), and in general SNRIs and SSRIs have a higher risk of withdrawal syndrome and it will depend on how long someone is on the medication. Hope this helps appreciate the comment

@@ShrinksInSneakers thanks been on 3 weeks i am weening off vium should be 4 weeks Then lime to jump off both tbe vium and tve mirt... so 8wks or so on mirt.. think should ween off

@@ShrinksInSneakers thank you.... after my tapper this med is gone ...how best to ween

@@garysimone4977 I want to stress that I do not recommend you follow this without the expert knowledge of your doctor. This is not medical advice it’s For educational purposes only. I’m going to use 40 mg daily as the example. Day one 18 mg in the morning and 20 mg at night. Day 2 is 18 mg in the morning and at night for a total of 36 mg. This continues at 2 mg per day until we get to 13 mg daily then it’s 1 mg per day until you reach 0 mg/day. This is a very slow taper and may not be required in all situations.

@@ShrinksInSneakers yes I will ck with my Dr when ready to ween...I am al as of today 1.1ml of valium and 7.5mg of mirt...looks like my tapperfrom valium will be over mid Jan. RE MIRT I GOT THE LIQUID started on Oct 16 plan to tapper Feb yes I know ya can't give advice etc but is this med easy to ween off Any tips much appreciated So say at 7.5 for 4-5month 1 ml a day good

MR C.P - Don't take it. It causes weight gain, and even a low dose can cause dependency. Withdrawal from it can be very difficult. (No, I'm not a physician, but I have personal experience with this drug.)

@@nokomismn9685 did it help your anxiety though?

@@mrc.p8423 - I took it at bedtime and was inclined to sleep soon after taking it. To tell you the truth, I do not know if it ever lessened my anxiety. It caused a great deal of anxiety while tapering off it, and that's why I advise against taking it. Everyone is different, of course. I wish you the best.

@@nokomismn9685 you too brother

At lower doses it’s more sedating, at higher doses the sedation is reduced due to increased norepinephrine. If the target is depression than at 30-45 mg/day sedation should be less of a risk. As the other commenter stated if you do start the medication and plan to stop, you need to taper it properly to avoid withdrawal. It’s important to point out that not everyone experiences withdrawal, and many people can stop without a taper. I would talk with your doctor about the concerns you have. All antidepressants have a black box warning for increased suicidal ideation and behavior for patients under the age of 24. Although this research is in question it remains on product labels.

As long as you come off slowly over time it should not be an issue. It's always a good idea to reduce the dose gradually just to be safe although many people tolerate shorter tapers. Hope this helps.

@@ShrinksInSneakers yes been on only 90 days at about 5 mg or so got tbe liquid.. they gave it to me to help sleep while weening off benzo but just don't feel right on it what a decent tapper in tbis situation generally speaking Had 2 pharmacist tell me ok just to stop thaughts Dr said up to me what I want to do

you really cannot get a much lower dose, if you want to continue tapering I will sometimes dose it every other day and slowly work to completely coming off (dose every 2 days and so on as tolerated)

It's one of the problems we have to contend with, I think we are moving towards newer medications that will have lower side effects in the future. Appreciate the comment and sharing your experieance

I had an attending who has tried many of the medications as well as most recreational drugs with the goal of understanding more about what it’s like to be on these medications. I would not recommend this to most trainees unless there is a specific need for medication e.g. depression

@@ShrinksInSneakers that means you personally haven’t then lol

@@christophergros9884 The answer to this question is why does it matter? When patients comes to see me I'm there to help them. knowing what I've taken or haven't taken or if I have a psychiatric disorder myself takes the focus off the person who is coming for help and puts it on me. This is generally not good or helpful for the patient in the therapeutic setting. My focus and attention is 100% on the person who is there seeking my expertise and treatment recommendations. 😁

@@ShrinksInSneakers I think it matters because unless you yourself have a mental health condition/disability, it’s extremely to difficult to understand what we go through on a daily basis … regardless of how much education you obtain (no offense). Mental health patients seek help from mental health professionals like yourself and it seems like the “solution” is always medication via the trial and error method. Why don’t we talk about more holistic methods to treat mental health conditions? Diet, exercise, natural supplements such as Inositol, etc. The truth is, mental health issues SUCK and while there IS medication out there to treat the majority of mental health related conditions, NONE of them come without drawbacks; even if those drawbacks (or side effects) occur at the time of discontinuation. Most mental health medications may take up to 4-6 weeks until the patient begins to notice a positive difference and they can also create a challenge for the patient to ween off. Just my two cents.

@@User_85923 Much of this will depend on the conical presentation of the individual patient. In the example of using supplements, diet, exercise, I always recommend these things as treatment. In most cases if you are seeing a psychiatrist you either have tried these things and they did not work or you function is so impaired by mental illness that you cannot begin to focus on diet and exercise as potential therapies. I think we do ALL these things you listed and often people remain depressed, psychic, manic. All supplements and even placebo have side effects. I think the decision to use medication is based on severity of symptoms, the cause of the depression (situational bad life event or is severe psychomotor retardation and anhedonia). To the point about needing to have mental illness to understand it, would you expect your cardiologist to have heart disease to understand it? There's already a severe lack of quality mental health professionals if we all needed to be mentally ill to qualify for the job there would be virtually no one. It's also hard to speak in generalities as all cases are different and require different approaches to treatment. Hope this helps, and I think we all know what it's like to depressed or anxious if you don't understand those things you aren't alive

I would agree there are several other options if primary insomnia is the issue. I like agomelatine a melatonin agonist or lemborexant an orexin antagonist both of which have better side effect profiles and no addictive potential. Many factors play a role including cost of these medications but I think all sleep disorders should start with things like sleep hygiene and CBT for insomnia then add medication of needed. Appreciate the comment hope this helps

@@ShrinksInSneakers whats the best way to come off it I only use 7.5 half of a 15 milli pill to sleep now can I skip a day and then 2 and stop ?

Is it worse than sertraline? I went through hell on that

When you look at the animal models which is usually how they determine receptor profiles it does not always translate to humans. All medications hit multiple receptors but it may not be clinically meaningful. There is also a lot of variation in response and side effects to medication. I've had many patient of mirtazapine who did well, and some who have not. I appreciate the comment

@@debbietaylor20 definitely

It's a fine combination and makes some sense from a neurotransmitter perspective targeting specifically dopamine and norepinephrine (more activating). I have not used this combination as much as desvenlafaxine or venlafaxine with mirtazapine but I can see why someone would prescribe this combination. I appreciate the support and the comment

I've just started wellbutrin 150mg. Combo with remeron (mirtazapine). I take 30mg at night and sleep like a baby. But take an hour before bed and not if you can't sleep 8hours at least. Knocks you out. Works well half tablet too... Not noticed weight gain yet, but do crave food more, but ate little when I was more depressed so so far it's a good thing.