Thank you for sharing! 🙏🏼

Wait till you start getting the issues! There highly addictive for one and I kept getting seratonin syndrome and nobody could tell me what the issue was!

@@EMPERORSPROTECTION-TERRA4LIFE no issues at all, nothing but benefits. I know about serotonin síndrome and that hasn’t been a problem. You may have taken something else in addition to mirtazapine to trigger that in the first place

@@pauls4923 😂 not at all! Read everybodies relies about the nightmare they are going through because of this addictive drug and how the doctor ignored the basic question to “explain why we need to wean off a non addictive drug?”. It’s an addictive drug simple as that

@@EMPERORSPROTECTION-TERRA4LIFE it’s a drug that has been a complete and total lifesaver for me and for many others. I don’t care if it’s addictive if it’s going to relieve overwhelming anxiety and depression. Thank God I’ve found it! I’ll be on it til death.

That’s good to know. Thanks for sharing

Thank you for your feedback

That’s good to know!

Thank you for your feedback 🙏🏼

Can I ask how long you were on it and what mg? Thanks 😊

Anna if you dont mind answering, what was your plan for withdrawal and how long were you on Mirtazepine? I am having problems with insomnia and worry about taking an antidepressant just for it, but seriously considering Mirtazepine

Thank you for your feedback 🙏

You do know that there’s not any proof whatsoever that a chemical imbalance causes depression ,It’s a theory and a bad one at that before you start your journey into Western psychology via big Pharma read a book called toxic psychology you might even question going into this profession if you have any morals

Thank you for your feedback 🙏🏼

Yes it's the antihistaminergic effect for some. Theoretically increasing the dose reduces it but increasing dose is indicated in anxiety / depression. There are other agents that can also address insomnia - we have done a video in insomnia. How to Evaluate and Treat SLEEP PROBLEMS and INSOMNIA? - A Quick Guide | Psychiatrist Explains kzfaq.info/get/bejne/iNiUq5Ri16rFaaM.html

Thank you for your feedback. 🙏🏼

You are wrong my friend, on the contrary, it made a change in heart rhythm. Ventricular extrasystole is one of the most obvious side effects of mirtazapine, I experienced it.

❤

@@umutrgp9269 can I ask what mg you was taking for this side effect to happen?

Thank you for your feedback. Really appreciate it 🙏🏼

Chemical imbalance in the brain is a theory for depression there is not one study that shows it causes depression these medication’s are evil if the doctor suggest some of them run don’t walk to find a new doctor

That's good to know! Thank you for sharing 🙏🏼

Thank you for your feedback 🙏🏻

Thank you 🙏🏻

Thank you for your feedback 🙏🏼

Not effective for OCD compared to SSRIs / Clomipramine and other augmentor. It may provide benefits for secondary OCD worsening mediated by depression and anxiety

Weight gain and increased appetite are well known side effects. Both me and my sister and a neighbour all piled on the pounds when on it. I came off them a few years ago but have occasionally had one for insomnia when it's been bad 🌼

Now I understand why I don't get bad headaches anymore...Thanks for sharing ❤️

Yes, it has an anti histaminergic activity, which leads to sedation in the morning. Some people experience it more than others. In many cases, as tolerance to antihistaminergic activity increases with more prolonged use ( 3-4 weeks), this side effect should reduce. If it doesn't, and it affects daily activities, best discuss it with your doctor to consider the alternatives. Agomelatine is another agent that helps with sleep and is an antidepressant but does not lead to grogginess as it doesn't have antihistamine activity but instead has melatonin potentiation.

I had severe drowsiness when first taking it on just 7.5 mg. It was so bad that I had to cut it down to 3.75 mg. Now I’m up to 1/3 of a whole 15 mg tablet (5 mg). 😆

I increased from 15 to 30 two weeks ago and for the first time experience this side effect. I feel groggy and sleepy all day but at the same time feel more restlessness, especially in my hands.

Thank you for your feedback 🙏🏼

Thank you for your feedback.

Yes it is a shift than can be done after discussion with the doctor. Agomelatine is now also TGA approved for Generalized anxiety disorder. One important point is that the last 15-7.5 mg of mirtazapine should be done very, very gradually as if done quickly or suddenly can lead to rebound insomnia / agitation. So in practice low dose mirtazapine can be kept for longer while agomelatine is optimised and then attempted to stop. This depends of course on if agomelatine treats insomnia and if insomnia is a feature of anxiety in first place. Ps not medical advice

I will do this thank you so much ❤

What about deprel trazodone. Someone suggested me to after taper the mirtazapine 7.5 if I come on deprel trazodone it will help to come off from it then. I had really bad depression and anxiety and I have been using many different tabs and from last 1 and half year using mirtazapine 30mg and try to wean gradually but when I stopped after 5th night was hell 😢😢😢. I got reversed and again started to take back so now for 2 months I took 30mg and from last week taking 15mg. I hate taking these tabs or any tabs, doctors never help I made appointments for advice etc but nothing. I am not addicted to any drugs etc, my diet is healthy I walk support etc. If you will reply me back it will be big help ❤ Thanks in Advance

@@motherofprincesses5032 I finally just went cold turkey and took agomelatine straight away (it sucked) took 2 weeks to finally feel okay again and omg im sleep was aweful but agomelatine wasnt strong enough for my anxiety also my sleep sucked even after 2 months of taking it it wasnt like mirtazapine. The problem is im trying to find a med that doesnt numb my feelings because atm yes i feel good with my anxiety but due to this meds (or any meds) my relationship is copping it due to me not feeling as much and the sex life is fucked! Fukn mental health.

Thank you for your feedback 🙏🏼

Sorry to hear. Mirtazapine reduction should be done gradually (mainly the last dose) as the last dose ceasing can lead to a antihistaminergic rebound. This rebound insomnia can be managed with other options which can be discussed with the doctor. However, it's important not to leave the severe insomnia untreated. Wish you well.

@@PsychiatrySimplified Thanks for the answer. At this stage I'm considering psychotherapy. Another thing that is I get very itchy skin rash in random places all over my body that comes and goes . It started when I quit Mirtazapine and gradually it's getting worse to the point my fingers are so swollen I can't grab any item. I already have a visit with my GP to try to fix the damn rash. It drives me nuts especially in the evenings.

Not necessarily. Theoretically it should but that’s not seen in clinical practice. As its 5HT2C antagonism also contributes to weight gain / metabolic aspects

@@PsychiatrySimplified Thank you Doctor. So there’s no escaping the weight gain other than adding in glp1 or sglt2?🧐or maybe metformin?

Thank you for your feedback. Can't give advice here. In general for mood and anxiety - 15-30 mg is needed - higher doses may be needed for depression. The anti histaminergic antagonism generally means that anxiety doesn't arisen - but can happen in some - dose adjustments then needed. Usually waiting 3-4 weeks for response is recommended before increasing dose. This is of course best discussed with your doctor who will individualise treatment for you.

Te fue bien? Tengo miedo de que me siente mal y me cree demasiada adicción, y me rompa las noches

@@javi.r.acosta lo siento. Trata de hablar con su doctor. Buena Suerte

I know 9 months has passed since this post for me this medication helped, although I put on 40kg I was wondering if you have had any symptoms like this. Thanks for sharing

@@deant6361 That's f up 40 kg oh nooooo

Is that a recommendation to have tik tok. Not forayed there yet . Too much SM. 😁

Thank you for your feedback 🙏🏼

One of the things that is important to recognise is that while withdrawal symptoms can occur the effects of the underlying illness need to be considered. Take an analogy - the medication puts a lid on the underlying symptoms so individuals get back to a level of functioning. When this lid is removed while withdrawal Sx are part of medication being tapered if the underlying illness was not in complete remission in for a period of time then this underlying illness Sx also come.up this exacerbating the overall picture. Generally individuals that have reached remission for a period of time can reduce and cease medication with withdrawals being manageable and time limited. There are always exceptions. But the key aspect is many look at it the medication side without recognising that underlying Sx of illness many be playing a part. Hence why it is important to discuss this with your doctor and get appropriate advice. Many individuals see the medication as a single factor but untreated or poorly treated anxiety or depression can continue to worseen in many which can preset with many different symptoms. Hence why it's important to consider a medical evaluation. Wish you well

Exactly the same issue with me aswell as finding out it was causing seratonin syndrome. Absolute nightmare

@@PsychiatrySimplified I actually find this response very offensive and the reason the medication has not been labeled as causing these issues as the original comment or and myself as well as thousands of other people who took the time to write the same side effects online are clearly telling you the tablets cause these issues? Doctors are giving it to people for sleep issues! For anxiety! For depression! They don’t know they are highly addictive and cause life threatening issues!!!

@@EMPERORSPROTECTION-TERRA4LIFE Mirtazapine has a very low probability of serotonin syndrome ; doesn’t mean it can’t - but if it doesn’t happen in 100s of patients and happens in one individual then it can be indicative of certain factors that maybe associated - pharmacogenetics , neurobiology , associated agitation, nature of illness etc. causality is never straight forward . One if the criteria for causality is consistency . Why doesn’t serotonin syndrome occur in the majority of it is causal is the question to ask in clinical practice .

@@PsychiatrySimplified 😂

Please discuss this with your doctor. Insomnia is not a single entity - there are different sleep phases - your doctor will be able to advise

good 4 you

While we can’t give individual advice : in general if one is experiencing SE from a medication reduction and cessation will ease or stop the side effects. So Mirtazapine can be reduced to 15 mg for 4 days and then to 7.5 mg . It is this 7.5 mg cessation that can give an antihistaminergic rebound. For some patients they may need to be on this for a week or two before ceasing ; for others shorter or longer . One can only now by trying. During this period of cessation the doctor can prescribe another agent to treat the insomnia. This is general only and not medical advice. In general the shorter one has been on Mirtazapine the ‘easier’ it is to come off. However it is also important to identify the condition being treated - for mixed features ( video done) can be associated with worsening with antidepressants and presents with anxiety , hyperarousal , agitation. We also have a video on insomnia on the channel. Ps not medical advice. General only. Wish you well

Hi there again, Thank you so much for your very kind and informative reply ❤! Apologies for this but I wonder if you could please kindly clarify what you meant by “....worsening with antidepressants and presents with anxiety, hyperarousal and agitation”. Does that mean that Mirtazpine can cause such a response (anxiety, hyperarousal, agitation)? Thanks again 🙏♥

@@lcy_123 Antidepressant treatment is meant to improve activity, cognition and mood (experience of reward) without activating anxiety, or arousal in an ideal situation. When antidepressants worsen anxiety and increase arousal (restlessness, racing thoughts), this can be due to a mixed state (which is important to rule out) as ADs worsen mixed states. Your doctor will be able to discuss this more. We have a video on this. Search for mixed features.Any antidepressant can do this.

@@PsychiatrySimplified Thanks once again for your kind and informative reply🙏

As mentioned in the video 45 mg and in some cases higher doses of 60 mg are needed for the dopaminergic effects. This may be the case in patients that have ultra rapid metabolism or rapid metabolism of the CYP enzymes that metabolise mirtazapine. Clinically 60 mg is used and in some rare cases 90 mg are seen in practice ( this is not recommended) as max doses are 45 or 60 mg depending on countries.

Also when thinking about doses it becomes more important to identify whvj symptoms are being targeted. If anhedonia and motivation is an issue then dopaminergic and NE enhancers are needed. Since mirtzapine is induced by 3 cyp enzymes - many patients being rapid metabolisers or smokers may need higher doses. A fixed dose of 30-45 mg in some patients may result in a sub therapeutic effect. psychscenehub.com/psychinsights/pharmacogenomics-drug-prescribing-psychiatry/

@@PsychiatrySimplified thanks for the reply really appreciate it also if your smoking and need you more what about vaping?????

@@jaydavis1673 unlikely to do so as no poly aromatic hydrocarbons. But change from smoking to vaping could change drug concentrations as.smoking induction has stopped.

As the mirtazapine dose increases, the noradrenergic effect increases, which can be associated with the activation phenomenon. This usually occurs at 45-60 mg - and hence higher doses are used to treat anhedonia and psychomotor slowing.

Thank you for your feedback 🙏🏻

lenghty, l mean. it is pretty hard to continue like this - oh and my tinnitus aggravated during withdrawal

Thank you for sharing. There is one aspect to consider. The original reason. The causality works in the following way. Insomnia present ➡️medication prescribed ( gaba initially) ➡️ stopped ➡️ mild withdrawal gaba ➕original insomnia ➡️insomnia severity ⬆️ ( gaba not addressed by Mirtazapine ) Step 2. Mirtazapine prescribed after swap( anti H1) ➡️ insomnia treated Step 3 ➡️ Mirtazapine ceased ➡️ insomnia pre step 2 likely more in severity due to course and mild gaba withdrawal ➕antihistaminergic rebound ➡️ significant increase in severity ⬆️ ➡️ 2-3 mg addresing antihistaminergic rebound . But the severity of the insomnia is the missing piece. This is a common scenario where associations are made between medication and what comes after . But the original condition usually increases in severity ( insomnia usually does) over time which when combined with rebound or discontinuation phenomenon leads to a significant increase . The above is not set in stone and cannot be individualised to your personal situation. Also it is an hypothesis in general based on clinical presentations . Ps not medical advice.

Thank you for your feedback

Thanks for the feedback and good question. A mixed state indicates a bipolar trait - does not necessarily mean bipolar disorder. It indicates the propensity for activation phenomenon with antidepressants. Anxiety and depression occurring together is not usually what is called a mixed state - but anxiety can be a feature in mixed states. We cover mixed state here in this video where we go into more detail. kzfaq.info/get/bejne/nrx9gsWks9PSlmg.html Usually doses of >30 mg but in some even lower doses can ‘activate them’. Hope this helps.

Best of luck!

Have you put weight on as any say

@@hypnotherapist2211 Yes I have but I'm working on it

@@ralfj.1740 has the drowsiness stopped. I ask as I am on day 7 and yesterday I could not get out of bed . And feel dizzy when I walk..

@@hypnotherapist2211 Drowsiness in the morning should get better over time, will take several weeks though. I still take the 7,5 mg dose, it works good for me personally, hangover is not so bad anymore. However I must exercise a lot to prevent getting overweight, I get so hungry especially late in the evening, that's a challenge sometimes.

@@ralfj.1740 so far I have been ok food wise if anything I have a loss of appetite and I am on 15mg . Thanks for answering . Praying that the tiredness wears off soon. I am only day 7 :)

Good to hear .

There are many different options for sleep. Please check the video we did on Insomnia. kzfaq.info/get/bejne/iNiUq5Ri16rFaaM.html

Try exercise mirtazapine is garbage

There are multiple options here. Have you discussed ethics with your doctor. They will be able to develop a plan specific to your needs. In general options include - ruling out medical causes, reduction of dose , switch to agent that doesn’t lead to weight gain ( withdrawal symptoms can be minimised) and /or augmentation with agents that result in weight loss. Many options available. Wish you well.

Mirtazapine has better tolerability and can help with sleep and anxiety. Weight gain is a side effect ( doesn't occur in all patients) ; however if it occurs, diet, exercise and additional strategies are treatments for weight gain. There are alternative medication like agomelatine that have similar effects like mirtazapine but no weight gain and no withdrawal. Evidence-based for anxiety and can treat insomnia. P.S not medical advice psychscenehub.com/psychinsights/agomelatine-mechanism-action/

Thanks you 🙏🏼

lower doses do not have prominent alpha 2 A action. And it doesn't cancel out, it potentiates at higher doses. Mirtazapine is alpha 2 pre synaptic antagonist which does the ‘same’ ( re neurotransmitters) as a post synaptic alpha 2 A - guanfacine. Just that one is via presynaptic end ; other direct post synaptic

​@@PsychiatrySimplifiedthank you for your reply, so helpful! I was hesitant after what i read online but this reassures me. Interesting, so even at 7.5mg it should potentiate the guanfacine effects or higher dosage are needed for alpha 2 effects?

Thank you for your feedback. I’ve covered mechanisms overall - hoping it’s helpful Psychopharmacology of Selective Serotonin Re-uptake Inhibitors (SSRIs) - Mechanism of Action kzfaq.info/get/bejne/mL52lad3tdXNiHk.html

Antihistaminergic action. Possibly 5HT2C antagonism also associated with increased appetite.

It depends. Often when medication is prescribed. It depends on the underlying symptoms that are being targeted and the other medications that may be prescribed together. For example, in some individuals mirtazapine at a low dose may assist with sleep in schizophrenia or bipolar disorder. However, it is more likely to do so, when an antipsychotic medication is already present as the primary pathophysiology and schizophrenia and bipolar disorder is to do with heightened dopaminergic potentiation. Thus in treatment, it becomes important to reduce the heightening of the dopaminergic system, and then a medication, such as Morteza peen, maybe prescribed to treat residual insomnia. Similarly, if mirtazapine is prescribed at higher doses in schizophrenia or bipolar disorder where prominent affect of symptoms are present. This could trigger of a manic or hypomanic episode. In summary, unopposed antidepressants are more likely to result in issues in bipolar disorder, rather than if a buffer with a mood stabiliser and/or antipsychotic is created. Similarly, mirtazapine can be prescribed in schizophrenia and there is evidence for this once the predominant psychotic symptoms are treated. Hope that makes sense. another important point is that in bipolar affective disorder or schizophrenia. The mechanism of insomnia is different hence It becomes important for the clinician to delve into the details of the nature of insomnia. For example, is it difficulty falling asleep versus difficulty staying asleep, waking up several times in the middle of the night, vivid dreams, or nightmares, versus early morning awakening. Each one of these has a different mechanism that needs to be targeted differently. Hence, an individualised approach to insomnia becomes necessary. You can see this described in the video that I did on insomnia on this channel.

❤

It's not that straightforwsrd. 5HT2A agonist activity at the level that psychedelics do ( a intracellular ligand) much more powerful increases activity of salience network ( network that integrates external and internal stimuli) . Different individuals have different effects - in extreme cases that's what is associated with psychotic experiences, anxiety. It's context dependent as its linked to the stimuli. 5HT2 antagonism increases frontostriatal Dopamine so had antidepressant effect but also any anxiety effect. Antipsychotics have 5HT2A antagonism

This specific question is best answered by your doctor. In general however, if sedation is there but symptoms have settled - reduction of dose is one option. If symptoms return then a trial of increase may be considered.( here 30 mg can be significantly sedsting as well; 45 mg is meant to increase NA and DA to counteract sedation but this doesn't always happen) . Hence the steps above. Wish you well.

@@PsychiatrySimplified Thank you so much for your answer!

When you try and come off them you will regret ever taking them

@@EMPERORSPROTECTION-TERRA4LIFE I've taken Mirtazapine for literally 15 years - no exaggeration. 14 days ago I split my dose in half. 7 days ago I stopped completely. THE MOST severe effect I could report on is marginally less heavy sleeping/sedation and marginally less appetite. Anti Depressant witch hunt nutters are the absolute worst, most confounding, saddest life wasters I've ever seen on the internet.

@@goldmidwest ok so people who get wothdrawals are you saying they are lying?

Lunesta works through GABA pathways. There can be a risk of dependence. Mirtazapine works through anti histaminergic action . Weight gain is a side effect. It also has anti depressant and anti anxiety properties. Newer agents for insomnia include suvorexant and lemborexant - orexin antagonist that are not associated with risk of dependence. In insomnia it is important to rule out other conditions and consider medication that is targeted. Your doctor will be in a better position to choose and explain. Wish you well.

@@PsychiatrySimplified thank you Dr may God Bless you

Thank you . Really appreciate it

Yes 5HT2A antagonism and alpha 2 presynaptic antagonism

In it's classical sense not classified as a psychedelic. What were the reasons you think it is? Curious?

@@PsychiatrySimplified why does my reply keep getting deleted?

@@psilocybe8135 which one ? Haven’t deleted any reply?

@@PsychiatrySimplified I wrote two detailed replies but they both vanished shortly afterwards. Will try again.

@@psilocybe8135 weird

Mirtazapine typically does not lead to akathisia - it’s also a treatment for akathisia . Akathisia has a strict definition of a subjective compulsion to move. Mirtazapine can lead to activation phenomenon - and at higher doses can potentially also lead to akathisia. Usually 5HT2A activation leads to akathisia ( Mirtazapine is an antagonist) . One key mechanism is the NAc ( nucleus accumbens shell part being activated through noradrenergic dysfunction ) Antipsychotic induced akathisia is multiple mechanisms How to Diagnose and Treat Akathisia (Antipsychotic Side Effect) - A Consultant Psychiatrist Explains kzfaq.info/get/bejne/faiDh8qExrK5o5s.html

Noreandrenergic dysfunction meaning an increase in norepinephrine? Would an alpha blocker be a suitable treatment. If one is already in an hypaepsusd state, would mirtazapine exacerbate they hyperaoused state even further ? Is there evidence of over stimulation of the locus coeruleus in akathisia?

@@jamescullen-657 Have a view of the video on akathisia. It's difficult to give yes, or no answers as symptoms have to be put in context of overall presentation.

Thanks for the reply Sanil. So it sounds like mirtazapine can cause restlessness due to activation of norepinephrine and dopamine? Can restlessness look similar to akathisia?

@@jamescullen-657 Yes absolutely it can

Medication mechanism plus individual vulnerability (genes, illness characteristics etc)

Have a listen to this video as it will give an undertanding kzfaq.info/get/bejne/i9WDbLqJnZmoeac.htmlsi=Apbv_ikA1VY_-egr

Not usually a first line treatment for OCD or neuropathic pain. It may help with sleep but there are other antidepressants indicated for OCD / pain. These are usually SNRIs as targeting noradrenaline is needed in pain Mx. Importantly however a full evaluation is needed to rule out other conditions and understand the nature, severity and type of symptoms before the appropriate treatment is implemented. Ps not medical advice. Wish you well

@@PsychiatrySimplified thank you sir for your suggestion ❤️

Have you discussed this with your doctor when prescribed? Would advise you to do so. Mirtazapine Is associated with weight gain and sedation at these doses in most cases. The severity varies. Your doctor would be able to advise the specifics for you. Wish you well.

I have had huge weight gain on 30mg. I found 15mg to lesser of 2 evils overall.

It would be inappropriate to provide advice on this forum. There are several aspects to consider when treating insomnia. Your doctor is in the best position to answer this. Please view this video on evaluation of insomnia. kzfaq.info/get/bejne/iNiUq5Ri16rFaaM.html

Thanks for the question. Both have effects in DA increase 5HT2 C and A but with Mirtazapine the DA increase also happens via a 5HT1A effect. 5HT2A is linked to emotional blunting. Hence Mirtazapine reducing this. But 5HT2C is exploited by Agomelatine to reduce emotional blunting. Vortioxetine does it via increase in DA and NA via multimodal mechanisms . Hope this help. If you are a GP interested in detailed education that’s RACGP accredited 👉academy.psychscene.com as it helps with showing these aspects via case studies

@@PsychiatrySimplified thanks a lot

Risperidone is quite different from Mirtazapine. Risperidone has D2 antagonism and 5HT2A antagonism ( Mirtazapine also has 5HT2A antagonism). Mirtazapine has dose dependent effects as mentioned in the video - so there is a increase in DA & NA with higher doses - with higher doses risperidone reduces dopamine ( DA). Both can be used in depression but for different purposes. Mirtazapine lower doses mainly anti anxiety, higher doses to promote cognition , activity and mood. Risperidone is used in depression to reduce ruminative negative thoughts , agitation or over valued thoughts that are all consuming and negative. So it acts as an augmentation agent.

@@PsychiatrySimplifiedah okay that does make sense. That is probably why risperidone worked so well is because I do get ruminative negative thoughts and thought maybe this anti depressant would potentially do the same with those negative thoughts which have been a huge problem with my depression (my depression is persistent btw)

This is not an uncommon side effect. Mirtazapine another NASSA has a 28 % incidence of Restless legs . While we can’t provide specific advice in general - non cessation is usually due to a triggered sleep dysfunction which can be addressed by usually short term long acting clonazepam 1-2 weeks - which is also evidence based on rem sleep behaviour disorder and is usually the choice or clonidine which reduces rem sleep activation and increases deep sleep. However it is essential.l that underlying agitation is treated ( which may require longer duration of agents ) Here is a detailed review I wrote for references if needed. Please note this is not advice and any treatment should involve consideration of the underlying illness and an individualised risk benefit analysis. psychscenehub.com/psychinsights/neurobiology-sleep/

You may want to look at the video on clonidine ad guanfacine which are used in combination with stimulants to manage or reduce anxiety. Ps not medical advice kzfaq.info/get/bejne/is-fgJx_3tO-iJc.html

Seratonin syndrome is a common thing with this drug especially if you mix with other drugs

We can’t recommend or provide advice. In general Mirtazapine doses for anxiety are between 15-30 mg nocte. Wish you well

The antihistamine effect can lead to metabolic dysfunction , the 5 HT2C antagonism can lead to increase in appetite. The effect varies from person to person

Thanks for the reply. Is this a temporary metabolic dysfunction once the medication has been stopped or can it be permanent?

@@jamescullen-657 depends. If intervened early temporary ; reversible. But if diabetes has developed - again in some can reverse but this depends on their risk factors as well ; genes, lifestyle , etc

Dr. Sanil thanks for the reply. I am confused because I have read that mirtazapine does not have a direct effect on glucose causing high blood sugars. What is the mechanism in which it can lead to diabetes? Do blood sugars need to be monitored on this medication if someone is not a diabetic?

@@jamescullen-657 anti histaminergic related weight gain and metabolic dysfunction.

At low doses Mirtazapine has antihistaminergic effects and therefore can be sedating. This effect can reduce over time ( 1 wk) , or by increasing the dose where it be one’s more activating ( 45 or 60) . In some though this effect can worsen with increased doses. Your doctor should be able to explain the reasons for the choice and what to expect. Wish you well.

@@PsychiatrySimplified thanks for your prompt reply! :)

​@@PsychiatrySimplifieddoes the drug still work for insomnia and increased slow wave sleep once the antihistamine receptors down regulate?

It is not prescribed in this manner.

From an evidence based perspective this is not something that has been recommended.

It is generally medication that does not affect the heart. It can result in weight again which can affect cholesterol levels. It does not affect sodium and K levels: in the elderly > 65 yrs there is a small probability of a drop in Na levels.

Interesting comment as my cholesterol level is up and so is my weight gain.

@@youknowcrimedontpay9257 this can be counteracted or an alternative metabolically friendly antidepressant can be considered. Your doctor will be able to advise.

M

I'm sorry to hear. Agomelatine is evidence based in bipolar depression and does not activate as it does not increase DA.or NA in the mesolimbic system which where the mixed features ( irritability ,Racing thoughts, hostility, anger dyscontrol etc occur). It does not have anti histaminergic action so no weight gain. eating foods with histamine does not reverse weight gain. In terms of antidepressant effect it is important to recognize that depression consists of 3 domains. Activity, cognition and emotion ( low mood and sadness - which is different from emotional lability - difficulty controlling emotions ( more related to mesolimbic). So when one wants an ‘antidepressant effect - the question is what specific symptoms are being targeted. Amotivation slowed movement ( activity dimensions - linked to dopamine and NA); cognition ( attention and concentration, decision making ) - linked to dopamine in the frontal lobe; cognition -Thoughts) - guilt, hopelessness, etc. - PFC - amygdala ( so here, one has to look at both intensity and severity as both frontal lobe and mesolimbic system to be addressed). Agomelatine is a mild dopaminergic agent. There is hierarchy.of dopaminergic and Norsdrenergic agents. Similarly - sleep - ruminations before sleep - frontal - limbic ; racing thoughts - mesolimbic ; waking up multiple times - hyper arousal ( NA driven) / nightmares - NA driven ; early morning waking ( mesolimbic). So essentially the symptoms provide better info to choose meds rather than a diagnosis which is a label that does not take into account individual symptoms. Importantly the fronto limbic system is also involved in trauma. In adhd also fronto-striato ( read movement area) - limbic - in females however the presentation can be with mood deregulation as the frontal lobe top down inhibition is not present adequately on the limbic system - hence can present like mixed states. Overall a history and formulation based on Sx provides a management plan This is educational only and not medical advice.

Depends on what were side effects ? Usually combination of Mirtazapine 45 mg and Vortioxetine increases DA and NA , if underlying hyperarousal is present then this can be worsened. Therefore a history of what has improved and what has worsened helps understand what the next steps are. It’s a balance between calming hyperarousal and I improving cognition and activity . So it’s not possible to predict for an individual unless a detailed history of symptoms is taken . Your doctor should be able to explain the duration of response . Wish you well . Ps not medical advice

Ps - not medical advice. Mirtazapine can be combined with SSRI. Of course, this should be discussed with the doctor.

No direct evidence - but if activation occurs - it is a possibility.

This could be due to a few reasons in general (PS - this is not medical advice) - Olanzapine was treating the illness's core symptoms and cessation has led to a relapse. 2. Olanzapine cessation can lead to antihistaminergic rebound. 3. Combination of the two. Relapse of illness would be most important to rule out. We wish you well.

It depends on the individual. In some cases the higher the dose theoretically the appetite increase is mitigated but this doesn’t always happen in real world practice .

Is mirtazapine more effective alongside Sertraline for OCD or is the efficacy the same taking mirtazapine alone?

It is difficult to give personal advise on here. A full assessment should be carried out before any advice. Mirtazapine has a sedative effect and is effective for depression and anxiety. However mixed features should be ruled out. Please have a look at the video on mixed features. You can discuss this more with your doctor. Wish you well.

@@PsychiatrySimplified thanks doct! And One more question, does it create a sexual problem?

@@MySasis mirtazapine is amongst the antidepressants with lower risk of SD. It is in fact one of the prescribed agents to avoid SD. psychscenehub.com/psychinsights/sexual-dysfunction-with-antidepressants/

Mirtazapine is associated with weight gain - in some it can be independent of diet. Several other factors play a part - metabolic profile. Genes, diet , lifestyle , age etc. your doctor is in the best position to answer that question for you.

This question for individualised treatment is best answered by your doctor. In general however, it can be associated with metabolic dysfunction and weight gain. It is however not cardiac toxic and is not associated with arrhythmias or QTC prolongation to any great extent compared to TCAs or other antidepressants with QTC prolongation effects. Anxiety itself can be associated with cardiac conditions. Hence a risk benefit analysis should be carried out based on individual risks and after a discussion with the doctor. Ps not medical advice

​@@PsychiatrySimplifiedeven if patient does not overeat? weight gain still can occur? from sedentary lifestyle perhaps (less pacing, not as much figeting, more sleep) ? My vet said dogs don't lose weight with exercise, only if you cut food. Exercise makes no difference. Do patients claim they exercise when they don't I wonder?

We can't provide advice here. Early morning awakening needs an evaluation to rule out agitation etc ; please discuss this with your doctor. Wish you well

Thanks for the feedback. No it won’t. Mirtazapine is alpha-2 presynaptic anatagonist at higher doses ( increase NA and DA with potentiation on adrenergic and dopaminergic receptors . Guanfacine is more postsynaptic alpha 2 ( see video on Guanfacine - potentiates action on adrenergic receptors. So both will do the same potentiate. It’s because one is presynaptic other is postsynaptic. Presyanaptic receptors are autoreceptors ( inhibition) - so antagonism has opposite effect.

@@PsychiatrySimplified wow, that is brilliant. Thank you! I am a bit of a nerd (electronics engineer) but not in biochemistry or medicine, so it's all new to me. That pre/post explanation clears up a LOT of confusion. My experience so far is that they definitely do seem to work well together, at least with respect to 'turning down' the peripheral nervous system a bit it seems. I do also take Adderall. The guanfacine has virtually eliminated side-effects of the amphetamine, and really the only reason I'm on mirtazapine is sleep assistance. I really do feel like this is the first time in maybe 30 years in which I am on a drug combination that seems to be working. I have no side-effects. Guanfacine is a pretty interesting drug. I will check out the videos. Thanks again.

@@lisweetie1556 good to know that it’s working for you. Good luck and wish you well. Thanks for sharing.

@@PsychiatrySimplified thank you very much. I have subscribed to the channel. One thing that I think is interesting to note, simply because I've never seen it ever mentioned, is that the guanfacine also fixed my Raynaud's and acrocyanosis, something that I've had my entire life (before Adderall, too). The color of my skin would concern me, and I saw a vascular surgeon, who said, not to worry it is just a cosmetic condition (benign). He said it is from "sensitive nerves", which sounded like an over simplification lol. I didn't think much of it. But years later, when I added the guanfacine to my ADHD treatment, I noticed within just a few days that for the first time in my entire life, my skin was normal color, not red or dusky blue. It is still normal color. It would seem to me that the guanfacine must be doing something to help modulate/moderate the signaling in that system. Anyway I just thought I'd share that, because it was so profound. Thanks again.

@@lisweetie1556 you raise a very good point. Yes clonidine or Guanfacine both are treatments for this. Dexamphetamine or Ritalin are both associated with Raynauds or worsening of it. Because they act on alpha adrenergic receptors associated with vasoconstriction and increase in peripheral vascular resistance - also increase BP due to this effect. Clonidine and Guanfacine both treat this. It is a side effect that can be overlooked but many complain of this. I always mention this in teaching. Thanks for sharing