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Ideas & Opinions Medication History

MrBlue

SF Supporter
#1
I first went on antidepressants around 2005, Citalopram was what I was prescribed for major depression. I can't remember the dose, but I am sure it was low to begin with. After around 5 years we added in Bupropion 150XL and I was up to 40mg Citalopram for the last couple years.

I did a taper during Summer 2020, about 3 months to get off the Citalopram and then I quit Bupropion about 2 months later. I wanted to get off of the meds, due to the side effects (constipation, dry mouth, irritability/anger, sexual issues, yawning, numbness/apathy). I had a relapse in December, more detail about my history in the "My Story" section.

I went back on meds on New Years Eve, 15mg Mirtazapine for 1 week, followed by 2 weeks at 30mg. My depression seemed to be improving, but I was feeling very uncomfortable. I am keeping a journal and was really trying hard to pay attention to what I was feeling. It felt like Akathisia to me, based on closest description I could find online, which is like a restless feeling of needing to move. Felt kind of like restless legs, but in my mind and body sort of thing. So, we switched to Zoloft 50mg and have been on it for a week. However, I can't sleep on the Zoloft so I have been taking 15mg Mirtazapine at bedtime to try and get some sleep. I am only getting about 6-1/2 hours of sleep a night right now and feeling kind of a restless & energized type of tired. Kind of like you are tired, but drank too much caffeine kind of feeling so you can't sleep.

Scenarios I would like to discuss:

1. I didn't stay on just the Mirtazapine long enough for things to smooth out? I was sleeping really good on just the Mirtazapine and having glimmers of good feeling, should I go off the Zoloft and get back to the 30mg of Mirtazapine and wait longer? I was still having bouts of severe crying and that sort of thing.

2. I have read about combining Mirtazapine and Effexor with very good results. Do you think Effexor would be a better combo than Mirtazapine/Zoloft? I have read that Effexor is more likely to allow for better sleep than Zoloft and maybe not the restlessness I am experiencing.

3. What about Effexor only, if I could sleep better on the Effexor maybe I wouldn't need the Mirtazapine at all?

4. Zoloft only. Perhaps with more time on the medication my nerves will settle down and I will be able to sleep w/o any other supplemental drugs?

32 days now on new meds and still seem to be struggling, it is getting frustrating. *blue

I am going to send these questions and concerns to my doctor today, so no worries there. Just wanted to share what I am going through and see if anyone has any thoughts or experiences with these drugs?
 

Harmony

Well-Known Member
SF Supporter
#3
Hi MrBlue,

These scenarios are well thought out and warrant serious consideration. I'm glad you will be speaking to your Dr to address the situation. Sometimes the side effects of antidepressants are worse upon initiation but later subside. However, that is not always the case and I would be somewhat apprehensive to try a full course of the meds which were causing you the unpleasant side effect unless there really was no other alternative option.

I know the venlafaxine/mirtazapine combo had received great acclaim in the past so much so that it had been coined "California Rocket Fuel" however, I remember it was concluded that there really wasn't substantial supporting evidence of the efficacy and the benefit derived from this combo had been attributed to the placebo effect. So there really wasn't much of a synergistic effect going on as originally believed. That being said, you might very well be able to give venlafaxine a try on its own and see how that works out. My personal belief is that less (if possible) is always more when it comes to meds.
Best regards
 

MrBlue

SF Supporter
#4
Is it your GP who is prescribing these?
Yes, I am working with my GP. They have a Psychiatrist on staff at this clinic, but when I met with him I did not get any valuable feedback. At least my GP seems to really care, listen, and provide feedback.
 

Sunspots

To Wish Impossible Things
Safety & Support
SF Supporter
#5
Hi MrBlue

Everybody reacts very differently to medication and there are a myriad of different combinations.

1. I didn't stay on just the Mirtazapine long enough for things to smooth out? I was sleeping really good on just the Mirtazapine and having glimmers of good feeling, should I go off the Zoloft and get back to the 30mg of Mirtazapine and wait longer? I was still having bouts of severe crying and that sort of thing.
My psychiatrist always made me stay on a medication for at least three months (normally six) as she says it takes that long to get the full effect. But that could just be her way if doing things - she's a bit of a pain in the arse.

3. What about Effexor only, if I could sleep better on the Effexor maybe I wouldn't need the Mirtazapine at all?
I was put on effexor by my GP - she specifically chose that one as she said it is known to be non sedating and can boost energy. I was still on it when I first saw my psychiatrist several years later and she immediately took me off of it as I was having trouble sleeping.

I'm glad you're talking to your doctor, hopefully they can come up with a solution for you.
 
#6
The psychiatrist might be more capable in prescribing meds, but a GP is usually able to handle prescribing antidepressants, and I like how she's relating to you well.

I'd recommend paying particular attention to recommendations that @Harmony, makes, as she has professional credentials in this area.

This link has some info on treatment methods. You might want to check out the self-treatment and alternative treatment sub-links in particular.

Treating Depression, Anxiety, Insomnia, Pain; Other Suicide Help

venlafaxine might be good, but I think it also can produce side effects like constipation, dry mouth, and sexual issues that you were having with other medication. I've also read that it can increase the risk of suicide, which worries me a bit.

Idk. I like how mirtazapine was helping you with sleep, though there were clearly some problems with that too.

If you read up about different medications, and your doctor knows what symptoms you've got and what side effects you'd find tollerable or intollerable, that might help you get the best medication.

Just my 2 cents, I hope it all works out.
 

MrBlue

SF Supporter
#7
Thank you for your responses, much appreciated.

I just sent the message to my doctor through their portal but it can take a few days to get answers back as everyone is so busy right now. I am glad the scenarios made sense to somebody who knows what they are talking about, I did put a lot of thought into it.

I originally really liked the idea of the Mirtazapine for several reasons.

1. Different class of medication than what I had before, was wanting to try a different approach and hopefully not the same side effects I had been dealing with. The constipation gets really bad and I already went 3 days this week w/o a mvmt on Zoloft, even taking daily Citrucel. I wasn't having that problem on just Mirtazapine.

2. Help with sleeping as I had not been sleeping well. One less pill if I don't have to take something to sleep, so less chance at more side effects.

3. Mirtazapine is also a strong antihistamine and I have bad allergies so a 'good' side effect. One less pill if I don't have to take a separate allergy pill, so less chance of more side effects like dry mouth or anxiety from that.

Yes, I probably should have stayed on Mirtazapine longer before bailing. 3 months is a long time, but I probably should have gone at least 6 weeks. Here is the thing, I didn't know what I was feeling and if it was a side effect that would go away, was it normal, was it really bad? It felt 'different' than anything I had felt on my old drugs, but that was an SSRI. So, called to get advice and talked to my doctor late on a Friday, but she wasn't sure and was going to get back to me on Monday as at this point I had just met with the Psychiatrist a few days before, but I got off the phone feeling left hanging as far as answers. Well...I didn't get a call back, turns out she was waiting on the Psychiatrist to get back to her. So he did finally call me, first he said increase the dose, I was like for a side effect? He said, well if it is a side effect go ahead and switch, it just felt so like do whatever and no explanation or understanding of what I was feeling. Hence why I am working directly with my GP now.

The story on the Zoloft is that my doctor had offered a couple of options on which antidepressant to try. We agreed to Zoloft first but changed my mind after I read about it and saw it is more like Citalopram (SSRI) and we talked about basically the 3 bullet point above, so she called in the Mirtazapine instead, but I had an unfilled Zoloft prescription.

Long story short...I took the Zoloft kind of as a knee jerk reaction as I was not doing that well, feeling suicidal, which is historically not that normal for me even when I am down, but it has been this whole bout which is about 6 weeks now. So I kind of went into crisis mode and filled that prescription while I was waiting to hear back as it took over 4 days since I had called late on a Friday and didn't hear back until Tuesday. I told my doctor what I did when she called, I had only taken 1 pill, and she agreed to let me give it a try. I just felt so immediately over energized on it, that is why I am taking only 50mg, the script was for 100mg. My original intention was to only do the Zoloft, but I couldn't sleep so added the Mirtazapine back in because it was so effective. However, I did some research and turns out the Mirt/SSRI combo can be a good combination so I felt like maybe it is the right path even if sorta by chance. I don't want to do another knee jerk reaction, so trying to gather some knowledge and opinions first.

Imagine that, a depressed and suicidal person doing something that maybe wasn't quite correct to try and alleviate their pain in a pinch! *wacko I know I am writing a lot, but it helps me sort through everything and document what I am feeling. I am keeping a journal, but much easier to type it in here and I put more thought into it if I know somebody is going to read it and...better yet maybe I learn something from the vast knowledge base of this forums members!
 

Sunspots

To Wish Impossible Things
Safety & Support
SF Supporter
#8
What time of day do you take your meds? Do you take the Zoloft in the morning and the mirtazapine at night?
 

MrBlue

SF Supporter
#9
What time of day do you take your meds? Do you take the Zoloft in the morning and the mirtazapine at night?
Yeah, I am taking them as you stated, Mirtazapine at night and Zoloft in the morning. My doctor wrote back already, she suggested that I continue taking Zoloft at 50mg along with the mirtazapine at night for another week and then try going it on the Zoloft alone. She also stated I might send these questions to the Psych for his opinion, so I did that too.

I dunno, I was kind of leaning towards a gradual transition back to the Mirtazapine as I don't think I gave it a fair shake. Was thinking of at least trying 30mg tonight instead of the half pill and see if I sleep better.
 

Ash600

Of dust and shadows
SF Creative
SF Supporter
#10
Hi there,
If you can, wait to see what the Pysch says before you do any tinkering with your med dosages. Ramping up the dosage of Mirtazepine combined with Zoloft could leave you open to experiencing side effects. Now what you don't want, is to raise your serotonin levels to the point it may trigger serotonin syndrome. It's generally accepted to allow the specialists (psych-docs) to manipulate the dosages and also monitor on an individual basis. Hang back if you can pal til you hear back from the p-doc. I know it can be frustrating when it comes to realising positive results from meds, but particularly with these types, patience is the key.
 

MrBlue

SF Supporter
#11
Hi there,
If you can, wait to see what the Pysch says before you do any tinkering with your med dosages. Ramping up the dosage of Mirtazepine combined with Zoloft could leave you open to experiencing side effects. Now what you don't want, is to raise your serotonin levels to the point it may trigger serotonin syndrome. It's generally accepted to allow the specialists (psych-docs) to manipulate the dosages and also monitor on an individual basis. Hang back if you can pal til you hear back from the p-doc. I know it can be frustrating when it comes to realising positive results from meds, but particularly with these types, patience is the key.
Okay, I got word back from the doctor today and this is the approved plan.

Going back to Mirtazapine 30mg before bed, no Zoloft. I really want this one to work and have been reading some very good things about it, including on this forum. I am buying in for the long haul, admitting to myself that there may be some growing pains until my body adjusts to it. I agree that the combo was probably too much Serotonin and it was making me jittery, but I was hesitant to stop taking the 15mg Mirtazapine, due to sleep issues. The good news is, since I never went off the Mirtazapine, just reduced it to half a pill, I have over 4 weeks of continuity now so should be relatively smooth change to make.

My wife and I discussed and no more job hunting or interviews until this is sorted, that was causing me a lot of anxiety. I think I have been putting a lot of weight on myself over losing my job, I am going to let that go. Thankfully, she has a good job and we are in good shape financially for now. I am doubling down on getting more active with exercise and doing activities around the house, I took a walk with the dog today and going to lift some weights here shortly.

I feel more relieved to have a good plan in place that will carry me through until my actual doctor appointment next week. I should have a pretty good idea how this transition is going by then.

I will report back on how I sleep tonight, last night I only got about 6 hours tops, woke up at like 4:30 AM. I am learning that I think I am better off to just get up once I realize there is no way I am falling back asleep, laying in bed wishing and hoping seems to be bad for me mentally. Do any of you have tips specifically on falling back to sleep if you wake up in the middle of the night?
 
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Sunspots

To Wish Impossible Things
Safety & Support
SF Supporter
#12
Sounds like an excellent plan *thumbsup

Do any of you have tips specifically on falling back to sleep if you wake up in the middle of the night?
For me I find getting up and going downstairs helps. I'll make some hot chocolate and something small to eat like a yogurt. Turn the lights down, lie down on the sofa under a warm blanket, put the TV on and I'll normally be asleep within half an hour or so.
 
#13
There's this sub link

Specific Info for Insomnia

In particular, I'd say it might help to get up and do a sitting meditation practice when you can't sleep.

Too much stress and too much thinking are probably part of what is driving your insomnia. I think the plan you made with your wife to hold off on job hunting sounds good. If you can find other ways to lower stress and be less mentally active, that might help too.

I'm glad that you're getting support from your wife, and I think your medication plan sounds good.

Eliminating consumption of sugar and sweets, alcohol, and caffeine might help. You might also want to try eliminating anything served cold or raw, as well as pre-cooked and chemicalized foods.

I hope something can help.
 
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MrBlue

SF Supporter
#14
Good info on the insomnia, I appreciate it.

Yesterday, I was feeling quite a bit better by evening and worked on a puzzle after dinner.

I took the MTZ at 9:45 PM and laid down at 10:15 PM last night, woke up at 7:50 AM this morning. I recall waking up 2 times, but I was able to get back to sleep pretty quickly. So, about 9-1/2 hours, felt really good as I was a bit sleep deprived.

*woohoo

Today I have been doing better, no tears yet so that is good. Moderate energy levels, no 'wired' feelings, overall doing pretty good. Seems to be as the Zoloft leaves my system, everything is settling down. Now, to see if my mood sustains as the last of the Zoloft goes out. I also will be on the lookout for the feelings of Akathisia I felt before, at 30mg of MTZ, so far not at all so perhaps a side effect that goes away or is manageable.
Thank you all for your support. *grouphug2
 

MrBlue

SF Supporter
#16
I took a step backwards over the weekend, went through some rough patches, but seemed better today. I feel like I had to go through the Zoloft slowly leaving my system and the Mirtazapine ramping up after raising it back up from 15 to 30mg. A full week now since the adjustment. Was hoping it would not get too ugly, it got bad enough for a couple tear-filled meltdowns and back to feeling like I wanted to get off the bus, but surprisingly woke up feeling alright. Getting ready for bed now, hopefully I sleep good and tomorrow is better still.
 

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