Your experience with mirtazapine?

August 15, 2020 9:30 AM

Just started taking mirtazapine. Does it get better?

My doc added 7.5mg mirtazapine to my 300mg bupropion, to help alleviate general anxiety and, hopefully, insomnia. I started taking it last night. It definitely helped me sleep, but, 12 hours after taking it, I am still cloudy, groggy, and woozy. I’m pretty useless, as it sits right now, and this is only my first ever dose.

Do these effects eventually lighten up over time, or is this what it’s going to be like on mirtazapine? If this is what it is, I’m not sure I’m going to even take a second dose tonight.

(fwiw, my doc tried adding cymbalta to my buproprion earlier this summer, and it was horrible. it took me quite some time to ween off it, even though I hadn’t taken it very long.)

posted by Thorzdad to Health & Fitness (23 answers total)

Mirtazapine (Remeron) was one of the worst drugs I've ever taken (FWIW, I have tried every SSRI, SNRI, TCA, some MAOI's... I've taken the fucking kitchen sink over here, and had lots and lots of bad reactions, so don't necessarily use me as a gauge for how your experience will be).

After my 2nd dose, I had a weird disassociation, which is something I've never had before, and never since. I felt completely disconnected from my body in a third person sort of way. I had sleep paralysis for the first/only time in my life. I only took four doses and had to stop, and the side effects persisted way longer than the half life of the drug should have let them. Drowsy and sedated were understatements in my case. That shit fucked me up for a couple weeks.

Also, check your memail, yo.
posted by furnace.heart at 9:55 AM on August 15, 2020

I had an okay-ish experience with mirtazapine about ten years ago but the grogginess on waking is real, I noticed it particularly when I started tapering off by taking it every other day, and the mornings after I hadn't taken it I was noticeably clearer-headed and found it a lot easier to wake up and get out of bed. I distinctly remember it knocking me out faster than anything I'd ever taken in my life the first night I took it, and in retrospect that sensation did lessen and waking up did get a little easier/more manageable the longer I took it, but the sleepiness was disabling enough that I once overslept on it to the point that I failed to show up to a job that started at noon.

At the time I read a lot of anecdotal accounts of this getting better as the dosage is increased (people taking 30mg or 40mg complained of less sleepiness than people on lower doses), but I only ever went as far as 15mg so I don't know from personal experience how true this is. If sleepiness is inversely correlated with dose, though, it stands to reason that you're getting the worst of this particular symptom at a dose of 7.5mg; it might be worth asking your prescriber if they've seen this effect before and whether raising the dose might help.
posted by terretu at 10:37 AM on August 15, 2020

I was groggy and sleepy on it as well. I tried that before going on bupropion, which was AWESOME for my depression, not so good for my anxiety and being on edge. My doc added Buspar, which really helped me with the anxiety. Good luck!
posted by kellyblah at 11:28 AM on August 15, 2020

I take it for sleep (with a half-dozen other drugs), currently at 15 mg, but I've taken up to 60 mg, divided. I think the morning grogginess gets somewhat better, but due to the severity of my insomnia and disability I'm willing to accept being less functional in the morning than a lot of people would, I think.

It does give me restless legs at night sometimes, about an hour after taking it. I've found that keeping my sodium down helps minimize that and an iron tab when it happens will relieve it, and at 15 mg I only need one or two iron tabs a month for that.
posted by jocelmeow at 12:15 PM on August 15, 2020

+1 on mirtazapine being the worst mental-health drug I have ever tried, and I've tried so many of them. I think I stuck it out for almost a week, but I was so nonfunctional that I couldn't get any work done, and that is a non-starter as a treatment. I wasn't just sleepy and foggy; I felt like I had some kind of knock-out mental flu.
posted by wens at 12:21 PM on August 15, 2020

I took it for insomnia, and it did get better over 2 weeks. Most insomnia drugs have grogginess. However, the weight gain side effect is real, and I didn’t stay on it for more than a few months.
posted by Valancy Rachel at 12:46 PM on August 15, 2020

I think it is is really best to take if you are extremely depressed and anxious and it’s presenting with not sleeping or eating, have stopped going to work and meeting friends or meeting general obligations etc. That was how I was when I took it and for me it really helped... I did, however, gain a lot of weight and I stopped taking it when I felt a little better.
posted by pairofshades at 12:51 PM on August 15, 2020

It's been great for me, which just goes to show how individual mental health treatment is, looking at the comments above.

Getting onto it was a process, for sure, but a much less awful one for me than getting onto SSRIs ever was (they ramped my anxiety up to unbearable levels). It's relatively fast acting, it lifts mood in the space of about 2 weeks IIRC, compared to maybe 6 weeks for a lot of other ADs.

However - mirt and tiredness and grogginess are definitely a thing, and a weird thing, at that. There seems to be a consensus online among folk who've taken it, that the drowsiness is worst at low doses. Seems crazy that that should be true, but everyone swears by it. I started on 15mg, went up to 30mg then 45mg and the constant grogginess did seem to alleviate through that process. Whether that was due to the changed doses or just my body acclimatising, I'm not sure. But you might find, counterintuitively, that increasing your dose will reduce the fatigue and grogginess in the beginning. My GP pooh-poohed the idea, but pretty much everyone you can find online who's taken it says the same.

I did still feel a certain level of fatigue at 45mg, though I could function OK on it, and it was worth it for the mental health benefits. After being at that level for a while, I decided to drop my dose to 30mg see what happened, and on the way down, the drop alleviated the tiredness to much more manageable levels. I dropped again to 15mg a while later and now I feel totally normal fatigue-wise on that dosage, though I also sleep like a hibernating bear at night, which is lovely.

It's been great for my anxiety and mental wellbeing.

The other main side effect is that you might find, especially a higher doses, that you cannot. stop. eating. Being on 45mg was an eye-opener for me in that I finally understood viscerally how it must feel to have issues around food that make it genuinely hard to stop eating. I used to think that if you had put something sweet in front of me, I could no more have resisted eating it than I could have resisted breathing.

That said, my total weight gain over a year or two was maybe 8lbs, which I was able to lose by watching what I ate after I dropped to a lower dose and lost The Appetite.

Wishing you the best - it really has been the bomb for me, I hope you settle on it too soon. Trying to find the right mental health meds can be a cruel experience in the middle of an already-cruel-experience, so I'm sending you solidarity and love and fortitude from a fellow traveller.
posted by penguin pie at 1:19 PM on August 15, 2020

I only took it once because it made me horribly afraid of the dark and didn't help me sleep.

So uh. No info on longer term use.
posted by bile and syntax at 3:11 PM on August 15, 2020

This drug has significantly changed my life for the better. Mental healthcare is super individual, so ymmv, but I found that the grogginess wore off in about two weeks. It was a really weird drug just start, for sure. I also had very vivid dreams and a voracious appetite (I gained ~10 much-needed pounds pretty quickly), both of which have subsided. Best of luck and take care.
posted by k8lin at 3:23 PM on August 15, 2020

YMMV with psych meds, as can be seen from above. I took it as an AD and for insomnia. It worked for sleep, but I was groggy in the AM. It worked as an AD for about 6 weeks and then pooped out. MD raised the dose. Rinse and repeat for months on end. I maxed out on it. It made me GAIN weight. Like probably 50+ pounds. Really, it's the second worst one I've taken aside from Prozac that caused such severe insomnia it made me suicidal.
posted by kathrynm at 6:13 PM on August 15, 2020

Also a big no from me. I regret taking it, and I only took it for maybe 2-3 weeks. (Don't actually remember the full duration because it was so terrible an experience that I have honestly shoved it out of my mind.) It gave me grogginess with night terrors. Like, I was groggy and hallucinating with it.
posted by Kitchen Witch at 7:27 PM on August 15, 2020

I took it for about a month, and it never stopped being awful for me. I still have complete memory blocks from some of that period. I felt like a total zombie. But the one thing I’ve learned from my years of antidepressants is that mileage varies wildly. It’s all shots in the dark, really.
posted by The Underpants Monster at 9:26 PM on August 15, 2020

I have nothing but good things good things to say about mirtazapine. My anxiety presents itself as insomnia, which I have been battling for 35 years. I took all sorts of SSRIs, but they never helped in any significant way (side effects always worse than any slight benefit). I swore off all SSRI's the last 15 years and (reluctantly) agreed to try mirtazapine after a horrible insomnia stretch about a year ago. I take 15mg at night and my sleep has improved dramatically. I also find my baseline anxiety level is significantly reduced. I did not have any grogginess issues and have not gained weight. I am pleasantly shocked at how well this has helped. Having dealt with anxiety my entire life and having tried this drug and that drug over the years, I don't think mirtazapine is any panacea, but it certainly is a welcome addition to my current arsenal.

Of course, as with all of this, YMMV (well, it will vary - not might!).
posted by gingerjules at 9:31 PM on August 15, 2020

You could offer me tens of thousands of dollars to take that again, and I would turn it down.

I took it for about 6 months,
The first couple weeks were ok. IIRC, the initial grogginess was short lived and decreased, counterintuitively, after the dose was upped. (This was expected / predicted by my psychiatrist).
The remainder of the time I was on it was quite bad.
Greatly disrupted my sleep (and my partner’s — due to severe RLS*, which disappeared as soon as I stopped Mirtazipine)
At the time I started, I needed it, for severe anxiety that was making it difficult to eat.
But I stayed on it too long and Greatly regretted that I had.

* confirmed by an inpatient sleep study performed soon after I started mirtazipine - the tech had videos showing my feet kicking, well, feet into the air. “No wonder you’re not getting any deep sleep “
posted by armoir from antproof case at 11:05 PM on August 15, 2020

P.s. FWIW, I do vaguely remember I did experience a noticeable improvement in symptoms (morning fog) after I started taking it earlier in the evening, rather than just before going to bed. I remember reading or theorizing that it needed some more time to digest and begin to metabolize, before sleeping, to minimize the hangover effect. Might be worth a try. Good luck Thorzdad.
posted by armoir from antproof case at 11:11 PM on August 15, 2020

I did Mirtazapine for 2-3 weeks for general depression when I was younger when I had issues sleeping and low appetite. It did address both symptoms, but almost like one was stoned, a persistent hunger and very drowsy the entire waking day. Couldn't see how I could live on that and had to switch off.
posted by artificialard at 12:28 AM on August 16, 2020

I am super sensitive to side effects of SSRIs (GI upset primarily) and have been taking Mirtazapine for about a year. It is apparently more sedating at lower doses. I recommend trying to push through the first few weeks of ramp up. I felt fine by about 30 mg. (I take 60 now)
posted by radioamy at 12:20 PM on August 16, 2020

I was also given low-dose mirtazapine (7.5mg) after experiencing insomnia while on bupropion. Prior to the mirtazapine my psych had tried trazodone, which would eventually put me to sleep but caused grogginess for ~4-6 hours after waking, even when I took it early in the evening and rigorously followed strict sleep hygiene. By comparison, the low-dose mirtazapine was much gentler in putting me to sleep, and I only experienced significant morning grogginess for a few days. It stabilized within a couple weeks, and my anxiety evened out despite some very stressful life circumstances at the time. I also put on some much-needed weight.

I took it for a few months before noticing that I was having some memory problems, and decided to cut my dose to 3.75mg for awhile. Eventually the nighttime carb/sweet cravings combined with the intermittent memory issues led me to taper off the medicine. Now, a year later, I'm finally all the way off of it -- and what a hellish ride it was to withdraw from the thing!

I've read a lot of the scientific literature and supplemented that with reading patient forums (all taken with a grain of salt, of course). It seems from the patient forums that severe discontinuation symptoms are more likely when higher doses are taken for longer amounts of time, and that great care needs to be taken when stepping down the lowest doses. I wish I had known when I started that it would be difficult and time-consuming to taper off of mirtazapine, because I would have gone off of it much sooner.

That said, I found that the mirtazapine/bupropion combination really did wonders for my anxiety. If I had a job where small intermittent memory issues wouldn't impact me very much, I might still be on it.

Best of luck to you in your psychiatric journeys.
posted by graticule at 2:33 PM on August 16, 2020

I took this stuff for the better part of a decade with mixed results. Eventually I dumped it because of some physical side effects that caused me to lose even more sleep than I already do. Looking back at it my intuition is that it permanently impaired my memory which was otherwise relatively strong before I started treatment. I have been off the stuff for well over a year and am still memory-impaired out of proportion to my aging.

These things work so very differently for each individual, but count my tale as a cautionary one.
posted by majick at 4:52 PM on August 16, 2020

I pretty much share what Valancy Rachel experienced: it helped me sleep when I needed it (grad school anxiety) but I gained a lot (maybe 20 pounds? I'm very short) of weight, Did not seem to affect me cognitively as I actually managed to stay in grad school this time, with its help.

I went off it in spring of 2018 after about a year on it and still haven't shed most of that weight.
posted by LoonyLovegood at 6:01 PM on August 16, 2020

I tried it for about a month. For me, the negative side effects didn't taper, and were severe enough that I stopped taking it. (I was sleepy all the time, and hungry. On the plus side, my sexual appetite & capacity for orgasm also both skyrocketed. That bit was quite fun.)
posted by yesbut at 12:07 AM on August 17, 2020

Thank you, all. I’ve gone off the mirtazipine. I lasted roughly a week before I just couldn’t handle it anymore. On the plus side; pretty interesting dreams, longer sleep for a couple of days (though, that didn’t last, unfortunately)

The negatives, though, were unsustainable. Primarily, the increased anger was shocking and worrisome. It almost seemed that the mirtazipine was converting my anxiety into anger. Even my wife noticed the change. Little things were sending me into fits of rage. With the anger came a resurgence of self-harm, something I haven’t dealt with in a long time. I just couldn’t put up with it.

Since discontinuing, my mood has turned for the better, thankfully. I really hoped it would be a positive addition, but I guess it wasn’t to be. And, yeah, that being constantly hungry was nuts. Again, thank you all for sharing your experiences.
posted by Thorzdad at 7:37 AM on August 28, 2020