Mirtazapine: Does it get easier?
May 6, 2019 3:38 PM   Subscribe

I've been prescribed mirtazapine (also known as 'remeron') for anxiety and insomnia. It makes me feel terrible, but the doctor has told me to keep taking it even so. I would like to hear from people who've had a similar experience with the drug.

The doctor initially prescribed a dose of 7.5mg.

I felt dreadful the next day - I was so tired that even simple activities were a struggle. The doctor told me to half the dose, so I tried 3.25mg. Again, I felt terrible the next day.

Today, the doctor told me to keep taking 3.25mg doses, explaining that the side effects will wear out as I become accustomed to the drug.

I'm a little worried about taking a drug that leaves me feeling so tired, especially because I have a little baby to care for.

So ... does it get easier?
posted by HoraceH to Health & Fitness (17 answers total) 2 users marked this as a favorite
I had to stop after two weeks because I just couldn't function while taking it.
posted by goatdog at 3:53 PM on May 6 [1 favorite]

I had the opposite experience on mirtazapine (prescribed for depression after SSRIs pooped out). It made me feel good – too good. Eventually I had a full-blown manic episode and had to discontinue.

I remember it being good for my maintenance insomnia before that happened, though.

After that experience I did some informal research, and anecdotally it sounds like it is one of those agents that is a miracle for some people and a ten-pound sack of intolerable side effects for others.
posted by murphy slaw at 3:56 PM on May 6 [2 favorites]

It could get easier. It did for me. I had exactly the experience your doctor described. For the first little while it really knocked me on my ass. But after a week I could take it at bedtime, sleep extra soundly, and then wake up in the morning as well as I ever do.

Psych meds are absurdly different from one person to the next, though. You might have my experience, and you might not.

Can you do some strategizing with your doctor about how long you're willing to keep trying for, and what side effects you're willing to tolerate? It can be easier to deal with this sort of thing if the plan is "We're going to give it another X days, and then if I can't Y or I'm still Z we'll drop it" rather than "My doctor just says 'keep taking it,' and I'm scared he means 'forever,' and sooner or later I'm going to lose my shit."
posted by nebulawindphone at 4:07 PM on May 6 [1 favorite]

Nope, made me feel like I had been hit by a bus. Only took it again when wanting to be semi unconscious a couple times. Would never be able to function on it.
posted by Kalmya at 4:13 PM on May 6 [1 favorite]

I took Mirtazapine for insomnia and got the most unbearable restless legs (brought me to tears, woke up punching my legs at night ) and it did not help me sleep.

Switched to Trazadone, also an anti-depressant/insomnia med and it's been great!
posted by i_mean_come_on_now at 4:23 PM on May 6 [2 favorites]

I started on 15mg, worked my way up to 30, then 45.

While working my way up, I’d get to 2pm every day and then have to leave work and go home to lie down. How much of that was meds and how much the acute depressive episode, I’m not sure. Once I was settled on 45 I felt pretty tired the whole time, but able to function. I went down to 30 and felt fine, and slept like a baby, without being inconveniently tired most of the time.

Once I was settled on it, it was good for my mood, especially on 30mg (because the sleepiness on 45mg was kind of depressing in itself tbh).

That said, everyone’s responses to antidepressants are completely individual. Yes, there is often a tougher period of getting onto a drug to begin with, which doesn’t necessarily mean it won’t work for you in the longer term. However, I am eternally grateful to the GP who actually listened to me when I told him how horrific I felt trying to go onto an SSRI and told me to stop taking it. I still hugely resent the other GP who, on a previous occasion, insisted that despite feeling completely unbearable, I should plough on through going onto an SSRI because this was just a normal teething problem - giving me what was without doubt the worst week of my life as I dutifully endured (and the awfulness did subside, eventually, but I still don’t think it was worth it).

Tl;dr - Yes, it can work, for some people, not for others; and bad initial effects don’t necessarily mean it won’t work for you. But don’t put yourself through utter hell to find out. There are other antidepressants and other GPs.

Good luck, it’s horrible, but I promise you’ll feel better one day, however endless it feels right now.
posted by penguin pie at 4:24 PM on May 6 [2 favorites]

I was a wreck for two weeks, but was also withdrawing from trazadone, which often does that on its own. After that though, I was fine on 15mg mirtazapine.
posted by metasarah at 4:27 PM on May 6 [1 favorite]

Mirtazapine drowsiness/sedation is notoriously stronger at lower doses (has to do with the multiple effects the drug has). If you need more of the anti-anxiety(/anti-depressant) effect versus the sedation, you may need to work on increasing dose, not trying to adjust to a low dose.

Personal anecdata: great for mood/anxiety, got past the daytime sedation after a week or two, eventually discontinued because of the carb cravings and weight gain.
posted by LadyInWaiting at 5:54 PM on May 6 [5 favorites]

I couldn't sleep on it and it aggravated my scotophobia for weeks even after I stopped it. I took it exactly once and that was more than enough.
posted by bile and syntax at 6:05 PM on May 6 [1 favorite]

No. It got worse and worse for me. I am so glad I stopped taking it within the first week of being prescribed it.
posted by Hermione Granger at 6:29 PM on May 6 [1 favorite]

Just to add to the “brain meds hit everyone differently” remeron gave me an insane level of physical disconnection and bananas level insomnia that it sits upon my “top 5 worst medication experiences ever.”

I’m really sorry. This kind of thing sucks.

As card carrying member of the Tried All The Meds club, I offer the following suggestions for trialing new medications if you tend towards having not great reactions: Only start new meds on a Monday, so your clinic or GP is on the clock for a few days after starting. Always ask for a contingency plan if a med becomes untenable and you’re unable to reach the prescriber; nurse lines and even the ER don’t always have someone to contact about psych meds and what to do when things go sideways.
posted by furnace.heart at 6:37 PM on May 6 [7 favorites]

Anecdata: I also did better on 15 then 7.5. For me, I had acute insomnia and was only sleeping every few nights, so the drowsiness was expected. Most insomnia meds are like that. It took a few weeks to adjust, but I did ok on it. But it gave me intense sugar cravings, like spend my free time doing image searches for cake on my phone. I gained 20 lb very quickly, and went off on my own.

I now take Aventyl/ nortriptyline, and I have no side effects, though it doesn’t help me sleep as well as the remeron, it’s good enough.

Good luck! Insomnia is a bitch, and I never realized how anxious I was until I took meds and realized how it felt to just pick up the phone without a panic attack. It’s worth trying to find the right med.
posted by Valancy Rachel at 6:56 PM on May 6 [1 favorite]

Significant dissociation for me, with nasty consequences in the rest of life, particularly at work. I stopped taking it as quickly as I could taper off.
posted by deadwax at 7:16 PM on May 6 [1 favorite]

I had an awful time on it - constantly dopey, suicidally depressed, added 4kg in ten days, couldn’t drive my car. I was a sobbing mess at my doctor’s, begging to stop taking it.
posted by honey-barbara at 8:39 PM on May 6 [1 favorite]

I took it ten years ago (15mg) and remember reading at the time that a lot of people find the intense tiredness gets better as the dose increases, with lower doses making it worse (I was very, very sleepy on 15mg at first, and tried to use this argument to move up to 30mg, but my doctor at the time wasn't interested for some reason); possibly that's what's happening to you here?

I did adjust to the 15mg dose over time (going from "too sleepy to reliably wake up for a student job that began in the not-unreasonably-early morning" to "routinely able to get up on time for and attend my adult job without ridiculous sleepiness") but I noticed when I was tapering off it, taking it alternate days, that the days after I hadn't taken any the night before I woke up with a completely clear head, while on the days when I had taken it the night before I had a distinct fuzzy hangover feeling. I had managed to tolerate it well enough to take it for three years or so, but the realisation that I felt much less blurry the next morning when I didn't take it motivated me to get off it entirely.
posted by terretu at 10:43 PM on May 6 [1 favorite]

I took mirtazapine for about nine months. Yes there was a ramp-up period of a week or two (on 15mg) that sucked but it did get better (then eventually I went up to 30mg, which seemed easier than 15mg). Far too late into the period when I was on it, I discovered that taking it at least 45 mins before bedtime had a SIGNIFICANT positive effect on how I felt the next morning. I had been popping it in my mouth basically as I was getting into bed. I speculate this wasn't giving my body enough time to break it down and start to metabolize it, so I was waking up with my body still having to do a lot of that. I have no knowledge nor data to back that up, just a gut feeling, My psychiatrist seemed to think there was something to this theory. If only the fucker had shared some similar guidance to me earlier, I might have a had an easier time with it.

I ended up going off it. While on it, I did seem to sleep better than previously. Actually instead of 'better' I should say 'more' -- finally I'd stay asleep the whole night, without waking up -- but I don't think it was quality sleep. I believe that at the very least the weight gain (15lbs in 6 weeks!) contributed to an existing borderline Obstructive Sleep Apnea situation, which was later diagnosed and is now being treated. That's had a much greater positive influence on the anxiety and depression than the Mirtazapine ever did. I theorized that the Mirtazapine was actually making it harder for my body to deal with the sleep apnea, but that's speculative. Oh, and the RESTLESS LEG thing, was so utterly annoying, both to myself and my spouse, it was making it hard for her to sleep. That went away as soon as I stopped Mirtazapine.

Other than that, I'd second what LadyInWaiting said above.

Feel free to memail me if you have any questions.
Good luck.
posted by armoir from antproof case at 9:26 AM on May 7 [1 favorite]

Thank you for your replies, everyone! I've decided to stick with the medication at least until my next appointment with the psychiatrist, at which point I'll try to negotiate a strategy, as nebulawindphone suggests...
posted by HoraceH at 10:58 PM on May 7

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