Hi All,

I am new to mirtazapine - just been prescribed it to mainly help with sleep, though i have depression too, just never taken anything for it, so am hoping for improvements on all levels. I took lorazepam (ativan) for the last 4 months, so the doctor also wanted me to come off that, and thought this would help.

I have taken it for 2 nights now, 15mg per night and am suffering some side effects which have really made it impossible to function the next day.... I cannot even get out of bed until 1pm (took the pill at 11.30pm the first night and 9.30pm last night), have headaches in the morning, completely groggy, spaced....... both nights I have also had REALLY vivid dreams, not nightmares, so OK, but just non-stop totally real feeling dreams. I think I will try to eat much earlier tonight and see if that improves (after reading some posts on this site - very useful, thanks!).

I guess I just want to know that these side effects are normal and will pass..... and roughly how long it will take for them to pass. I have been unable to work the last 2 days (kind of the least of my worries just now, but still, it does not make me feel good about myself to have to cancel workplans), and also have to move flats next friday.... cannot even imagine having the strength for that the way I feel today :-(.

I have not been able to speak to my doctor due to being in bed the last 2 mornings and its now the weekend and I just am not sure whether I should stop taking the mirtazapine or whether to persevere..... I am also aware of the fact that of course these side effects could also be related to the fact that I have stopped the ativan......

I would really like to hear the experiences of others!!!!

Many many thanks!!!!!

Hi Lucy,

From what i've heard other people say about antidepressants the side-effects, and their severity, are dependent upon the individual. So the side-effects you are suffering from might be normal for you, and it might be that they will subside after a couple of weeks or so. Your doctor should be able to ease your concerns about this more than me, so i would definitely get in touch with him or her as soon as you can.

It may be that this drug is not suited to you at all, which would be a shame considering its been prescribed to help you sleep - i don't think there is another AD out there that has a similar effect.

Ativan is a drug of addiction you need to wean off of it to avoid the withdrawal effects. The symptoms you describe seem to be typical Mirtazapine type. My experience was that the first 15mg flattened me. This effect quickly reduced but there is still permanently a sleep inducing effect. I must take it before bed or I will want to fall asleep where ever I am.

Thanks Mogwai and Old friend for your replies. I am doing better now (its sunday, and i'm now on my 4th day of Mirtazapine). The ridiculously groggy/spacey effects which meant I could not even leave the house lasted only 2 days, and yesterday I was fully of energy! Its only 10.30am here in Amsterdam on sunday morning, but already I am feeling like it will be another good day!

I am still not sleeping too well..... certainly can stay up a few hours after I have taken my 15mg... and find when I do fall asleep, I wake up one hour later and then continuously throughout the night, and the vivid dreams continue. But, despite this, I am feeling better. Forgot to mention it in my first post, but I have also been suffering chronic fatigue, and am hoping this will be less on Mirtazapine.

I will discuss with my doctor again soon.... I am surprised now I have researched more that she did not cut down the ativan dose; but instead replaced it with mirtazpine. I was taking 1-3mg per night of ativan, which is maybe also not the way you are meant to take it?? I was basically varying the dose depending on whether or not I was sleeping on it. Some nights I'd sleep 3 hours then get up and take another pill.

Anyway, thanks again, and I'll keep on the Mirtazapine and see how I go!!!

LucyH,

Only just joined so picked up on this thread a bit late. I have been on Mirtazapine (M) for about ten weeks now and for me at least, the sedating effects you are describing did fade after a week or two.

I have read somewhere (and my doctor has confirmed) that ironically, M can be more sedating at lower doses (ie 15mg) due to its antihistaminergic properties. Higher doses are generally less sedating as this sedating effect is thought to be offset by the increased noradrenaline release at higher doses (ie 30mg - 45mg). My doctor started me on 15mg for five days to be upped to 30mg thereafter. Once I had been on the 30mg for a few days, the sedating effect had almost completely disappeared.

Far be it from me to give any prescription advice but it may be worth discussing with your doctor upping the dose from 15mg.

Incidentally, a good friend of mine is a vet and and he said that M is indicated as an appetite stimulant for cats!

Just thought I'd throw that into the mix.

I just joined, so maybe it's too late for peopole to see this in the thread. Anyway, yesterday I got prescribed mirtazapine. I have been on fluoxetine for a while but it wasn't helping that much at all. I took 1 15mg tab last night. Had a broken sleep, woke in the night with a rging headache, vivid dreams (though not nightmares) and couldn't get up this morning. It's not 5:00pm and I still feel totally spaced out, almost drunk-like. I'm going to take 1 15mg tab tonight and see how it goes. I don't like these additional feelings, they are not welcome and if today is anything to go by then they are going to upset my routine, which I don;t see as good.

Took my dose last night and slept well. It's only Day 2 but the difference in sleep is that I feel I have rested, so big tock in the box. Lots of dreams again, though not nightmares. I woke late again and still difficult to get out of bed on time, although now I am up (at 10:00am) I feel slightly weary but a lot better than yetsreday - not nearly as spaced out.
I'm also working today, which is great. Hope it lasts!

Lucy H,

I have been taking Remeron for 2 days now. The first night I took it I slept very deeply and for a long long time. I was very tired and lethargic all day. The second night I took it I did not fall asleep until 12am despite having taken it at 9pm. My sleep was very light and I woke up often. I also had very vivid dreams. On the plus side I am not nearly as lethargic or tired today, so that is good.

You commented that:


That was back in May. I wondered what your experience has been since then in terms of sleep. I am a bit dismayed that this drug is supposed to help with sleep but didn't help me last night. I am curious to see what it does tonight. Does it take a while for the sleep part to take? It seems to work on sleep for everyone and I find so little from anyone that said it didn't work except you. I would love to know what happened next for you!

AZ

This post has been edited by az8zs: Jun 28 2009, 12:03 PM

As with all psychotropic medications, it takes time for our bodies to get adjusted to them.

Benzodiazepines ( Ativan, Xanax, Valium) are so far the safest medications in terms of their wide marginal safety profiles, also Benzos are not cardiotoxic (doesn't affect heart fuctions), no anticholinergic effects ever noticed, and work on the first day it is being taken. Although our bodies develop tolerance to its sedating and "re-inforcing effect" (things that make us feel good in the brain system, through GABA-A/Benzodiazepine receptors), research shows that our bodies do not develop tolerance to its antianxiety effect.

With Mirtazapine, it laso lacks anticholinergic effect, does not affect heart function as Tricyclics or SNRI ( Effexor, which raises blood pressure), does not impair sexual performance.

Mirtazapine works by releasing noradrenaline and serotonin from the synaptics, but unlike SSRI's (Prozac, Zoloft etc), it blocks Serotonin (5-HT2) type2, Serotonin (5-HT3), as well as Histamine (H1), and alpha-adrenoceptor, therefore it does not cause nausea, nor akathisia ( a form of restlesness ), and it improves sleep, and considered as being a 'nootropic agent' ( improve cognition on the next day, when researches being conducted had shown that it improve driving performance compared to placebo).

It takes time for our bodies to get adjusted to this medication. It has a half life around 20-40 hours in the body, and if sedation still persists even with a low dose, maybe another form " The Soluble Tablet" would be appropriate, as it is absorbed faster into the blood stream, and entirely metabolised during sleeping, reducing the hangover the next day.

A couple of my friends are taking the SolTab, found that it sedates them for 20 minutes, then they wake up again, unable to continue to sleep.

I guess everyone has a different reaction to Mirtazapine, mainly we have different genetic and different level of the amount of the enzyme to breakdown Mirtazapine, that is Cytochrome P450 2D6 and 3A4. Some medications induce the enzyme in our liver, such as Carbamazepine, Sodium Valproate, Phenytoin, Phenobarbital, making it faster to breakdown the substrate ( in this case the Mirtazapine), some other medications inhibits the breakdown of the substrate, making it longer for Mirtazapine to stay in our body system.

So far, Ativan does not have an active metabolite, neither does Oxazepam ( SEREPAX, SERAX, MURELAX in Australia), but when Mirtazapine is taken together with Xanax ( Alprazolam), which is also a substrate of CYP 450 3A4, the level of either drugs could be raised double, even triple in the blood stream, leading to a feeling of severe drowsiness.

In my own experience, I used to take Xanax 2mg daily, but when my Psychitrist added Mirtazapine, a quarter of a tablet of Xanax ( 0.5mg) produces the same effect as though I am taking 2 mg of Xanax on its own. So I cut down on Xanax to 0.5 mg.

I think in your case, it is best to give it a time for Mirtazapine to get adjusted in your body system, meanwhile, if sedation still persist on the next day, maybe you can discuss it with your doctor to switch it to the SolTab form. Good luck.

Hi, I just started on mirtazapine about a week or 10 days ago, to battle insomnia mostly but also depression. I have that weird sleep cycle that seems to be reversed or gone, I fall asleep only when I'm so exhausted I can't go on. I have noticed the headaches and vivid dreams, also a different mental state after taking this med, in the last couple of days my sciatic nerve has started really bugging me, I didn't make it to work today because I could hardly sleep last night it was so annoying. Is this possibly a side effect of the mirtazapine? I also have been taking buproprion for 9 years and was prescribed oxazepam as a backup in case the Mir didn't put me to sleep. Thanks


Ryan

Also taking the mirtazapine for anxiety, forgot to add, I have very high anxiety.

This post has been edited by awakentired: Jul 9 2009, 11:58 PM

Hmm, those side effects never really go away. Well, they lessen over time, but some remain indefinately, speciffically having a hard time dragging yourself out of bed (i have a dual alarm clock at the other side of the room). Groggyness should lessen, as should feeling spaced. Headaches should go away completely. This drug will slow you down.

Hi I took mirtazapine and it took around 2 weeks for my body to get used to it. The first 3 days where the worst and then it got slowly better. I had to get used to the groggy feeling as well but it does go away. Although I should mention I didn't sleep for 4 days straight before I started the meds. I can't sleep when I am depressed. So the second night I slept for almost 20 hours. I'm guessing the 15mg are just the starting amount as they where with me but don't worry if you up your meds later you won't go through the same symptoms as when you started, your body will already be used to the drugs. I also agree with the others that you could also be experiencing side effects from ativan but the drowsiness of the mirtazapine should help it a bit, it did with me, although I was stopping another med not ativan. I hope you start feeling better soon xoxo

This was not the case with me, after a few months my sex drive slowly decreased and after 10 months it was practlicaly gone and that is when I quit. Advise to others if you are lossing your sex drive talk to your doctor the meds might be at a wrong dose

I started Mittazapine almost a week ago. I slept heavily through the first night. After that, my sleep was more "normal" for me (waking up throughout the night) but I have been having vivid dreams throughout the night. I tend to get tired very quickly after taking it but I don't feel very groggy in the morning. In fact, today I was far more alert than I'd been in a while.

Hi mauers,

It can take up to 8 weeks for your med to have it's full effect, it seems that at least you are able to sleep better and not feel groggy in the mornings. Some people after given the time for the med to take full effect the vivid dreams seem to go away but every individual reacts differently to each med. It's good to hear that you are feeling more alert now as that is important to make it through each day.