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[electrochemistry]

I've been trialing Mirtazapine since late March 2012, for depression.

I seemed to have finally controlled my bipolar mania and hypomania through making the right diet choices alone. I'm sensitive to anything that gives me a quick energy boost - cola, coffee, chocolate, alcohol, and sugery foods.

I've switched back to 30mg, from 15mg of mirtazapine yet again. What seems to be happening is that I get the dose about right for myself at 15 or 30mg, for a period of about a week. But after a week or two on 30mg, I get too unmotivated (too much serotonin?), although not depressed. Then at 15mg for a week or so, I get too depressed and caught up on my irrational, or at least, unhelpful misery (not enough serotonin?). So what happens is that there are days inbetween those doses that seem to feel 'normal' to me. The dose is actually right for a while?

I may have to see if 22.5mg might work better? If it doesn't, I think i will just have to keep moving doses up/down in line with my mental states.

I'm also still experimenting with Reboxetine (increases noradrenaline). This med does give me the much needed feeling of wanting to be more active, motivated and doing stuff. But! With the big down side of eventually making me feel too aggressive, if i take it for too long, even at the tiny dose of 1mg per day. So, I'm still trying to work out how little I need. From tomorrow I'll try to take 1mg every second day for a while. I find I need about 2 - 3 days off it for my aggression to drop to levels I'm comfortable with (that don't remind me of bipolar high moods). I'm sensitive to stimulants in general, and this stuff registers in my system as a stimulant would.

Previously i've tried, in order - Xanax, Sertraline, venlafaxine, Duloxetine, dexamphetamine, ritalin, amitriptyline, duloxentine (again), sodium valproate, and now mirtazapine and reboxetine.

Here's a link I found interesting singing mirtazapines potential praises as an atypical A.D. - http://www.preskorn....lumns/0003.html

[Soccer_Dude]

Hi Electro,

I found your new thread...

I'm on 15mg of Remeron. It doesn't seem to be doing much for me, although I just went off Lexapro after 4 weeks. So, not sure how effective Remeron would have been with Lexapro doing it's thing, although I know you can take both together as my doc's suggested. Lex made me feel too depressed, so it might not have worked well with Remeron. I'm off Lex now for about 3-4 days and felt a little better. Not sure if I need to go to 22.5mg or 30mg to see a difference or not.

A while back, I had tried Lex for four weeks, couldn't take the depression it gave me, so I went off, and started Remeron for the first time. Started at 7.5mg and slept for the first time good in a long time, so my mood improved, then after 3 days went to 15mg per my docs instructions. Then at day 7, I felt like 100% better, but then I felt a drop in my mood the later part of that day, then was at that level for a few days then had a relapse, and anxiety and all the bad stuff came back. Was this Remeron poop out already at 15mg, or Lexapro withdrawal? Not sure I will ever know. Anyway, right now at 15mg of Remeron, it doesn't seem to be helping me sleep as good, although Lex migth have messed that up, and I don't think it's helping with depression, although it might be helping with anxiety a little.

I've been contemplating dropping Remeron and meds all together and try to battle this nutritionally. We'll see. I just want to feel better and I haven't found the key yet to doing so.

I have tried Remeron at 30mg once or twice, but end up going back to 15mg. Maybe 22.5mg might be the right amount....

Soccer

[electrochemistry]

Hi Soccer,

Not sure how long you have been trying various A.D's, but I've been trying for about 5 and a half years now to find something that works best for me personally. I know I'm not the only one in this situation either. You really need to be as methodical as you possibly can be. Mixing meds is something I've only tried recently. It's good to know what one med does before adding another IMO. So yeah, try 22.5 for a while and see how it goes. But as has been suggested by others on here, 30mg of Mirtazapine is supposed to be the clinical minimum to achieve a antidepressant effect, which it does on me (but also creates a lack of motivation/care). Lower doses are generally prescribed for poor sleeping. It's interesting that Lexapro gives you greater depression than you'd normally have. I would of thought, if anything, it would just make you unconcerned about things? Which isn't good either. Dropping the Mirt altogether for a while might be useful to give you an idea of just how effective (or not) Mirtazapine is? When I'm on a 15mg dose for a few weeks, I can feel my depression/anxiety slowly build to very uncomfortable levels (obviously not a high enough dose). So, I now know it is definately effective when I increase to 30mg for a couple of weeks, until, of course, the scales tip too far that way to make me feel unconcerned/unenergetic about getting my life back together.

I'm going to try 22.5mg of Mirt from tonight. Previously I thought it was silly to try this inbetween amount, as my Doc thinks it's not going to work effectively until I'm on at least 30mg, but i've now tried 30mg on a few occasions with the same unsatisfactory long term result. I've been on 30mg for about the last week and am starting to feel a little too unconcerned about things yet again, so I think it may be too much SSRI action? I really don't like the procrastination and lowered energy that 30mg's gives me after a week or so of continuous use...and that's why I currently continue to up/down the dosage. So, let's see how 22.5 goes!

[electrochemistry]

Ok, I think i've got as much as i can from Mirtazapine. It will only be useful to me at about 15-30mg, depending on current life situations. If I take higher doses it makes me too inactive, isolating myself from the world and unconcerned about things. 45mg is only good when I experience deeper depression perhaps. I've trialled it long enough and find it partially effective, so not as satifactory as I hoped for.

Reboxetine is useful in small amounts (1-2mg) every 2-3 days. It gives me a bit more drive to do things. Higher doses cause too much aggression due to it's noradrenaline activities. So, again partially effective. But not as satisfactory as hoped for.

My thinking at present is that i've tried a few different serotonin and noradrenaline A/D's. I think i really might just need the ones that act more on dopamine. Yes, i've tried ritaline and dexamphetamine that do act on dopamine, but they simultaneously act on noradrenaline too much too. So I'm hoping to find something that gently acts on dopamine without too much noradrenaline action. I'm currently looking at the Selective MAO-B Inhibitors to do this, and at a hopeful low dose. I have not tried the MAO class at all. I'll have to ask my Doc if the MAO-B's are indicated here for depression (think they are just indicated for Parkinson's, Demetia). Wellbutrin might be worth trying too (where I hear it may be prescribed by a PDoc), but I'm aware it's noradenaline actions might not work for me? Otherwise there is l-tyrosine supplement, which I've read helps act on increasing dopamine more naturally? Also tried the 5-htp suppliement and gradually get more miserable by the day on them (Too much serotonin?), Afterall of this i don't think serotonin and noradrenaline are my major problems, minor players i think. Dopamine is getting my focus ATM, I have tried nicotine gum to give me some proof of dopamine's good effects on me, and it does give me a nice lift, better feeling of wellbeing, albiet for an hr or so. Yep, I'm a non-smoker.

I might continue with this thread, if i end up keeping Mirt....or perhaps coming back to it?

Edited by electrochemistry, 21 July 2012 - 08:01 AM.

[Girly]

Hi electrochemistry, I think it is important that you speak to your doctor about trying something new or adding something in as they will know which meds can be taken with the ones you currently take and also they will be able to help you to ween off the Mirtazapine safely if that is what is decided for you.

Let us know what happens.

[electrochemistry]

Hi Girly, i find weening off most of th A.D's not too problamatic myself. The only one that was, and the first used med, was that d*** xanax. The suppliments I'm adding to my meds are my own experiments based on my own research and not intended for others to try, as we are all very much chemically individual. I have had some recent success with 15mg mirt and aspartame, of all things! Perhaps due to it's MAO-B inhibition? Short term so far, but it's given me a much needed lift. Nicotine gum still gives me a lift too when i need a bit extra, probably for the same reasons. More reading/research to be done....

[Girly]

I'm glad that you have found some things that help you. I'm using nicotine lozenges right now but they don't seem to give me a lift a all. Just be careful with your research, although I am sure you are.

[electrochemistry]

Yep, all very individual with chemicals we are. I've never been a smoker, so that might also help to explain the lift I feel from nicotine. I only need 2 to 4mg a day. Anymore than that and i feel like vomiting. Which is the reaction i got when i tried cigarettes a very long time ago.

Hey Girly, is the olanzapine very effective for you? Or is the jury out? Nicotine likely helps dopamine along to give you a lift, where as olanzapine is thought to act as a dopamine antagonist. So your usage of nicotine clashes with what olanz is partly doing for you. Mao-b inhibitors like nicotine, aspartame and cocoa help to increase dopamine, so might not be right for an Olanzapine user? If you need a lift, your doc might suggest lowering your olanzapine dosage to allow more dopamine activity?

I've been on the seratonin/noradrenaline merry-go-round for long enough to realise that too much medication is as bad as too little. It also has helped me to realise, in simplistic terms, that dopamine is the key 'happy' neurotransmitter. Noradenaline is the key 'aggression' neurotransmitter, and seratonin is the one I least feel any benefit from, all i know is if i have too much it flattens my mood to the point of being uncaring about anything. It's supposed to make you more social and lift mood, but i don't find that to be the case with me. The other two important neurotransmitters are far more socially activating. Normal or low amounts of seratonin don't seem to have any obvious measurable impact on me, with maybe the exception of better quality sleep?

[Girly]

Hi electrochemistry

I'm using the nicotine lozenges as my umpteenth attempt at stopping smoking. It is going well so far. I'm on day 6!

The olanzapine for me is tricky. I saw a new pdoc today to discuss if I really need to be on an anti psychotic to aid my sleep. He gave me plenty to think about and several options. Too much olanzapine and I'm a zombie, too little I'm a stress head. He has recommended an anti histamine to aid sleep, together with a lower dose of olanzapine and other options and is writing to my GP.

Sleep is a huge issue for me too.

[electrochemistry]

Well, if you find long term that nicotine is helping you function, lozenges are obviously alot safer than smoking.

I slept like a baby when I was on amitriptyline, but it's too sedating for me to operate during the day.