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  1. The first days and even weeks on sertraline are not fun at all. In my opinion the starting dose should be 25 mg, not 50 mg. I used sertraline a number of times but the first days are just as unpleasant even the 7th or 8th time I tried it. But I also know that it gets better once your brain gets ajusted to the drug. While probably it will never make you happy, after you get over the first weeks it tends to have some positive effects on your mood and on the symptoms of depression in general. And if it doesn't work even after 2 months, there are many other types of antidepressants that you can try.
  2. One thing that I learned from my long experience with sertraline is the fact that the recommended dose is always 50 mg. It's not the severity of the symptoms that require higher doses but the tolerance that the pacient has developed over time. Somebody who used sertraline for 5 or 10 years needs a higher dose because over time he became less responsive to the action of the drug. It's a false believe that many pacients have that a higher dose means a stronger antidepressant and anxiolytic effect when in reality higher doses can lead to anxiety and other serious side effects.
  3. WARNING! Do not take my personal opinions as a medical advice! Mirtazapine is a noradrenergic and specific serotonergic antidepressant drug with a very interesting non linear action. It's effects are very much dose dependent. At 7.5 mg it has a strong sedative action, while it's adrenergic effects are negligible. At this dose it can be used in combination with other antidepressants to cancel the sleep problems caused by them. At 15 mg it's still a strong sedative, but it's adrenergic and serotonergic action is more pronounced. At this dose it still cancels the side effects of other antidepressants but their dose has to be lowered. Mirtazapine alone is not a very efficient antidepressant at 15 mg. At 30 and 45 mg it's adrenergic effects are very strong and mirtazapine becomes a very activating drug, while it's sedative effects become so negligible that it can even cause insomnia. From my experience, this drug should be used in three ways: 1. To cancel the side effects of other drugs at a dose of only 7.5 mg. 2. To cancel the side effects of other drugs and to obtain a stronger antidepressant effect in combination with other drugs at 15 mg. The dose of the other drug has to be adjusted in this combination. 3. As a single drug, without the need for any other antidepressant at 22.5 mg. At 30 or 45 mg, mirtazapine's adrenergic effects become to strong and it can cause insomnia and increased anxiety, so higher doses should be avoided.
  4. I have a problem with the fact that I can only find Mirtazapine in the 30 mg form. The are pre-scored so they can be halved. But my prescription is for 7.5 mg. I bought a pill cutter but can I cut my 30 mg pill, pre-scored to only be halved, in 4 parts? I cannot ask my doctor until next month and the pharmacists didn't knew either.
  5. Not according to Wikipedia anyway. I think someone should correct that false and very dangerous information. Last year I got the serotonin syndrome while combining 150 mg of sertraline with 30 mg of mirtazapine against my doctor's advice. There are numerous scientific medical journals who clearly state that Mirtazapine is serotonergic. It's even classified as a Noradrenergic and Specific Serotonergic Antidepressant (NaSSA).
  6. This year four different psychiatrists have strongly recommended me to completely avoid coffee. I'm under treatment with a combination of sertraline and mirtazapine. But in the scientific medical journals I couldn't find any consensus on this topic. What has your doctor recommend you about coffee?
  7. This year four different psychiatrists have strongly recommended me to completely avoid coffee. I'm under treatment with a combination of sertraline and mirtazapine. But in the scientific medical journals I couldn't find any consensus on this topic. What has your doctor recommend you about coffee?
  8. Update I'm currently trying a solution for my problem which was basically severe anxiety and a terrible mood in the early hours of the morning. My mood improves spectacularly around 10 AM. The culprit is mirtazapine but I depend on it for my sleep which was ruined by my xanax addiction. So I tried to take my mirtazapine 3 hours earlier and my sertraline just before I go to bed. The results are promising.
  9. I am a former Xanax addict and sertraline, while it helped with my depression, it also made my chronic insomnia worst. Xanax had ruined my normal sleep patterns and I believed that I just had to accept that I will never be able to sleep well for the rest of my life. After months of severe insomnia I got 15 mg of mirtazapine added to sertraline and it did miracles as I never slept better in my life. And after almost an year it still works every single night.
  10. I used to love benzodiazepines with passion! Nothing seemed impossible, I could handle anything with a smile on my face. And they were fun too, as nothing beats the euphoria of 60 milligrams of xanax. My tower of illusions collapsed in November 2017 with a convulsive status epilepticus episode. I'm 37, thus too old to refuze reality. So my only option were the antidepressants. I used sertraline before, I know what it does, what to expect from it. And it work for my symptoms of depression, but it had big shoes to fill, my benzodiazepine addiction having ruin my natural sleep patterns. After months of insomnia, mirtazapine was added to my treatment. And it was love at first sight! How could a drug on it's lowest dosage help someone who couldn't sleep on 60 milligrams of xanax sleep well night after night? And it still works after almost an year at the lowest dose of 15 mg. But it ruined my days, as my depression got worst and it never work well with sertraline. I tried mirtazapine alone at 30 mg but it was ineffective. Now as I write this, I feel very frustrated because I have to choose between two drugs, one that makes my days better but ruins my nights and the other who does exactly the opposite.
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