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Mianserin + Wellbutrin Instead of Mirtazapine + wellbutrin

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So Mirtazapine and wellbutrin is a well known combo.. But I looked into the Pharmacology  OF both Mianserin and mirtazapine and based on the Pharmacology the Mianserin seems better -

I asked on another forum and a guy said this :

''Mianserin acts on alpha receptors but as an antagonist meaning it blocks the binding of NE to alpha-1 (and hence its "activation") and by blocking alpha-2 (a presynaptic autoreceptor) it increases the release of NE into the synapse by the presynaptic neuron. Inhibition of NET also prevents the reuptake of NE into the presynaptic neuron so the increased amounts of NE being released isn't being reabsorbed and is free to then act on the alpha-adrenergic receptors (that haven't already been occupied by the Mianserin) and on the beta-adrenergic receptors.

Mirtazepine does not inhibit NET, therefore reuptake, so NE is free to be reabsorbed from the synapse into the presynaptic neuron. It also does not antagonise alpha-1 so NE is free to activate this receptor as it usually would. Antagonism at alpha-2 again increases the release of NE into the synapse.

So in summary seems to me Mianserin would have the most net increase of adrenergic neurotransmission. There's many other mechanisms of action at play here though so it's hard to call one superior to the other - that is subjective.''


So basically mianserin is better even tho he wont admit it.. So I wonder why Mianserin + wellbutrin isnt well known? I believe they made mirtazapine just so the patent would last and they could make more money even tho its weaker than mianserin..


So  I wanna Start Mianserin + wellbutrin soon? Anyone been on this combo or Mirtazapine  + wellbutrin? since mianserin and mirtazapine are pretty similar  but mianserin is better as explained above..

I also wanna add low dosage Abilify to the mix .. So any opinions are welcome .


my dream combo would be Mianserin + wellbutrin + abilify


and maybe I will try mirtazapine to see if I like it better than mianserin ...Anyhow.. Any experiences with Mirtazapine + wellbutrin or mianserin + wellbutrin ? :D


I have a few questions about mianserin or mirtazapine?


1. do  they make you tired?

2. do they make you gain weight? if yes how much?

3. what other side effects did you encounter?


Edited by Farshad

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Hi Farshad,

Thank you for your post - you have clearly done your research.

This post is generally medical in nature, and should not be provided with a medical response in such a forum - your provider knows your history, which plays a significant role in both potential side effects as well as which medication will likely be more effective, despite our understanding of drug mechanisms of action (MOA) - psychiatry is not an exact science for this reason.

Regarding side effects, mirtazapine certainly comes with the potential for drowsiness, increased appetite, and weight gain (though generally not as much as some other medications, depending on the individual, of course).  There is a risk of anticholinergic side effects such as dry mouth, blurred vision, etc.  However, these are not guaranteed to occur, and one can never truly predict the likelihood or severity.

Continue to discuss these questions/concerns with your well-informed provider - you seem to be interested in a specific combination of medications, which may have unwanted synergistic effects as opposed to working alone, and could increase likelihood of certain side effects.  Only a medical professional with your detailed history can know the best course of action.

I wish you the very best of luck.

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