Mirtazapine (Remeron) prescribed for depression symptoms co-occurring with inattentive ADHD

[AdvocatingMama]

Hello, my son is 12 y/o (7th grader) He was diagnosed about 8 months ago with inattentive ADHD and has been taking medication to treat the ADHD symptoms. I recently spoke with his Psychiatrist about some other symptoms which I wasn’t sure was related or not to ADHD that were noticeable before his diagnosis and have lingered even after, (up/down moods, more emotional and sensitive to constructive criticism, lack of enjoyment of activities, low self-confidence and several days of unhappiness) he absolutely hates school which started in 6th grade when ADHD symptoms really peaked and not yet diagnosed. He’s doing much better with his classes since starting medication. His Psychiatrist recommended he begin Mirtazapine (Remeron) 15mg. Is anyone that is familiar with the medication able to provide a “review” of their experience? I am new to this group and have greatly appreciated this forum! Hoping someone may be familiar? Thanks in advance!

[LAJ12345]

hi, my husband had it for clinical depression and has gone on to develop Parkinson’s. I feel mirtazapine contributed as it kept him in a highly sedated state which meant he would not do anything except sleep all day.

In my view it should only be prescribed for geriatric patients who need sedation.

[AdvocatingMama in reply to LAJ12345]

I’m so sorry to hear that, thank you for sharing!

[Klmamma]

I'd give it a few more months on the stimulant and do therapy as well. The symptoms you've listed are actually ADHD symptoms. It should gradually get better over time with the medication. His confidence has taken a big hit the last 12 years and needs time to be rebuilt. I'd also recommend CBT or DBT therapy before the anti depressant. Giver therapy and the stimulant a little more time; then reassess.

[AdvocatingMama in reply to Klmamma]

Thank you, he starts therapy in a few weeks. Unfortunately we couldn’t start sooner due to provider availability I’m really hoping the ADHD meds and therapy are the combination we need 🤞🏾

[Klmamma in reply to AdvocatingMama]

It will get better! We tried prozac and it actually made our son worse. I'm 100% for whatever medication is needed for these kids to be happy and successful, but I do think therapy is crucial. Your child is also hitting those rough puberty years too, buckle up lol.

Guanfacine can actually be added to help with the Rejection Sensitive Dysphoria and it helps immensely. It's also not an SSRI or a stimulant. It's a blood pressure medication used off label and has been amazing when paired with the stimulant for our son and at least 5 others that I know. Read up on Rejection Sensitive Dysphoria. They still don't know as much about ADHD as they think they do. There is a MASSIVE emotional side that goes grossly untreated and unnoticed. That's the reason most girls aren't diagnosed until we find ourselves miserable and struggled in our late 30s.

[AdvocatingMama in reply to Klmamma]

THANK you!! So much! I will be looking this up tonight! As well as the medication recommendation.

[Mamamichl]

No advice on remeron, u fortunately, but those other symptoms can definitely be attributed to adhd.

[AdvocatingMama in reply to Mamamichl]

Thank you!

[Knitting20projects]

I’m also wondering if his ADHD is being maximally addressed, both with medication & with executive functioning support by the school. If depression is still a concern, I would ask to understand exactly why his doctor wants to start with mirtazapine. I’m not at all saying it’s the wrong choice. I just haven’t seen it used as a frequent first choice for depression in ADHD. However, there may be excellent reasons in your son’s situation for using it. I think it can cause an increased appetite and sedation. In someone with poor appetite from depression or stimulant medication or both, that could be useful. Also, I think in someone with a more agitated type of depression maybe the sedation effect of mirtazapine could be calming? Worth a discussion so you feel comfortable with the plan. And your doctor probably knows lots of details about your son’s situation that may make it a good medicine to try.

[AdvocatingMama in reply to Knitting20projects]

Thank you so much! During our first appointment with his Child Psychiatrist I spoke with him about “depression like symptoms” and not sure how it relates to his ADHD symptoms. The stimulant he was taking previously (prescribed by pediatrician) didn’t seem to help in fact seemed to worsen his emotional stability, agitation, etc. I also mentioned his chronic headaches in school and lack of appetite especially while at school. My son also has a difficult time knowing how to respond to “crappy” adults and authority figures at his particular middle school that tend to say and/or use very poor choice of words, remarks and comments to students in the classroom and hallways. You very nicely explained how this medication could have been prescribed and I believe you are spot on! Thank you so much for responding! I misunderstood what the medication would help treat. Increasing his appetite and better sleep habits, less anxiety during the school day. Coupled with therapy were his suggestion. THANK YOU! This process has been challenging to learn and navigate. I greatly appreciate everyone’s input! ❤️

[Knitting20projects in reply to AdvocatingMama]

Is there an epidemic of middle school teachers who need education on neurodiversity? Sigh. So frustrating. I’ve started telling my 2 kids (ADHD, ASD) that they’re brave for making it through a day. I really believe it. They truly work so hard to do what most people do effortlessly. Sending you hugs!!!!

[AdvocatingMama in reply to Knitting20projects]

My weekly rant, it certainly appears that way right?! I’m sure the teachers and admin staff hate to see me coming! It’s very very disheartening and disappointing. I had a literal front row seat to several teachers at parent teacher conference this past semester make uneducated and lack of empathy comments about my son’s “lazy” behavior in the classroom, but one in particular stated…”she doesn’t make accommodations for her other students, it’s honors English, maybe he should be moved back into regular English classes”. She didn’t want any parts of helping with strategies to help him succeed in her class her solution was to have him removed (she never read his 504 for the ADHD) and once I informed her of his right to accommodations, and why he’s exhibiting “lazy behavior” she says, “ohhhh…my son has ADHD, and now that you’ve mentioned these things to me it’s very similar to his afternoon classes and energy, etc. BLEW MY MIND! Thankfully, she had a much more positive attitude following parent teacher conferences. It’s like a light bulb went off once I quickly educated her on his inattentive ADHD symptoms. My son has since been doing very well in her class. But, speaking from personal experience and listening to the experiences of others, it’s a very sad situation for children, parents and the current state of education/educators.

Thank you again so very much!

[AdvocatingMama in reply to Knitting20projects]

One last question: the executive functioning support through the school, is there a specific faculty member or provider within the school that may typically provide this type of support or service for a student? I’ve been looking online to find a ADHD specialist or counselor/therapist who may be able to provide some support as well. I’m hopeful the therapist his psychiatrist referred us to helps in this area as well. Thank you again! Returning hugs your way!

[Knitting20projects in reply to AdvocatingMama]

If he’s not on a 504 plan at school, I would ask the special education coordinator or the counselor what you need to do to request he be evaluated for a 504 plan and get documentation from his physician and therapist about his diagnosis and recommended supports at school. He might benefit from additional evaluation by a child psychologist or educational psychologist (unfortunately these are expensive but they can write a report with recommendations you can present to the school). Actually, this reminds me I need to contact my son’s school about what they’re doing! I requested a 504 evaluation in September. Hmmmm. As you can see, it’s a process….

[Knitting20projects in reply to AdvocatingMama]

PS Oops, I see he’s already on a 504. Apparently i can’t read after 10 pm. 🤣

[AdvocatingMama in reply to Knitting20projects]

Haha, no worries! I totally understand! I appreciate any and all recommendations and feedback! I hope things work out with your little one and his school accommodations!