I was prescribed Mirtazapine a good couple of years ago (I forget how long exactly). Anyway prescribed predominantly for anxiety and sleep issues (delayed onset sleep phase disorder). Later diagnosed with OCD which it’s also used for. I was up to 45mg daily but found it wasn’t effective for sleep. GP lowered to 30mg, as said has a better effect on sleep at lower dose. It absolutely does help me sleep and was working well for me. Been at that dose for many many months.
Since then I was diagnosed with ADHD too. I now take Elvanse 40/50mg a day. Been taking for a few months now. It’s only been the last few months but I CANNOT wake up. Like physically I cannot be roused properly from sleep. I feel anger the moment I’m woken and it takes for my husband to gentle shake me for a good 15 mins to get me up.
I’m a 35 year old woman. This is ridiculous abs causing me so many issues. I luckily work from home a lot but when I do have to get up I have to make sure I set about 50 alarms.
It doesn’t matter what time it is, early or late or how much sleep I’ve had. I wonder if anyone else has experienced this. Maybe not the exact same diagnoses or taking Elvanse at same time. But does anyone relate to this and share any insights on Mirtazapine?
Written by
PTNewbie
To view profiles and participate in discussions please or .
I have been struggling with getting up in the morning, but the cause for me is different. For me, it started with a change in life circumstances. (Divorce, relocation to a new time zone, new to co-parenting / being a single parent, went through many months of depression, constant anxiety.)
Once I started having trouble getting up, it just stuck. I've been trying to figure out for a year how to change.
• For the record, I first had sleep issues due to severe anxiety a few years ago. When I finally got treatment for the anxiety, I also got my ADHD diagnosis. I didn't have such a hard time getting up back then, because I felt I was under constant threat of losing my job for any reason.
• Ironically, I'm now in a stable job that allows me to be flexible with my time, which took away the panic that used to get me out of bed.
~~~~~
ADHD is caused by issues with norepinephrine (noradrenaline) &/or dopamine.
I'm on a completely different medication: atomoxetine, a non-stimulant selective norepinephrine reuptake inhibitor. Atomoxetine (best known by the name Strattera) keeps working 24/7.
Your medications are Elvanse (a stimulant which triggers the release of dopamine) and Mirtazapine (an antidepressant which triggers the release of noradrenaline and serotonin). Stimulants begin working after you take them, and work for a limited length of time. I think your antidepressant works similarly, but I don't really know for sure.
Some people taking stimulants have to set an early alarm, take their meds, go back to sleep, and then get up after the meds have started to work. That might be worth a try for you.
(It won't work for me, because as I said before, my medication works 24/7. I will have a doctor's appointment in a couple of weeks, and I will ask about trying a low dose stimulant. I know I also have to get into a habit of getting to bed earlier, because I am not getting enough sleep, which also makes it difficult to get up in the morning.)
~~~~~
It's good that you have a spouse who can help you. I hope that he knows how much you appreciate him. Even men who are the "strong, silent type" need to receive appreciation and validation.
I am no longer married, and the last several years that I was, the marriage was very unbalanced. (I was giving my all, and getting almost nothing back from her.)
So, while you might be too cranky in the morning to do so, please be sure that sometime during the day you tell your husband how much you appreciate his effort.
Oh he absolutely knows how much I appreciate him. Here’s the thing I’m not cranky with him, I’m immediately angry at having to wake up - never feeling like it’s time. I physically cannot rouse so even if I set an alarm it just becomes part of my dream. Someone could break in and I wouldn’t hear them or wake. That’s what’s causing me most concern is it’s not about my choice it’s almost like I’m trapped in sleep once I do fall asleep..
That was what I gathered by your first post...that you were just irritable upon waking. I've known of people who had to be left alone for at least half an hour after waking up, because they needed time to adjust, or else they could be very crabby.
In my youth, growing up in California, I was able to sleep through earthquakes up to 5.5 in the Richter scale (or up to 6.0, if the epicenter was far enough away). I was the same way through my 20s and 30s.
(My wife had insomnia and envied that I could sleep so well. I also snored, and was hard for her to wake to get me to turn over or move to the couch.)
Then, when I was almost 40, my youngest child was born. She wasn't breathing when she was first born, and stopped breathing twice more in her first 3 days since birth. So, I learned to wake to the sound of... silence. When I didn't hear her breathing, I would snap awake at any time if night.
... I've been a much lighter sleeper ever since.
(I don't recommend developing panic as a transition to sleeping lighter. Now I don't get enough sleep, and haven't for almost 9 years. --- In the middle of that time was when I had a bad job and difficult boss that brought on anxiety that robbed me of half my sleep for 3-4 years years. That was when I kept waking up really cranky! I've spent the last 3 years trying to get back into a good sleeping schedule.)
I hope your daughter is well and thriving now, must’ve been so scary, I couldn’t imagine and no wonder you’re such a light sleeper now!
This is what’s worrying me as I don’t think even an emergency I would wake for. And not through choice, that’s super important for me to be clear on, it’s that I’m completely sedated…
I’ve had a similar experience in ways. Lived with chronic insomnia, anxiety and panic attacks from ages 12-33ish. I survived on 3-4 hours sleep a night for most of my career. Diagnosed with onset sleep phase disorder, OCD and ADHD very late in life (all within the last few years). I used to be able to wake easily as soon as my alarm went off I’d be so worried about sleeping in I’d jump straight out of bed and get ready! But now though I sleep better (why I was prescribed mirtazapine) and my anxiety is almost all gone (Elvanse I put this down to) is seems like the sedative effect of the mirtazapine just doesn’t mix well with Elvanse (vyvanse in US I believe). I’m thinking of coming off the mirtazapine to see how I go, as even when awake I never feel rested or refreshed and my head feels like cotton wool. The anger I feel isn’t outward anger, I could be alone and feel it. It’s almost like you’re in a deep sleep and have gone to bed a normal time to then be woken up too soon (like someone coming in and shaking you awake at 2am) and you just know you’ve not had a full nights sleep.
It’s like that but whether I’ve had 4 hours or 8 hours it’s like I’m dead to the world. Which I’ve never ever had before, I’d always be able to wake up immediately. Whereas now it feels impossible. My alarms become part of my dream and even if I put them across the room I’ll go and get it and turn it off but I have no conscious awareness / control in doing so. It’s starting to feel debilitating almost to have to rely on my partner to rouse me… so hoping someone might have some experience they can share… x
Thanks for asking about my daughter. She was prone to getting bronchitis (and onset of pneumonia) from every cold or flu until she turned 4...and then miraculously stopped getting bronchitis. When she had COVID, it showed up like a mild cold. (Meanwhile, it put me in the hospital with pneumonia.) She's very healthy most of the time now, but she's currently getting over a bad cold (maybe flu) and an ear infection. (She still gets those about once a year.)
.....
Have you done a sleep study? If not, would you consider doing one? (The anger you speak of sounds almost like an animalistic response, like it's coming right from your amygdala. Does that seem like it?)
I considered doing a sleep study a few years ago, but getting treated for the severe anxiety that I had and starting ADHD medication brought my sleep issues down to much more manageable level. (Though I still might have benefitted from the sleep study.)
For much of this year, I was on escitalopram (generic Lexapro) for depression. It was mild, but persistent. I thought it was what was making it so hard to get out of bed in the morning. Maybe that was part of the reason, but I beat the depression and stopped the medication as my doctor had said to do...and I still have the problem with getting out of bed in the morning.
It's like I have no motivation. I don't feel any motivation to do things until I've gotten to work and done something...even then, it's limited motivation.
I'm trying to get myself to bed earlier each night this week. (It's too late for last night...I didn't get to bed until after midnight, because I wasn't paying attention...but now it's almost 10:15pm, and I'm signing off to go to bed now.)
Having children is beyond my imagination you know, so much to think and worry about them. Glad that’s she’s doing well despite the illness she experiences still. I did a sleep study, stayed overnight in a sleep clinic with electrodes on the head and everything - that’s where I got my diagnosis delayed onset sleep phase disorder. It basically means I’m a night owl and circadian rhythm is wired differently which I could’ve told them without a sleep study! Turns out there’s a high correlation of this with ADHD, which has just been another enlightening factor I’ve learned about myself recently! I’m on day 3 of halving my mirtazapine - seems to have had an effect in not feeling like my head is cotton wool! But I didn’t get to sleep until about 6am last night and slept through the day (day off work). So I’m a bit worried I’ll fall in to that cycle again, but I have to get up tomorrow so even if I don’t sleep tonight I know I can survive a day on a little to no sleep and then hopefully I’ll be tired enough come normal bedtime to get back in to the usual routine… fingers crossed!
I think that there's good information at sleepfoundation.org
(The information seems to be balanced, and references research findings. Unfortunately, there hasn't been enough research on using supplements to treat sleep issues.)
I take magnesium, folate and vitamin D. GABA I don’t think you can legally buy in UK. Melatonin have had this prescribed in the past, only for short term use. It’s the mirtazapine then prescribed for longer term x
Magnesium is supposed to cause the brain to release GABA. So there might not be much difference where sleep is concerned.
~~~~~
There is more research that indicates that magnesium works than about GABA supplements.
Early GABA research resulted in the opinion that it cannot cross the blood-brain barrier. Recent research suggests that there might be a mechanism to do so, but if there is, it hasn't been found yet.
I just know from personal experience that I usually sleep better on nights that I take a GABA supplement. I take melatonin to help me get to sleep, but the GABA seems to help me stay asleep. (Lately, though, it leaves me groggy in the morning.)
~~~~~
Everybody has their own unique neurobiology and neurochemistry, though. That's what makes it so hard to find solutions to sleep issues. There are no predictable solutions.
I just read your profile, and saw that you also have tinnitus. One of the possible causes of tinnitus has to do with a neurotransmitter called GABA.ata.org/why-gaba-may-be-one...
GABA is sometimes called the "calming" neurotransmitter. (Some people take a magnesium supplement to help with sleep. One way that magnesium acts is to trigger a release of GABA, which helps quiet nerve transmission activity. In the US, I can actually get a GABA supplement, which is great for sleep sometimes, but lately has made me overly tired in the morning, so I'm considering trying magnesium to use my body's own GABA supply instead of supplementing extra GABA.)
GABA deficiency has been suggested to be a cause of certain kinds of sleep issues. (My GABA supplementation was helpful when I was waking up in the middle of the night but struggling to fall back asleep. It didn't help me fall asleep, but it helped me stay asleep. I take melatonin to help me fall asleep.)
The opposite of GABA is glutemate, the most abundant neurotransmitter because it signals nerves to start transmitting signals (so it can be called the "activating" neurotransmitter). The body makes much less GABA. It's necessary that these two be in a certain balance, but if that balance is off, then it can cause problems.
It is believed that excess glutemate and/or a shortage of GABA can contribute to:
• insomnia/sleep disturbances
• intrusive thoughts, overactive brain
• anxiety
• headaches, including migraines
• chronic pain
• restless leg syndrome
• even contributing to irritable bowel syndrome (and other digestive motility issues)
*Note that this is not yet widely accepted, and that there has only been some research done on this glutemate/GABA imbalance issue. More research needs to be done to replicate and expand on those studies.
~~~~~
I'm mentioning GABA, because it might be a common factor between your sleep issue and tinnitus (and possibly anxiety, too). Or, your various issues might have separate, unrelated causes.
The body and brain are complex, which is why we need doctors and other medical professionals to help us with figuring out all these things.
hi PT. I ended up here as I s recently been prescribed mirtazapine. I’ve been using elvanse for a couple of years after adhd diagnosis at 45. Currently in a very stressful situation and struggling with depression. I don’t really have anxiety since discovering it was basically adhd and using elvanse. GP gave mirtazapine as I am always a poor sleeper, everything going on plus I’m post menopausal too, meant I was just not able to get to sleep and woke frequently with racing thoughts at night usually not able to get back to sleep if I’d managed a couple of hours.
I’m wondering if the interaction makes the daytime waking harder? I can’t find any info. But it almost midday and I’m just starting to feel awake. This is my 10th night of using. I’m so relieved to sleep at night and even wake sometimes but not have racing thoughts and be able to easily just fall back asleep, I don’t want to discontinue. But… I have two kids who are ND need a lot of support in the mornings plus a stepson to get up and ready for school. I’m a teacher and on a university course with loads of work/study to do. Teachers absolutely cannot be late for work!
I’ve taken melatonin for years but I find it’s largely ineffective when I’m stressed so that wasn’t helpful at all.
I’m going to persevere with mirtazapine for now as it’s so helpful and either that or that plus the fact I’ve slept is reducing my depression significantly which I’m grateful for. But hoping the drowsiness and fatigue stops. I may try taking earlier in the evening. The first dose I could barely stay awake for 15 minutes but now I notice I can fall asleep but it doesn’t immediately knock me out so maybe 6-7pm is worth a try.
I’m still finding it incredibly difficult to wake. I sort of get trapped in dreams, hard to explain. I’m still very drowsy for a while but nothing like I had been, before I felt like I was wading through treacle with a head of cotton wool all day. I’m back on Elvanse now though after a shortage, I was taking concerta as a stop gap but it’s not for me. I’ve reduced mirtazapine already to 15mg but can’t get an actual GP appt to discuss with a doctor 6 weeks!
Eeek 6 weeks is insane! I couldn’t get elvanse for over a month and nobody would prescribe an alternative! I think the lack of it was a big factor in my breakdown at the beginning of January. After 2 years of relying on it I struggled to exist without it (massive life changing events in the interim too).
Yesterday I just couldn’t wake all day. Yes the cotton wool/treacle was heavy, I think because I had alcohol the night before it was worse. I’m feeling relatively clear headed now. Will try taking earlier tonight and see what happens. Have you experimented with that at all?
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Trouble waking up in the AM
Why Does My Vyanse/Elvanse Dosage Increase Feel Useless?
New ADHD - Elvanse and Sertraline: feeling terrible
If I can’t do my job without meds, should I find another job? 
Today I’m struggling with ADHD and life 
