Anyone taking Mirtazapine and Sertraline?

[Annie2609]

I have been prescribed these 2 medications for anxiety and insomnia. I am concerned as both have a warning for QT prolongation. Does anyone here take them and are doing well on them?

[Ppiman]

In attempts to help my insomnia and anxious personality, several years ago I was prescribed mirtazapine and two very similar drugs to sertraline (the SSRI drugs citalopram and fluoxetine).

I cannot comment on any heart side effects, but I can say that the drugs were completely unhelpful and, in the case of the SSRI drugs, simply dreadful, increasing my anxiety and worsening my insomnia as well as bringing on a whole raft of odd and sometimes deeply unpleasant side effects (for example, itching, twitchiness, nerviness and, it sounds silly but was truly awful, having a song stuck in my head 24/7 and for weeks on end).

Mirtazapine was much "kinder" but still wasn't a pleasant drug to take. It caused severe drowsiness which, strangely, still did nothing to help my sleep, with the drowsiness persisting throughout the daytime, leaving me feeling horribly "dull-headed" all the time I was taking it. In the end, I just gave up taking it, as I had the SSRIs. Mirtazapine, I gather, is a potent antihistamine, so it is very similar in action (but somewhat stronger) to the diphenhydramine found in products like Nytol.

You can guess that I wouldn't recommend these to anyone and I genuinely question their now near-mass use. For anxiety, the only drug that I've ever found somewhat useful is diazepam, but that can cause varying levels of dependency in about a third of people taking it, so doctors now pretty much refuse to prescribe it in the UK. I think this is a great shame since it means that a somewhat effective drug is being withheld from people who might genuinely and safely benefit from it.

For insomnia, the "z" drugs (zolpidem and zopiclone) all work well to get you off but don't keep you asleep for long (about 3 hours); I have zolpidem and if needed I take 2.5mg or 5mg at about 3am.

You have my sympathies if anxiety and insomnia are a part of your life. It's a real burden.

Steve

[Annie2609 in reply to Ppiman]

Steve, thanks for your reply. Yes I do struggle a lot at the moment with both anxiety and insomnia (probably induced by anxiety). I have other heart problems and cannot just spend my.life in ER, that's why I decided to try these drugs. I'm not new to SSRIs and had both good and not so good experiences in the past. I am new to Mirtazapine and frankly I suggested this to my family dr seeing that quite a few people on this forum take it. Apparently it's more commonly prescribed in Europe than in N America (I live in Canada) but my doctor didn't have a problem prescribing it. Your comment about diazepam hit a very sensitive spot as I too was on Clonazepam (as needed, then switched to a min daily dose) with much better results in terms on anxiety. No chance for my doctor to prescribe it anymore even though I explained to her we replace a drug that works great for anxiety with 2 drugs, that have so many more side effects and might not even work and they also create dependency.. I don't understand their point, maybe we are missing something..

Anyways thanks for listening to my frustrations and sharing yours.

Annie

[Ppiman in reply to Annie2609]

I read an impassioned plea that to refuse benzodiazepines to the 2/3 of people who would never be affected by them in terms of dependency is plain cruel. I agree with that. They are not miracle drugs and they were (just as SSRIs are being...) heavily over-prescribed; but to refuse a useful drug? I'm cross, too.

I do hope that you find the near future brings you some comfort - it usually does!

Steve

[cbsrbpm]

I am struggling with severe depression at present and have been put back on Mirtazapine having tried it before, they have now upped the dosage gradually until I am taking the full dosage of 45 mg. I am on 30 mg at the moment. I went back into AF since taking it again although I didn’t first time round so I don’t know if it is to do with it or not. I sleep very well with it but wake feeling very wired and edgy. I hate taking it but I have to give it a fair go this time as my depression is just getting worse. I am to start with psychology sessions in four weeks and am hoping that may help. I also take a small dose 2 mg of diazepam in the morning to try and counteract the edgy feeling. My EP knows I am taking Mirtazapine and checked for long QT. I am hoping he will keep an eye on that for me as I have a Kardia and will send ECG to him now and again. Might be a good idea to ask for yours to be checked. Hope you get some relief soon.

[Bolander in reply to cbsrbpm]

I always assumed that Mirtazapine is an SSRI, but apparently not. However, according to the article on the Patient.co.uk website, "Mirtazapine works by increasing the amount of noradrenaline and serotonin available in your brain. This can help ease the symptoms of depression." It is therefore similar in effect to SSRIs and not an antihistamine

[sewingscissors]

Hi Annie. I am taking Sertraline 150 mgs and a very small dose of Mirtazipine and have been doing so for a number of years and haven’t had any problems with them, so perhaps have been lucky! Eventually I hope to come off them both gradually, but with all the anxieties just now, it is not a good time. All the best and I hope you can get something worked out. Liz

[Annie2609 in reply to sewingscissors]

Thanks Liz, this is pretty re-assuring. Can I ask how much Mirtazipine you are taking and is it on a daily basis. I just started with 25 mg of sertraline to be increased to 50 and then 75 in 3-4 week, and am supposed to take 7.5 mg of Mirtazapine.

[sewingscissors in reply to Annie2609]

Hi Annie. I am taking 150mgs Sertraline in the morning and 7.5 mg Mirtazipine in the evening.i am meant to be cutting out the Mirtazipine, but as it has a really good side effect of stopping my restless legs, I am staying on it! You don’t often get GOOD side effects, do you?! Anyway, I do hope you feel better soon and let me know how you get on. Liz x

[Auriculaire]

I would try supplementing magnesium for anxiety before trying any prescription drugs. It worked for me. My anxiety was not constant but I would get out of the blue attacks of it. Supplementing magnesium taurate 300mg split into 3 doses with meals knocked it on the head. You could take an extra dose before bedtime to help with the insomnia.

[Annie2609 in reply to Auriculaire]

I did try magnesium for 10 months and unfortunately didn't help with the anxiety. I think I was sleeping better on it though.

[Auriculaire in reply to Annie2609]

What type did you try? There is a big difference between different sorts of magnesium an magnesium oxide is not very well absorbed.

[Palpman]

Taking one of the two would not prolong QT as much unless you have congenital LQTS or take an antiarrhythmic drug such as Flecainide.

You should have gotten a normal baseline of your ECG prior to commencing the drugs and then can compare going forward.

Sertraline did nothing for me but I had to stop them due to it increasing my QT to 480ms. I am also on Flecainide so I had to choose between the two.

Prozac was the only antidepressant that actually worked for me but did not help with sleep at all.

[Annie2609 in reply to Palpman]

Thank you Palpman, great advice. I thought so too that it's safer to take just one of the two. I actually had an ECG done last week, and know my baseline QT. I am supposed to do an ECG 2 weeks after starting Zoloft. I couldn't tolerate Prozac at all.

[Palpman]

I must also add that if you have bradycardia and take any of the above tablets then it can also increase QT. Most people forget this.