mirtazapine and buspirone ?

Treatment and medication
1

Hi All

First happy new year to you all ☺

After the mirtazapine began losing its effect before Xmas and I started slipping back into my old panic ways. After seeing the doctor in a bit of a mess he refereed me to see a psychiatrist again as they previously declined my referral. This time they see me within 4 days 😊

Anyway the psychiatrist has increased the buspirone the doctor prescribed last week from 15 mg to 25mg. I'm also on 45mg mirtazapine.. has anyone else been on this combination?

I have another follow up appointment in a month or so with him and if there is no improvement he's going to try a different antidepressant to mirtazapine .

Any thoughts / comments on the mirt / buspirone much appreciated

Richie

2

I don't have any experience with the Buspirone, but I am on Mirt and Effexor.  I was in protracted withdrawal from Effexor when I was put on mirt.  It helped me sleep, but very quickly it wasn't helping otherwise and so I kept upping the dose until I was at 37.5 mg and feeling worse than ever.  I knew giong higher wasn't going to work, so went back to my doc in desperation.  He thought since I had tolerated Effexor well in the past that maybe we ought to try it again.  Well, that worked, but because I was getting the fix I needed from withdrawal!

So now I am on both, but tapering.  I have learned tons about withdrawal and these drugs in general. 

Mirt goes well with SSRIs and SNRIs because they work in complementary ways. Not sure about Buspar, though, as it is not an SSRI.  I would be a little concerned about this combo because you are on a high dose of mirt already.  I did a drug interaction check and found the following:

Interactions between your selected drugs

Major buspirone  mirtazapine

Applies to: BuSpar (buspirone), mirtazapine

Using busPIRone together with mirtazapine can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should seek immediate medical attention if you experience these symptoms while taking the medications. Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Hopefully, your doctor knows what he is doing in this regard, but I would recommend doing a slow taper off of mirt since it wasn't working for you and best to not be on more than you need. 

However, mirt is very tricky to get off of, and the taper schedule that most doctors advise is way too fast and will cause withdrawal, even though you'd be on another med that might temper that a little.  

If you would like information on how to taper safely, visit the topic "Reducing ADs using a 10% withdrawal method" in this thread:

https://patient.info/forums/discuss/depression-resources-298570

3

Hi

Thanks for your reply.I read about the interaction after my gp prescribed it last week.. when I see the psychiatrist today he wanted me to try venlafaxine instead of mirtazapine. But as I had already started with the buspirone he advised that it would be better for now to increase this dose by 10mg a day rather than introducing a third antidepressant.

Well at least I hope he knows what he doing otherwise I'll be 😨😨😨.

I've tapered of anti depressants in the past (prozac) and it's no fun.

Glad to here you are feeling better . Wishing you well with the tapering

Thankyou

4

Well, if you were to go on ven with mirt, you'd be on two of the most notorious ADs to get off of - lucky me!  Less is more.  Don't get caught up in cocktails if you can help it.  Docs love to chase the side effects of one drug with another :-(  Good luck!  I hope you find something that will work for you.

Just a side note:  since you said the mirt isn't working anymore and you are at a fairly high dose, it is likely that mirt "pooped out" on you, otherwise known as tolerance withdrawal.  Google that and you will learn more, but basically your body responds as if you had done a dose reduction and goes into withdrawal, even though you didn't.  Those withdrawal symptoms include anxiety and depression which are not relapses of the old condition but actual withdrawal symptoms  The difference being that tapering off mirt will actually RELIEVE those symptoms.

5

Complete;y agree with this, Betsy. When the mirt pooped out on me after almost 4 years on 30mg, I was plunged into the most awful depression and anxiety and insomnia. I felt really desperate because I was already on an AD that was supposedly working so what to do next? I considered upping my dose but figured it would eventually poop out on me again, even if it worked for a while, and that would leave me a higher mountain to climb coming off it. Very strangely, when I started to come off it, I actually started to feel better, not worse. I was expecting the most horrendous withdrawal symptoms because I was already bad enough and so withdrawing would make it even worse, right? I am still confused as to why it didn't. I am putting it down to the inositol, but I might be wrong. Sadly, my insomnia has remained.