Mirtazapine for agitated anxiety

was given two years ago. Hasnt done much for my anxiety which was the real problem. Now decided to lower dose.  Have gone from 15 to 7.5 to 3.75 using cutter. Now trying to lower.  Sleep very erratic and feel strange, as if i am not so doped.  Dr gave me valium 2 years ago, I take 5mg night and try to manage on 3mg day.

Dont think i am depressed as such but anxiety still there. Frightened of normal things like going to visit friends, relatives, shopping in large areas, cinema. Theatre, all things i would normally do before all,this.

i just feel weird, not quite all here and the anxiety is being controlled by the valium alone. How do I find myself again without all these fears?

I go to a local buddist class.  Buddism does address a lot of everyday fears.

I think a low dose of mirt does little to help with anxiety (it is better for insomnia and perhaps depression),  Go to your doctor and get treatment for anxiety (eg an SSRI antidepressant). 

Best wishes.

Been to psych and tried effexor and sertraline,  early drove me mad with anxiety even taking diazepam to try to control it.  Seems i am 'sensitive' to ssris.  What do i do next? Tried breathing techniques,relaxation tapes, cbt. Is there a med better than diaz  to help my anxiety as its running so high.

I am surprised that the drugs you tried did not work or made you worse. I hope you gave them long enough - as they can make you worse before making you better.

You should rely on your psychologist.  There are several drugs he/she could prescribe which work differently from SSRIs.      

Hi Ann

​I feel bad for you because I know exactly how you feel.  I am in the same situation now I even have to pop a benzo to go and visit my daughter because it is out of my "comfort zone", have fears about everything and I dont really go out much not in the winter anyway.

​August 2015 I had the most horrendous 13 weeks, started off with racing heart, then nausea and insomnia.  This went on day after day, hour after hour, right through the night.  In the end I was popping xanax just to get two hour's sleep at night but come 2 a.m. my racing heart would waken me.  I lost so much weight couldnt eat and eventually collapsed in a heap.  Nobody took me seriously, psych team said depression and anxiety but I wasnt depressed.  Was started on 7.5mg mirtazapine and then 15mg, things started to calm down but I didnt feel right, they then upped me to 30mg and I began to feel really irritated and slightly aggressive.  I kept telling them I felt it was something physical wrong with me but no, it had to be anxiety and depression (they have tunnel vision).  They also gave me valium which didnt agree nor do any calming down.  It maybe that mirtazapine doesnt agree with you, I was okay on the small dose but they were careful to start me off gradually as I had a terrible reaction to cypromil many years ago when I had a frozen shoulder and a very poorly mother and GP thought it might help. 

​To cut a long story short, months later went to see an endocrine surgeon because I had suspected primary hyperparathryoidism.  Had an ultrasound and the guy said he didnt think it was phpt but noticed inflammation on the thyroid and suggested thyroid blood tests including antibodies.  Surgeon ignored this and wanted me to do big doses of vitamin D, anyway, I started weaning myself off the mirtazapine and over 12 months later it turns out I have thyroiditis.  The start of it was the racing heart and nightmare 13 weeks but the mirtazapine just masked it.  If you google the symptoms of Hashimotos you will see that a lot of familiar symptoms.  I still have these horrible symptoms but I know what it is now.  So what I am saying is, ask to have blood tests and ask them to look for other reasons.  I occasionally pop 7.5mg of mirtazapine if I think I am going to have a restless night and I acquired some bromazepam from overseas, a benzo that really agrees with me but I would only take say one a week as I dont want to get hooked.  I was on them full time for 8 years after my husband died young 30 odd years ago and I wouldnt want to go through the withdrawal of them again.  Andrew below mentioned a buddhist class but I wouldnt even be able to sit amongst people and would have to be at the back near the door.

​Ironically there have been a couple of people on another mirtazapine thread who experienced the same and it was their thyroid.  Biggest problem is getting the GP to listen and also they dont do T3 tests nor are antibodies on the general list.

​I hope you feel better soon.

Hi, thanks for your very helpful information.  Like you, I have had this problem with mirtazapine for a while and cannot get dose up..i reacted badly to sertraline and had to discontinue, the agitation was high even on low dose.

i had some ordinary blood tests done by gp and she just said thyroid looked ok.   I am still ill and wondering if there is a more thorough thyroid test can be done to find the abnormality?

i couldnt sit in any class just now, my anxiety is doing this to me.

i am waking feeling nauseous in morning which dissipates as day goes on but waking early having to take buccastem to quell it.  Im fine when i go to bed.

i hate having to take diazepam to get out but am in such a mess.  Gp despairing of me I think.   I am even wondering if i need endoscope to check stomach, gp just keeps saying its anxiety.

i dont know how to approach her to ask for referral to endocrinology, she will probably think i am too anxious.

any hints you have would be helpful.  Thank you for taking time to write

It's a tricky one with Gp's as they hardly know anything about thyroid.  They dont do the T3 just the TSH and T4 and we get the usual annoying thing "within the normal range".  What is normal for some might not be normal for others.  I have been down the private route since June 2015 since a GP was trying to get me to chew on 3000mg of calciuim per day because of my osteoporosis and she hadnt noticed that my blood calcium was over the range, so if I hadnt had my wits about me and always get any tests printed off, I could have ended up with kidney stones, a stroke or heart attack.  I have actually wasted over £6000 of my old age savings on numerous scans and private endocrinologists and they were useless.  I dont really know what to suggest to you because I might be leading you in completely the wrong direction as regards to the thyroid.  By the way, someone on a thyroid forum posted up a study that had been done and valium can actually suppress the thyroid hormone.  After I eventually got my blood tests back from the private endo surgeon I went to see in the July of last year and got them in September, I figured by December they would be out of date and so I sported out the £99 on a home kit finger prick test which included all the relevant thyroid tests, antibodies, ferritin (which is quite low) B12 which was high and was a surprise because of the low folate and vitamin D.   I was nervous that I would not squeeze enough blood out into the tiny little tube but it was fine.  However, the results were not and then someone suggested a Functional Medicine Practitioner and I have found one locally who is also a GP.

Of course you are anxious, who wouldnt be, but as I already said thyroid causes anxiety anyway, in fact not feeling well causes anxiety so which comes first the chicken or the egg, ie. physical or mental.

​I really hope you can get some help but you should try to cut back on the diazapam (I know pot calling kettle black) but there will come a time when the GP will not give you any more, or he might retire or anything.   Most GP's do not give more than 2 weeks supply and that's it.  I still have a few valium but I have noticed they make me feel very slightly nauseous and do not really calm me down.

Oh dear I just wrote you a long respone and now its being modified and I forgot to copy and paste.  So annoying and one of the reasons why I dont visit the forum any longer but just get a weekly summary.  I didnt mention any names except for the place where you can get a home kit blood test.

Dont worry Elaine, i will research. I understand your problem with forum, feel a bit the same too.

thanks for trying

If it's not approved will send you something via private message.  I also had endoscopy, also ct scan on pancreas etc. and all came back normal.  As I said in my unapproved comment, is always difficult to find whether it's the chicken or the egg, ie. physical or mental.  However, feeling physically ill can make you anxious.  I don't want to encourage you down the thyroid path if it is nothing to do with that but so many symptoms are thryoid related.  Take care Elaine

Glad they actually approved it not that it will help you much.  I have to tell you that I had a physio appointment today for my frozen shoulder.  I needed half a benzo to get me there, anyway, taxi driver was talking to me and telling me about his wife who was really unwell for 18 months (same gp surgery as mine).  She used to have these terrible attacks of a racing heart which would come out of the blue and so bad they had to call an ambulance, this went on so many times that he used to say call me when you a ready for me to collect you.  GP said it was anxiety.  Anyway, she had an attack out in the street and got raced off to A and E again but this time the doctor said he felt he ought to scan her as her GP had been blaming it on anxiety all this time and ecg registered normal which it does and did with my racing heart problem.  They discovered five blood clots on one lung, specialist said if just one of them had moved she would have been a gonna!!!   Anxiety!!!!!!  The reported the numpty to PALS and she got a letter of apology from the GP.  Now she is on blood thinners, beta blockers and something he said that makes her doze off every night by 7.30.  She was only 42, non smoker and drinker.  Not suggesting yours is anything like that, but this is what we are up against, 10 minute rushed appointments that you have to wait weeks for and told "anxiety", grrrr!!

I noticed this morning on another part of this forum that someone had posted up 100 symptoms they have, she typed it a year ago, am wondering if she is still around literally, all caused by anxiety of course!!

https://patient.info/forums/discuss/over-100-symptoms-associated-with-anxiety-479538

Yes, amazing.  That happened to me.  Dr said frozen shoulder get physio. Six weeks later im in a and e with double pulmonary embolisms and couldnt breathe.  Now have to be on warfarin and anxiety and deoression wont leave, tried several ssris make me somill cant tolerate them. What he will give me next i dont know, or is the anxiety and depression part of pulmomary embolisms and warfarin?

Oh you poor thing, you  really have been unfortunate and again a cruddy GP service.  At least I did have an ultrasound to confirm the shoulder and have since learned and confirmed by rheumatology there is a connection with thyroid and frozen shoulders, although now physio are suggesting arthritis and I should have x-ray but not so soon after spinal x-ray.

​Anyway, getting back to you, it's no wonder you are going through all of this and obviously the drugs you are being given for anxiety are not doing any good.  I picked this off "The Clot Spot" -

"Recovery Expectations And Time

Pulmonary embolism survivors will have very different recovery experiences based on the amount of damage that was done by the clots.  Some patients have a small clot and were diagnosed immediately while others had multiple, large clots that were not diagnosed until the patient collapsed.  Survivors need to know that recovery is very individual.

The best advice for the recovery period is to have patience and to stay in communication with the medical team regarding symptoms and concerns.  Symptoms will often come and go throughout recovery.  If symptoms reappear or are bothersome, the primary care physician should be notified.  The patient may also wish to consider going to the emergency room to ensure that no new clots have appeared.

Recovery times vary greatly.  On HubPages, an informal study notes that while only 9% of patients will feel fully recovered in less than a month, 68% will feel recovered by two years.  Illness or stress during recovery can set back recovery by days to months depending on the severity of the situation.  A simple cold will hit someone in recovery much harder than a typical person.  Allergies or changes in the weather can also impact recovery.  Cold dry air or damp air seem to cause symptom flares in some individuals.

As mental health can be severely impacted by a pulmonary embolism, patients should speak with their primary care physician about any anxiety or depression problems.  Trying to participate in day to day activities can be very stressful for someone in recovery.  Also, many survivors are faced with the challenge of understanding why he or she survived a life threatening condition.  Panic attacks and post traumatic stress syndrome may also be a problem.  Counseling and or medication are reported by many survivors to be very helpful in the recovery period"

 

I'll send you a support group link.  I am generally not into happy clappy type groups but sometimes comparing notes with others does help.  Thyroid group have been invaluable to me. Elaine

Thanks so much.  I am sure the emergency admission with p.e's has done a lot of this, along with the warfarin, almost feel i want to not take it tomsee but thats dangerous. Three years since embolisms, three years of anxiety/dep!  Support group may help,thanks. meanwhile awaiting which horrendous anti dep will be given at next psych appt while i try to get through my days counting the minutes.

I am no better, been to see dietitian who has suggested i cut out wheat and gluten and go lactose free for a bit to see if it helps the ibs.  Anxiety still high but next appt at gp will be suggesting T3 and i know she will look at me and think oh no, not another thing!   I know i have anxiety and depression but i do feel theres something at the root of it. My p.e. has settled down, taking the warfarin but my general health is just the pits.   Do you think my gp will refer me to a private endocrinologist if I ask?  Thanks for the info about finger prick test - may end up on that route!  i am an educated and normally sharp person like you but feel the system is letting me down.   Yes, my anxiety is high, but what else is at play they dont want to know. Just keep offering more anti deps.

I am no better. They have tried to double the mirtaz and i have now got nausea and migraines too. They also want to add augmentation in shape of risperidone which i have been warned is a strong drug and not to take lightly.   I think i will have to drop the mirtaz back down first anyway as i cant tell you how ill i feel. My dr is not keen to do bloods in a hurry - help, ive been ill for three years! Says thyroid looks in range.  Not pleased when i asked for more in depth tests.   I have a fight on my hands i think. I cannot find the useful info about private testing, any chance you can help? And how are you, are things any better?