I suffer with Bipolar II. I am on Lithium 250mg BD plus lamotrigine 100mg BD. My doctor started me on mirtazapine 2 1/2 months ago slowly working up to 45mg. It is not helping my anxiety and panic attacks. It is making it worse. How do I titrate down off 45mg to 30mg which might be a more suitable dose? Desperate. Thank you.
Mirtazapine causing more anxiety and panic attacks?
Question posted by Medicine003 on 13 Jan 2024
Last updated on 14 January 2024
Answers
masso
13 Jan 2024
Hello,
In order to discontinue the use of the antidepressant (Mirtazapine) you must work with your Dr. and have him/her come up with a discontinuation schedule. Your Dr. is responsible of your treatment and above all, your safety. You must minimize any withdrawal symptoms that may present themselves if you stop using the medication too fast, this is why it is so important to discontinue the use under medical supervision.
Regards, masso
masso
13 Jan 2024
I saw you do not mention the use of any antipsychotic medication. I suffer from Bipolar Disorder too, and have been many years taking Seroquel ( quetiapine-atypical antipsychotic) which for me it has been crucial in my treatment, do consider the possibility of taking an antipsychotic, perhaps quetiapine or another one.
https://www.drugs.com/seroquel.html
https://www.drugs.com/drug-class/atypical-antipsychotics.html
I was also on Lithium but the side effects were too much, a good mood stabilizer is Lamictal (lamotrigine), I have been on it for a while and it also has helped me, remember everyone reacts differently to medications, this is the reason there is a trial and error process.
Medicine003
14 Jan 2024
Thank you for all that helpful information. Yes I’ve only been on a very low dose of Lithium for about 4 months now plus Lamotrigine plus mirtazapine. I don’t know which medication is making me feel so unwell. Maybe it is the Lithium. What side effects did you experience from it. I presented to my closest emergency department this morning and they are admitting me tomorrow morning to my usual private health clinic. Soo do you find Lamotrigine and Quetiapine is a hood combination for you. I have never gone manic. I always drop into deep depression with this bipolar. It is soo debilitating. I never suffered with crippling anxiety and panic attacks until the last four months. I really got rock bottom this morning. My appetite has been shocking for the past 5 months.
masso
14 Jan 2024
I am sorry to read you are having an awful time.
I believe it could be the lithium which is making you feel unwell and as you know you have to have constant blood work done when on lithium to check you are on the right dose due to its toxicity.
Having said that, I experienced terrible tremors in my hands, dry mouth and vision issues, but as you are aware everyone reacts differently to medications.
Perhaps you are not taking the right meds and need to try as I mentioned before other alternatives in order to live a "normal" life, when medicated correctly (and it takes a bit of time to find the right combo, you can actually function pretty well, speaking from experience).
I am 55 y/o male and at the moment my life is ok, but there have been hard times, nothing is easy or free in life, in my case I am 99.9% manic which I do prefer rather than depression, and I have carried this condition for many years. But if I can do it, get out of that dark deep hole, so can you, maybe you need another Psychiatrist, one specializing in treating bipolar disorder and other mental conditions, mine does, try to find one.
Last, I did some research and found the following:
"The second-generation, so-called atypical antipsychotics (SGAs), such as clozapine, risperidone, olanzapine, and quetiapine, have antimanic activity and are also effective for the maintenance treatment of bipolar disorder. Additionally, quetiapine exerts therapeutic action in bipolar depression."
Source: National Library of Medicine
I sincerely wish for you to get on the right path and start living.
Regards and of course you are welcome, masso
poisonbabe27
13 Jan 2024
This is something that should be discussed with your physician. It can be dangerous to try to titrate off of medication especially any psychiatric med on your own. It should be done properly and you should be supervised by the prescribing physician while you are titrating. Also I'm not sure what you've tried for your anxiety but there are medications that do work very well. Ask your doctor about buspirone, Xanax, or hydroxyzine. Xanax is more of a controlled substance but does help with anxiety and panic attacks that are hard to control. Xanax can be very addicting. So think about it before you start taking them. As for buspirone and hydroxyzine as far as I know they are not addictive and are tolerated very well by most.
I hope this helps you
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bipolar disorder, anxiety, panic disorder, lamotrigine, lithium
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