# Doctor didn't seem to know what mirtazapine was.



## Ash09 (Apr 27, 2009)

Today when I was at the gp (who kept trying to force prozac onto me) I asked about mirtazapine and she said "they all cause sexual dysfunction", now considering all the studies I've read show that it doesn't, am I missing something or did she not know what mirtazapine was?


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## arth77 (Jun 4, 2009)

I doubt that remeron doesnt ever cause sexual problems although the makers have spent a fortune on advertising this claim
I also doubt that adding it to another AD can cure sexual problems, remember all anxiety sufferers can get a big placebo effect

rememon is known for sometimes causing compulsive eating as it did with me


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## jim_morrison (Aug 17, 2008)

Yeah from my experience as a Mirtazapine user, I'd have to say that it's completly neutral when it comes to sexual functioning. The food cravings on the other hand are fierce for the first month or so and then slowly dissipate there after.


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## euphoria (Jan 21, 2009)

Regarding your doctor, she sounds like a ****ing ****. Why is it that supposed "experts" who've trained their whole lives don't even know such basic facts about the powerful pills they're handing out? Why even bother going into medicine if you have such an apathetic attitude towards patients?

Another thing: why are mirtazapine or ondansetron not prescribed as standard with SSRIs/MAOIs? They're literally choosing for you to have sexual dysfunction. Bloody bureaucracy!


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## bezoomny (Feb 10, 2007)

Did you mention that it's Remeron? I find it really unbelievable that a doctor didn't know what Remeron was. Especially if he's putting you on other SSRIs. I was given that for insomnia. It's good if your depression tends towards melancholic (don't eat, can't sleep, etc.). But it just made me gain too much weight.


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## Medline (Sep 23, 2008)

I think Wellbutrin XL (bupropion) is a better choice for the treatment of SSRI-induced sexual dysfunction than Remeron (mirtazapine), because even if they were equally effective (which has never been proven) the following reasons have to be considered:

Wellbutrin XL can counteract two other possible side effects of SSRIs - somnolence and weight gain - whereas Remeron is known to cause somnolence and significant weight gain often enough.

There exists definitively more controlled data from human studies that proves that Bupropion is effective in the treatment of SSRI-induced sexual dysfunction compared to Mirtazapine.

http://en.wikipedia.org/wiki/Bupropion#Sexual_dysfunction


> Bupropion is one of few antidepressants that do not cause sexual dysfunction.[26] According to a survey of psychiatrists, it is the drug of choice for the treatment of SSRI-induced sexual dysfunction, although this is not an FDA-approved indication. Thirty-six percent of psychiatrists preferred switching patients with SSRI-induced sexual dysfunction to bupropion, and 43 percent favored the augmentation of the current medication with bupropion.[27] There are studies demonstrating the efficacy of both approaches; improvement of the desire and orgasm components of sexual function were the most often noted. For the augmentation approach, the addition of at least 200 mg/day of bupropion to the SSRI regimen may be necessary to achieve an improvement since the addition of 150 mg/day of bupropion did not produce a statistically significant difference from placebo.[28][29][30][31][32][33]
> Several studies have indicated that bupropion also relieves sexual dysfunction in people who do not have depression. In a mixed-gender double-blind study, 63% of subjects on a 12-week course of bupropion rated their condition as improved or much improved, versus 3% of subjects on placebo.[34] Two studies, one of which was placebo-controlled, demonstrated the efficacy of bupropion for women with hypoactive sexual desire,[35][36] resulting in significant improvement of arousal, orgasm and overall satisfaction. Bupropion also showed promise as a treatment for sexual dysfunction caused by chemotherapy for breast cancer[37] and for orgasmic dysfunction.[38] As with the treatment of SSRI-induced sexual disorder, a higher dose of bupropion (300 mg) may be necessary: a randomized study employing a lower dose (150 mg) failed to find a significant difference between bupropion, sexual therapy or combined treatment.[39] Bupropion does not affect any measures of sexual functioning in healthy men.[40]


There exists also more controlled data from human studies that proves that the combination of an SSRI with Bupropion is an effective strategy in partial- or non-responders compared to the combination SSRI + Mirtazapine.

http://en.wikipedia.org/wiki/Bupropion#Depression


> According to several surveys, the augmentation of a prescribed SSRI with bupropion is the preferred strategy among clinicians when the patient does not respond to the SSRI.[18] For example, the combination of bupropion and citalopram (Celexa) was observed to be more effective than switching to another antidepressant. The addition of bupropion to an SSRI (primarily fluoxetine or sertraline) resulted in a significant improvement in 70-80% of patients who had an incomplete response to the first-line antidepressant.[19][20] Bupropion improved ratings of "energy", which had decreased under the influence of the SSRI; also noted were improvements of mood and motivation, and some improvement of cognitive and sexual functions. Sleep quality and anxiety ratings in most cases were unchanged.[20] In the STAR*D study, the patients who did not respond to citalopram (Celexa) were randomly assigned to augmentation by bupropion or buspirone (Buspar). Approximately 30% of subjects in both groups achieved a remission. However, bupropion augmentation gave better results based on the patients' self-ratings and was much better tolerated. The authors observed that "these findings reveal a consistently more favorable outcome with sustained-release bupropion than with buspirone augmentation of citalopram."[21] The same study indicated a possibility of higher remission rate when the non-responders to citalopram received bupropion augmentation rather than were switched to bupropion (30% vs. 20%).[22]


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## Keith (Aug 30, 2008)

personally i take prozac and wellbutrin together and am able to function sexually. Before the wellbutrin i could not have an orgasm.I take 150mg of wellbutrin xl i still have a slight bit of a harder than normal time achieving orgams but i dont think the ladies mind!


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## RockiNToM (Jun 15, 2009)

Personally this pro-sexual stuff you speak of, I haven't experienced while on Mirtazapine.


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## Andre (Feb 27, 2004)

For me (and I am male), bupropion works better than mirtazapine at stimulating my sex drive.

I am curious about how the two function at promoting sexual arousal and satisfaction. I'm taking bupropion currently which affects not only sexual desire but orgasm intensity.


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## UltraShy (Nov 8, 2003)

rocknroll714 said:


> She sounds like an idiot to me.


Agree, the doc is an idiot.

Remeron is famous (or infamous) for three things: lack of sexual side effects, drowsiness, and weight gain.


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## RockiNToM (Jun 15, 2009)

I haven't really had any of those, but I am eating like there's no tomorrow, so far no weight gain, but I guess there's still time. :no


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## soaringfalcon11 (Jun 7, 2009)

rocknroll714 said:


> She sounds like an idiot to me.
> 
> Mirtazapine (Remeron) does NOT cause sexual dysfunction under any circumstance and has often been used in combination with meds that do like the SSRIs/SNRIs to alleviate it. It's probably several fold better than bupropion (Wellbutrin) for that purpose. If anything it has a positive effect on sexual function. Personally, I found it mildly aphrodisiac, and it significantly enhanced sexual sensation, though that's just me. Also, I've read that it sometimes even causes spontaneous orgasms.. another effect that I encountered in fact, though I was having a naughty and totally disgusting dream when it occurred ;D
> 
> Also, don't let her put that fluoxetine (Prozac) down your throat if you don't want it! You decide what medication is right for you, nobody else.


OK! Enough is enough. I'm sick of going to the grocery store and not thinking twice about the beautiful lady looking at the yogurt! You got me with "mildly aphrodisiac".

The research I've done suggests that Remeron can effectively treat SA. So could you tell me, how did it effect your SA?

Also, I hear it's sedating? Comments appreciated.

w00t w00t


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## jim_morrison (Aug 17, 2008)

soaringfalcon11 said:


> OK! Enough is enough. I'm sick of going to the grocery store and not thinking twice about the beautiful lady looking at the yogurt! You got me with "mildly aphrodisiac".
> 
> The research I've done suggests that Remeron can effectively treat SA. So could you tell me, how did it effect your SA?
> 
> ...


Yes it is sedating, however I take it and still need the occasional Klonopin so don't expect a magic bullet for SA, however it can be very helpful in the chronic treatment of insomnia/depression/low to moderate anxiety


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## jim_morrison (Aug 17, 2008)

rocknroll714 said:


> Mirtazapine helped my SA to a degree, though personally I found it to be too mellow in effect for my liking. I didn't spend more than 3-4 days dosing it chronically at a time, however, so it may have made more of a difference once its effects came to full prominence after 2-3 weeks or so. My phenelzine (Nardil) is much better in comparison as far as I can tell (and likely so anyway), though I may actually augment it with low dose (15 mg) mirtazapine to combat certain side effects and enhance efficacy in the future.
> 
> Indeed, mirtazapine is extremely sedating. It's the most powerful antihistamine (which are commonly used as hypnotics, or anti-insomniacs) on the market. Though, if you dose at night right before you go to sleep, or if you take higher doses in which it becomes more adrenergic in effect and therefore more stimulating, the sedation and somnolence becomes less prominent. Notably, in most people, high tolerance typically develops to the antihistamine effects upon chronic dosing after 1-2 weeks, after which you may even be able to take it during the day without problems.
> 
> ...


Nardil and Mirtazapine would be an interesting combo, for SA but also for depression considering that even california rocket fuel should pull most people out of the bleakest depression.

Have you ever tried dosing them together chronically for more than a week at a time? 
When the full effects come to prominence. Might be interesting


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## soaringfalcon11 (Jun 7, 2009)

rocknroll714 said:


> Mirtazapine helped my SA to a degree, though personally I found it to be too mellow in effect for my liking. I didn't spend more than 3-4 days dosing it chronically at a time, however, so it may have made more of a difference once its effects came to full prominence after 2-3 weeks or so. My phenelzine (Nardil) is much better in comparison as far as I can tell (and likely so anyway), though I may actually augment it with low dose (15 mg) mirtazapine to combat certain side effects and enhance efficacy in the future.
> 
> Indeed, mirtazapine is extremely sedating. It's the most powerful antihistamine (which are commonly used as hypnotics, or anti-insomniacs) on the market. Though, if you dose at night right before you go to sleep, or if you take higher doses in which it becomes more adrenergic in effect and therefore more stimulating, the sedation and somnolence becomes less prominent. Notably, in most people, high tolerance typically develops to the antihistamine effects upon chronic dosing after 1-2 weeks, after which you may even be able to take it during the day without problems.
> 
> ...


Hmm. With my soon-to-be busy schedule (school and work), I'm not so keen to try it anymore. Nearly ALL of the reviews I've read mentioned terrible sedation. And with all the dose augmentations people were mentioning, I don't think it's worth my time right now.

Also, with a relativity short half-life, I'd imagine taking it at night would mitigate the anxiety relief throughout the day.


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## jim_morrison (Aug 17, 2008)

rocknroll714 said:


> Not yet. I'm running short on mirtazapine tablets and my doctor won't prescribe anything with phenelzine in conjunction right now I believe, so I've got to ration what I have left and I can't afford to dose it consistently. I'd have to really push him for him to prescribe mirtazapine or just about anything else in combination, and that's not necessarily something I want to do at the moment as he's a pretty cool guy and he trusts me quite a bit.
> 
> I have, however, taken mirtazapine with phenelzine acutely approximately three or four times, mainly to put me to sleep and to test out the effects of the combination.
> 
> ...


Thats interesting to hear, I guess that it would be fairly difficult to get a doctor to prescribe both Nardil and Mirtazapine at the same time, thanks to their default contraindication (which as you said, is not based on anybody actually ever having a reaction between these two specific drugs, but simply due to the "theoretical" idea that Mirtazapine rasies serotonin via alpha 2-adrenergic antagonism.)
As I beleve you've discussed already though, Mirtazapine's ability to raise serotonin levels is questionable, and it is more than likely that most of it's antidepressant and anxliotic efficiacy is mediated via it's antagoism of various serotonin receptors.
The only cases of Mirtazapine related SS that I could find are as follows, (the latter being far more likely due to the additional coadministration of venlafaxine and tramadol):
http://www.ncbi.nlm.nih.gov/pubmed/12671522
http://www.theannals.com/cgi/content/abstract/36/4/641
http://www.theannals.com/cgi/content/abstract/38/3/411

I don't however know enough on the subject of MAOI's to know whether or not Mirtazapines ability to enhance noradrenergic transmission would interfere with MAOI's.

As for Mirtazapine not alleviating your sexual dysfunction, while there are many studies suggesting that Mirtazapine can indeed help alleviate SSRI (or theoretically MAOI) induced sexual dysfunction (via it's antagonism of certain 5HT receptors as well as the alpha 2-adrenergic autoreceptors and heteroreceptors), according to the text book "Biology of depression"; "It is suggested that while treatment of SSRI-emergent sexual side effects with adjunct Mirtazapine is not supprted by one double blind trial (Mitchelson et al., 2002), switching to Mirtazapine may alleviate SSRI emergent sexual dysfunction in SSRI remitters (Gelenberg et al., 2000)." 
So I guess that it is possible that some people may not respond to Mirtazapine augamentation in the alleviation of sexual dysfunction.


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## Medline (Sep 23, 2008)

> Not to mention my own experiences have proved the combination not to be dangerous or cause any adverse reactions. For these reasons, I strongly vouch for and support the augmentation of any antidepressant, including the MAOIs, with mirtazapine.





rocknroll714 said:


> The first time with 45 mg of mirtazapine I dosed at night and went to sleep. Upon waking up, I seemed to have developed prominent hypomania, which was really, really crazy and weird, but interesting nonetheless. The effects included euphoria, considerably improved mood, significantly enhanced perception and quality of music, a paradoxical combination of anxiolysis and anxiogenesis, irritability, restlessness, racing thoughts, moderate cognitive/memory impairment, dizziness, and complex visual and auditory hallucinations (no joke). Later, after several hours, the mood boost and music enhancement wore off and I just felt really disoriented, dysphoric, and ****ed up.


Mirtazapine can be combined with MAOIs, but one must either do it in the right order (starting with the Mirtazapine therapy and after the dose is adjusted, slowly adding the MAOI) or carefully titrating the dose of both drugs up simultaneously. Taking a high Nardil dose regularly and then suddenly adding a pretty high Mirtazapine dose is "incorrect" (to find a nice word ).


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## nedoedaw (Sep 27, 2011)

I have been on Mirtazipine for a year and can definitely confirm positive sexual side effects. Anyone know if this is gender based? (I'm a dude...) If not, do I need to slip one into my date's drink when she goes to the bathroom? J/K.... To sum up, in order of 'severity' of side effects:

1. Increased appetite, 4sho. I remember craving hitting me 20 min after my first dose. Thankfully I'm an exercise junky. However... see #3
2. Sex drive itself isn't increased, but erections happen with startling ease. I've read about 'unusual dreams' but I have no idea what this means. All dreams are unusual to me. If anything, my dreams have become very pedestrian on mirtazipine.
3. There is a general energy loss coupled with a hyper sensitivity to cold or hot temps (I'm not sure why, but I have a very truthy-feeling in my gut about this connexion). I have to drag my *** to the gym when before I was chomping at the bit.
4. Muscle weakness/soreness/stiffness. As someone who is extremely vain and lifts weights because of it, this is the worst side effect for me. My bench press has gone down by about 30 lbs. I'm also a runner and have encountered injuries in my feet, knees, and hips that I've never encountered before mirtazipine.
5. Sleepy sleepy. zzzzzzzzzzz.... it is handy for a stress monster like me to get knocked out. I'm actually really torn about the mirt. if you haven't guessed already....


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## CD700 (Apr 22, 2010)

But it is helping your social phobia ?


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## GotAnxiety (Oct 14, 2011)

You'd think ritilin would off set the extreme hunger cause from mirtazpine? I would like to do a formal review on the combination remeron and stims. Maybe i can do like ritilin wellbutrin remeron combo and try dexedrine with it.


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## beaches09 (Feb 1, 2009)

GotAnxiety said:


> You'd think ritilin would off set the extreme hunger cause from mirtazpine? I would like to do a formly review on the combination remeron and stims. Maybe i can do like ritilin wellbutrin remeron combo and try dexedrine with it.


Adderall abolished the otherwise extreme hunger mirtazapine gave me.

Wellbutrin helps slightly.

Wellbutrin without mirtazapine abolished my appetite.


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## GotAnxiety (Oct 14, 2011)

beaches09 said:


> Adderall abolished the otherwise extreme hunger mirtazapine gave me.
> 
> Wellbutrin helps slightly.
> 
> Wellbutrin without mirtazapine abolished my appetite.


Hey beaches how was remeron and adderall together?


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## sansd (Mar 22, 2006)

I wouldn't expect a general practitioner to know details about various types of antidepressants.


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## reef88 (Mar 5, 2012)

I took half a pill of Remeron once and it put me right to sleep even after doing coke. It has powerful hypnotic properties, I don't see how you wouldn't be affected at all sexual-wise, but I guess everyone reacts differently, specially when it comes to antidepressants.


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## beaches09 (Feb 1, 2009)

GotAnxiety said:


> Hey beaches how was remeron and adderall together?


Horrible. Remeron for the most part pounced on the positive cognitive effects of Adderall. The antihistamine is too damn strong, if it wasn't for that Remeron would be a fantastic drug.


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## wxolue (Nov 26, 2008)

Give her a break. She's a general practitioner, not a psychiatrist. Also, Remeron is relatively new. She might not have heard of it yet; might have been out of med school after it came out.

Most importantly, Remeron isn't groundbreaking-ly successful, and makes up plenty in other side effects (mostly fatigue and weight gain) what it lacks in sexual side effects. For most people id say SSRIs are better tolerated. Should she know about Remeron? Probably. Is she a complete f%$king idiot for not knowing? no-that's a bit harsh


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## riptide991 (Feb 1, 2012)

wxolue said:


> Give her a break. She's a general practitioner, not a psychiatrist. Also, Remeron is relatively new. She might not have heard of it yet; might have been out of med school after it came out.
> 
> Most importantly, Remeron isn't groundbreaking-ly successful, and makes up plenty in other side effects (mostly fatigue and weight gain) what it lacks in sexual side effects. For most people id say SSRIs are better tolerated. Should she know about Remeron? Probably. Is she a complete f%$king idiot for not knowing? no-that's a bit harsh


Agreed. GP's don't have to know that nor should they waste their time knowing that. They should be referring you to a psychiatrist. In fact, GP's do have the ability to give prescriptions for these drugs but should only be done if the person is already taking them. They should in no way be making decisions about what they are taking but simply filling something a psychiatrist already prescribed. If something goes wrong they can be penalized for malpractice. At least, here in Canada. In the event that they have to make a decision they go with SSRI's as they are safe.

It's like calling a psychiatrist an idiot for not knowing which blood pressure drug you should use.


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