# What does mirtazapine (Remeron) feel like once you're used to the sedation?



## GregW (Jul 6, 2011)

I am very interested to know just what it feels like to be taking mirtazapine/Remeron at 30-45 mg/day (or higher) once the antidepressant effects have fully kicked in and the sedation is no longer a problem. Is it the emotionally calmed, tranquillised, serotonin sort of effect that people always talk about with SSRIs, or more of an energetic, motivated, norepinephrine type of antidepressant effect (or both)? I need the latter effect more than an SSRI type of feeling, and would put up with mirtazapine's sedation for weeks (if necessary) if it does indeed produce this. I have been prescribed it but haven't been able to hack the 24-hour sedation long enough to give it a fair trial, and am now thinking of asking for mianserin instead (which did give me a norepinephrine type of mood lift).


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## swim (Apr 4, 2011)

sedation never completely goes away when taking mirtazapine, it just slightly decreases so better not take the dose in the morning and when you want to stay awake. the antidepressant effect is quite mild and not comparable with that given by SSRIs/SNRIs/NRIs and the anxyolytic effect is zilch. On the pro side you'll be able to sleep soundly and for many hours and enjoy enhanced sex drive.


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## cindy8701 (May 5, 2011)

People drug shopping with little comprehension of neural underpinnings just piss me off. 

I took 40mg of mirtazapine once daily for about 6 months, I also suffered from horrific insomnia so it barely had a 'sedative' effect, simply just put me to sleep at night. It didn't induce any motivation or happiness, it simply blunted the negative reactions... Oddly enough exactly what it is suppose to do. 

I hear crack is great for induced happy mood and motivation, have you looked into that?


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## Inshallah (May 11, 2011)

There was a study published recently that concluded Mirtazapine has no serotonergic action, which affirmed my feeling while being on it (as swim's feeling as well apparently). It doesn't feel serotonergic at all, it doesn't induce that blanket of happiness and the anxiety reduction like the SRI's do. Made both my depression and anxiety a little worse actually.

Makes you sleep easier and longer and will likely make you eat more, both of wich contribute to feelings of happiness. (this is why it does work for people imo) I wouldn't consider it pro-sex neither but people have differing reactions there.

Always worth a try but it get's my vote for worst antidepressant on the market :teeth


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## swim (Apr 4, 2011)

Inshallah said:


> Made both my depression and anxiety a little worse actually.


yeah...hard times when I was on mirtazapine, the anxiety was overwhelming even at maximum dosage of 45mg.
But it HAS to be the best antidepressant at least because wikipedia says so :doh


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## gilmourr (Nov 17, 2011)

It definitely has a serotonin component, because my mood doesn't feel great but I feel well enough to do enough things. It doesn't work that well on anxiety.

Sedation 5 weeks in, and I'm still pretty tired 24/7 I still am sleeping 12am-12 pm and then a nap from 2-4/5 pm. Just lucky that I'm in school and studying can be done from home.


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## GregW (Jul 6, 2011)

Thanks for the opinions folks.


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## GregW (Jul 6, 2011)

cindy8701 said:


> People drug shopping with little comprehension of neural underpinnings just piss me off.
> 
> I took 40mg of mirtazapine once daily for about 6 months, I also suffered from horrific insomnia so it barely had a 'sedative' effect, simply just put me to sleep at night. It didn't induce any motivation or happiness, it simply blunted the negative reactions... Oddly enough exactly what it is suppose to do.
> 
> I hear crack is great for induced happy mood and motivation, have you looked into that?


You have misunderstood me, although perhaps the way I worded my question is partly to blame. I'm not looking to get high off antidepressants, and in fact I know you cannot normally abuse them for this purpose even if that was someone's goal. People doing dumb s*** with medication annoys me too. I was just wanting to get a better understanding of mirtazapine's effects against depression, which I genuinely suffer from. Also I am not "drug shopping", as this medication was prescribed by my doctor.


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## jim_morrison (Aug 17, 2008)

The daytime grogginess never went away for me over a prolonged period of taking 45mg/day.

As this blogger points out, two scales which are commonly used in depression research/drug trials count reduced appetite and sleeplessness as symptoms of depression, so mirtazapine by fixing these symptoms directly may give a falsely higher score of improvement.



> Mirtazapine is an unusual drug, with a pharmacological profile very different to that of most antidepressants. Notably, it's a powerful hypnotic - it makes you sleep - and it increases appetite. Patients on mirtazapine in the present study put on over 2kg in 6 weeks.
> 
> Why does this matter? Because the two scales used to rate depression in this study, the Hamilton Scale and the Montgomery-Asberg Scale, both count reduced appetite and sleeplessness as symptoms of depression. If you're on mirtazapine, you're unlikely to have either problem - you'll be more worried about the exact opposite, insatiable hunger and drowsiness. So mirtazapine could reduce your total score on these scales even if it didn't change your mood.


http://neuroskeptic.blogspot.com.au/2009/12/two-drugs-are-better-than-one.html


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## GregW (Jul 6, 2011)

Thanks Jim, I'm skeptical about antidepressant efficacy already, and becoming even more skeptical about mirtazapine! For me, being sedated indefinitely by this drug would just increase my depression, as I find it an unpleasant sedative effect. I've tried sticking with this drug 3 times already but have not succeeded.

Regarding the possibility that mirtazapine is not serotonergic at all, and therefore not really a dual action antidepressant, I first read a scathing review of both mirtazapine and mianserin by Dr Ken Gillman, an Australian psychiatrist who has a website called psychotropical. I know he believes mirtazapine does not increase serotonin activity, and he regards mianserin as being an ineffective antidepressant. As I said elsewhere, I found mianserin helpful myself, so I guess this again shows how everyone reacts individually to medications.


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## Inshallah (May 11, 2011)

jim_morrison said:


> The daytime grogginess never went away for me over a prolonged period of taking 45mg/day.
> 
> As this blogger points out, two scales which are commonly used in depression research/drug trials count reduced appetite and sleeplessness as symptoms of depression, so mirtazapine by fixing these symptoms directly may give a falsely higher score of improvement.
> 
> http://neuroskeptic.blogspot.com.au/2009/12/two-drugs-are-better-than-one.html


So if today I decide to stop eating and sleeping and some other banalities, a week from now I'll be classified as a major depressive if I then took such a questionnaire :roll Great job there Hamilton!

I'm starting to see why everyone is depressed


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## joetrader (Aug 2, 2013)

*Trimipramine Better than Mianserin (IMHO...)*

I never could shake the excessive sedation with the Remeron/Mianserin family of ADs, not even at 6 weeks. And the antidepressant effect was only modest (much less than what I'd been led to believe) so I did not stay with this med. Like you, I too wanted a more "activating" AD, not the zombie-"night of the living dead"-type stuff that makes up much of the modern SSRI complex. In this regard, I tried both desipramine and protriptyline (two old norepinephrine-oriented TCAs) with some success, but the agitation and insomnia was too much on the former, and the excessive drying effects were intolerable in the case of the latter. Finally I tried another older tricyclic called trimipramine (Surmontil, Rhotrimine) and let me tell you -- THIS med worked like magic!! Very strange...it was extremely sedating for the first couple of weeks, so I only took 25 mg at bedtime initially. But then the daytime sedation got a lot better after about 4 weeks, though it still knocks me out at night. I'd call the full-blown trimipramine state (which I define as achievable by taking 25-50 mg per night for at least 4 weeks) to be one of calmness and clarity, but with a great deal of energy and motivation as well. Very unique as modern ADs go -- I've tried over 20 of them (new and old) and no antidepressant so far even comes close to trimipramine in terms of effectiveness for anxiety, depression, and chronic neuropathic pain, which was my main reason for taking ADs. It also completely stopped my long-term migraine headache cycle, which I never thought would be possible. Interestingly, they don't even understand how or why trimipramine works. It's the only TCA that doesn't significantly affect serotonin or norepinephrine! Don't believe any online sites that tell you otherwise, because they are just parroting standard tricyclic spiel if they claim that 5HT or NE are potentiated...they definitely are not. Trimipramine is believed to work primarily via it's inhibitory action on neuronal calcium channels, but also perhaps through it's effects on the endogenous endorphin system. And the story gets even weirder, because trimipramine also has atypical antipsychotic effects (!!), thanks to it's chemical similarity to a neuroleptic drug known as clozapine. Unlike the latter, though, trimipramine doesn't carry any risk of tardive diskenesia. Finally, it's one of the most "cardiac-safe" tricyclics known, causing fewer arythmias and less tachycardia than many other TCAs. In short, I'd say that trimipramine was everything I WANTED in mirtazepine, but couldn't get from that drug. It's something different, and may be worth a try.


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