Posted by Alexanderfromdenmark on August 11, 2009, at 21:06:24
In reply to Re: Popular Antidepressants: How They Stack Up, posted by morganator on August 10, 2009, at 23:07:12
> Still, I have to wonder what it is that keeps it from actually being that popular. Side effects?? You mentioned some up sides to Mirtazepine relative to SSRIs, what are the downsides?
Well, mirtazapine is a powerful drug. It may be reduce cortisol so much that cortisol is too low. Adquate cortisol is needed for normal metabolism and metabolism of thyroid hormones. So I think espcially in the beginning of treatment, patients may get symptoms similar to those of hypocortisolism(aches and pains, flu like symptoms), hypothyroidism(puffiness, weight gain, constipation). I think this get's better with a higher dosage(if that means more NE) as noradrenalin stimulates the adrenal glands. However cortisol may remain too low and many of these symptoms may continue. Also it's sedative histamine effects may be too strong and may never fully go away.
It can also cause akathsia and RLS which are horrible. I got fed up when I took the drug and night and was so sleepy I was about to pass out, and then I would get RLS and have the urge to walk about and couldn't sit or lie down. I also got nightmares in the middle of the night.
As such, I think the start up period can be very rough. But I think that many of these symptoms normalises after some weeks as noradrenalin picks up. I only gave remeron 2,5 weeks and wish I'd given it a month at least.
I think providing cortisol picks up a bit more and the HPA axis becomes a bit more activated with the weeks that go by, MIrtazapine is a much better long term choice than most SSRI's since it's not quite as detrimental on the bodies endoctrine system as SSRI's and the long sleep with miratzapine can eventually pull you out of adrenal fatigue and major depression.
But for some people the sedation never goes away or the NE may cause too much anxiety, or they may feel too much out of it general(feeling drugged).
I do think it's drug in the right direction. I think future antidepressants have to improve sleep and have some pro-dopamine effects and block the serotonin receptors which cause apathy, sexual dysfunction and what not.
poster:Alexanderfromdenmark
thread:910431
URL: http://www.dr-bob.org/babble/20090810/msgs/911661.html