Mirtazapine (remeron) And Duloxetine (cymbalta)

[NovemberStar]

I do always wonder whether someone is clinically depressed (i.e. has an imbalance of brain chemicals), or is simply 'depressed' because of all the PTSD symptoms.
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Wouldn't the PTSD change brain chemicals in itself though? That is my understanding of it anyway. Trauma changes our brains, and meds can help with the resulting imbalance.

I'm not familiar with the med combo you are on OP, but i'm taking the combo known as 'Californian Rocketfuel' - Mirtazapine and Venlafaxine. I had to reduce the amount of Venlafaxine I was on because every morning it was like I had taken a nasty dose of caffeine and speed - instinct told me it was 'too much' seratonin, and I reduced my Venlafaxine and then it worked well.

 

[cherryblossom]

Wouldn't the PTSD change brain chemicals in itself though? That is my understanding of it anyway. Trauma changes our brains, and meds can help with the resulting imbalance.

I am aware that some studies using MRI have shown changes in the brains of PTSD sufferers. However, it's not something I know enough about, to comment on whether those changes result in a chemical imbalance, that could be addressed by increasing serotonin and/ or noradrenaline.

That is why I said

I do always wonder

because I don't know. Nor, am I sure that anyone knows, because I think if there was compelling evidence that showed a scientifically significant amount of PTSD suffers had a chemical imbalance affecting serotonin /noradrenaline then these type of medications would be the first line of treatment for PTSD.

I just know for me, anti-depressants never worked, and I have tried many over the years, during those times that I've hit rock-bottom. Therapy was the only thing that helped me. So from that I concluded that whatever was going on in my brain that made me so depressed, it wasn't a lack of or reduction of serotonin.

I'm not anti-medications and if they work for a person, then it's obviously worth pursuing (safely). We are all different, and as a result different things work for different people, which is what makes topics like this interesting reading.

 

[Kas_Can_Fly]

'Californian Rocketfuel' - Mirtazapine and Venlafaxine.

Apparently the combination of Mirtazapine and Duloxetine is referred to as Limerick Rocketfuel - sorry I forgot I already wrote that! I'm wary of anything with such a nickname, but for me it truly worked.

Like Cherry Blossom, nothing I had tried had helped and I'd reached the conclusion that it must be caused by the stresses, situations and past. I only kept trying things because I'd given up. I tried things I previously refused, because I had nothing to live for and what difference would it make. This changed everything, it helped so much - it didn't fix everything, but it did fix some things, alleviated others and so much was just simply, healthily better.

 

[Kas_Can_Fly]

SUCCESS!!! After carefully reviewing the submitted evidence, the psychiatrist agrees that I'm allowed to stay on the medication that actually works. Hurrah! :):laugh::woot::D

My mum also came to say her piece as well as my social worker. I'm so relieved that after over a decade of being in and out of the mental health system something is finally working. I'm also relieved that I am permitted access to that thing.

The Psychiatrist kept saying it wasn't him, it was the guidelines, but as I showed from the NICE guidelines"If a person is informed about and prepared to tolerate the increased side-effect burden, consider another antidepressant, augmenting[...] an antidepressant with such as[...] mirtazapine" and also "Treatment and care should take into account people’s individual needs and preferences. Good communication is essential, supported by evidence-based information". I also showed that I was aware of the side effect possibilities including the symptoms of serotonin syndrome for which there have been no reported cases for the combination of Mirtazapine and Duloxetine, and their mechanisms of action. Lastly I stated that as my mum keeps and monitors all of my medication use, any fears that these medications could be dangerous and pose as a suicide hazard were quashed.

My social worker congratulated me at the end of the appointment for the way I put myself across. He said that the psychiatrist had been adamant before the weekend and this morning at a meeting that I would not be permitted to stay on this combination and that the information I gave must have been a huge deciding factor in what changed his mind - though my mum's rather heated speech must have helped too!

I think I might run through the streets naked, singing and dancing - though then they may take them away so a cup of tea and that left over creme egg will serve as a replacement act of celebration. :coffee:

 

[MartinWantsToLive]

Hi there, sorry for bumping up this thread, but it caught my attention regarding to the mirtazapine + duloxetine combination.

How are you doing with such combination, is it effective ? For how long ? What is would be a good starting rose ?

I've been taking mirtazapine for 11 days ( 7 first days 30 mg ) (45 mg for 2 days then back at 30 mg) at Night. The first 2 days made me sleepy, but did not put me to sleep, at mornig I noticed a change in mood, dizzyness but was feeling well, but after 3rd day I felt ok, nor too happy. nor too.sad, still depresed, unmotivated, so the pdoc up my dose to 45 mg, took it for 2 days, didnt notice much change , except that effect May be lasted longer and felt irrritated, and also didn't made me sleepy at Night either.

So I stick to the 30 mg for another week even if I feel not much improvement in sleep or mood, energy etc to see what happens but I may need another AD like duloxetine for better results and since the combination called" Limereck Rockect Fuel " (mirtazapine + duloxetine) sounds to be good and also for the chronic pain in my back and body.

I will be talking to my pdoc for a refill Rx and tell him about this combo to see if I take it with 30 mg or 45 mg and see what he thinks about it.

I may need proof material like you to convince my pdoc, where did you find evidence for this combo to be an effective treatment ? (more pros than cons) If you please could give me any info so I can show it to my pdoc next visit would be really helpful.

Thanks

 

[anthony]

I may need proof material like you to convince my pdoc

Writing on an Internet forum is not proof, and your psychiatrist is a doctor and will make their own determinations. I would recommend you simply discuss this with your doctor and get their feedback?

 

[Kas_Can_Fly]

I take 60mg Duloxetine in the morning and 30mg of Mirtazapine at night. Even though I'm still highly depressed by most scales that "score" depression, I have had a remarkable improvement and have not been hospitalised since. For me it's not just about finding a medication that helped combat intense suicidal urges and self-harm, it was about an overall stability across a number of symptoms and conditions.

For me the combination has reduced some of the most distressing elements of my nightmares, lowered the frequency of flashbacks, lowered my anxiety a little, lowered my depression a little and helped me with other sleeping problems and dissociation, I suspect as a result of lowering my anxiety. I still don't leave the house and am unable to a lot of things due to my mental health, but I am suffering less and hurting myself less as a result. I actually had a bit of a fight to get my psychiatrist to allow me to stay on the combination and printed a whole host of articles sighting the improvement of the combination in particular for treatment resistant depression in particular and others sighting that there was no significant risk of serotonin syndrome in taking the two medications together. I fought my case, as did my family and social worker, in the end the doctor agreed that I could stay on them both as long as they continued to help.

I highlighted parts of the NHS NICE Guidelines for depression including a line that recommended Mirtazapine and another SSRI or SNRI type medication, as well as parts of the following articles:

• Treatment Options in Treatment-Resistant Depression by Jennifer Gotto and Mark H. Rapaport
• A chart of the Increased eficacy of combination antidepressant treatment
• Combining antidepressants a review of evidence by Lena Palaniyappan, Lisa Insole and Nicol Ferrier (Advances in Psychiatric Treatment)
• Prevalence and Management of Treatment Resistant Depression by Charles B Nemeroff
• Information printed from the Wikipedia entries for Duloxetine, Mirtazapine and Serotonin Syndrome
• Combining Mirtazapine and Duloxetine in Treatment Resistant Depression Improves outcomes and Sexual Function from the Journal of Clinical Psychopharmacology, February 2008, vol 28, issue 1.

Of course I was arguing to stay on the medication I knew was already helping me, against the psychiatrists wishes not to try it but there is a lot of information there that should allow you to put your case across to trial it. The only thing I don't think you can get freely and easily on the internet is the last article.

 

[MartinWantsToLive]

Thanks for the information, it will be of a lot of help to me and my pdoc. Well for me is not just to take the meds, but to start getting stable mentally with the right meds, to start feeling well again.

Thanks.

 

[anthony]

but to start getting stable mentally with the right meds

Well said... that is the aim. Nothing worse than psychiatrists shoving meds at people, them saying they feel worse, and being ignored and told to up the dosage or such. When you have the right meds for your body, you should only feel better with minimal side effects, and certainly no side effects that require further medication cocktails.

Really good focus and approach @MartinWantsToLive

 

[Deleted member 28740]

Hi Cherry Blossom, I have concern over a new med reaction with 7.5mg Mirtazapine. First night had significant leg cramping and spasms mostly on left leg, would subside if I stood up. On set was within 30 mins, and lasted 3 hours. Called in to Dr. (thursday night, no call back. called again Fri morn no call back.) Tried again Fri night, same results. Called dr again, no return call. Did not take it again over the weekend, anxiety and very bad sleep, flashbacks etc. Prior to that was on Vistral for a few weeks. Vistral helped with the chocking vomitting, not the sleep or other anxiety.

Since the two nights of taking Mirtazapine I have painful and weak legs, especially the feet. Was that just from the cramping? I will call the Dr again today, but have no trust in them. I called the 24 hour service, advice to not take again, and make an appointment.

What to do? Has anyone else had this immediate reaction? (no other meds involved)

 

[Kas_Can_Fly]

Leg cramps are usually caused by salt deficiency, or an imbalance of calcium and magnesium (you may need more of one than the other) and after the initial pain of the cramp, dull aches last for up to a week. I suppose it could well be a side effect though certainly not a common one. Best if you're concerned to see the prescriber and talk with them about it. If you're concerned either stop and don't take it again, you could try one more time a week later- if it returns immediately stop taking it entirely. Or continue taking it regularly and see if they persist. Don't keep messing around with it though because it won't hep anything, especially psychologically.

 

[Deleted member 28740]

"When to the doctor and guess what he told me, girl you better have fun…." Tried to keep that song in my head. Dr. seemed to have no idea why I was back since our Thursday appointment. Quick glance at notes and hmmmm, well could be a reaction. YA THINK? Bit my lip and explained all of the phone calls made about what seemed a significant reaction. Very rare she said. AND? "Well you haven't done well on some of the other meds either." Yes, the purpose of my visit. I mentioned that I had spoken to the pharmacist at the mental health service (appointment will be 12/18). That he told me about the seretonin syndrome, and it sounded likely I was that rare reaction. It was mainly only on the left side of my body, though I feel beat up all over, all the muscles ache, some twitch, but the ankle and instep on the left leg are really painful and my gait is stumbly. More hmmmmm. Then gave me a scrip for clonezapam, 1mg 15 tables

Then it really got fun. appointment was 1 hr behind schedule. Dr sent script to pharmacy (in house). Indicated I would wait to pick it up. 5-10 minutes turned into 40. To process they asked for ID. Gave it to them, and he said "no can do" your license is expired. Did not know it, but that is depression for you. But you have filled all of my scrips for a few years. It is the LAW. Can't do it. No meds for 3 days, an now this.

What does anxiety NEC mean? That is on the scrip.

Perhaps tomorrow I can get this filled. Any experience out there with this med for flashbacks and panic attacks while sleeping, wake up chocking and vomitting. Not from nausea, just gag and can't breath and start wrecthing.