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[nattyd]

Hi, I'm new here.
Post menopausal and taking Utrogestan and oestrogel (4 pumps, split dose) but been experiencing insomnia and anxiety. GP prescribed Citalopram but I crumbled after five nights of less than 2 hours sleep. With hindsight, I should probably have stuck with it and asked for something to take alongside to help with the insomnia, but I wasn't thinking straight and felt like I was at breaking point so just stopped taking it.

GP has suggested that Mirtazapine might be a better choice for me due to the sedative effect,  but Citalopram seems the more successful choice for menopausal anxiety.

Can anyone help me with some experiences of taking Mirtazapine? I understand that it can increase appetite but have lost 2.5 stone in the past 4 months due to my anxiety so not worried about putting a bit back on.
My main concern is whether it will make me feel numb/sedated and how effective is it at lifting anxiety? I'm feeling pretty low due to the insomnia so don't want to feel more depressed. How long does it take to feel a difference? Also I've heard that low dose helps with sleep but you need a higher dose to combat anxiety?  In need of information and moral support please
xx

[Dotty]

  Hi and welcome

How long have you been using Oestrogel and Utrogestan? X

[nattyd]

Thanks Dotty
I've been on my HRT since Feb 2021,  upped the oestrogel about 8 weeks ago, though it doesn't seem to have made much difference
:-(

[Nas]

Poop,
I tried mirtazapine a while back, but didn’t like it.
It made me feel very groggy in the morning and I couldn’t wake up at all.
I think short term, it’s okay, but long term , if you have to work , definitely not.

I definitely felt numb and spaced out on it.

[nattyd]

Thanks Nas,
That's what I was worried about.
I know that everyone reacts differently but there are a few online reviews saying the same thing.
Yes, have to get up, do school run, work and the usual women's load!

Though I have been signed off work for three weeks so do have the luxury of resting up to get through side effects if they are temporary.

[Nas]

Yes I think they are the main side effects natdukes.
You could always trial it for a few weeks to see how you get on.
The other thing is, I don’t know how addictive it is?

Are there any other drugs which have been suggested, which could help?
What about over the counter tablets? Cbd oil?

[discogirl]

hi natdukes

i just wanted to say your not alone with insomnia and anxiety.

i have tinnitus and take amitrypline. it did originally knock me out but thsy wore off and as i take them for nerve pain (tinnitus) i take it in the morning and im fine taking it that way.

i used to sleep for britain but no longer, although the hrt is helping a bit.

i felt really anxious lsst night and only got a couple of hrs sleep myself

i hope you find mirtazapine ok for yourself though xxxx

[nattyd]

thanks Nas and Discogirl

I have tried OTC sleeping aids and CBD, sometimes helps a little but not enough to keep me functioning well.

Sorry to hear about your tinnitus insomnia and anxiety :-(
Amitriptyline was also mentioned to me by the GP but he suggested that Mirtazipine would be a better bet for the next attempt.

I'm not sure whether to give the citalopram another go but with an additional medication to help me through the first couple of weeks. Difficult to make a rational decision when you're so exhausted

[nattyd]

Nas
Can I ask how long you took the Mirtazapine for and at what dose? Were you taking it for anxiety and insomnia?
Did you try anything else before or after?
Sorry so many questions !!
x

[Gilla999]

Hi Nat - I've been on Mirtazapine now for 3.5 years, at doses of anywhere between 2mg and 30mg.

Everyone reacts differently to different ADs so my experience could be completely different from yours, but for me it is the best sedating treatment there is, of any kind. It worked for me in the depths of insomnia hell when nothing else did, so if sleep is your main problem i would highly recommend it. I never had depression or anxiety (except as a result of prolonged insomnia) so can't fully comment on how good it is for those but i hear only good things. As you say I did gain approx 2 stone on it - because of the way it affects your metabolism it is very hard not to gain weight on it - but as you have lost 2.5 stone this isn't an issue for you!

In terms of dose - I have never personally found there to be truth in lower doses being more sedating, though I realise this is discussed a lot. For me it was more sedating at the higher doses (so much so that I would struggle to stay awake past 8pm even before taking the dose).  My psychiatrist also didn't hold any weight to the theory of lower doses being more sedating.

The start up side effects can be sticky (like any AD) but they do subside after a few weeks and then I had / have none at all. I always think it's good to start off on a lower dose (eg. 7.5mg) and work your way up once your body has adjusted.

One last thing I would say is that in my personal experience no AD is going to rid you from the symptoms of menopause,. They may reduce some but for me the side effects i experienced such as palpitations, night sweats and insomnia were all present regardless of what AD and at what dose I was on. I'm only saying that because if your issues ARE hormonal I think a "two pronged" approach would be best - ADs can be great tools and definitely great to get you out of this initial hole, but perhaps in parallel to trying to balance your hormones? However sometimes it can be hard to know what's menopause related and what isn't, so you never know - it could help you on its own.

Feel free to ask any more questions, there's not much I don't know about Mirt! (Although as I am careful to say, everyone is different  )

[Gnatty]

I only have a couple of minutes so can reply more fully tomorrow. Mirtazapine was a life saver for me. But I wanted to just quickly say that taking a split dose of oestrogel might not be helping your sleep. Try taking it all in the morning as some of us find an evening dose prevents sleep. X

[shoppingqueen]

Hi

I have just tapered off Mirtazepine (not easy or pleasant at all for me, but everyone is different) and took it for 6 months. It did an amazing job for my sleep (15mg) but I did have very strange dreams on waking every night/ early morning which I didn’t like. Unfortunately, the benefits outweighed the benefits on sleep as I was very sedated and not really here until well after lunch. A bit like a spaced out zombie. I was off work so it wasn’t an issue but if I had to do my normal morning routine and work, there is no way I could on those tablets. I’m not sure it helped with my anxiety either but I wasn’t prepared to push the dose up.

I’ve been off it now for 7 weeks after a taper and have battled the most awful rebound insomnia so back to where I was. It’s improving now but I have vowed not to do any more ADs, try and focus on using calming anxiety apps etc and will ask for short course sleepers if needed in the future. I feel normal now when I wake up (asides from
Meno symptoms) so I know for sure it was the Mirtazepine.

X

[Nicodemus]

I've been on Mirtazpine at various doses (currenty 30mg) for over 10 years. I can't take any SSRIs (serotonin syndrome - Citalopram made me absolutely wired) and found Mirtazapine quite calming and gentle by comparison. I was taking it for anxiety and depression not related to menopause. It did help me sleep for a while but after some time it didn't any more and got given amitriptylline which worked for a few years and then didn't. I did find Mirtazapine sedating in the 15mg dose and better as an anti depressant in the higher doses but that could well be because my doctor suggested it behaves like that.

The dreams are amazing but I rarely get them any more.

Yes - it can interfere with the "I'm full" switch in your brain - it's often given to people with eating disorders - and I put on a bit of weight before I realised what was happening but as long as you're fairly mindful and eat your usual portion sizes you should be ok.

[nattyd]

Thank you everyone for sharing your experiences and wisdom
.. and for the tip about not splitting the oestrogel dose which I will try.

I have heard that withdrawal is more problematic for Mirtazapine than SSRIs. A bit worrying that withdrawal can be so bad after just 15mg for 6 months.
Nicodemus - how did you find the Amytryptiline vs the Mirtazapine? Did you stop taking the mirt and how was the withdrawal?

When you say the start up side effects are sticky - what was you experience?, how long did they last and how soon was it before you felt any better. Did you have any withdrawal symptoms when you reduced your dosage?

Thank you everyone
x

[nattyd]

Insomnia is my main problem, when I have had a few more hours sleep I can cope better with the anxiety using breathing, meditation, and distraction.
but when I'm soooo tired the anxiety seems overwhelming and I don't have the motivation to exercise or care for myself, absolutely no appetite hence the weight loss