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[Smokey]

Hi ladies so I need some advice. I’m going to the Doctors tomorrow not only to discuss my gastritis but the pain I’ve been getting in my legs over the years, I think it ms related I have been having the pain on and off in my lower legs but it always wore off by lunchtime and wasn’t every day more like a couple of times a week so really just ignored it as was usually busy in the mornings anyway and it wasn’t too painful. I thought it may have been circulation or where I’ve been squatting down looking in cupboards etc. The pain was more of an ache. You may well ask why has my ms Nurse not picked this up when mentioned and prescribed something for me but to be honest I think it was because I kept forgetting to ask as always had other symptoms to discuss and they weren’t really bothering me at the time.

My question to you guys is if I ask to change from Mirtazipine to Amtriptyline what sort of dose would I need that would help with pain and sleep I’m on 45mg of Mirtazipine, I had planed on reducing the  Mirtazipine anyway as docs just increased my dose to help with meno symptoms. I don’t want a high dose of Amitriptyline due to it causing constipation.

Thanks ladies.

[Mary G]

Smokey, I take 50mg amitriptyline every day for migraine prevention. 

The migraine specialist said it's best to start with a low dose and work up to roughly 50-75 mg for pain, IBS-D and migraine prevention.   For depression higher doses are often needed.

Regarding sleep, I found that even 25mg made me completely crash out for 8 hours solid.   

Despite being an old school type TCA, I think amitriptyline is a great all rounder medication with virtually no side effects and I regret not taking it sooner.   

I read up on Mirtazipine but I don't like the sound of the gastro side effects. 

[Smokey]

Thanks MaryG I didn’t realise Mirtazipine caused gastric side effects, I wonder if this is why I keep getting gastritis?

I’ve been on the sister drug to Amtriptyline , Nortriptyline many years ago but stopped as really effected my bowels it made me so constipated in the end I stopped.

That’s good to know that a low dose helps with sleep as I don’t want to be in the same situation again constipation wise.

[Smokey]

Mary I just looked up side effects of Mirtazipine and I seem to be unknowingly getting a lot of them, especially the feeling of being inside a bubble looking out which I get every now and then and it lists aches and pains and dizziness.

[Mary G]

Smokey, this might be useful guidance for switching to amitriptyline:

https://wiki.psychiatrienet.nl/w/index.php?title=Mirtazapine-amitriptyline&mobileaction=toggle_view_desktop#:~:text=Switch%20medication%20from%20mirtazapine%20to%20amitriptyline.&text=Before%20day%201%3A%20Gradually%20reduce,8%3A%20Stop%20administration%20of%20mirtazapine.

It sounds like mirtazapine was not a good choice for you.  I tried Escitrolapram(?) for migraine aura prevention only to find that migraine aura was a side effect of the wretched stuff!

On a separate but related issue, I'm actually very annoyed that ADs have had such a bad press in recent years.   It is not very widely known that ADs have a very useful function off label for many different health issues when used at low doses.   Obviously in the past, far too many women have been fobbed off with ADs when they need HRT but equally, people like me who should have been directed to ADs years ago for migraine prevention have been badly misled.

I hope this will help at your appointment tomorrow.

[Smokey]

Thanks MaryG

That’s very useful knowing how to swap from Mirtzapine to Amtriptyline I was thinking I would have to comply stop the Mirt before starting anything else which to avoid withdrawal would take forever.

I agree about ads having a bad reputation they are very useful and sometimes necessary for some people as long as they are prescribed correctly.

I don’t think I’ve ever been depressed and needed them however I have had a lot of tearfullyness when not on them, whether that was a mixture of hormones or just because my brain was used to being on one type or another they were prescribed originally for nerve pain caused by my ms. I know longer get the nerve pain. Now I really need them for sleep as no sleep and ms definitely do not mix and it makes me feel jet lagged all day if I keep waking up at 3am 4am and so on probably caused by hormones.

Last night I had a nightmare about not being able to see or breath and woke up in the middle of the night and couldn’t see because it was dark and it really freaked me out  that was definitely a Mirtazipine side effect as I do get vivid dreams but mostly good ones and I do get vertigo when turning over in bed also listed as a sideffect.

[Mary G]

Smokey, good luck with your appointment tomorrow and please let us know how you get on.   It will be interesting to hear what you doctor has to say about switching to amitriptyline.