Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: nattyd on October 04, 2022, 04:19:21 PM
-
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
-
:) Hi and welcome
How long have you been using Oestrogel and Utrogestan? X
-
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
:-(
-
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.
-
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.
-
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?
-
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
-
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
-
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
-
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 :) )
-
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
-
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
-
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.
-
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
-
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
-
i completely hear you there. i grieve for the way i used to sleep.
how long have you been on your current hrt regime xxxx
-
Hi - I've never stopped Mirtazapine so don't know about the withdrawal. But I have gone down from 45 to 30 and from 30 to 15 (and back up) at various times without any problems - no tapering just stopped 45 and started 30 the next night.
Amitriptylline: I had the type of insomnia where I would get off to sleep easily but wake at 2am worrying about stuff and be unable to get back to sleep. It helped for a while but then didn't any more and so I stopped it as it also made me incredibly constipated - it dried me out basically. Sadly it did nothing for my migraines either. Beware - I stopped it dead which I later found out you are NOT meant to do and had quite a nasty withdrawal for a few days.
I can't really compare the two - I was taking Mirtazpine the whole time I was on amitriptylline, I didn't get particularly bad side effects with either and didn't mind taking them when they worked for sleep. I'm only still on Mirtazapine as the last couple of times I tried to go down to 15 my depression worsened so it obviously is doing something on that front, and without a doubt it saved my life as I was near suicidal when I first went on it.
I wouldn't really recommend amitriptylline, I personally would not take it again.
If your anxiety and insomnia has come about because of menopause then you might be better off following the advice about not splitting the oestrogel first. I see a lot on here about GPs chucking anti depressants at a problem that sounds hormonal and I think it's probably better to not embark on anti ds without tweaking the hormonal side of it first- it just feels like fixing the wrong problem to me.
-
started feb 2021 and upped my oestrogel about 8 weeks ago
feels like a very long time since I felt normal!
xx
-
hi nicodemus
i take amitrypline as it helps my tinnitus.
it intially helped my sleep then the sedating effect wore off so i take it in the morning now. i was trying to wean off it but when i do my tinnitus increases so im stuck on it i guess.
do you mind me asking why you wouldnt recommend amitrypline. im just curious about other peoples experiences on it.
i hope you dont mind me asking xx
-
when i mentioned checking my hormone levels to my GP he said that it was pointless as the levels fluctuate so it would not tell us anything meaningful! What's the best route for me to go down to properly investigate the hormonal side?
Do I need to go private?
-
I have had no trouble coming off the mirtazapine but I do feel quite sorted hormonewise so that probably plays a part. Also just to throw another idea out there (!!!), has anyone heard of Alpha Stim? It's a device available on the NHS or you can buy your own for the hefty sum of £500. I used it to great effect the other week when I was beside myself with worry about a health issue. All fine btw but had a few days of waiting. The device had a real calming effect and it's supposed to be very good for sleep too. I had never heard of it but it came very highly recommended from a therapist.
-
I've heard of Alpha Stim - I think in relation to migraines but don't know much about it.
discogirl I wouldn't recommend amitriptyline because of the bad withdrawal (which was totally my fault) and the constipation and because I don't think it's particularly effective for sleep. But if it's working for your tinnitus and not giving you any problems then there's no reason to stop it. I guess with any drug you have to weigh up whether it works vs any side effects you have.
-
hi nicademus
your right it only works for sleep the first few weeks.
and you have to withdraw very carefully off it.
did you find it disrupted your sleep at all. thats part the reason i take it in the morning xxx
-
Hi again nat,
I took 15mg mirtazapine for about a month ( anxiety and insomnia).
I work in a busy school, so did the mirtazapine experiment during the holidays. Side effects were that I became constipated, dry mouth, numb ( mentally) and vivid dreams. I couldn’t wake up at all. Maybe had I given it a few more weeks, things would have gotten better.
I then swapped to Amitriptyline 10mg. At first it helped with sleep, then the effectiveness wore off. I upped to 25 mg and whilst it helped for a few months, it doesn’t now. Also, if I didn’t take it early enough, I become constipated the next day! Whilst I can cope with most things, constipation is not one of them! Not really conducive with an early start and getting ready for work etc. So now I take nothing. My sleep is atrocious tbh.
I don’t know what the answer is. I run on adrenaline during the week, collapse at the weekend and live for the school holidays! Not ideal but hey ho that’s where I’m at. CBD Is hit and miss. Again,if you take that too late in the evening, it can have an adverse effect. Plus, there are a ton of products, all claiming to possibly help with sleep!
Some say reaching the optimum dose of HRT is the answer. It hasn’t worked for me. I use a 75 patch and coil and feel vile on the 100 dose, even if I do need it.
Hope you can get some sleep soon. Cbd tea at night is good, or valerian tea.
There’s a cure in nature for everything they say! Also CBD gummies for relaxation.
Xx
-
Nat withdrawal is a very real thing from Mirtazapine, although some people are lucky and don't seem to exeprience it. From experience I know I need to taper down at 10% a month otherwise I get rebound insomnia. But that's fine - there are worse things in life! (I experience this with all ADs not specifically Mirt).
I agree with the earlier comment about not splitting your dose of HRT - I've seen several ladies here comment that it gives them insomnia if taken in the eve (though again not everyone!).
All sedating ADs will "stop working" after a while, but (in my opinion) in the sense that they still send you to sleep faster than if they weren't there, but that if there is an underlying reason why you're not sleeping, they won't get rid of it (which is what I was referring to when I said a two pronged approach is best, to address any underlying hormone imbalance).
If I were in your shoes I would try Mirtazapine (starting at a 7.5mg dose), stop splitting my HRT dose and get a blood test to understand your hormone levels. I have had blood tests done almost monthly for nearly 2 years and I have found them invaluable, despite the line peddled that there is no point. They do fluctuate a bit - eg to within 100pmol - but there isn't these wild swings from day to dat that make the data unusable. I use Medichecks who are very good - you'll need a venous blood test if you're using HRT (not a finger prick test). Do the test around day 21 of your cycle (and if you test in future months, test at the same time of your cycle). If you need any more help on the test / which to choose etc, just shout :) This will at least give you a baseline of where your hormone levels are and if you decide to increase your HRT dose, you can monitor.
xx
-
Hi Nas, thanks for sharing your experience - after the month of trying mirtazapine at 15mg and deciding to stop, did you have any withdrawal symptoms?
I woke about four or five times last night, though thankfully managed to get back to sleep until 5.30am this morning, which is a good night for me these days.
Hope you slept last night, have a great day
xx
-
Hi Gilla, thanks for the advice about the blood tests. I am post menopausal so no monthly cycle.
Yes please, any advice on how to find the right tests is appreciated, I think I've only seen a fingerprick one but it didn't seem to be checking all the levels.
Thanks for your help
x
-
Nat if you're post meno then there's even less reason why your levels would be fluctuating and even more reason to get a blood test. Even my GP (who is generally useless) wants to check my levels once a year while on HRT.
This is a link to the Estrogen only blood test on Medichecks. There are lots of others to choose from, depending on what else you might want to get tested, but I would personally start with just Estrogen.
https://medichecks.com/products/oestradiol-blood-test
You need to choose the "visit a clinic to have a venous blood test" option (which is an extra £30). You put in your post code and it gives you the nearest clinic you can go to. Medichecks send you the box, which you take to the hospital, they do the test and then you post it Medichecks. Results usually take 2-3 days. If you don't yet know what Estrogen level you need to feel "well" the first blood test you get might not be super helpful in itself, but it will give you a baseline from which to potentially try increasing or decreasing (under the guidance of your GP) and correlating with how you feel. It could be that it's not enough (I've observed a lot of ladies here not absorbing well) or it could be that it's too much, but in either case I think understanding your baseline will be useful for you.
I would also echo again what others have said in terms of splitting the dose - it may be that taking two pumps of it at nighttime is contributing to the problem. Keep us posted! x
-
that's super helpful, thanks so much.
will let you know how I get on
xx
-
I dont know if its MORE sedating at lower levels but its AS sedating. I take it (very effectively) at 7.5mg (by using pill splitter. This might be because of my low weight though, needing less?) I prefer to consume as little as possible. I was prescribed 30mg per night, but gradually reduced it over few weeks to get to 7.5mg. I even get a sleep-benefit from 3.75mg, but the tiny bits of pill were impractical.
Ive taken it for 15 years. It made me put on a little weight at beginning (which I needed) but unfortunately the weight went again. I havent seen any benefit to mood during day (I only take it at night. Tried during day as experiment but just felt drowsy.)
It makes me sleepy 1 hour after taking and I usually sleep right through night. If I forget it one night, I go back to not getting sleepy until 2 am then sleeping for couple of hours, then being wide awake till I need to get up. (Before this, I had extreme insomnia for 10 years and tried everything possible to no effect.) If I dont immediately switch of light and settle in bed during the sleepy 'window' of opportunity, I end up awake all night, or just take another tablet and wait for the next 'sleep window'...
If you are tired following day after taking it, try going to bed earlier (scientifically proven 1 hour of sleep before 10pm is at least twice as beneficial than 1 hour after 10pm.)
If you are prone to weight-gain your GP might resist prescribing it for you. Mine confirmed what I already knew- that its one of the few anti-depressants that actually works (most are no better than placebo) but because it usually causes weight gain, that have to balance the benefit against the side effects.
-
Should say that although I say that I didnt notice any great improvement in daytime anxiety.....thats maybe not fair. I did feel a hell of a lot better because I wasnt surviving on 2 hours sleep a night. I just meant that it didnt completely solve my anxiety. Im really grateful the GP prescribed it. Its the reason Im alive.
-
It's the reason I'm alive too.. I echo those words totally. Nothing is a magic bullet without side effects or down sides, but my insomnia was so severe and serious that I literally wouldn't be here if the doc hadn't prescribed it for me, as absolutely nothing else worked.
I am in the process of switching to Trazodone (becauss of the massive weight gain) and although it's as effective at sending me to sleep I'd say it's not as effective as Mirt for keeping me asleep throughout the night. I have to take another quarter of a pill when I wake at 3am. That's no big deal though and will be worth it if I can lose the Mirt weight. So jealous of anyone on Mirt who didn't gain weight! And nice to hear others positive stories from it :)
-
Gilla, people with normal metabolisms, on this drug, have my total sympathy.
The only reason I didnt really gain weight wasnt because of any kind of will-power, it was because Im 'naturally' really thin. And in a horrible angular, boney, ill-looking way!
When younger, I was always over-eating, desperately trying to gain weight, to no effect. But this drug did something to my metabolism that meant I (briefly) was able to retain some extra fat. For the first time in my life I looked almost normal and it was fantastic! But my metabolism corrected itself and reversed it agggrrrr ;D
I used to joke with friends that we should develope a 'fat swap' procedure where it was sucked out of their desired areas and pumped into me. This was before liposuction became a thing. I think its possible to do that for our own fat, redistributing it, but I wonder if its possible to donate it to someone else ??? Hmmmmm ;D
-
Hi, a quick update since my last post
I've started taking 7.5mg of Mirtazapine and it is really helping with my sleep, enough to help me to nod off and to stay calm enough to get back to sleep if I wake in the night. I have had a bit of daytime drowsiness but not too troublesome - just grateful to be getting some rest. I have gained about 2lbs in three weeks, but to be fair I am eating more as I am generally happier, less tired and anxious, so will keep an eye on this.
I also had my private meno appt which found that my estradiol level was just 91. Apparently it should be c. 400 on hrt. So it seems that I am not absorbing from my oestrogel. The consultant has encouraged me to persevere with the oestrogel as she believes it to be the safest and most effective if you can get it to work for you. She has advised that I apply 2-3 pumps to inner thighs in the morning and another 2-3 pumps to inner thighs early evening. Tbh I probably hadn't previously been patient enough with allowing the oestrogel to absorb fully. I have found that for me this takes at least 20 minutes to be fully dry, so at the moment it seems that I am spending a lot of time walking around the house in my pants waiting for gel to absorb!
I have been advised to do this for four weeks and then return for another blood test and if my estradiol level is not in the region of 400 then I may need to change to oral hrt. The consultant mentioned Bijuve if I need to go down the oral route.
So far the combo of increased oestrogel and the mirtazapine is really helping. Not quite feeling 'normal' but loads better than I was
xx
-
Hey Nat,
Sounds like you are heading in the right direction.
Does the mirtazapine make you constipated by any chance? It did me a few times, but my sleep is so poor again, I may trial it again. Don’t want to be constipated though!
Fingers crossed you continue feel well x
-
Noestrogen I feel for you - it's no easier being super skinny if you feel unhappy with it, and in some ways I imagine it's harder to be taken seriously over! If you're ever looking for a fat swap volunteer, here I am ;D
Nat, so glad to hear you're doing a little better. Just to say, a level of circa 400 would be WAY too low for me - I need it to be at least 700 to feel well, though I wonder if this is because I have high SHBG, so less Estrogen is actually available to my cells. So really the level you need varies enormously, but certainly 90 is very low! I'm curious as to why they want you to stick with oestrogel over any other HRT - as far as I am aware it is no more safer than the patch for example, and you may absorb that better and avoid all the drying time! It is of course safer than oral HRT which uses non body identical estrogen, which is what she may have meant.
Nas I suffer from terrible constipation but it's hormone related and began when I started HRT - I didn't find that Mirt gave me it, just in case that helps. I really hope you start to feel better soon xx
-
I took Mirtazepine for 6 months, initially for insomnia and anxiety. It helped with sleep but I felt numb. I also gained some weight. Tapering off was not easy and I developed IBS too and my anxiety became a big issue, but that might have been coincidence. But we are all different, if it was for sleep and anxiety I wouldn't recommend it, but that's just my experience.
-
Coming off it is notoriously hard and I can only taper at 10% every 3 weeks (I have the liquid version) without getting withdrawal symptoms (some people are much more able to tolerate the symptoms though, I'm just a baby!). Having said that my brother in law who takes it has managed to stop relatively quickly without any problems so I do think it just depends. I also have to taper slowly off SSRIs so it's not particular to Mirt (for me).
-
So far no constipation from the Mirtazapine, though I do only take 7.5mg and take a daily probiotic supplement and drink lots of water - not sure if this helps.
I am concerned about the withdrawal when the time comes and this nearly stopped me from taking the mirtazapine, but after horrible experiences with sertraline and citalopram, and simply not being able to function on two hours sleep a night, mirtazapine has been a live-saver and I'll have to cross the withdrawal bridge when the time is right.
I'm not sure why the consultant was so keen for me to stick with oestrogel over any other HRT - I was so sleep deprived when I had my appointment, I didn't really question anything but I will ask when I have my next appt.
-
I wouldn't worry too much about the coming off it - I've been on a slow taper for quite some time... yes it's a pain when you'd just like to stop it quickly but it's no hardship really - a small exchange to make for being well! And as long as you do taper slowly you'll be fine (I have no withdrawal at all from doing 10% every 3 weeks). And you may be one of the lucky ones who doesn't need to go so slowly!
Definitely worth asking about another method of HRT next time if you want to - I've seen lots of women here commenting that absorption of one product (eg patch vs gel or vice versa) was better for them, it seems to be quite unique. Good luck xxx
-
I use Seroquel. It's also called Quetiapine. You need the immediate release formulation, and you take it right before bed. In the dose range of 12.5 to 100mg, it is used off label for sleep. I've used 50mg every night for years, and it's been brilliant for sleep. You might want to ask your doctor about it. Plus, I've had no side effects:)
-
That's great information, thank you. Will ask about this at my follow up appointment.
Best wishes
Nat