Can Mirtazapine Cause Diabetes / High Blood Glucose?

[Logan-]

Assuming the person’s food intake and diet hasn’t changed after starting mirtazapine...

I have seen conflicting things about this.

This one says it’s actually good in this respect: Changes in Weight and Glucose Tolerance During Treatment With Mirtazapine

Some other people warn against it.

With me, Mirtazapine helped me sleep, until the initial side effect wore off. It also made my constipation worse. Had no other positive benefit.

However, my endocrinologist told me that it can interfere with the glucose metabolism. He actually said "it causes diabetes". I don't know if that's true, but it could account for the hunger and weight gain that it can cause.

mirtazapine...

Will mirtazapine cause my sugar to rise. i am diabectic.?

If you have diabetes, mirtazapine can make it more difficult to keep your blood sugar stable. Monitor your blood sugar more often for the first few weeks of taking mirtazapine and change your diabetes treatment if necessary.

Mirtazapine: a medicine to treat depression, obsessive compulsive disorder and anxiety disorders

What do you think?

 

[Logan-]

@DaveFoster, could you share your thoughts on this?

 

[DaveFoster]

@DaveFoster, could you share your thoughts on this?

Yes, mirtazapine has been linked to diabetes through two or more potential mechanisms. Firstly, the drug activates the 5-HT1A receptor, which increases one's appetite for carbohydrate. Available food products tend to be processed and calorie-dense, which promotes weight gain. Secondly, the drug increases leptin. By itself, additional body fat tends to increase a person's leptin levels, but, even if the patient mindfully restricts calories and maintains his weight, mirtazapine still increases leptin levels.

References

1. Berendsen HH, Broekkamp CL. Indirect in vivo 5-HT1A-agonistic effects of the new antidepressant mirtazapine. Psychopharmacology (Berl). 1997;133(3):275-282. doi:10.1007/s002130050402
2. Dourish CT, Cooper SJ, Gilbert F, Coughlan J, Iversen SD. The 5-HT1A agonist 8-OH-DPAT increases consumption of palatable wet mash and liquid diets in the rat. Psychopharmacology. 1988;94(1):58-63. doi:10.1007/BF00735881 "The 5-HT1A agonist 8-OH-DPAT, at a dose of 30 μg/kg, enhanced the consumption of sweetened wet mash and sweetened milk in non-deprived rats."
3. Fischer S, Hanefeld M, Haffner SM, et al. Insulin-resistant patients with type 2 diabetes mellitus have higher serum leptin levels independently of body fat mass. Acta Diabetol. 2002;39(3):105-110. doi:10.1007/s005920200027 "...fasting leptin level significantly and positively correlated with BMI (r=0.49, p=0.02) and with fasting insulin (r=0.69, p=0.001), while it negatively correlated with the glucose disposal rate (r=-0.62, p=0.002)."
4. Halford JCG, Blundell JE. Separate systems for serotonin and leptin in appetite control. Annals of Medicine. 2000;32(3):222-232. doi:10.3109/07853890008998829 "Very little evidence exists to support any direct link between the actions of 5-HT and leptin, suggesting that they are separate systems."
5. Han J-M, Kim H-G, Lee J-S, Choi M-K, Kim Y-A, Son C-G. Repeated Sense of Hunger Leads to the Development of Visceral Obesity and Metabolic Syndrome in a Mouse Model. PLOS ONE. 2014;9(5):e98276. doi:10.1371/journal.pone.0098276"...the repeated sense of hunger induced the typical characteristics of metabolic syndrome in an animal model; a distinct visceral obesity, hyperlipidemia, hyperglycemia and hepatic steatosis. Furthermore, we found that specifically leptin, a major metabolic hormone, played a major role in the development of these pathological disorders."
6. Laimer M, Kramer-Reinstadler K, Rauchenzauner M, et al. Effect of Mirtazapine Treatment on Body Composition and Metabolism. The Journal of clinical psychiatry. 2006;67:421-424. doi:10.4088/JCP.v67n0313 "The antidepressant therapy with mirtazapine was associated with a significant increase in body weight, body fat mass, and leptin concentration."
7. Schilling C, Gilles M, Blum WF, et al. Leptin plasma concentrations increase during antidepressant treatment with amitriptyline and mirtazapine, but not paroxetine and venlafaxine: leptin resistance mediated by antihistaminergic activity? J Clin Psychopharmacol. 2013;33(1):99-103. doi:10.1097/JCP.0b013e31827cb179 Leptin plasma concentrations increased during treatment with amitriptyline and mirtazapine, even after controlling for increased body mass index and irrespective of response to treatment
   
8. Segal KR, Landt M, Klein S. Relationship Between Insulin Sensitivity and Plasma Leptin Concentration in Lean and Obese Men. Diabetes. 1996;45(7):988-991. doi:10.2337/diab.45.7.988 "...insulin resistance is associated with elevated plasma leptin levels independent of body fat mass.

 

[olive]

It increase appetite significantly like cyproheptadine but is actually shown to improve body composition (more muscle, less fat) when calories are controlled. Meaning any weight gain is simply a result of over feeding, not due to the drug itself. There’s a reason why virtually all body builders use this stuff, and a majority of them stay under 8% year round.

The benefits on sleep are remarkable; it actually increases REM sleep quality better than anything else - GHB/analogs excluded.

 

[SB4]

@olive How big is this drug in the body building community and what doses do they use?

 

[olive]

@olive How big is this drug in the body building community and what doses do they use?

Massive, it’s been used since the early 2000’s by just about everyone at the top. Just a well kept secret among the coaches. 7.5mg-15mg sublingual before bed is the go to dose - more than that actually has an inverse effect and will be stimulatory. Powerfully lowers cortisol, attenuates muscle atrophy, stimulates appetite, shifts body to prefer carbs, increases Leptin 2fold without desensitising receptors, improves nutrient partitioning, increases neurosteroid production, positively modulates gut motility, is directly lipolytic, alleviates anxiety, potent antidepressant, enhances sleep cycles - REM especially.

 

[SB4]

Massive, it’s been used since the early 2000’s by just about everyone at the top. Just a well kept secret among the coaches. 7.5mg-15mg sublingual before bed is the go to dose - more than that actually has an inverse effect and will be stimulatory. Powerfully lowers cortisol, attenuates muscle atrophy, stimulates appetite, shifts body to prefer carbs, increases Leptin 2fold without desensitising receptors, improves nutrient partitioning, increases neurosteroid production, positively modulates gut motility, is directly lipolytic, alleviates anxiety, potent antidepressant, enhances sleep cycles - REM especially.

Interesting. I have been taking 7.5mg for 2/3 yrs now before bed. I think it helped my POTS a fair amount. Have you heard anything on these forums about particular brands and negative experiences. I am fairly sure I have significant sides with actavis but I can't say with 100% certainty.

 

[SB4]

@olive Why do they take it sublingual? Better absorption? Quicker delivery?

 

[Logan-]

Yes, mirtazapine has been linked to diabetes through two or more potential mechanisms. Firstly, the drug activates the 5-HT1A receptor, which increases one's appetite for carbohydrate. Available food products tend to be processed and calorie-dense, which promotes weight gain. Secondly, the drug increases leptin. By itself, additional body fat tends to increase a person's leptin levels, but, even if the patient mindfully restricts calories and maintains his weight, mirtazapine still increases leptin levels.

References

1. Berendsen HH, Broekkamp CL. Indirect in vivo 5-HT1A-agonistic effects of the new antidepressant mirtazapine. Psychopharmacology (Berl). 1997;133(3):275-282. doi:10.1007/s002130050402
2. Dourish CT, Cooper SJ, Gilbert F, Coughlan J, Iversen SD. The 5-HT1A agonist 8-OH-DPAT increases consumption of palatable wet mash and liquid diets in the rat. Psychopharmacology. 1988;94(1):58-63. doi:10.1007/BF00735881 "The 5-HT1A agonist 8-OH-DPAT, at a dose of 30 μg/kg, enhanced the consumption of sweetened wet mash and sweetened milk in non-deprived rats."
3. Fischer S, Hanefeld M, Haffner SM, et al. Insulin-resistant patients with type 2 diabetes mellitus have higher serum leptin levels independently of body fat mass. Acta Diabetol. 2002;39(3):105-110. doi:10.1007/s005920200027 "...fasting leptin level significantly and positively correlated with BMI (r=0.49, p=0.02) and with fasting insulin (r=0.69, p=0.001), while it negatively correlated with the glucose disposal rate (r=-0.62, p=0.002)."
4. Halford JCG, Blundell JE. Separate systems for serotonin and leptin in appetite control. Annals of Medicine. 2000;32(3):222-232. doi:10.3109/07853890008998829 "Very little evidence exists to support any direct link between the actions of 5-HT and leptin, suggesting that they are separate systems."
5. Han J-M, Kim H-G, Lee J-S, Choi M-K, Kim Y-A, Son C-G. Repeated Sense of Hunger Leads to the Development of Visceral Obesity and Metabolic Syndrome in a Mouse Model. PLOS ONE. 2014;9(5):e98276. doi:10.1371/journal.pone.0098276"...the repeated sense of hunger induced the typical characteristics of metabolic syndrome in an animal model; a distinct visceral obesity, hyperlipidemia, hyperglycemia and hepatic steatosis. Furthermore, we found that specifically leptin, a major metabolic hormone, played a major role in the development of these pathological disorders."
6. Laimer M, Kramer-Reinstadler K, Rauchenzauner M, et al. Effect of Mirtazapine Treatment on Body Composition and Metabolism. The Journal of clinical psychiatry. 2006;67:421-424. doi:10.4088/JCP.v67n0313 "The antidepressant therapy with mirtazapine was associated with a significant increase in body weight, body fat mass, and leptin concentration."
7. Schilling C, Gilles M, Blum WF, et al. Leptin plasma concentrations increase during antidepressant treatment with amitriptyline and mirtazapine, but not paroxetine and venlafaxine: leptin resistance mediated by antihistaminergic activity? J Clin Psychopharmacol. 2013;33(1):99-103. doi:10.1097/JCP.0b013e31827cb179 Leptin plasma concentrations increased during treatment with amitriptyline and mirtazapine, even after controlling for increased body mass index and irrespective of response to treatment
   
8. Segal KR, Landt M, Klein S. Relationship Between Insulin Sensitivity and Plasma Leptin Concentration in Lean and Obese Men. Diabetes. 1996;45(7):988-991. doi:10.2337/diab.45.7.988 "...insulin resistance is associated with elevated plasma leptin levels independent of body fat mass.

Thank you.

 

[DaveFoster]

Thank you.

You're welcome!