Is Mirtazapine Safe With Potential Thyroid Issues? (Quick Help Appreciated)

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Hi all,

I've written about some issues in another thread: Nightmarish Life After 8 Years On SSRIs

I think some part of my symptoms might relate to thyroid dysfunction, since I have: chronic fatigue, dizziness, trembly, hair loss, palpitations, exercise intolerance, temperature intolerance, insomnia. I'm getting this tested fully, but won't get the results for a week.

Tonight I'm feeling extremely agitated, unable to sleep, and very very fatigued. All I have available is an unopened packet of mirtazapine. I am not otherwise medicated.

I'd take this immediately, but came across several studies where it is shown to alter thyroid and cortisol functioning very quickly. Now I'm no longer sure if it's a good idea, since I'm feeling pretty fragile anyway E.g.
- Effect of mirtazapine on thyroid hormones in adult patients with major depression. - PubMed - NCBI


Could taking mirtazapine be potentially harmful for one night if I am in fact hypo or hyperthyroid, or if there is some cortisol dysfunction?

-Johnson
 

DaveFoster

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All of your symptoms except for fatigue and hair loss should improve with a low dose of mirtazapine. Fatigue will improve with a high dose.
 
OP
J
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All of your symptoms except for fatigue and hair loss should improve with a low dose of mirtazapine. Fatigue will improve with a high dose.

Thanks very much Dave, I took 7.5mg and slept a little better. With the exception of a pronounced tight/crawling sensation in my chest area.

Do you (or anyone else reading this) understand how dose levels influences the effects of mirtazapine?

I understand similar pharmaceuticals often have U shaped dose efficacy curves, but this is more complicated since it's "dirty" and hits so many different receptors.


What might be an effective starting dose for my symptoms?
 

DaveFoster

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Thanks very much Dave, I took 7.5mg and slept a little better. With the exception of a pronounced tight/crawling sensation in my chest area.

Do you (or anyone else reading this) understand how dose levels influences the effects of mirtazapine?

I understand similar pharmaceuticals often have U shaped dose efficacy curves, but this is more complicated since it's "dirty" and hits so many different receptors.


What might be an effective starting dose for my symptoms?
1 mg, maybe 2 mg.
 

DaveFoster

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What would be the effect of this compared to 7.5 / 15 / 30 + ?

Or point me towards any studies?

Much appreciated !
It depends on the person. Doses under 0-15 tend to be sedating up to 30 mg, which marks the approximate transition from sedation to stimulation. Doses above 30 mg tend to be stimulating. Give it 4 weeks to work if you're taking it as an antidepressant, and many have positive experiences taking 3/4 of the dose before bed, and 1/4 of the dose upon rising.
 
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J
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Thanks Dave

Some observations on first day of 7.5mg taken before bed:

  • Body temperature seemed higher throughout the night / heat was more noticeable
  • Sleep duration was longer, although FitBit showed far more restlessness and less deep sleep.
  • Morning blood glucose was significantly lower than usual. I'd assume this points to reduction in cortisol, which usually contributes to glucose spiking
  • Feeling very groggy and a little fragile, some palpitations. Heart rate is already low and at night it seemed a little too slow or weak, which I found a bit concerning.

I'll try 2-3mg tonight
 

CoconutEffect

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It depends on the person. Doses under 0-15 tend to be sedating up to 30 mg, which marks the approximate transition from sedation to stimulation. Doses above 30 mg tend to be stimulating. Give it 4 weeks to work if you're taking it as an antidepressant, and many have positive experiences taking 3/4 of the dose before bed, and 1/4 of the dose upon rising.

Hey Dave,

Wouldn't you want a smaller (sedating) dose at night and a larger dose in the morning?

I started 15mg at night a little over a month ago, and have been sleeing reliably ever since.

I'm about to try Emsam, to help with my mornings which are very very difficult (even before mirtazapine)

If that fails I may try to get an upper and a downer out of Mirtazepine, say 7.5 and 37.5 (activating dose) in the mornings.

Have you tried this or know of anyone that has? I ran it by my psychiatrist, he saw the rationale but really had nothing to say about it.
 

DaveFoster

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Thanks Dave

Some observations on first day of 7.5mg taken before bed:

  • Body temperature seemed higher throughout the night / heat was more noticeable
  • Sleep duration was longer, although FitBit showed far more restlessness and less deep sleep.
  • Morning blood glucose was significantly lower than usual. I'd assume this points to reduction in cortisol, which usually contributes to glucose spiking
  • Feeling very groggy and a little fragile, some palpitations. Heart rate is already low and at night it seemed a little too slow or weak, which I found a bit concerning.

I'll try 2-3mg tonight
If you continue to have "palpitations," as in your heart rate seems to be arrhythmic (missing beats, abnormal beating, etc.) I'd get an EKG.

Hey Dave,

Wouldn't you want a smaller (sedating) dose at night and a larger dose in the morning?

I started 15mg at night a little over a month ago, and have been sleeing reliably ever since.

I'm about to try Emsam, to help with my mornings which are very very difficult (even before mirtazapine)

If that fails I may try to get an upper and a downer out of Mirtazepine, say 7.5 and 37.5 (activating dose) in the mornings.

Have you tried this or know of anyone that has? I ran it by my psychiatrist, he saw the rationale but really had nothing to say about it.
I don't think that would work because of the 22-hour half life on mirtazapine. A large (say 3/4) dose in the morning would raise the plasma concentration, and the smaller (1/4) dose about 16 hours later would result in a very similar concentration. It should still facilitate sleep, but I don't think it will be as potent in its "knock-out" actions as a large dose before sleep.
 
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J
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I think it is harmful.

It turned out to be quite harmful yes, worsened sleep and higher TSH. Mirtazapine influences cortisol, which has interdependencies with thyroid, and was already suppressed in me. Cypro had a similar reaction. So these aren't necessarily benign substances in all cases
 

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