What Would Cause Significantly Worsened Morning Anxiety On Mirtazapine

[Johnson Bagfoot]

Hi there,

I've tried mirtazapine 3.5 - 7.5mg for the past 3 weeks.

I notice that it will calm / sedate me slightly when taken before sleep. Sleep is slightly interrupted, and equal/worse than without it. In the morning a spike of what feels like adrenaline will wake me. Without mirtazapine, this spike will not go any higher, it will just remain at the level it was upon waking.

With mirtazapine, the adrenaline spike seems to continue to intensify more and more until feeling very high anxiety. It's a physical feeling of contraction and hollowness around the abdomen, along with a feeling of fragility and like I desperately need to eat or perhaps have some sugar. Blood glucose is fine, so this isn't the problem.

I'm trying to trace the cause of these symptoms - perhaps to some kind of adrenal insuffiency, so wondered if this might be a useful clue or indicate anything?

Johnson

 

[Frankdee20]

I liked Mirtazepine, I was on roughly 7.5-15 mg, in conjunction with Effexor. It knocked me out but made me fat and hungry. It hits 5ht receptors via antagonism, no reuptake. Perhaps your anxiety comes from rebound adrenaline since it also antagonizes alpha adrenergic receptors.

 

[Johnson Bagfoot]

I liked Mirtazepine, I was on roughly 7.5-15 mg, in conjunction with Effexor. It knocked me out but made me fat and hungry. It hits 5ht receptors via antagonism, no reuptake. Perhaps your anxiety comes from rebound adrenaline since it also antagonizes alpha adrenergic receptors.

I see, thank you. Could this also have anything to do with cortisol suppression on mirtz? Maybe cortisol is already low and this contributes to some kind of heightened rebound?

 

[Frankdee20]

I see, thank you. Could this also have anything to do with cortisol suppression on mirtz? Maybe cortisol is already low and this contributes to some kind of heightened rebound?

Can't say for sure, so many intricate synergies at play with these drugs

 

[Frankdee20]

It does antagonize 5ht2a though, so that receptor is involved with Cortisol.

 

[bionicheart]

I would give it another week or two to see if the anxiety dissipates. I've been on it for 6 weeks now. The first two weeks my anxiety became much worse, especially in the morning. I was talking 3-7.5mg, now am taking 15mg and no longer have anxiety.
Increased anxiety, irritability and aggression is common at the beginning of treatment with mirtazapine.