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Metformin + Mirtazapine for Weight Gain Prevention


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hiiii,

i have found mirtazapine to be a pretty damn good medication with a terrible side effect: insatiable hunger. i'm in limbo right now with medications and i am at a very normal and very healthy weight, but this medication has caused me to gain weight in the past perhaps due to metabolic effects and definitely due to never being satiated. does anyone think that adding metformin at the time of potentially restarting mirtazapine would circumvent this issue?

thanks!

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1 hour ago, basuraeuropea said:

hiiii,

i have found mirtazapine to be a pretty damn good medication with a terrible side effect: insatiable hunger. i'm in limbo right now with medications and i am at a very normal and very healthy weight, but this medication has caused me to gain weight in the past perhaps due to metabolic effects and definitely due to never being satiated. does anyone think that adding metformin at the time of potentially restarting mirtazapine would circumvent this issue?

thanks!

I don't have any personal experience with metformin, so I can't give much advice on a mirtazapine/metformin combo...Although I know well about the mirtazapine causing weight gain, because I've tried it, and had to stop it due to weight gain.

I'm going to tag some other folks who might have better advice..... @browri, @Iceberg, and @Wonderful.Cheese......If i remember correctly, I think Wonderful Cheese still takes metformin.

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1 hour ago, basuraeuropea said:

hiiii,

i have found mirtazapine to be a pretty damn good medication with a terrible side effect: insatiable hunger. i'm in limbo right now with medications and i am at a very normal and very healthy weight, but this medication has caused me to gain weight in the past perhaps due to metabolic effects and definitely due to never being satiated. does anyone think that adding metformin at the time of potentially restarting mirtazapine would circumvent this issue?

thanks!

Hi there! @basuraeuropea  I do in fact take 2,000 mg Metformin ER. CRH is correct. I will tell you about my Metformin journey.

I started topiramate first without much success for weight/metabolic issues.

Then they added Metformin (the regular Metformin) for weight control and metabolic control due to psych meds. 

With the addition of Metformin (ER) I was able to lose 70 lbs that I had gained due to seroquel. I lost the weight over maybe about 1.5 years and I’ve maintained the weight loss (and I’m working on slowly losing more too).

I would suggest that you try the Metformin ER version though, should you get any of the upset stomach side effects that Metformin is known for, before giving up on it completely.

I would say that metformin ER has definitely helped me lose weight and maintain a weight loss and helped control metabolic side effects from psych meds. I take Zyprexa and I’m not gaining weight! That’s pretty major.

I would say ask your dr if you could try this combo of mirtazapine and metformin (or metformin ER). It is worth a shot. Especially if the mirtazapine works so well for you. Sorry to hear lamictal isn’t helping you thus far. It never helped me. My brain likes the AP’s and AD’s. I hope you can find some way to take the mirtazapine successfully. Maybe Metformin can help this. I hope so.  

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2 hours ago, Wonderful.Cheese said:

Hi there! @basuraeuropea  I do in fact take 2,000 mg Metformin ER. CRH is correct. I will tell you about my Metformin journey.

I started topiramate first without much success for weight/metabolic issues.

Then they added Metformin (the regular Metformin) for weight control and metabolic control due to psych meds. 

With the addition of Metformin (ER) I was able to lose 70 lbs that I had gained due to seroquel. I lost the weight over maybe about 1.5 years and I’ve maintained the weight loss (and I’m working on slowly losing more too).

I would suggest that you try the Metformin ER version though, should you get any of the upset stomach side effects that Metformin is known for, before giving up on it completely.

I would say that metformin ER has definitely helped me lose weight and maintain a weight loss and helped control metabolic side effects from psych meds. I take Zyprexa and I’m not gaining weight! That’s pretty major.

I would say ask your dr if you could try this combo of mirtazapine and metformin (or metformin ER). It is worth a shot. Especially if the mirtazapine works so well for you. Sorry to hear lamictal isn’t helping you thus far. It never helped me. My brain likes the AP’s and AD’s. I hope you can find some way to take the mirtazapine successfully. Maybe Metformin can help this. I hope so.  

thank you so much for all of the helpful information, @Wonderful.Cheese! i'll mention this to my psychiatrist on monday. i asked this very question on reddit as well and it seems as though it's a hit or miss. because mirtazapine helped so much while also harming quite a bit, i'm hesitant but perhaps willing to trial this medication again. destabilization is real, but i'm not doing well right now anyhow, so...

i've also tried topiramate and it didn't work very well (it induced depression), although i do remember it cutting appetite a bit. due to the worsened depression, the drug was pulled. i'm at my wits' end with medication and continued suffering.

thank you all for being there for me! and thanks, @CrazyRedhead, for grabbing the attention of those who might chime in to help!

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I had a bad metformin experience (nothing says fun like pooping yourself in your sleep, amirite?  I know Toby's a keeper because when I woke up and realized he just took the sheets down to the laundry room and washed them without a thought) - BUT - Cheese will have some better experience with the ER which I never took.  I also come from a family of poopy people though, so take my experience with a grain of salt. 

I take rybelsus now.  It's more expensive - dunno in the States, but in Canada a 3 month supply costs around $750 I think?  Bit more?  I have insurance but was poking around on the app (we don't have pharmacare yet) and was shocked to discover that.  Most expensive med by far.  

Given you're American don't know what your insurance situation is like but that's another thought.  

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Posted (edited)
10 hours ago, basuraeuropea said:

hiiii,

i have found mirtazapine to be a pretty damn good medication with a terrible side effect: insatiable hunger. i'm in limbo right now with medications and i am at a very normal and very healthy weight, but this medication has caused me to gain weight in the past perhaps due to metabolic effects and definitely due to never being satiated. does anyone think that adding metformin at the time of potentially restarting mirtazapine would circumvent this issue?

thanks!

Just my thinking I might give it a trial period without the metformin first. Since remeron mostly drives weight through appetite, being aware of that when you go in might allow to fight the weight on your own, just because metformin can definitely have its own issues. I think that is why it is less common to start metformin right away with remeron than with APs, because the aps (looking at you zyprexa) act  more on metabolic causes and appetite… I was going to suggest topamax first because of this but obviously not a good option for u 

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42 minutes ago, Iceberg said:

Just my thinking I might give it a trial period without the metformin first. Since remeron mostly drives weight through appetite, being aware of that when you go in might allow to fight the weight on your own, just because metformin can definitely have its own issues. I think that is why it is less common to start metformin right away with remeron than with APs, because the aps (looking at you zyprexa) act  more on metabolic causes and appetite… I was going to suggest topamax first because of this but obviously not a good option for u 

 

 

1 hour ago, jarn said:

I had a bad metformin experience (nothing says fun like pooping yourself in your sleep, amirite?  I know Toby's a keeper because when I woke up and realized he just took the sheets down to the laundry room and washed them without a thought) - BUT - Cheese will have some better experience with the ER which I never took.  I also come from a family of poopy people though, so take my experience with a grain of salt. 

thanks for the insight, @Icebergand @jarn. so i surprisingly received a ton of answers on this via redditers who are suffering or have suffered from the same side effect. iceberg, i have taken the medication multiple times and tried to manage the appetite stimulating  properties on my own to no avail, thus the metformin question, although given the experiences that many have had with metformin or other diabetic medications to curb appetite on psych meds, it doesn't seem  like it works very  often. perhaps it stabilizes metabolic syndrome, but  it doesn't seem to quell appetite. @jarn, i live in the US and have really great, comprehensive medical insurance, so i'm not worried about the cost of any medication, really.

it was suggested to me there that i trial memantine again in very low dosages as i've been on a lot and not a lot helps. i'll update my other thread on that suggestion. 

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19 hours ago, jarn said:

I had a bad metformin experience (nothing says fun like pooping yourself in your sleep, amirite?  I know Toby's a keeper because when I woke up and realized he just took the sheets down to the laundry room and washed them without a thought) - BUT - Cheese will have some better experience with the ER which I never took.  I also come from a family of poopy people though, so take my experience with a grain of salt. 

I take rybelsus now.  It's more expensive - dunno in the States, but in Canada a 3 month supply costs around $750 I think?  Bit more?  I have insurance but was poking around on the app (we don't have pharmacare yet) and was shocked to discover that.  Most expensive med by far.  

Given you're American don't know what your insurance situation is like but that's another thought.  

Yep. Metformin can cause stomach problems for sure! My husband tried metformin and had a lot of stomach issues and had to stop it. I actually forgot to mention that! So thank you jarn!

He actually takes the same thing you take @jarn, only it is called Ozempic here in the US and comes in an injection (if I’m understanding all this correctly). It has the same active ingredient (semaglutide). Unless I am not understanding. And yep, expensive! But there is a copay card which helps us a lot.

Husband’s dr has also said it is good for weight loss. So definitely this could be another option for the OP to ask dr about if metformin doesn’t work or causes problems etc. 

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@Wonderful.Cheese Rybelsus should be in the US too - it's just it's a semaglutide pill vs. weekly injection.  Was worried only once a week would be more difficult to remember vs. daily.  Both are available here.

I was reading this last night - if it's available in the UK I would be shocked not available in the US. https://www.theguardian.com/science/2022/jun/05/diabetes-drug-tirzepatide-leads-to-notable-weight-loss-in-people-with-obesity-study

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On 6/4/2022 at 1:37 PM, CrazyRedhead said:

I don't have any personal experience with metformin, so I can't give much advice on a mirtazapine/metformin combo...Although I know well about the mirtazapine causing weight gain, because I've tried it, and had to stop it due to weight gain.

I'm going to tag some other folks who might have better advice..... @browri, @Iceberg, and @Wonderful.Cheese......If i remember correctly, I think Wonderful Cheese still takes metformin.

So will it work? Yes. Is it a direct positive effect? Maybe not.

Part of the weight gain from mirtazapine comes from the 5HT2C antagonism. This causes an increase in hunger, a reduction in satiety. So in that regard, it's simply the hunger drive. If you can resist, then theoretically you shouldn't gain weight.

However, mirtazapine is also a significant alpha-2 antagonist. Adrenergic and dopaminergic receptors are located significantly on pancreatic cells and certainly do regulate glucose control, insulin resistance, etc. It's possible that mirtazapine causes metabolic disruption via pathways other than 5HT2C antagonism.

Metformin will certainly cause weight loss via reduction of absorption of sugars and fats in the gut. This is simply to counteract the poor management of any sugar that does make its way into systemic circulation. This would be the same as metformin combating the metabolic dysfunction from olanzapine that works well for @Wonderful.Cheese

It's true though that metformin ER may be the way to go to make it most tolerable. I know some who can't go higher than 1000mg of the ER though.

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I am on mirtazipine (currently 22.5mg).  I have had weight gain but nothing extreme.  I am very active so the weight has stayed down.  I want to lower my dose a little.  It serves as sleep/antidepressant and is effective.  I am totally afraid to switch to another AD. I want to come off it.  I went back on it because my sleep became severely disrupted and I had a stressful move.

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2 hours ago, wookie said:

I am on mirtazipine (currently 22.5mg).  I have had weight gain but nothing extreme.  I am very active so the weight has stayed down.  I want to lower my dose a little.  It serves as sleep/antidepressant and is effective.  I am totally afraid to switch to another AD. I want to come off it.  I went back on it because my sleep became severely disrupted and I had a stressful move.

that's great that it doesn't cause for a ton of weight gain for you. keep taking it because it is effective! i wish that i were to take it without ballooning up.

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