Mirtazipine/Remereon Experience - When to titrate dose?

[ArtlessAesthetic]

Hi all,

I've had depression for 13 years. It tends to come and go, with Major episodes interspersed with dysthmia - so, duble fail, basically! My last major episode started in February, saw Doctor in April, got Venlafaxine, did bupkis, so the past few months have just been spent bouncing between CMHT, the GP and the crisis team. A fortnight ago, the GP switched me to Mirtazipine, and in some ways it's been really helpful : it's kicked my insomnia's ass, dialled down my agitation and dampened my anxiety somewhat. The problem is, I feel like it's done more for all those than the depression - I'm still having the little incidences of suicidal thinking, although less often than on Venlafaxine, and I'm still dealing with the feeling of just utter pointlessness of everything, no hope, motivation, staying home all the time etc.

I saw the Doctor on Monday for a medication review, but the surgery was running late and he was obviously in a rush, when he asked me how the meds were working, all I got the chance to say was "Not bad. before he cut in and said we'd keep the dose at 15mg in case more was needed down the line, and he'd see me again in a month. Literally, 3 minute consultation. So know not only am I worried he's decided I'm magically cured and will try and get me back to work (nursing is stressful enough when I'm well), I'm kind of confused about the medication issue. Did anyone else find Mirtazipine was more effective as a hypnotic/anxiolytic at first, then as an anti-depressant later? Is two weeks too early to expect much symptom relief? How long should a low dose of it generally be tried before being titrated? I'm not treatment naive, but I've been mostly on SSRI's - the other classes are all fairly new to me. I'm thinking of going back early, in a fortnight for a review - to be honest, I'd have been happier getting the dosage upped now, but maybe I'm trigger happy with meds. Does waiting that long sound reasonable? Thanks for any inout guys, and apologies for the rambling - massive brain fog at the moment.

[jt07]

I don't find mirtazapine particularly helpful as an antidepressant by itself. However, it works good in combination with an SSRI which in my case is citalopram. I take 45 mg of mirtazapine, and it is working well in combination with my other meds. From what my old pdoc once said, 15 mg is mostly a sleeping pill dose and that it doesn't begin to hit NE (norepinephrine) until you get over 30 mg.

[ArtlessAesthetic]

I don't find mirtazapine particularly helpful as an antidepressant by itself. However, it works good in combination with an SSRI which in my case is citalopram. I take 45 mg of mirtazapine, and it is working well in combination with my other meds. From what my old pdoc once said, 15 mg is mostly a sleeping pill dose and that it doesn't begin to hit NE (norepinephrine) until you get over 30 mg.

I had heard it was quite often combined with an SSRI/SNRI - I would have asked just to have it as an add-on to the Venlafaxine if I'd been able to tolerate it. I'm due my first pdoc apoointment in years soon, so I might bring that up to her. Thanks.