DOSE:	30 mg	oral	Pharms - Mirtazapine	(daily)
	200 mg	oral	Pharms - Bupropion	(daily)
	15 - 30 mg	oral	Pharms - Temazepam	(daily)

BODY WEIGHT:

135 lb

Mirtazapine for Anxiety and Depression

Background: I am a 30 year-old-male scientific professional diagnosed with major depression who has had severe anxiety, panic attacks, delusional guilt and depressed affect for approximately 25 years prior to concomitant dosing of mirtazapine (30 mg, taken in the evening) with a previously established regimen of buproprion SR (200 mg, taken in the morning). Prior to psychiatric care, I routinely self-medicated with alcohol for approximately seven years and consequently evolved a serious chemical-dependency problem. My alcoholism was effectively managed with cognitive therapy and licit benzodiazepine use. Prior to treatment with mirtazapine, I was voluntarily abstinent from diazepam (Valium) for several months after a lengthy taper, but was still habituated to a 30 mg nightly dose of temazepam (restoril) for insomnia.

Before taking mirtazapine, my psychiatrist recommended taking an SSRI, specifically (S)-citalopram. I was impressed with the efficacy of the drug in treating depression and anxiety, but suffered intolerable side effects, most importantly bruxism (grinding of teeth at night time), reduced sex drive, genital anesthesia, markedly delayed ejaculation, ejaculatory anhedonia (pleasureless orgasms), and frequent anorgasmia (total inability to have an orgasm regardless of physical stimulation). Increased doses of bupropion did not mitigate these effects. Since the sexual side effects plausibly arose from the SSRI’s indirect agonism (via increased serotonin) of the serotonin receptor subtypes 2 and 3, I suggested to my psychiatrist that I try mirtazapine, since it functions as indirect agonist of the serotonin receptor subtype 1 and direct antagonist of subtypes 2 and 3. I stopped taking (S)-citalopram and began taking 15 mg of mirtazapine at night time. I increase the dose to 30 mg in two 7.5 mg increments added a week apart.

The mirtazapine has had a remarkable effect on my mood. I no longer experience intensely negative feelings in reaction to adverse events (getting my car stolen, breaking up with a girlfriend, discovering cockroaches in my apartment, etc.); rather, I am very emotionally even (without being “flat”) and find that I am far more confident now in my ability to deal with difficult situations and difficult feelings. I make eye contact more often with people around me, particularly women, and feel much more at ease in my social environment. I was once an exceedingly shy person. I’m still shy, but less pathologically so.

Mirtazapine seems to have increased my sex drive and has not negatively affected sexual performance or subjective enjoyment of sexual stimulation.

Mirtazapine’s sedative effects were initially quite pronounced, including moderate grogginess in the morning. This abated after several weeks, but enabled me to drop my nightly dose of temazepam from 30 mg to 15 mg without precipitating any noticeable benzodiazepine withdrawal symptoms (not even rebound-insomnia).

For the first month of mirtazapine therapy, I had carbohydrate-cravings pretty much around the clock. Since then, my diet has normalized, and I no longer have intense food cravings. My net weight gain was on the order of 5 pounds. Significantly, I was rather underweight before I began taking mirtazapine (at 5’10’’, I weighed <130 lbs).

Exp Year: 2011	ExpID: 91952
Gender: Male
Age at time of experience: 31
Published: Apr 23, 2020	Views: 1,342
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Pharms - Mirtazapine (311) : Combinations (3), Retrospective / Summary (11), Depression (15), Therapeutic Intent or Outcome (49), Medical Use (47), Not Applicable (38)