Discussion Venlafaxine vs Mirtazapine

[L-L]

Hi everyone. First time I've posted my own thread despite being around for a while.

I had my psychiatric assessment yesterday and I didn't get sectioned despite being very open and honest about having acquired SN and anti-emetics. However, he did suggest some new medications to replace the Citalopram that I am currently taking and I wondered if any of you guys had any experiences - both positive and negative - that you would care to share before I make a decision on which one I'd like to go with.

As the thread title suggests, the two that he was keen for me to try are either Mirtazapine or Venlafaxine. I've done a bit of searching around for studies done on their tolerability, side effect profiles and interactions that I'll post below if anybody else is interested, but any experiences you have to share would be welcomed.

Thanks for taking the time to read.

Mirtazapine vs Venlafaxine:

Mirtazapine versus venlafaxine in hospitalized severely depressed patients with melancholic features - PubMed

The aim of this multicenter, randomized, double-blind, 8-week study was to compare the antidepressant efficacy and tolerability of mirtazapine and venlafaxine in the treatment of hospitalized patients with DSM-IV diagnosis of severe depressive episode with melancholic features. Patients with a...

www.ncbi.nlm.nih.gov

Info on Mirtazapine:

A review of the pharmacological and clinical profile of mirtazapine - PubMed

The novel antidepressant mirtazapine has a dual mode of action. It is a noradrenergic and specific serotonergic antidepressant (NaSSA) that acts by antagonizing the adrenergic alpha2-autoreceptors and alpha2-heteroreceptors as well as by blocking 5-HT2 and 5-HT3 receptors. It enhances...

www.ncbi.nlm.nih.gov

https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=Mirtazapine+&btnG=#d=gs_qabs&u=%23p%3DAvwtohcZx9AJ

Venlafaxine:

Venlafaxine - Drugs

Synopsis Venlafaxine is a phenylethylamine derivative which facilitates neurotransmission in the brain by blocking presynaptic reuptake of serotonin (5-hydroxytryptamine; 5-HT) and noradrenaline (norepinephrine). Clinical data from patients with major depression are consistent with the...

link.springer.com

Venlafaxine as the 'baby ecstasy'? Literature overview and analysis of web-based misusers' experiences - PubMed

Physicians should carefully evaluate patients for history of drug dependence and observe them for signs of venlafaxine misuse.

www.ncbi.nlm.nih.gov

And finally, a very niche study into the possible effects of combining MDMA with Venlafaxine - one of the few things that I enjoy is rolling every now and then - full article accessed by clicking pdf:

Deaths Involving MDMA and the Concomitant Use of Pharmaceutical Drugs

Abstract. The increasing use of 3,4-methylenedioxymethamphetamine (MDMA, “ecstasy”) and tendency of users to combine MDMA with pharmaceutical agents (espec

academic.oup.com

 

[Nanami]

From my own experience, Mirtazapine will make you sleep a lot and Venlafaxine will make you struggle to sleep.
They're often combined because of how they affect sleep (California Rocket Fuel).

Personally I preferred just Mirtazapine as I already have severe insomnia issues, and it also acts a bit as an anxiety reducer. Though weight gain is a serious issue of it.

Also, if you ever plan to stop them, mirtazapine withdrawal is uncomfortable but venlafaxine withdrawal is pure hell for a few weeks.

 

[L-L]

From my own experience, Mirtazapine will make you sleep a lot and Venlafaxine will make you struggle to sleep.
They're often combined because of how they affect sleep (California Rocket Fuel).

Personally I preferred just Mirtazapine as I already have severe insomnia issues, and it also acts a bit as an anxiety reducer. Though weight gain is a serious issue of it.

Also, if you ever plan to stop them, mirtazapine withdrawal is uncomfortable but venlafaxine withdrawal is pure hell for a few weeks.

Thanks, @Nanami. I did come across the California Rocket Fuel concept when reading about them, but I'm not sure it's on offer to at the moment.

Even though there are horrendous withdrawals I'm leaning towards Venlafaxine - one of the things I don't like about the Citalopram is that I'm a lot more tired than usual.

Really appreciate your input.

 

[nonamegirl]

I was on Venlafaxine for a few months, didnt help my anxiety or depression, just made me fell sorta "weord" and gave me horrible sweats. I couldnt walk up 10 steps on stairs without getting so sweaty it nearly ran down my face. It was not something I ould live with and seiing as I didnt really feel any effect on my depression and anxiety I tapered off. It was fairly easy and my symptoms during withdraval was managable. Took only a couple of months.

Mirtazapine I have been on 2,5 years. In the first couple of years it was by far the most effective antidepressant I have tried. Amd worked like a charm on sleep (I have tinnitus which makes it very hard to fall asleep) BUT now after 2,5 years my depression and anxiety is back with a vengance. it still works on my sleep but not as effectively as in the beginning. Actually Mirtazapine has worked 10x better on my sleep, then when I was on benzo's. I used to lay awake 1½-2 hours before falling asleep on benzo's. NOT with mirtazapine, it knocks me out.

 

[L-L]

I was on Venlafaxine for a few months, didnt help my anxiety or depression, just made me fell sorta "weord" and gave me horrible sweats. I couldnt walk up 10 steps on stairs without getting so sweaty it nearly ran down my face. It was not something I ould live with and seiing as I didnt really feel any effect on my depression and anxiety I tapered off. It was fairly easy and my symptoms during withdraval was managable. Took only a couple of months.

Mirtazapine I have been on 2,5 years. In the first couple of years it was by far the most effective antidepressant I have tried. Amd worked like a charm on sleep (I have tinnitus which makes it very hard to fall asleep) BUT now after 2,5 years my depression and anxiety is back with a vengance. it still works on my sleep but not as effectively as in the beginning. Actually Mirtazapine has worked 10x better on my sleep, then when I was on benzo's. I used to lay awake 1½-2 hours before falling asleep on benzo's. NOT with mirtazapine, it knocks me out.

Thanks, @nonamegirl. With your Mirtazapine is there any lingering effects on sluggishness or somnolence in the morning?

Mirtazapine does interest me as it's not your typical treatment - most are SSRI's or SNRI's like Venlafaxine.

 

[Susannah]

I used Venlafaxine (Efexor) for 4 years (3 y at 300mg), and it didn't do me any good. I was depressed, but never suicidal when I started taking it. I remember thinking it helped a little bit in the beginning, but after a while, I got worse and started having suicidal thoughts. I wanted to get of meds, but the withdrawel was awful, even though I "followed the book". I actually ended up at the psyc ward. I've talked to others about Mirtazapine, and then felt ok about this med (except maybe gaining some weight).

 

[CynicalHopelessness]

I used venlafaxine for several months. It made me functional, and the only observable side effect was loss of any sex drive. Withdrawal was very heavy for about 3 weeks, even though I've been gradually reducing the dosage, felt stressed and in the fog all the time.

 

[nonamegirl]

Thanks, @nonamegirl. With your Mirtazapine is there any lingering effects on sluggishness or somnolence in the morning?

Mirtazapine does interest me as it's not your typical treatment - most are SSRI's or SNRI's like Venlafaxine.

I am drowsy , I can't deny that, but not all day long. Mostly the first 3-4 hours of my day. But I have always been a slow starter and drowsy several hours after waking, so I don't feel the mirtazapine makes that much difference to me in that area. I get most of my energy in the evenings and mirtazapine has not ruined that for me.

 

[L-L]

I used Venlafaxine (Efexor) for 4 years (3 y at 300mg), and it didn't do me any good. I was depressed, but never suicidal when I started taking it. I remember thinking it helped a little bit in the beginning, but after a while, I got worse and started having suicidal thoughts. I wanted to get of meds, but the withdrawel was awful, even though I "followed the book". I actually ended up at the psyc ward. I've talked to others about Mirtazapine, and then felt ok about this med (except maybe gaining some weight).

That really doesn't sound pleasant! Would you attribute your stay in the ward to the Venlafaxine?

I used venlafaxine for several months. It made me functional, and the only observable side effect was loss of any sex drive. Withdrawal was very heavy for about 3 weeks, even though I've been gradually reducing the dosage, felt stressed and in the fog all the time.

How bad was the loss of sex drive? Sounds terrible but having sex is one of the few pleasures I have left.

I am drowsy , I can't deny that, but not all day long. Mostly the first 3-4 hours of my day. But I have always been a slow starter and drowsy several hours after waking, so I don't feel the mirtazapine makes that much difference to me in that area. I get most of my energy in the evenings and mirtazapine has not ruined that for me.

It's good that you still got your energy left. I used to be pretty active in the morning but the Citalopram I take has made me more drowsy as I have moved the dosage up, so I'd like to minimise the risk of it.


There's such an issue with treatment of depression. So many different modes of action for different drugs, and no one drug will work for one person. Can be so disheartening and frustrating when you're trying so hard for the people around you, or even yourself, but everything seems to be stacked against you.

 

[CynicalHopelessness]

How bad was the loss of sex drive? Sounds terrible but having sex is one of the few pleasures I have left.

It was pretty absolute. Nothing aroused me at all, but I didn't feel like I was missing something. It also fully recovered after I stopped.
Then again, I was in despair back then, and pills made me zombie-like, neither of which are a satisfactory state for me. I probably won't be using any ADs anymore.

 

[SonOfSam]

I was on venlafaxine at 300mg for over a year and it was the most effective anti-depressant I've been on. After about a year though it lost it's ability to keep me stable. Coming off of it, being tapered down while in the hospital was really uncomfortable. Although they tapered me, I still got "brain-zaps", which are like shocks inside your head.

I was also on mirtazapine a long time ago. I took it at bed time. It's definitely a sedative medication. If I remember correctly I gained some weight on mirtazapine but not as much as some other meds.

 

[nonamegirl]

I was on venlafaxine at 300mg for over a year and it was the most effective anti-depressant I've been on. After about a year though it lost it's ability to keep me stable. Coming off of it, being tapered down while in the hospital was really uncomfortable. Although they tapered me, I still got "brain-zaps", which are like shocks inside your head.

I was also on mirtazapine a long time ago. I took it at bed time. It's definitely a sedative medication. If I remember correctly I gained some weight on mirtazapine but not as much as some other meds.

But it doesnt have this effect on anybody. I have talked to some people who didnt get this effect on it.

 

[SonOfSam]

But it doesnt have this effect on anybody. I have talked to some people who didnt get this effect on it.

Medications will effect everyone differently. Brain chemistry varies greatly and you shouldn't base the effectiveness of a medication off of someone else's experience. If you want the best chance at getting the most out of an anti-psychotic, anti-anxiety, or anti-depressant, you should do your research, but take it with an open mind and record your feelings while on said medication.

 

[nonamegirl]

Medications will effect everyone differently. Brain chemistry varies greatly and you shouldn't base the effectiveness of a medication off of someone else's experience. If you want the best chance at getting the most out of an anti-psychotic, anti-anxiety, or anti-depressant, you should do your research, but take it with an open mind and record your feelings while on said medication.

Exactly! :)

 

[BPD Barbie]

Mirtazipine at low dose is very very sedative. The higher the dose, the less sedative it becomes. Its a funny drug in that sense.

 

[nonamegirl]

Mirtazipine at low dose is very very sedative. The higher the dose, the less sedative it becomes. Its a funny drug in that sense.

But again, not for everybody. And for me the low doses didnt sedate me much. I am on 30 mg. and that worked the best for me in all areas, including sleep. Drugs work differently on people,

 

[RealLifeTamagotchi]

I'm quite satisfied with venlafaxine right now, but one does have to watch out for serotonin withdrawal syndrome. A month ago my psychiatrist decided to change my medications, and he did it without tapering. I ended up suffering from nausia, dizziness, diarrhea, insomnia. etc. Got back on venlafaxine and the symptoms were gone. I didn't suffer like this when I stopped taking vortioxetine or desvenlafaxine...

 

[Emily_Numb]

Mitrazapine has to be my least favourite psychiatric mediation. It makes you want to do nothing but eat! I would take it at night and within 30 minutes I'd be out of bed and making myself food in the kitchen. I've never been on a drug that had that strong of an effect on me. I put on about 8lbs in 28 days. I stopped it for this reason. There is no way I would ever recommend this drug to anyone.

I am on Escitalopram now which is totally weight neutral and almost appetite suppressing with me which I like. I haven't been on it long enough yet to see any marked benefits but I need to give it time.

 

[Little Mook]

I was put on Mirtazapine a few months ago and my moods significantly improved. I'm eating more , but no massive weight gain and I'm sleeping better. No serious side effects so far .

 

[mathieu]

I've used them both, together and separately. Neither helped my depression that much. Maybe a little numbing. Mirt is very sedating so good if you have insomnia. It gives you the munchies but I personally didn't gain any weight.

 

[TotallyIsolated]

Mirtazapine made me extremely sleepy within minutes of taking the first dose! I gained a noticeable amount of weight but then my weight tends to fluctuate anyway.

Currently on Venlafaxine (225mg for a few years and just recently up to 300mg) and I find it *FAR* more effective, though I'm concerned that it disrupts my sleep. Plus the withdrawal is super nasty. I was late getting a refill once... by the fourth day I was shaking and crying all the time. It makes me a little nauseous, but you get used to it quickly.

You need to be on a high dosage of Venlafaxine to get the secondary effects which make it so effective. In the UK you need to speak to a psychiatrist or a GP who specialises in mental health to get the higher dosage.

 

[L-L]

I've used them both, together and separately. Neither helped my depression that much. Maybe a little numbing. Mirt is very sedating so good if you have insomnia. It gives you the munchies but I personally didn't gain any weight.

Mirtazapine made me extremely sleepy within minutes of taking the first dose! I gained a noticeable amount of weight but then my weight tends to fluctuate anyway.

Currently on Venlafaxine (225mg for a few years and just recently up to 300mg) and I find it *FAR* more effective, though I'm concerned that it disrupts my sleep. Plus the withdrawal is super nasty. I was late getting a refill once... by the fourth day I was shaking and crying all the time. It makes me a little nauseous, but you get used to it quickly.

Thanks guys. I went for the Venlafaxine in the end, for better or worse. Don't think I'm going to be able to roll whilst on it, as the withdrawal is too bad to justify it by the sounds of it; but Mirtazapine with its sedation just doesn't seem to be worth it. Difficult to keep up the motivation to carry on sometimes when you consider all of the different variables in the scenario.

Thank you to all for your input, I genuinely appreciate all of you for your inputs.

 

[Deleted member 1465]

Mirtazapine also affects your metabolism. There's a reason why it makes you hungry and gain weight, my endocrinologist told me it can induce the onset of diabetes.

 

[Susannah]

That really doesn't sound pleasant! Would you attribute your stay in the ward to the Venlafaxine?

Yes! My psychiatrist had diagnosed me (blood test) with something called serotonin syndrome. My serotonin levels were way too high. This syndrome

How bad was the loss of sex drive? Sounds terrible but having sex is one of the few pleasures I have left.


It's good that you still got your energy left. I used to be pretty active in the morning but the Citalopram I take has made me more drowsy as I have moved the dosage up, so I'd like to minimise the risk of it.


There's such an issue with treatment of depression. So many different modes of action for different drugs, and no one drug will work for one person. Can be so disheartening and frustrating when you're trying so hard for the people around you, or even yourself, but everything seems to be stacked against you.

That really doesn't sound pleasant! Would you attribute your stay in the ward to the Venlafaxine?

Yes! My psychiatrist had diagnosed me (blood test) with something called serotonin syndrome. My serotonin levels were way too high. This syndrome is caused by meds like SSRIs. Nobody at the psyc ward had heard of it, and they thought I was making it up:(

How bad was the loss of sex drive? Sounds terrible but having sex is one of the few pleasures I have left.


It's good that you still got your energy left. I used to be pretty active in the morning but the Citalopram I take has made me more drowsy as I have moved the dosage up, so I'd like to minimise the risk of it.


There's such an issue with treatment of depression. So many different modes of action for different drugs, and no one drug will work for one person. Can be so disheartening and frustrating when you're trying so hard for the people around you, or even yourself, but everything seems to be stacked against you.

 

[Little Mook]

Mirtazapine also affects your metabolism. There's a reason why it makes you hungry and gain weight, my endocrinologist told me it can induce the onset of diabetes.

Maybe that's why my gp is already talking about when I start coming off it , which worries me , as whenever I've been med free I have become really delusional with my bdd and severely depressed!

 

[Sadddd]

Catching up on this thread after posting a similar question today.

Been on Mirtazapine for 8/9 months. A lot of food cravings (especially carbs) and get very drowsy taking it. Started at 15mg which for me was like a sleeping tablet (hadn't slept more than 3/4 hours for 2 months by that stage tbf) so great that i started sleeping again. then went up to 30 which helped with the anxiety and eventually 45 which was a bit too much.

do find that i am struggling getting up and generally a bit confused and having vivid dreams (nobody else has mentioned this it seems) but situationally i am in a bad place atm so tough to know how much that is effecting it.

Been offered venlafaxine or they will let me go back onto citalopram if i want. The side effects of V have put me off but as @L-L mentioned he has been generally ok and better off on V so it does depend on the person

 

[Moonomyth]

I am on a low dose of Venlafaxine presently and I have had mostly good results. My mood has improved and I haven't had any serious side effects that would make me want to stop taking it - no weight gain, sexual dysfunction, anything like that.

The most significant side-effect has been that my dreams have become increasingly strange and vivid since I started taking them. This is not normally a big deal but it can make the nightmares very nightmarish.

 

[Sadddd]

Can I ask how much a low dose is?

Sorry to hear about the dreams/nightmares :-(

 

[Moonomyth]

I am on a 75mg dose, which is the lowest I can reasonably get. I am told that there are half-doses of that but you may need to negotiate with your psychiatrist; most research I've seen does increments of 75mgs.

 

[L-L]

Glad you found this thread, @Sadddd - I came on to link you to it now I'm home.

I am on a 75mg dose, which is the lowest I can reasonably get. I am told that there are half-doses of that but you may need to negotiate with your psychiatrist; most research I've seen does increments of 75mgs.

I was one of the people who started at 37.5mg, @Moonomyth, because I was cross-tapering with Citalopram. Today will be first dose of 70mg.

@Sadddd, I don't see why you couldn't request to start at the half-dose I started on, if you're still worried. I saw my Psychologist this morning (not the Psychiatrist who does the prescribing) and she said she thinks I need to go up to 225 as soon as possible. I imagine it'll take a while of increased dosages but I'll let you know how I get on.