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What Causes Panic Attacks While On Mirtazapine?
Question: I am 53....and have been on SSRI's for 18 years. My symptoms were usually anxiety and some depression.
One month ago I got a great bout of GAD and an onset of depression set in. It has been the worst ever.
My doctor changed my zoloft which wasn't working to 15meg of Mirtazapine. Then uped that to 30meg and then again to 45mg in the past week. In the past week I have been experiencing XXXXXXX panic attacks
everytime I go to bed in the evening. I have never ever experienced these in the 18 years that I toook the other SSRI's. He gave me 50mg of trazodone which made me drowsy in the evening but did not alleviate the panic attacks. Then he gave me .5mg of clonazepam which worked. I am very anxious and worried about the clonazepam. Please help me!
I don't know why I am having these XXXXXXX panic attacks this past week as I try to go to sleep. I am usually drowsy or tired and within minutes I start to breathe heavy. As that continues I stand up and walk into another room and lie down there. Then it repeats itself again. I am now afraid of going to bed. I do not want to rely on the clonazepam pills as I never did in my life before.
One month ago I got a great bout of GAD and an onset of depression set in. It has been the worst ever.
My doctor changed my zoloft which wasn't working to 15meg of Mirtazapine. Then uped that to 30meg and then again to 45mg in the past week. In the past week I have been experiencing XXXXXXX panic attacks
everytime I go to bed in the evening. I have never ever experienced these in the 18 years that I toook the other SSRI's. He gave me 50mg of trazodone which made me drowsy in the evening but did not alleviate the panic attacks. Then he gave me .5mg of clonazepam which worked. I am very anxious and worried about the clonazepam. Please help me!
I don't know why I am having these XXXXXXX panic attacks this past week as I try to go to sleep. I am usually drowsy or tired and within minutes I start to breathe heavy. As that continues I stand up and walk into another room and lie down there. Then it repeats itself again. I am now afraid of going to bed. I do not want to rely on the clonazepam pills as I never did in my life before.
Brief Answer:
Consultation
Detailed Answer:
Hello, and thanks for your question.
Your panic attacks are likely a reaction to the higher dose of mirtazapine. This paradoxical anxiety reaction can sometimes occur when the antidepressant dose is increased. I would cross-titrate from mirtazapine to a different antidepressant such as escitalopram. This would solve the problem and avoid having to use clonazepam.
Please remember to rate and close this answer thread when you are finished and satisfied.
In the future, for continuity of care, I encourage you to contact me directly at my private link below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers
Consultation
Detailed Answer:
Hello, and thanks for your question.
Your panic attacks are likely a reaction to the higher dose of mirtazapine. This paradoxical anxiety reaction can sometimes occur when the antidepressant dose is increased. I would cross-titrate from mirtazapine to a different antidepressant such as escitalopram. This would solve the problem and avoid having to use clonazepam.
Please remember to rate and close this answer thread when you are finished and satisfied.
In the future, for continuity of care, I encourage you to contact me directly at my private link below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers
Above answer was peer-reviewed by :
Dr. Raju A.T
Thank you for responding Dr.Sheppe
Since I had been on Pristq and Zolodft for the past few years my family doctor decided when my nee GAD episode stuck to go for mirtazaprine.
You mentioned taking escitalopram. I did take that years ago but my family doctor
changed it like he changed all the other ssri's because of the sexual side effects.
To be honest all the ssri's had the same sexual side effects. But it has been years since I used escitalopram. Since my recent bout was so bad my dr. decided
on something new, ie mirtazapine. The first dose of 15mg wasn't doing anything so then he asked me to up it to 30mg. Perhaps I needed more time but within that same week and a half he uped the dose to 45mg. It was around that time that I noticed the panic attacks as I was just starting to sleep. This would not happen when I was sitting or standing. Furthermore, I had never experienced these attacks before, ever.
I will go see my doctor tomorrow and bring your recommendation to him.
Since I had been on Pristq and Zolodft for the past few years my family doctor decided when my nee GAD episode stuck to go for mirtazaprine.
You mentioned taking escitalopram. I did take that years ago but my family doctor
changed it like he changed all the other ssri's because of the sexual side effects.
To be honest all the ssri's had the same sexual side effects. But it has been years since I used escitalopram. Since my recent bout was so bad my dr. decided
on something new, ie mirtazapine. The first dose of 15mg wasn't doing anything so then he asked me to up it to 30mg. Perhaps I needed more time but within that same week and a half he uped the dose to 45mg. It was around that time that I noticed the panic attacks as I was just starting to sleep. This would not happen when I was sitting or standing. Furthermore, I had never experienced these attacks before, ever.
I will go see my doctor tomorrow and bring your recommendation to him.
Brief Answer:
Followup
Detailed Answer:
Yes, given this history switching to another SSRI or lowering the dose of mirtazapine back to 30mg for a longer period of time both make sense.
Please remember to rate and close this answer thread when you are finished and satisfied.
In the future, for continuity of care, I encourage you to contact me directly at my private link below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers
Followup
Detailed Answer:
Yes, given this history switching to another SSRI or lowering the dose of mirtazapine back to 30mg for a longer period of time both make sense.
Please remember to rate and close this answer thread when you are finished and satisfied.
In the future, for continuity of care, I encourage you to contact me directly at my private link below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers
Above answer was peer-reviewed by :
Dr. Raju A.T
So you think the increased dose in mirtazapine has caused the panic attacks?
You have seen this before?
How long before I return to normal sleep?
I went from 15mg of mirtazapine to 45mg in just under the last 2 weeks.
I am afraid to go to sleep now because I am afraid of the attacks.
I never ever had them before this past week and a half.
You have seen this before?
How long before I return to normal sleep?
I went from 15mg of mirtazapine to 45mg in just under the last 2 weeks.
I am afraid to go to sleep now because I am afraid of the attacks.
I never ever had them before this past week and a half.
Brief Answer:
Followup
Detailed Answer:
It's possible yes, I've seen this. It could take days to weeks for the anxiety to die down. Hopefully with these changes you will feel better quickly.
Dr. Sheppe
Followup
Detailed Answer:
It's possible yes, I've seen this. It could take days to weeks for the anxiety to die down. Hopefully with these changes you will feel better quickly.
Dr. Sheppe
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Raju A.T
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