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Does Quetiapine Work Better With Mirtazapine Than Oleanz?

Posted on Mon, 19 Oct 2015

Question: i have been on mirtazipine 7.5 and oleanz 2.5mg for depression and anxiety attacks. Was surfing internet and found out that quetiapen works better for anxiety than olenaz. Went to my doctor today and he has told me to continue with oleanz 2.5mg and add quetiapen half of 25mg. was thinking of making oleanz half of 2.5mg and adding quetiapen half of 25mg. What would be your advice? Another friend of mine who is a doctor told me that oleanz is better than quetiapen....Have following clarifications:
Does quetiapen work better with mirtazipine than oleanz?
Should i totally stop oleanz 2.5 and add quetiapen 25mg or add half of oleanz 2.5 along with quetiapen half of 25mg to mirtaz?
Is there any drug interaction between mirtaz and quetiapen?
my anxiety is still not under total control

Answered by Dr. Shubham Mehta (42 minutes later)

Brief Answer:
use minimum number of drugs.

Detailed Answer:
Hello
Welcome to HCM.
I can understand your concerns.

In my opinion, oleanz is a better mood stabilizing, calming and antianxiety drug than quetiapine.

Rather than adding half of 25mg quetiapine, I would suggest a dose increment of oleanz to 5mg.

Oleanz (O) and mirtazapine (M) combination is better than mirtazapine and quetiapine (Q).

M+Q can cause heavy sedation and drowsiness. This combination can also cause fall in blood pressure.

I would suggest you to use 5mg Oleanz plus 7.5mg mirtaz.
Avoid use a multiple drug cocktail having suboptimal dose of different drugs.

Kindly discuss this with your doctor and make dose changes accordingly.

Hope this helps.
Thanks.

Above answer was peer-reviewed by : Dr. Neel Kudchadkar

Follow up: Dr. Shubham Mehta (2 days later)

Is quetiepen better for anxiety than oleanz?Was surfing internet and it says that quetiepen helps better with mental anxiety than oleanz. And safety profile of quetiepen is better than oleanz is it?

Answered by Dr. Shubham Mehta (4 hours later)

Brief Answer:
oleanz is better.

Detailed Answer:
In my opinion and clinical experience, oleanz is a better antianxiety agent than quetiapine.

Oleanz has a better side effect profile than quetiapine.
Quetiapine has more sedation, chances of hypotension and almost equal weight gain potential as compared to oleanz.

More importantly, oleanz is a well studied drug with better efficacy than quetiapine.

So, I would choose oleanz over quetiapine.

Thanks and regards.
Dr. Shubham Mehta,MD (Psychiatry).

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shubham Mehta (15 hours later)

With mirtaz 7.5 and oleanz 2.5, I observed my aggression had increased and earlier when I had taken quetiepen, I was much calmer. Also, I suffer from anticipatory anxiety of attending meetings and oleanz2.5 and mirtaz7.5, though helped but not fully. Therefore, I am again bothering you to get your advise on the right set of medication. SSRIs don't suit me, tried paroxetine but it gave me upset stomach. Though I have never taken quetiepen along with mirtaz, I have taken it with dveniz but the combo of dveniz and quetiepen gave me upset stomach. With mirtaz, atleast my stomach is alright. My request to you is to help me with an additional drug with mirtaz that will keep me calm and help me with anxiety. Oleanz till now has helped me a great deal.......

Answered by Dr. Shubham Mehta (1 hour later)

Brief Answer:
I prefer and recommend oleanz

Detailed Answer:
I would still suggest you to increase the dose of oleanz to 5mg as you have mentioned that oleanz has worked a great deal for you.

I recommend oleanz over quetiapine as a calming agent.

Increasing the dose should reduce your anxiety further.

Quetiapine would have been used if oleanz would not be working for you.

So, My choice of medications for you would be mirtazapine plus oleanz.

Kindly discuss this with your doctor.

I wish you well.
Thanks.

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar