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Is Mirtazapine Effective In Treatment Of Anxiety?
Question: I have been on Zoloft for 15 years for anxiety and panic disorder.
Also, I have been on Klonopin for the same thing for 15 years. Same dosage for both.
Question: Why did the VA change my meds? They never considered increasing my dosage of Zoloft of Klonopin.
Now, they have me on mirtazapine @ 7.5 mg @ night with up to 3 mg of Klonopin.
Also, I have been on Klonopin for the same thing for 15 years. Same dosage for both.
Question: Why did the VA change my meds? They never considered increasing my dosage of Zoloft of Klonopin.
Now, they have me on mirtazapine @ 7.5 mg @ night with up to 3 mg of Klonopin.
Brief Answer:
That is the first question came in my mind
Detailed Answer:
Hi, thanks for your query.
Zoloft 50 mg is the starting dose and usually it is increased as per the improvement in the symptoms for which it has been given. usually I go up to 200 mg in a day.
When I started reading your query, first question in my mind is why your zoloft has not been increased for 15 years? it may be possible that initially, when it was started before 15 years, you had shown good response to the drug and you were maintained on that for long. [so they didnt try to increase the dose]
I want to ask: whether symptoms have increased recently? whether you have any stress recently? whether something that upset you a lot has happened before increase in the symptoms?
It might be possible that your anxiety symptoms have increased to higher level and the response you have shown to zoloft previously is lost, so they think that you might not respond to the same extent now and they have changed the medication. mirtazapine is also a good anxiety controlling drug, so they have started. They can go up to 60 mg a day, so it is just a starting drug.
Mirtazapine causes sedation and increase the appetite, so it is very good drug to give in your age. they might have considered your age factor now.
Another important question is whether you have significant sleep problem? 3 mg of klonopin at night is really a high dose.
hope I have cleared some of your doubts. if you have further query, feel free to ask..wishing you a good health..
That is the first question came in my mind
Detailed Answer:
Hi, thanks for your query.
Zoloft 50 mg is the starting dose and usually it is increased as per the improvement in the symptoms for which it has been given. usually I go up to 200 mg in a day.
When I started reading your query, first question in my mind is why your zoloft has not been increased for 15 years? it may be possible that initially, when it was started before 15 years, you had shown good response to the drug and you were maintained on that for long. [so they didnt try to increase the dose]
I want to ask: whether symptoms have increased recently? whether you have any stress recently? whether something that upset you a lot has happened before increase in the symptoms?
It might be possible that your anxiety symptoms have increased to higher level and the response you have shown to zoloft previously is lost, so they think that you might not respond to the same extent now and they have changed the medication. mirtazapine is also a good anxiety controlling drug, so they have started. They can go up to 60 mg a day, so it is just a starting drug.
Mirtazapine causes sedation and increase the appetite, so it is very good drug to give in your age. they might have considered your age factor now.
Another important question is whether you have significant sleep problem? 3 mg of klonopin at night is really a high dose.
hope I have cleared some of your doubts. if you have further query, feel free to ask..wishing you a good health..
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Dr. XXXXXXX
I do have a sleep problem and Klonopin does the job however, dreams are sometimes vivid. The higher dose of Mirtazapine sent me into orbit, very bad dreams, (military) retired and I was at 15 Mg. Until a Doctor mixed Zoloft and mirtazapine. Bad idea! The two are not good combined. As for the klonopin, I take .5 mg during the day if needed, and so far, I take it at noon and the other .5mg around 4:30pm. Later, I take the remaining 2mg. With the 7.5,mg of mirtazapine. My appetite is great on Mirtazapine and that's not very good. I need a balance. Would you recommend me getting off mirtazapine and going back to a zoloft/Klonopin regiment?
Do you think my tolerance to Klonopin and Zoloft has gone? Can it be an effective combo again under supervision, which isn't available other than online.
What's your guidance here?
I did have a lot of stress the past three years. I lost a business, went bankrupt, lost a home, and had several trips to the hospital. Cut off a finger and then three surgeries. I moved to Arizona from Maine and developed ,Rabno , with a CK level of over 2200. This month has been very stressful, as my church needs my presence.
Once, I encounter stress, it triggers a panic attack, or I get very irritated and aggressive. Public Speaking demands precise concentration and my fear of making mistakes, starts a panic attack. I use to be able to vent stress through pro-cycling however, my back is now hurting. Any ideas? Thank you!
V/R,
MDM
I do have a sleep problem and Klonopin does the job however, dreams are sometimes vivid. The higher dose of Mirtazapine sent me into orbit, very bad dreams, (military) retired and I was at 15 Mg. Until a Doctor mixed Zoloft and mirtazapine. Bad idea! The two are not good combined. As for the klonopin, I take .5 mg during the day if needed, and so far, I take it at noon and the other .5mg around 4:30pm. Later, I take the remaining 2mg. With the 7.5,mg of mirtazapine. My appetite is great on Mirtazapine and that's not very good. I need a balance. Would you recommend me getting off mirtazapine and going back to a zoloft/Klonopin regiment?
Do you think my tolerance to Klonopin and Zoloft has gone? Can it be an effective combo again under supervision, which isn't available other than online.
What's your guidance here?
I did have a lot of stress the past three years. I lost a business, went bankrupt, lost a home, and had several trips to the hospital. Cut off a finger and then three surgeries. I moved to Arizona from Maine and developed ,Rabno , with a CK level of over 2200. This month has been very stressful, as my church needs my presence.
Once, I encounter stress, it triggers a panic attack, or I get very irritated and aggressive. Public Speaking demands precise concentration and my fear of making mistakes, starts a panic attack. I use to be able to vent stress through pro-cycling however, my back is now hurting. Any ideas? Thank you!
V/R,
MDM
Brief Answer:
Other SSRI drugs for anxiety can be tried
Detailed Answer:
Hi, thanks for writing again. You have replied in detail.
Here you have told me something important. You have anxiety during the performance like you have mentioned. So your Performance anxiety and panic attacks can be prevented by better management if you have anxiety at the onset. Drugs very effective for that as per me are: Propranolol and klonopin combination and SSRI paroxetine. I feel that if you have not been given paroxetine [paxil] then it should be given a try.
Apart from this, I feel you can be better benefited if you go for psychotherapy sessions for your anxiety. There are specific sessions for different types of anxiety disorders. Discuss it when you arrange appointment with your doctor. Stress always matter and one should find the way coming out of it.
I don't feel going back to zoloft would be the good idea now. The drugs should be changed. Night dose of klonopin can be reduced with adding of zolpidem or other similar drugs for sleep. Discuss this with your doctor. I will try if you were my patient: paxil and combination of klonopin and propranolol.
Hope you will discuss these all with your doctor. I have tried my best to suggest you. It is on your doctor now. If you have further queries feel free to ask.
At 54 years of age, You can take supplements of calcium and vitamin D3, it is very important, it will benefit you in your back pain and joint pains.
Wishing you a good health.
Other SSRI drugs for anxiety can be tried
Detailed Answer:
Hi, thanks for writing again. You have replied in detail.
Here you have told me something important. You have anxiety during the performance like you have mentioned. So your Performance anxiety and panic attacks can be prevented by better management if you have anxiety at the onset. Drugs very effective for that as per me are: Propranolol and klonopin combination and SSRI paroxetine. I feel that if you have not been given paroxetine [paxil] then it should be given a try.
Apart from this, I feel you can be better benefited if you go for psychotherapy sessions for your anxiety. There are specific sessions for different types of anxiety disorders. Discuss it when you arrange appointment with your doctor. Stress always matter and one should find the way coming out of it.
I don't feel going back to zoloft would be the good idea now. The drugs should be changed. Night dose of klonopin can be reduced with adding of zolpidem or other similar drugs for sleep. Discuss this with your doctor. I will try if you were my patient: paxil and combination of klonopin and propranolol.
Hope you will discuss these all with your doctor. I have tried my best to suggest you. It is on your doctor now. If you have further queries feel free to ask.
At 54 years of age, You can take supplements of calcium and vitamin D3, it is very important, it will benefit you in your back pain and joint pains.
Wishing you a good health.
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Answered by
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