mirtazapine & PN
 

Hi,

has anyone on here been prescribed mirtazapine ? Here's why i'm asking:

as I explained in another post i've had symptoms (vague feelings in lower legs & extreme fatigue) for a couple of years & have been through various tests which didn't result in any diagnosis. I've then suggested PN to my doc as i've worked with certain chemicals for awhile & that is now, hopefully, been explored by a referral to a neurologist. The fatigue eventually pushed me into a depression.

So, here's the nub of this: the docs prescribed 2 different anti-dp's incorrectly (I have Right Bundle Branch Block) & eventually the doc said one of the only ones he knew of that wasn't flagged for not being ideal for folks with RBBB is mirtazapine & he's prescribed that. I haven't started taking it yet as I decided to do some research & i've found that weight gain is a common side effect for one thing & i'm already slightly overweight & really don't want to risk increasing the chances of diabetes. Also, as they still haven't fully confirmed whether my PN is down to chemical exposure it could also be down to early symptoms of problems with kidney / liver & mirtazapine isn't recommended for folks with that either.

I feel low in the am but it tends to improve slightly through the day.

It seems to me that the docs are prescribing anti-dp's without fully considering my complete history or being careful not to complicate the process of diagnosing / treating the PN. I've also for example read that if one is diagnosed with PN certain anti-dp's could be prescribed as part of that & they're different ones than mirtazapine - seems problematic to keep changing the meds. One thing i'm thinking is should I try to wait until i've seen the neurologist at least ?

any thoughts would be appreciated.

Hi jshire

I was prescribed Mirtazapine for my Major Depressive Disorder. It did not help so my psychiatrist and I decided to try something else (Venlafaxine), which works for me.

When I was on Mirtazapine I did not experience any PN symptoms (I do not have a PN Dx).

A PubMed search shows no evidence that Mirtazapine is a known risk factor for causing/making PN worse.

This is a comprehensive list of potential side effects:

http://www.webmd.com/drugs/2/drug-13...st-sideeffects

This is why this drug is not popular today, or used much.

The prolongation of QT is concerning as it affects the heart.
More on QT issues:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3221427/

http://www.bmj.com/content/346/bmj.f288
There is a risk with the heart rhythm but it appears less than with some other drugs.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2771193/
this shows a risk, but a small one.

Just to give you a heads up.
I think even most neurologists prescribe antidepressants like nortriptylene or cymbalta right away and then next they add in neurontin or lyrica if needed. After that, they might prescribe a break through pain med or send you to pain management. In the beginning I was prescribed about 6 different meds between all the doctors and neurologists I had seen. It didn't seem to matter what my cause was. It seems the routine everywhere around here is similar.

Hi jshire,

I am on Mirtazapine and I think it is a heavy duty med for your Dr to be considering. Somewhat like Kiwi, I take it for severe Depression caused by Depressive Personality Disorder.

I would not choose to take it prior to seeing a Neuro who may rx another AD to treat PN and a Depressive Mood.

Dave.

thanks for your replies folks. I'll be seeing my doctor next week so will discuss this then but he seemed to say that this was one of the only ones that wasn't not recommended for folks with RBBB.

RBBB may affect the QT segment of the heart beat.
and this drug mirtazipine is listed as potentially
affecting this also. This is why I gave you all those
links. I'd consult your cardiologist before taking
this drug.

Keep in mind, that not all doctors know everything
about drugs.

thanks. I don't have a cardiologist - at least here in the UK RBBB is not a problem that means you get to see one of those regularly - it seen as quite common & not serious. Also mirtazapine in the UK medicine directories is not indicated as an anti-dp that could effect RBBB or electrical impulses in the heart, whereas others are.

Well it is up to you... if you take this drug be very vigilant and
watch for lightheadedness, fainting, or other weird symptoms.

Mirtazapine has potential to cause heart irregularities. They are reported in the literature, but if UK doctors think this is to be ignored, that is their right.

Here is one example from 2013:
http://www.ncbi.nlm.nih.gov/pubmed/24201230
There is quite a bit of information out there to find, if one looks.
And there are comments that mirtazapine is the lesser evil of many of other antidepressants ...but that does not mean it is free of effects on the heart.

If you go with this drug be aware and report ANY side effects.

I agree with mrsD - all ADs can have bad side-effects.

I am currently on Venlafaxine and have well-managed primary hypertension. My GP (who I chose carefully because he knows about MH things as well as physical health), knows this and checks me out carefully whenever I see him.

Apart from that most ADs come with what is called a "black box warning" label. This is legally (FDA) required in US. A black box warning label advises of known adverse side-effects of many prescription drugs (not just ADs).

I recommend that people read the black box warning label carefully for any drug which they may have been prescribed.

thanks. What's frustrating is that there appears to be differences in the information that doctors use. I'll try to research if there are any anti-dp's that don't affect the heart.

You can start here:
http://www.medsafe.govt.nz/profs/adv...s151.htm#3.2.1

Put mirtazapine into your "find" tool in your browser and you
will get this:
According to the above site (from New Zealand), more data and research are needed for accurate therapeutic use in patients with heart beat problems.

Keep in mind the "old boys" on committees are making the decisions about drugs. They do this too with therapeutic textbooks. And an example of this is the failure for those "old boys" to update the B12 therapeutic manuals also.

I continually post the 2003 American Association of Family Physicians site which does try to educate American practicing doctors about new B12 information...but we still see here doctors who are not testing patients with neurological problems to see if low B12 is the reason.

So I do think people should search and find some information themselves.

People with heart beat irregularities should maintain good potassium and magnesium levels....when these get low from poor diet, or dehydration from illness the risk of arrhythmias increases for those who have already a diagnosed one.

Also combining drugs that have similar risks, increases the risk to the patient much more than just taking one such drug.

RBBB is sometimes associated with long QT... as it is a slowing of the conductivity of part of the heart. Since you do not see a cardiologist, you cannot know your real risks with this disorder, as people vary.

Important question and Information
 

jshire,

I am glad you have asked the question! :)
This is VERY important issue and information!

I am in the U.S. and find some psychopharmacologists minimize the potential effects upon the heart, even when a person has a clear heart issue.

In the past, I have had (very wise) pharmacists refuse to fill the doctors orders because the doctor was not careful enough and was combining two meds which had this heart QT potential. :eek:

It's critical people take an interest, do research, ask lots of questions.
People feel less like following through on all of this when depressed/low energy, etc.

Thankfully, your question here has been met with very sound, scientific information and advice.

I know you'd written many do not see a cardiologist in the UK re: your cardiac issue for med consults. I'd personally push for a consult anyway, if at all possible.

I know psychopharmacologists here in the U.S. favoring the use of mirtazapine with cardiac patients.

In any case, due diligence and caution are in order.
Great question.

I hope you obtain further clarity on the best options soon.

To our Health,
DejaVu

thanks. yes, here in the UK RBBB is classed as common & does not mean you can get to see a cardiologist unless it is causing problems.

frustrated !

so, I had an appointment with my doctor & I told him I hadn't started taking the mirtazapine because of finding out that one if its main side effects is putting on weight & I thought that actually that would increase my depression + at my age add to the risk of diabetes + that it has been linked to side effects that are similar to PN & so thought it best not to risk that before seeing a neurologist to assess my possible PN. His response was to clearly be frustrated with me for checking things online. He said 'online groups that focus on one condition can be a good thing but perhaps they should try sorting you out if they're giving you advice like this'. Now, I can understand that doctors probably do get fed up of people coming in with info they've found online but as he didn't even mention PN until I suggested it could be a possibility I think he's not exactly being helpful. I simply need to find an anti-dp that I can take considering I have RBBB & that doesn't have a main side effect of putting on lots of weight. He seemed to imply there aren't any others I can try. Here in the UK swapping doctors can be complicated but a part of me feels like I can't keep going back to my current gp with the same questions.

If you have SAMe where you are, you could try this.

It is a natural compound that your body makes under ideal nutritional conditions.

Since SAMe came from Europe to US, you must have it there?

To enhance your own manufacture of this methylating compound, B6, folate, B12 and omega-3's have to be present. If you have the DNA mutation called MTHFR...you cannot methylate your vitamins in food to the active forms that are used to make SAMe.

http://www.lifeextension.com/Magazin...t_same/Page-01

I've used 400-600mg a day orally for a decade now.

If you start it, do 200mg a day in the morning for at least 2 weeks and raise it slowly. Some people only need 200mg a day and others do better with 400mg or 600mg a day. It is quite energizing, so only take it in the morning on an empty stomach.

thanks - you can get SAM-e tablets here in the UK, though they're expensive. Lots of stuff online about the side-effects of that also of course, but i'll keep researching it.