DOSE:

15 - 45 mg

oral

Pharms - Mirtazapine

(daily)

BODY WEIGHT:

154 lb

I have suffered with obsessive compulsive disorder, or OCD, since I was 14-years-old. The obsessions’ stubbornness to abate and also their inherently irrational nature quickly led me to also suffer with anxiety, panic attacks, and depression. I am now 39 and still suffer with the disease, meaning I have been battling this enemy within for 25 years. A quarter of a century. Wow – writing that down has made me realise what an incredibly long time that is. There are bad days and better days, but I have resigned myself to the one thing that is certain – that I will suffer with this disease for the rest of my life.

Throughout my OCD journey I have taken several medications to try to ease my suffering. I, like many other OCD sufferers, did not even think of visiting my doctor about the distressing thoughts and symptoms that had become a part of my life until a very long time after it first emerged; 10 years in my case. This was because of my lack of awareness about OCD and also because I didn’t realise I had a disease. As I believe is typical of many OCD sufferers, I assumed these repetitive, intrusive thoughts were normal and thought I was doing something wrong in my head, making some mistake in not being able to manage them better. Insomnia often accompanied my worst bouts of obsessions. After one particularly bad attack when I got hardly any sleep (occurring, in a cruel twist of irony, on what was supposed to be a fun holiday in beautiful Greece), I went to my doctor to tell him I had a problem. I was 24.

I was first prescribed Citalopram, which is one of the selective serotonin reuptake inhibitor, or SSRI, class of antidepressant drugs. I took Citalopram for six years and chose to stop taking it (without telling my doctor) at age 30. I was prescribed Sertraline, another SSRI, briefly during that time as an alternative to Citalopram but didn’t take that for very long. I won’t describe my experience of Citalopram in detail here but I will say in hindsight I think it did a pretty good job of keeping me on an even keel during the time I was taking it. It didn’t prevent me from suffering two seriously obsessional periods during my treatment with it but I don’t think any anti-depressant works perfectly on OCD. I decided to ween myself off it during the second of these obsessional periods because I didn’t think it was working. However, in retrospect I think I was foolish for doing this because I hadn’t discussed this with my doctor and things got much worse afterwards.

In 2009, I took work as an English teacher in a high school after completing my university studies. This was a very challenging year for me in terms of badly behaved students, a poorly managed English department, and my quick realisation that I had chosen the wrong career because teaching a class of more than 30 unruly pupils was not the right job for my temperament. I resigned after six months in the job and almost immediately afterwards began a very demanding Master’s degree course consisting of full-time study for one year. My OCD had flared up about halfway through my time teaching at the school – I think because of the very stressful, demanding nature of the job – and continued to get worse throughout the one year I was studying for my Master’s. By the end of the Master’s I was completely frazzled and again went straight into another role, an administrative job this time. The responsibility of this new job coupled with my fragile mind state meant my insomnia returned with a vengeance and after three weeks on the job only getting one to two hours’ sleep per night, I eventually reached breaking point and just crumbled, sobbing in my mother’s arms for hours one cold December afternoon.

I resigned from the administrative job and returned to my doctor, explained everything that had happened over the last two years and said I needed help. That’s when I was first prescribed Mirtazapine. That was in 2011 and I had just turned 31. I have been taking the drug ever since then, so over eight years now. At a recent routine medication review, my new doctor recommended perhaps tapering down my use of Mirtazapine due to her belief the drug had potential negative long-term psychological and physiological side effects. I am not sure if she is correct on this point because I have done some online research and have read that Mirtazapine is tolerated well when used long-term. Nevertheless, the prospect of perhaps tapering down made me reflect on my experiences with the drug and spurred me on to write about them. Here goes.

My doctor decided to prescribe me Mirtazapine not only because it is an anti-depressant but also because it has a sedative effect. Since I had severe acute insomnia at the time, he did this to help me get some much-needed sleep. This is where my experience began. I started on a low dose and gradually worked my way up, starting with 15mg at night for one week, then 30mg for the second week, then 45mg from the third week onwards.

The first thing I noticed was that its sedative effects are very potent. Mirtazapine helped me sleep from the first night onwards, helping me fall into a very deep sleep, which came as a huge relief after three weeks with virtually no sleep at all. One of the quirks of this drug is that it initially causes the user to experience extremely vivid, sometimes bizarre dreams, and I was no exception. I experienced two incredibly vivid dreams during my first week using Mirtazapine. I almost instantly forgot the details of the second dream after waking and all I can remember is that part of it included me talking to my cousin in a bar – not that unusual. However the first dream was so vivid that it felt like real life and will be etched on my memory forever.

Where I live in the UK, there was a rap trio at the time called N-Dubz. I wasn’t then, nor have I ever been a particularly big fan of theirs and I can’t remember them being on my mind much around then. However, in the dream I found myself starring alongside them in one of their rap videos. The four of us were atop a very tall television transmission aerial, in the daytime, in the middle of a very green park, maybe a forest. I saw not through my eyes but through the fisheye lens of a camera myself and the other members of the group miming to one of their songs and making hand gestures towards the camera. Next thing I know, I am zip-lining down from the top of the television aerial into the lush green space below, but now suddenly it’s full of people. As I got closer to the people on the ground below, I noticed that all of the people were actually the same person – a brunette, attractive, model-type woman. There were hundreds and hundreds of this same woman as far as I could see in the forest, like she’d been cloned endlessly. As I got closer still I realised the woman wasn’t actually alive at all, she was a mannequin, and the forest was full of hundreds and hundreds of this identical mannequin. As my feet hit the grass, I woke up. What a bizarre dream! But it was the sense of realness about it that was most startling. I awoke stunned and asked myself, “Wow, did that really happen?”

Another thing I noticed during my first week was the way Mirtazapine affected my breathing. I remember waking one night, a few hours after taking my dose, and noticing there were incredibly long pauses between my exhalations and inhalations. I remember lying in bed and worriedly thinking, “I’m not breathing”. More and more time passed but nothing happened; it was as if the automatic rhythm of inhale-exhale-inhale had been shut off in my brain. Fear panged inside me as I worried that I would suffocate, so I had to very deliberately and consciously take another breath, then another, and then another, to ensure I continued to breathe. Even then, I was struck by how short the breaths were that I was taking. I thought because I hadn’t taken a breath in such a long time that I would inhale deeply, but I only took in a normal-sized breath, which was followed by another very long pause. Looking back on this, I’m surprised it didn’t trigger a panic attack but I guess I was sedated by the drug which prevented this from happening, and it wasn’t long before I’d fallen asleep again. My breathing was obviously still working automatically but the gaps between each in-breath and out-breath were much larger than normal. My breathing returned to normal after a few nights, however the effects the Mirtazapine had on my dreams and my breathing were striking and made it clear to me this drug was stronger and was affecting my brain very differently than the SSRI class of drugs I was used to taking.

During those first few weeks taking Mirtazapine, I awoke each morning, from what was usually a 12-hour sleep, with a pounding headache. I think I slept so long those first nights because I had such a lot of sleep to catch up on. The headaches were really bad and I couldn’t do much for the first 30-minutes after I got up. I’m not sure if the headaches were caused by the drug or if it was because I’d awoken from such a deep sleep, however I have read that headaches can be a side-effect of taking Mirtazapine. Another thing I noticed was that my depression got markedly worse after each incremental increase of the dose. So for example, when I increased from 15mg to 30mg I felt really, really depressed with little motivation to do anything – not even to get dressed – and the same happened when I increased from 30mg to 45mg. I think this lasted for about 2-3 days each time before it subsided and my mood lifted again. Again, I know this is common with anti-depressants in general, however I never experienced this with the SSRI I used to take, and I was startled by how stark the change in my mood was with the Mirtazapine, which again seemed to suggest this was a stronger drug.

After I reached 45mg and the depression from the increase in dosage subsided, I would say my mood levelled-off over the months and years that followed. The biggest initial benefit of Mirtazapine for me was that it restored my sleep back to normal. After I had caught up on the sleep I’d missed, I returned to getting about 8 hours a night – what I usually get – and I didn’t suffer with the headaches on waking anymore, which was also a big relief. For me, getting enough sleep and regularly eating are two really important factors in keeping my obsessions and depression in check. When I was sleep-deprived, my mood worsened and it became much harder to fight the intrusive thoughts I am bombarded with every day. So being able to sleep again really improved my mood and helped me to manage my OCD better. The sedative effect still works to this day, even after eight years of use. If I stay up for too long after taking my dose, usually after 30 minutes, I begin to feel very groggy – a little bit like being drunk – and I know it’s time to turn out the light. Mirtazapine is not a complete cure for insomnia, however, and I did suffer with another nine-week bout of sleeplessness two years after starting on the drug. This was caused by anxiety about beginning a new job. Interestingly, I didn’t feel any of the sedative effects during this period and, again, I only got about one to two hours’ sleep per night. However, I got through this difficult phase and my sleep returned to normal after this, with the Mirtazapine suddenly resuming its sedative effect.

I had read that I should avoid drinking alcohol while taking Mirtazapine, however as I got used to taking the drug I inevitably became more confident and about three months after starting on it I drank alcohol on a night out and took my pill before bed as usual. Just a few alcoholic drinks – say three or four beers – was fine, but any more than this and I experienced a worse hangover than usual the morning after. Hangovers in general were difficult for me during the times when my obsessions, anxiety or depression were bad, but I found that taking Mirtazapine had the potential to make hangovers more pronounced. Specifically, the next day I had trouble eating anything more than a bowl of soup, I suffered headaches, felt very groggy, experienced heightened anxiety, and was susceptible to suffering multiple panic attacks which could last for extended periods, sometimes hours at a time. Eventually, through trial and error, I realised my limit of what was an acceptable amount to drink and still take my dose; my number was six bottles of beer – if I drank any more than that in one evening I would skip my dose of Mirtazapine that night because I knew the hangover would be too hard the next day.

Interestingly, I didn’t experience any side-effects from Mirtazapine until about six years after starting on the drug. For this reason, I’m not sure exactly whether the Mirtazapine is causing this, however since I don’t take any other psychoactive medication, I don’t use any illicit drugs, I don’t smoke, and I no longer drink alcohol, the Mirtazapine is the only thing I can think of that might be responsible. About two years ago, I began to occasionally wake early in the morning with a very upset stomach. A sweaty, nauseous feeling would mean I’d have to sit up in bed as lying on my back would be very uncomfortable, or sometimes I would need to walk it off by pacing around the house. I have no appetite at all while this lasts, which is usually between 30 minutes and one hour. More recently still, this nausea has sometimes jolted me suddenly out of sleep and made me sit upright in bed, the nausea on these occasions accompanied by panic too. Fear of vomiting and obsessively scanning for signs that I might be about to vomit was a precursor to my OCD at one point very early on in my life and vomiting still remains a source of anxiety for me, so I think the panic I experience in these episodes is largely caused by this very ingrained fear. However I think there is something about waking too quickly while under the influence of Mirtazapine which can cause the user to feel uncomfortable because I have felt a similar sensation of anxiety and nausea when waking very abruptly in the middle of the night with the need to use the toilet.

Another side effect, which again has only presented itself in the last couple of years, is experienced at the point of drifting off to sleep. Occasionally I experience the feeling of falling into a hole just as I am about to go to sleep. But this is not the usual falling dream that is commonly experienced by people at the point of sleep. I have had these dreams as well and in my experience these happen only once on a given night and are quite enjoyable once the second of fright has passed and you awaken relieved that you have not actually tripped down the stairs or fallen down a well. The dream I’m describing is a much darker experience and can repeat multiple times before I fall asleep, or should I say more accurately before I succumb to sleep. A strong feeling of fear accompanies this sensation of falling, or rather a sensation of being sucked into something – perhaps a black hole. I feel a grave sense of dread that I will die if I allow myself to be sucked into this black hole and I urge myself not to let it happen, which is the point at which my eyes open again from the cusp of sleep. This can happen six, seven, eight times, and each time I have to force myself not to fall into oblivion at the last second, until the feeling of dread passes and I can eventually give in to sleep. This side effect is strange but this and the nausea side effect occur so infrequently that they do not deter me from taking Mirtazapine. And I am very grateful that I have never suffered any of the more common side effects the drug can cause, like erectile dysfunction or weight gain.

So has Mirtazapine made me feel better? This is a difficult question to answer. I don’t feel at the mercy of my mental health condition so much anymore. Before I started taking Mirtazapine, a serious flare-up of my OCD and the accompanying anxiety and depression could turn my life upside down completely in just a matter of weeks. The obsessions would become all-consuming and life would become a misery, forcing me to quit my job and shut myself off from my friends, things which have happened several times in the past. However, since I have been taking Mirtazapine I have managed to remain in continuous full-time employment for more than six years (the longest stretch of time I have ever held down consistent work). This is not to say there haven’t been hard times during these six years, but I have been able to weather the storms well and get through them.

This is not solely a result of taking Mirtazapine though. I have made a lot of changes in my life in these last eight years as well. I have had four courses of cognitive behavioural therapy with three good psychotherapists during this time. I was determined to make the most of these sessions and these gave me a lot more knowledge about my disease and equipped me with a whole set of tools I can use to help me cope better with my condition. I started eating a healthier diet. I started working out at the gym, running and lifting weights. I was able to dramatically improve my acne that I suffered with all my life after being prescribed Roaccutane, which greatly improved my confidence. I chose to stop drinking alcohol when I was 34. I decided that it was irresponsible to continue drinking because I knew the depressant effects of alcohol were not doing my mental health any good. I began to date. I began to travel more. I began learning to speak Spanish. I began socialising more (even when I didn’t feel like it). Recently I began playing sports, something I’ve never done before. I learned how to cook. I began to share my feelings more with those I care about. And I have been making a conscious effort to change my perspective on my disease and on life in general. Before, self-pity was a very seductive emotion for me but now I try to accept things that I can’t change, even if they are painful, and work hard on those things that are within my power to change.

This is not to say that I feel happy all of the time. I don’t. I have good days and bad days, like we all do. But I would describe my default feeling as one of numbness now. There is a sensation of hollowness in my chest, which I describe as feeling like I have been “scooped out”. This began two or three years ago. I do wonder and worry whether the Mirtazapine is the cause of this numbness, or whether it is the result of the work I have had to do on my emotional and psychological responses to my OCD and the anxiety it causes. Because make no mistake, the Mirtazapine absolutely did not stop the obsessional, intrusive thoughts bombarding me every minute of every day. I have learned no drug will ever stop these and that the main challenge in my life is to work my hardest not to let this enemy within get the better of me.

Exp Year: 2020	ExpID: 114394
Gender: Male
Age at time of experience: 39
Published: May 23, 2020	Views: 8,404
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Pharms - Mirtazapine (311) : Hangover / Days After (46), Depression (15), Medical Use (47), Retrospective / Summary (11), General (1), Various (28)