What is the best combination with Mirtazapine for anxiety? (3 Options) 

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In this blog post, we are going to answer the question, “What is the best combination with Mirtazapine for anxiety?”. Mirtazapine is an atypical antidepressant which is used to treat a variety of mental health conditions. 

It can also be used for the treatment and management of anxiety, but off-label. However, it can be paired with an approved anti-anxiety medication to achieve a good therapeutic response. This blog will talk about the best possible combinations of Mirtazapine for the management of anxiety. 

What is the best combination with Mirtazapine for anxiety?

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The best combinations with Mirtazapine for anxiety include:

  • Mirtazapine with selective serotonin reuptake inhibitors (SSRIs) 
  • Mirtazapine with serotonin-norepinephrine reuptake inhibitors (SSRIs) 
  • Mirtazapine with benzodiazepines 

Mirtazapine with selective serotonin reuptake inhibitors (SSRIs) 

Mirtazapine can be used in combination with SSRIs for the management and treatment of anxiety and related symptoms. Several studies have indicated that Mirtazapine works really well in combination with SSRIs. 

As we have just discussed, Mirtazapine is not approved yet for the treatment of anxiety, but research shows that it can be as effective as Paroxetine and Citalopram when it comes to counteracting the symptoms of anxiety. Some of the common SSRIs include:

  • Sertraline (Zoloft) 
  • Escitalopram (Lexapro) 
  • Citalopram (Celexa) 
  • Paroxetine (Paxil) 
  • Fluoxetine (Prozac) 

Mirtazapine can be paired with any one of the above-mentioned SSRIs. They all have their own pros and cons. Every single medication on this planet is associated with some side effects. It is not possible to predict what kind of side effects you will suffer from before actually taking the medication. 

However, some of the combinations of Mirtazapine and SSRIs are considered dangerous. The combination of Lexapro and Mirtazapine is considered safer than the combination of Prozac and Mirtazapine. 

This is exactly why the pros and cons of the combination should be weighed prior to using them. Although the drugs belong to the same class with the same mechanism of action, they do differ from one another in terms of potency and side effect profile. 

This is why you should always stick to your doctor’s recommended combination. If you’re being treated with Mirtazapine individually, do not take any SSRI along with it on your own. This is not your job and you should never take such matters into your hands. 

Several studies have suggested that the combination of Mirtazapine and SSRIs can be used for the treatment and management of treatment-resistant depression or persistent depression that does not respond to monotherapy. 

Side effects of Mirtazapine + SSRIs combination therapy 

Mirtazapine and SSRIs combination therapy is associated with some side effects. These include:

  • Nausea
  • Diarrhoea 
  • Flatulence 
  • Vomiting 
  • Dizziness 
  • Drowsiness 
  • Weight gain or loss 
  • Excessive sweating or night sweating (nocturnal/night hyperhidrosis) 
  • Frequent urination 
  • Polydipsia or excessive thirst
  • Tremors 
  • Muscle twitching and pain
  • Acid reflux or heartburn 
  • Abdominal pain 
  • Flu-like symptoms, including irritation in the eyes and a runny nose
  • Loss of libido in both males and females. Males may suffer from inability to ejaculate, while females may suffer from inability to have an orgasm. 

Make sure you talk to your healthcare provider as soon as you can if you exhibit any sign of an allergic reaction soon after taking this combination therapy for the first time. Some people are naturally allergic to some meds and there is no way to predict that before actually taking the med. 

In case of overdose, immediately reach out to the hospital and inform them how much drug has been taken and when. If you have accidentally missed a dose, take it as soon as you remember. If a lot of time has passed, it’s better to skip the dose and take the next one on time. 

Mirtazapine with serotonin-norepinephrine reuptake inhibitors (SSRIs) 

Mirtazapine can be taken with SNRIs, particularly Venlafaxine. There are many research studies which suggest that Venlafaxine pairs really well with Mirtazapine as compared to Mirtazapine monotherapy. 

They both can actively counteract the symptoms associated with a generalised anxiety disorder (GAD) and social anxiety disorder (SAD). Both Venlafaxine and Mirtazapine possess good anxiolytic properties. Venlafaxine is one of the most commonly prescribed SNRIs. 

It inhibits the reuptake of both serotonin and norepinephrine, two excitatory neurotransmitters which are responsible for a number of physiological and psychological functions. However, this combination may not work well for everyone. Some of the common SNRIs include:

  • Venlafaxine (Effexor) 
  • Desvenlafaxine (Pristiq) 
  • Milnacipran (Ixel) 
  • Levomilnacipran (Fetzima) 

However, as stated earlier, not all SNRIs make good combinations with Mirtazapine. Most commonly Venlafaxine is used for that purpose and it does hold great clinical significance. 

However, this combination is also associated with some side effects and the doses at which you use these two antidepressants can make a huge difference. 

Well-adjusted doses can significantly help you with your anxiety, whereas higher doses can exacerbate your anxiety, agitation, and irritability. It can cause you much more harm. 

Side effects of Mirtazapine + SNRIs combination therapy

Mirtazapine and SNRIs combination therapy is associated with some side effects. These include:

  • Nausea 
  • Vomiting 
  • Diarrhoea or Constipation 
  • Upset stomach 
  • Abdominal pain 
  • Drowsiness 
  • Dizziness 
  • Fatigue
  • Weight gain
  • Increased appetite 
  • Tremors or shaking
  • Insomnia
  • Decreased sex drive
  • Impotence
  • Inability to ejaculate
  • Mood swings
  • Convulsions 
  • QT prolongation 
  • Pain and tightness in chest
  • Arrhythmia 

These side effects can be mild for some people, but severe and unbearable for others. Every single person has different body physiology and they can not be compared. 

You will react to meds according to your body physiology and I will react to the same meds according to my body physiology. This is why you should never share medications. Always consult your healthcare provider. 

Too many of these drugs can cause the disturbing symptoms associated with serotonin syndrome, which occurs as a result of too much serotonergic activity in your body. 

In case of overdose, immediately reach out to the hospital and inform them how much drug has been taken and when. If you have accidentally missed a dose, take it as soon as you remember. If a lot of time has passed, it’s better to skip the dose and take the next one on time. 

Mirtazapine with Benzodiazepines

Mirtazapine can be paired with benzodiazepines, the most common anti-anxiety medication. However, there are a lot of things that you need to understand about this combination. 

The combination of Benzodiazepines and Mirtazapine should not be used for a long period of time. Mirtazapine usually takes 3 to 6 weeks to start working to relieve your anxiety symptoms. Before that, it won’t do much and you have to wait patiently for your antidepressant to start working. 

During this time period, a low dose of a Benzodiazepine can significantly help you overcome your anxiety, but this combination can not be used for a longer period of time and benzodiazepines should be stopped soon after your Mirtazapine kicks in. 

However, if you’re responding really well to Benzodiazepines then your doctor may not prescribe you Mirtazapine at all. At low doses, benzodiazepines can be used for years alone to help fight your anxiety and insomnia. 

If we talk about the combination of Mirtazapine and Benzodiazepines, addiction is not the only problem. Both of these meds are highly sedative in nature. Benzodiazepines and Mirtazapine both have clinical importance in the treatment and management of insomnia. 

The concomitant use can make you excessively drowsy and may affect your daily life activities and mental alertness during the daytime. Make sure you only use this combination if prescribed by your healthcare provider. Common benzodiazepines include:

  • Alprazolam (Xanax)  
  • Lorazepam (Ativan)  
  • Oxazepam (Serax)  
  • Triazolam (Halcion)

Side effects of Mirtazapine + Benzodiazepines 

The combination of Mirtazapine and Benzodiazepines can cause the following side effects:

  • Unbearable dizziness
  • Tiredness or fatigue 
  • Excessive drowsiness 
  • Muscular pain
  • Vision-related problems 
  • Headache 
  • Somnolence 
  • Inability to remember things properly 
  • Troubled or intrusive thoughts
  • Impairment of motor coordination 
  • Constipation or diarrhoea 
  • Nausea 
  • Vomiting 
  • Increased or decreased appetite 

Conclusion 

In this blog post, we have discussed the best combination of Mirtazapine with another medication for the treatment and management of anxiety and related mental health conditions. 

We have learned that Mirtazapine can be paired with selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SSRIs), and benzodiazepines for the treatment of anxiety. 

However, all of these combinations are associated with some pros and cons of their own and proper dose administration and side effect monitoring can help you achieve your therapeutic goals. Make sure you never take any medication with Mirtazapine without your doctor’s approval. 

FAQs: Best combination with mirtazapine for anxiety 

What works well with mirtazapine for anxiety?

Mirtazapine can be paired with selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SSRIs), and benzodiazepines for the treatment of anxiety. 

However, all of these combinations are associated with some pros and cons of their own and proper dose administration and side effect monitoring can help you achieve your therapeutic goals. Make sure you never take any medication with Mirtazapine without your doctor’s approval. 

What is a good combination with mirtazapine?

Mirtazapine can be combined with a number of medications. Most commonly it pairs well with selective serotonin reuptake inhibitors (SSRIs), like Sertraline, Escitalopram, Citalopram, Paroxetine, and Fluoxetine. It also pairs well with Venlafaxine, which is a serotonin-norepinephrine reuptake inhibitor (SNRI). Make sure you ask your healthcare provider which combinations will work best for you. Do not take any medication without your doctor’s advice. 

Is mirtazapine good for severe anxiety?

Mirtazapine is considered a good medication for the management and treatment of anxiety, but it has not been approved by the Food and Drug Administration (FDA) yet for that purpose. There are plenty of other options that can also be used to counteract the symptoms associated with severe anxiety attacks. Make sure you ask your healthcare provider what medication will work best for your symptoms. 

What is the drug of choice for anxiety?

Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are considered the drugs of choice for the treatment and management of anxiety. However, benzodiazepines can also be used but they are highly addictive and people tend to misuse them because of the way they feel after taking them. Proper dose administration is the key to achieving your desired therapeutic goals, no matter what drug you’re taking. 

How much mirtazapine should I take for anxiety?

The initial dose of Mirtazapine for anxiety should be 15 mg per day. Most healthcare providers increase the dose after determining the tolerability of the patient towards Mirtazapine. If not tolerated well, the treatment is discontinued. If it is tolerated well, the dose is escalated to 30 or 45 mg per day. However, the dose should not exceed 45 mg per day. 

References 

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