Is Venlafaxine and Mirtazapine combination treatment effective? (3 research studies revealed the truth) 

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In this blog post, we are going to answer the question, “Is Venlafaxine and Mirtazapine combination treatment effective?”. Mirtazapine is an antidepressant which is used to treat a variety of mental health conditions. 

However, sometimes Mirtazapine is not enough alone and another antidepressant is added to make the treatment more effective. This blog will cover all there is to know about the combination treatment of Mirtazapine and Venlafaxine. 

Is Venlafaxine and Mirtazapine combination treatment effective?

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Yes, Venlafaxine and Mirtazapine combination treatment is quite effective as compared to the individual use of either Venlafaxine or Mirtazapine. 

This combination can be used effectively for the treatment and management of major depressive disorder (MDD), generalised anxiety disorder (GAD), and post-traumatic stress disorder (PTSD). 

However, the doses at which you take these two antidepressants can make a huge difference because higher doses are more likely to cause side effects as compared to the lower and adjusted doses.

If you’re being treated with the combination of Mirtazapine and Venlafaxine, make sure you monitor your side effects closely. If you notice anything unusual, immediately reach out to your healthcare provider. 

What does research suggest? 

Several research studies have investigated the combined effects of Mirtazapine and Venlafaxine for the treatment and management of depression and related mental health conditions. Let’s look at the three clinical trials. 

A 2008 study investigated the safety and efficacy of the combination of Mirtazapine and Venlafaxine. The study conducted a clinical trial in which 22 depressed patients with major depressive disorder (MDD) were included. 

The combination treatment was continued for 8 weeks and the effects of the drugs were closely monitored in each patient. The doses were kept low to keep dangerous side effects at bay. 

Each patient showed slightly different responses to the combination treatment, but overall it was tolerated well. After the course of the study, it was observed that the majority of the patients showed a good response to this combination as compared to other treatment options.

The response rate was found to be approximately 82%, which was quite good and more than the researchers’ expectations. This concluded that the combination of Venlafaxine and Mirtazapine can significantly help counteract the symptoms associated with depression, particularly treatment-resistant depression. 

In 2007, a team of researchers gathered around to investigate the safety and efficacy of Venlafaxine and Mirtazapine combination for the management and treatment of persistent depression. 

This clinical trial included those depressed patients who did not achieve any therapeutic response previously and had persistent depression or some people call it ‘stubborn’ depression. 

32 patients were included and the treatment was carried out alternatively during the course of three years. Again, each patient was monitored for the evaluation of side effects. Some did develop harmful effects like increased sedation, weight gain, and some gastrointestinal side effects. 

Some people had more pronounced effects as compared to others. This clearly indicates that no matter how same the conditions are, people always respond differently to medications. 

We all have different physiological compositions and no med can work in the exact same way for every other person taking it. After 6 months of study, patients show significant differences in their depression symptoms. 

The success rate of this combination was relatively higher than other combinations of antidepressants and that’s what the study concluded. 

This combination was found to be tolerable, was not associated with disturbing side effects, and showed good therapeutic outcomes in those patients who suffered from persistent depression or depression that did not respond well to the monotherapy of antidepressants. 

Another 2018 study monitored the safety and efficacy of the concomitant use of Venlafaxine and Mirtazapine. It showed that the combination was well tolerated and it reduced the occurrence of sexual side effects in females. 

This indicates that this combination can also be used to control the sexual side effects caused during monotherapy. However, every research study showed exceptions as some people did not show results that good. 

What is the difference between Mirtazapine and Venlafaxine? 

Mirtazapine is considered an atypical antidepressant because its mechanism of action is entirely different from Venlafaxine, which is a serotonin-norepinephrine reuptake inhibitor (SNRI). Mirtazapine has a dual mode of action. 

It can activate 5-HT1 receptors, which are one of the serotonin receptors. It also enhances the stimulatory action of the noradrenergic system which increases the secretion of serotonin, while preventing the inhibitory action of the noradrenergic system which hinders the release of serotonin. 

Venlafaxine, on the other hand, inhibits the reuptake of both serotonin and norepinephrine by blocking serotonin transporters (SERT) and norepinephrine transporters (NET) respectively. 

These transporters are usually responsible to take the leftover serotonin and norepinephrine back to the presynaptic neuron. 

When they are blocked, more of these excitatory neurotransmitters remain available in the synaptic cleft for a longer period of time and they bind to their respective receptors and help counteract the symptoms associated with depression, anxiety, and several other mental health related problems. 

Although the mechanism of action of Mirtazapine and Venlafaxine is different, they both increase the number of excitatory chemicals in your brain. Serotonin and norepinephrine both are responsible for a huge number of functions. 

Serotonin has receptors in almost every single part of your body, including your gastrointestinal tract. This neurotransmitter can affect your mood, cognition, reward, learning, memory, hunger, intestinal motility, and several other functions. 

Norepinephrine, on the other hand, is also associated with a lot of functions like contraction of skeletal and cardiac muscles etc. 

What are the side effects associated with the use of Venlafaxine and Mirtazapine in combination? 

Both Venlafaxine and Mirtazapine are associated with some side effects which may become more pronounced when these two are used together. Let’s look at the common side effects of both of these drugs:

  • 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

This combination is also associated with some serious side effects. These include:

  • Allergic reactions associated with symptoms like redness of skin, itching, burning sensation, blisters, blue-purple patches, tightness of chest, wheezing, difficulty in breathing, hoarseness etc. 
  • It could cause low sodium levels which can result in psychological symptoms like confusion, agitation, inability to understand surroundings, memory loss etc.
  • Convulsions 
  • QT prolongation 
  • Pain and tightness in chest
  • Arrhythmia 

These side effects can vary from person to person. However, there are some complications that may arise if the doses of both Venlafaxine and Mirtazapine are too high or not adjusted enough. 

The risk of serotonin syndrome is the biggest concern when it comes to combining two or more antidepressants together. This is because all of these meds increase the number of excitatory neurotransmitters in your brain. 

If the doses are not properly adjusted or people don’t follow their doctor’s advice and take more than what is prescribed, the risk of serotonin syndrome increases. This is because too much serotonin, an excitatory chemical in your brain, can make your entire body start malfunctioning. 

It excessively binds to a huge number of its receptors throughout the body and causes disturbing symptoms. Some of which include:

  • Nervousness 
  • Convulsions 
  • Confusion 
  • Erratic behaviour 
  • Fever with chills
  • Muscle Shivering 
  • A rapid change in blood pressure 
  • Uncontrollable heartbeat
  • Vision problems 
  • Auditory and visual hallucinations 

These symptoms can vary from person to person. Some people can start getting these symptoms soon after taking the excessive dose of this combination. This is why you should always stick to your doctor’s recommended dose and never take more than the prescribed dose. 

Mirtazapine and Venlafaxine can also cause arrhythmia, heart palpitations, and QT prolongation. However, they are not considered that common, but there is no way to predict who will get these side effects and who will not. 

This is why you should never start using this combination without your doctor’s approval if you are a heart patient and should always stick to your doctor’s recommended prescription. 

Conclusion 

In this blog post, we have discussed the concomitant use of Venlafaxine and Mirtazapine. The combination treatment is quite effective as compared to the individual use of either Venlafaxine or Mirtazapine. T

this combination can be used effectively for the treatment and management of major depressive disorder (MDD), generalised anxiety disorder (GAD), and post-traumatic stress disorder (PTSD). 

However, the doses at which you take these two antidepressants can make a huge difference because higher doses are more likely to cause side effects as compared to the lower and adjusted doses. You should always consult your healthcare provider before you start taking Mirtazapine and Venlafaxine together. 

FAQs: Venlafaxine and mirtazapine combination treatment

Can mirtazapine and venlafaxine be taken together?

Yes, mirtazapine and venlafaxine can be taken together. It is considered quite effective as compared to the individual use of either Venlafaxine or Mirtazapine. This combination can be used effectively for the treatment and management of major depressive disorder (MDD), generalised anxiety disorder (GAD), and post-traumatic stress disorder (PTSD).

However, the doses at which you take these two antidepressants can make a huge difference because higher doses are more likely to cause side effects as compared to the lower and adjusted doses.

What is a good combination with mirtazapine?

With Mirtazapine, you can take SSRIs like Zoloft (Sertraline), Lexapro (Escitalopram), Celexa (Citalopram), Paxil (Paroxetine), and Prozac (Fluoxetine). Mirtazapine can also be paired with Venlafaxine, which is a serotonin-norepinephrine reuptake inhibitor (SNRI). 

The rest of the classes of antidepressants do not pair well with Mirtazapine because of the side effects that are associated with them. However, these combinations may also affect some people negatively, especially when the doses are high.

Can you take another antidepressant with mirtazapine?

Yes, you can take another antidepressant with Mirtazapine. The best antidepressants to take with Mirtazapine are selective serotonin reuptake inhibitors (SSRIs) and Venlafaxine, which is a serotonin-norepinephrine reuptake inhibitor (SNRI). 

The rest of the classes of antidepressants do not pair well with Mirtazapine because of the side effects that are associated with them. However, these combinations may also affect some people negatively, especially when the doses are high.

What works well with mirtazapine for anxiety?

Several studies suggest that Mirtazapine can be used with Paroxetine for the safe and effective treatment of generalised anxiety disorder (GAD) and social anxiety disorder (SAD). However, other SSRIs can also be combined with Mirtazapine for the treatment and management of symptoms associated with anxiety. Make sure you stick to your doctor’s directions for a safe and effective therapeutic outcome. 

What are the common side effects of Venlafaxine and Mirtazapine? 

Both Venlafaxine and Mirtazapine are associated with some side effects which may become more pronounced when these two are used together. Let’s look at the common side effects of both of these drugs:

  • 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

References 

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