What to do if mirtazapine does not work for sleep disturbances?

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In this blog post, we are going to answer the question, “What to do if mirtazapine does not work for sleep disturbances?”. Mirtazapine is an antidepressant which is used to treat a number of mental health related problems, including insomnia.

However, sometimes the medication simply does not work and you don’t even feel a slight difference in your condition. This blog will cover some alternatives if mirtazapine does not work out for the best in you. We will also talk about some natural herbs that may help you fall asleep. 

What to do if mirtazapine does not work for sleep disturbances?

If mirtazapine does not work for your sleep disturbances, some alternatives that can be used include:

  • Benzodiazepines
  • Sleeping pills (Zolpidem, Zaleplon, Zopiclone/Eszopiclone)
  • Antidepressants 

Note: These are the alternatives of mirtazapine and should not be used along with it. Make sure you ask your healthcare provider before starting any new sleep medication.

Benzodiazepines 

Benzodiazepines are well known for their beneficial effects for the treatment and management of insomnia or inability to fall asleep. These meds can not only help you fall asleep, but can also reduce the frequency of nighttime wakefulness and morning anxiety and fatigue. 

They are also used to help control anxiety, convulsions and panic attacks. This medication basically mimics inhibitory chemicals in your brain, like GABA, to control the excessive neuronal activity. This calms your brain down and helps you relax. 

This relaxation leads to the induction of sleep. However, one thing to bear in mind is that these meds can cause addiction. This addiction can literally make your life a living hell. This is exactly why you should use this medication very carefully and only when it is prescribed by your healthcare provider. 

Side effects associated with the use of benzodiazepines include:

  • Dizziness
  • Tiredness or fatigue 
  • Drowsiness 
  • Muscle pain
  • Vision problems 
  • Headache 
  • Hypersomnia 
  • Forgetfulness 
  • Troubled or intrusive thoughts
  • Impairment of motor coordination 
  • Constipation or diarrhoea 
  • Nausea 
  • Vomiting 
  • Increased or decreased appetite 

Serious side effects include:

  • Allergic reaction associated with symptoms like redness of skin, itching, painful blisters, blue-purple patches, burning sensation etc. 
  • Serious respiratory depression which lowers down breathing rate and can decrease the availability of oxygen in the blood. It could be life-threatening for people suffering from asthma or chronic obstructive pulmonary disease (COPD) 
  • Dementia 
  • Abnormal behaviour
  • Blackouts 

One of the side effects of benzodiazepines include respiratory depression, which is dose dependent. A person with normal respiratory function might not even notice this side effect on the normal therapeutic dose.

It affects people with chronic breathing disorders like asthma, chronic obstructive pulmonary disease (COPD) and emphysema etc, who can suffer from significant breathing difficulties. 

Most common examples of benzodiazepines include:

  • Valium (Diazepam)
  • Ativan (Lorazepam)
  • Xanax (Alprazolam)
  • Klonopin (Clonazepam)
  • Halcion (Triazolam)

Sleeping pills (Zolpidem, Zaleplon, Zopiclone/Eszopiclone)

Sleeping pills or the three Z’s  (Zolpidem, Zaleplon, Zopiclone/Eszopiclone) are typically used for the treatment of insomnia. These are prescription medications and are different from benzodiazepines. 

Research suggests that these pills are somehow safer than benzodiazepines. These meds can also be used with other medications like antidepressants. 

One pharmaceutical company performed clinical trials to study the effects of Ambien (Zolpidem tartrate) and Lexapro (Escitalopram) together for the treatment of comorbid depression and insomnia. 

The trial concluded that this combination can be efficacious in providing relief in the symptoms associated with both of these conditions.

However, it was found extremely important to maintain doses of the two drugs together and the duration of treatment with zolpidem, as sleeping aids can not be used for a longer period of time because of the risk of addiction. 

Another study revealed that the concomitant use of SSRI and lunesta (Eszopiclone) can help relieve the symptoms of general anxiety and insomnia. This combination, is in fact, preferred for such conditions because researchers found no relapse of insomnia after discontinuing lunesta.

Make sure you do not use these medications without your doctor’s approval. They are also capable of causing an addiction, especially when they are misused. 

Antidepressants

Some antidepressants are also used to treat insomnia, especially if your insomnia is comorbid with depression. Mirtazapine, trazodone and amitriptyline are usually used for this purpose.

As you have tried mirtazapine and it does not work for your symptoms, your doctor may shift you to another antidepressant after tapering off mirtazapine. 

Is there any natural treatment option for sleep disturbances?

There are a couple of natural herbs that can be used for the treatment of insomnia. These include:

Chamomile 

Chamomile is well known for its relaxing properties. Chamomile tea has been used for decades now to regulate good night’s sleep. Studies suggest that chamomile possesses natural antidepressant and antianxiety properties and can help stabilise your mood. 

You can try its tea or use essential oil for the purpose of aromatherapy. One study indicated that chamomile can start regulating your sleep pattern within 2 weeks of its use. 

Lavender

Lavender is a herb which is well known for its relaxing and calming fragrance. Studies show that lavender has antidepressant and antianxiety properties and can be used to help treat insomnia associated with disturbed mood and mental condition. 

This effect is possible due to the presence of silexan in lavender, which is an active chemical compound which can calm your racing mind down and help you feel relaxed. Lavender essential oil can also be used for this purpose.

Ashwagandha 

Ashwagandha is a plant that’s used to make medicines. This medicinal plant is native to Africa and Asia, and is most commonly used by the Indian population. 

This plant is said to be an adaptogen, which can help you respond to daily life struggle, anxiety, stress and fatigue. In some Indian practices, it is also used to treat insomnia within 3 months of its use. It is also safe to take with your antidepressant. 

Passion flower

Passion flowers can also be used to enhance the quality of your sleep. Study suggests that this herb can help reduce the time taken for a person to fall asleep and also reduces the chances of waking up in the middle of the night. 

Few studies suggest that the sedative effects of passion flower can be enhanced when it is used with other herbs like valerian root, chamomile or lavender. 

Mint

It is well known for its digestive properties. Studies suggest that mint tea can help you feel relaxed and light after heavy meals, which might reduce the quality of your sleep. Mint leaves also possess muscle relaxing properties and can prepare you to fall asleep. 

Turmeric 

Research suggests that turmeric acts as a mild tranquilliser. Its pain relieving and sedative effects have made it a big part of herbal treatment. Some studies suggest that drinking lukewarm milk with turmeric can really help you calm down and induce sleep. 

Leafy green vegetables

Leafy green vegetables are rich in a lot of minerals like magnesium, potassium etc, which can calm your body down. When you lie down on your bed to sleep, the relaxation you feel makes you want to close your eyes and drift off to sleep. 

These minerals help enhance this kind of relaxation by working on your muscles.  

Carrots

Several studies suggest that carrots are packed with minerals which can help regulate your sleep cycle and increase the duration of your sleep. Carrots are rich in calcium and  carotenes, which can enhance the quality of your sleep. 

In fact, people with deficiency of these minerals are more susceptible to sleep disorders. 

Bananas

Experts revealed that banana is a rich source of tryptophan which is used as a precursor of serotonin synthesis. Serotonin, on the other hand, acts as a precursor for melatonin synthesis, a hormone which holds great importance in your sleep cycle. 

Studies indicate that it’s melatonin which makes you fall asleep and when your body is deficient in this hormone, you find it extremely difficult to fall asleep. 

Conclusion

In this blog post, we have discussed some alternatives if mirtazapine does not work for your sleep disturbances. We have learned that benzodiazepines, sleeping pills and some antidepressants can be used to replace mirtazapine. 

Sleeping aids can be dangerous, especially if you overuse them. Make sure you do not use these medications without your doctor’s approval. It is not advised to take more than the prescribed dose as it will cause you more harm than you can even imagine.

Report any problems with bleeding or bruising to your doctor. If you see any unexplained blisters or rashes on your body, or experience any problems with urination, or if you feel changes in your vision, immediately report to your healthcare provider. 

FAQs: mirtazapine not working for sleep

Why can’t I sleep after taking mirtazapine?

You may not sleep well after taking mirtazapine because of the inefficiency of the drug. It is a known fact that mirtazapine may not work well for every other individual. Make sure you immediately inform your healthcare provider if the medication does not work for you. However, don’t stop the treatment abruptly. 

How long does mirtazapine take to work for sleep?

Mirtazapine may take up to 2-4 weeks to start producing its beneficial effects. When the drug kicks in, it helps you sleep better and also reduces the frequency of nighttime wakefulness.

Experts believe that mirtazapine enhances the stimulatory action of the noradrenergic system which increases the secretion of serotonin. It also prevents the inhibitory action of the noradrenergic system which hinders the release of serotonin.

What antidepressant works well with mirtazapine?

Several studies have suggested that mirtazapine works well when it is used in combination with an SSRI or an SNRI. However, a combination of antidepressants can only be taken when prescribed by your healthcare provider. 

This is because when two meds for the same illness are used, the doses are adjusted. Individual therapy comes with higher doses, while combination therapy has to be adjusted on the comfortable doses to help avoid the side effects. 

What can I take to help me sleep while on antidepressants? 

If your lexapro is causing severe insomnia, your healthcare provider might couple your treatment with a low benzodiazepine, like clonazepam (Klonopin) or alprazolam (xanax), till your antidepressant kicks in. You should not take any sleeping pill without your doctor’s approval. 

What should you not take with mirtazapine?

  • Monoaminoxidase inhibitors (MAOIs). The combination use can increase the risk of serotonin syndrome. 
  • Non-steroidal anti-inflammatory drugs (NSAIDS). The combination use can increase the risk of bleeding. 
  • Pimozide. The concomitant use can increase the plasma concentration(availability of a drug in the blood) of pimozide to much higher levels. It can result in life-threatening arrhythmia.
  • Controlled substances, including all narcotic analgesics. The concomitant use can cause severe psychological side effects. 
  • Mood stabilisers 
  • Alcohol 

References

  • A Holbrook, R Crowther, A Lotter, Y Endeshaw (2001) – The role of benzodiazepines in the treatment of insomnia: meta-analysis of benzodiazepine use in the treatment of insomnia https://pubmed.ncbi.nlm.nih.gov/11454123/
  • Anne M Hausken, Kari Furu, Svetlana Skurtveit, Anders Engeland, Jørgen G Bramness (2009) – Starting insomnia treatment: the use of benzodiazepines versus z-hypnotics. A prescription database study of predictors https://pubmed.ncbi.nlm.nih.gov/18810397/
  • P D Nowell, S Mazumdar, D J Buysse, M A Dew, C F Reynolds, D J Kupfer (1997) – Benzodiazepines and zolpidem for chronic insomnia: a meta-analysis of treatment efficacy https://pubmed.ncbi.nlm.nih.gov/9417012/ 

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