Depression medicine: Mirtazapine ?

[papzombie]

I have done and am doing these

- Practice good sleep hygiene (Google it and read several sources)
- Eat a good diet
- Have a regular, moderate exercise program
- Practice total abstinence of caffeine including sources like chocolate (sigh)
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep
- Use the bedroom for sleeping (and sex) only, and make sure the bedroom and bed are comfortable.
- Do not listen to your breathing or the sound of the machine as you are falling asleep.
- Use CPAP software, such as the free SleepyHead, to make sure your therapy is optimized
- If you still don't feel or sleep well, make sure you have regular medical checkups to confirm there are no other medical problems

CG

I have not done these yet

- Try to avoid daytime naps --> I am always sleepy and tired, so avoid daytime naps is irrelevant
- Learn to appropriately handle emotional stress in your life --> I don't know how to handle it
- Distract your mind by thinking of a pleasant, relaxing activity that you enjoy. Thinking of sitting under an umbrella on a quiet beach with a warm gentle breeze works for me. --> I don't have a habit of thinking about something pleasant, but the opposite: I often think about negative things

CG

[papzombie]

Note that I have maintenance insomnia, not sleep onset insomnia.

(Although it is not excluded that my too many awakenings are caused by irritation from the mask as well, so could be no insomnia at all). I am still working on my sleep videos to find out more about my sleep.

[49er]

papzombie,

You might take a look at light therapy to see if that might be an option to relieve your excess sleepiness during the day and insomnia. This was a very small-scale study done regarding patients with Parkinson's disease but I think it would be applicable to your situation:

http://www.medscape.com/viewarticle/824282#vp_1

I would start by asking your medical team whether this would be a possibility.

Best of luck and happy Thanksgiving.

[papzombie]

Hi all,

Thanks for your info,

I am more into Mirtazapine 3.25mg per day, with the higher benefit for sleep and much much less benefit for depression.

My psychiatrist suggests more about Trazodone if I want to also address depression.

Which one of these two do you recommend ? (I will still need to ask the psychiatrist about increasing or stopping the dose)

[49er]

Hi all,

Thanks for your info,

I am more into Mirtazapine 3.25mg per day, with the higher benefit for sleep and much much less benefit for depression.

My psychiatrist suggests more about Trazodone if I want to also address depression.

Which one of these two do you recommend ? (I will still need to ask the psychiatrist about increasing or stopping the dose)

As an FYI, most psychiatrists no longer prescribe Trazadone for depression. So I am not sure why she thinks it would address that.

I will let others chime in on which drug would be a better option.

49er

[papzombie]

Oh, thanks. I am living in Europe, and there could be difference in how psychiatrists believe.

Luckily, I have decided to go for Mirtazapine before reading this.

[49er]

Oh, thanks. I am living in Europe, and there could be difference in how psychiatrists believe.

Luckily, I have decided to go for Mirtazapine before reading this.

Good luck with it.

[Therapist]

I have not done these yet

Therapist wrote:

- Try to avoid daytime naps --> I am always sleepy and tired, so avoid daytime naps is irrelevant
- Learn to appropriately handle emotional stress in your life --> I don't know how to handle it
- Distract your mind by thinking of a pleasant, relaxing activity that you enjoy. Thinking of sitting under an umbrella on a quiet beach with a warm gentle breeze works for me. --> I don't have a habit of thinking about something pleasant, but the opposite: I often think about negative things

CG

Well, you know what to work on.

As far as emotional stress, what is the source? Work? Family? Family tragedy? Physical health?

[SpicedRum]

Oh, thanks. I am living in Europe, and there could be difference in how psychiatrists believe.

Luckily, I have decided to go for Mirtazapine before reading this.

Hello again papzombie. I hope the Mirtazapine works out well for you. Just because you mentioned Europe, I thought I might add another suggestion to the list of alternative medications you're already building up: Circadin. It's a prolonged-release formulation of the chemical Melatonin - a hormone your body naturally makes in the evening to induce sleepiness. It's relatively new, only in the EU, and one of the few drugs that's actually licensed specifically for insomnia (as well as having very few side effects). As it is a prolonged release formulation, you will ingest it at a constant pace throughout your sleep, hopefully helping with sleep maintenance.

I guess it's also worth pointing out that wakening up would be a normal and important reflex if your body detects that something's wrong (particularly with breathing) during sleep. Maybe further investigation into the exact cause of the awakenings is warranted - there's not much point soundly sleeping through the night if your body's struggling to get enough oxygen for parts of it.

Best of luck

[BlackSpinner]

The sleep doctor presribed CBT-I, and this psychiatrist has asked my sleep doctor before giving me those 3 choices, I don't remember she said who prescribed the Quetiapine.

About weather or not I should try CBT-I before taking the meds, this psychiatrist told me that "I should not have a high expectation on CBT-I, because it's only about using the bed for sleep and sex, and go to bed on time, ....". But upon hearing that I thought she did not know enough about CBT-I.

Well your psychiatrist seems to know very little about CBT if she thinks this.

CBT would not be an instant solution like meds will be, but it will be a solution which puts you in control. You CAN do both. Use meds to give you immediate relief and learn CBT to get control over your issues. Once your cpap therapy is functioning well it will be important to re-evaluate all your medications because real sleep will change how your body uses the drugs.

[49er]

Hi papzombie,

You said, ""I am always sleepy and tired, so avoid daytime naps is irrelevant""

How will taking Remeron resolve this if you can't avoid naps during the day? Is it supposed to give you such great sleep that won't be tired during the day?

When I was on the psych med cocktail several years ago, that included Remeron as a sleep med, one of my meds during the day was Adderall, which kept me awake. But it seems if you can't stay awake during the day, it would seem to negate the effectiveness of the med.

By the way, what explanations have been given for your excess sleepiness during the day?

49er

[menlodoc]

I have used Mirtazapine in the past at a dose of 15 mg at bedtime for anxiety. I found that in addition to helping my psych issues it improved my AHI. I was using a dental appliance at the time. Before adding the Mirtazapine my AHI with the appliance was 15, after adding Mirtazapine it dropped to 7. There are articles in the medical literature about this but the studies produced conflicting results. Those that get benefit probably do so because Mirtazapine improves neurotransmission to muscles in the throat. For those that get benefit only lower doses work (15 mg). This would be another extra benefit for choosing Mirtazapine as long as it doesn't cause weight gain for you (which make sleep apnea worse)

[NachtWürger]

I was using a dental appliance at the time.

Do you mean as an adjunct to CPAP?

[menlodoc]

That was when I was using a dental appliance alone, before I started CPAP

[NachtWürger]

Before adding the Mirtazapine my AHI with the appliance was 15, after adding Mirtazapine it dropped to 7.

That was when I was using a dental appliance alone, before I started CPAP

How did you determine your AHI when not using CPAP?