I have a few cases of depression when person stabilized on mirtazapine (taken for several weeks without reaction) got additional SSRI drug (no matter which) there was a good antidepressant reaction but very short-term (about a day) and does not appear anymore despite continuation of both drugs. And this reaction does not appear when both drugs were started simultaneously. Any ideas why there is such reaction? What biological synergy was behind it, and most important: how maintain this antidepressant reaction? What drugs can be taken instead of mirtazapine? Thanks.
Check these papers, the authors are probably here on RG:
COMBINED MIRTAZAPINE AND SSRI TREATMENT OF PTSD: A PLACEBO-CONTROLLED TRIAL.
Schneier FR, Campeas R, Carcamo J, Glass A, Lewis-Fernandez R, Neria Y, Sanchez-Lacay A, Vermes D, Wall MM.
Depress Anxiety. 2015 Aug;32(8):570-9.
Increased platelet count after treatment with venlafaxine or mirtazapine in depressed patients.
Gronau W, Paslakis G, Lederbogen F, Weber-Hamann B, Gilles M, Schilling C, Deuschle M.
Pharmacopsychiatry. 2015 Jan;48(1):37-9.
Effect of the coadministration of citalopram with mirtazapine or atipamezole on rat contextual conditioned fear. Masuda T, Inoue T, An Y, Takamura N, Nakagawa S, Kitaichi Y, Koyama T, Kusumi I.
"Mirtazapine decreased freezing in a dose-dependent manner, which is consistent with a previous report; it also enhanced an anxiolytic-like effect at a high dose (30 mg/kg) of citalopram. Because mirtazapine blocks α2-adrenoreceptors, the combined effect of atipamezole, a selective α2 receptor antagonist, with citalopram was also examined. Similar to mirtazapine, atipamezole reduced freezing dose-dependently, but the enhancement of citalopram's effects by atipamezole was not clear when compared with mirtazapine."
Neuropsychiatr Dis Treat. 2014
Psychoneuroendocrinology. 2009 Feb;34(2):238-48. doi:
Suppressive effect of mirtazapine on the HPA system in acutely depressed women seems to be transient and not related to antidepressant action.
Horstmann S, Dose T, Lucae S, Kloiber S, Menke A, Hennings J, Spieler D, Uhr M, Holsboer F, Ising M.
Case Rep Psychiatry. 2013;2013:697872.
Mirtazapine treatment of a severe depressive episode and resolution of elevated inflammatory markers.
Alikhan SM, Lee JA, Dratcu L.
There is a body of literature suggesting the lithium carbonate when used to supplement SSRI treatment enhances and stabilizes the antidepressant effect. Generally, I add omega-3's and turmeric as well for good long wave control over dysphoric symptomatology.
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