Mirtazapine (AKA Remeron)
Mirtazapine (also sold as Remeron) is an atypical tetracyclic anti-depressant used to treat major depressive disorder. It's also the thing that's kept my baseline mood relatively stable for the better part of a decade.1
I started taking medication for my mood back in 2009. In reality, I'd been dealing with depression since school. Nothing and no-one could have prepared me for the difference between GCSEs and A Levels, and during last couple of years of school I watched helplessly as I struggled to get the grades that came so easily to me before. Case in point: I got an A at GCSE Math despite taking a total of half an hour to answer the questions in a two hour exam. I barely scraped by with an E at A Level. That one stung.
After failing to get any sort of grades to go to college, and mum facing reduced housing benefit as I hit working age, I went out and got any job I could. Then I lost that through my own stupidity (got caught stealing - story for another day) and was unemployed. In 2008.
Guilt and circumstances left me aimless and dark. Suicidal thoughts became the norm.
I had spent my life knowing exactly what I was going to do. Now, I had nothing.
The straw that broke the camel's back was my half-sister turning back up in our lives and dropping that a) she was an alcoholic drug addict, b) she'd had kids taken off her, and c) my nan on my dad's side had died years previous.
My dad died when I was still three months old, and his mum/my nan was a huge part of my life as a toddler. One of my most lasting memories was being in her flat, playing with her thimbles, while an audio book or Robin Hood was playing. I still hear the music in my head. She eventually moved up north, and being dirt poor train travel wasn't really an option. I don't know why we never had a phone number or address; I was a kid.
So when my half-sister dropped that she had died, it broke me. I'm not sure why. Maybe it was guilt at never having gone up, or the last real trace of my dad now gone. But it all came out, and I couldn't get it back together again.
In September 2009, I started on 20mg Citalopram, what I started calling the gateway anti-depressant. Six years later, when it wasn't enough to stem the tide anymore, I tapered onto Mirtazapine, working my way up to the maximum dose of 45mg.
The most common side effects of Mirtazapine are weight gain and sleepiness, and boy did I find that one out.
I've always been a comfort eater, and by always I mean literally. I have memories as a pre-schooler eating stuff to distract from whatever was going on. Sweets, biscuits, Hell I once managed to convince my Aunt that I would be fine eating an entire pack of Mr Kipling's Apple Pies. I was four. So being prescribed a pill used off label to help with under-eating2 drove my already high appetite into overdrive.
My tiredness has long been a sticking point for me and my wife. A combination of sleep apnea from my weight, stress from work, and Mirtazapine (also used off label for insomnia) has meant I'm almost always tired. Not necessarily physically tired (I've been able to go for a 30 minute run whilst feeling like I'm about to drop offer before) but mentally tired, to the point where conversation past a few words is difficult. Social interaction has the same effect; too much and I need to go lie in a darkened room for a little while.
I've had month long relapses on it, and I've had major episodes, but they're usually situational or triggered by a life event. On the day to day it's largely kept me level, and without it, those episodes would have been much, much worse. So despite the clear and obvious problems of the side effects, I resigned myself to the idea that I would likely have to be on this medication for the rest of my life.
Three months ago, I started tapering down my dose. I'm currently down to 30mg, down from 45mg, and I'm planing on dropping further from February after I get Winter out of the way.
I kind of started by accident. I was having my medication review, and I asked how tapering down would work. My actual aim was to change medications, following on from a conversation I had year previously where I was told in order to change them, I would have to come completely off Mirtazapine. This did a fairly good job of scaring me off the idea.
Nothing is permanent though. After the years of work, building up our security, and finally getting some hardcore therapy, I was starting see the light at the end of the tunnel. So when the doctor asked if I wanted to try tapering down, I said yes.
It's been going pretty well. It's been so long since I started them that I've forgotten how it felt even on a lower dose. I'm still tired and occasionally overeating, but not as much as before. My head feels like I've turned it up a couple of notches. Sometimes that's good, sometimes it makes me feel like I used to; my mind racing a mile a minute, wanting to sprint rather than walk. Already I'm starting to feel like I can do everything despite evidence to the contrary, and combined with the winter blues and it's having an occasional effect on my mood and anxiety. Something to be mindful of.
The encouraging thing is that I am being mindful of it, something I'm managing relatively easily. A combination of some learned coping mechanisms and anxiously analysing thoughts, words, and deeds for signs of problems is currently working. Journaling in particular is probably the most helpful thing I do at the moment, both traditional end of day clearing and bullet journalling observations through the day.
One thing I am definitely struggling to not do is out a timeline and milestones in place, as though this was a project in need of micro-managing. Circumstances change, things happen, and the last thing I need is a relapse making me miss a self imposed deadline. I'm happy with the idea that if things stay as they are, I'll be off my meds by 2024, but if not, that's ok too. It'll come in time.
I never thought I'd reach this place. I'd made my piece with the idea that I would be dealing with major depression and the side-effects the rest of my life. Managing, rather than moving forward. Yet here I am.
And that feels amazing.
It's good to know my dress sense at the time was under analysis.
Fun fact: I went through my medical records online to find exactly when I started taking Mirtazapine and found this entry on 27th April 2015: 'Examination: good rapport, normal eye contact. Appropriately dressed, not unkempt.'↩
I once brought up that I was trying to lose weight while taking 45mg Mirtazapine to a GP doing an occupational health review, and he literally laughed.↩