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Suggest Treatment For Recurrent Depression

Posted on Tue, 1 Sep 2015

Question: I am 73 years of age and have on four occasions become depressive. The first in early forties when I had three young children, had just built and moved into a new home (in South Africa) and obviously became exhausted. It happened again at menopause when I was around 50 years of age. Now, it has hit me badly again - I visited XXXXXXX Fe, New Mexico beginning of May and caught a chest virus and a parasite (both gone now) but being run down has plunged me once again into a depression. My (very busy) G.P, is Dr. Edmunds. He has subscribed 2 Mirtazapine (ie 30 mgs) at night and 1 - 5mg Clonazepam, then half a Clonazepam in the morning at breakfast. I had been taking 3/4 of a Mirtazapine at night since the last bout of depression (about eight years ago) and had felt very healthy. I began the two Mirtazapine on 13th July and although I am sleeping better, I still feel horrible during the day. On top of that, today I found that I have an infection on my leg which I now have to treat with Penicillin. I have been swimming regularly as an exercise to try to combat the depression. Now I cannot swim or wet my leg for one month. IS THE 30 GRAMS OF MIRTAZAPINE ENOUGH OR WOULD IT HELP TO INCREASE THE DOSE? XXXXX

Answered by Dr. Shubham Mehta (2 hours later)

Brief Answer:
change of drug advisable.

Detailed Answer:
Hello
Welcome to HCM.
I can understand your concerns.

You are having recurrent depression.

You have been taking 30mg of mirtazapine. This has improved your sleep but you still feel bad in daytime.

I would like to tell you that the maximum dose of mirtazapine is 45 mg for depression.
However, this dose can cause heavy sedation in some cases.

In my clinical experience, those patients who do not respond to 30mg of mirtazapine, usually does not respond to increasing the dose.
Increeasing the dose to 45 mg increase risk of havong side effects rather than benefits.

My opinion would be,
If your depression is not responding to 30mg mirtazapine, its a better idea to change the drug than to increase the dose.
Effexor or pristiq or zoloft (prescription drug) should suit you if you have not used them earlier.

These drugs are safe with penicillin.
Kindly discuss this with your doctor.

Hope this helps.
Feel free to ask further.
Take care.
Thanks.

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Shubham Mehta (6 days later)

Thanks. It was very helpful – the only other question I had was HOW LONG should one expect to wait for feeling better after taking the drugs?

Answered by Dr. Shubham Mehta (29 minutes later)

Brief Answer:
atleast 2-4 weeks.

Detailed Answer:
You are most welcome.

One should atleast wait for 2 weeks after starting a new drug to see any noticeable effect of drug.

But in some cases, it may take upto 4 weeks.

Hope this answers your query satisfactorily.

Kindly close the discussion if you are satisfied with response and give your valuable feedback.

I wish you well.

Thanks.

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar