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What Causes Restlessness After Switching From Mirtazapine To Effexor XL?
Question: Dear Doctor, I did visit with you a few weeks ago and was very impressed with your answer. Please refer to that conversation for your background information. The psychiatrist here has tried to change her medicine and I have had some negative results and am wondering what to do. He took her off of her 15mg of Mirtzapene and put her on 75 mg of effexor XL and she has developed what you call I believe Akathisia or restlessness. I tried to take her off of both of them and just do the ativan (3 Mg) a day and Gabapentin 1200 mg a day. She then becomes very quiet and unmotivated to do anything. I am at a loss as to what to do. Should I start her back on Mirtzapene or the effexor or what?
Brief Answer:
Start with mirtazapine again but increase the dose.
Detailed Answer:
Hello Dear,
Welcome again to HCM.
I remember our earlier conversation. You had asked about the treatment of your wife.
I can understand that how difficult it would be for you to see your wife in pain.
As I mentioned in our earlier conversations, If your wife was doing well on Mirtazapine, The first choice would have been to increase the dose of it to 30mg.
Changing of medicines just after trying minimal doses is not a good step because every individual reacts to different drugs differently.
The best combination which I can suggest you for your wife would be Mirtazapine 30mg alongwith ativan 3mg (as these two drugs have working well for her).
My second choice for her would be to use zoloft or lexapro, if not tried earlier.
I would also like to mention that please donot expect a dramatic response with these drugs because depression in frontal lobe dementias are really hard to treat,as we discussed earlier.
Feel free to ask further.
Hope this helps.
Wishing for good health of your wife.
Dr. Shubham Mehta, M.D.
Start with mirtazapine again but increase the dose.
Detailed Answer:
Hello Dear,
Welcome again to HCM.
I remember our earlier conversation. You had asked about the treatment of your wife.
I can understand that how difficult it would be for you to see your wife in pain.
As I mentioned in our earlier conversations, If your wife was doing well on Mirtazapine, The first choice would have been to increase the dose of it to 30mg.
Changing of medicines just after trying minimal doses is not a good step because every individual reacts to different drugs differently.
The best combination which I can suggest you for your wife would be Mirtazapine 30mg alongwith ativan 3mg (as these two drugs have working well for her).
My second choice for her would be to use zoloft or lexapro, if not tried earlier.
I would also like to mention that please donot expect a dramatic response with these drugs because depression in frontal lobe dementias are really hard to treat,as we discussed earlier.
Feel free to ask further.
Hope this helps.
Wishing for good health of your wife.
Dr. Shubham Mehta, M.D.
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