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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Can Mirtazapine Taken For Depression Cause Chronic Nerve Pain And Nocturia? Should I Switch To A Different Medicine?

I have had MDD most of my life, I am an almost 60 y.o./ F. Most antiDs have intolerable side effects. SSRIs and others exacerbate my insomnia greatly, even at a low dose. Cymbalta does too. The antiD most effective for sleep for me has been mirtazapine. However it causes OAB (I have to get up to urinate 3-6 times a nite). My Gp added on imapramine to the Mirt to counteract the nocturia but it seems to cause me to awaken and not be able to go back to sleep. One of my primary Sx of depression is lack of appetite. I am already underweight for my frame (126.5 lbs at 5 8 ). Mirtazapine helps me to have an appetite more than anything. If it weren t for the nighttime OAB, it would be the perfect med for me, I also have chronic nerve pain which the Mirt seems to be helping some. My question, do you recommend prescribing a med to counteract nocturia caused by mirtazapine? I do not have urinary frequency during the day, only after going to sleep and thru the night. I had this side effect with Trazadone also. Urinalysis tests show no signs of infection.
Wed, 11 Dec 2013
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Psychiatrist,  's  Response
Greetings !

Yes nocturia can be a side effect of mirtazapine but not chronic nerve pain.

It will not be a good ploy to use another anti depressant to counter act against the action of mirtazapine because this will lead to excess of serotonin levels in the body and may lead to side effects including the life threatening condition called as Serotonin syndrome.

Instead of adding an anti depressant like imipramine which may bring along with it another set of new side effects , it will be better that you ask your doctor to add an anti cholinergic drug like Trihexylphenidyl at dose of 2 mg at bedtime which shall prevent this nocturia from occurring.

As far as the nerve pain is concerned it seems to be a part of your underlying chronic depression and it will wane off once depression gets treated completely.

I hope this helps.

Wish you all the best.

Regards.
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Can Mirtazapine Taken For Depression Cause Chronic Nerve Pain And Nocturia? Should I Switch To A Different Medicine?

Greetings ! Yes nocturia can be a side effect of mirtazapine but not chronic nerve pain. It will not be a good ploy to use another anti depressant to counter act against the action of mirtazapine because this will lead to excess of serotonin levels in the body and may lead to side effects including the life threatening condition called as Serotonin syndrome. Instead of adding an anti depressant like imipramine which may bring along with it another set of new side effects , it will be better that you ask your doctor to add an anti cholinergic drug like Trihexylphenidyl at dose of 2 mg at bedtime which shall prevent this nocturia from occurring. As far as the nerve pain is concerned it seems to be a part of your underlying chronic depression and it will wane off once depression gets treated completely. I hope this helps. Wish you all the best. Regards.