The Saga of Remeron/mirtazapine

I mentioned in my last post that, despite my distrust, I tried prescriptions, plural. But, I spent the whole post whining about Prozac. The other one I tried was remeron. Let's talk about that.

About ten months after my experience with Prozac, I was referred to a mental health clinic. I was well into my second year being unemployed so I had to go on the first available Sunday and their community clinic. In other words, I showed up for the first come, first serve, free service. You just try to find more depressing circumstances!

Anyway, the psycho-whatever guy took in my story. I know, sounds irresponsible to not remember for sure what his title/position was, but at this point in my life I was emotionally and physically exhausted. Also, I liked and trusted the doctor who referred me to him. We’ll talk more about her later.

I was so in the depths of it at this time that walking to the end of the block was a major accomplishment. Driving the fifteen miles or whatever to this guy’s office was nothing less than herculean.

So, I told him about my struggle with depression. In those ten months it had become so much worse. After Prozac, the episodes of heavy limbs, crying helplessly and days of endless sleep continued to come and go. I’d have a good week then two days of useless paralysis.

I put it to him plainly. I was ready to try another prescription. I had two conditions: 1) Don’t say the P word and 2) I wanted the meds that had the lowest incidences of sexual dysfunction associated with them.

Sidebar: Sex is incredibly important to my new wife and me. We met some months after my divorce and her separation on one of those hook-up apps. It was literally meant to be a one-night - well, one-morning - stand. Turns out, we’re still standing.

So, back to it. He, the psych-whatever guy, totally understood. He listened to my whining and worries and suggested Remeron (mirtazapine). Said it had one of the lowest incidences of sexual problems and was good at smoothing out one’s depression/emotional issues.

In an FAQ on the Mayo Clinic's website they list mirtazapine as one of the antidepressants with the lowest incidence of sexual problems. However, they don't go so far as to say that there are no sexual problems associated with it. A study published by the National Institute of Health in December, 2005 reported that patients suffering from sexual issues while on other antidepressants saw improvement when they tried mirtrazapine

We filled the prescription and, after staring at the bottle for about a week, I finally started in with the recommended dosages. I stuck to it for two weeks before my wife asked why we weren’t having sex anymore. I hadn’t even noticed but we’d gone from twice a day and ten on the weekend to maybe once a week. MotherFuck! (Well, actually, quite the opposite.) I hadn’t even noticed.

The standard information/disclosure information about mirtazapine says nothing about the possibility of sexual side effects. Whether it was real or some kind of messed up placebo thing, I'm obviously in the minority or their studies sucked. 

We tried paring it down. Half a day, then half every other day; no joy. Having no libido and disappointing my partner is no solution to depression. At least in my world it’s not.

So, I’ve let mirtazapine go, too.

Tried Prescriptions

I know. The original point of this blog was to chronicle my battle with depression without prescription drugs. Well, since we last spoke I broke down and tried a couple of prescription antidepressants. Let me tell you about that.

First, a few background details that may or may not be relevant and may or may not be further explored later. As you know, I’m not a big fan of prescription drugs. Obviously, they have their place but I think today’s western society overuses them. From antibiotics to emotional and mental medications, I think that patients and doctors alike are too quick to turn to them. This isn’t either parties’ fault, the system has simply been set up in such a way that there’s not enough time in the doctor/patient relationship to explore slower – even if more effective – solutions. Also, there’s the pharm industry… There are a lot of rabbit holes to fall down here. Point is, I’m more reluctant than the average patient to accept prescriptions. Let’s leave that there for the moment; maybe we’ll get into it later.

I may be a bit paranoid in this area. For a more balanced view of the issue of prescription drugs in the US, check out this article in the Washington Post from November 2015. It points out that, among other things, prescription drug use is up possibly due to increased advertisements and an aging population. Happily, it also mentioned a decrease in antibiotic use.

Second, my wife doesn’t necessarily agree with me on this.I’m not saying she’s trying to shove a pill down my throat every time I feel a little ouchy, but she’s seen antidepressants help people in her life before and she didn’t like to see how much I was suffering. Besides my natural proclivity to depression, having lost my job and my home left me in a pretty bad place. So, when I needed to get a prescription re-upped – heart thing, not gonna fight that one – she came along with me to the clinic to talk about these squishier issues.

The nurse practitioner we saw was compassionate and took the time to listen to my story. She patiently asked questions and encouraged me to tell her everything. It was painful. Anyway, after it was all said, she proscribed Prozac. Obviously I knew about the big P. It’s an old drug and I’ve heard a lot of people have been helped by it. After some convincing I decided to give it a try. (Not much convincing, mind you. When you’re as low as I was then it doesn’t take much.)

It was a disaster. I took the prescribed dose for three days. It shut me down. I mean it literally turned me off. I’ve told this to doctors since and, save one, I can see clear skepticism in their eyes. But that’s what happened. I stopped functioning. For a week I could only get out of bed to urinate or vomit. The rest of the time I slept all day and all night. I was in a black/grey fog. My arms and legs felt like great weights that were impossible for me to lift. Had it not been for my wife – then fiancé – keeping me hydrated I might not have come out of it. Dramatic, I know, but it was really that scary. Aside from a few auto and flying incidences, my lucid moments during this episode were some of the most terrifying I’ve encountered.

According to this study published in JAMA in June, 2018 "between 2005 and 2014, the estimated overall prevalence of US adults using medications with depression as a potential adverse effect was 37.2%.The adjusted percentage of adults with concurrent depression was higher among those using more concurrent medications (eg, estimated 15% for ≥3 medications)."

Obviously, I dropped the Prozac after this. The incident left me with a strange side effect. My left ear was completely plugged up. My right ear was, too, to a degree, but at least I could hear out of it. The left? Nothing. Strange, right?

The Symptoms of Depression

I really hate the big pharmaceutical companies. I’m a US citizen that it’s generally known here that Big Pharm holds a huge amount of control over politicians. They use this control to squeeze more and more money out of our broken health-care system.

A few years ago Big Pharm managed to make advertising prescription drugs on TV legal. At first it might have seemed silly, advertising to consumers who would have to go supplicate to their doctors in order to get the drugs that they want. Well, Big Pharm was also working the doctor side of the equation and their TV campaigns were wildly successful.

This causes all kinds of problems. Patients taking wrong drugs or way too much for their ailment not only drives up insurance rates for the rest of us, it also creates a population more likely to produce drug resistant bacteria. And it creates a medical community that is more likely to believe in the power of drugs which leads to over prescribing. All drugs have side effects which sometimes require additional drugs if they are severe enough. The whole systems sets in motion a vicious cycle that, whether by design or luck, produces obscene profits for Big Pharm.

I could go on but I won’t. I just want you to get a feel for why I hate Big Pharm and the ads that they have all over TV.

Seven or eight years ago I was watching TV with my wife and one of these Big Pharm ads came on. Sometimes when I see one I delight in picking apart their wording to get to the heart of their deception. In this case the ad was for an antidepressant. The narrator, a silky voiced woman, said with great sympathy, “Do you suffer from…” and she listed around ten different symptoms while images of various sad people flashed on the screen. The deception here was so obvious that I had to laugh aloud.

“Of course we do,” I blurted, “That’s the human condition.”

My wife didn’t say anything. She just kept watching.

“I mean, these are daily things, right?”

Now she looked at me. “You think about suicide?”

“Well, yeah, doesn’t everyone?”

“Promise me you won’t do anything stupid.”

I laughed, “I’m to much of a wuss to actually do it. I just think about it.”

She let it drop then but a few days later she brought up again. She was obviously thinking about it.

I was too. The next time I saw the ad I wrote down the symptoms that they listed. I regularly experienced almost ever one of them to one degree or another. I decided to look them up and found them listed virtual verbatim on the National Institute of Health’s website under Symptoms of Depression. This was the first time that I began to think that I actually had depression.

Those symptoms are:

• Persistent sad, anxious, or "empty" mood
• Feelings of hopelessness, pessimism
• Feelings of guilt, worthlessness, helplessness
• Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
• Decreased energy, fatigue, being "slowed down"
• Difficulty concentrating, remembering, making decisions
• Insomnia, early-morning awakening, or oversleeping
• Appetite and/or weight loss or overeating and weight gain
• Thoughts of death or suicide; suicide attempts
• Restlessness, irritability
• Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

This is still a strange list for me. Except for those symptoms that become evident as changes from regular behavior, I’ve had all of these since as long as I can remember. There’s never been a catalyst; this is just how I live.

I don’t know if it will ever change. If I ever make enough money for it, I will seek a professional therapist, one with a holistic approach that won’t say “drugs” in our first session.

For now, though, this is all I have.