Mirtazapine-induced anxiety, or possible hypomania?

[KayCam]

Hello. Forgive me for this being so long, I just want to make sure I'm providing good context because I'm not exactly sure what's going on. I've had depression since childhood, and as of a few years ago I began developing some mild symptoms of anxiety. Anxiety does run in my family, but there's also been some question as to whether or not my sibling also has comorbid bipolar disorder. My previous doctor thought I may have bipolar 2, so she put me on escitalopram and lamictal. I've since stopped talking the escitalopram, as the 2 SSRIs I've been on in the past have both seemed to "poop out", as has the lamictal to some extent. So, after a particularly nasty episode of depression, my new doctor started me on Remeron (mirtazapine).

I've worked up to 30mg over about a month and a half, and with the exception of the cognitive distortions, this drug has worked amazingly well for my depression! But, there's a catch; from the first week I began to get irritable. Really irritable. And since reaching 30mg, I've had an explosion in anxiety-like symptoms; extreme worry over big and little things, racing thoughts, muscle tension, dizziness, chest pain and gut spasms, and being almost totally unable to breathe deeply and calm myself. My nerves have become so jangled that it's actually impairing my motor skills (for instance, coordinating my fingers to type on a laptop), and I've began to do things I don't remember doing (like putting objects where I normally don't put them). What's more, I've become chronically unable to get to bed until at least 3 in the morning, mostly because I don't want to physically shut down and go to bed at night--it's the only time of the day where I have time to do things for myself, like cooking and reading, or even just de-stressing. And although I don't feel that tired the next day, I know it can't be good for my mental health.

During this last episode of depression, I've also started to have difficulty concentrating, and suddenly I began to have reading difficulties that have persisted (despite the fact that I've taken vyvanse for years). I've never been a strong reader, but it's just unusual that it's suddenly become such a problem.

I've only every seen my new doctor twice, and since I saw her a week ago, she said to just lower my dose to 22.5mg and come back in a month. Don't get me wrong, I love the fact that I have the energy to be a person again, but I almost wonder if these symptoms are any better than the depression. This is all very distressing for me, and I'm not really sure what's going on. Is this just high anxiety? Or is there something more going on? I'm hoping for a second opinion, to see if I should call my doctor and try to find an earlier follow-up. Thank you for listening!

[Paxiled]

Remeron is usually very sedating, but these drugs are very weird and very individual.  But you're on several drugs, it appears, and it might be interacting with one or more of them.  But generally, remeron is so sedating and induces people to eat so much and gain so much weight that my psychiatrist rarely uses it except with geriatric patients who have stopped eating.  If you're using a general doc for this, perhaps see a psychiatrist who is more familiar with these meds.  Also, diagnoses of various bipolar disorders is a controversial area of mental health care.  There's only one true bipolar, and the other diagnoses are just a type of depression.  Taking drugs such as lamictal might not be appropriate if it's not true bipolar, though if it was helping you than for you it might well have been good.  You're taking speed, I gather you've been diagnosed with another controversial one, ADHD, but maybe again this isn't doing well with the Remeron.  All this being said, your doc's reaction is the right one -- by reducing your dosage, if these symptoms go away the doc will know it's the remeron causing them.  That will allow him to know what to do next.