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substitute for mirtazapine

ALL local pharmacies say mirtazapine UNAVAILABLE.....I have been off for 2 weeks...need a replacement that is most like this....Don't have a psyocrist only a reg Dr  
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5801192 tn?1389204087
Dear lorraineelizabeth:

I apologize for the previous answer. It was sent in error.

I checked the American Society of Health-System Pharmacists (ASHP), and indeed there is a major mirtazapine (Remeron) shortage.

I also called Food and Drug Administration (FDA) to see what patients can do and when the medication may be available from the manufactures. The pharmacist, Henry, advised us to report the shortage by emailing FDA at:

Because I do not have your complete medical and medication history, I am not able to recommend an alternative to mirtazapine. Please consult your primary care physician with the information provided in my post.

Bipolar disorder, also known as manic-depressive illness, is a complex mood disorder to manage. It is not the same as major depression and should not be treated the same way.

As you are well aware of, bipolar disorder consists of severe cyclic mood swings from mania to depression. There are three major categories of bipolar disorder: I, II, and cyclothymia. It is a good idea to figure which category you are in to better manage your condition.

A successful and effective treatment plan for bipolar patients should include a combination of medication and psychotherapy, usually guided by a skilled psychiatrist and often will be lifelong. Medication alone is not enough to fully control the condition, patients will also need lifestyle changes and social support.

To treat bipolar disorder, mood stabilizers are the preferred medications, if not the drug class of choice. They include: valproic acid or divalproex (Depakote), lithium, lamotrigine (Lamictal), etc.

Antidepressants, such as fluoxetine (Prozac), sertraline (Zoloft), mirtazepine (Remeron), and etc., are not recommended to treat bipolar alone, because they may actually worsen bipolar by triggering the manic cycle.

Per FDA, "Understanding Antidepressant Medications"

"Serious Risks
Mania: When people are in a manic "high," they may be overactive, overly talkative, have a great deal of energy, and need less sleep than normal.

There are two different types of mood disorders, both of which are cyclical. One is unipolar disorder, in which the cycle is that a person feels normal and then feels depressed. The other type is bipolar disorder, in which the person's mood cycles from depressed to normal to manic.

"The doctor needs to screen patients for a bipolar history," said Mathis. If an antidepressant is prescribed to a person with bipolar disorder, it can cause mania. And the person can even become psychotic if the mania is severe."

This is a good opportunity for you to discuss your current medication regimen with your primary care provider and psychiatrist. It may take some time to find the right bipolar medication but do take the time to educate yourself. You, in addition to your provider and love ones, need to monitor signs and symptoms of your bipolar closely, since you have been off your medication for 2 weeks.

Questions to ask and share with your providers and pharmacist regarding your new medication(s) are:
1. What are the risks vs benefits of the medication you are recommending? Will it interact with my other medications?

2. How should I take this medication and for how long to see effect? What are the side effects?

3. Are there any medical conditions or medications that may cause or exacerbate my mood swings? Will withdrawing from the drug be difficult if I decide to stop? Will my symptoms return when I stop taking the medication?

Also, if you are interested in participating in clinical trials, please go to:
http://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml#part8. There are NIMH supports research studies on mental health and disorders and ClinicalTrials.gov, the NIH/National Library of Medicine's registry of federally and privately funded clinical trials.

Good luck and take care!

For more information, please go to:
1. What is Bipolar Disorder? National Institute of Mental Health

2. Mirtazapine - Daily Med

3. Bipolar Disorder Help Guide - Helpguide.org
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