45 mg of Mirtazapine Doesn't Help Me Sleep — Need Advice for My Disabling Tinnitus

Hi everyone!

Well, I'm not going to tell you my whole tinnitus story because I could write a novel about it, but to sum it up: I've been suffering from very disabling tinnitus for over 3 years following a music festival.

This already debilitating tinnitus was made permanently worse by taking Naproxen.

I have been living in hell for 3 years, especially when it comes to sleeping.

I accepted in November 2021 to take antidepressants (Mirtazapine), because I read on Tinnitus Talk that it is the safest antidepressant and that it promotes better sleep.

Gradually, under the supervision of my psychiatrist, I went up to 45 mg (the maximum dose), but it still doesn't help me sleep, as my tinnitus is so strong and intense.

My psychiatrist is considering adding a second antidepressant. What do you think about this?

He really suggests taking SSRI-type antidepressants, but I am absolutely opposed to this, as I have read that this type of antidepressant is likely to make existing tinnitus worse.

Are there people like me who have to accumulate several antidepressants to get to sleep? If so, which ones do you take?

Thank you for your valuable advice.

 

Have you considered Trazodone? It's not an anti-depressant (I believe it's a muscle relaxant), but its side effect is drowsiness.

 

That doesn't seem to be correct. It appears to be a drug specifically to treat depression: https://medlineplus.gov/druginfo/meds/a681038.html

 

Trazodone is an anti-depressant. Not a muscle relaxer.

My doctor prefers it over Mirtazapine for sleep and tinnitus.

I have never tried it.

 

Sorry my bad, I had the wrong information.

 

45 mg is a high a dose. It only works for sleep at 15 mg or lower.

 

How many hours of sleep do you get every night? Have you considered Z-drugs or benzos? I use that in combination with an SSRI. As you know, benzos can be hard to stop with but once you get your tinnitus under control it should be fairly easy for most people.

 

According to Google, Trazodone is an anti-depressant more commonly used to treat sleep disorders (insomnia). It seems interesting. I guess my psychiatrist didn't suggest me trying it as it might not be the best anti-depressant to help with my deep depression. But I will talk about Trazodone during my next appointment with the psychiatrist.

I first started with 15 mg, but it didn't help me sleep. Then I tried 30 mg which allowed me to sleep better during the first 2 months and then my sleep has become catastrophic again. For 1 month now I have been on 45 mg but still my sleep is not restorative.

I am one of the worst tinnitus cases on Tinnitus Talk.

I have at least 4 different sounds all the time (ultra high pitched sound, dental drill sound, electric sound, pipe/morse code sound). All in my head or ears. I can here all of them everywhere, everytime, even in the noisy underground (Parisian metro).

Yet during the music festival where I had my noise trauma I was wearing custom-made hearing protection that cost €150 and stayed at the back of the room stage...

I am truly cursed.

 

For me I needed 30 mg to sleep. I tried both 7.5 mg and 15 mg and they didn't do anything, but 30 mg knocked me out hardcore. But yes, usually it works best for sleep at lower doses.

But it's a horrible drug and I, like many of you know, so regret taking it and I would advise anybody to get off it fast. You do NOT want to be on this long term. It's brutal hell to get off again, and it can wreak havoc on your body.

 

Trazodone is a good alternative to Mirtazapine. I was on both for a while and got off of Mirtazapine because it loses its ability to make you sleepy after a few months, as you are experiencing. 200 mg Trazodone is enough for me to sleep.

Seroquel (aka Quetiapine fumarate) is another very powerful, yet non-addicting medication that is often used for sleep. It is technically an anti-psychotic, but they use it for sleep when they want something non-addicting and nothing else is working. It will definitely knock you out, I promise. I was also on Seroquel for about a year as well with no effect on my tinnitus. I started having uncontrollable weight gain from it so that's why I stopped, but as long as you don't get any bad side effects, Seroquel was so much more effective than Trazodone.

Try Trazodone first, and if your sleep isn't restorative switch to Seroquel. I have a feeling Trazodone will not be powerful enough to combat your intense tinnitus, so don't be afraid to try Seroquel. It will definitely give you restorative sleep.

 

@Kam75, try 7.5mg.

 

Really sorry to hear about your condition. Did it happen immediately after the music festival? Are you able to work okay?

 

Is Mirtazapine really a dangerous drug? All the psychiatrists I saw told me that antidepressants are not dangerous and that some people take them all their lives.

As far as I'm concerned, I cannot sleep at all without Mirtazapine. I tried everything before starting it, to no avail (or at least some of the things I tried did work just for a couple of weeks). Among the things I tried was: CBD oil, Alimemazine, Melatonin, Amitriptyline at a small dose and many other things... Only Clonazepam had the ability to knock me out, but I only took it 5-10 times in my life as I read horrible things about it.

For the moment, the only side effect I'm experiencing with Mirtazapine is weight gain. But since I was always skinny in my life, for me it's more a "good" effect, let's say

Ok thanks a lot for this advice. I'm going to talk about that to my psychiatrist next week!

 

Yes it happened 2 days after the festival. But please don't talk me about that terrible event, it reminds me of very bad memories

With regards to work, before starting the antidepressant, I sometimes had to skip work (it was impossible to go to work with just 1 hour of sleep).

Thanks to COVID-19, now I'm allowed to work from home between 2 and 3 days a week. This is a real blessing for me.

 

There is no such thing as a non-addictive psychiatric med. They are all potentially addictive and can have severe withdrawals.

Seroquel is btw not always effective for sleep. I tried it for sleep before Mirtazapine. Personally, it didn't make me sleepy at all.

 

Mirtazapine can be dangerous and is for many people. Don't trust the words of a psychiatrist on this matter. They don't have first hand experience with all these drugs they prescribe. Seek personal stories online, from people who have tried them. I can tell you that Mirtazapine was great the first year but after that it has turned on me bad and has broken down my body, made my tinnitus worse, and given me visual snow/floaters, and I am trapped on it because the withdrawal is insane even when taking it slowly. I am of course probably one of the most unlucky ones on the drug and a fairly rare cause, but many people do have insane brutal several-year long withdrawal coming off this drug. Try EVERYTHING ELSE in your power to obtain sleep, which I understand is crucial so I feel your pain. If you're desperate, try Seroquel. It's not without its own risks but everything is better than Mirtazapine imo.

 

I shouldn't have said "non-addicting." What I meant is "not a controlled substance" like Ambien.

And if Seroquel didn't make you sleepy you may not have been on a high enough dose.

I was on 800 mg. It knocked me out.

But then again different medications affect everyone differently.

 

Oh I see. I only tried between 25-75 mg. It's generally only used at those doses when it's only for sleep. I never heard of anyone using it above 75 mg for sleep. It made me feel weird and off, in a really uncomfortable way, so I don't think I would have felt well at all at such a high dose though.

 

You're right - I had a serious insomnia problem due to bipolar mania - I was only getting 2 hours of sleep per night. That's why my dose was so high.

 

I use Trazodone 50 mg to 100 mg for my patients a lot.

It works well.

Are you suicidal?

 

I suffer with severe high frequency noise induced T and suffered terrible insomnia and anxiety over the years because of it. Mirtazapine recently worked best for sleep for me at 7.5mg but apparently does nothing for anxiety that low. Once I got in control of my sleep again the anxiety did ease a lot. The dose your taking will most likely have no sleep benefit, way too high. And at a lower dose bonus is there will be even less chance of it being ototoxic. Win win.

 

You should look into the new generation of drugs called Dual Orexin Receptor Antagonists. I see you're in the EU, they recently approved Daridorexant (commercial name is Quviviq) as a treatment for insomnia here, so you might want to try and ask if it's available at your local pharmacy and, if so, pay a psychiatrist to get it prescribed.

In case you can't it, there are ways to buy its predecessor, Lemborexant (commercial name Dayvigo), which is sold from some online Japanese pharmacies (Bio Japan or something like that) in the format of 5 mg pills.

 

Hi @Óscar PP, oh yeah, I've already read some articles recently about the Quviviq! It is a new sleep medication that had just started to be commercialized (in June 2022 if I'm correct). I was planning to talk about it to my psychiatrist soon, but I'm sure he will prefer me to stay on the antidepressant. I'll see, but thanks for the suggestion

 

In case no one has mentioned it yet, I'd consider another psychiatrist.

With Mirtazapine, the higher the dose, the less sleepy it will make you. I've found that the ideal dose for sleep is 7.5mg. Your psychiatrist should be reducing your dose instead of putting you on yet another medication.

 

I tried Trazodone. On the first night when I woke up, my head was humming, then it came down a little. The 2nd night was hell. I only took 25 mg, and it caused my hissing to go off the charts. I lay in bed for 8 hours, suffering. I couldn't sleep. It was brutal.

I think the type of tinnitus I have is sensitive to antidepressants. I have a hissing noise and a BAD ETD. Any inflammation in my ears or head causes the hissing to get louder.

I need to find natural remedies.

 

7.5 mg - 15 mg of Mirtazapine is the dosage for sleep. Somehow the lower the dosage is, the better it works for sleep. I felt really sluggish in the morning when I was taking it.

For a natural alternative, you could try a sleep tea with 3 mg Melatonin and some Ashwagandha.

 

A GP did explain the mechanics behind a lower dose being more effective, but I've forgotten it now. I took 15 mg for years for anxiety which didn't make me drowsy, then when I was having trouble sleeping my GP prescribed 7.5 mg which did the trick.

Never had any issues taking Mirtazapine with my tinnitus. No drug is 100% safe for the ears, but Mirtazapine is one of the few anti-anxiety drugs that is not listed as ototoxic.