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Dr. Vikas
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2239
Experience:  MBBS ; M.D Psychiatry, MS. Health Informatics
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My psychiatrist has just increased my Avanza to 30mg at night

Resolved Question:

My psychiatrist has just increased my Avanza to 30mg at night and lowered my Zoloft to 200mg. I am being treated for Depression&OCD. Do these medications mix well together?
Submitted: 7 years ago.
Category: Mental Health
Expert:  Dr. Vikas replied 7 years ago.
Hi mick,

It is a common strategy to use Avanza (Mirtazapine) with Zoloft (Sertraline) to augment the clinical effect of one another.

Zoloft (Sertraline) is considered to be activating ( may cause inability to sleep ) in patient and since it belong to an SSRI class of drug it is also known to cause Gastrointestinal troubles such as nausea, diarrhea, constipation , decrease appetite. Some patients report sexual side effects while being on SSRIs.

Avanza that is Mirtazapine is often used as an augmenting drug (for depression and anxiety) as well as to counteract the side effect of SSRIs ( Zoloft in your case) such as Insomnia, sexual side effects and gastric troubles.

OCD is a difficult disease to treat, and may take time, as well as the increase of doses if clinical response is not achieved.

I hope it helps.

If you have any other query, please feel free to ask.

Best wishes
Customer: replied 7 years ago.

Given I have been on The Zoloft for 7 weeks how much longer should I expect both medications to take effect (lift the depression). I have had the OCD for 20 years and 2 episodes of depression during this time. The OCD gets worse with the depression and gradually is more manageable as the depression lifts. I have sufferred in silence with the OCD over this time and only been diagnosed with it as it involves intrusive thoughts without compulsions (harming myself/others).

My Psychiatrist is suggesting to leave it for another 4 weeks before considering moving me to clomipramine. Given I have not improved much I am seeing if this sounds like the best course of action at present.

Expert:  Dr. Vikas replied 7 years ago.
Thanks for the information. It depends on patient to patient, as some may have partial or complete response to a drug, some may not respond at all, and some may respond initially, but relapse later.

Maximum dose for Zoloft is usually 200 mg per day both for depression and OCD which you are already on.

Avanza has a dose range of 15 - 45 mg per day, and if you are having benefit from it ("Anxiety has lifted in last week and depression improved marginally."), the dose can be further increased also if your psychiatrist think it is beneficial to do so.

I agree with your Psychiatrist in this respect that you may wait for few more weeks to see the full effect.

Also Clomipramine is a very effective drug for OCD and it may be considered as an alternative option if the current strategy dose not work.
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