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TherapistMarryAnn, Therapist
Category: Mental Health
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Experience:  Over 20 years experience specializing in anxiety, depression, drug and alcohol, and relationship issues.
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Is there an alternative to mirtazapine? I have been taking

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Is there an alternative to mirtazapine? I have been taking 45mg daily for 5 weeks now and my anxiety is no better
Hello, I'd like to help you with your question.

The medications you have been taking are geared to dealing directly with anxiety; however, many of them are also used in the treatment of depression. Sometimes the medications that are used to treat depression and anxiety such as mirtazapine take a considerable time before you may symptom relief. In the case of this medication, you may not experience any significant relief for up to 8 weeks. As a result, I would encourage you to consider staying on the mediation for the full initial treatment period.

Alternative to the medications you have been taking depend on the type of anxiety you are experiencing. If the anxiety is free floating and steady, medications like Buspar may be helpful. If these are attacks of anxiety, some of the medications listed below may be most helpful. However, please know that each of these medications, with the exceptions of the benzodiazepines (such as Xanax and Valium) take several weeks to work.

Whenever medications are used for treatment, it is very common for people to need to try several different medications or more before finding one that helps. This is because everyone's body chemistry is different. So if one medication works for one person, it may not work for another or it might even cause adverse side effects. So don't be discouraged. You will find the right medication for you.

Here are some of the more common medications for anxiety:
Xanax (alprazolam)
Klonopin (clonazepam)
Valium (diazepam)
Ativan (lorazepam)

These medications are known as benzodiazepines. They help to slow down your system and help produce a calming effect. They are also fast acting. As a result, they are very popular and often the first line of medications tried for someone with anxiety disorder. But they do have unwanted side effects such as slowing down reflexes and thinking ability, making a person feel foggy or even drunk. This can impair a person's ability to function in such situations as driving.

Anti depressants can also be used for anxiety disorders. Prozac is an example of an anti depressant. Others include Zoloft, Paxil, Lexapro, and Celexa. These work by regulating serotonin levels in the brain to elevate mood. They can take up to 4 to 6 weeks to establish full effect in the blood. Side effects include nausea, sleepiness and weight gain. Withdrawal is also an issue, requiring a doctor's supervision.

Another possible mediation is Buspar. It also works to increase serotonin in the brain like anti depressants do. It takes up to 2 weeks to work. But it has less of a sedating effect than other mediations. It also has low risk of dependence.

Also, anxiety is easy to treat with therapy. In therapy, you learn to pay attention to what you are thinking to make yourself anxious. The therapist then can help you change your thoughts and therefore how your body reacts to your thoughts. You also can learn about how to let yourself float through your anxiety thereby gaining more control over how you feel. When a panic attack comes on, you allow it to flow over you without tensing or panicking in response. This makes the panic reduce or go away faster. To find a therapist, talk to your doctor about a referral. Or you can search on line at

You can also help yourself at home. There are numerous resources to help you learn more about anxiety and how to control your panic. Here are some to get you started:

The Anxiety and Phobia Workbook by Edmund Bourne is excellent for any fears. It is self help and contains everything from supplements to relaxation techniques.

The Cognitive Behavioral Workbook for Anxiety: A Step-by-Step Program by Bill Knaus Ed.D. and Jon Carlson Psy.D. Ed.D.

From Panic to Power: Proven Techniques to Calm Your Anxieties, Conquer Your Fears, and Put You in Control of Your Life by Lucinda Bassett

You can find these books on or your local library may have them for you.

I hope this has helped you,
Customer: replied 4 years ago.

Kate. thank you for your advice. My anxiety is free floating. I have also been prescribed beta blockers. you don't mention these


Yes, beta blockers are often used to control anxiety. But they are first line choices which means if you have anxiety that has not responded to other medications, beta blockers will not be tried because typically, they are the least effective medications. What you are describing is generalized anxiety of which Buspar is most typically given.

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