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Hello I believe I can help you with your concern
Taking both Sertraline and Mirtazapine can increase your risk for a condition that is called Serotonin Syndrome, which can be very serious. Here is a link detailing the interactions for you and another link describing Serotonin Syndrome for you.
Now these medications can be combined if they are at low dosages, but if they are at standard or higher than average dosages then your risk for Serotonin Syndrome is considerable and not advisable.
What does would you recommend the sertaline and mirtazapine to be at then
50mg of the Sertraline and 15mg of the Mirtazapine as the initial dose to see how you react
what would the symptons be if I couldnt tolerate the combination
Also what are you thoughts on venlafaxine and miertazapine combination as i have had depression for 13 years and resistant to treatment
The links that I gave you have a list of the symptoms, but they include confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea.
I get diarrhea from sertraline at 200mg on its own but no improvement in mood
You are going to have the same risk of Serotonin Syndrome with Venlafaxine as well because Venlafaxine also increases serotonin in your system like the Sertraline
It takes away my anxieties for half the day
Well adding both the miertazapine and Sertraline has been shown to improve mood more than when just one of the medications are used, but you do have to take the lower dosages because of the risk of Serotonin Syndrome
I just know a few people on the venlafaxine mirtazapine combination and its works for them do you have any recommendation for dosage of these combinations
Same dosages as before, 50mg of Venlafaxine and 15mg of the Mirtazapine, but as your body gets used to it after 2 weeks you should increase the Venlafaxine to 75mg.
Is that the lowest dose of venlafazine and would you advise to start them at the same time
You should start them at the same time, and the lowest therapeutic dosage is usually 75mg of the venlafaxine, but Effexor has a norepinephrine boost, so starting at 50mg will reduce being jittery associated with both medications taken together
Again these are starting dosages and you can increase them slowly under the guise of a physician to get a good dosage that is beneficial and does not cause Serotonin Syndrome, so gradually increasing the dose is wise.
I have seen some patient with this combination have Serotonin side effects at low dosages and some with dosages never having side effects, it really depends on how your body reacts to the medication combination as we are all different. This is why starting at low dosages is very low risk and increasing slowly further reduces the risk of serious effects of serotonin syndrome.
Also here is the link on the drug interactions of mirtazapine and venlafaxine for your information
what is the effect of taking mirtazapine on its own for mood and ptsd
Well it is very effective in treating disorders like depression, anxiety, and PTSD. Some individuals do not like the side effects like weight gain, sedation, dizziness, and general malaise, but it is a very effective medication
sedation and malaise doesnt sound like mood improvement
Usually these side effects are temporary as you get used to the medication, usually around 4-6 weeks these effects are not as problematic. Truthfully the biggest complaint I hear about is the increased appetite, which causes increased weight gain.
thankyou for your advice