Hi. 30mg paroxetine + 15mg mirtazapine. Is this a good combination for an anxiety disorder with depression? I have been on venlafaxine and then duloxetine for 6 years, which I understand they belong to a different family of drugs. While I was more or less stable, I never managed to be myself again. Initially it was only anxiety, which has turned into depression over time.Are SSRIs more effective than SNRI when you have both depression and anxiety?
Ms. Judith Desbonne
Ms. Judith Desbonne
Mental health specialist, Psychotherapist
Bridgwater
Sorry but I an unable to answer medication related questions. I can only suggest that you discuss your concerns with your prescribing Doctor. In the meantime you might like to consider a talking therapy alongside medication, I recommend looking at the Human givens institute website to find an effective therapist near you.

Dr. Miguel Montenegro
Dr. Miguel Montenegro
Psychologist, Psychotherapist
Liverpool
Paroxetine belongs to a class of medication known as selective serotonin-reuptake inhibitors (SSRIs) and it is licenced in the UK to treat a range of depression and anxiety disorders, including OCD, panic, etc. Which means it targets a range of conditions and not just one. Mirtazapine is a presynaptic alpha2-adrenoreceptor antagonist which increases central noradrenergic and serotonergic neurotransmission, and is licences in the UK to treat major depression. The combination of both medications is seen to help select levels of serotonin which is a neurotransmitter (a messenger chemical that carries signals between nerve cells in the brain), and it is believed to have good influence on mood, emotion and sleep.

Serotonin-norepinephrine reuptake inhibitors on the other hand completely block both serotonin and norepinephrine neurotransmitter. These class of medications are more appropriate for acute symptoms and not long term issues, because they can cause long term side effects including triggering manic or hypomanic episodes.

Medication needs to be taken with caution and you need to also take something to help line your stomach, like Omeprazole, because medication can cause gastric problems in the stomach and related organs.

Also, medication is best used with psychological treatments, to help people identify triggers for the symptoms and better coping mechanisms during relapses.

 Judith Geddes
Judith Geddes
Mental health specialist, Psychologist
Clitheroe
You need to ask your GP or psychiatrist about this as I am unable to answer medication-related questions.

Dr. Richard Fry
Dr. Richard Fry
Child and adolescent psychiatrist, Psychiatrist
Windsor
I would start researching alternative approaches alongside psychological and drug ones. Nutritional aspects may also be well worth looking at and research 'methylation' too. The long answer above is strictly correct in conventional terms, but it does not address such matters as the emerging evidence around the role of inflammation in depression and mood disorders in general (see Ed Bullmore's recent v readable book - The Inflammed Mind). Some are now wondering if antidepressants work via that pathway.... Dr R Fry, Integrative Psychiatrist.

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