Mirtazapine (Remeron) help me understand this drug

[KestonyYou]

Hello, I need help to understand how this antidepressant work for anxiety. I am suffering from severe anxiety (suspected hyperadrenergic postural orthostatic tachycardia syndrome - hyper pots) which causes my heart rate to increase by 30-50 beats per minute upon standing along with blood pressure increase, and so it's hard for even to even stand because of heart palpitations, fatigue, dizziness etc, and so i lay in my bed for 22-23 hours daily for 8 months, my muscles are GONE, i am only existing. Medicine history story in few sentences: after more than several heart tests year ago, they found nothing except mentioned sinus tachycardia episodes and high blood pressure when anxious, for example it was 170/90 with the heart rate of 120 just sittting and talking to cardiologist cuz of anxiety and body many posture changes, but it's in 40s when i sleep and it varies from 50s to 140s every hour during the day, which cardiologists think relates to anxiety. I decided to go to psychiatrist and so she saw severe anxiety and gave me ssri antidepressant escitalopram which made me a lot worse, my heart rate was 90-100 even when i wanted to go to sleep. Now she wants to put me on mirtazapine and i just can't understand how it can work because its serotonin and norepinephrine reuptaker, so how it will reduce my anxiety if i will have more norepinephrine in my blood, i thought they will block it, not increase it. This is a paradox that i fail to understand, what kind of treatment is that? I am scared that this will increase my anxiety/panic attacks/heart rate/blood pressure just like escitalopram. What were your experiences with it? Thank you!

[Paxiled]

I think you're confusing this drug with the snri class, which do significantly target norepenephrine as well as serotonin and can be hard for anxiety sufferers.  Remeron is a drug that slows metabolism usually, which is why it usually comes with significant weight gain for most people -- my psychiatrist only uses it for geriatric patients who have stopped eating because this drug can make anyone want to eat.  But there are a couple of people on this site for a long time who found this the best med for their anxiety.  I will say I'm not sure about anxiety causing the kind of blood pressure and heart problems you're asserting -- your doctors are a lot more expert than I am, but this is pretty radical.  Also wondering why you started testing your blood pressure and such so often -- we all have fluctuations, and most people have elevated blood pressure while seeing a doctor -- very common.  I guess you've been diagnosed by enough people, so I hope the med works for you.  If it were me I'd be at the Mayo Clinic or Johns Hopkins or some place like that if your heart and blood pressure are so bad you can't get out of bed to make sure nothing else is going on, but again, you have seen the docs.

[AJWS6]

I was given the med for sleep, I loved the med !!!!  helped me relax.  I tapered off for two weeks, no withdrawals.  Be aware though, Mirtazapine does cause weight gain, and high blood pressure, I gained 40 lbs in 7 months, my bp went from normal to high range.