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Mirtazapine (remeron) on the heart

Hello, I need help to understand how this antidepressant work for anxiety and potentially will lower my HR/BP. 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!
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Avatar universal
I have bouts or episodes of panic attack every few years, and over time, my psychiatrist has tried me on four or five different SSRIs.  My experience is that one size does not fit all, and that the medications have to suit individual patients.

For example, Escitalopram and Paroxetine made my anxiety worse.  By contrast, both Citalopram and Sertraline calmed down the anxiety and panic very nicely.

I think you are wise to be worried about this.  In reading about Mirtazapine, I get the impression that it can pretty easily worsen a patient's depression *or* anxiety (and in the US, the drug does carry the so-called 'Black Box' warning about this possibility).  

Since I suffer from anxiety and panic, I myself would ask the shrink for a medication better know for a sedating effect.   Sertraline works beautifully for me in this regard.
Avatar universal
I was on Remeron and it caused more pvc's for me, the psychiatrist looked up side effects and did'nt see anything about that causing pvc's and wanted to increase the medication, needless to say I never went back to him, once i stopped the Remeron they calmed down significantly.
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