Welcome to the first official newsletter! Below you will find the general format that we will follow:
1. Counselling Conundrum: a real question from a patient
2. Concise Conclusion: a straight-forward patient-friendly answer
3. Quick Wrap-up
Clearly, there are nuances that may not be captured in this format. The goal here is to provide you with helpful counselling tips which often draw from multiple sources or those which are not commonly accessed by busy healthcare providers serving the community.
Counselling Conundrum: "Since starting my mirtazapine 15 mg at bedtime, I wake up drowsy. My doctor suggested I take half instead, but now it's like I'm even more drowsy! What should I do?"
Concise Conclusion: Unfortunately mirtazapine is not like most medications; at higher doses it tends to have more effect on a chemical called norepinephrine, which makes you more awake. At lower doses, it can actually cause more drowsiness than at higher doses. The solution may be to actually increase your dose to 30 mg, or to change to a different medication altogether.
Quick Wrap-up: We first encountered this issue while reading about the treatment of depression. Surprisingly, this information was not in the monograph, and nowhere in the usual go-to references. It is not at all surprising the prescriber was not aware (it's difficult enough to excel at diagnosis of disease, let alone learn complex pharmacology on each medication they prescribe), but it was surprising to be just learning this now. How many patients had suffered this same fate while taking their mirtazapine?
We hope you have found this useful, and please reply to this email with any feedback or topic suggestions you can; it will be the key to making this newsletter the best it can be.
P.S. Thank you to one of our readers, K.G., for the correction; it is NORepinephrine, not epinephrine!
Dive Deeper
Comentarios