Managing Anxiety Medications: Adjusting Dosages for Better Stability

Anxiolytics

My daughter has been stationed in mainland China for nearly two years, but due to the pandemic, she has had few opportunities to return to Taiwan.
Six months ago, she sought psychiatric help in China due to feelings of depression and anxiety.
She was prescribed Lexapro 10 mg (half a tablet daily) and Mirtazapine 15 mg (half a tablet daily).
Initially, her condition was stable, but recently, after switching brands, her mood has become unstable again.
I would like to ask if the dosage of Mirtazapine is too low to achieve the desired therapeutic effect.
What would be a better configuration? Thank you! A concerned and helpless father.

Ping Ge, 50~59 year old female. Ask Date: 2023/02/15

Dr. Wu Enliang reply Psychiatry

If the instability is caused by switching brands, it is possible that the quality of that medication is not ideal.
It is recommended that she discuss this with her physician.
Dr.
Wu Enliang.

Reply Date: 2023/02/15

More Info

Managing anxiety and depression through medication can be a complex process, especially when dealing with changes in medication brands or formulations. It’s understandable to be concerned about your daughter’s emotional stability, particularly after a change in her medication.
From your description, your daughter is currently taking Lexapro (escitalopram) at a dosage of 5 mg (half of a 10 mg tablet) and Mirtazapine at 7.5 mg (half of a 15 mg tablet). Both of these medications are commonly prescribed for anxiety and depression, but their effectiveness can vary based on individual responses and circumstances.

Lexapro is a selective serotonin reuptake inhibitor (SSRI) that is often used to treat anxiety and depression. The typical starting dose for adults is usually 10 mg, which can be increased based on the patient's response and tolerance. Since your daughter is on a lower dose, it may be beneficial to discuss with her healthcare provider whether an increase to the full 10 mg dose could provide better symptom control.

Mirtazapine, on the other hand, is an atypical antidepressant that works by increasing the levels of norepinephrine and serotonin in the brain. The usual starting dose is 15 mg, and it can be increased based on the patient's needs. The 7.5 mg dose your daughter is currently taking is considered low and may not be sufficient for optimal therapeutic effect. Again, consulting with her doctor about the possibility of increasing the Mirtazapine dosage could be a good step.

It's also important to consider that switching brands or formulations of medications can sometimes lead to variations in effectiveness due to differences in inactive ingredients or the way the medication is absorbed in the body. If your daughter has recently switched brands and is experiencing instability in her mood, it may be worth discussing this with her healthcare provider. They might recommend switching back to the previous brand or adjusting the dosages of her current medications.

In addition to medication adjustments, it might be beneficial for your daughter to engage in therapy, such as cognitive-behavioral therapy (CBT), which has been shown to be effective for anxiety and depression. Therapy can provide her with coping strategies and tools to manage her emotions, especially during challenging times.

Lastly, it’s crucial to maintain open communication with her healthcare provider. Regular follow-ups can help monitor her progress and make necessary adjustments to her treatment plan. Encourage your daughter to report any side effects or changes in her mood, as this information is vital for her provider to make informed decisions about her care.

In summary, the current dosages of Lexapro and Mirtazapine may be on the lower side, especially if her symptoms have returned after a change in medication brand. Consulting with her healthcare provider about potential dosage adjustments or alternative treatment options, including therapy, could help improve her emotional stability. Your concern as a father is commendable, and supporting her through this process is invaluable.

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