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Mirtazapine and HPPD

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Hey guys,

Just thought I would add a quick post for anyone who's interested.

I saw my psych doctor a few days ago, and he's decided to start me on an antidepressant called Mirtazapine. Mirtazapine is a tetracyclic antidepressant, one that is relatively new to the market compared to most tricyclic and SSRI anti depressants.

It's day 3 now, and so far I am absolutely loving this medication. I had let my psych doc know that most SSRI's that I have tried have exacerbated my symptoms by a fair margin, and that I had to stop taking them. He gave me this one to try out.

As with all anti depressants and HPPD, it does affect the way you perceive the HPPD a little bit, but what separates Mirtazapine from other SSRI's is that Mirtazapine plays nicely with my HPPD. My visual symptoms have not gotten any worse, although the way that my body perceives the HPPD is a little bit different.

What i'm loving about this med is that it's pretty much completely taken care of depersonalization and derealization, while also working wonders for my depression and anxiety. I think once you've found a med that tackles DP/DR and anxiety and depression all at the same time, it makes dealing with the visual symptoms a very minor disturbance. Not everyone has had luck with mirtazapine, but I guess im one of the lucky ones here, as it is easily the best medication if taken for my HPPD by a long shot. Just thought I would start a topic as I really believe that this medication is worth a try if you find yourself struggling with DP/DR and anxiety+depression all at the same time.

If any of you guys have questions feel free to ask! I'm on 15mg once daily, and il be staying at this dosage for a full month before I titrate. The maximum dosage of this medication is 45mg daily.



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21 minutes ago, Onemorestep said:

Good to hear Jbalsa! Let us know how it goes. Does mirtazapine interact with the 5ht2a receptor? For some reason I feel like I heard it did once. 

Its actually an antagonist at 5ht2a, although some people have reported worsening of visual symptoms on mirtazapine.


So far my visuals are exactly as I would perceive them when I wasn't taking an antidepressant. This medication seems to differ in side effects from person to person, as for me, I'm well immersed in its antidepressant activity, and my hppd symptonology has been left untouched. This could prove useful for people who are depressed and can't take SSRI's due to their hppd.

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Yea I haven’t heard the best about mirtazepine either from those with hppd or without. It seems to be a very dirty MoA. But sometimes, dirty really works! I mean just look at keppra—that has like 6 mechanisms I can think of off the top of my head and some people achieve full remission with it. So if you find something that works stick with it I guess.


I’d suggest, based off of your negative experiences with dosage changes, that you should probably just stick with whatever dosage you’re at for a while. It might be an antagonist, but that receptor is incredibly complicated and has a ton of downstream effects. 


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It is beyond me,


One thing I can say is that Mirtazapine is continuing to have a profound effect on my pathology. Its now day 4 on my initial dose and I feel like the old me, the me that existed before I ever had HPPD. Don't get me wrong the visual snow is still there but it's just become a fact of life. A simple visual phenomenon that has only a minimal effect on who I am.

My depersonalization and derealization no longer exists. I guess I'm just lucky in terms of my pathology in that my visual symptoms have remained exactly as would if I wasn't on the mirtazapine.


Perhaps worth a try if one was really looking for relief.

My 2 cents 

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@Onemorestep am just on keppra now. Im going to hold off on posting any threads, and stay on keppra for a full year. So far after 1 month and 1000mg split twice daily I've noticed a drastic decrease in DP/DR and about a 30% improvement in visual snow and visual symptoms.


Increasing to 1500mg daily tomorrow. Im going to stay on just keppra for a full year, fingers crossed a year of this can cure my hppd, as my symptoms are already hugely improved. ?

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