Certain Anti-depressants and alleviation of parkinsons symptoms

After reading all your posts, Titan, I can't understand why I had to come off of Azilect (which I found to be very beneficial) about 3 years ago to be prescribed Mirtazapine.

Both my GP AND neurologist told me that the two COULDN'T be taken in conjunction!

I'm very confused!!!  Have I missed something - or am I just being thick?



You seem to be a victim  of what we were trying to avoid......medical staff who do not have the info to prescribe effectively and safely.

After our experience of lack of agreement about the way forward, the chief pharmacist in the

psychiatric  hospital, who was consulted by other medics in the north when in doubt about drug interactions, 

gave us the results of the investigation of all relevant literature...Mirtazipine is the safest AD to be taken with

Azilect but must be introduced carefully and the patient monitored.

We only want PDUK to publicise this and then folk like you will not be told to forego the benefits of Azilect.

You could relay this info to your GP , let him/her check it out and try Azilect again, carefully.



Hi All

Yes i had a similar problem a few years ago.

Having been overdosed on Mirapexin for  number of years (over 2 years at 8.4 mg - max recommend dose 3.14mg) my PD nurse came up with the idea that Prozac would benefit me as a replacement for the reduced Mirapexin.

Cut a long story short I read the drug leaflet and found that Prozac interacted with the selegeline. to the point it could potentially have killed me.

I stopped the Prozac and I challenged the chemist at Boots and they got the book out and reluctantly accepted I was right.

All the professionals missed this.

I know a fellow PWP given trycyclic anti deps by gp and then an SSRI by neuro and the plan was to add Azilect!!!

This was raised as a problem and dealt with by withdrawal which was no fun for the patient only to be followed by an excess dose of Azilect which when taken with sinemet caused nausea. 

Again this was brought to the attention of the medics by the patient, the PD nurse was apologetic admitting they should have followed up the prescription.  This patient receives as and when care not regular appointments at clinic.

What chance has the patient got when the medics have such an array of drugs at their disposal and different preferences by individual neuros with varying degrees of care and the odd mistake thrown in.


Hello everyone,

Thank you for raising this.

I'm going to investigate all the points you've raised about information you feel is missing from our resources.

But do note that this will take time. All our health and social care information is Information Standard accredited, which means it goes through an extensive process to make sure the information is robust, up to date and medically sound.

As part of this process, all our information is reviewed by expert Parkinson's professionals.

Our Drug treatment for Parkinson's booklet is currently being reviewed and I will highlight the issues you've raised with the experts helping us to produce our latest version.

Thanks again for you comments.

Thank you Alison for taking on this necessary task.

I do appreciate that medical staff are involved in treating many conditions and cannot be expected to know all drug interactions and dangerous combinations but PDUK can collate necessary info on Parkinsons meds  and make sure it gets into the right hands.

Otherwise the life of a PWP  is going to be a bit Russian roulette!

Clearly many potentially dangerous situations are being created by lack of correct info.

On a different note, I was surprised to see that my post had been rearranged into a poem format!

How creative!



As I've been off Azilect for about 3 years would there be any benefit going back on it or is it too late?

All the time I was on it, my symptoms were minimal, but since coming off, I have deteriorated rapidly to such an extent that my "off" periods last almost all evening and I find that my "freezing of gait" has advanced to not being able to walk at all most evenings (especially when I've been to work all day on site after taking my first dose of Stalevo at 6.15).

I am undergoing DBS in July probably - would I gain anything meanwhile by taking Azilect again?

Many thanks


The honest answer, Gary, is that I have no idea...and worse..I have no idea who can answer accurately.

The Helpline is unlikely to know , nor the GP

I would guess that the consultant overseeing the DBS would be the best person to ask.

Do people carry on taking Azilect after DBS seems the main question. If they do, to maintain its neuro protective link, then it would seem a good idea to restart it.

You could ring the consultant's secretary and ask for an appointment or a phone consultation.

Tell him/her what you have read on the Forum and ask if s/he could look into the situation and advise.

I'm sorry I can't be more help but do try and get some reliable info.

If it is possible to restart and take after DBS it would be a shame to lose out on the benefits.

Good luck!



    Well Gaz1403.To discontinue the Azilect when starting the Mirtazapine would at first glance of the leaflet which accompanies the medication,seem to be the wize move.However,this is not the case with Mirtazapine.A further in-depth search by experts in the field have found that Mirtazapine is safe to be used in conjunction with Azilect.But i admit that the leaflet does incite confusion.
     The whole reason i dug deeper was because i could not believe that something for depression could not exist that could be taken in conjunction with the Azilect.I don't think you are confused or missed something,or even being thick.You were just being a compliant patient,how could you know.
      I am not compliant however,am rather paranoid,which is why i would not rest.This is why i have continually highlighted this topic.PWP like yourself are going without a possibly vital parkinsons medication(Azilect),due to ignorance in the medical profession.Worse still,there could be countless of PWP taking other Anti-depressants with the Azilect,with a high possibility of seriously compromising their health.
      As for your DBS procedure,i can't see any reason why you can't start the Azilect again.The usual procedure with pd meds is to take them up to the time of operation and start taking them again as soon as physically able or safe to do so.As Goldengirl says,it may be an idea to confirm this with your DBS team.I wish you all the best with your DBS in July.
      Leyther,Seems like we were going through similar at the same time,makes perfect sense now.When i was first diagnosed in Nov 2009,my Neuro was going to start me with an Anti-depressant at the same time as my Azilect,similar to you.I declined at the time,with Azilect being my first med,followed a couple of weeks later by Mirapexin,i didn't want conflicting side-effects.How right i was back then.God knows what Anti-d they would have put me on.Could have caused untold problems from the beginning.The Neuro had no clue and on my last visit,my first for a year and a half,a couple of months ago,STILL DOSEN'T.Looks at me like i'm insane or something.I think we are our own best judges!
       To PDUK team,thanks for taking this matter seriously.
                          Take care

I am intrigued by the posts i have just read about antidepresants and anti convulsants i have had experiances with all the afore mentioned meds and await further posts with interest, [sorry about the spelling mistakes ]

Further to my post of 6 March, I contacted my neurologist and asked if she could put me back on Azilect - which she did, much to my surprise, without any hesitation (I was expecting a negative response).

I don't know if it's coincidence or not, but from my first day back on it, I have felt so much better - I have been able to go 3 hours between doses of Stalevo with hardly any "off" periods whereas before, I was having to take it every 2.5 to 2.75 hours and was experiencing elongated "off's".

Also, my mood seems to have lifted considerably and I don't feel as tired in the evenings as I had been recently - even though I have been having 5 - 5.5 hours' sleep, getting up at 6.00.a.m. and working on site laying bricks all day!

I just hope it carries on like this - I can cope with my Parkie's while it's like this!

Cheers, Gary

Well done, Gary!

It is a pity we have to find all the info ourselves before we can  get a good combination of meds!

I do hope you continue  to feel so well.



Thanks, GG

Love, GG

After seeing no-one for ten months my wife got a cancellation and saw her consultant yesterday.She has been takings 4 Sinemet and 1 x Azlitec a day and 15mg of Mirtazapine.  Amongst other things she has low blood pressure and has gained a stone in weight since seeing the consultant last April. We explained to him that we didn't think the Azlitec was of any benefit and about low BP and her weight gain. I had looked up Mirtazapine and found that it can cause weight gain. Anyway the consultant has told her to drop the Azltec and take 1 more Sinemet and to see her GP about changing the Mirtazipine. She had her BP taken and it was low he said to add more salt to her diet and monitor the BP.Today when looking up Mirtazipine it says to contact your GP if you have low BP !!!!!!....... I will have to keep an eye on things just wish she could have seen someone sooner.                    all the best   Billywhizz                                                                                                                                                      

That's very interesting, thanks for that, Bill.

I also take 1 x Azilect along with Mirtazapine so will have to keep an eye on it too!



Gaz it will probably take some weeks before we notice any change (it there is any) hopefully for the better, but who knows. My wife had to take ill health retirement, she suffers from fatigue, balance , slow movement and slurred speech amongst other things. I will let you know how things go


see post 33...............Me again, my wife hasn't felt good since changing her meds 3/4 days ago, feeling unwell and lightheaded, but she has been like this before. We are not sure if its coming off the Azilect or the extra sinemet or just going through a bad spell..... i suppose time will tell.