Hi iris11 and Hikoi,
I have flagged this up a number of times on here.I went through a number of Anti-depressants including Mirtazapine then back to Mirtazapine again.The contra-indications/interactions of the Mirtazapine and Azilect being the main concern/issue.The serotonine syndrome being the main concern.One of the side effects I had when first placed on Mirtazapine was hair loss on my lower legs.Not just patchy,but almost entirely smooth.Women my find this a bonus,but not men.
So I stopped the Mirtazapine whilst the matter was looked into in depth by a Pharma psychologist.Having been under a psychologist and psychiatrist for some time now for depression and other issues.The hair loss was a new one on him,having looked into reported side effects with Mirtazapine.His findings were,that Mirtazapine was the safest option of all the Anti-depressants when used in conjunction with Azilect.Mainly due to the serotonine syndrome link.Also,that the hair loss was a small price to pay for the hopeful alleviation of depression.
Azilect being in the MAOI(Monoamine Oxidase Inhibitor),a group which should not be used in conjunction with MAOI Anti-depressants.The contra indications will always be of concern.Plus everybody is different in their tolerance and side effects.The same applies to all medication.The other option was to stop the Azilect for at least 2 weeks before taking an Anti-depressant,then recommencing the Azilect 2 weeks after completion of treatment of Anti-depressants.This is not really practical if the Anti-depressant is long term ongoing(as in my case).As is the Azilect.
I did not want to stop the Azilect,as I feel it of benefit in slowing the progression of parkinsons ,having taken it for 4 years now without any problem or side effects,and in conjunction with both Mirapexin and Sinemet.
The risk of Mirtazapine used in conjunction with Azilect was deemed as small by the pharma psychologist in my case.Other people however may react differently,it is as well to be observant,as no other Anti-depressants were deemed suitable when used at the same time as Azilect.
I take 45mg of Mirtazapine(maximum dose per day)each evening.Have done for over a year or so.I have taken 1mg Azilect(fixed approved beneficial dose) each morning now,for over 4 years.No other adverse effects,even the hair loss on legs is diminishing.
The thing is though,there have been a large number of pwp who just can't take to Azilect on its own(or should i say,without the addition of Anti-depressant),hair loss,sickness and migraine being 3 of the more common side effects mentioned.We are all different.Medication unfortunately is a minefield,it is always best to stay vigilant.
I hope i have not made this too confusing.