Peter: Mirtazipine withdrawal

[Peter]

I am 65 and was prescribed Mirtazipine 2.5 years ago for severe stress/anxiety as a result of continued work and business pressures.

7.5mg for 9 months although was prescribed 15mg at first but couldn’t stand the feeling it generated.
Stopped taking cold turkey after life crisis over - sold business. Intolerable anxiety and insomnia for about a month after stopping. Reinstated to 3.5mg after that month. Remained on 3.5 mg for 6 months.
Stopped taking cold turkey. Intolerable symptoms as before - tolerated for about 3 weeks. Reinstated at 1.85mg approx ie 1/8 tablet - symptoms just tolerable. About 4 weeks to 1/16 tablet then after another 4 weeks 1/32 tablet then as it impossible to get a consistent dose stopped taking altogether.
Now 4 months clear but still suffering terrible sleep problems with nervous/anxiety attacks every time I drop off to sleep - about every 2 hours.
Currently getting about 4 hours disrupted sleep a night. Usually up between 3am to 4am and meditate - has taught me how to let the symptoms wash over me.
Daytime now not too bad provide I keep occupied and have plenty of fresh air and exercise - but so tired. Still have bouts of severe anxiety although there is no obvious cause. Booze is a no no - even one beer seems to exaggerate the symptoms to intolerable levels and further disrupts sleep.
I have lost my trust in GPs and do wonder whether they really know what they are talking about regards these sorts of issue and the drugs they prescribe. I prefer to go it alone.
Really now just wonder how long I can expect these sleep and anxiety issues to resolve themselves.

Resources I have used:

Claire Weekes: self help for your nerves 

Anxiety Coaches Podcast by Gina Ryan

Headspace app

Rewire your Anxious Brain

 

[Altostrata]

Welcome, Peter.

 

You have withdrawal syndrome from mirtazapine. Rebound insomnia is common. You might reinstate 1mg; this topic explains how to measure a small dose Tips for tapering off Remeron (mirtazapine) You'd stabilize on that for a month or more, then taper off by tiny amounts. See

 

What is withdrawal syndrome?
 
About reinstating and stabilizing to reduce withdrawal symptoms
 
The Windows and Waves Pattern of Stabilization

 

You might also find these topics helpful:

 

Tips to help sleep -- so many of us have that awful withdrawal insomnia

 

What is the sleep cycle?

 

Melatonin for sleep: Many people find it helpful

 

TV or computer use in evening can disrupt sleep: Bright light signals the brain that it's daytime

 

 

Please let us know how you're doing.

 

To help us out, see these instructions Please put your drug and withdrawal history in your signature

[Peter]

It’s seventeen weeks now since complete withdrawal from Mirtazipine. I was hoping that my disruptive sleep pattern would have started to stabilise but I am still finding I fall asleep for 2-3 hours only to awaken with a start with pounding anxiety symptoms. I still find my best policy is to get up and sit quietly and “watch” the symptoms “with curiosity” as my meditation practise advises. It does make one’s waking life quite challenging - tiredness and constant stress symptoms are difficult to cope with. I have to remind myself to take one day at a time, one hour at a time etc.

 

The question that I often pose to myself is how much are the symptoms as a result of the withdrawal process as opposed to being a “defect” in me? After 17 weeks one would think that the body would have self corrected but then I have read somewhere that any psychological trauma takes at least 6 months to recover from and that is with no psych drugs involved.

 

I am very reluctant to reinstate 1mg of Mirt  as the last 6 months have been at times intolerable and I would not want to have to go through that again - everyday that passes is one day nearer to complete recovery and I suppose all this does teach you stress coping strategies.

I think one of the most challenging things is coping with one’s social life. When one breaks a leg or has a knee replacement (I’ve had both) people are very sympathetic, kind and helpful but with “mental” and “psychological” conditions that understanding is not there - or so I fear - there is great stigma attached to mental ill health. I have become an expert in acting as though I am OK which frankly is quite stressful!

That’s all for now. Fingers crossed that this wretched sleep disruption resolved itself sometime soon.

 

Edited June 15, 2018 by ChessieCat
added spacing

[Altostrata]

Peter, that is a typical pattern of mirtazapine withdrawal syndrome. Withdrawal syndrome is not a psychiatric condition, it is an adverse drug reaction.

 

Please read my post and all the links in it

 

Reinstatement is up to you. A very small amount could alleviate your sleeplessness. You would taper off by very tiny amounts later.

 

But if you find your symptoms are tolerable and gradually improving, you might want to let time and healing take its course. Be patient, could take months.

 

You might want to examine your embrace of high negativity towards your own mental balance.

[Songbird]

Hi Peter, it's not you - I don't believe you have a "defect" - many people have experienced anxiety and insomnia from mirtazapine withdrawal.  It sounds like you have some great coping tools in your toolkit already which should be very helpful in your recovery process.  You might also find relaxation exercises helpful.  They are great for calming the nervous system, helping to reduce anxiety and encouraging sleep.  For example: progressive muscle relaxation, gentle yoga, calming breathing exercises, meditation, guided visualisation, etc.  I like to use recordings with gentle music and an instructor's voice telling me what to do so I don't have to think about it.  I have also used sleep CDs to help me fall asleep.  You could try a few things out to see what works for you.

[Peter]

Hi Songbird

Thanks for the advice and tips - I’ll certainly give them a try

Peter

[Peter]

Hi Altostrata

Your comments are very reassuring - thank you

Peter

[Peter]

I had been feeling much much better and was quite optimistic that things would continue to improve. Then just four days before the 6 months after a good previous few days and feeling that my sleep had returned almost to normal, quite unexpectedly my severe “stress” symptoms flared up at 1:30am when I awoke in an acutely anxious state. I felt that I had gone back to square one with severe “anxiety” and “depression” and dreadfully disrupted sleep for no apparent reason. I am still feeling rather fragile four days later but the intensity of the symptoms has now after four days  ebbed somewhat.

Is this something like the 10 month wave that is talked about in the “How long is this going to take” essay on this site?

[manymoretodays]

Hi Peter,

Definitely something like that.  We talk about windows and waves here a lot too. The windows and waves pattern of stabilization.  There's a link to that particular topic in your first post from Altostrata.

 

This is your main introduction/journal page.  I merged your question back here, as we like to keep each member to just one introduction.  Feel free to add to discussions anywhere but try to ask questions pertaining to your situation right here.

 

It looks like you've been navigating around a bit.......that's great!

 

Love, peace, healing, and growth,

mmt

 

 

Edited August 15, 2018 by manymoretodays

[Peter]

I am about 9 months of Mirtazipine and I thought I was doing quite well and had gone through the worst. I was beginning to feel normal again. The last three weeks have been very challenging with even more disrupted sleep awakening every hours or so with nervous system going wild (anxiety but it’s not anxiety if you know what I mean) and bad “anxiety” symptoms during the day again with the nervous system going haywire. I feel very distressed and exhausted. 

Any advice or reassurance would be appreciated. 

Thanks

Peter

 

[Altostrata]

Hello, Peter, I joined your post to your existing Intro topic, to continue your case history.

 

It sounds like you may be sleeping more deeply and, paradoxically, your nervous system is jumpy about that, sounding an alarm. You might find playing some gentle music, such as meditation music or trance music, throughout the night helps with this. It can keep your nervous system just enough awake so you can sleep. After a bit, it will get used to increased relaxation.

 

Many people do better with fish oil and magnesium supplements, see http://survivingantidepressants.org/index.php?/topic/36-king-of-supplements-omega-3-fatty-acids-fish-oil/
http://survivingantidepressants.org/topic/15483-magnesium-natures-calcium-channel-blocker/

 

A lot of people find them helpful. Try a little bit of one at a time to see how it affects you.

[Peter]

I am not sure what to do. I have been 9 months off Mirtazipine and for the last 3 weeks my anxiety has gone through the roof and has become debilitating and the insomnia and fragmented sleep continues. Not sure whether this is still withdrawal syndrome or a reoccurrence of my original condition. Should I reinstate and at what level? Don’t know what to do for the best.

[ChessieCat]

Did you see Alto's previous response?

 

On 10/16/2018 at 6:26 AM, Altostrata said:

 

I joined your post to your existing Intro topic, to continue your case history.

 

 

And I've joined the new topic to your Intro.

 

This is the place to ask questions about your own situation and where you can journal your progress.

[Peter]

Hi Chessie

Yes I did receive Alto’s response. I was on holiday in Portugal and all I could find at the time was Magnesium-OK which has 145mg Magnesium + 8mg Zinc + Mangnesese 2mg, Selenium 25micrograms, B1, B2 and B6 .

I have been taking now for 27 days.

The only fish oil I could get were 1000mg Salmon Oil capsules - taking 2/day for 6 days now. There is only 360mg EPA and 240mg of DHA per capsule though.

 

I thought being on holiday would improve things as where we go is quiet and peaceful and we can play our favourite games tennis and golf and swimming but appear to have become worse.

Back in the UK now so will try to get the correct strengths.

Any other insights that may ease my suffering?

 

Thanks again

PS I meditate daily and do Progressive Muscle Relaxation but nothing seems to help

[ChessieCat]

Vitamin B6 can be activating.  hypersensitive-to-b-vitamin-or-b-vitamin-complex

 

 

Even good stress can increase withdrawal symptoms.  It might take a few weeks for things to settle down.  I had a helicopter flying lesson for my birthday last year and my anxiety increased for several weeks afterwards.

 

Non-drug techniques to cope

 

Sleep problems - that awful withdrawal insomnia

 

Is it withdrawal or relapse?  Or something else?

How do I know it's withdrawal and not relapse?

[Altostrata]

On 10/15/2018 at 12:26 PM, Altostrata said:

It sounds like you may be sleeping more deeply and, paradoxically, your nervous system is jumpy about that, sounding an alarm. You might find playing some gentle music, such as meditation music or trance music, throughout the night helps with this. It can keep your nervous system just enough awake so you can sleep. After a bit, it will get used to increased relaxation.

 

[Peter]

Just an update. Things don’t seem to be improving -.sleep still fragmented  - in fact even when asleep it doesn’t feel like sleep. Anxiety levels through the roof at times.  I feel so fragile despite the new supplement regime of Omega 3s and Magnesium started just over 2 weeks ago.

Would reinstating at a lower level be still an option or will this instability settle soon? The last month has been brutal at times - is this still Mirtazipine withdrawal despite being free of it for some 9 months now?

 

[WiggleIt]

Dear Peter, 

To answer your question, yes, this can be withdrawal despite being free of it for 9 months.  Withdrawal for some people can last years.  My insomnia was so bad at times, I thought I was going to die.  In fact, I think I logged onto this forum and asked if it was possible to die from insomnia because I frequently went over 30 hours without sleep.  My insomnia problems lasted well over a year.

I realize you are suffering badly, but it also sounds to me like you are comparatively doing rather well compared to other people in withdrawal, and, hopefully, that can give you some solace.  Anxiety notwithstanding, if you are physically able to travel, then that is a hugely hopeful sign for achieving stability.  

May I ask: Is your anxiety now better, worse, or the same as before you took meds?  

In my opinion, if anxiety has come back worse after meds and is accompanied by new physical symptoms that you didn't experience before meds, then it's a clue that what you are having is likely withdrawal and not likely a recurrence of the original anxiety.  If your anxiety is about comparable to what it was before meds and not accompanied by any new physical symptoms, then it's possibly a return of original anxiety.  In a nutshell, if something didn't exist before meds, then it was probably caused by meds.     

Also in my opinion, perhaps a "less is more" approach would be best for vitamin supplements.  After psych meds, not very many people do well with supplements, and they definitely don't do well with a zillion supplements at once.  Maybe scale back a bit?

Please note that my input here is subjective, and I'm neither a doctor nor a site moderator.  I'm a survivor here offering opinions.

[ChessieCat]

How much and how often are you taking magnesium?  It works best if taken throughout the day, not only once a day.

 

Have you tried Alto's suggestion about playing music?

 

Are you following good sleep hygiene?  Sleep problems - that awful withdrawal insomnia

[Altostrata]

Hi, Peter. Are you taking any other drugs? Have you taken an antibiotic in the last several months?

 

You might try the "sleep hygiene" tips here

 

Tips to help sleep -- so many of us have that awful withdrawal insomnia

 

Waking with panic or anxiety -- managing cortisol spikes

 

What is the sleep cycle?

 

Melatonin for sleep: Many people find it helpful

 

TV or computer use in evening can disrupt sleep: Bright light signals the brain that it's daytime

[Shebon]

Hi Peter:

 

How are you faring these last few weeks?  Hopefully, more good days and less bad nites.  Did you have anxiety issues before the rem started?  Withdrawal brings pre-anxiety back and then some. 

 

I have found some triggers that are the same when I tapered off Valium and now tapering off Rem.  I have to stay clear of violent or stressful TV or movies...anything that overstimulates the CNS.  Also, a high carb dinner ( I make sure I have more protein), and stuff with MSG in it. 

 

I hope you are well on your healing way...please stay in touch and let us know how you are feeling.

 

Best regards,

Shebon

[Phoenixmama]

@Peter how are you