BfromNJ: mirtazapine taper

[brassmonkey]

It's not an adverse reaction, but you have really shocked your body with the much higher dose. You are giving yourself a 500% increase from what your were stabilizing at and your body doesn't know what to make of it. You may stabilize at this dose, but it will take a very long time and be quite uncomfortable doing so. Once stable you will then have a much longer way to taper to get off the drug.

 

Your body is more likely to tolerate the lower dose and may stabilize faster there. But it still is going to take a long time to stabilize. I would opt for the lower dose, either 10 or 15.

[BfromNJ]

1 hour ago, brassmonkey said:

It's not an adverse reaction, but you have really shocked your body with the much higher dose. You are giving yourself a 500% increase from what your were stabilizing at and your body doesn't know what to make of it. You may stabilize at this dose, but it will take a very long time and be quite uncomfortable doing so. Once stable you will then have a much longer way to taper to get off the drug.

 

Your body is more likely to tolerate the lower dose and may stabilize faster there. But it still is going to take a long time to stabilize. I would opt for the lower dose, either 10 or 15.

Okay.  Makes sense.   Since I already have the 10s made up I guess I'll go with that, since I was there before.   What a mess I've made of things.  😫

[BfromNJ]

@brassmonkey

So I have some fluid in my middle ear and doctor says to take pseuophedrine (sudafed) to drain it before it develops into an ear infection.   Pharmacist says its ok with my meds , but being the issue I just had with the dosage increase then reduction back down am I going to rock the boat?  I'm two days now back at my 10 mg of fluvoximine.  Doing ok.  I dont know much about Sudafed and psych meds.  There is also a chance I will need to take an antibiotic for a uti.  I'm a mess. 🥴

[brassmonkey]

Sorry B, but I really can't offer advise on medical conditions. I do know that Sudafed has psycho-active properties and may not play nicely with your other drugs. But you don't want an ear infection, they are no fun at all.

 

For the UTI try to stay away from Fluoroquinolone based antibiotics. They are the ones that can cause a lot of problems.

[BfromNJ]

1 hour ago, brassmonkey said:

Sorry B, but I really can't offer advise on medical conditions. I do know that Sudafed has psycho-active properties and may not play nicely with your other drugs. But you don't want an ear infection, they are no fun at all.

 

For the UTI try to stay away from Fluoroquinolone based antibiotics. They are the ones that can cause a lot of problems.

Yes he gave me ceftin.   So good there.   

 

Yeah I'm leery of the pseuophedrine myself.  Good thing is though that this antibiotic can treat an ear infection too.  

Thanks! You have been a big help. 

[BfromNJ]

@brassmonkey

 

So I had a question regarding my recent updose to 50 mg for 4 days and then my reinstatement back down to the 10 mg that i was at before the updose.  Is that reduction from 50 mg down to 10 akin to abruptly stopping?  Or is it not since I am still taking 10 mg?  is it like suddenly stopping?  I wouldnt think so because I still have the drug in my system the whole time?  

 

Just wondering because I am suffering with some symptoms that I would equate with completely stopping a med cold turkey.  

 

Really suffering .  5 days now at 10 mg.  it seems like every minute of the day my symptoms change.  

[brassmonkey]

No it is not like a CT. It will have confused your body a bit, which will take some time to stabilize, but things will settle out given time.

[BfromNJ]

1 minute ago, brassmonkey said:

No it is not like a CT. It will have confused your body a bit, which will take some time to stabilize, but things will settle out given time.

Thank you.   I hope you all know how much you are appreciated. 

[BfromNJ]

@brassmonkey

 

I see a little information here and there on here about melatonin.  So I am assuming this is okay to take during withdraw and with the meds?  I did take it a few times last week, but I felt a bit more depressed the next day.  I am having an awful time now with sleep, last night because of my tinnitus and the muscle spasms and involuntary movements I am experiencing.  These actually scare me.  It used to happen years ago on prozac but only my legs.  this is all over my body.     

 

I do have vistiril to take as needed.  I havent really taken any recently since being out of the hospital. I do know it does relax me.    What is your thought on this?  Bad idea with my recent changes or is vistiril not so so bad?  I know its an antihistimine.  

[BfromNJ]

@brassmonkey

So its been 2 weeks that I went back down to the 10 mg after being put on 50 mg inpatient for 4 days.   Prior to the inpatient I was at the 10 mg for about 2 weeks as well.  I know in addition to the 50 mg updose, that I also tapered too quickly from january/feb to may.  I went from 18.75 to 10 mg in those months.  I knew  better and shoud have waited more after my gaba taper. I'm struggling.   Do I stay the course at the 10 mg and ride it out?  Or updose some?  im dealing with physical symptoms.   Im too embarrassed to say what.   Its debilitating.    

[brassmonkey]

If at all possible just ride it out. Hope the embarrassment lifts soon.

[BfromNJ]

10 hours ago, brassmonkey said:

If at all possible just ride it out. Hope the embarrassment lifts soon.

Thanks.  I will.   I didnt want to indicate what is going on because I dont like to see it in writing.   Its just another reminder and makes me feel like it will never go away.   I feel so uncomfortable and hopeless at this point.   So another question-  if 25 mg is what they say is the lowest starting dose, and im only at 10 if I stay at 10 a while, will I be in constant withdrawal?  Does that make sense?  Is it always not gonna be enough?   Or is their therapeutic dosing just an arbitrary number?  I always wondered how they determine that.  

 

Fluvoximine has a very short half life which I am sure isn't helping.    

 

The weird thing is I seem to have a pattern.   Feel really bad, even with my physical issue in the morning, along with anxiety.  Slight improvement in the afternoon but by late afternoon I have a terrible spike in anxiety and depression.  I improve all around late in the evening.   

 

Here is all my physical  symptoms- 

Insomnia

Body vibrations (internal tremors)

Pounding heart 

Blurry vision

Urinary and genital issues (this is the embarrassment,  the genital part) 

Bad body jerks/muscle spasms at night

No appetite

 

Gosh I messed up. I wish I waited to taper thid med.   What was I thinking?  

[brassmonkey]

In my mind the "starting dose" and other prescribed doses are all made up numbers. The manufacturers probably have some sort of "plan" about what is a good dose, but they have to average it out over thousands of patients and make a "one size fits all" recommendation.  The reason we have people taper to such lose doses is because even a very small amount still can have quite an affect on a person.

 

I don't see you having problems with the dose being too small while holding. Down the road there could be a tolerance problem come up, but that would take years of holding at this dose before it happens.

 

That pattern of daily symptoms is pretty common. It actually can help you plan your day, as you will know when is a good time to take it easy and when you are likely to feel better. Please don't blame your self, ADWD is such a complicated experience it is very hard to know just what to do, and it doesn't help that the people we are meant to trust have no idea what is going on. We do what we can with what we know and let our bodies guide us.

[ChessieCat]

 

14 hours ago, BfromNJ said:

Fluvoximine has a very short half life which I am sure isn't helping.    

 

The weird thing is I seem to have a pattern.   Feel really bad, even with my physical issue in the morning, along with anxiety.  Slight improvement in the afternoon but by late afternoon I have a terrible spike in anxiety and depression.  I improve all around late in the evening. 

 

It could well be that you are experiencing interdose withdrawal because of the short half life.  If the pattern you have described occur everyday, then that would be a good indication that this is what is happening.

 

You could try splitting your dose.  You would do this by moving a portion of your dose by 1 hour each day.  Keep daily notes to see if the symptom pattern changes.  If you notice that the worsening starts to happen later then that would indicate that it is interdose withdrawal.  Keep a check on your sleep because you don't want to mess that up.

[BfromNJ]

29 minutes ago, ChessieCat said:

 

 

It could well be that you are experiencing interdose withdrawal because of the short half life.  If the pattern you have described occur everyday, then that would be a good indication that this is what is happening.

 

You could try splitting your dose.  You would do this by moving a portion of your dose by 1 hour each day.  Keep daily notes to see if the symptom pattern changes.  If you notice that the worsening starts to happen later then that would indicate that it is interdose withdrawal.  Keep a check on your sleep because you don't want to mess that up.

Interesting.  I was wondering about that. But I couldn't understand why I felt BETTER at night, after that afternoon  anxiety spike.  This spike is usually being distraught and upset about a  physical symptom that is debilitating me. I take it now before bed. So wouldn't I feel even worse in the evening?  I was wondering about cortisol or hormonal spikes maybe too?  I'd like to try splitting my dose,  as I have heard its sometimes taken twice a day.  But im recently trying to stabilize after some too big drops and an updose inpatient.   Would splitting upset the apple cart?

 

Another thought-  am I now having more side effects on a lower dose? I took it earlier than normal tonight before going to bed and I felt physical symptoms ramping up.  Can  lower dose give u more side effects?   I know that makes no sense but nothing with these meds does.  🙄

[BfromNJ]

 

 

I wanted to also add to the above.  When I say the afternoon anxiety spike, its not really another spike because i really dont get a break from it.   Pretty much continues all day from the morning.  And then seems to improve around 8 pm.  I have noticed by about 5 pm I am beside myself after dealing with this physical issue all day.  I believe its pgad again.  I had an issue with this two years ago when I reduced the fluvoximine by 25%.  I had thought back then it would be okay because I had not been on it very long.    I cannot distract or think of anything else. So I am wondering if my anxiety is just straight anxiety in dealing with this horrible condition.  Im having a really hard time dealing with it.  To the point of wishing I was just gone.   I see no light at the end of the tunnel.   Although yesterday I had a good day with it.  Which i feel tricks us into thinking it is gone for good.  Only to come to another day of torture.  I did not previously indicate what my physical symptoms were because I feel like even writing it makes it all that more real.  

 

If its interdose I cant understand why it gets better later in the evening.  But maybe the withdraw has worn off?  

[BfromNJ]

On 7/10/2021 at 4:34 PM, brassmonkey said:

In my mind the "starting dose" and other prescribed doses are all made up numbers. The manufacturers probably have some sort of "plan" about what is a good dose, but they have to average it out over thousands of patients and make a "one size fits all" recommendation.  The reason we have people taper to such lose doses is because even a very small amount still can have quite an affect on a person.

 

I don't see you having problems with the dose being too small while holding. Down the road there could be a tolerance problem come up, but that would take years of holding at this dose before it happens.

 

That pattern of daily symptoms is pretty common. It actually can help you plan your day, as you will know when is a good time to take it easy and when you are likely to feel better. Please don't blame your self, ADWD is such a complicated experience it is very hard to know just what to do, and it doesn't help that the people we are meant to trust have no idea what is going on. We do what we can with what we know and let our bodies guide us.

Thanks brassmonkey.  it makes sense, since everyone is different - bigger, smaller, more sensitive etc.  I have even heard women and men differ because of hormones.  

[BfromNJ]

@brassmonkey  

 

Hi brassmonkey.  I was wondering what you think about Chessiecats post above regarding the interdose withdrawal?  It makes sense.  but I wanted to run it by you, since you are familiar with my recent updose inpatient and too quick reductions prior to that.  I am still trying to stablilize on the 10mg now.  been like 16 days.  Would it be a bad idea to start the process of splitting my dose right now?  

[brassmonkey]

CC usually has some good ideas, this looks like one of them. I might wait to stabilize a bit more before starting to shift part of the dose, but it might help.

[BfromNJ]

3 hours ago, brassmonkey said:

CC usually has some good ideas, this looks like one of them. I might wait to stabilize a bit more before starting to shift part of the dose, but it might help.

I was thinking that.   I am severely unstable right now and the anxiety over my physical issue is insane.  Its so uncomfortable and really hard to distract from.   I know I've asked before-  is it a bad idea to updose to see if I get relief?   Or continue where I am? Would I be playing with fire?  

 

Here is the total history of my reductions-

1/7- 18.75 to 15 - 20%

2/7- 12.5 mg 
3/7 -10 mg

4/1- 9 mg
5/1- 8.1 mg
5/27- updose to .052 (10 mg) due to anxiety.   
too fast of a taper
6/21-  in patient updose to 50 mg
6/25- reinstate to 10 mg 

 

Honestly I barely make it through the day now.  Im desperate.   But i know its a crap shoot.  I had this issue two years ago when I reduced by 25% so not sure why I didn't remember and be more cautious.   

[BfromNJ]

@ChessieCat

@brassmonkey

 

So the more I am reading on here on Fluvoximine it seems to make sense that I am experiencing interdose withdrawal.   Although I cannot understand why it did not affect me since I have started taking it and only now that I am tapering it?  Alto indicated in a post that it is the ssri that has the shortest half life.  I dont understand why the doctor didnt do twice a day for me when it was prescribed? (oh wait, i do know , they have no clue or dont care.)  or maybe it was because I was only on 25 mg, which is the lowest dose it comes in?  

 

Again though, why am I now having an issue if this is this case?  Why not all along?  The only thing I can think of is because I was taking gabapentin, which maybe was helping to mask the interdose withdrawal of the fluvoximine?  

 

So if i do start to split my dose in the near future, am I to expect yet more instability?  Or will i be a bit better considering I will still be taking the correct amount each day?

 

I also wanted to double check on something with my tapering method- I use a digital scale.  Crush my pills up, and weigh the pill weight i need.   then i recapsule them.  Am i still okay with doing it this way at this point or should i just be shaving off with a razor.  I was always concerned with crushing that it does not distribute the actual drug evenly?  

[BfromNJ]

Daily symptom log 

 

7/12
5 am - woke up and layered awake until 7 
mild anxiety
9 am- anxiety turning extreme.  hard time dealing with physical issue (genital as stated above)   persists all afternoon along with deep depression and hopelessness. vibrations in body. most noticable in left foot , genitals, lips, chest. 
3 pm.  burning sensation in torso . hot flushed feelings.   
3:30 pm - anxious lessons some. 
5- extreme anxiety spike along with uncontrollable crying.  
6- genital issues lesson.  feel better. 
8- burning in feet. vibration feeling left foot up leg to groin 
10- 10 mg fluvoximine and 25 mg quietipine 
11- bed. layer down. noticed body trembling/thumping. 

 

7/13
4:30- wake up.   unable to fall back asleep. 
heart pounding, anxiety.   racing thoughts. 
- went to bathroom and had severe burning (already checked for uti) 
6:30 & 8 am - diarrhea with burning sensation 
9 am -tight anxious feeling in chest . mood is very down and apathetic (ahedonia?)
- vibrations (tremors) in left foot, genitals,  pelvic area
10:30- hot feeling through out body.  
1:00- genital symptoms . not as bad as usual. 
5 pm- anxiety climbs.  genital symptoms.  
still very down. and apathetic. fearful. 
6:30- bedtime- felt all around better.   
10:30- 10 mg fluvoximine and 25 mg quietipine 
11:15- bed
 

[Colonial]

On 7/13/2021 at 10:27 AM, BfromNJ said:

Again though, why am I now having an issue if this is this case?  Why not all along?

 

This really is understandable, it's happened to Me and others

The reason is before your system was not destabilized so it could handle the inter dose WD.

Now that Your so sensitive, even the slightest thing will be problematic.

 

Think of it as having a rash on your arm.

Normally you could run a comb up your arm and it would not hurt.

Do it with a rash and it not only hurts but ruptures into an open wound, making your situation worse.

 

 You thinking of 2 options:  updose or splitting.

 I thinking splitting the dose to 2 a day is not only less risky but has a higher likelihood of success.

Up dosing is only going to continue the destabilization with no promise of success.

Split dosing - moving half forward an hour every few days helps many people stabilize, in my opinion, quicker than updosing. 

It also keeps you on the lower dose, which means less to withdraw off later.

 

Hope that helps.

 

 

 

Edited July 14, 2021 by Colonial

[BfromNJ]

1 hour ago, Colonial said:

 

This really is understandable, it's happened to Me and others

The reason is before your system was not destabilized so it could handle the inter dose WD.

Now that Your so sensitive, even the slightest thing will be problematic.

 

Think of it as having a rash on your arm.

Normally you could run a comb up your arm and it would not hurt.

Do it with a rash and it not only hurts but ruptures into an open wound, making your situation worse.

 

 You thinking of 2 options:  updose or splitting.

 I thinking splitting the dose to 2 a day is not only less risky but has a higher likelihood of success.

Up dosing is only going to continue the destabilization with no promise of success.

Split dosing - moving half forward an hour every few days helps many people stabilize, in my opinion, quicker than updosing. 

It also keeps you on the lower dose, which means less to withdraw off later.

 

Hope that helps.

 

 

 

I love that analogy.  And what you say makes sense.   So I take my med at like 11 pm.  So that means I would take 1/2 at 10 pm then 1/2 at 11 pm?  Then next 1/2 at 9 pm and 1/2 at 11? And so on? 

[Colonial]

If you are taking it at night, 11pm, than it would make sense to work the other way.

Otherwise, you'll be forcing yourself to get up in the night to take it.

 

If You start taking half at 10pm, then half at 11pm.

Then, after a few days, move it to 9pm and 11pm,

Then, after a few days, move it to 8pm and 11pm,

 etc.

 

Keep very good notes on symptom change since as Chessie said, if you go too fast you can get temporarily worse, but keeping good notes will also show improvements over time IF your issue is, Atleast in part, the interdose WD. 

 

 

Edited July 15, 2021 by Colonial

[BfromNJ]

1 hour ago, Colonial said:

If you are taking it at night, 11pm, than it would make sense to work the other way.

Otherwise, you'll be forcing yourself to get up in the night to take it.

 

If You start taking half at 10pm, then half at 11pm.

Then, after a few days, move it to 9pm and 11pm,

Then, after a few days, move it to 8pm and 11pm,

 etc.

 

Keep very good notes on symptom change since as Chessie said, if you go too fast you can get temporarily worse, but keeping good notes will also show improvements over time IF your issue is, Atleast in part, the interdose WD. 

 

 

Okay.  I am going to give myself a bit longer right now then ill consider this. Thank you!  You all are great.  

[BfromNJ]

@brassmonkey

@ChessieCat

@Colonial

 

Three weeks now that I am holding at the 10 mg.  The worst symptom I am having is the genital issue.  I have a hard time even typing it because I hate seeing the word even, because it feels like such a hopeless condition.  But I think we all know what I mean.  Begins with a P ends with G.  I was having better days, but today is a really bad day.  And it makes me think that its just going to get worse.  My mind is going to the "what if you updose place".  In looking at my history with the fluvoximine, is this unwise.  Do I still hold where I am?  On a bad day, I cant help but try and figure out what I can do to just feel better. Does this condition only go away with updosing or reinstatement?   at 3 weeks, I thought I would see more improvement and not the other way.    I will search this site for what others have gone through with this. Maybe it will give me some hope.   the other thing is that before this started, I had hemmroid band ligation.  And then I think, could this have affected my vagus nerve?   And I have also been struggled with bacterial vaginitis that has been hard to treat.  So then I think does that have something to do with it?  but with the BV, it has been ongoing for many months so i doubt it.  But there are these other factors that make it hard.   The only thing I can think of that I did different was last night I took d-mannose.  I have been taking this supplement for some time for bladder health and preventation of UTI.  Well, I hadnt taken it for a few days, but then I did last night and i am so much worse today.  Does anyone know the impacts this supplement may have?  I mean I was taking it for so long with no issues, but maybe now im sensitive to it? 

 

I have doctor appointments arranged - follow up with color rectal, gyno and regular doctor.  Just to rule things out.  Id like to get an mri of my pelvic region.  and my do pelvic floor therapy.  

 

 

Recent Fluvoximine dosage changes ( i am posting here because I havent added it do my signature yet):

1/7- 18.75 to 15 - 20%

2/7- 12.5 mg 
3/7 -10 mg

4/1- 9 mg
5/1- 8.1 mg
5/27- updose to .052 (10 mg) due to anxiety.   
too fast of a taper
6/21-  in patient updose to 50 mg
6/25- reinstate to 10 mg (holding here)

[brassmonkey]

This is a condition that comes up regularly here. There is a lot of information on different threads throughout the site. A site search will bring it all up. It's not something I'm too familiar with, but I do know that like all the other WD symptoms it dose resolve with time. Sometimes quickly but for others it can take a while.

[BfromNJ]

39 minutes ago, brassmonkey said:

This is a condition that comes up regularly here. There is a lot of information on different threads throughout the site. A site search will bring it all up. It's not something I'm too familiar with, but I do know that like all the other WD symptoms it dose resolve with time. Sometimes quickly but for others it can take a while.

Thank you, once again.  lol.  So do you know anything about the supplement D-Mannose and how it may interact with medication and withdrawal?  I cant find much on it.  

[BfromNJ]

@brassmonkey

 

So instead of getting 25 mg pills of fluvoximine now I will be getting 50 mg.  This is because that is the new script I was given inpatient.  I weighed them and they are exactly double the 25 mg.  Which I guess makes sense.  So I am assuming I would just crush as usual and weigh out my 10 mg (.052 pill weight)?  It is the same manufacturer.  

[Colonial]

I think at this point, this is one of those cases we have seen a lot of where, the more you "tamper" with Your dose, the more you destabilize your Central nervous system and actually delay your stabilization. The issue is never just what dose, but knowing stabilization will take time, and constantly trying to "tweak it", even a small amount can do more harm than good.

 

Looking at your dose reductions and since you were on 10mgs as far back as March and then again in May, I would say this is likely a good dose to attempt to stabilize at, the problem is your massively jolted your system with the 50 mg up dose.  That will take time to settle down.  So while you are definitely in wd, your also chronically destabilizing yourself by dose changes.  3 weeks is not a long time at a dose. I needed 6 months at a dose to feel recovered and waited 9 months before changing again.

 

You have 2 issues going on here, wd and the med not being at a stable dose for any extended period of time which delays the healing. But because your symptoms get worse after dose changing, and because this med has such a short half life, I do think you would get relief from the split dosing quicker than if you continue taking it all at once.  

 

I still think that has the better risk/reward ratio that up dosing since raising the dose higher may just cause a greater inter dose wd reaction the further up you go dosage wise.

 

 

Edited July 16, 2021 by Colonial

[brassmonkey]

Yes, you can crush the new pills and use them just like the old ones.

[BfromNJ]

17 hours ago, brassmonkey said:

Yes, you can crush the new pills and use them just like the old ones.

I did notice when I crushed them that the coating was a bit harder. So there were larger pieces of it.   This won't be a problem getting an accurate weight?  

[brassmonkey]

Shouldn't. If you're using the two spoon method try putting the powder on a piece of paper and use one spoon to crush it against the table to make a finer powder.

[BfromNJ]

@Colonial

@ChessieCat

 

@brassmonkey

 

I just felt like checking in.  I am still holding my fluvoximine at the 10 mg.  I dont plan on doing anything for some time.  Considering I basically went from 18.75 mg down to 10 mg from February till  June  I think its best to just stay where I am for a while. I think I will even hold off on splitting my dose for some time.   I am in no rush.  lesson learned. again.   

 

thank you all again for your help this last month or so.  Its really been such an enormous help.  

[ChessieCat]

5 hours ago, BfromNJ said:

I think I will even hold off on splitting my dose for some time.

 

It is a fact that fluvoximine has a half life which is less than 24 hours.  That means that there will most likely be interdose withdrawal.  If you happen to be a fast metaboliser then you would experience a longer period of interdose withdrawal.  Someone who is a slow metaboliser would experience a shorter period of interdose withdrawal.

 

If it was me, I would be splitting my dose.  Note that you will be still taking the same dose.  Even though splitting your dose is classed as a change, it is only a very minor one, with the aim of eliminating interdose withdrawal which, if you are experiencing this (which I think is very likely because of the regularity of the symptom/improvement times you mentioned previously) then you will still be experiencing this if you continue on one dose and hold for a few months.

 

If you are concerned about doing this instead, of moving a portion by 1 hour each day you could move by 1/2 hour each day, or even 1/2 hour every second day or longer. 

 

Or even 1/4 hour (15 minutes) every day.  I know that sounds a bit fanatical, but if it lessens your anxiety about dose splitting then you do what you are comfort with doing and it will achieve the goal.