Kornyboyo1917: Remeron 15mg

[Kornyboyo1917]

Hello, 

 

I was put on remeron 1.5 months ago after being hospitalized for severe benzo withdrawal.  I have been off benzos for 9 months after a rapid taper.  My symptoms are horrific and 24/7.

 

- Racing thoughts/ruminations

- Ear-worms (things I watch/read and conversations repeat over and over all day long)

- Racing negative thoughts

- Intrusive thoughts/memories

- Loud inner critic/voice

- Sensorimotor Hyperawareness OCD (thinking/thoughts and occasionally other themes)

 

The remeron seemed to help with the pacing akatheisa and terror but did nothing else for my mental symptoms.  

 

I started at 7.5 for a week or so and then went up to 15mg.  At 15 I got his with depression.  Went up to 22.5 for a few days but couldn't handle the anxiety and fear it triggered so went down to 15mg.

 

I don't want to be on remeron anymore because It's interfering with my benzo recovery but my mind is tormenting me on how to come off of it.  

 

I don't know much about tapering and what would be the best thing for me since I'm already in benzo withdrawal.  I think its making the OCD worse (compulsive researching, chain smoking).  The problem is i'm not going to know if I am having new symptoms from discontinuing the remeron or if it was masking some of the benzo withdrawal and it's coming back.  Unless i develop new symptoms like DP/DR (which i don't have).

 

I am looking for advice on a taper.  I know my situation is different but any help would be appreciated. Thanks

 

 

 

[Kornyboyo1917]

Hello, 

 

I was put on remeron 1.5 months ago after being hospitalized for severe benzo withdrawal.  I have been off benzos for 9 months after a rapid taper.  My symptoms are horrific and 24/7.

 

- Racing thoughts/ruminations

- Ear-worms (things I watch/read and conversations repeat over and over all day long)

- Racing negative thoughts

- Intrusive thoughts/memories

- Loud inner critic/voice

- Sensorimotor Hyperawareness OCD (thinking/thoughts and occasionally other themes)

 

The remeron seemed to help with the pacing akatheisa and terror but did nothing else for my mental symptoms.  

 

I started at 7.5 for a week or so and then went up to 15mg.  At 15 I got his with depression.  Went up to 22.5 for a few days but couldn't handle the anxiety and fear it triggered so went down to 15mg.

 

I don't want to be on remeron anymore because It's interfering with my benzo recovery but my mind is tormenting me on how to come off of it.  

 

I don't know much about tapering and what would be the best thing for me since I'm already in benzo withdrawal.  I think its making the OCD worse (compulsive researching, chain smoking).  The problem is i'm not going to know if I am having new symptoms from discontinuing the remeron or if it was masking some of the benzo withdrawal and it's coming back.  Unless i develop new symptoms like DP/DR (which i don't have).

 

I am looking for advice on a taper.  I know my situation is different but any help would be appreciated. Thanks

 

[Altostrata]

Welcome, Korny.

 

What time of day do you take Remeron? How's your sleep?

[Kornyboyo1917]

Hi Altostrata,

 

I take it at 12PM every night. It makes me sleep like 12-13 hours. Before Remeron i was sleeping 8-9 hours. 

 

@Altostrata

Edited October 16, 2019 by Sassenach
mark for Alto

[Altostrata]

What makes you think it's interfering with your benzo recovery? Have your symptoms become worse since you've started mirtazapine?

 

Why did you increase from 7.5mg?

[Kornyboyo1917]

It's hard to tell if my symptoms are worse or not since I live in a constant hell all the time without being able to distract. I increased because my psychiatrist and family wanted me to because they said it would help with the racing thoughts but it never did. It might have helped the akatheisa a little bit and the terror.

 

I've been told you can't heal from the damage from benzos until you are off everything. I went through prozac withdrawal 10 years ago but had to reinstate because it felt like I was going to die every second and that anyone I looked at was going to die too. It was horrendous. I end up staying on other SSRI's for 5 more years and then kind of stopped taking then without any withdrawals again.

 

My concern is remeron is preventing me from healing and that it's going to be another horrible withdrawal in the future if I ever recover from the benzo damage.

[Kornyboyo1917]

Any advice on how to come off of it.  I have developed looping music now and I'm pretty sure it's from the remeron as I never had it before.  I want off this drug!

[Altostrata]

On 10/16/2019 at 4:00 PM, Kornyboyo1917 said:

I've been told you can't heal from the damage from benzos until you are off everything.

 

This is untrue. Your nervous system can stabilize on mirtazapine -- if it's helping -- and then you can taper off.

 

What times of day do you get this looping music symptom? When did it start?

[Kornyboyo1917]

My mind is just torturing me 24/7 about the remeron. It only helps with the pacing and terror.  But all the other mental symptoms are still there.  I noticed the looping start a week or so ago but it was only briefly.  Today I listened to a song and one part of the song has been playing in my head all day.  

 

I have other kinds of earworms as well.  Anything I read/watch/hear and conversations play in my head constantly.  Have you heard of this symptom before Altostrata?

 

Would it be better to switch to an SSRI like Luvox if I'm going to be on antidepressant.  At least one that is designed for OCD.  Even though i never had OCD before the benzos.

[Altostrata]

You have post-acute benzo withdrawal syndrome. I don't know if taking an antidepressant is going to help, that's something we've never recommended. Perhaps @Shep has some suggestions.

 

Have you tried fish oil and magnesium supplements? A lot of people find them helpful, see
https://survivingantidepressants.org/index.php?/topic/36-king-of-supplements-omega-3-fatty-acids-fish-oil/
https://survivingantidepressants.org/topic/15483-magnesium-natures-calcium-channel-blocker/

 

Try a little bit of one at a time to see how it affects you.

 

To help us out, follow these instructions Please put your drug and withdrawal history in your signature You may need to use a computer to do this.

 

[Kornyboyo1917]

I've also developed pretty painful brain pressure/squeezing since I started remeron.  Usually starts toward nighttime.  I can't take any supplements especially magnesium in benzo withdrawal.  I'll update my signature.

[Shep]

11 hours ago, Kornyboyo1917 said:

I have other kinds of earworms as well.  Anything I read/watch/hear and conversations play in my head constantly.  Have you heard of this symptom before Altostrata?

 

Yes, this is a common symptom for both antidepressant and benzo withdrawal. Please see:

 

Intrusive repetitive song symptom or ear worms

 

These threads may also be helpful in understanding your symptoms:

 

How psychiatric drugs remodel your brain - about antidepressants

 

What is happening in your brain? -  about benzos

 

The Windows and Waves Pattern of Stabilization

 

Are We There Yet? How Long is Withdrawal Going to Take?

 

 

On 10/14/2019 at 3:51 PM, Kornyboyo1917 said:

Racing thoughts/ruminations

- Ear-worms (things I watch/read and conversations repeat over and over all day long)

- Racing negative thoughts

- Intrusive thoughts/memories

- Loud inner critic/voice

- Sensorimotor Hyperawareness OCD (thinking/thoughts and occasionally other themes)

 

We have a non-drug coping skills section that can be particularly helpful for handling these types of symptoms. Here are some links to read:

 

Neuro-emotion

 

Shame, guilt, regret, and self-criticism

 

Dealing With Emotional Spirals

 

Withdrawal causing intrusive or repetitive thoughts, rumination, and increased panic?

 

Obsessive Compulsive Disorder or OCD: Repetitive, intrusive thoughts, compulsive behaviors

 

You'll find many other helpful links here:

 

Non-drug techniques to cope with emotional symptoms

 

After you update your signature and we have your complete history, we can provide more targeted advice. 

 

 

[Kornyboyo1917]

I'm really freaking out!

 

I have a new symptom that's driving me insane.  When i am reading, writing, or watching something I find myself mouthing or my inner voice repeating what I am reading, writing, or hearing at the exact same time it is happening.  It's really hard to explain.  Is this from the remeron? I'm 2 months on remeron and developing new symptoms I never had before.  

 

I can't update my signature right now because I can't think backwards without my brain scrambling. 

[Shep]

On 10/15/2019 at 1:24 PM, Kornyboyo1917 said:

I take it at 12PM every night. It makes me sleep like 12-13 hours. Before Remeron i was sleeping 8-9 hours. 

 

Were you sleeping 8 - 9 hours after you came off the benzo? Were you sleeping this well without any drugs? 

 

What benzo were you on?

 

17 hours ago, Kornyboyo1917 said:

I can't update my signature right now because I can't think backwards without my brain scrambling. 

 

You're able to log in and write, so you're exaggerating your symptoms. I know this is difficult, but please do the best you can. 

 

Without a drug history, we aren't able to give you any specific advice. You don't need to place it in a signature, just write it in a post for now. 

 

We just need the month and year you started each drug, the dose for each drug, and the date you stopped for any drug you're no longer taking. 

 

[Kornyboyo1917]

Yes i was sleeping 8-9 hours before Remeron.  I'm not exaggerating my symptom.
 

The first one I was on was Prozac back in 2012.  I was on it for a year and cold turked not knowing any better.  A month later I got hit with horrible withdrawals where I felt like I was going to die every second.  I reinstated and then between 2012 - 2016 I was tried on a few different ones and ended up on lexapro which i was only for roughly 3 years.  I stopped it without any problems.  I was on clonazepam 1mg for 6 months in 2017.  Stopped CT with no problems.  Then October 2018 I was on 1mg of clonazepam for about a month.  Tapered for 4 days and had a panic attack and took .5 and my brain went absolutely crazy.  Tapered for 45 days with what I have left because no doctor would let me taper long term after being on such a short time.  The past 11 months have been hell on earth.  I'm sorry I don't have access to any medical records.  My brain isn't working enough to remeber exact months/years. If i find them i will add.

[Altostrata]

Is sleeping 12-13 hours a problem for you? Many members here have the opposite problem of withdrawal insomnia. Are you groggy in the morning?

 

On 10/23/2019 at 6:01 PM, Kornyboyo1917 said:

I've also developed pretty painful brain pressure/squeezing since I started remeron.  Usually starts toward nighttime.  I can't take any supplements especially magnesium in benzo withdrawal.  I'll update my signature.

 

Do you do anything regularly in the afternoon that might trigger this symptom?

 

On 10/24/2019 at 11:14 AM, Kornyboyo1917 said:

I have a new symptom that's driving me insane.  When i am reading, writing, or watching something I find myself mouthing or my inner voice repeating what I am reading, writing, or hearing at the exact same time it is happening.

 

I've experienced this inner voice all my life. I always thought it was normal. Maybe you're just paying more attention to what you're reading, writing, or watching?

 

Please try to keep balanced about your self-observation and not exaggerate or dramatize normal or very minor behaviors.

 

Follow these instructions Please put your drug and withdrawal history in your signature You may need to use a computer to do this.

[Kornyboyo1917]

I know all these symptoms are NOT normal. I have a racing inner dialogue that doesn't stop. It fight's back and forth constantly making my head feel like it is going to explode along with uncontrollable racing thoughts (intrusive thoughts and memories) and earworms where everything I read/watch/write plays in my head.  Stuff i watched or read months ago.  Now I have developed looping songs and a parrot brain.  My brain mimicks the sounds of birds, my dog barking ANYTHING.  Everyone has a inner voice and thoughts but when you are extremely HYPERAWARE of every thought where it feels like someone is stabbing you in the head with a knife and it shoots adrenaline through your body.  I am talking about EVERY SINGLE THOUGHT that comes into my head 60,000 times a day.  My brain will forget something and try and remember it every second for days on end.  I never had any of this a year ago.  Just generalized anxiety.  Not full-blown psychotic OCD

 

I'm fortunate I can sleep but I would gladly trade any of my symptoms for insomnia.  I've had insomnia most of my life.

 

I am really ticked off that your suggesting that I am exaggerating the level of my suffering.  I thought this was a support forum?!?  I came on here asking for help in tapering off remeron.

[Altostrata]

Whatever your symptoms are, you're going to have to learn to cope with them, we can't do it for you.

 

I can guarantee that you would not want withdrawal insomnia instead of 12=13 hours of sleep.

 

I see you've decided to take offense rather than give us requested information, including creating your signature.

[Kornyboyo1917]

Altostrata - I've updated my signature to the best i can remember without having access to medical record to get correct dosages for old medications.

 

[Shep]

Korny, thanks for doing such a great job with your signature. If I had to guess what is causing your severe symptoms, I would say benzo kindling. You were able to come off Xanax in 2015 and clonazepam in 2017, both without any withdrawal. And then you went on and off again in 2018 and that time, suffered from severe withdrawal. Benzos are notorious for causing nervous system destabilization by going on and off more than once, with each subsequent withdrawal getting worse. 

 

Here are some links about this. 

 

What is the kindling phenomenon that occurs with benzodiazepines?

 

Kindling - Wikipedia

 

Unfortunately with damage caused by benzo kindling, there's not much you can do but self care and giving your brain and nervous system time to heal. And it can take a long time. 

 

The fact that you were able to sleep so well shows a lot of nervous system resiliency. Yes, the looping thoughts and hyperawareness is extremely disturbing, but if you can work to disconnect your thinking from the intrusions and consider them like an annoying TV show or annoying neighbors and let them pass, that may help.

 

What I did when I was going through acute cold turkey benzo withdrawal was play guided meditations for hours and hours in the background. My brain started looping meditations and I become incredibly calm after a few weeks of doing this. It didn't happen overnight, but it did happen. Do your best not to feed into your symptoms, but use your symptoms as teachers. 

 

That played into establishing some powerful neuroplasticity and healing. Here's some information on neuroplasticity (it's on antidepressants, but the same holds true for benzo withdrawal):

 

Healing from antidepressants: The power of neuroplasticity video (7.5 minutes)

 

Some links for mindfulness, meditation, and breathing: 
 
Easing your way into meditation for a stressed-out nervous system
 
Mindfulness and Acceptance
 
Good links for anxiety/worry

Inhabiting our bodies in meditation

Pranayama Breathing for Anxiety and Depression

 

Do you feel better at 15 mg Remeron or worse than when you were at 7.5 mg a month ago? If you're feeling worse, you may be able to decrease the dose, since it's been so recent. 

 

[Kornyboyo1917]

Hi Shep,

 

Thanks for awesome response.  I apologize to you and Altostrata for getting angry in my previous posts.  I had a lot of benzo rage recently with the change/addition of new symptoms and not knowing what is causing what.  

 

I guess at 10.5 months out going back on and doing a long slow taper would just be a ridiculous idea since I am already kindled?  I'm just concerned I am so far out with no relief in symptoms so my brain is telling me it's permanent. 

 

I will try the guided meditations in the background.  Does it have to be guided meditation or just meditation music?  It was actually a guided meditation which caused me to become hyper-aware of my thoughts.  Or maybe it was going to happen regardless.

 

I have been lucky enough to sleep 8-9 hours even before remeron.  I'm suprised considering how bad my symptoms are during the day.

 

Regarding Remeron.  I believe I became more compulsive at 15mg than I was at 7.5mg however I was also on seroquel for about 5 days while in the psych ward, stopped for a week or so and then took it for another 5 days when i bumped my dose on remeron up to 22.5.  However, the seroquel only ended up making it worse.  I haven't taken any seroquel in a month.  

 

i'm very worried that these new symptoms I have developed might be from the remeron as I have never experienced them before

- looping songs

- parrot brain - my brain mimicks the sound of birds etc. pretty much anything I hear 

- subvocalization with reading and repeating what people are saying in my head while they are talking.

 

Thanks for your help

[Shep]

15 minutes ago, Kornyboyo1917 said:

Thanks for awesome response.  I apologize to you and Altostrata for getting angry in my previous posts.  I had a lot of benzo rage recently with the change/addition of new symptoms and not knowing what is causing what.  

 

No worries, Korny. We understand. 

 

16 minutes ago, Kornyboyo1917 said:

I guess at 10.5 months out going back on and doing a long slow taper would just be a ridiculous idea since I am already kindled?  I'm just concerned I am so far out with no relief in symptoms so my brain is telling me it's permanent. 

 

Correct. Reinstatements work best within 2 - 4 weeks of coming off, so you're well past that range. 

 

But it's definitely not permanent. The fact that you're sleeping - and were sleeping BEFORE going on Remeron - is a very good indication that you're going to heal. 

 

Whenever you brain tells you it's permanent, tell it to cut it out because it's simply not true. 

 

18 minutes ago, Kornyboyo1917 said:

I will try the guided meditations in the background.  Does it have to be guided meditation or just meditation music?  It was actually a guided meditation which caused me to become hyper-aware of my thoughts.  Or maybe it was going to happen regardless.

 

That's an excellent point. Music can be a better option if you're locking onto words. I used classical music with nature sounds in the background. Here's one of those videos on a playlist: 

 

Ludwig Van Beethoven's Moonlight Sonata -Relaxing Tranquil Classical Instrumental Piano Music video (6.5 minutes)

 

If you don't like classical music, you can find soft jazz or just nature sounds or the sound of ocean waves. There's tons of options out on YouTube. A great distraction is exploring and bookmarking the videos you find especially helpful. 

 

 

26 minutes ago, Kornyboyo1917 said:

Regarding Remeron.  I believe I became more compulsive at 15mg than I was at 7.5mg however I was also on seroquel for about 5 days while in the psych ward, stopped for a week or so and then took it for another 5 days when i bumped my dose on remeron up to 22.5.  However, the seroquel only ended up making it worse.  I haven't taken any seroquel in a month.  

 

Do you remember what dose of Seroquel you were on? Seroquel in doses of around 150 mg or less affect histamine (not dopamine). It's a quirky drug because it's actually more sedating at the lower doses. Combining two sedating drugs likely did make you worse. 

 

Since that was a month ago, it may still be affecting you and causing these upticks in symptoms. 

 

It will fade out, but it may take awhile, so do as much self care as you can. 

 

30 minutes ago, Kornyboyo1917 said:

i'm very worried that these new symptoms I have developed might be from the remeron as I have never experienced them before

- looping songs

- parrot brain - my brain mimicks the sound of birds etc. pretty much anything I hear 

- subvocalization with reading and repeating what people are saying in my head while they are talking.

 

Because your nervous system was so destabilized from the rapid benzo taper, it may be hyper-reacting to the Remeron. But what you're describing are classic benzo withdrawal symptoms.

 

It does go away. 

 

What do you think about holding the Remeron steady for a week or so to see if some of these symptoms are from the addition and subtraction of Seroquel? If that's the case, you may find relief by simply holding the Remeron steady and working with the relaxation videos. 

 

If you still think the Remeron is causing upticks in symptoms, you may want to take a small reduction toward the dose you were at a month ago, say reducing by 25% for a few days to see how you do. Here's some information on tapering Remeron: 

 

Tips for tapering off Remeron (mirtazapine)

 

[Kornyboyo1917]

The first time I took seroquel was 25mg and it made me want to go to the kitchen and grab and knife.  The urge went away.  I then tried one dose of 25mg anafranil that really messed me up and landed me in the psych ward where I was on 7.5mg of remeron and 100mg of seroquel at night.  I was doing better in the psych ward for the 4 days I was in there.  I think it might have been from not smoking and having access to benzo forums.  My thoughts were still racing but It was managable.  

 

The next time I took seroquel was maybe 5 days to a week at 100mg but i took it during the day opposed to a night when i was in the psych ward.

 

The problem is my symptoms are always there but change in intensity everyday. I never know how I will wake up.  The other day I was pacing my neigborhood for 7 hours straight with an extreme racing negative inner dialogue and looping thoughts.  

 

I think ill stay on 15mg remeron for a few more days.  Some days my mind just latches onto the remeron and looops and races about it.  However my mind was like this even before remeron.  

[Kornyboyo1917]

Shep  - are you aware of any posts on this forum which talks about the hyperawareness of thoughts/thinking and inner voice.  It seems like its a rare symptom and I can't find anyone on the benzobuddies website that has it.

[Shep]

15 hours ago, Kornyboyo1917 said:

Shep  - are you aware of any posts on this forum which talks about the hyperawareness of thoughts/thinking and inner voice.  It seems like its a rare symptom and I can't find anyone on the benzobuddies website that has it.

 

On 10/26/2019 at 6:55 PM, Kornyboyo1917 said:

The other day I was pacing my neigborhood for 7 hours straight with an extreme racing negative inner dialogue and looping thoughts.  

 

I'm combining parts of your lasts posts because I think you answered your own question - it sounds like you're dealing with a mix of looping thoughts, hyperawareness, and akathisia. I've already posted links for OCD symptoms and looping thoughts, but have you read about akathisia?

 

Akathisia vs restlessness, anxiety, agitation

 

If you read through that thread, you'll see some posts by members who describe their symptoms as more "mental akathisia" than "physical akathisia," meaning their thoughts are completely out of control and they want to crawl out of their skin. It's an extremely uncomfortable feeling.

 

Do you think you may have mental akathisia? 

 

[Kornyboyo1917]

Shep - Yes I believe I have the mental akathisia combined with sensorimotor OCD.  Thank you for the links

[Kornyboyo1917]

I would like to start reducing my dosage on the remeron.  Can anyone offer some advice?

[Shep]

You've been on 15 mg since sometime in September, so you may or may not be dependent on that higher dose. You could test the waters with a 10% reduction and see how you feel.

 

Tips for tapering off Remeron (mirtazapine)

 

Let us know if you have any questions about setting up your taper. 

[Kornyboyo1917]

Thanks Shep. I'll start with a 10% reduction. Are there any videos that explain how to make the reductions? Is it possible to do a DLMT from the remeron tablet? 

[Shep]

What type of videos do you need - scale or liquid?

 

For using a scale, please see:

 

Using a digital scale to measure doses

 

A scale that many members recommend is this one:

 

Gemini 20 Scale

 

This is a video for how to do a taper using a scale. Please note this is for a benzo taper, but the same principle applies:

 

Scale use video (6.5 minutes)

 

This thread is for doing a liquid taper:

 

How to make a liquid from tablets or capsules

 

This post in that thread contains a video.

 

On 11/3/2019 at 12:48 PM, Kornyboyo1917 said:

Is it possible to do a DLMT from the remeron tablet? 

 

Instead of a DLMT, you may want to look into the Brassmonkey Slide.

 

 

The Brassmonkey Slide Method of Micro-tapering

 

A lot of people are having success with this method. Instead of daily reductions, it's weekly and it has a two-week hold at the end of the month. 

 

Please read the first post in this thread:

 

Micro-taper instead of 10% or 5% decreases

 

As Alto writes, "The idea is you might be able to make smaller decreases more often. Micro-tapering does NOT mean making a reduction every day -- don't go faster than your nervous system allows!"

 

So we don't generally recommend the DLMT for this reason. Some people find out that these daily reductions catch up to them. 

 

 

[Kornyboyo1917]

Title added: Mirtazapine/Remeron Liquid Taper

 

Hello,

 

I was wondering if anyone has tapered of Mirtazapine/Remeron 15mg using 2.5% reductions per week using liquid?  I'm currently in benzodiapizine recovery (1 year off) and have been on remeron for about 4.5 months.  

 

Someone told me I can dissolve the 15mg tablet in 15ml of water and reduce like that?  How can i take 0.375 out of the 15mg/ml solution? 

 

This is all very confusing for me and I want to make sure I am doing it correctly

Edited January 23, 2020 by manymoretodays
merged to intro, moved from tapering

[manymoretodays]

Hi Kornyboyo, @Kornyboyo1917

 

I just moved your new stand alone topic back here to your introduction.  This is the best place for you to post with your specific questions.

 

And yes, you could do a liquid "microtaper" of your Remeron/mirtazapine.

Good to go over things, before beginning to taper too, KB.

 

Yes, you could do a 1mg per 1mL homemade solution.

 

It looks like there is pharmacy solution that is available with a prescription too.

Tips for tapering off mirtazapine(Remeron)

Using an oral syringe and other tapering techniques

How to make a liquid from tablets and capsules

 

How much Remeron are you taking now?

 

And how are you doing right now?

 

Best, L, P, H, and G,

mmt

[Kornyboyo1917]

Hi, Manymoretodays

 

I'm going to see if I can get a  pharmacy solution to make things easier.  I've been on 15mg of remeron for about 4.5 months now.  Still dealing with the brain damage from benzos.  Horrific mental symptoms.  I want to get off remeron and let my brain heal.  

[manymoretodays]

13 hours ago, Kornyboyo1917 said:

Hi, Manymoretodays

 

I'm going to see if I can get a  pharmacy solution to make things easier.  I've been on 15mg of remeron for about 4.5 months now.  Still dealing with the brain damage from benzos.  Horrific mental symptoms.  I want to get off remeron and let my brain heal.  

 

That sounds good Kb.

And then to do a microtaper, you have a couple of options:

Micro-taper instead of 10% or 5% decreases

 

Brassmonkey Slide Method of Microtapering

^ this can be successful as well

You would calculate a 10% drop from your current dose, and then do a weekly drop of just 1/4 of that, or 2.5 %

You do that for 4 weeks and then HOLD for 2 more

And if, the first 2.5 % decrease is rocky and rough, you can just HOLD longer

 

Anyway.......get some idea of how you'd like to start and good to be trying to get the liquid now.

 

To calculate a 10% decrease from 15 mg:

15 X .90 = 13.5 mg 

The 13.5 mg would be your total dose based on a 10% decrease.

Or a 1.5 mg decrease total, which could be divided by 4, to get 2.5% decreases.

 

Anyway, I'll let you look things over and hopefully reach your own understanding and math method. 

Do use us, please......to check your math and method.  As we do know, how tough it can be, when working with a WD brain and the cognitive difficulties that arise.

 

Okay, keep us posted and ask away when needed.

 

L, P, H, and G,

mmt

[Kornyboyo1917]

MMT - thanks for the detailed response on tapering methods.  I have a couple questions. 

 

I am on 15mg of remeron.  

 

I will probably do the 2.5% a week cut at first to see how I do. 

 

So,

 

10% of 15mg is 1.5mg

 

1.5mg divided by 4 is 0.375

 

So 0.375 a week.  How is that possible with liquid tapering?  I have 10ml, 3ml and 1ml syringes.  I could round it up to 0.4mg or down to 0.3 for better accuracy. 

 

Also,

 

I am a smoker and I have learned that smoking affects the metabolism of remeron.  Would it be wise to quit before starting a taper?

Are there others on the forum who have tapered while smoking?

 

Thanks

 

KB

[manymoretodays]

Great questions!

I just found a great table here:  CYP450 Interaction Table

 

So yes, with the CYP1A4 a liver enzyme(involved in metabolism of some drugs), right at the top........we can see that smoking is an inducer and then mirtazapine(Remeron) is a substrate.

 

INHIBITORS, INDUCERS AND SUBSTRATES OF CYTOCHROME P450 ISOZYMES
remember
inhibitors and substrates INCREASE the effectiveness of another drug metabolized by that isozyme
inducers DECREASE effectiveness

 

(I just took that ^ right from the chart and copied over here)

BTW, I just love this stuff!

 

So you could go ahead and either quit smoking first, if that is a realistic option for you.  I know, I'm still working on getting smoke free myself.......trying to taper to a certain point and then just jump off.  It's a bear.  My gosh, it's so darn addictive.

Or just do slight reductions with cigarettes,   taper by 1 every week, and/or month.

 

If you jump.  You may get a greater overall absorption of the mirtazapine/pharmacological action/effect.  And whether that brings on side effects, or adverse effects from your mirtazapine, for you, I don't know.

 

And then, I didn't mention the "cross over" for if and when you go to liquid mirtazapine.

Important, for you, to do some cross over from solid to liquid form.  Our usual recommend is:

1/4 new with 3/4 old form, hold for 3-7 days with no change in dose

1/2 new and 1/2 old, hold as above

3/4 new and 1/4 old, hold as above

and then to all new, in your case liquid, same dose

 

The reason being that liquid generally absorbs faster and you might feel some bumps and adjustments during this phase.  You may be able to just quarter some of your 15 mg tablets in order to do this.

 

I get what you are asking on the math too.  I'll get back to you on that ASAP too.

 

Best. mmt.

 

Hey, just going to add this one too, here for now, until I figure out where to put it on the site.
Effect of nicotine on cytochrome P450 1A2 activity  2011

Edited January 24, 2020 by manymoretodays
links, and clarity I hope