jordy: Mirtazapine withdrawal - 4 months in and no noticeable improvement

[jordy]

I was incredibly ignorant and did not realise how important it was to taper off mirtazapine, and basically came off 30mg cold turkey at the start of January. I KNOW this is a huge mistake and I didn't realise it at the time and my doc didn't think anything of it either. I had no physical symptoms to speak of like a headache or dizziness or brain zaps or anything like that, so I thought I was fine. However, since coming off mirtazapine, I have had terrible anhedonia and emotional numbness, zero motivation and energy, zero appetite and significant sexual dysfunction/low libido. These were not symptoms for me during or prior to taking mirtazapine. It has almost been four months now and have seen little improvement. I am very concerned but want to stay positive. Can you please tell me if there is a way out of this for me? Thank you so much. 

(The one thing that helps in all of this is vitamin D3, however it seems to lose its effectiveness if I take it too many days in a row, so it's not a sustainable solution for me.)

[Gridley]

Welcome to SA, jordy.  I'm sorry you're suffering.

 

What you're experiencing is withdrawal from your cold turkey of mirtazapine.  The symptoms you describe are very typical.  The damage is not permanent and you will heal, but unfortunately we can't predict how long it will take.  

 

What is withdrawal syndrome.

 

Glenmullen’s withdrawal symptom list.

 

When we take psychiatric medications, the CNS (central nervous system) responds by making changes over the months and years we take the drug(s). When the medication is discontinued, the CNS has to undo all the changes it made. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur.  

 

Reinstatement of a very small dose of the original drug is the only known way to help alleviate withdrawal syndrome.  The only other alternative is to try and wait out the symptoms and manage as best you can until your central nervous system returns to homeostasis.  As I said, no one can give you an exact timeline as to when you will start feeling better and while some do recover relatively easily, for others it can take many months or longer.  

 

Reinstatement isn't a guarantee of diminished symptoms for everyone but it's the best tactic available.  You're two months outside the time period (up to three months after last dose)where reinstatement predictably works.  So reinstatement might work or it might not.  There's also the possibility it could make things worse.   We usually suggest a much smaller reinstatement dose than your last dose.   Please read:

 

About reinstating and stabilizing to reduce withdrawal symptoms. -- at least the first page of the topic

 

If reinstatement is something you think you might want to pursue, please let me know and we will suggest a reinstatement dosage.  Please do not reinstate without letting us suggest a dosage.

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Add in one at a time and at a low dose in case you do experience problems.

 

This is your Introduction topic, where you can ask questions and connect with other members.  We're glad you found your way here.

[jordy]

19 hours ago, Gridley said:

If reinstatement is something you think you might want to pursue, please let me know and we will suggest a reinstatement dosage.  Please do not reinstate without letting us suggest a dosage.

 

 

Thank you very much Gridley for such an informative reply. I really appreciate that. This is all stuff that I had no idea about. I'm in a frustrating situation. When I discontinued mirtazapine at the start of the year, I observed to the doctor after two weeks that I was feeling symptoms unlike I had felt during or before taking the drug. They confidently replied that this is because my depression was simply worse and they recommended stronger drugs like nardil. I was very skeptical of this and have been wondering for the last three months what the hell mirtazapine did to me to make me feel so sluggish, numb and inhuman.I'm frustrated, because I was only taking mirtazapine for 12 months. For me to feel no improvement even after four months makes me terribly worried. I've wasted too much time like this and really want to begin my life in earnest. I just want to feel the way I used to feel  before taking medication. 

Your suggestion of reinstatement did intrigue me, and it has crossed my mind over the last few months from time to time. I felt like "god I wish I were taking mirtazapine again just so I could feel a little bit more functional". That said, a large part of has the feeling at this stage four months in that reinstating would betray the last four months of effort and persistence. I'm not sure though. This situation is so hard, because all professionals I've seen just want to shove different, stronger drugs in my face and show me the door. I'm leaning towards just committing to the withdrawal and trying to see it through. I'm not sure if this is folly or not. 

[Gridley]

2 hours ago, jordy said:

They confidently replied that this is because my depression was simply worse

They always say this.  They confidently misdiagnose withdrawal as "return of the depression" and prescribe more and stronger drugs, putting their patients of the drug merry-go-round.  It's very good you didn't take the Nardil.

 

2 hours ago, jordy said:

For me to feel no improvement even after four months makes me terribly worried.

Four months is not that long for withdrawal to last.

 

2 hours ago, jordy said:

I'm leaning towards just committing to the withdrawal

 

 

That is certainly a valid approach.  If you change your mind about reinstatement, please let us know so we can suggest a dosage.  It will be very small.  Do not reinstate your former dosage.  Your system is very sensitized and too large a dosage could overwhelm your system and destabilize you further.

[Altostrata]

Hello, jordy. How's your sleep?

[manymoretodays]

Hi henor, @henor

I sent you a prompt to start an introduction for yourself.

My own sleep issues were not too awful, as I managed to get to at least 5 hour stretches, at night, after a couple of months I think. 

Best,

mmt

[jordy]

On 4/27/2020 at 12:24 AM, Gridley said:

That is certainly a valid approach.  If you change your mind about reinstatement, please let us know so we can suggest a dosage.  It will be very small.  Do not reinstate your former dosage.  Your system is very sensitized and too large a dosage could overwhelm your system and destabilize you further.

 

Hi Gridley, I realise it has been a while, 5 months now, but I keep thinking about the idea of reinstating the mirtazapine. I am just struggling so, so much. If I were to do that, what sort of dosage would you suggest and how slow a taper should I commit to? If you think it is just flat out too long since I stopped to reintroduce the drug, let me know. Thanks so much. 

[Gridley]

4 hours ago, jordy said:

it is just flat out too long

It's a risk.  Reinstatement works most predictably within 3 months of your last dose, and you're 2 months beyond that.  So it might work or it might make things worse.  If you do reinstate and it works, it will take some weeks or months before your system settles down but symptoms won't be as intense.  Then you could begin a slow taper no faster than 10% of current dose every four weeks.

 

If you decide to reinstate, I'd suggest a dose of 1mg Mirt--no more.  It takes about a weeks for the reinstatement to reach full effect in your system. If you feel worse, stop immediately.

 

This link tell you how to get this small nonstandard dose.

 

Tips for tapering off Remeron (mirtazapine)

 

 

 

 

[Teppo125]

@jordy

Hi!

I took escitalopram only 2 months last year and then ct’d because of the side effects. I’m almost 9 months of and still strugling almost every day, but I have noticed major improvements in my symptoms. You will heal, stay strong💕

[jordy]

On 6/2/2020 at 11:05 PM, Gridley said:

It's a risk.  Reinstatement works most predictably within 3 months of your last dose, and you're 2 months beyond that.  So it might work or it might make things worse.  If you do reinstate and it works, it will take some weeks or months before your system settles down but symptoms won't be as intense.  Then you could begin a slow taper no faster than 10% of current dose every four weeks.

 

If you decide to reinstate, I'd suggest a dose of 1mg Mirt--no more.  It takes about a weeks for the reinstatement to reach full effect in your system. If you feel worse, stop immediately.

 

This link tell you how to get this small nonstandard dose.

 

Tips for tapering off Remeron (mirtazapine)

 

 

 

 

 

Hi Gridley, I wanted to ask a follow up question if that is okay. I did not go through with reinstatement. I felt over the last couple of months I was making very promising improvements. The main, most trying symptom I seemed to be finally gaining control over was my terrible fatigue. However, in the last week and a half - for reasons I cannot fathom - I have fallen back into almost total and utter fatigue and despondency. In truth, I felt that I was making very steady, almost imperceptible improvements each and every day. However, this last week and a half so far has shaken my resolve to its core. Is this something I should be worried about? Should a trajectory towards recovery have this strange, sudden, unexpected pitfall? I can't for the life of me understand the reason for it. 

[ChessieCat]

The fact that you have experienced improvement is a good sign.  However, recovery isn't linear.  It will be in a Windows and Waves pattern. 

 

We strongly encourage members to learn and use Non-drug techniques to help them get through the difficult patches.

 

Please also check out the links in Post #1 of this topic:

 

are-we-there-yet-how-long-is-withdrawal-going-to-take

 

And this video: 

 

Healing From Antidepressants - Patterns of Recovery

 

And from this topic:  What is Happening in Your Brain

 

"It would be like if the World Trade Center Towers hadn't completely fallen - but had crumbled inside in different places.. Imagine if you were [...] to rebuild the tower - WHILE people were coming and going and [...] to work in the building!  You'd have to set up a temporary elevator - but when you needed to fix part of that area, you'd have to tear down that elevator and set up a temporary elevator somewhere else. And so on. You'd have to build, work around, then tear down, then build again, then work around, then build... ALL while people are coming and going, ALL while the furniture is being replaced, ALL while the walls are getting repainted... ALL while [...] is going on INSIDE the building. No doubt it would be chaotic. That is EXACTLY what is happening with windows and waves.  The windows are where the body has "got it right" for a day or so - but then the building shifts and the brain works on something else - and it's chaos again while another temporary pathway is set up to reroute function until repairs are made."

 

 

 

Edited July 27, 2020 by ChessieCat

[Gridley]

3 hours ago, jordy said:

I have fallen back into almost total and utter fatigue and despondency. In truth, I felt that I was making very steady, almost imperceptible improvements each and every day. However, this last week and a half so far has shaken my resolve to its core. Is this something I should be worried about?

This is completely normal and nothing to be worried about. It's going to be up and down with a slow gradual trajectory upward.  Take a look at the links ChessieCat provided.