zen81: sertraline and mirtazapine for sleep anxiety adrenal surges

[zen81]

Hello everyone,

 

I am so glad and thankful to have found this site. I am currently on antidepressants for sleep related issue. It started a few months back where I used to get adrenaline surges just on sleep onset. The doctor then put me on citalopram 10 mg and propanalol 40 mg * 2. The citalopram was not helping at all so this was stopped and I was given mirtazapine for sleep. I started with 15mg then 30 mg for few weeks. Still had the issue with surges during sleep so doctor put me on Sertraline 50 mg and Mirtazapine 15mg, I was able to sleep well during this period. I had to take zopiclone a couple of times. Its been 6 weeks on the sertraline and i have stopped mirtazapine cold turkey according to doctors advice. I have noticed in the last few days i am getting jerks just as i am about to fall asleep. It makes me impossible to sleep as its so activating. I took 3.5 mg zopiclone and slept really well. Can you please help me ? Is this a WD effect. I really want to get rid of it as its affecting my life. Is this due to the mirtazapine?

 

Any advice will be so much appreciated.

 

 

[Gridley]

Welcome to SA, zen81.

 

The jerks you describe are a common withdrawal symptom stemming from your cold turkey of citalopram or mirtazapine or both.  Here is SA's topic:

 

hypnic-jerks

 

It includes several success stories about the jerks stopping.

 

Three questions, please:

1. Why did your doctor cold turkey you off mirtazapine?  

2. How often do you take the Zopiclone?

3. Do you have any symptoms other than the jerks?

 

What is withdrawal syndrome.

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

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, in your case Mirtazapine,  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.  Unfortunately 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 still in the time period where reinstatement predictably works, up to 3 months after last dose.  It is best to reinstate as soon as possible after withdrawal symptoms occur. We usually suggest a much smaller reinstatement dose than your last dose.  These drugs are strong,  your system has become sensitized and If you take too much it may be too much for your brain and can cause you become unstable.  Then, once you've stabilized on the reinstated dosage, which can take several months,  you can begin a 10% per month taper down to zero.   Please read:

 

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

 

If you're interested in reinstating a very small dose of Mirtazapine, let us know and we'll 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.

 

 

 

 

 

 

 

[zen81]

Hello Gridley,

 

Thankyou so much. Your post is such a welcome relief. It really is. I have been crying on and off since these jerks started. I dont know why my doctor did not mention withdrawal. He said he could increase my zoloft to 100 to tackle the anxiety but my anxiety is basically because of this falling asleep issue. I spoke to him today and he said he can increase the dose of zoloft to 100 and we could see else we go back on Mirtazapine. Thing is i am really scared of not being able to sleep because of these jerks. Do these jerks go ? Its not like i am not sleepy but they wake me up. Ii am also taking calcium and chelates magnesium. I really need all the support i can get. Ii only took the zopiclone last night. I havent taken one since april and not sure my doctor would prescribe it. Ii dont have any other symptoms maybe because i am on zoloft and propanolol and its taking care of the anxiety. The jerking while falling asleep is the only one that started probably 2 days after i stopped. I just want to live my life and look forward to things like before but i am so scared really. Any recommendation is welcome 

 

Many Many thanks

[Gridley]

7 minutes ago, zen81 said:

we could see else we go back on Mirtazapine.

 

You need to know that there is a major drug interaction between Zoloft and Mirtazapine.

Interactions between your drugs

Major

Using sertraline together with mirtazapine can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should seek immediate medical attention if you experience these symptoms while taking the medications. 

------

The link I gave you in my previous post contains several posts about the jerks stopping.

 

Sometimes when you reinstate the full dose of a drug (in your case 15mg) after you've stopped it, it can overwhelm your system, which is quite sensitized at this point, and destabilize you further.  It might go fine but I wanted you to be aware of this risk.  

 

Doubling your Zoloft dose could also destabilize you. It will do nothing for withdrawal.

 

[zen81]

Thankyou again Gridley,

 

Really appreciate your help. I will not take the 100 like the doctor suggests.

I also found that I have a box of Mirtazapine with me. How should I resintate this?

I had to tell my doctor that the jerks was a withdrawal symptom because it only started a couple of days ago,

I am surprised he did not know this. I like my doctor and the zoloft really helped me. I just want to sleep without being dependant on the Mirtazapine.

Also the day these jerks started I had also exercised a lot but not in the evening. It was early morning. Do you think that could have added to the issue?

I desperately want to loose the weight from the Mirtazapine.

Thank you for sharing the interaction. I dont have those symptoms but agree with your point of not resinstating at the same dose.

Please can you advise on a dosage?

Thank you

[Gridley]

40 minutes ago, zen81 said:

Please can you advise on a dosage?

I would like to be very cautious and so would recommend reinstating 1mg Mirtazapine--no more.  The following link on tapering Mirtazapine tells you how to get this small nonstandard dosage.

 

Tips for tapering off Remeron (mirtazapine)

 

It takes a little more than a week for the reinstated dose to reach full effect in your system.  You should gradually start feeling some improvement during this period.  If you feel worse, stop the reinstatement immediately.  It's a good idea to keep daily notes on paper as to how you're doing and if the jerks are improving.

 

42 minutes ago, zen81 said:

I had also exercised a lot

It could have added to the issue.  People in withdrawal often find strenuous exercise to be overstimulating and do better with a gentle walk.

 

 

 

[zen81]

Thank you once more Gridley,

 

I wanted to update on last night. I must admit i went to bed pretty scared but had very few jerks. I could sleep through the night without any sleep aid.

The different things i did

 

1. Started calcium citrate ( took 3 times ) 300 mg

2. Started chelated magnesium glycinate ( 3 times ) 300 mg

3. Ate a bowlful of cherries

4, Took zinc 15 mg

5. Ate a banana before bed with milk + nutmeg

6. Bath before bed with Magnesium salts + lavender oil

 

I had a few jerks but overall sleep was pretty good

 

I am not going to increase my zoloft dose by 50 mg. Its crazy.

 

I will read through the tapering and will do it. Thank you again Gridley. 

[ChessieCat]

3 minutes ago, zen81 said:

1. Started calcium citrate ( took 3 times ) 300 mg

2. Started chelated magnesium glycinate ( 3 times ) 300 mg

 

It is better to take magnesium and calcium 2 hours apart:

 

magnesium-natures-calcium-channel-blocker

 

[zen81]

Mirtazapine cross taper Sertraline

 

Hello all,

 

I need some help please. I was on Mirtazapine 15 mg and Sertraline 50 mg now upped to 100 mg. I have sleep anxiety due to adrenal surges which have stopped now.

I however keep getting hypnic jerks just after i fall asleep and sometimes a wierd sensation in my head.

Is this withdrawal? it only started once i stopped Mirtazapine. It happened for a few days at first and then stopped and now its back.

What is this?

Any help is much appreciated.

 

Edited July 4, 2020 by ChessieCat
added topic title

[Gridley]

4 hours ago, zen81 said:

hypnic jerks

 

Here is a link:: hypnic-jerks

 

It includes several success stories about the jerks stopping.

 

Hypnic jerks are recognized as a withdrawal symptom, as discussed in the link.

 

In the future, please post any questions you have about your situation in your original Introductions thread.  That way, all your information is in one post.  

 

Edited July 4, 2020 by Gridley

[zen81]

Thanks Gridley for your continued support. Is there a thread that talks about the suppliments to take and timing ? I have started fish oil today.

 

thankyou

[Gridley]

44 minutes ago, zen81 said:

Is there a thread that talks about the suppliments to take and timing ? I have started fish oil today.

 

 

Here are the links to the only two supplements we recommend, magnesium and omegas.  You can takes the omegas 3 times a day with meals.  It's good to spread out the magnesium with small doses throughout the day.  Wait until you see how you do with the fish oil for a few days before you start the magnesium.  A low starting dose for omegas would be around 1000mg and you can work up from there after you see how it agrees with you.  A low starting dose for magnesium woiuld be 50 to 100mg, spread throughout the day.

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

[zen81]

Thank you Ridley,

 

I will start on the same.

I also did check the link on hypnic jerks. There were a few items in there that can help and will try those.

I just hope i am able to get rid of these as these are my only source of anxiety

i feel v hopeless. its either these or the loud bangs i sometimes hear when i try and sleep. Are they brain zaps?

It can be a sound/bang or a music or like a button clicking enough for me to wake up.

What else can i do

 

Please advise

 

[zen81]

Bacopa Monieri and Sertraline

 

Hello all,

 

Has anyone taken the combination of 50 mg sertraline and 500 mg Bacopa Monieri?

 

Would really like to know the outcome.

 

Thank you

 

Edited July 9, 2020 by ChessieCat
added topic title

[ChessieCat]

From this topic:  bacopa-or-water-hyssop-supplement

 

On 9/4/2016 at 4:21 AM, scallywag said:

 

Terry, I did a bit of searching about Bacopa also known as Water Hyssop.  It's a neuroactive plant substance. Personally I wouldn't take it while dealing with symptoms of psych drug withdrawal.

 

 

On 9/28/2016 at 5:35 AM, Altostrata said:

Please note that nootropics are very popular among people who either like to experiment with gray-market drugs. These are not people whose nervous systems have become sensitized to drugs.

 

If your nervous system has been sensitized by psychiatric drug withdrawal or adverse effects, you will want to be very, very careful with anything that's called a nootropic.

 

 

And I found this when I searched for sertraline bacopa monieri

 

From:  https://www.reddit.com/r/StackAdvice/comments/5zjpox/bacopa_monnieri_sertraline/

 

Quote

 

iakobos

3 years ago

 

The issue with bacopa + sertraline has to do with metabolism. Bacopa inhibits some of the enzymes that metabolize sertraline, which means that the concentration of sertraline in your system will increase if you take them both. The increase in sertraline levels may increase the risk of adverse drug reactions (i.e. side effects). I'd recommend asking your prescribing physician about the safety of taking bacopa while on sertraline before you do so.

 

 

 

[ChessieCat]

The only supplements which SA recommends are Magnesium  and Omega-3 Fish Oil.

 

It is best to only make one change at a time (ie don't make a dose change at the some time as trying a new supplement, and only try one supplement at a time) and when trying anything new start by taking a small dose first.

 

See:

 

the-rule-of-3kis-keep-it-simple-keep-it-slow-keep-it-stable

[zen81]

Thank you dear ChessieCat  You are such a darling.

 

Kind Regards

[Altostrata]

Hello, zen 81.

 

What drugs are you taking now?

 

On 6/7/2020 at 10:47 PM, zen81 said:

It started a few months back where I used to get adrenaline surges just on sleep onset.

 

Were you taking anything to sleep when this happened? Herbs?

 

How much exercise do you get? Do you use the computer or your phone late at night?

 

It's absurd to take drugs for hypnic jerks. They are normal. You might look into CBT with a therapist or meditation (you can teach yourself for free!) to control your anxiety about hypnic jerks. See

 

Non-drug techniques to cope with emotional symptoms

 

Easing your way into meditation for a stressed-out nervous system

 

Music for self-care: calms hyperalertness, anxiety, aids relaxation and sleep

 

Ways to cope with daily anxiety

 

Health anxiety, hypochondria, and obsession with symptoms

 

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

 

Path to Better Sleep FREE online for everyone from the US Veterans Administration

 

What is the sleep cycle?

 

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

 

Nightmare While Awake? Sleep Paralysis, Hypnogogic Hallucinations, etc.

 

 

[ChessieCat]

This is an excellent website.  It can be a bit tricky to find things.  If you want to find something specific try doing a search for the topic (eg unhelpful thinking habits) and include site: getselfhelp.co.uk

 

This page has a list of topics:

 

https://www.getselfhelp.co.uk/selfhelp.htm

[zen81]

Thankyou so much @ChessieCat will look at the website now.

 

@Altostrata  thankyou for your response. I have included below a detail to give you more insight.

 

Before the adrenal surges began, i was not taking any antidepressants. However this was following my IVF treatment and the only thing I was taking was Progesterone. I had a few sleepless nights before the surges began and simply could not do anything about it. Long story short I miscarried and was utterly sleep deprived had anxiety about sleep. The doctor did not listen properly and put me on propanolol and citalopram  obviously it did not suit and made me so restless no sleep carried on. then i phoned another gp who put me on mirtazapine. it helped me sleep for  a few days but pooped out.

I then spoke to another gp and he listened to my issue. I was put on sertraline 50 mg and it made me feel v good and i started sleeping as well. the adrenal surges were gone. Still had anxiety around sleep though but was no longer afraid of my bedroom. then doc asked to stop mirtazapine after a few weeks which i did. didnt have major symptoms but when i exercised a lot led to hypnic jerks.

i stopped heavy exercise and stuck to plain walking. They stopped and i started sleeping well. Then in week 3-4 of stopping mirtazapine sleep issues started. Then i had an argument with my husband and the anxiety was high that night. had hypnic jerk that night but could sleep. Doc said he wanted to raise the sertraline to 100 mg . I took it for 2 days and it was unbearable. I am now on 50 mg again. I dont have anxiety of anything else but sleep and jerks. I only take 1 propanolol 40 mg in the evening sertraline first thing in the morning,

I go for 2 walks gentle ones in the park everyday.

I dont see the laptop or mobile after 6 in the evening but just watch tv till 8. Then go to bed and read. I sometimes hear my heart in the head,

I am only taking fish oil tablets and vitamin c.

 

Do you think the surges were a result of the IVF drugs? I have never had anxiety this bad :(. I still regret doing the IVF,

 

What else can i change ? any help is appreciated......

[Altostrata]

It's very possible these symptoms you identify as adrenaline surges were caused by progesterone and other drugs you may have been taking for IVF treatment.

 

Given you've been on and off drugs for this issue, with a cold turkey off mirtazapine, it can take some months for your nervous system to settle down.

 

If your only problem is your worrying about hypnic jerks, suggest you keep up your exercise and see a psychotherapist to work on your tendency to worry.

 

What do you want to do about the 50mg sertraline and 40mg propanolol?

[ChessieCat]

5 hours ago, Altostrata said:

 

If your only problem is your worrying about hypnic jerks, suggest you keep up your exercise and see a psychotherapist to work on your tendency to worry.

 

 

https://www.getselfhelp.co.uk/unhelpful.htm

 

https://www.getselfhelp.co.uk/sleep.htm

 

https://www.getselfhelp.co.uk/anxiety.htm

 

The get self help website has a lot of excellent resources.  There is a list of links to topics on this page; scroll down to see the list:  https://www.getselfhelp.co.uk/selfhelp.htm

[zen81]

Thank you Altostrata,

 

Very very appreciative of your help. Sorry was away so could not respond.

 

It's very possible these symptoms you identify as adrenaline surges were caused by progesterone and other drugs you may have been taking for IVF treatment.

 

I do agree that it has to be the drugs that enhanced the anxiety effect  as i read that they directly affect the HPA axis in the brain

 

Given you've been on and off drugs for this issue, with a cold turkey off mirtazapine, it can take some months for your nervous system to settle down.

 

Yes i have to bear it until the effect wears off.

 

If your only problem is your worrying about hypnic jerks, suggest you keep up your exercise and see a psychotherapist to work on your tendency to worry.

 

I am currently in talking therapy but also doing breathing while i sleep

 

What do you want to do about the 50mg sertraline and 40mg propanolol?

 

For now i am sticking to only 50 mg and would like to reduce the propanalol. Is there a way I can do it?

 

Edited July 14, 2020 by ChessieCat
coloured Alto's questions for easier reading

[Altostrata]

How often have you been taking propanolol? When have you taken it in the last week?

[zen81]

Hi Altostrata

 

I have been taking propanalol since february. I started off with 2 pills 40 mg each ( one in morning and one in the evening )

Now i am down to 40 mg in the evening only.

 

How can i reduce dose without getting affected

 

Thank you

[ChessieCat]

tips-for-tapering-off-propranolol

 

[Altostrata]

@zen81, how are you doing?

[zen81]

Tapering Mirtzapine 15 mg after 11 days. Please help and support

 

Hello,

 

I was put on Mirtzapine 15mg to be increased to 30 mg after 2 weeks for sleep anxiety. I got anxious surge one night before falling asleep and the doc put me on it.

 

I really want to come off this medication as i don't think its right for me.

 

Can you please help me taper this so that this sleep anxiety does not come back?  Including the axniety. I am also taking a sleep anxiety CBT course on the side.

 

Any help is greatly appreciated.

 

Please help:)

 

Edited June 11, 2022 by ChessieCat
added topic title before merging with intro topic

[ChessieCat]

Current drug signature:

 

Quote

 

February: 10 mg citalopram - for anxiety related to sleep ( getting adrenal surges on sleep onset )

March : Mirtazapine 15 mg as citalopram side effects unbearable - Mirtazapine prescribed for sleep. Stopped Citalopram cold turkey

April: Anxiety around sleep still bad put on Sertraline 50 mg - continued with Mirtazapine - 15 mg

June: Anxiety around sleep in good control and able to sleep well most nights. Stopped Mirtazapine 15 mg cold turkey based on Doctors advise

 

 

We need to know the doses and the dates you started the doses please.  We cannot work out the timeline from the information you provided.

 

Please also update your drug signature.  Please add the YEAR/S for the existing information and include anything else that you have taken since the current June entry.

 

Account Settings – Create or Edit a signature

[Altostrata]

Hello, @zen81

 

It seems we have been around this barn before. Here are Tips for tapering off mirtazapine (Remeron)

 

If you continue to accept prescriptions for psychiatric drugs, take them for a while, and then want to go off, you can be assured you will need to taper each one. For future reference: 

 

 

[zen81]

😬Thankyou Altostrata where can i ask questions if any during the taper process ? Xx