awawa: mirtazapine insomnia

[awawa]

I found this site through google when searching for Mirtazapine withdrawal related insomnia and thought this would be a good place to get opinions.

 

I was originally prescribed Mirtazapine 15mg for depression earlier this year (~march 2020), and soon after went up to 30mg, but through personal research and self reflection it appears that my depression is actually just a sympton of neurotransmitter desensitisation caused by a heavy porn addiction of mine. So I started solving that problem by reducing the frequency of porn use and I've already noticed improvements in my mood and other things.

 

As a result, I wanted to start going off the Mirtazapine, as it was causing problems such as oversleeping and over-appetite, and the Mirtazapine barely even improved my mood, what a disappointment.

 

Of course, I was aware of withdrawal symptoms, so I went up to the doctor to ask how I should go off them. From reading this website, it seems that might have been a terrible idea. He told me to halve my dosage every two weeks, then drop it to 0mg after the third reduction, so it went 30mg -> 15mg -> 7.5mg -> 0mg.

 

I went down from 30mg to 0mg just in the space of 6 weeks. During that time, I didn't notice any withdrawal symptoms. It was only about 2 weeks after dropping to 0mg that my sleep quality started drastically decreasing, only getting just a few hours of proper sleep, and now can barely sleep at all. even when I do manage to fall asleep, it doesn't feel like a proper sleep, but some half-way in-between state of sleeping and awake. I don't feel rested at all in the morning and I'm worried what long term effects sleep deprivation is going to have on my mental health. It's been like this for more than a month now, gradually getting worse.

 

I have reinstated a one-off 7.5mg dose a couple of times, and they did solve the insomnia, but the last time I reinstated I felt weird and really weak in the limbs, which is something I didn't feel in any previous reinstatements. I may have passed the point where reinstating can help.

 

So I'm left with a decision. I can either continue cold-turkeying this and wait it out, or I can go back onto a stable dose of 7.5mg for a while and reduce from there.

 

My question that mainly influences my decision is, how long does it typically take to recover from Mirtazapine insomnia? And am I going to cause long term damage to myself if I wait it out like this? If it only takes a few weeks or months then I'd rather just wait that than slowly taper off it over the course of years. Is that a really bad idea?

 

what if I stay on 7.5mg for a few months, then halve it to 3.75 for a few months, then drop it to 0mg?

 

I've only been on Mirtazapine for a little bit over half a year, does that affect how long recovery takes?

 

Edited October 21, 2020 by ChessieCat
added spacing

[Gridley]

Welcome to SA, awawa.

 

To give members the best information, we ask them to summarize their medication history in a signature -- drugs, doses, dates, and discontinuations & reinstatements, in the last 12-24 months particularly. A list format is best.  Please put the dates and details of your taper and the two times you took 7.5mg.

 

Account Settings – Create or Edit a signature.

 

Doctors know nothing about withdrawal or safe tapering, and your taper was far too fast, causing the withdrawal insomnia you're now experiencing.

 

What is withdrawal syndrome.

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

These explain the healing process really well.

 

Brain Remodelling 

 

Video:  Healing From Antidepressants - Patterns of Recovery

 

17 hours ago, awawa said:

It was only about 2 weeks after dropping to 0mg that my sleep quality started drastically decreasing,

 

Withdrawal symptoms are often delayed.

 

17 hours ago, awawa said:

I have reinstated a one-off 7.5mg dose a couple of times, and they did solve the insomnia, but the last time I reinstated I felt weird and really weak in the limbs, which is something I didn't feel in any previous reinstatements.

It's not a good idea to start and stop a psychiatric drug.  If you reinstate, you should remain consistent in your dose or very gradually increase if necessary.  

 

17 hours ago, awawa said:

I can either continue cold-turkeying this and wait it out, or I can go back onto a stable dose of 7.5mg for a while and reduce from there.

 

17 hours ago, awawa said:

 

My question that mainly influences my decision is, how long does it typically take to recover from Mirtazapine insomnia? And am I going to cause long term damage to myself if I wait it out like this? If it only takes a few weeks or months then I'd rather just wait that than slowly taper off it over the course of years. Is that a really bad idea?

 

Unfortunately, there is no way to predict how long withdrawal symptoms will last.  It's to your advantage that you were on the drug for only six months, but there isn't an absolute correlation between time on the drug and how long withdrawal lasts,  A lot of your decision should rest on how bad the withdrawal insomnia is.  Your body will sleep when it needs to.  

 

So, there are two choices.  Reinstatement of a very small dose of the original drug is the only known way to help alleviate withdrawal syndrome.  The other alternative is to try and wait out the symptoms and manage as best you can until your central nervous system returns to homeostasis. 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.  Question: When was your last dose?  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, and your system has become sensitized and If you take too much it may be too much for your brain and can cause you become more unstable    Please read:

 

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

 

7.5mg is too high a reinstatement dose.  I would recommend 3.75mg, which you can get by halving a 7.5mg pill with a pill cutter or single-blade razor.  It takes about 4 days for a dose change to get to get to full state in the blood and a few days bit longer for it to register in the brain.  Be patient and give the reinstatement a chance to work.  If 3.75mg isn't enough, you can increase very slightly, using one of the methods described in the following link about tapering Mirtazapine.  It's important to be aware that the purpose of reinstatement isn't to eliminate withdrawal symptoms (though it does for some) but rather to bring them down to a tolerable level.

 

Tips for tapering off mirtazapine (Remeron)

 

Once you've stabilized on the reinstatement dosage,, which can take several months,  you can begin a 10% per month taper down to zero.  

 

Why taper by 10% of my dosage?

 

17 hours ago, awawa said:

what if I stay on 7.5mg for a few months, then halve it to 3.75 for a few months, then drop it to 0mg?

This rate of taper is way too fast and is what got you into this situation.  See the link above about the 10% taper.

 

HERE ARE SOME LINK TO HELP WITH SLEEP.

 

Relaxation exercises, guided meditations, calming videos, sleep hypnosis

 

Tricks and tips to fall asleep faster

 

http://articles.mercola.com/sites/articles/archive/2017/02/16/tips-tricks-fall-asleep-faster.aspx?utm_source=dnl&utm_medium=email&utm_content=art1&utm_campaign=20170216Z1&et_cid=DM133787&et_rid=1889748952

 

This link contains helpful information, including insomnia and also non-drug coping skills.  

 

Important topics about symptoms, including sleep problems

 

Some members have found Melatonin helpful with insomnia.   

 

 Melatonin for sleep   

 

It's best to start at a very low dosage, such as .25mg, and gradually increase if needed to the lowest effective dose.  

 

 

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. Get supplements that ae single ingredient (not mixed with other types of supplements).

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[awawa]

Thanks for all the information. I've filled out my signature as well. Another sleepless night has convinced me to go back onto a Mirtazapine dosage of 3.75mg, which I will taper off from there.

 

I do have Omega-3 and Magnesium (in the form of a multivitamin) supplements but I stopped taking them for a while. I'm going to resume taking those as well.

 

I took a 7.5mg dose last night and it had an immediate effect (within 2 hours) that allowed me to sleep somewhat decently.

[Gridley]

7 hours ago, awawa said:

I do have Omega-3 and Magnesium (in the form of a multivitamin) supplements

It would be better to have separate single ingredient omegas and magnesium supplements.  We don't recommend multivitamins, because if there's a problem you won't know the cause.  Introduce the single ingredient magnesium and single ingredient omegas one at a time and at a low dose.

 

Please keep up updated on how the 3.75mg reinstatement works with your sleep.

Edited October 22, 2020 by Gridley

[awawa]

I have taken the same Omega-3 and multivitamin before, it caused no problems, so I will continue taking them. The Omega-3 is already a separate supplement, containing 900mg EPA+DHA per tablet, so I'm taking 3 according to the recommendations on this site (2000-3000mg). the multivitamin contains 50mg Magnesium.

 

1 hour ago, Gridley said:

Please keep up updated on how the 3.75mg reinstatement works with your sleep

I will.

[awawa]

After being a week on a dose of 3.75mg, I've been able to sleep well so far, until I decided to try Ashwagandha, a medicinal herb said to increase sleep quality. I must have taken it wrong, because it actually did the opposite, it immediately brought the insomnia back within the same night of first taking it.

That was the only day I took it, and I immediately stopped taking it after that. It's been 3 or 4 days since then and I'm still on Mirtazapine 3.75mg but the insomnia hasn't improved at all since taking the Ashwagandha. What should I do?

[ChessieCat]

You'll just have to wait it out.  Do not change the dose of mirtazapine and don't add anything new.

 

When reinstating is important to be patient.  The idea of reinstating isn't to get rid of withdrawal symptoms completely but to bring them to a bearable leave.

 

Once a person experiences withdrawal symptoms the nervous system can become sensitised.  That means that "normal" doses of drugs/supplements might be too much.  When trying anything new it is best to try a very small dose to see how you respond to it.  And only make one change at a time so that you know what has cause any issues if they arise.  the-rule-of-3kis-keep-it-simple-keep-it-slow-keep-it-stable

 

Before trying any I suggest that you do your research.  There are many existing topics on SA.  Use an internet search engine and add site:survivingantidepressants.org to the search term.

 

ashwagandha-herb-for-anxiety-stress-and-toxic-overload

[ChessieCat]

Please add the ashwagandha date and dose to your drug signature.

[ChessieCat]

It would be helpful if you can add dates to the existing drug signature, particularly the reinstatement date.

[awawa]

I adjusted the signature. There are no precise dates because I don't remember them. Even the months are approximate.

[ChessieCat]

Okay.  Thanks for adding "late" for the reinstatement.  That is helpful.  If you do happen to remember the date or approximate date at a later time, please update it.  Thanks.

 

Do you take your magnesium in one dose?  To get the benefits of it to relieve anxiety it is better taken throughout the day.  I find that twice a day works for me but if I get extra anxious I might take another dose in the middle of the day.

[awawa]

I was able to get the precise date of the reinstatement from my calender, since I set a repeating schedule to remind me. Unfortunately I don't have any calender events left over from previous dosages so they remain approximate.

 

I'm taking Magnesium as the bottle recommends, trying to anyway. 11 tablets per day, no more than 3 tablets at a time, each tablet is 37.4mg. That makes 411.4mg per day but since I consistently forget, I often only take 3 in the morning and 3 at dinner. The multivitamin also contains 50mg Magnesium so it replaces one tablet in the morning, so that makes up 237mg per day.

[ChessieCat]

22 minutes ago, awawa said:

I was able to get the precise date of the reinstatement from my calender, since I set a repeating schedule to remind me.

 

That's really good.  That was the most important one.  Thanks for updating the drug signature.  It's very helpful to know the exact date for the reinstatement.