Marius: Mirtazapine withdrawal late issues

[marius76mc]

In the middle of 2018 I started to show symptoms of burnout after working around 20 years in a stressful executive manager position.

Sleep deteriorated quickly and I had difficulties both falling and staying asleep.

Tried a short holiday but as I returned to office being faced with multiple changes in operational procedures I found no relief from previous situation.

 

I requested medical help and was put initially on Sertraline 50 mg + Xanax 0.5 mg.

 

Became very agitated and with lots of brain zaps and after two weeks no sleep at all.

 

Then switched to clonazepam 0.25 mg in morning and evening + carbamazepine also morning and evening. Had a lot of secondary effects such akathisia, body temperature ups and downs, rigidity in muscles but managed to sleep somehow  a little bit more. Six months later I evaluated my situation as not very much better that in June and had to change the doctor because it was cleared that I become addicted to clonazepam. Found a psychiatrist who was against using benzo and she suggested a combo of Duloxetine + buspirone that I tried for another three months without success being unable to support the secondary effects.

 

During next three months at doctor suggestion I tried also for different period of time zolpiderm, zopiclone and trazodone again without any significant progress is improving my sleep. Anxiety was worsening, the job stress was even bigger and due to lack of sleep I started to show signs of depression which I haven't had in the past. June - July 2019 was switched to venlafaxine again without being able to support it and finally reached to 30 mg of mirtazapine which was good to offer me 8 hours of sleep. It lasted around two months till it dissipated and I was so sedated during the day that I could not do my job anymore.

 

September 2019 I quit the job and decided to clear myself of any drugs. With up and downs I started to do my own research with the goal of regaining my old self both professional and emotional.

 

First I tried to withdraw by the doctor advice cutting to 15 mg to two weeks and then to 7.5 mg to another two weeks but this lead to a horrorific nine days of zero sleep in the row. Switched back to 30 mg, gave up any medical assistance and started my own reduction scheme with liquid solution based on my body reaction. 

 

Three months later in April 2020 finished the tapering process and started a withdrawal during which the main problem was the insomnia. It took me four months to arrive to a sleep of at least six hours and a bearable life during the day but onward things have improved constantly and now ten months after last dose of mirtazapine I am almost the old myself except one thing that I will detail below.

 

Now I fall asleep very easily around 9:30 - 10:00 pm but after exact 4:30 hours I wake up and stay awaken for a while (30 minutes in the best case - 3 hours in the worst) then I have a second wave of mostly REM sleep till morning. The problem is that each time I wake up during the night or during morning I have a kind of sickness hard to describe in words (a kind of nausea, abdominal discomfort, sometimes like a cold blow in my head ...). If I get out of bed and start moving it dissipated in around 20 minutes, but if I stay laid down in bed it is worsening.

 

I know this must be probably PAWS symptom but I feel stuck in it for a long time, this being the only thing that stop me in considering my withdrawal a successful story. I studied the cortisol awakening response topic, did some limited lab test on it but they were not relevant as in my country the knowledge and procedures on testing cortisol during night are not available.

 

Tried feedbacks on other forums but did not find fruitful discussions. 

 

I am 45 years old and still in job pause of almost 1 year and a half struggling to solve this last matter of my withdrawal so please have a look on my case and ask any information if you think that you can help in some sort.

Thank you.
 

Edited February 6, 2021 by Shep
added spacing for readability

[Shep]

On 2/3/2021 at 5:02 AM, marius76mc said:

Now I fall asleep very easily around 9:30 - 10:00 pm but after exact 4:30 hours I wake up and stay awaken for a while (30 minutes in the best case - 3 hours in the worst) then I have a second wave of mostly REM sleep till morning. The problem is that each time I wake up during the night or during morning I have a kind of sickness hard to describe in words (a kind of nausea, abdominal discomfort, sometimes like a cold blow in my head ...). If I get out of bed and start moving it dissipated in around 20 minutes, but if I stay laid down in bed it is worsening.

 

I know this must be probably PAWS symptom but I feel stuck in it for a long time, this being the only thing that stop me in considering my withdrawal a successful story. I studied the cortisol awakening response topic, did some limited lab test on it but they were not relevant as in my country the knowledge and procedures on testing cortisol during night are not available.

 

HI, Marius.

 

Welcome to Surviving Antidepressants.

 

I sounds like you've already found the thread on cortisol and have already done your research. If you haven't already seen this thread, please have a read, as some of the tips can be helpful for the symptoms you're describing:

 

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

 

You may find some helpful information to handle your symptoms here: 

 

Non-drug techniques to cope with emotional symptoms

 

Are you currently taking any supplements? We don't recommend a lot of supplements, as many members report their nervous systems are simply too fragile to handle them. However, magnesium and fish oil tend to be calming to the nervous system and many people report they do help. Please only add in one supplement at a time and at a small dose. For more, please see:

 

 King of supplements: Omega-3 fatty acids (fish oil)

 

Magnesium, nature's calcium channel blocker

 

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[marius76mc]

Hi Shep ! Thank you for your reply.

I have already looked over many of the indicated topics as I was following this forum since the start of the tapering. 

I tried a lot of tips and tools extracted from here with more or less success.

In my opinion what was helping me the most was the pass of time and increased connection with nature in all forms. 

Healing after drugs is very possible for everyone, it takes more or less but now I do not blame what has happened to me in the last two years.

I consider myself more experienced and more prepared for the years that will come as sustaining the aging process in a optimal way.

 

I have made a diet improvement and also added supplements on regular basis like magnesium glycinate, high DHA Omega-3, PPQ, Zn, D3 vitamin, Alpha lipoic acid

and this lead to solving all the lack of energy issues during the day when I am completely fine and just like before. 

Only during the night I still have to work on my issue and now I follow three different clues: cortisol response, SIBO (small intestinal bacterial overgrowth) and histamine reaction.

[Shep]

It sounds like you've done your research and have reached a high level of acceptance in allowing time and nature to heal you. All good stuff, Marius. 

 

Please let us know how you're feeling from time to time and if you have any questions you think we could help with, please feel free to post them here. 

[tsranga]

On 2/3/2021 at 2:02 AM, marius76mc said:

Now I fall asleep very easily around 9:30 - 10:00 pm but after exact 4:30 hours I wake up and stay awaken for a while (30 minutes in the best case - 3 hours in the worst) then I have a second wave of mostly REM sleep till morning. The problem is that each time I wake up during the night or during morning I have a kind of sickness hard to describe in words (a kind of nausea, abdominal discomfort, sometimes like a cold blow in my head ...). If I get out of bed and start moving it dissipated in around 20 minutes, but if I stay laid down in bed it is worsening.

 

Very interesting..  My pattern is very similar to yours, and I have been off since Feb 2019 (it was a C/T withdrawal from 3.75mg of mirtazapine).  In my case, I can fall asleep easily most nights, but some nights, I get a spike between 11pm-12am, mainly triggering burps, and I have to wait until I release the burps, have a BM, reduce bloat before I can go back to sleep. I used to have this pattern even before mirtazapine, so watching what & when we eat maybe a good idea. 

 

I didn't want to end up struggling at 2-3am, so I try to sleep after my gut settles around 11-11:30PM, and I am able to sleep around 4:30 hrs and wake up between 3:30-5:30, and go into a weird sleep/wake state (my fitbit shows REM, but I feel I am awake and can sense everything including my thoughts). This definitely seems to be a mirtazapine induced pattern, and I haven't found any solution other than to have a set wake-up time (5:30AM was a reasonable time) and stay in bed until then, whether I am awake or asleep. After that, getting into some movement/yoga helps. I also find that the first 90 minutes after wakeup is when I feel the anxiety/edginess/heat/temperature sensitivity the most, and then it settles.  I do have days when the body doesn't settle at all, and I can't sleep or sleep later (after 1AM), but those probably occur once or twice a month. 

 

Unfortunately, I don't have any information to identify the root cause, but I suspect that it is some sort of sympathetic overactivation that causes it, and histamine could be a potential trigger to that overactivation. I have also been tested and treated for SIBO in 2019 and actually had noticed improvements in Jan-Mar 2020, before the symptoms came back in April 2020, and got worse in Sept 2020.  I am still focused on healing the gut with diet (low FODMAP, low histamine) and alternative treatments, and I try to get additional rest during the day by doing some diaphragmatic breathing as many times a day as possible for 15-20 min each time. This has been very useful in getting the body into a parasympathetic state easily, and in fact has helped restore my ability to have daytime naps (something that I had lost for 10 years).

 

I just met an autonomic function specialist to rule out any other obvious issues, and he seemed to notice a couple of things that were not normal (not related to sleep directly), and I am scheduled to undergo further testing to evaluate nervous system function.

 

My opinion based on personal experience is that how we live our lives and the stress (both emotional and physical) that we have put on our nervous systems has been adversely affected by mirtazapine, and it will take a while to get it back to normal, provided we work on addressing all the other pre-existing issues. 

 

 

 

 

[marius76mc]

Looks like we are in the same boat navigating through the same waters ...without having a map.

 

I just had a very bad night as yesterday I took the AstraZeneca vaccine and after feeling perfect till evening I woke up at 1:00 am after three hours of sleep and then the fever reaction kicked in.

 

At 3:30 am the cortisol started its show and till 7:00 am I was in a hell ride. Now I am somehow better but fever still lingering.

 

During my mirtazapine withdrawal the nausea and histamine issue was very limited for me and not as annoying as it is now. I was more concerned  with the cortisol awakening response since the moment that I understood that 

mirtazapine was blocking the cortisol during night and suppressing the REM phase of sleep. I am now more convinced as ever that my initial underlying issue was this dysautonomia but I do not have any specialist around to talk to.

 

Last three months I did a strict keto diet in order to improve my insulin resistance as I was showing prediabetic signs and also fixed some extra weight of around 12 kg. Now I have very good HOMA IR and blood glucose values and my weight is optimal, but I guess this all diet took some toll on the nervous system. Maybe still too much stress from too many changes in a year time plus restarting to work after a one year and a half break on a totally new position not in line with my base profession. I had to do the change and it was obvious that I started to hate my old job ...

 

Please update me if you have any new findings from your specialist and I will focus more on the next days on this histamine topic. 

[tsranga]

On 2/20/2021 at 10:46 PM, marius76mc said:

Please update me if you have any new findings from your specialist and I will focus more on the next days on this histamine topic.

 

I am seriously debating whether I should put myself through testing, if the end result is more meds. I haven't seen any quick fixes - just  control of symptoms, and the usual poop out / switching drugs routine.

 

Now what I would be interested to find from others on this forum if they eventually recovered.

 

My most common pattern is the morning 3-6am disturbance. Then I have the odd days when I feel extremely sleepy and disoriented in the early morning or late evening, and I usually can take a nap or get to  bed early. Some days like tonight, I feel great through the day, and the only sign that something's afoot is not feeling sleepy at my usual time, and as I lie down, I get the burps, adrenaline rushes, rapid thoughts, flushing, etc.. which prevent me from sleeping. If I am lucky I can get 2-3 hours after 3am. I get this once or twice a month usually close to full/new moon (that's the only correlation other than maybe a combination of weather change, or food.  I am really at a loss here, but I guess I can put up with a day or two in a month of no sleep.

 

I have had this pattern through the entire withdrawal period of two years.

[marius76mc]

@tsranga On my knowledge burps and bloating are connecting with deficiency in stomach activity (too high pH) and also not enough bile produced by liver, or not enough concentrated by the gallbladder. 

I follow a few doctors on YT that have materials about these issues and their advices worked as indicated for me. My today digestion is way better than the mess it was two years ago. I can point some links if needed.

[tsranga]

9 hours ago, marius76mc said:

@tsranga On my knowledge burps and bloating are connecting with deficiency in stomach activity (too high pH) and also not enough bile produced by liver, or not enough concentrated by the gallbladder. 

I follow a few doctors on YT that have materials about these issues and their advices worked as indicated for me. My today digestion is way better than the mess it was two years ago. I can point some links if needed.

Thank you.  I don't have this so much now. Only at night when there is a histamine dump.

[arbor]

Hi @marius76mcHow are you doing?  Are you still doing the keto diet?  I hope things are going well--

Arbor