MJean1 Mirtazapine 2.5 years trying to taper

[MJean1]

Hello.  I’ve been on mirtazapine for 2.5 years.  Started at 15mg.  Tapered to 15 mg every other day.  Now back on 7.5/15.   I recently tried to go back to 15mg every other day and 2 weeks later horrible symptoms came about.  Dizziness, fear, obsessive thoughts, tearful, no motivation.   So I reinstated 7.5/15.   
It’s been a week and I still feel bad but slightly better some days.  How long does it take to stabilize?

Thanks  for your help!

 

[DataGuy]

Hello @MJean1,

 

Welcome to SA. I am going to need a few more details to help you. 

 

You say "I’ve been on mirtazapine for 2.5 years.  Started at 15mg.  Tapered to 15 mg every other day.  Now back on 7.5/15." I guess you used the every other day tapering method (not recommended here, it will mess up your nervous system). Did a doctor recommend this? To clarify, you were taking 15mg once every 2 days? How long did you take to get from 15mg every day to 15mg every other day?

 

Here we recommend tapering by 10% every month, as this is the tapering speed which helps to best avoid injury. Symptoms of dizziness, fear, obsessive thoughts are likely withdrawal symptoms from tapering too fast. Since the half life of Mirtazapine is not very long, we recommend taking the same dosage every day. You are taking 22.5mg over a two day period, so I'd suggest taking it in even doses of 11.25mg every night (I assume you are taking it at night?). By taking it every other day you are confusing your nervous system, which is going from oversedation to overactivation every other day. These states can be harmful to you, so best to keep an even keel if you can. 

 

You may want to try some non drug coping mechanisms until you stabilize.

 

If you'd like regular assistance (something we'd be happy to provide), please fill out your drug history and signature as shown in that link. This link will take you directly to your signature.

 

Good luck and hope to get you off the drug safely : )

Edited March 17, 2021 by DataGuy

[MJean1]

Thanks DataGuy.  I followed your advice after chatting with my doc.  I’m currently on 11.25mg of Remeron.  Feeling more stabilized.  Now planning my next drop (10%).  Although I’ll have to crush/dilute med as I can’t seem to find it in liquid form.

Thanks for your help

[Altostrata]

Hello, @MJean1 Good to hear you're feeling better.

 

Here are Tips for tapering off mirtazapine (Remeron)

[DataGuy]

Sounds great, @MJean1. Let us know if you have any questions or problems. As you can see from the link Alto provided, Mirtazapine also comes in a sort of crumbly, wafer form which is very easy to crush. I don't know what form you are taking now, but the wafer might be useful to you for tapering.

[MJean1]

This post is helpful. I’m experiencing an emotional spiral (health anxiety).   I was feeling great on 11.25 mg of mirtazapine for 5 weeks.  But 4 mornings ago I woke up with horrible anxiety which led to brain fog.  I’m now on day 4 and still spiraling.   I asked my doc his advice.  He said give it a couple more days and if no improvident I can go back to 15mg.  I’m disappointed but also desperate for relief as I have 4 young children to care for.  I want to feel ok and less foggy.  My health anxiety is my trigger and I cycle through fear, scan, relief.  So far I’ve been given good reports Which I am so grateful for but it only lasts a month bf my fear creeps up and triggers me again.   I’m a 2 time cancer survivor which is where my health anxiety stems from.  Any advice / anyone with similar issues with some solutions greatly appreciated.  Also even if I go back to 15 of mitz.  I can try again when stabilized right? 

[MJean1]

Thank you both.  I’m so bummed.   I was feeling really good on 11.25 mg mirtazapine for 5weeks.  Then last Sunday 4/18 I woke up with crazy anxiety and it followed with tearfulness, fear, brain fog.   I’m on day 4 now and it hasn’t improved.   I don’t know what happened.  I do have health anxiety and am getting over surgery from a double mastectomy which was 2.5 months ago.  Anyway my psych doc said wait until Friday and see if I’m feeling better.  If not he said I can go up to 15mg mirtazapine. I’m so bummed.  I want to taper and feel like this is a huge setback.  But I also feel awful and I have 4 kids to care for.  Any advice greatly appreciated.    

[getofflex]

https://www.survivingantidepressants.org/topic/24458-mjean1-mirtazapine-25-years-trying-to-taper/?do=findComment&comment=530131

 

Quoted post moved to your intro to keep all your history in one place.  Please keep all you questions and discussion of your situation to this one thread.  Thank you.  

[getofflex]

14 hours ago, MJean1 said:

I was feeling great on 11.25 mg of mirtazapine for 5 weeks

Have you changed your dose of remeron since Sept 2020?  Saying you were on your current dose for 5 weeks indicates that you made a dose change in March, but I don't see it in the drug signature. Please update your drug signature accordingly.  (see the link above from data guy) We need very specific info about your taper before we can advise you properly. If it were me, I wouldn't make any drug changes just yet.  The vast majority of doctors have no idea how to properly update or taper patients off these drugs.   

 

Once we know more details about what has happened with your drugs between last September and now, we will advise you. 

Edited April 22, 2021 by getofflex

[MJean1]

1 hour ago, getofflex said:

Have you changed your dose of remeron since Sept 2020? 

I just updated my signature.  
Really struggling so I took 15 mg last night.  Thanks.

 

[getofflex]

Thank you for updating your drug signature.  Can you please describe your recent symptoms? 

 

These drugs are not like taking an over the counter Tylenol or Motrin, where you can just take extra when you feel bad, or just stop and be OK.  They literally make major changes to your nervous system.  Here is some information about how these drugs actually work.   Please read the following links carefully.

 

How Psychiatric Drugs Remodel Your Brain

 

This helps you understand what withdrawal syndrome is: 

 

What is Withdrawal Syndrome?

 

Important Tapering Topics

 

The more times that we start or stop a psych med, or makes changes in the dosage, either up or down, alternate doses, miss doses, etc, the more likely we are to sensitize and destabilize the nervous system,  and thus bring on worse symptoms.  And often it takes weeks or months for your system to settle down from this. Your system could very well be still trying to recover from the every other day dosing inDecember and February, and/or the 50% taper back in October. What is tricky is that often the symptoms don't show up right away.  It may take several weeks to get hit with the symptoms.  We live in a modern world with instant this and that, and we want a quick fix for everything. Unfortunately, these quick "fixes" can often make things even worse.  

 

Keep it Simple, Slow, and Stable

 

When we recover, there are times of feeling OK mixed in with times of feeling bad.  This is called windows and waves.  When in a wave, sometimes it is better to tough it out instead of changing our drug dose.  

 

Windows and Waves Pattern of Stabilization

 

Here are some techniques to cope with symptoms: 

 

Non Drug Ways to Cope with Withdrawal Symptoms

 

 

We don't suggest many supplements, but 2 that many of us find helpful are magnesium and omega-3 fish oil. Here are the links for info about those. It is suggested to add one at a time, and start with a low dose to see how it affects you. 

 

Magnesium

 

Omega 3 Fish Oil

 

Finally, going back on a small dose of your drug, or increasing your dose, which we call reinstatement, is best done very carefully.  You went from 11.75 to 15, which is a big jump (28%).  Reinstatement can be risky, and it may help, or it may actually make things worse. When we reinstate, we go up by a very small amount to test the waters.  I will discuss this with the other mods to get a suggestion for a good reinstatement amount.  

 

About Reinstating and Stabilizing to Reduce Withdrawal Symptoms  

 

I've given you quite a bit of information here.  Please read through it, and mull it over, and we will take it from there. In the meantime, take care of yourself, and take heart.  We in this forum have been through this, and we understand first hand the pain and discomfort you are going through.  Please know that the brain is amazing in it's healing abilities.  It takes time, but healing can and will happen. 

 

Edited April 22, 2021 by getofflex

[MJean1]

Thanks again for all that useful info.  I feel a bit scared to be honest.  I just want some relief but realize it’s a process.  My symptoms are intense body anxiety you waking.  Pit in my stomach, difficulty focusing, Brian fog.  Waves of tearfulness and super lack of motivation.  I find myself ruminating a bit and just so hard to focus.  
  I cut out coffee in the am and am trying to breath, drink tons of water, walk outside at least and hour a day, and praying a lot.  

[getofflex]

This all sounds like classic drug withdrawal symptoms. 

 

Dr Joseph Glenmullen Withdrawal symptom checklist

 

It sounds like you are doing a lot of good non drug things to cope.  I would suggest cutting out caffeine 100%. I did this, and it helped me.  Even decaf coffee has some caffeine in it, which can aggravate a sensitive nervous system. Have you checked out any other non drug coping techniques as per the link above?