Jimmyt Help Dealing with Mirtazapine PWS

[Jimmyt]

Hi this is my first post, I ct of mirtazapine 10 months ago as per doctors recommendations and since then have been experiencing severe muscle weakness, spasms and knots. I believe my history will be included in the signature of this post?  I’ve been trying all the recommended treatments like magnesium, heat etc which helps only a bit. Hoping to get help with the following questions:

 

I’m still taking 25 mg sertraline, which I was taking before the mirtazapine, and did not experience the muscle issues. However, with my CNS kindled could the sertraline be contributing to the spasms?

 

My understanding of mirtazapine is it hits +25 receptors so would anyone know which ones in particular could have been adversely affected to cause the muscle issues, ie histamine, serotonin, norepinephrine, dopamine, etc?

 

Not sure if other medications are ever recommended but wondering about the use of a muscle relaxant or other drug that could help relax the muscles without causing further damage to my CNS.

 

Any other supplements and/or diet recommendations such  as low histamine or low glutamate?

[Jimmyt]

Hi this is my first post, I ct of mirtazapine 10 months ago as per doctors recommendations and since then have been experiencing severe muscle weakness, spasms and knots. I believe my history will be included in the signature of this post?  I’ve been trying all the recommended treatments like magnesium, heat etc which helps only a bit. Hoping to get help with the following questions:

 

I’m still taking 25 mg sertraline, which I was taking before the mirtazapine, and did not experience the muscle issues. However, with my CNS kindled could the sertraline be contributing to the spasms?

 

My understanding of mirtazapine is it hits +25 receptors so would anyone know which ones in particular could have been adversely affected to cause the muscle issues, ie histamine, serotonin, norepinephrine, dopamine, etc?

 

Not sure if other medications are ever recommended but wondering about the use of a muscle relaxant or other drug that could help relax the muscles without causing further damage to my CNS.

 

Any other supplements and/or diet recommendations such  as low histamine or low glutamate?

[Altostrata]

Welcome, @Jimmyt

 

I am sorry you had this bad reaction to cold-turkey of mirtazapine. What times of day do you take each of your drugs, and their dosages? How do you feel before and after taking each of them?

 

How's your sleep? How has your symptom pattern changed in the last 3 months?

 

To help us out, follow these instructions Please put your drug and withdrawal history in your signature You may need to use a computer to do this.

 

[Jimmyt]

Hi Altostrata thanks for your response!

 

I’ve updated my signature to include my major withdrawal symptoms, and I though I did have my drug dosages and withdrawal sequence laid out already. (Although perhaps not clearly enough or with enough detail? Please let me know if it needs further editing.

 

As for your questions here are my responses:

• What times of day do you take each of your drugs, and their dosages?

  • I take the 25 mg of sertraline in the morning right after breakfast.

• How do you feel before and after taking each of them?

  • I don’t notice much difference between before and after. However I do wake up with overall muscle and joint stiffness, shakiness and weakness but the stiffness goes away after moving around. I think eating helps with the shakiness and weakness. With these symptomsI have not taken the sertraline yet.

• How's your sleep?

  • My sleep is pretty good, I do wake up every few hours and typically have to go to the washroom. However, I think that is somewhat due to drinking a lot of water in the evening in an attempt to stay hydrated.

  • I find when I wake up in the early hours of the morning I’m not stiff or weak. However, when I awake near my normal time to get up I experience the muscle and joint stiffness, shakiness and weakness.  Also if my legs are bent when I straighten them them they spasm for a few seconds. 

    • Wondering if this is due to an overactive reaction as a result of the normal cortisol rise in the morning? 

• How has your symptom pattern changed in the last 3 months?

  • In the last 3 months my symptoms have improved.

    • I’m gaining strength but very slowly.

    • My overall muscle stiffness has decreased. However, I still experience spasms and knots especially in spots where I strained/tore muscles during my initial severe symptoms 6-10 months ago.

    • I still get muscle spasms/cramps if I move too quickly or exert my muscles too much. Also, getting less severe. Although now the spasms seem to be located in a few specific locations ( back, hamstrings) and more persistent lasting for hours if not longer.

    • I also still get random twitches that last a few seconds. The worst seems to be my left eye which quivers and last for minutes at a time.

    • I also get some jerks when trying to go to sleep, but decreased significantly.

By far the most debilitating symptoms are the persistent know in my upper back and to a less extent the weakness if I try to do too much, the most noticeable being thighs giving out after climbing more than a few flights of stairs, etc.

 

Appreciate any advice and help!

[Jimmyt]

One bit of advice I’m looking for from your experience and expertise is there any merit in considering other medications such as reinstating Mirtazapine, muscle relaxants or other antidepressants (are my muscle issues related to a lack of serotonin or norepinephrine caused by the abrupt withdrawal of Mirtazapine?) or other psycho tropic drugs that may alleviate my symptoms that right now I find very debilitating and painful. I realize any other medications will cause  further damage and long-term tapering requirements so that is why I’m looking for your assistance.

 

thanks!!

[Altostrata]

What time in the morning do you take sertraline? Do you take any other drugs?

 

After you went off mirtazapine June 24, did your sleep pattern change?

 

What is your usual exercise schedule?

 

We cannot tell what neurotransmitters are responsible, that's a myth. The drugs affect everything in the body.

[Jimmyt]

No other drugs. I usually take the Sertraline around 9:30 am.

 

No other drugs, although I started taking some vitamins and supplements although not convinced they are helping. Vitamins C, D3, magnesium, NAC, CoQ10 and wild yam.

 

I ended up trying some lemon balm tea yesterday and today and my knots are a lot less. I understand lemon balm affects GABA so now I’m worried it will exacerbate my withdrawal symptoms once it wears off, although I must admit it feels better now.

 

it is difficult to recall my sleep cycle from the time I took Mirtazapine to when I stopped since I was not taking it regularly. From what I recall I experienced a few weeks of poor sleep abs insomnia but it got better fairly quick compared to others I’ve read about.

 

I try to do some moderate exercises everyday, 39-40 minutes of walking, and 20-30 minutes of really upper body movements, careful stretching and really light weight. I’ve only just lately been able to stretch without causing pain and/or muscle strains.

[Altostrata]

8 minutes ago, Jimmyt said:

I’ve only just lately been able to stretch without causing pain and/or muscle strains.

 

This is a good sign. I would proceed with gentle stretching, perhaps massage, chiropractic, acupuncture, or osteopathic manual treatment, if you can find it.

 

Does the stiffness go away after you take sertraline in the morning? Is there a connection? Do you take anything else before bed, such as an antihistamine?

 

It appears that going off mirtazipine has caused your nervous system to become hypersensitive, something like fibromyalgia. We see this happen frequently. Good to hear lemon balm was relaxing.

[Jimmyt]

56 minutes ago, Altostrata said:

 

This is a good sign. I would proceed with gentle stretching, perhaps massage, chiropractic, acupuncture, or osteopathic manual treatment, if you can find it.

 

Does the stiffness go away after you take sertraline in the morning? Is there a connection? Do you take anything else before bed, such as an antihistamine?

 

It appears that going off mirtazipine has caused your nervous system to become hypersensitive, something like fibromyalgia. We see this happen frequently. Good to hear lemon balm was relaxing.

The overall stiffness goes away on its own I think but then the specific cramping in the back etc seems to get worse as the day goes by. Although the back spasms seem to be triggered by me sitting and leaning against a chair back. Unfortunately I’ve never been able to correlate any symptoms to the sertraline. I’ve considered not taking it one day to see if it makes a difference but figure that will just add to my CNS confusion. Do you think it might be contributing to the spasms or helping?

 

I do take Claritin when my seasonal type nasal allergies get too bad. Typically it will be in the am but sometimes in the evening if I notice the symptoms are coming on. Are you wondering about it’s affect on sleep? I’ve wondered if it might help given the strong antihistamine effects of mirtazapine (although you’re saying these drugs are not that specific?)

 

Are you ok with lemon balm? I just read it affects GABA so now I’m all worried about it becoming addictive, which I know is very ironic considering I’ve been asking about other psychotropic drugs to ease my condition.

 

Thanks again!

 

 

 

[Altostrata]

2 hours ago, Jimmyt said:

Although the back spasms seem to be triggered by me sitting and leaning against a chair back.

 

This suggests you need physical therapy and exercises. Strongly recommend you seek non-drug treatments for your pain issues.

 

If lemon balm works for you, I have no problems with it.

[Jimmyt]

14 hours ago, Altostrata said:

 

This suggests you need physical therapy and exercises. Strongly recommend you seek non-drug treatments for your pain issues.

 

If lemon balm works for you, I have no problems with it.

Thanks Altosrtrata, I agree, I’d really like to get off of all meds but when the spasms get too bad and I think of how long it has gone on for, 11 months, and how I could be looking at another year or more I get to the point where any immediate relief, especially if it could be a lifetime affliction now, regardless of the long term consequences is worth it...although my brain and gut instinct say “don't go down that path”.

 

 

 

I do physical therapy and exercise but I find if I have really bad cramping it is so easy to pull muscles. Which is why I was asking about meds. What about the occasional use of a low dose of Robaxin? 

 

Will it get better? I read in your paper that you experienced muscle spasms for 1.5 years...did it gradually get better or was it a fairly sudden improvement? what did you do to find relief? 

 

So if I may ask where were you heading with your question regarding my sertraline? Were you trying to determine if it was affecting my muscles? Also, what about your question regarding antihistamines?

 

I guess my final question is that I’d really like to taper off the sertraline, very slowly, but I’m concerned it could cause increased anxiety and induce insomnia, neither of which I want while still dealing with my muscle issues. So do you think I should wait until my CNS settles down? I guess that leads to my question if more serotonin or less might be a cause? I certainly don't want to take more sertraline but if more serotonin might help perhaps some SAMe or 5_HTP? That is why I’m keen I trying to figure out if more or less serotonin would help, or as you mentioned earlier, no one really knows what these drugs do in the brain? 

 

Sorry for all the questions, but your support and answers are really helpful. Much appreciate your support!!

[Altostrata]

Strongly recommend you seek non-drug treatments for your pain issues.

 

This is a site for going off drugs. We are not in a position to recommend additional drugs that may incur dependency and withdrawal.

 

Use search in the Symptoms and Self-Care forum for discussions of 5-HTP and SAM-E. In general, we do not encourage people to add to their problems by taking neuroactive supplements. The serotonin explanation is hogwash.

[Jimmyt]

Hi Altostrata, you are 100% correct, I should not even be considering any other harmful medications and I really appreciate your stern guidance and helping to keep me from more self harm through more psychotropic drugs. I will review the files for additional guidance and put more consideration in before posting on this site to ensure I stick to appropriate topics.

[Jimmyt]

 HI Altostrata, not sure if I should just continue this thread or make a new post in the tapering section.

 

Given my current symptoms of muscle weakness and cramping I’m wondering if I should try to start a very slow taper of the 25 mg sertraline I’m still taking. My gut feel is that it is not affecting my muscles given I was taking it before the mirtazapine, however, wondering if my system has been so destabilized that it is affecting me more negatively, ie the muscle spasms. I can’t really correlate any connection between symptoms before or after I take it daily every morning after breakfast. 

 

but I’m concerned it could cause increased anxiety and induce insomnia, neither of which I want while still dealing with my muscle issues. So do you think I should wait until my CNS settles down? Thanks.

[Jimmyt]

Micro Dosing of Lamotrigine

 

Hi hopefully ok to post this question.

 

 I’m almost at 1.5 years dealing with chronic muscle spasms and cramping, and muscle/nerve pain Just read some info on this site and a paper that mentions the procedure has had some success in certain situation.
 

I’ve resisted any medications up til now but getting very frustrated, anxious and depressed because of the constant pain. Of course the doctors are recommending gabapentine, Cymbalta, amitriptyline, etc. 

 

I’ve tried pretty much every non- drug therapy: diet, exercise, Physio, magnesium, needling, trigger point injections, etc.

 

Thanks.

 

Edited November 8, 2021 by ChessieCat
added topic title before merging with intro topic

[ChessieCat]

1 hour ago, Jimmyt said:

Micro Dosing of Lamotrigine

 

Please see Altostrata's post's in this topic:

 

lamictal-lamotrigine-to-calm-post-acute-withdrawal-symptoms-paws

 

And before starting anything new I think it is a good idea to know about how to get off it when the time comes:

 

tips-for-tapering-off-lamictal-lamotrigine

 

[Jimmyt]

Hi ChessieCat I reviewed all the posts I believe for the lamotrigine treatment and the withdrawals. Doesn’t seem too encouraging, seems like pretty mediocre results and lots of problems, although most didn’t seem to keep the dosage low and tapered too fast.

 

im getting pretty desperate though for some relief. Didn’t seem to indicate what symptoms people were trying to treat, I was intrigued initially by AltoStrata’s success given she mentioned in her paper that she suffered from 1.5 years of painful muscle spasms. Do you know if that was one of the withdrawal symptoms the lamotrigine relieved?

 

Also I realize this forum does not promote drug therapies but a fairly knowledgeable source suggested I could try a low dose of Baclofen for my spasms and the taper off it slowly after a couple of months. The theory here is it affects GABA B and should not adversely affect my already destabilized serotonin receptors etc.

 

Thanks.

 

[Jimmyt]

Hi ChessieCat, haven’t heard from yourself or anyone else since my last post. Should I move my questions over to the lamotrigine thread?

 

Also wondering about the Baclofen idea. Thanks.

[ChessieCat]

On 5/8/2021 at 11:12 AM, Altostrata said:

 

This is a site for going off drugs. We are not in a position to recommend additional drugs that may incur dependency and withdrawal.

 

 

SA staff are not medical professionals, they are unpaid peers.  As Alto has already stated above we are not able to recommend drugs.

 

On 11/15/2021 at 2:17 AM, Jimmyt said:

 

fairly knowledgeable source suggested I could try a low dose of Baclofen for my spasms

 

 

As stated below Alto has already made a suggestion regarding your spasms etc:

 

On 5/8/2021 at 11:12 AM, Altostrata said:

 

Strongly recommend you seek non-drug treatments for your pain issues

 

[ChessieCat]

  

6 hours ago, Jimmyt said:

I was intrigued initially by AltoStrata’s success given she mentioned in her paper that she suffered from 1.5 years of painful muscle spasms. Do you know if that was one of the withdrawal symptoms the lamotrigine relieved?

 

See:  about-altostrata-11-years-of-protracted-antidepressant-withdrawal-syndrome

 

[Jimmyt]

Thanks for the reminder of the sites guiding principles. I guess what confuses me a bit is it seemed there was quite an active dialogue regarding lamotrigine by members and administrators especially back around 2012 so it made me wonder if I could discuss other possible options as well as the micro dosing of lamotrigine. Has the policies changed in recent years to try to discourage the lamotrigine bridge concept?

where I’m at now is after 1.5 years of pain and disability and trying every non drug solution im getting very frustrated and worried that the constant tight muscles are damaging my joints. 
 

ive seen numerous doctors and had countless tests and been offered various drug options but have resisted hoping I can recover without them but my quality of life has gotten to the point where it seems I need some help in that area.

 

 

Thanks.

[Altostrata]

I very reluctantly discuss lamotrigine because I was treated with it.

 

The back pain I experienced was relieved by acupuncture.

[Jimmyt]

Thanks for the reply Altostrata. I appreciate your position in the matter and your information regarding the back pain. My main question to you was if the lamotrigine helped with your muscle spasms but it sounds like it did not and the acupuncture was your remedy. I tried acupuncture once really early on and it didn’t seem to help but perhaps I should try it again now that I have recovered somewhat to the point I can move and flex my back much better although still get frequent spasms.

 

Take care and thanks for running this site!

[Foxclover6]

On 11/19/2021 at 4:27 PM, Jimmyt said:

Thanks for the reply Altostrata. I appreciate your position in the matter and your information regarding the back pain. My main question to you was if the lamotrigine helped with your muscle spasms but it sounds like it did not and the acupuncture was your remedy. I tried acupuncture once really early on and it didn’t seem to help but perhaps I should try it again now that I have recovered somewhat to the point I can move and flex my back much better although still get frequent spasms.

 

Take care and thanks for running this site!

My muscle spasms are non stop at 5 months. Hope you find relief

[Jimmyt]

 

Recently sustained an injury got distracted and missed at least 2 doses, maybe 3 although 2 most likely. Take the 25 mg capsule every morning after breakfast. I’m pretty confident I took it Thursday morning but might have missed Friday and definitely missed Saturday. It is now Sunday afternoon here.

Last night (Saturday) when trying to go to sleep I kept getting the muscle jerks and then a faint trembling through my body. Each would last a few seconds but would repeat every time I tried to sleep. Finally realized I had missed my dose(s) so took it around midnight. Still couldn’t sleep so took a Benadryl. Which now I realize is not a good idea! Finally got to sleep but this morning getting muscle twitches and jerks. Once up I feel quite groggy and my movements seem a bit disassociated. Chest seems tight as well.  (Not sure if some of this is from fatigue and/or the Benadryl and/or withdrawal.

Also for the last couple of days my movements and reflexes seem accelerated. Initially I attributed it to the stress of my injury but now think it is because I was going into withdrawal. Currently this afternoon I’m feeling a bit better.

 

My question is when should I take my next dose and what dosage? Given only 2-3 days gap I assume still 25 mg, especially since I did reinstate already last night with 25 mg. Questioning it now though given my alerting overactive reflexes and muscle jerks am I now at the point where I should reinstate at a much lower dose? Ie 10% as per the “Surviving Antidepressants” site Reinstatement Guidelines? Or since it has only been 2 days just go back to 25 mg in the morning?

 

Thanks!

[Jimmyt]

Recently sustained an injury got distracted and missed at least 2 doses, maybe 3 although 2 most likely. Take the 25 mg capsule every morning after breakfast. I’m pretty confident I took it Thursday morning but might have missed Friday and definitely missed Saturday. It is now Sunday afternoon here.

Last night (Saturday) when trying to go to sleep I kept getting the muscle jerks and then a faint trembling through my body. Each would last a few seconds but would repeat every time I tried to sleep. Finally realized I had missed my dose(s) so took it around midnight. Still couldn’t sleep so took a Benadryl. Which now I realize is not a good idea! Finally got to sleep but this morning getting muscle twitches and jerks. Once up I feel quite groggy and my movements seem a bit disassociated. Chest seems tight as well.  (Not sure if some of this is from fatigue and/or the Benadryl and/or withdrawal.

Also for the last couple of days my movements and reflexes seem accelerated. Initially I attributed it to the stress of my injury but now think it is because I was going into withdrawal. Currently this afternoon I’m feeling a bit better.

 

My question is when should I take my next dose and what dosage? Given only 2-3 days gap I assume still 25 mg, especially since I did reinstate already last night with 25 mg. Questioning it now though given my alerting overactive reflexes and muscle jerks am I now at the point where I should reinstate at a much lower dose? Ie 10% as per the “Surviving Antidepressants” site Reinstatement Guidelines? Or since it has only been 2 days just go back to 25 mg in the morning?

 

Thanks!

[Altostrata]

@Jimmyt how are you? I hope you went back to your regular dosing schedule as soon as possible.

[Jimmyt]

Hi Altostrata, doing better thanks. Hope you’re doing well too!

I did go back to my schedule and seem to be getting better although still experiencing muscle twitching and jerks but much less. 
 

I’m wondering now if I triggered the symptoms through a combination of events over the last month.

 

I suffer from GERD with some strictures so have been on 25 mg Omprazole. I took it for 2 months then started to taper off the Omprazole over the last month (just by skipping days).

 

I have pretty severe seasonal allergies so have also been taking various second generation antihistamines like Claritin and Reactin fairly regularly but not daily.

 

Unfortunately during this last month I sustained a couple of injuries, bicep strain and more recently I cracked my jaw quite hard. As a result I’ve been taking Tylenol and Advil pretty much daily, although not in the last week.

 

Reading on line I now see Omprazole increases the serum levels Sertraline somewhat and painkillers may affect the kevels of SSRi’s in the body and antihistamines may affect serotonin too.

wondering if i created the perfect storm over the last month with the above and then missing a day or two of Sertraline?

 

I know I should try to not take any other medications, prescribed or over the counter but the drug interaction checker I use didn’t indicate any of what I mentioned above.

 

im thinking now in my case the better strategy would be to either take the Omprazole steady long term or not at all, but acid reflux has its own serious consequences.

 

Thanks for responding!

 

 

 

[Jimmyt]

 

Have not taken an antihistamine or omprazole now for a couple of days but wondering if I should taper them as I would a AD? I was tapering Omprazole by increasing skipped days as per most websites suggested but obviously not those like yours here where proper slow and steady tapering is required.

 

Thanks for responding!

 

 

 

[Jimmyt]

I know I recently tapered off on Omeprazole over the month of July just by skipping days, initially once every 4 days then gradually increasing skipped day over 4 weeks.

 

Since then I have been experiencing increased muscle tightness, cramping, twitching and hyper-reactivity.

 

Read an article that mentions these symptoms being reported by those stopping PPis, as the changes in stomach acid will affect neurotransmitters. Also currently taking 25 mg Sertraline.

 

Wondering if I should reinstate at a much lower dose of the Omeprazole, was taking 40 mg and taper off much more slowly and steadily.

 

I did post recently that I thought it might be due to me missing one or two days of my 25 mg Sertraline, but thinking back now these symptoms started earlier.

[Altostrata]

Omeprazole is not a psychiatric drug. See Tips for tapering off stomach acid blockers or PPIs...

 

[Jimmyt]

Reviewed but since I’ve stopped now for 2 week’s wondering if restarting might help as stomach acid levels can affect the absorption and blood serum levels of antidepressants.

 

Effect of Proton Pump Inhibitors on the Serum Concentrations of the Selective Serotonin Reuptake Inhibitors Citalopram, Escitalopram, and Sertraline

 

Effect of Proton Pump Inhibitors on the Serum Concentrations of the Selective Serotonin Reuptake Inhibitors Citalopram, Escitalopram, and Sertraline - PMC.pdf

[Jimmyt]

If i mistakenly increased my Sertraline dose from 25 mg to 27.5 mg over the last 7 days can I just go back to 25 mg or should I taper and if so at what recommended rate? Thanks!

[Jimmyt]

I thought I was in withdrawal over the last month due to stopping a non psychotropic drug but that had been affecting the metabolism and blood concentration of my Sertraline. Started getting all the withdrawal symptoms, zaps, chills, twitches, etc.

 

in a mistaken attempt to offset this effect i increased my Sertraline from 25 mg to 27.5 mg. However now experiencing more muscle tension, cramping and overall flu like symptoms. 
 

Have been on the increased dose for a week now so can I just go back to my 25 mg dose or should I taper and if so at what rate? 

[Altostrata]

On 9/14/2023 at 8:36 AM, Jimmyt said:

If i mistakenly increased my Sertraline dose from 25 mg to 27.5 mg over the last 7 days can I just go back to 25 mg or should I taper and if so at what recommended rate? Thanks!

 

You can just go back to 25mg.

[Jimmyt]

Thanks! I’m now on day 7 of being back at 25 mg, down from the 5 days at 27.5 mg, which might have been even more given it was compounded at a pharmacy where I’ve now learned they typically add 10% for losses.

 

Feeling even worse today but understand it may take a few weeks to re-stabilize again? Just want to confirm I should not increase again but not the 2.5 mg, maybe 1 mg or 0.5 mg?

 

I'm a bit confused regarding the differences between keeping the dosing stable and the option suggested in some of the tapering discussions to maybe go back up a bit if the drop was too much? Thanks.