Jimmyt Help Dealing with Mirtazapine PWS

[Altostrata]

Hello, @Jimmyt, how are you feeling now?

[Jimmyt]

Hi Altrostrata. Unfortunately based on the results of a GI scope it was strongly recommended for me to go back on a ppi in late September. Not sure if connected but my muscle spasms, cramping, etc got much worse. I rode out October but was seeing any relief and my anxiety was becoming panic attacks. In a state of extreme stress I was convinced by my doctor to increase my Sertraline to 50 mg from 25 mg. My gut said this was not a good idea given my experience and understanding from this site but went ahead and doubled my dose a week ago so to feelings of hopelessness that I will never recover. First 4 days seemed to actually help, anxiety went way down, probably just from the thought I was doing something that might help. However last 2 days I’ve been waking up with new random muscle cramps and pain.

 

Totally lost now! What should I do? Ironically, mentally I feel better, numb? So the new and increased muscle issues don’t seem quite as bad mentally but physically I know they have gotten worse.

 

should I drop back to 25 mg? How long at the double dose results in a need to stabilize and then slowly taper? Or can I start tapering back right now quickly given it will only be a couple of weeks?

 

I’m scheduled for shoulder surgery in January and had planned to taper next spring. Now I have no idea what to do and am totally stressed and in pain daily.

 

Please provide your suggestions, thanks!

[Jimmyt]

Unfortunately based on the results of a GI scope it was strongly recommended for me to go back on a ppi in late September. Not sure if connected but my muscle spasms, cramping, etc got much worse. I rode out October but was seeing any relief and my anxiety was becoming panic attacks. In a state of extreme stress I was convinced by my doctor to increase my Sertraline to 50 mg from 25 mg. My gut said this was not a good idea given my experience and understanding from this site but went ahead and doubled my dose a week ago so to feelings of hopelessness that I will never recover. First 4 days seemed to actually help, anxiety went way down, probably just from the thought I was doing something that might help. However last ~dozen days I’ve been experiencing new random muscle cramps and pain, chronic insomnia, tingling, heightened anxiety and stress twitching, hypnic jerks at night and increased muscle tightness

 

Totally lost now! What should I do? Ironically, mentally I feel better, numb? So the new and increased muscle issues don’t seem quite as bad mentally but physically I know they have gotten worse. And the insomnia is wreaking me.

 

should I drop back to 25 mg? How long at the double dose results in a need to stabilize and then slowly taper? It has been approx 19 days now. Or can I start tapering back right now quickly given it will only be a couple of weeks? What rate given 3 weeks of increased dose?

 

I’m scheduled for shoulder surgery in January and had planned to taper next spring. Now I have no idea what to do and am totally stressed and in pain daily.

 

Please provide your suggestions, thanks!

[Jimmyt]

Is there a way to calculate a time required to taper based on the time you’ve been on a drug or brain altering supplement (Ashwagandha)?

Or if has been more than 3 weeks you need to follow the 10% per month schedule?

 

For example 1 or 2 months can you do a shorter taper safely?

 

Or if it is within the 3 week period, what sort of taper is required?

 

 

 

[getofflex]

on exactly what date did you increase your sertraline from 25 mg to 50 mg?
 

Please update your signature with all of your drugs and drug changes over the past several years.  Please specify the dates of your mirtazapine use.

Edited November 20, 2023 by getofflex

[Altostrata]

23 hours ago, Jimmyt said:

I was convinced by my doctor to increase my Sertraline to 50 mg from 25 mg. My gut said this was not a good idea given my experience and understanding from this site but went ahead and doubled my dose a week ago so to feelings of hopelessness that I will never recover. First 4 days seemed to actually help, anxiety went way down, probably just from the thought I was doing something that might help. However last ~dozen days I’ve been experiencing new random muscle cramps and pain, chronic insomnia, tingling, heightened anxiety and stress twitching, hypnic jerks at night and increased muscle tightness

 

If this dosage increase seems to have made you ill, perhaps reversing it makes sense?

 

Please read this topic from the beginning. You have been under active physician care and bouncing around on sertraline since May 2021.

 

We offer peer support for tapering and psychiatric drug withdrawal syndrome. While it's possible you are experiencing an adverse drug effect, it does not appear that you are tapering or have withdrawal syndrome. We cannot assist your doctor in monitoring your ongoing drug treatment or offer general medical advice. Please let us know when you'd like tapering information.

[Jimmyt]

13 hours ago, getofflex said:

on exactly what date did you increase your sertraline from 25 mg to 50 mg?
 

Please update your signature with all of your drugs and drug changes over the past several years.  Please specify the dates of your mirtazapine use.

Hi Getofflex, thanks for responding. Increased the sertraline to 50 mg on Nov. 3, 2023.

 

I took the Mirtazapine sporadically,  from late Feb to June 24, 2020. Totally kindled myself over that time period without realizing the cause, stopped ct on ~June 24. Not sure of the exact dates taken but was in one to two week stretches as well as the odd single day or a few days in a row.

[Jimmyt]

7 hours ago, Altostrata said:

 

If this dosage increase seems to have made you ill, perhaps reversing it makes sense?

 

Please read this topic from the beginning. You have been under active physician care and bouncing around on sertraline since May 2021.

 

We offer peer support for tapering and psychiatric drug withdrawal syndrome. While it's possible you are experiencing an adverse drug effect, it does not appear that you are tapering or have withdrawal syndrome. We cannot assist your doctor in monitoring your ongoing drug treatment or offer general medical advice. Please let us know when you'd like tapering information.

Thanks Altostrata, wondering if I can drop back down after almost 3 weeks or will it kindle me more? The insomnia is resolving as well as the jerks and headaches. The increased muscle cramping is persisting. Wondering now if I should stay steady @ 50 mg until I stabilize again. Confused as to whether it is the changes causing the problems or a reaction to the drug itself.

 

I’ve actually been steady on 25 mg for the last 3 years until I panicked and increased to 50 mg due to debilitating constant health anxiety, caused by my ongoing muscle tightness. It has gotten worse of course. I believe cycling the ppi did affect the plasma concentration of the sertraline sand led to the reappearance and worsening of symptoms since July.

 

I do want to taper off, had for last 3 years, but some other health issue always caused me to think it was not a good time to start a long slow taper. Broken arm, neuropathy, GERD, pending shoulder surgery. Not looking for you to assist my doctor in further drug support. 
 

I do want to start tapering it will not cause further destabilization so now wondering how I should proceed regarding the recent increase to 50 mg. Better to hold and stabilize and then start a taper or do a reasonable but quicker  taper back to 25 mg or somewhere in between? Or just drop back immediately to 25 mg? Given I seem to be sleeping better again and the jerking has settled down I’m thinking I should hold at 50 but I guess that is where I’m looking for some advice from this group.
 

I’ve finally convinced myself that I’m having a bad reaction to sertraline for the last 3 years causing muscle issues, exacerbated by the ppi causing issues. In the past I thought it was protracted withdrawal from the mirtazapine only, but that episode I think sensitized my system to the sertraline, which prior to the mirtazapine I had no problem with taking. So now do I drop back and start tapering, hold but then taper from a much higher dose?

 

thanks for your interest and concern.

[getofflex]

13 hours ago, Jimmyt said:

I panicked and increased to 50 mg due to debilitating constant health anxiety,

It's not a good idea to jump around on our drugs based on fear and panic.  This can lead to a lot of problems, especially doubling a dose.  Doctors are almost always going to throw more drugs at us - it is what they are trained to do.  Healthcare now is driven in large part by big Pharma.  You must decide whether you want to follow the advice of your doctors, or whether you want to taper off your drugs and follow our advice here.  Doctors advice will usually conflict with our advice here.  

 

Here is a link to help you to manage health anxiety.  

 

Health Anxiety

 

Your drug signature is hard to read.  All we need are drug names, dates, and dosages, in a simple list format.  Thank you.  

 

In light of this statement of yours: "I’ve finally convinced myself that I’m having a bad reaction to sertraline for the last 3 years causing muscle issues", if it were me, I would probably drop back down to 25 mg.  But, it is your choice to make.

 

Here is the dilemma: we live in a culture where there is a pill to fix everything instantly, or at least we think there is.  This sort of thinking is what lead many/most of us to depend on psych drugs, and then also try to depend on drugs to fix our withdrawal/adverse reaction symptoms, which seldom if ever works.  Jumping up and down on our drug doses is likely to cause more problems.  Please read 

 

Stability - Stop Jumping Around

 

Sometimes, we have to put up with some temporary discomfort in order to achieve a long term goal of living a drug free and happy life.  

Edited November 21, 2023 by getofflex

[Jimmyt]

3 hours ago, getofflex said:

 

In light of this statement of yours: "I’ve finally convinced myself that I’m having a bad reaction to sertraline for the last 3 years causing muscle issues", if it were me, I would probably drop back down to 25 mg.  But, it is your choice to make..  

Hi getoflex thanks for your reply and information. Safely over the last few months I did go through a lot of the site’s materials and understand the need for stability and a slow and steady taper etc. unfortunately in times of extreme pain, frustration and panic I make bad depictions, as you remind me.
 

I’ve updated my drug profile, hopefully it is much easier to follow.

 

I had a bad sleep last night after a few good nights but I think it was because of being extremely stressed over what to do regarding my increasing muscle cramping and the increase to 50 mg.

 

To clarify my comment you quoted I do think the drug itself is causing issues but I think the bigger issue and cause of my symptoms is the changes. Each time I’ve made a change or added another drug that affects my drug metabolism I get renewed physical symptoms.

 

Therefore given I’ve been up to 50 mg for 3 weeks and some of my adjustment symptoms have settled a bit I’m concerned an immediate drop back to 25 mg would be more harmful and could send me into another long term kindling, if not there now. Terrified of getting Akathisia or some other long term movement disorder, already experienced a bit of that going up to 50 mg, restlessness, twitching, sudden muscle jerks, etc.

 

My understanding is it takes 6 to 8 weeks for the brain to really start to remodel around the drug, although obviously it is being affected immediately too. So does that mean a drop back to 25 within the 3 week rule is reasonable?

 

Wondering if you and the experts here using your experience and knowledge think a taper back down to 25 mg, maybe more aggressively than 10%, or max 10%, might be a safe and more conservative approach? And maybe a quicker time between adjustments such as weekly to get back down with one or two months?

Or just start the recommended 10% per month taper?

 

And should I wait a few more weeks to stabilize before tapering?

 

Or would dragging out the higher dose just allow more time for my brain and body to adjust to the higher dose?

 

I'm personally thinking a taper back down would be less harmful but no experience on such a thing, but just know my jumping around is causing big issues.

 

Sorry for all the questions just trying to be thoughtful and careful, for a change.

[getofflex]

Thank you for updating your drug signature - this is much better!  

4 minutes ago, Jimmyt said:

My understanding is it takes 6 to 8 weeks for the brain to really start to remodel around the drug,

It takes 4 weeks for an SSRI drug such as sertraline to remodel the brain.  

 

5 minutes ago, Jimmyt said:

Wondering if you and the experts here using your experience and knowledge think a taper back down to 25 mg, maybe more aggressively than 10%, or max 10%, might be a safe and more conservative approach? And maybe a quicker time between adjustments such as weekly to get back down with one or two months?

Yes, you could do that.  You might try an accelerated taper of, say, 25% per week, until you get back down to to 25 mg.  Then, once you get to 25 mg, please stick with that dose for a long time, to allow your nervous system to stabilize. I would suggest you start doing this right now, before your brain gets fully adjusted to the 50 mg sertraline. 

 

8 minutes ago, Jimmyt said:

Sorry for all the questions just trying to be thoughtful and careful, for a change.

Yes!  This is the key.  Do not react to a bad day, or a wave, by suddenly changing your dose of your drug.  Instead, learn non drug coping techniques.  

 

Non Drug Ways to Cope with Withdrawal Symptoms

 

 

[Jimmyt]

12 minutes ago, getofflex said:

 

It takes 4 weeks for an SSRI drug such as sertraline to remodel the brain.  

 

Yes, you could do that.  You might try an accelerated taper of, say, 25% per week, until you get back down to to 25 mg.  Then, once you get to 25 mg, please stick with that dose for a long time, to allow your nervous system to stabilize. I would suggest you start doing this right now, before your brain gets fully adjusted to the 50 mg sertraline. 

 

So now I’m a bit confused if at 4 weeks my brain has adjusted and I start dropping 25% now in another week I’ll still be over the 25 mg at the 4 week mark so my brain is now expecting more and I’ll be continually dropping it aggressively over the next few months. Also would the 25% be from the 50 or 25 mg?

sorry contradicting myself I know.

 

what about holding at 50 until I stabilize and then doing the conventional taper? Would that be safer?

 

I guess the question that needs answering regarding the increase is it the increase in the drug or the change that is causing my current flare? Get it out asap or avoid any more drastic changes.

 

is there a precedent within the group knowledge to optimize the best plan or I guess everyone is different.

 

thanks you for your help?

[getofflex]

25 minutes ago, Jimmyt said:

So now I’m a bit confused if at 4 weeks my brain has adjusted and I start dropping 25% now in another week I’ll still be over the 25 mg at the 4 week mark so my brain is now expecting more and I’ll be continually dropping it aggressively over the next few months.

I believe you might be overthinking this.  It's not as if at 4 weeks your brain is suddenly 100% used to a certain dose, it just gradually adjusts over time.  

 

Here is what I would do:  

 

week 1: 44 mg 

week 2: 38 mg

week 3: 31 mg

week 4: 25 mg

 

Then, stick with the 25 mg for a long time, as in several months. 

 

 

[Jimmyt]

Ok thanks for your help. So just one final check do you advise strongly against trying to stabilize on 50 and then doing a slow taper? The reason I keep bring it up is I am somewhat better than last week wrt sleep, twitching, headache, panic, high heart rate except maybe the cramping is a bit hard to judge. Therefore concerned about making another change too quick. 
 

is it a 50/50 type decision or is the dropping the preferred choice as far as you are concerned?

 

sorry repeating my questions I guess, hopefully the last lol.

[Altostrata]

If you feel better taking 50mg, you might consider staying at 50mg.

 

We do not assist in smoothing out the adverse effects from an ongoing drug regimen, that's your doctor's job.

[Jimmyt]

3 minutes ago, Altostrata said:

If you feel better taking 50mg, you might consider staying at 50mg.

 

We do not assist in smoothing out the adverse effects from an ongoing drug regimen, that's your doctor's job.

Definitely not better in fact today the cramping has gotten worse. Yes I understand regarding my choice not being technically in your mandate given I increased but after these 2 weeks I’m definitely at the point of wanting off, just hoping for guidance regarding the best strategy now.

 

These last few days has shown me even though some of the symptoms have settled the muscle cramping seems to be getting worse. Given it is increasing it tells me it is not going to resolve itself.

 

Therefore just trying to decide if I should give it 2 more weeks and then taper, kind of like following the 1 month adjust and hold guideline while tapering or if it would be better to bring the dose down carefully but asap to avoid a lot of time for my body to mold around the higher dose.

 

My doctor has no clue to be honest and I wish I had never listened.

 

Thank you to you and your team. I guess I have your recommendations and it is up to me to make the decision.

[Altostrata]

You'll have to make up your own mind about this. Have you considered the role your health anxiety might play in your treatment choices?

[Jimmyt]

Yes my health anxiety is huge. In fact I’m sure it contributes significantly to my muscle tightness, at least prior to up dosing. If fact the health anxiety is what caused me to up dose, in some belief it will lower my anxiety and reduce my muscle cramping. Is that what you are referring too?

.

 Of course now my anxiety is high again trying to decide what to do next, hold or step down.

 

id prefer to step down as it will lead to lower dosing and perhaps a quicker long taper but concerned about it just adding to another change and kindle me even more.

 

That is why I am trying to get some input from yourself, I know you can’t tell me but was hoping based on your experience a preferred strategy might be available.

 

so you are ok with me dropping  10% weekly as a reasonable option?

[Jimmyt]

1 hour ago, Altostrata said:

You'll have to make up your own mind about this. Have you considered the role your health anxiety might play in your treatment choices?

I will just wanted to confirm that given my situation either staying @. 50 to stabilize and then taper or dropping now on the schedule suggested on both reasonable options and I just need to decide. I’m a bit confused I guess because if feels like I got two different suggestions from two different moderators.

 

sorry won’t bug you anymore, thanks for all your help and patience.

[KenA]

3 hours ago, Jimmyt said:

Yes my health anxiety is huge. In fact I’m sure it contributes significantly to my muscle tightness, at least prior to up dosing. If fact the health anxiety is what caused me to up dose, in some belief it will lower my anxiety and reduce my muscle cramping. Is that what you are referring too?

.

 Of course now my anxiety is high again trying to decide what to do next, hold or step down.

 

id prefer to step down as it will lead to lower dosing and perhaps a quicker long taper but concerned about it just adding to another change and kindle me even more.

 

That is why I am trying to get some input from yourself, I know you can’t tell me but was hoping based on your experience a preferred strategy might be available.

 

so you are ok with me dropping  10% weekly as a reasonable option?

@Jimmyt I found that the anxiety was responsible for quite a few of my symptoms. Muscle aches and twitches, shortness of breath, racing heart rate. All of it came on when my anxiety elevated, and once the anxiety passed, those symptoms calmed down as well.

[getofflex]

12 hours ago, Jimmyt said:

I will just wanted to confirm that given my situation either staying @. 50 to stabilize and then taper or dropping now on the schedule suggested on both reasonable options and I just need to decide.

Yes.  

[Farm24]

On 11/20/2023 at 9:49 PM, Jimmyt said:

Hi Getofflex, thanks for responding. Increased the sertraline to 50 mg on Nov. 3, 2023.

 

I took the Mirtazapine sporadically,  from late Feb to June 24, 2020. Totally kindled myself over that time period without realizing the cause, stopped ct on ~June 24. Not sure of the exact dates taken but was in one to two week stretches as well as the odd single day or a few days in a row.

You know what? I took mirtazapine as needed for sleep and I had some back aches from it. Doc said it was a low dose so it was fine to do that.  Now I have progressive muscle pain. I'm wondering if the mirtazpine as needed started the issues. 

[Jimmyt]

On 3/12/2024 at 1:16 PM, Farm24 said:

You know what? I took mirtazapine as needed for sleep and I had some back aches from it. Doc said it was a low dose so it was fine to do that.  Now I have progressive muscle pain. I'm wondering if the mirtazpine as needed started the issues. 

Hi Farm24 might have, did for me. When I stopped in June my muscles got even more tight and cramping. I quit most exercise and activity and got weaker. Took over a year to gradually settle down. During that time I continued to take the 25 mg Sertraline which I have been on and off of a few times. Never associated the muscle spasms to the Sertraline. Should have tapered off but never did, 4 months ago I increased the Sertraline to 50 mg and the muscle spasms since then have greatly increased. Not sure if I should taper now or wait it out. I think my brain is just totally kindled and does not tolerate the drug, increased serotonin or all drugs now. Want off but seeing your experiences make me think tapering now will just make it even worse.

 

Did you have spasms while on the SSRi’s or only after your fast taper?

[Farm24]

39 minutes ago, Jimmyt said:

Hi Farm24 might have, did for me. When I stopped in June my muscles got even more tight and cramping. I quit most exercise and activity and got weaker. Took over a year to gradually settle down. During that time I continued to take the 25 mg Sertraline which I have been on and off of a few times. Never associated the muscle spasms to the Sertraline. Should have tapered off but never did, 4 months ago I increased the Sertraline to 50 mg and the muscle spasms since then have greatly increased. Not sure if I should taper now or wait it out. I think my brain is just totally kindled and does not tolerate the drug, increased serotonin or all drugs now. Want off but seeing your experiences make me think tapering now will just make it even worse.

 

Did you have spasms while on the SSRi’s or only after your fast taper?

I had them on and after.  The tapering didn't make it worse.  However as things are lifting I am seeing other issues. Like nerve pain

[Jimmyt]

4 minutes ago, Farm24 said:

I had them on and after.  The tapering didn't make it worse.  However as things are lifting I am seeing other issues. Like nerve pain

Sorry to hear that, are the muscle spasms decreasing as you taper?

[Farm24]

1 minute ago, Jimmyt said:

Sorry to hear that, are the muscle spasms decreasing as you taper?

I went off ct. I had so many side effects on this med.  I couldn't feel my legs anymore. I was only on it 3 months. 

[Jimmyt]

2 minutes ago, Farm24 said:

I went off ct. I had so many side effects on this med.  I couldn't feel my legs anymore. I was only on it 3 months. 

Yikes! These meds are horrible. I’m so mad at myself for increasing last November. I don’t know if I should wait some or start tapering. I guess I need to repost in my intro thread and see what advice I receive from the admin people.

 

are you seeing any relief? How long has it been?

 

3 minutes ago, Farm24 said:

I went off ct. I had so many side effects on this med.  I couldn't feel my legs anymore. I was only on it 3 months. 

 

[Farm24]

1 minute ago, Jimmyt said:

Yikes! These meds are horrible. I’m so mad at myself for increasing last November. I don’t know if I should wait some or start tapering. I guess I need to repost in my intro thread and see what advice I receive from the admin people.

 

are you seeing any relief? How long has it been?

 

 

I'm seeing better days, but not normal days. I bought a tens unit and started massage last week for the muscle pain.  This week I started getting nerve pain. I don't know why I'm getting new symptoms.  

[Jimmyt]

40 minutes ago, Farm24 said:

I'm seeing better days, but not normal days. I bought a tens unit and started massage last week for the muscle pain.  This week I started getting nerve pain. I don't know why I'm getting new symptoms.  

That is good news. My understanding is in withdrawal anything can happen. Thanks for your replies.