Imnotbroken Short-term dose increase - rapid taper?

[Imnotbroken]

In January 2021, I had a period of anxiety do you work stress.
 

In March, I was placed on Mertazapine (7.5mg to help me sleep).

 

In mid April, my Doctor suggested I stay in an inpatient clinic for therapy and to ‘sort the correct meds out’.

 

I was upped to 15mg, and then quickly to 30mg. And put on a whopping 1.5mg of Clonazapam.

 

After 10 days they then rapidly tried to take me of the Clonazapam and I had already developed a tolerance and hit withdrawal symptoms at 0.75mg. No clue about what these meds really did. I just felt confused on them, but got plenty of sleep.
 

I had assumed it sensible to taper the benzo first, however, I’m learning this might not be the case, so I joined the forum.

 

What a world of pain this is. Hugely sad.

 

 

Edited May 8, 2021 by Gridley

[Imnotbroken]

I’ve only been on this new dose of Mirtazipine for 2 weeks, could I go back down to 15mg? I was only on that for a week. Prior to that 7.5mg for a month or so. 

[Imnotbroken]

I’ve also been on Mirtazipine for 2 months (7.5mg for one month, 15mg for 5 days and 30mg for 3 weeks). The 3 weeks takes us to today.

 

I don’t feel any particular benefit of being on the higher dose. And I don’t want to be pumping twice the amount in there is some sense i can still quickly react and undo some future damage.

 

Is three weeks a safe enough window to drop back down to 15mgs? 

 

To add to my woes, I’m on 0.75mg of Clonazapam. I've been on it three weeks and have struggled with Dr induced fast taper - I will now do this very very, very slowly too.

 

[Altostrata]

Welcome, @Imnotbroken

 

Being on a drug for a month or more increases risk of withdrawal. One of the symptoms of reducing mirtazapine too fast is rebound insomnia. As 3 weeks is borderline, I would step down gradually every few days from 30mg to 25mg to 20mg to 15mg. This should minimize the risk.

 

If I were you, I would not change 2 drugs at once, this causes major complications. What has been your daily clonazepam schedule over the last 3 weeks? There's a good chance you're already physiologically dependent on it, meaning subject to withdrawal if you reduce it too fast.

 

Were both of these drugs prescribed at the same time, and both for sleep? That is a very bad call on the part of your prescriber.

 

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.

 

 

 

[Imnotbroken]

Thanks for the quick reply.

the original prescriber had me on 5-10mg of Diazapam as needed for the start of April. Looking back I was already feeling withdrawal symptoms then, when missing a few days. I didn’t recognise them as such. 

 

The private clinic had me on whopping 1.5mg of Clonazapam for 2 weeks... and rapidly try to taper me off. How they thought that was ever going to work!? I settled at 0.75 as a baseline that I’ve found tolerable for the last 10 days. But I already feel daily withdrawal symptoms from it. There is clearly physical dependency and I intend to taper from this point very, very, very slowly - in-line with all benzo withdrawal wisdom (AshtonMsnual / Micro taper etc).

 

The hope is / was that there was a small window to reduce the Mirtazipine to his original 15mg prescription, rather than 30mg which knocks me out. I’m aware without reducing it, both drugs hugely counteract against each other.

 

I reduced the mirtazipine to 15mg last night and slept fairly well. 
 

Do you think that given the Clonazepam changes, I’ve missed my window? After such short term use of Mirtazipine at this high dosage. I’m conscious I live with decisions I make now for a very long time. Years of slowly tapering. 
 

I agree the slower few days approach makes more sense.

 

I’ll add a signature today. 

[Imnotbroken]

I should add I don’t intend to taper both at the same time. I need a period of stability, before deciding which to tackle... very, very, very slowly. 

[Gridley]

Welcome to SA, Imnotbroken.  This is your Introduction topic.  Please make all future posts here--only one Introduction topic per member.

 

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.  Please include the dates and doses of your updoses of Mirtazapine.

 

Account Settings – Create or Edit a signature.

 

Your question is, can you drop back down to 15mg Mirtazapine from 30mg after having been on 30mg for two weeks.  The brief answer is, it's impossible to tell.  Generally, we advise making as few changes as possible to these drugs, which are very powerful.   You've made a lot of changes since January, including the introduction of the Mirt, two updoses and the addition of a benzo. Each of these changes causes disruption and sensitivation to your nervous system.  Over the two weeks you've been on 30mg, your system has become acclimated to the increased dose.  We can't tell you how you will react to another change and a 50% reduction.  The safe approach would be to taper down from the 30mg to 15mg.  We recommend tapering no more than 10% of your current dose every four weeks.

 

Why taper by 10% of my dosage?

 

This link is specifically about tapering Mirtazapine, including how to get the non-standard doses you'll need for a 10% taper.

 

Tips for tapering off mirtazapine (Remeron)

 

Mirtazapine is a curious drug, in that at the low doses it has a sedating effect and at the higher doses an activating effect.  There is no specific point delineating the dosage where the change occurs, but it may well fall between 15mg and 30mg.  Since you were prescribed Mirtazapine for sleep and anxiety, your doctors may have unwittingly tipped you over from sedation to activation when they increased your dose to 30mg.   How do you feel after taking the 30mg Mirtazapine?  Did you notice a change in its effect when you updosed from 15 to 30?

 

We recommend making only one change at a time.  My suggestion is that you hold where you are on the Clonazepam and taper the Mirtazapine down to 15mg using the 10% taper.  Once you've reached that point, we can address what you want to do with the Clonazepam.

 

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 are single ingredient (not mixed with other types of supplements).  Complete this process before you do anything with the Mirtazapine.

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Edited May 8, 2021 by Gridley

[Altostrata]

That reduction in mirtazapine will take a week or so to completely settle.

 

We will need your daily clonazepam schedule with dosages and history. You may need to spread the doses out to avoid interdose withdrawal.

[Imnotbroken]

I’ve decided to stay at 30mg and accept my fate. There are no shortcuts here.

 

I’m already getting withdrawals from the Rapid Clonazapam reduction and interdose too. 
 

I do t think I should mess with my CNS any more than I already have done. 
 

I need to stabilise the Benzo side and then decide which of these two to take first or some sort of staggered approach between the two. 
 

It all eventually felt like too big a risk. Especially after struggling so much with the Clonazapam reduction. 
 

Let’s treat last nights one off reduction as a missed dose. 
 

I cannot believe it took just over a month to get to this point. A life irreversibly changed. 
 

Thank you for your help. Let’s change the conversation to slow and steady! 

[Altostrata]

I don't understand your decision to stay on the higher dosage of mirtazapine.

 

It's likely a lot of your problems stem from your use of clonazepam. We need your daily schedule to figure out what to do about that.

[Imnotbroken]

Hey,

In very late April, I was described Diazapam on an as you need it basis (5mg). By the same doctor who prescribed Mirt at 7.5mg for sleep (early April). I took the mirt daily as above for sleep. And over a couple of weeks dipped into the Diazapam (10 x 5mg pills - not knowing what I was dealing with).

 

Still left feeling a host of symptoms in early April - and  still feeling anxious (understandably) I checked into a private clinic to help(!) with the continued anxiety. I now know those symptoms were withdrawal.

 

In a daze, the psychiatrist put me in Clonazapam (1.5mg) and upped my Mirt to 15mg (13/04/21). I had no clue what I was doing - still somewhat dazed from the withdrawals. That first few days were a blur and was a total daze (04/13/21 - 04/20/21). In that time in response to me not being able to remember anything, he quietly upped by Mirt to 30mg (April 17). I settled somewhat by April 20th and was relatively functional. Since then, I have been taking the Mirt before bed 10pm. It knocks me out for 8 hours.

 

At this stage, I was on 0.5 of Clonazapam at 9am, 2pm and 10pm. On Monday 26th of April, the Psychiatrist tried to rapidly taper me off the Clonazapam, removing the 9am dose. I was fine over the following 3 days. On Thursday (29th) he cut the 2pm dose (taking me to just .5mg) and I suddenly hit all sorts of withdrawal symptoms. Tremor, restlessness, anxiety, forgetfulness, tinnitus - nothing overly scary (yet) but uncomfortable. 
 

In response, he wanted to reintroduce the 2pm Clonazapam dose (.5mg). I refused to go up the full amount and went up .25mg instead. This was split as 0.25 at 9am and 0.5 at 6pm.

 

Mirt remained consistent at 30mg at 10pm. 
 

Still struggling, I then insisted he split the Clonazapam dose to 3 times a day on Saturday 1st May. I’ve been there ever since, without much let up in symptoms (uncomfortable but just tolerable).

The nurses chop the 0.5 Clonazapam by hand without weighing it, so there has been no real accuracy with the .25mg dose (9.30am, 3.30pm, 9.30pm). Withdrawal symptoms are uncomfortable, but tolerable. With my body reacting to all this inconsistent dosing, I have no way of accurately reducing my Mirt intake until Monday (other than in half quietly). I’ve now have a near-lab style setup waiting for my return home (tomorrow).

 

Given the timeframe, if you think I still can attempt a similar reduction and get this even a bit lower, then I’m very open to do so.

 

The less of this poison in me the better, but with the Clonazapam inconsistencies, it’s hard to know where my current Clonazapam withdrawal symptoms begin and any possible Mirt ones might start. My Clonazapam withdrawals remain consistent. I could measure any uptick and put them down to changes in the Mirt? And even if I got the Mirt down a bit lower. It’s something.

 

This has all been such a short timeframe, with so many changes. I didn’t want to fry my CNS. But if there is still a possible reduction window, I am happy to do the incremental reductions over a few days, as you suggested and watch for any significant changes over those few days.

 

Last night, I worried, that just quietly biting off a bit of the dose would cause more instability. There is such a small window of opportunity to do something about this.

 

I might add this was an option stay!!! I should add to the above, that I had moderate anxiety at the start of this for 3 months, over work and a health concern (which was turned out to be nothing) - prior to that - no issues. I was a fit and healthy 40 year old man.

 

Many thanks,

 

Sam

 

 

 

[Imnotbroken]

* Opening line - inital 7.5mg of Mirt for sleep was prescribed in mid March, not early April

[Imnotbroken]

I've read around all morning. This is my only window (I may have missed it). Tonight, I'll go to 22.5mg (averaging the 2 nights so far) and hold there for a few days. In line with your earlier suggestions.

 

I'll keep you posted and if I feel no major uptick in symptoms over the next few days, i'll step down again over the following few days and hope to settle somewhere near 15mg, without a major uptick in symptoms. Then obviously hold for a few weeks while deciding which of these to tackle first and go incredibly slowly at that point. 

 

This may be my only window of opportunity. I understand it's risky and will consult with you about reinstating, if symptoms get bad. I'm in the UK so I receive your reply after I get knocked out by the Mirt. 

 

Assume, I'm doing this tonight, in response to the above. I'm hoping I've not missed my window.

[Imnotbroken]

After 3 days on the lower dose, today I started getting some withdrawal symptoms. Although, I do feel a little better.
 

But have a slight stomach cramp, a small rash on belly button, minor brain zaps, a bit of confusion and dizziness this morning. 
 

I sense the above confirms that I have adjusted to the higher dose and I should quickly reinstate back to 30mg and stay there? And stay there for a few weeks to stabilise.

 

Tapering can then be done more slowly, once I settle down after the Clonazapan inconsistencies in the last month. Lesson learnt, slowly, slowly.

 

 

[Altostrata]

I don't know what you mean by "window".

 

1 hour ago, Imnotbroken said:

Although, I do feel a little better.

 

In what ways do you feel better?

 

We need to see your drug and withdrawal history in your signature You may need to use a computer to do this.

[Imnotbroken]

1 hour ago, Imnotbroken said:

After 3 days on the lower dose, today I started getting some withdrawal symptoms. Although, I do feel a little better.
 

But have a slight stomach cramp, a small rash on belly button, minor brain zaps, a bit of confusion and dizziness this morning. 
 

I sense the above confirms that I have adjusted to the higher dose and I should quickly reinstate back to 30mg and stay there? And stay there for a few weeks to stabilise.

 

Tapering can then be done more slowly, once I settle down after the Clonazapan inconsistencies in the last month. Lesson learnt, slowly, slowly.

 

 

My mood is improved. I’ve been struggling with the rapid Clonazapam changes, but today has been a little easier. 

[Imnotbroken]

‘Window’ having only been at the higher dose for 3 weeks. 

[Altostrata]

Could these symptoms have been from the irregular clonazepam dosing?

 

1 hour ago, Imnotbroken said:

But have a slight stomach cramp, a small rash on belly button, minor brain zaps, a bit of confusion and dizziness this morning. 

 

[Imnotbroken]

These are new. Not experienced in the last two weeks of withdrawals. And are similar to a previous WD in March. They 'resolved' by up-dosing the Mert. That was pre clonazpam. The over zealous Psych who just needed to give me some therapy! Now this.

[Altostrata]

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.

 

Please keep a diary of all your drug changes and let us know how you're doing.

[Imnotbroken]

Signature added. As you can see, my system has had a lot of rapid drug changes in a very short space of time. 

 

After an acute patch of anxiety (2 months). I checked into a private clinic to help(!) with my anxiety, looking back I was evidently in withdrawal, from inconsistent dosing of the Mertazipine in the previous few days (no idea what I was dealing with - see signature).

 

That wasn't spotted, and the over zealous Psych quickly put me both Clonazepam and Mertazipine. In W/D and spaced out, I took new new meds without any idea of the repercussions. The first week was a blur, the second week, I steady up and started to feel like my old self (no wonder on all that). The Phych then attempted to rapidly withdraw me from the Clonazapam (intending it to be in-patient only). 1.5mg / 1 mg / 0.5mg over the course of a week).

 

I practically fell apart at .05 and have been on .75mg for the last two weeks. Those two weeks have been a real struggle, but he was hell bent of reducing the Benzos at all costs. Would not countenance the A/D. The A******e Psych now wants me to taper off Clonazapam slowly(!) at home. The daily symptoms are an hourly battle. Nothing overly scary yet, but my cognitive functioning and memory is terrible and the agitation / anxiety comes in waves. Nonetheless, I've held Clonazapam at 0.75mg (split 3 times a day). 

 

As discussed, I looked to bring the Mertazipine down quickly, just in case, there was still an opportunity to do so (cutting to 22.5mg for 4 days). Initially, I felt considerably clearer, but then stranger symptoms started appearing (halos on lights, missed heart beats, rapid heartbeat, brain zaps, odd rash on belly button). The heart ones scaring me the most. I have reinstated to the original 30mg now and that is still giving me 6/7 hours of sleep a night.

 

As you can see I have had a huge amount of drug changes in a very short space of time. I now want to stabilise at these doses (if that is indeed possible). The big reduction in Mertazipine (30mg to 22.5mg) was clearly too much too soon. I'm home and can control the meds myself now, so am working on being very consistent for the next few weeks. 

 

The Psych still wants me to tackle the benzo first and is willing to support a slower taper (what other possible choice is there than slowly!). 

 

As you can see, none of this has been slow and I need to stabilise - I will do so. The Benzo community and Psych all say taper the benzo at all costs, but I can't help but feel that most of the issues stem from the speed of all this and the Mertazipine will no doubt soon stop knocking me out in the evening (my only rest bite). 

 

I might add, I have had windows over the last three days where my head is a lot clearer. They are windows, which makes me think whilst the timing and the speed of the Mert reduction created W/D symptoms and was too much at this stage, much of my confusion stems from all these changes and the Mert... it's the only think that has changed in the last few days. 

 

I will hold at this dose until I stabilise. I've read all about the A/D being the 'accelerator' and the Benzo being the 'break'. I'm worried about putting all that Benzo in for the time it takes to do a long taper off the Mert. And how I would ever get the prescription to support that.  

 

All that said, I am tempted to taper slowly down to 15mg (using the 10% guide) and then make a decision on which to reduce. It's a big call to make, as Bnezos have the big scary reputation and I'm still suffering from the withdrawal symptoms from his mad rapid taper. 

 

Would your opinion be, post stabalising, that getting the Mert to 15mg (where it's more sedating, is more important that tapering the Benzo yet further?

 

 

[Imnotbroken]

I've not posted for just under a month. This last month, has been a mixed bag.

 

I am currently 'stabilising' on .75mg of Clonazepam and 30mg of Mertazapine.

 

As such a short-time user, in early May, I attempted to reduce my Mertazapine dosage and after experiencing a rush of difficult withdrawals on the 3rd night, I reinstated the 30mg dose.

 

The following morning, my digestion slowed to a halt and I developed Pots-like symptoms (heart rate jumping from 60 to mid 80s when upright) and skipped heartbeats (which I've found the scariest symptom aspect) with some chest ache. Lots of ANS systems seems to go offline, and have subsequently all improved. 

 

I've made no further attempts at tapering and, despite the Pots-like symptoms, have been doing lots of walking to stay active. Full blown exercise would scare the life out of me. But I've got 15/20k steps in per day for the last week.  

 

Although, my ANS has taken a real battering, and my heart still seems to be uncomfortable, I'm otherwise symptom free and sleep is holding (couple of low moods). The long, long walks have really helped.

 

The Pots symptoms don't strike me as symptoms that will just clear up in a few weeks, this may be something I need to deal with throughout any taper and beyond. I accept the damage that the enforced, rapid Clonazepam reduction seems to have had on my nervous system. With that in mind, I'm not sure I should be hanging around waiting for a quick fix (as in weeks). 

 

I am back and forth on which to begin tapering... I had such a bad reaction to reducing the Mertazapine in early May. I wonder if it's still masking some of the W/D from the enforced benzo reduction and as I removed it, so the horrors of that we're uncovered....

 

Cut a long story short, should I continue to hold and hope these symptoms clear up, or should I look a first conservative cut (maybe 5%)? And if so, which would you suggest to do first?