onetime: tapering mirtazipine

[onetime]

Hello,

 

I have been on medication for most of my adult life. Over the last 2 years I have been tapering the following:

Xanax 2mg per day - 10% per month  - finished taper June 2020

Quetipine 100mg per day 10% per month  - finished taper March 2021

Started to taper Mirtazipine 15mg per day 10% per month -started April 2021

 

So many withdrawal symptoms with windows and waves but the one that is bothering most is hand and finger stiffness, pain and weakness. This seems to be persistent ( no windows) and got worse since starting the mirtazipine taper. 

My question: Is this withdrawal? 

 

I would be grateful to get advice.

 

Thanks in advance.

[DataGuy]

Hi @onetime,

 

Yes, this symptom is likely withdrawal related. If you search the site you will almost surely find other people with this symptom. I would guess it is from the Quetiapine, which can affect motor control and may result in symptoms like tardive dyskinesia, dystonia, twitches, jerks etc. If you remain abstinent from these drugs this symptom should go away after some indeterminate length of time. Difficult to say when it will improve for any one person.

 

If you are still experiencing symptoms that cause excessive dysfunction or distress, we recommend holding until the symptoms improve, and then beginning to slowly taper again. If you would like some more guidance we would be happy to answer your questions. Some may need to hold for months to see any improvement. Unfortunately withdrawal symptoms can last quite some time once they take hold. This topic on tapering helps explain why. 

 

Is Mirtazapine the only drug you are taking? Are you taking any supplements? Some other drugs can interfere with metabolism and can also have psychotropic effects (antibiotics, steroids, some supplements, coffee, nicotine etc.). It would be very helpful if you could create a drug history in your signature like this one. This link will take you directly to the signature. Signatures generally look like this: 

 

Example:

2001–2002 paroxetine 
2003  citalopram 
2004  paroxetine
2008  paroxetine slow taper down to 2016 Aug off paroxetine
2016  citalopram May 20mg  Oct slow taper down
2018  citalopram 13 Feb 4.6mg 15 Mar 4.4mg 29 Apr 4.2mg

 

This will allow any moderator or member to quickly see your history and where you are in your taper, and thus be able to help more easily without too much reading (most people here are volunteers and have other jobs).

 

Thanks and hope you are feeling better soon. 

[onetime]

Thank you DataGuy,

 

I think I have created my signature:

Prozac 2000 - 2018

Xanax Quetipine Mirtazipne 2018

Xanax 2mg per day - 10% per month  - finished taper June 2020

Quetipine 100mg per day 10% per month  - finished taper March 2021

Started to taper Mirtazipine 15mg per day 10% per month -started April 2021

 

Mirtazipine is the only drug I am taking now. To be honest, I am worried that I may have rheumatoid arthritis. However, I do remember having a stiff painfull hand ( just the right hand)on and off when I was tapering quetipine. So I was wondering, do you think the continuous stiff painful hands are from quetipine or mirt withdrawal or both?

 

Thanks again for your help and advice

[DataGuy]

Thanks @onetime, your signature looks good 👍

 

Yes, I would bet it is from the Quetiapine. Can I ask you what your last dose of that drug was before jumping off? Sometimes symptoms can worsen a bit for a few months after cessation and then flatline for awhile before slowly improving. Some other types of drugs may cause muscle problems in withdrawal as well, though. In the case of Quetiapine, it is likely due to the supersensitization of dopamine receptors as a result of the prolonged blockade of these receptors by the drug. At least that is what psychopharmacologists strongly suspect. See an article like this one, for example.

 

The reason I ask about your last dose is because if someone is tapering 10% per month, they would typically take quite a long time to get off the drug (multiple years). I'm not really sure how long you took to get off, but if you started these drugs only in 2018 and then decided to taper shortly thereafter, you may have gone a bit more quickly in some places. Usually we try to taper hyperbolically, reducing 10% from the previous dose. Sometimes people will read this as reducing from 100mg, to 90mg, to 80mg, to 70mg etc., but it is supposed to be 100mg, 90mg, 81mg, 72mg, 63mg and so on, to avoid greater and greater reductions as a proportion of the last dose. As you get to lower and lower doses, the drug typically dose more work per mg, and dose reductions result in steeper declines in receptor occupancy, which can result in more severe withdrawal symptoms. But you may already be aware of this, I was just making sure. 

 

 

[onetime]

If memory serves my last dose of quetipine would have been:

1/4 of a 25mg tablet mid March 2021

Started Mirt taper on the 13th April 2021 .

 

I started Quetipine taper 100mg Oct.2020. So from 100mg to 0 with duration of:

Oct 2020 to April 2021 i.e. 6 months!!

 

If I could get my head right and believe it is withdrawal and not rheumatoid arthritis, I think that would really help!

 

Thanks again for the advice

[DataGuy]

Oh yes, I think it must be withdrawal. You did taper fairly quickly. I'm not sure I understand how you got from 100mg to 0mg if you were tapering 10% per month? That seems more like a 20% per month taper. Do you have other symptoms other than just stiff fingers that are clearly withdrawal symptoms? These would be symptoms that you didn't really have before the meds or symptoms that are much more intense than any you had prior to the drug. That would strengthen the case that it is a withdrawal symptom. 

 

As I mentioned before, I think the best thing you can do is hold the dose and wait for your system to catch up with the quick withdrawal (this involves downregulation of dopamine receptors etc.). Continuing to taper can result in worsening withdrawal symptoms like the hand stiffness and muscle weakness. 

[onetime]

20 hours ago, DataGuy said:

Thanks @onetime, your signature looks good 👍

 

Yes, I would bet it is from the Quetiapine. Can I ask you what your last dose of that drug was before jumping off? Sometimes symptoms can worsen a bit for a few months after cessation and then flatline for awhile before slowly improving. Some other types of drugs may cause muscle problems in withdrawal as well, though. In the case of Quetiapine, it is likely due to the supersensitization of dopamine receptors as a result of the prolonged blockade of these receptors by the drug. At least that is what psychopharmacologists strongly suspect. See an article like this one, for example.

 

The reason I ask about your last dose is because if someone is tapering 10% per month, they would typically take quite a long time to get off the drug (multiple years). I'm not really sure how long you took to get off, but if you started these drugs only in 2018 and then decided to taper shortly thereafter, you may have gone a bit more quickly in some places. Usually we try to taper hyperbolically, reducing 10% from the previous dose. Sometimes people will read this as reducing from 100mg, to 90mg, to 80mg, to 70mg etc., but it is supposed to be 100mg, 90mg, 81mg, 72mg, 63mg and so on, to avoid greater and greater reductions as a proportion of the last dose. As you get to lower and lower doses, the drug typically dose more work per mg, and dose reductions result in steeper declines in receptor occupancy, which can result in more severe withdrawal symptoms. But you may already be aware of this, I was just making sure. 

 

 

 

[onetime]

Thanks so much for your advice.

 

Yes my maths is off regarding the taper!

 

I have had loads of withdrawal symptoms during my taper from Xanax and Quetipine:

During Waves:

Anxiety

Compulsive googling for answers

Depression

Suicidal Ideation

Hopelessness

Benzo Belly

Muscular Pain

Anger

Short fuse with family

Sleepless nights

and much more

 

Above symptoms not all together and lasting a few days. Windows lasting 1 - 5 weeks on occasions.

 

It is the stiff fingers and painful hands that is lasting for some time i.e. no break, no window. This symptom leading to anxiety, depression and catastrophic thinking.

 

Thanks again DataGuy, I just might need to hold for a time.

[DataGuy]

On 5/30/2021 at 7:48 AM, onetime said:

Thanks again DataGuy, I just might need to hold for a time.

 

I think that is a good idea, @onetime. It can take quite awhile for protracted withdrawal symptoms to improve, sometimes months or years. You don't need to hold for that long, but you may wish to hold for at least a few weeks, until you are satisfied the symptoms you are experiencing are tolerable. I know it's tough to live with symptoms like that. 

[onetime]

In a strange way DataGuy its comforting that it can take some time for protracted withdrawal symptoms to improve. In other words, it can mean that I am not suffering from an incurable illness like RA! 

I just have another question:

Do you think my taper from Mirtazipine componded withdrawal from Xanax and Quetipine?

 

Thanks for all your help

[marie123]

Hello onetime. I just wanted to let you know that I have been getting achy painful hands and fingers while tapering Mirtazapine. These drugs cause inflammation in the body as side effects and withdrawal effects. I am pretty sure this will get better or at least improve a lot once we are off. Marie.

[onetime]

Hi Marie,

 

Thanks for letting me know. I had the itchiness and insomnia the last time I tried to get off Mirtazipine. I have a long way to go. I am cutting the tablets but you seem to be right on the money with your taper procedure. 

 

Thanks for posting. 

[DataGuy]

@onetime, I'm not sure. It's very possible, but you are probably in a better position to answer that than I am. Did your symptoms worsen after you started the mirtazapine taper? If yes, the mirt taper was probably responsible. There are plenty of factors involved, but generally tapering when your system is already in a state of distress will worsen symptoms. This is why we recommend holding if symptoms are not stable. It can be tough to reverse withdrawal symptoms when they get out of control. 

[onetime]

Thanks DataGuy, Yes the symptoms of painfull stiff fingers occured  after I started the Mirtazipine Taper. I think that it is possible that tapering Xanax, then Quetipine followed by the Mirt taper are all factors. 

I have no problem with withdrawal, once I know it is withdrawal and not something else. 

 

 

[EveningMuffin]

I've got exactly the same symptoms with my both hand fingers! They are painful and stiff when clenching fists. Now I understand it began when I started taking psychotic drugs, including Quetiapine. I am not tapering yet though.

[onetime]

Oral Degenerative Mirtazipine

 

Hello,

 

I was wondering if anyone could help me with the following:

 

I am tapering 15mg of Oral Degenerative Mirtazipine by cutting. Is this okay? I am not accurate with the cuts but it has taking me 6 months to get to 3.5mg with the usual window/ wave pattern.

Is it okay to continue cutting or should I make a water solution and measure with syringe?

 

Please advice when you have a moment.

 

Thanks in advance

 

Edited January 28, 2022 by ChessieCat
added topic title before merging with intro topic

[ChessieCat]

Please read Post #1 of this topic which explains how to get non standard doses.  Please make sure that you read ALL the information in the post.

 

Tips for tapering off mirtazapine (Remeron)

[onetime]

Thank you CheesieCat. So it looks like I was doing it right and it's okay to cut the solutab mirt. Just to be double sure: Putting smaller cuts i.e. 1/4 of  15mg into water an using a syringe is okay? Thanks again- like others this has been a long long journey!

[ChessieCat]

It would depend on how accurately you can cut up the soltab.

 

I suggest that you post that question in the mirt tips topic and you might get a response from another member tapering that drug.

[ChessieCat]

I did a search for the word "soltab" in the Introductions forum and this is the link to the results.  You could visit those members' Introduction topics and see how they tapered.

 

https://www.survivingantidepressants.org/search/?&q=soltab&type=forums_topic&page=1&quick=1&nodes=3&search_and_or=and&sortby=relevancy

[onetime]

Thanks so much Chessie,

 

I will check that link.

 

Thanks again

 

[Frogie]

@onetime

 

All the reference information I read, you can crush it and weigh it. Then dissolve it in your mouth or water and you can also dissolve it in water and use a syringe to dispense the correct dosage. You just don't want to use any other liquid other than water.

 

Hope that helps.

[onetime]

Thanks Frogie. Like myself, looks like you were on meds for a long time!

[Frogie]

@onetime

 

I was on way too long,  longer than you even. But it can be done. 

[ChessieCat]

  

On 4/11/2012 at 10:07 AM, Altostrata said:

 

After making the liquid, I would take the dose immediately and discard the rest -- do not count on it keeping for any length of time.

 

 

[Shep]

@onetimeI received your PM but am responding here on your intro thread. That way all of your information is in one place.

 

You mentioned being off all your drugs now for 3 weeks and suffering from itchy skin. This is common, especially after being on drugs such as quetiapine and mirtazapine which both affect histamine.

 

Please let us know more about your taper for all of the drugs and bring us up to speed. It's possible you might benefit from a slight reinstatement, but we need to know more about your taper - the speed of your taper and the dose you stopped at.

 

Also, please update your signature:

 

Account Settings – Create or Edit a signature

[onetime]

Thanks Shep. I tapered roughly 10% per month starting with the Xanax then the quetipine and finally the mirt. Took 3 years. I hear you about the reinstatement but would I be okay if I didn't? Just had enough of it all after 3 years. Do I stay away from the antihistamines? I take cetrine antihistamine 10mg just twice so far in the last 2 weeks i.e 1 tablet a week. Thanks again.

[Shep]

10 minutes ago, onetime said:

I hear you about the reinstatement but would I be okay if I didn't? Just had enough of it all after 3 years. Do I stay away from the antihistamines? I take cetrine antihistamine 10mg just twice so far in the last 2 weeks i.e 1 tablet a week.

 

I would try a tiny reinstatement of the mirtazapine, perhaps 1 mg since you stopped last month at 1.5 mg. If that helps, it will keep you from continuing to search for other drugs to take in its place.

 

Just a thought. Don't look at reinstating as any type of failure. The goal is to give your body what it needs to feel better.

[onetime]

Thanks Shep. I will give it some thought. What is the longest one can go before reinstatement? 

[ChessieCat]

35 minutes ago, onetime said:

What is the longest one can go before reinstatement? 

 

Unfortunately we cannot give you the answer to this question because we have seen different results for different people.  However it is generally better to start with a small dose and increase if needed than to risk taking too much.  Please carefully read Post #1 of this topic:

 

About reinstating and stabilizing to reduce withdrawal symptoms

[onetime]

Thanks Shep

[ChessieCat]

@onetime You have replied as I was posting.

 

Please be sure to read the link that I provided.

[onetime]

Thank you Cheesiecat

[onetime]

Hello, I am 5 months off all meds and I am in a real crisis. I reinstated 3.75mg of Mirtazipine 5 days ago because of severe unrelenting anxiety, depression, insomnia, burning all over body pain and off the charts leg pain( can't sit for more then a minute) because pain in the back of both legs gets so bad. I went up to 7.5mg 2 days ago because I got no relief. ( I thought that reinstatement at 3.5 would give me some relief). For the last 5 months insomnia which doesn't really bother me. It's the anxiety lose of appetite and the above symtoms that has me in turmoil. Now I don't know what to do. I am also afraid of kindling ( 25 years of drugs). Do I stay at 7.5mg? Any advice please

 Thank you.

[ChessieCat]

I've asked the other staff for their assistance.

[onetime]

Thanks CheesieCat