timetofeelgood: Tapering off of Mirtazapine

[timetofeelgood]

I've been on Mirtazapine since March 2020 for perimenopausal anxiety and insomnia.  I'd struggled for a year with it and tried a lot of natural supplements before resorting to medication, although my doctor never suggested any type of hormone replacement.  I started on 7.5mg and then after two weeks went up to 15mg.  It worked well for 8 weeks and then stopped.  I've been up and then down in dose but nothing has helped.   My doctor and I agreed that it's definitely not working.  

 

I was up to 30mg for five weeks and decreased to 22.5mg with minor side effects.  When I dropped to 15mg I was hit with a ton of symptoms that have taken a long time to decrease.  I experienced dissociation for the first time along with skin burning, prickling, burning tongue, severe head pressure, migraines, depression, facial numbness, dizziness, nausea, appetite loss, night sweats, anhedonia, insomnia, nightmares and lucid dreaming.  So, I've held at this dose for 5 months now.  In the meantime, my doctor prescribed buspar which I am now taking 3x5mg.  

 

I still have the burning/numbness/prickling, anhedonia, nightmares, poor sleep and lucid dreaming but I had all of those prior to tapering (after starting mirtazapine).  I also have head pressure but suffer from chronic migraines and can deal with a high level of head pain, so I'm ready to start tapering again.

 

I'm going slower this time and have decided on a liquid taper.  I was on a benzo for a short time back in 2016 and got off of it with minimal withdrawals after microtapering (I had an initial failed taper by dry cutting) using liquid and decreasing by .004mg per day.  My body seemed to respond better to tiny decreases daily vs. a cut and hold.

 

I'm afraid of what's to come, but hopeful that I can successfully use the microtaper approach.  I'm so tired of not feeling joy, happiness or even interest in my family along with all of the physical problems.  My sister asked for my opinion on something the other day and my reply was "it's fine".  She commented that I say that a lot lately  My son is starting his senior year of high school this fall and I need to be present and involved in so many things.

Edited July 7, 2021 by manymoretodays
name to title

[DataGuy]

Hi @timetofeelgood,

 

Welcome to SA. Sorry for the delayed answer and also your experience with mirtazapine! 

 

Did you drop all at once from 22.5mg to 15mg, or was this done over a period of weeks? Normally we recommend tapering by around 10% per month, which helps to mitigate withdrawal symptoms. For some good reasons to taper slowly, check out this link: why taper by 10%. However, a daily liquid microtaper is also a great alternative, if you already know how to do that. It sounds like you do. 

 

Here are some specific tips on tapering mirtazapine. 

 

Am I right in reading that you experienced "burning/numbness/prickling, anhedonia, nightmares, poor sleep and lucid dreaming" as adverse effects of taking mirtazapine? Have these decreased at all with the decrease in dosage? Have your symptoms stabilized after your 5 month hold? I think that was the right thing to do.

 

Are you taking any other medications other than buspar and mirtazapine? Any supplements? If yes, please enter them into your signature here. The instructions for filling out your signature are here and 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). It also helps us to know your medication history. It's possible taking many medications, having many withdrawals and/or drug switches might have an effect on the severity of future attempts to withdrawal from meds.

 

Mirtazapine has the paradoxical effect that it seems to be less sedating at higher doses, since the adrenergic effect becomes more dominant over the antihistamine effect at a certain point, but where that inflection point lies appears to be different for different people. 

 

I'm sure you are used to dealing with the adverse drug effects of mirtazapine and the withdrawal symptoms by now, but if you need ideas on coping with them, we have a section of non-drug coping techniques, where people can usually find at least a couple that help them deal with symptoms. 

 

Thanks and hope we are able to help get you off mirtazapine safely : )

Edited July 8, 2021 by DataGuy

[timetofeelgood]

On 7/8/2021 at 9:17 AM, DataGuy said:

Hi @timetofeelgood,

 

Welcome to SA. Sorry for the delayed answer and also your experience with mirtazapine! 

 

Did you drop all at once from 22.5mg to 15mg, or was this done over a period of weeks? Normally we recommend tapering by around 10% per month, which helps to mitigate withdrawal symptoms. For some good reasons to taper slowly, check out this link: why taper by 10%. However, a daily liquid microtaper is also a great alternative, if you already know how to do that. It sounds like you do. 

I did drop from 30mg to 22.5mg with no real withdrawal symptoms.  I still had my typical side effects of burning/prickly skin, pins and needles, lucid dreams and anhedonia.  I then dropped in one go from 22.5mg to 15mg.  A few weeks later I was hit with the slew of symptoms that I mentioned above.  It took four months for those to settle, but I still have my typical side effects plus head pressure and neck pain.

On 7/8/2021 at 9:17 AM, DataGuy said:

 

Here are some specific tips on tapering mirtazapine. 

 

Am I right in reading that you experienced "burning/numbness/prickling, anhedonia, nightmares, poor sleep and lucid dreaming" as adverse effects of taking mirtazapine? Have these decreased at all with the decrease in dosage? Have your symptoms stabilized after your 5 month hold? I think that was the right thing to do.

 

Yes - they seem to be adverse effects from mirtazapine but strangely didn't show up for a couple of months into taking it.  I'm wondering if my increase from 7.5mg (only on it for two weeks to ramp up to my prescribed dose) to 15mg was too much for me and once stable on the 15mg then the adverse side effects were triggered.  My symptoms seems stable now but still ongoing.  The decrease didn't help much but I do seems a little more clear headed.  At this point, I think it may take being off of mirtazapine completely for me to heal.

On 7/8/2021 at 9:17 AM, DataGuy said:

 

Are you taking any other medications other than buspar and mirtazapine? Any supplements? If yes, please enter them into your signature here. The instructions for filling out your signature are here and 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

I believe that I added a signature although I may need to edit so that it's easier to read.  Thank you so much for your help and support.  

 

[DataGuy]

Thanks so much @timetofeelgood. Your signature looks great. 

 

I think the likely reasons that you experienced much worse problems from the second drop in mirtazapine is 1) the drop was a larger % of the dose than the previous one  2) at lower doses, drops of the same magnitude (even as a %) tend to result in steeper declines in receptor occupancy (to learn more about that, check out this thread)  3) You could have still been recovering from the previous cut.

 

With slower reductions, hopefully we can make the taper much more comfortable. And yes, I agree that getting off the drug completely will likely be a prerequisite for complete healing. 

 

You may want to wait until the head pressure and neck pain dissipate a bit before tapering again, if you believe those symptoms are due to withdrawal. It's always best to avoid tapering if you are still suffering from the effects of the previous cut and these effects are over and above what you would have normally experienced on the drug. This just helps to avoid destabilizing your nervous system and ensures you get to the finish line in the best condition possible. Sometimes people will continue cutting into worsening symptoms, thinking they will "heal when they are off", but this can take a very long time, and it seems like withdrawal syndromes induced by cold turkey / rapid withdrawal are both more intense and longer lasting than those induced by slow, steady tapering. 

 

 

[timetofeelgood]

Thank you.  I did start decreasing prior to your reply.  I’m now on 13.5mg and will be holding here until I see what this decrease brings.  I decreased by .1mg per day to get there so I’m hoping that it minimizes the withdrawals or at least they don’t hit all at once.  My sleep has been suffering for the last three nights which is frustrating because I’m physically incapable of napping during the day.  It’s really the strangest thing to come from my medication is that my ability to sleep during the day completely went away.

 

The head pressure had reduced too, which I think may have partly been due to starting buspar.

[Gigi68]

Hello Timetofeelgood, I am tapering Mirtazapine also and went through the inability to nap thing. I was on 7.5mg and couldn’t sleep or nap. It was horrible. Now that I’m down to 4.5ml, I can sleep and even nap although I sometimes wake up really grouchy from a nap. Still I’m glad I can take one! I also take Buspirone but hope to taper off that when I’m done with Mirtazapine. Best wishes for a smooth taper!

[timetofeelgood]

@Gigi68that's great to hear!  I know that it’s been a month.  How is it going?  

[mstimc]

On 7/6/2021 at 12:10 PM, timetofeelgood said:

My son is starting his senior year of high school this fall and I need to be present and involved in so many things.

Hi Time!

When I began my taper, our soon was in junior high.  One of the things that kept me going was knowing I had to be there for him.  In fact, my first real window was during one of his jazz band concerts.  The look of pure joy on his face lifted me out of my own mind for just a few minutes.  From then on, I knew I'd recover.  Being responsible for someone else is a great motivator for recovery. 

[Gigi68]

Hi Timetofeelgood, my taper is going well. I am pleased that the lower I go, the better I feel despite some WD. I have been dropping 3% of my current dose every 9-14 days. I used to have severe anxiety, agitation and feelings of dread when I woke up  in the morning or after a nap and at random times during the day. Those have been gone now for about 3 weeks. Good riddance!  My current issues include occasional insomnia, bloating and gas, diarrhea. I’m trying a probiotic for that and I think it my be helping. 
 

How are you doing? Have you been able to drop any more?

[timetofeelgood]

@mstimc thank for your helpful reply!  I just feel so guilty because if this withdrawal and sickness was happening when they were younger, then they wouldn’t remember it.  I do try to look toward the positive but as time goes on, ive been struggling.

[timetofeelgood]

@Gigi68 it sounds like you are on your way to being off.  I’m still on 15mg unfortunately.  I’ve tried to reduce but after a week started feeling awful so I went back to 15mg.  I’m going to try to lower by .5mg soon.  I wish that I could do more but I really think it’s the most that I can tolerate right now.

[mstimc]

15 minutes ago, timetofeelgood said:

@mstimc thank for your helpful reply!  I just feel so guilty because if this withdrawal and sickness was happening when they were younger, then they wouldn’t remember it.  I do try to look toward the positive but as time goes on, ive been struggling.

If there's one thing I've learned on my journey its that guilt serves no purpose and has no value.  If you'd known how the meds would have affected you, you would have never started using them.  You shouldn't feel guilty about dealing with WD than you would if you had any other chronic condition.  Looking back, there were times I thought I was letting my son down but in reality I was there for him; anxiety and WD make you think you're failing them when the reality is you're doing the best you can.  The important thing is to stay focused on the future. 

[Gigi68]

I’m sorry to hear that. It’s so frustrating. I tried a 5% taper but often had nausea so I switched to 2.5% and now 3% and it has been much easier for me. There is an app called The Percentage Calculator that will figure out percentages for you. You might check out the Brassmonkey slide method of tapering. It’s on this website. The basic idea is to drop 2.5% of your current dose every two weeks with a 2 week hold after every 4 weeks if I remember correctly. It takes longer but is more easily tolerated which in the end would allow you to get off quicker. A 2.5% cut for you would be 14.62. Are you making your own liquid?

[timetofeelgood]

@Gigi68i am going to try a smaller taper.  I tried a liquid taper and it didn’t work well for me.  I decided to do a dry taper by crushing a lot of pills and weighing the powder on a scale.  I saw this way posted in the SA files.  Right now I’m weighing out 15mg (the average pill weight was 15.3).  Just started last night.  So I’ll use that weight for 2 weeks and then drop down to 14.7.  I may do liquid when I get lower.

[timetofeelgood]

I am currently on 7.5mg of Mirtazapine.  I’ve been to a number of doctors due to symptoms from taking and tapering Mirtazapine.  I’ve developed neuropathy, high cholesterol and anemia.  All doctors agree that Mirtazapine itself is making me ill since the neuropathy started two months into taking a 15mg dose.  It also stopped working at that point, so I’m now just trying to taper off while still feeling unwell.  

[DataGuy]

Hi @timetofeelgood,

 

Thanks for the update. How did you manage to get from 15mg to 7.5mg? Would you say you feel worse or better since the drop? Are you still taking the buspar? Any symptoms you attribute to that? 

 

Sorry you are experiencing these terrible symptoms. I just checked the FDA label for mirtazapine and it doesn't report neuropathy as an adverse effect. I would encourage you to file a report with the FDA, otherwise this ADE may never be officially recognized. You can find the reporting forms here. We were successful in getting severe withdrawal syndromes from benzodiazepines recognized by the FDA and Health Canada as a result of a reporting drive. 

 

Please be careful in your taper. Remember to take frequent pauses to make sure the withdrawal is not worsening things for you. Hope you are able to get off and feel better soon : )

 

Good luck @timetofeelgood!

 

[timetofeelgood]

It’s been a while since I’ve posted and am thankful to report that I am off of both Mirtazapine and buspar.  My withdrawal symptoms were many, some severe and some more of a nuisance.  I had my final dose of Mirtazapine in November 2021.  Overall my health was improved after 8 months off with some nagging symptoms.  
 

I’ve had chronic migraines for 25+ years and have trialed many medications just to try to get to a point of being able to manage the pain and cognitive issues that come with daily migraines.  While trying to avoid prescriptions, I started taking certrizine daily to try to help my constant head pressure.  Additionally, I went on a cruise a couple of weeks ago and was prescribed the scopolamine patch for motion sickness.  Unfortunately, stopping one or both has thrown me back into withdrawal.  I’m experiencing insomnia, anxiety, gi issues, heart palpitations and high heart rate, burning skin, mild depression, random thoughts on waking, hot flashes.  I know that I’m still very sensitive to any types of medications and supplements and am so upset that I’m back to feeling poorly.  I definitely wasn’t at 100%, but was finally sleeping ok and feeling improved mentally and physically.  For some reason this setback has really affected me emotionally.  I’m trying to be patient and remind myself that the symptoms will pass and improve with time but it’s hard to be positive at the moment.

 

Internet searches haven’t shown much for antihistamine withdrawal aside from itching, but I think my prior Mirtazapine use made me much more sensitive to this type of medication.

[Hibari]

Hi @timetofeelgood

 

I'm sorry your are experiencing a setback. I am in one myself due to surgery and anesthesia. I'm slowly getting better but it has been hard and I ended up on Mirtazapine again. 

 

Many people recover after a few weeks or months from a setback and you will recover as well. I know people from BenzoBuddies who have recovered quite well from their setback. 

 

May I ask how your taper ofg Mirtazapine went? This is my second time on it and it has not down anything for me. I'm actually having a paradoxical reaction to it. I got off a much higher dose 5 years ago but now I have to taper while in a setback. I'm started at  7.5 and have been for 9 weeks. I'm now down to 7mgs. 

 

Any words of encouragement or insight would be appreciated. 

 

And I want you to know you will heal from your setback. 

 

Hibari