Jools44: badly managed reinstatement of mirtazapine

[Altostrata]

They are using the pure chemical. This is as close to standardized as you can get.

[Jools44]

@Altostrata yes I reread and thought about it after I left that message. No fillers so no variability in bioavailability of the drug. I swear something is different about each batch but perhaps I'm just super-sensitised to the whole process now. 

[Faure]

Don’t liquid solutions deteriorate over time, so is it possible the strength weakens over the month and then when you start a new bottle it’s stronger? 

[Jools44]

@Faure yes it is possible. I did start tapering over from one bottle to another but didn’t this time, I think that helped though.

 

I’m going to change to the tablets and weighing them out though as that just seems to be the most consistent method to me, and I’m 

moving somewhere where the liquid isn’t available so it’s that or home made liquid.

[Altostrata]

14 hours ago, Faure said:

Don’t liquid solutions deteriorate over time, so is it possible the strength weakens over the month and then when you start a new bottle it’s stronger? 

 

We've seen that this is particularly true of mirtazapine.

[Faure]

8 hours ago, Altostrata said:

23 hours ago, Faure said:

Don’t liquid solutions deteriorate over time, so is it possible the strength weakens over the month and then when you start a new bottle it’s stronger? 

 

We've seen that this is particularly true of mirtazapine.

interesting, makes me think when I may switch to liquid for the lower doses I’ll be better off making my own solution regularly….

[Jools44]

@Altostrata what is your opinion about weighing tablets to taper? I'm currently using the liquid prep available in the UK but will soon be moving to another country where this won't be an option.

I'm not overly keen on the liquid prep as no matter what I do I seem to have difficulties when changing from one bottle to a new one. 

I'm on a FB group for tapering mirtazepine who expressly forbid mentioning this method as they don't recognise as a reliable method to taper. 

I'm a bit confused as to what to do for the best? 

TIA

[Altostrata]

My opinion is that tapering with a liquid is very much easier and more accurate than dry-cutting and weighing. I would taper with dry-cutting and weighing only if using a liquid is impossible. 

 

If you prefer to get advice in the Facebook group, please do so. Come back and let us know how you're doing from time to time, please.

[Jools44]

@Altostrata thank you. Does that include home made liquids?

[Jools44]

@Altostrata also, looking at the instructions here by Rhiannon, she made her solutions up without a suspending liquid. Is that still advisable? I would prefer to make the mirtazepine up fresh every night as I simply don’t trust that it’s that stable in liquid form so I wouldn’t be looking to store it. The oraplus liquid is quite expensive these days too but if using it has a much greater advantage over plain water then so be it.

I will be tapering from 15mg.

TIA

[ChessieCat]

I'm not sure if you have been provided with this link.  Post #1 explains how to get non standard doses:

 

Tips for tapering off mirtazapine (Remeron)

[Jools44]

@ChessieCat yes thank you, I did read through that post. I'm just looking for some clarification on whether I need a suspension if I'm making it up daily? Or is shaking it adequately before drawing it up sufficient? 

 

TIA

 

[ChessieCat]

I suggest that you also post in the Tips for Tapering mirtazapine topic.

[Altostrata]

You can use water, a pharmacy liquid is not required.

[ck1984]

Hi @Jools44 hope you don't mind me contacting you. I have read through your thread here as my kindling situation is so similar to yours. I was wondering how you are getting on 12 months since you started this post? I am having dreadful insommia after reinstating and need some hope. I also have been prescribed zopiclone, which I know you were. I have had to take it last night because I literally can't function with a toddler on no sleep! 

 

Tia, Charlotte

[Jools44]

@ck1984 

 

Hi Charlotte,

 

I'm so sorry to hear you're going through the mill with this drug and yes I've have been where you are now and I really sympathise with you. 

 

12 months on and I'm in a much better place. 

 

Just to reassure you that it can take some time for your sleep pattern to normalise once you've suffered withdrawals. It took at least 6 months for my sleep to improve to a solid 5-6 hours a night, every night but it does eventually get there I promise. 

 

How much sleep are you getting? Are you having the waves and windows effect - some better days/nights, followed by harder days/nights?  Do you drink alcohol still? 

 

Using zopiclone regularly may be causing you more problems to be honest, although I appreciate how difficult it can be when you're not sleeping. Try and use it as little as possible as I think it confuses the brain further and just pushes the problem down the road. 

 

If you've got any specific questions please just go ahead and ask. 

 

I'll definitely help where I can as I know how devastating this feels to go through. 

 

Jules

 

 

 

[ck1984]

Hey Jools, thank you so so much for your lovely reply 😊 

 

I am still struggling so much with insomnia. The zopiclone is making it worse I feel, the GP has advised to take it 3 days on and 4 off. I have a 2.5 year old though as well as working and just can't afford to not sleep. Struggling with the terrible 2s so badly, and my patience has never been so low.

 

I am still on 7.5mg but apparently it must have popped out since I reinstated after 2 months off since Cold Turkey. 7.5mg used to make me so sleepy I could have slept all day, but now it just seems to have no effect. Not sure if its actually giving me insomnia or if that is protracted withdrawls.

 

No one has replied to my post on here so I am just struggling on, and really appreciate your reply. 

 

Just hoping i can somewhat stabilise before I attempt to taper off. No idea how detrimental the taper would be if I don't stabilise. 

 

The worst thing is that no one seems to listen... the gp just makes it worse and friends and family think i am crazy 😢

 

Just so frightened i will never sleep again and that i will lose everything! I truly regret the day i ever took this crap!!! 

 

 x

[Jools44]

@ck1984 you're really not alone in this although i know it feels like you are. Your doctor will have no comprehension of how to manage your withdrawals, as they've been told fora long time that you don't  get withdrawals, which those of us that suffer with them know is not true.

It is very likely that the zopiclone is making things worse unfortunately, I was taking them for short while and I always felt worse the next day and it didn't help to reset my sleep. I decided to stop using anything but the mirtazepine and allow myself time to stabilise on that, no matter how long it took. However, I was not working at the time (I was off sick) and I did not have a young child to care for so I had the time and space to recover. 

The people on this website do recommend not taking any additional drugs when you're trying to stabilise so if you can cut the zopiclone out you may well find that in time your sleep will start to return but it's not linear I'm afraid. I had nights where I slept and others where I didn't. It was very up and down. On the nights I didn't sleep I just stuck it out knowing that the sleep deprivation would help me restore my sleep pattern, and that is what happened eventually. It did take some weeks but things did gradually improve. It can also take a short time to become dependant on the Zopiclone so you risk having to deal with the fallout of getting off of two drugs instead of just one. 

I'm now sleeping well most nights and I began tapering again at a much slower rate and am down from 22.5mg to 16mg now. I'm not going to say its been easy but I am making progress. I am also perimenopausal so it's hard for me to untangle withdrawal from peri symptoms, which you won't have to worry about. 

Family don't understand withdrawal either. It's hard for anybody to believe that a prescribed drug can cause so much distress, not least of all those of us that have been unfortunate enough to be prescribed it. 

Another thing that is worth doing is cutting out high histamine foods. Mirtazpeine is a very potent antihistamine so it is very likely that you have developed histamine intolerance. Histamine intolerance can cause insomnia so it's worth just looking at cutting out high histamine foods for now, tomatoes, avocado, fresh fish are all quite high, but Google it and you'll find a more comprehensive list of foods. I know it annoying to have to do it but histamine can be a real problem with mirtazepine withdrawal. 

There are some resources that you can access that both you and your family might find useful:

The Bristol Tranquilliser Project is UK charity that helps people trying to get off these drugs. They have a website and a UK helpline (if you're based in the UK). They also support families to try and get them to understand what's happening to a loved one. They have info on their website so check it out. 

Medicating normal have a Facebook page which us really interesting. 

Inner compass is a website for people withdrawing from these drugs and has lots of info on it. 

Google Mark Horowitz too, he's a psychiatrist who has experienced withdrawal and is pioneering safe ways to taper and bringing lots of attention to the subject as he faced the same level of ignorance that we have from medics (and he is one!!) 

Where are you based, in the UK? 

So in essence, when I was where you are now, I stopped taking the Zopiclone and any other sleep aid. I cut histamine from my diet and tried to get some exercise every day (just a, walk). It took a few weeks but things did start to settle down. 

It will for you too. The drug will start working predictably again but at the moment your brain has been destabilised by withdrawing the drug too quickly, but it's not permanent and things will improve. 

Do you have a partner to help you? Can you take some sick leave from work as this would really give you the time to recover? I would strongly recommend you prioritise your health at the moment. 

If you haven't already then tag Altostrata in your post, she's normally very good at replying. They will want your full drug history first though and keeping a diary is also incredibly useful to track your symptoms. 

You will get past this but it takes time. I would only start tapering again once you've been stable for a good period of time. 

I hope this helps and feel free to reach out anytime, I know how lonely it feels xx

[ck1984]

Hi Jools

 

Sorry I didn't reply yesterday, but I did read your message and so glad I did because it honestly was a beacon of hope for me. I was in total crisis yesterday, as had literally zero hours sleep on tuesday night. 

 

Those nights are tough. I am really running on empty now. Luckily I managed to sleep around 4 or 5 hours last night.

 

I really do not want to take the zopiclone any more because it really is delaying healing, I feel. Wish the GP would prescribe melatonin but they won't. I may have to take the zopiclone occasionally, but it's so unpredictable knowing whether I will sleep or not any given night.

 

Thank you for the contact info also. The histamine definitely plays a huge part! Tuesday night I had a salmon noodle dish in a spicy tomato sauce and then a banana! I didn't read much into it before you said, but they are all really high histamine so no wonder i was wide awake! Last night I had some plain pasta and then oat cakes at 7pm and nothing else and I think that must have helped. 🙏

 

My job is really not stressful in honesty, its sometimes a relief to get out of the house, but yes I think I do need to look at doing less hours and worrying less about money for the time being.

 

I empathise with you re hormones, I am not quite peri menopausal yet (I'm 38) but i do suffer pmdd and usually get severe depression plus at least 2 nights of insomnia each month. Hope you are going ok.

Just wish I could afford more childcare and also acupuncture or massages etc! That would probably be the most helpful right now!

 

My husband does try and help but his aunt and cousin passed away suddenly and he is working so many hours as well, things are just extremely stressful which never helps.

 

I hope your taper is going well and you are stable. We will get through this! 

 

Thank you again so, so much. Xx

[Jools44]

@ck1984 so pleased to hear you slept last night. I think keeping a regular bed time pattern, regardless of how much sleep you get, and keeping busy during the day (not a problem for you I suspect!) does help increase sleep drive, but the withdrawals will impact sleep regardless, so on those days you just have to push through and remind yourself that it's not forever and it will become more regular and predictable.

Rather than take the zopiclone, if you have a bad night, why not take a sick day the next day instead? Take that time if you need it. We're so conditioned to put work before health, but now's a good time to do the opposite. 

Recovering from withdrawals can leave you feeling in despair but it honestly does get better. I was in a very bad way with lots of unpleasant symptoms but they've nearly all resolved or are very much improved. 

I'm still suffering withdrawals as I'm tapering again but I am functional. Once you're stable again and have been for a decent period of time (months not weeks) then you can start tapering again but much, much slower than your GP recommended. 

 

You will get off this stuff but for now it's just about getting your CNS stable again. 

 

Xxx

 

[ck1984]

Hi Jools, just wanted to say hey! I have pretty much been sleeping since we last spoke. Had a couple nights flat out insomnia but I think that was down to histamine.. trying to get my husband (who does most the cooking) to do histamine friendly meals is a battle itself! Also my cycle when i ovulate and pre-menstrual both usually bring me 1 or 2 nights of very broken sleep even pre-mirtaz.

 

Well, I hope your tapering is going well and not causing you any big problems. What a destructive drug this is.

 

Thank you again so much 💖 

[Jools44]

@ck1984 really pleased to hear you’re doing better 😊 Once you’re feeling stronger and up to it you can always try reintroducing some higher histamine foods to see how you react. Think of histamine in terms of buckets, when you eat too many high histamine foods and your “bucket” overflows, that’s when you’ll start to feel it, whether it’s insomnia, low mood, dry eyes etc but it can take a few days to show up so you do need to go carefully and everybody’s buckets are a different size so some may tolerate more than others.

In the mean time stick with what you’re doing if it’s working. The most important thing is you’re sleeping and feeling better.

 

I’m doing okay thanks. Having perimenopausal issues which confuses the picture for me!

 

Take care xx

[Jools44]

@Altostrata hi just wanted to give you a brief update on my situation. After starting tapering again 1 year ago I have managed to reduce from 22.5mg of mirtazepine to 15 mg which I’m pleased about. It’s not been easy even at this slow rate but I suspect perimenopausal symptoms have been a factor too.

I’ve had to start HRT (tried to avoid but not possible)which has I suspect stirred up some withdrawal but it’s bearable most days, mainly bad brain fog and tinnitus and I’m hoping my brain readjust to this in time.
 

My question is relating to moving from the liquid prep to making my own  from a tablet. I want to use one tablet a Night and dispose of any left so I’ve tried using 2 mls of water to 15 mg of dispersible tablet but I’m concerned that’s too little water (I’m tapering off the liquid to the homemade liquid). Is there a minimum amount of water I should use when making my own to ensure it is evenly distributed through the water?

 

TIA

[ck1984]

Hi Joolz

 

Just got an email from SA and had time to read it straight away!

 

I personally do a homemade liquid taper a few months back, which I need to resume actually for accuracy.

 

There is a video on the Mirtazapine Withdrawal Facebook group which is very useful. They said to use 15ml of liquid with a 15mg tablet. They said to use an equal mixture of water and maple syrup (the syrup acts as a carrier), so in equal measure 7.5 of water and 7.5 of maple syrup. This means you can keep it in the fridge for four days and withdraw however many mls you wish up to the full amount. 

 

However if you want to make it daily, I guess you can just use 15ml water. However please check that any and all of this info is correct. 

 

Hope the hrt is helping.

 

I am still on 7.5 but escaping a mentally abusive husband so planning to stay on this dose for at least 6 months, or til I am settled. 

 

Take it easy.

Charlotte X

[Jools44]

@ck1984 Hi Charlotte 👋 thanks for responding. Sorry to hear about the situation with your husband but absolutely the right thing to get away from an abusive marriage. I’ve no doubt your mental health will improve enormously with time by doing that alone.

 

thank you for the advice re: tapering. I am aware of the mirt FB group and their tapering advice but I really want to make the solution up every day and using 7.5ml maple syrup a day is quite expensive! Plus I have gained weight thanks to this drug so am trying to avoid sugar where possible. Having said that, getting the mirt dose accurate obviously takes precedence.

 

I might try 15 mls of water as that seems most sensible in terms of ease of dosing.

 

The HRT is going okay thanks. Adding in one hormone at a time to try and avoid overloading/aggravating my CNS although I’m hoping it will beneficial in the long term as it helps prevent the big fluctuations occurring at this age.

 

Good luck with your taper once you commence it. As you say no rush and you need to be in a good place when you start again.

 

take care 

 

Jules xx

[littlebird]

6 minutes ago, Jools44 said:

absolutely the right thing to get away from an abusive marriage. I’ve no doubt your mental health will improve enormously with time by doing that alone.

 

Saw this in the main feed, and wanted to pop and in echo you Jools in saying WELL DONE, @ck1984 on getting away from abuse. It's so hard, and you're doing the right thing. Cheering you on! Sorry to pop in like this, just couldn't resist joining you in saying GO CHARLOTTE! 

[ck1984]

Oh my gosh thats so sweet! @littlebird and @Jools44 

 

I hadn't realised that I have been married to a narcissist.. i started mirtazapine when our son was 6 months old, not realising at that time why I needed it. It's all become very clear, the mental abuse I have lived with for 9.5 years and the effect its taken on me and my poor son who is nearly 3.

 

I guess maybe the breakdown I had from mirtazapine had something to do with me realising the reality of the situation. I was on prozac when I mst him so obviously wasn't seeing clearly or in a good place.

 

Anyway thanks again ladies 💓 and wishing you all well xxx

[littlebird]

1 minute ago, ck1984 said:

It's all become very clear, the mental abuse I have lived with for 9.5 years and the effect its taken on me and my poor son who is nearly 3.

 

I guess maybe the breakdown I had from mirtazapine had something to do with me realising the reality of the situation. I was on prozac when I mst him so obviously wasn't seeing clearly or in a good place.

 

Sometimes these drugs will keep things numbed to a serious point, but it's hard to see these things in people. Often, an abuser is very, very good at hiding/disguising what's going on. They can also be very good at putting the person they're abusing on their back foot, with things like DARVO (Deny, Attack, Reverse Victim and Offender). It can take years to see what's happening.

 

You're doing the right thing to get yourself and your son out. I'm so glad he won't grow up with that abuse. I have a feeling you're going to feel a lot better waking up in a safe space in the morning. Cheering you on!! 

[Altostrata]

4 hours ago, Jools44 said:

I’ve had to start HRT (tried to avoid but not possible)which has I suspect stirred up some withdrawal but it’s bearable most days, mainly bad brain fog and tinnitus and I’m hoping my brain readjust to this in time.

 

Have you gotten brain fog and tinnitus from HRT? Those are not acceptable effects. Suggest you consult with your prescriber about lowering your dosage.

 

3 hours ago, Jools44 said:

using 7.5ml maple syrup a day is quite expensive!

 

Sorry, I don't see the point of the maple syrup, unless you require a flavoring. It's not a preservative.

 

See Tips for tapering off mirtazapine (Remeron)

 

[Jools44]

@Altostrata thanks for your reply. The brain fog and tinnitus have been a major symptom of withdrawal for me. Some days are worse than others. I've noticed a bit of an uptick since starting HRT but nothing unbearable, and it could just be that I'm still reducing the mirt and not really associated with the HRT. Hard to know for sure.

 

I believe that the maple syrup is supposed to act like a suspension, distributing the drug more evenly through the handmade liquid. I've no idea if this actually works?

[Altostrata]

It would be unusual for HRT to cause tinnitus. Could be related to your mirtazapine taper.

[Jools44]

@Kiasofia hi there, I’ve got another Norway related question I’m hoping you can help me with.

 

Is it possible to buy a suspension liquid like the Oraplus here in Norway so that I can make my own liquid up? I’ve had a Google but nothing has come up.

 

TIA

 

Jools

[Vasherr]

I think that You can order it on Amazon with shipping from US, but it would possibly be expensive.

 

https://www.amazon.com/PADDOCK-LABORATORIES-Ora-Plus-Suspending-Vehicle/dp/B000GGHSQM

[marie123]

Hello Jools. Maple syrup will work as a suspension agent. This is what I will use when I make the switch to liquid soon. If you don't want the sugar use light syrup. I think that because it's not a chemical there is a better chance the switch will work. Marie.

[Altostrata]

@Jools44 are you in Norway? You may wish to start a Norway or Scandinavia check-in topic in our Relationships and Social Life forum.

 

Amazon has a site in UK and might have a site in Europe.