Tania: 45mg mirtazapine tapering

[Tania]

Hi! Please help! I'm not sure if I've been doing the tapers right...so I'm on 30mg now, and apparently if I do a 6% reduction (by 2% increments,  brassmonkey method) I'd go down to 15mg...I use a gemini scale, and when I weigh the pills, they weigh 300...so 2% of 300 is 6, 2% of 240 is 4.8, and so on. So it gives me 150 when I do a 6% reduction, and that is 15mg, is this right?? Thank you!! 

[Faure]

Well, that can’t be right, because it would be a 50% reduction!!! I am not good enough at maths to give advice but here is a link to where the spreadsheets are kept ☺️

[Tania]

Hi thank you. I know these already but can someone please tell me why the gemini scale indicates 300? 300 what? What's the unit I'm looking at here? 

[Faure]

All pills have fillers to bulk them out. Fortunately with mirtazepine the pill weighs 10x more than the active ingredient of mirtazepine which makes the numbers fairly easy to deal with. 
 

I’ve tagged @brassmonkey as he can explain better than I can. 

 

Whatever you do don’t do the reductions you’re talking about in your earlier post.  You don’t want to do a 50% drop!  You want to drop 30mg over 4 weeks, taking you down to 270mg by the end of that 4 weeks. 

[Mcat]

Hey Tania, I just read some of your thread, and I want to reassure you that the depression you feel as you taper is very likely due to the drugs. My partner was on 45mg last year, and it messed with him bad. He ended up in a private hospital, and a negligent doctor yanked him off it overnight and put him on a different cocktail, and when he came home, he was such a mess I had to take him to ER, and further hospitalisation ensued. Do not underestimate the power of this drug. He only stabilised when they took him off most of that cocktail and reinstated Mirt at a lower dose (he's on 15mg now and is tapering off the other drug first). So, my advice is to go slow and steady and assume most of the distress feelings are related to your brain readjusting to your normal serotonin operations. I'm tapering off from a much lower dose - 7.5mg was my standard, and I'm now down to 5, and I just got a bout of depression that seemed taper-related, timing-wise. I've also had some IBS flare-ups that I suspect are taper related, so it's possible your GERD is WD. From what I've read, there are loads of serotonin receptors in the gut/bowel, so it makes sense we're going to feel the taper there, and gastro disturbance seems to be a common WD symptom. 

[brassmonkey]

On 6/12/2023 at 12:14 AM, Tania said:

Hi! Please help! I'm not sure if I've been doing the tapers right...so I'm on 30mg now, and apparently if I do a 6% reduction (by 2% increments,  brassmonkey method) I'd go down to 15mg...I use a gemini scale, and when I weigh the pills, they weigh 300...so 2% of 300 is 6, 2% of 240 is 4.8, and so on. So it gives me 150 when I do a 6% reduction, and that is 15mg, is this right?? Thank you!! 

 

The Brassmonkey Slide involves doing four equal reductions equaling a predetermined amount and an additional hold period. Which is usually 10%. It will work well using 6% as the total reduction. For that your reductions would be 1.5, 3, 4.5 and 6 percent.

 

To determine the reductions, you would start with the full pill weight (300mgpw as stated above).

Week 1: (300 X 0.985 = 295.5) With rounding you would weigh out 296mgpw for your dose.

Week 2: (300 X 0.97 = 291) You would weigh out 291mgpw for your dose.

Week 3: (300 X 0.955 = 286.5) With rounding you would weigh out 287mgpw for your dose.

Weeks 4-6: (300 X 0.94 = 282) you would weigh out 282mgpw for your dose.

 

For the next cycle you would start with 282mgpw instead of 300 and do the same calculations.

 

Calculating the strength of the doses uses the same formulas, but you start with the strength of the tablet (30mgai as stated above.

Week 1: (30 X 0.985 = 29.5) Your dose strength is 29.5mgai.

Week 2: (30 X 0.97 = 29.1) Your dose strength is 29.1mgai.

Week 3: (30 X 0.955 = 28.6) Your dose strength is 28.6mgai.

Weeks 4-6: (30 X 0.94 = 28.2) Your dose strength is 28.2mgai.

 

The next cycle follows the same calculations but starts with 28.2mgai instead of 30.

[Tania]

Hi Peeps, I'm asking for some heart-felt advice here...I wrote a little while back. I broke up from the father of my child, and am now on 30mg (tapered from 45mg one and half years ago). I do therapy, acupuncture, yoga etc. but still, my anxiety has gone through the roof. A work opportunity has come up to travel to Croatia for a couple of days, and I absolutely don't know what it is that I should do...a part of me wants to go, but another is terrified I'll experience panic attacks on the plane, while there etc. What would you advice? X 

[Tania]

Hi Peeps, I'm asking for some heart-felt advice here...I wrote a little while back. I broke up from the father of my child, and am now on 30mg (tapered from 45mg one and half years ago). I do therapy, acupuncture, yoga etc. but still, my anxiety has gone through the roof. A work opportunity has come up to travel to Croatia for a couple of days, and I absolutely don't know what it is that I should do...a part of me wants to go, but another is terrified I'll experience panic attacks on the plane, while there etc. What would you advice? X 

[Mcat]

Hi Tania. It sounds like you're doing lots of good things, but nothing is a match for Mirt. I say this as someone who has used Mirt @ 7.5mg for sleep primarily but has gone as high as 15mg and has now tapered down to 2.9mg: my anxiety levels would be through the roof on 30mg. At the higher end of my scale, 15mg, I found Mirt to be very odd - on one hand, it was calming, but on another, it seemed to trigger my anxiety like anything and be plain too much for my nervous system. I can only say what I would do in your situation, which is that I would avoid any travel or big moves likely to trigger or worsen anxiety until I was down to about 7.5mg (if you have the option, that is). My partner, a non-problem flyer, was on high-dose Mirt (about 45) and had a massive panic attack when flying interstate. Had to be driven home and was a mess for some time. I don't say that to scare you, but just that this is the risk. You might be fine, but personally, I wouldn't take the chance. This is such a powerful drug. 

[Tania]

Hi, I dropped to 30mg back in April and due to personal circumstances, break-up from child's father and family problems, I stopped tapering. I'd like to start again but my anxiety is still present and I'm going through the perimenopause. I feel there will never a right time to start tapering again...any advice? 

[Mcat]

It's a tricky one, Tania. Like you say, there's never a good time to taper in that it's a long haul, and if we wait for perfect conditions, we'll likely never get there, but I do think there are probably especially bad times to taper, and only you can be the judge of whether you have enough stability in your life, albeit with some anxiety on board, to tackle it. On the other hand, perimenopause is a long haul, too, and if you wait for that to be done, it could take ten years. I really feel for anyone going through both at once. I see you were on the Brassmonkey Slide - what about a trial round of 6 weeks slide, but at a smaller dose than 2.5%, to try it out and see how you go? You could do, say, a 1.5% drop for 4 weeks, then hold for two. If you cope well with that, you could increase it to 2.5% in the next round. All the best with it. 

[Tania]

Hi Mcat, thank you for your reply. I'll do that. Just to clarify, are you saying to drop by 0.375 over a period of 4 weeks? 

[Faure]

Hi Tania, I think @Mcatis saying that instead of doing 10% split over 4 weeks, you do 6% split over 4 weeks (i.e. 1.5% a week) which would result in a drop of 1.8mg over the period.  Sounds like a pretty good place to start as a “test the water” strategy. 

[Tania]

Hi Faure, thank you I didn't see this till today. I didn't get a notification. I tried to taper again and became anxious.. so re-instated to 30mg. Will try again in the next few days. 

[Mcat]

You should, of course, do what feels right to you, but do take into account that anxiety is a very common side effect of tapering, and some of us can't avoid it while tapering. It's important to remember when it hits that, it isn't usually permanent. As someone who had a pretty bad anxiety disorder to start with, I know that as I get further down, I'm losing whatever benefit I had from the drug on that front, and once I'm off it altogether and through whatever final tapering side effects I have, I'll be left with what I started with. But what I see time and again with my taper is that there are waves where I'm like a live wire: some sleep disturbance, heightened anxiety, etc., and then it settles down again into what people around here call a window - a spell where things are relatively calm and feel more normal. During those periods, my sleep settles more, and my mood/anxiety stabilises and becomes more manageable. So, when you feel ready to try another taper, try not to panic if you experience a bit of anxiety and give it a few weeks to sort itself out. The other option is to reduce your % even more when you drop.

[Faure]

Excellent advice @Mcat 👍