EasyThereCowboy: Documenting my Story

[EasyThereCowboy]

Hello,

I'm not the type of person who likes to talk about themselves much, so introductions like this are always a little awkward. I'll skip over the first panic attack I had in 2000 (for now) and fast forward to 2019. My Mom died after a long illness, and shortly thereafter my wife and I moved to a new city and state after living in the same town for 16 years. I was on 250mg of sertraline at the time, and had been tapering off of 1.5mg of clonazepam since the summer of 2018. When I got to our new city and state, I learned the hard way that not every legal area will respect your former residences' policies and procedures for medications. 200mg of sertraline is the max they would give at the pharmacy. I should have pushed back harder, but I thought it couldn't hurt to take a reduction. My new PCP also talked me into tapering my clonazepam further, and gave me a prescription for hydroxyzine. In hindsight, it was all too much too quickly. I developed a high baseline of anxiety that would not go away, all centering on death. The start of the pandemic did nothing to alleviate those particular fears....

 

My PCP also referred me to a local psychiatrist. I wanted this to manage my continued taper of clonazepam in addition to trying to address this persistent high baseline of anxiety that just... would... not... go... away. I was starting to despair. In summer of 2021, the psychiatrist and I agreed to a gradual taper of the sertraline during which I would start on venlafaxine. By mid July, 2021 I had tapered off sertraline completely, and had reached 150mg/day venlafaxine. By the end of August I'd finished my taper of clonazepam, too. I was thrilled that I was, at the time, only on one medication, and had beaten the clonazepam.

 

Not long after starting the venlafaxine, however, I began having what I can only describe as *thoughts of horrific possibilities*. Like, what if I was secretly a really bad person? Just the thought of this made me more anxious. In October 2021 I had a horrifying nightmare that left me anxious and panicky for at least three weeks. "Why am I having these kinds of dreams?" I asked myself. "Am I really a horrible person deep down?"

 

In hindsight I see that some of my inhibitions had gone down. I started spending money on things that I normally wouldn't, like apps and games. I was also kind of a jerk to my wife. I started feeling more and more resentful of the move, which we did on the basis of her job and career. I began contemplating the possibility of divorce. I thought, perhaps, the venlafaxine was too high a dose and tapered down from 187.5mg to 150mg. I think I told my psychiatrist about this, but I truly don't remember. At the beginning of November, my psychiatrist told me about "California rocket fuel", i.e. adding Remeron/mirtazapine to the venlafaxine. I took my first 7.5mg dose on November 2, 2021. The morning of November 3rd I felt a bit dizzy, but otherwise okay. I thought maybe this was a good idea. I continued tapering the venlafaxine: from 150mg to 112.5mg on November 6. From 112.5mg to 75mg on November 11. On November 17 I went down to 37.5mg, and on November 22 I went to zero. The weeks just before and after were physically unpleasant in many ways, but bearable. I had the zaps, but they were minor (as far as I could tell). I might have been experiencing a bit of mania, but I continued to be short and argumentative with my wife. I felt like divorce was more and more of a possibility.

 

The day after Thanksgiving, and a day after a huge row with my wife, the anxiety and panic began to intensify. In an attempt to mitigate my growing concerns I reintroduced 37.5 mg of venlafaxine. I upped my dosage of mirtazapine to 15mg, remembering how it seemed to help. I don't remember it helping, so on Monday, November 29, 2021 I took my last 37.5mg of venlafaxine. Three days later I had a major panic attack. The five-day wait to see my psychiatrist was an eternity. I took clonazepam to help my system calm down. I was desperate.

 

When I did get in to see the doctor, she advised me to restart the sertraline and up the dosage of the mirtazapine to 30mg. I did, supplementing these with .5mg of clonazepam here and there to get through work. By mid-December I'd finally gotten tired of the awful taste the mirtazapine left in my mouth, and was growing concerned that with the reintroduction of sertraline I was experiencing symptoms of serotonin syndrome. On December 21 I reduced my mirtazapine dosage to 22.5mg. Noticing no side effects I reduced again, on the 22nd, to 15mg. The morning of December 23, 2021 was a lovely window of calm. I felt like I was doing the right thing. That evening I took .25mg of clonazepam to help with sleep. Although I had moments of nearly overwhelming panic and anxiety, I felt like I was able to manage them. On the 26th I dropped my dosage of mirtazapine to 7.5mg.

 

The next day at work I started feeling worse throughout the day. My mind seemed more or less okay, but my body felt more and more like I was going to have another panic attack. I realized that I may have tapered the mirtazapine too quickly, so I re-upped my dosage to 15mg at 5pm and went to bed not long thereafter. December 28th I started feeling like my CNS had been fed through a paper shredder. I woke up at 2am unable to go back to sleep. My stomach burned. I couldn't eat. My skin crawled and burned. There were moments when all I could do was breathe moment to moment. I was in hell.

 

At my psychiatrist's this past Thursday, I made it clear that I wasn't tolerating the mirtazapine and would not be increasing the dosage again. Ever. She and I have agreed to hold things at 150mg of sertraline and 15mg of mirtazapine for the next couple of weeks. And here I am.

 

I am not a perfect being. I know I've made mistakes, mistakes that I will regret for the rest of my life, and I own them. I can accept, and ultimately Iive with that. This has been the worst experience of my life, but I continue to get glimpses of a better future. While mornings are still very difficult (I've lost over 5 pounds in the last week alone, and I can't seem to sleep past 2am), my evenings grow calmer. I feel a certain sense of self settle back in, if even for just a little while.

 

Just typing this all out has made me feel a bit better, and even a bit more hopeful.

Edited January 3, 2022 by Kiasofia
Removed duplicate paragraph

[Kiasofia]

Welcome @EasyThereCowboy

You have been given bad advice from medical professionals, so don't be too hard on your self. Unfortunately they have a poor understanding of how these drugs affect people. I found this post helpful to understand how these drugs actually work:

How Psychiatric Drugs Remodel Your Brain  

 

Thank you for creating your signature. Can you please add the date you quit sertraline and the date you restarted it?

 

When there are these many drug and dose changes within a few months it is hard to sort out what is withdrawal symptoms and what might be side effects and what drug is causing withdrawal or side effects.

What is withdrawal syndrome?

Dr. Joseph Glenmullen's withdrawal symptom checklist

 

Staying at the current dose of mirtazapine and sertraline for a few weeks is a good idea. I would recommend keeping a daily symptoms journal of times o’clock you take your drugs, their dosages, and your symptoms throughout the day. Make sure to be consistent with the doses and take the drugs at their set time each day.

Keep daily notes of drug schedule and symptoms to track patterns and progress

 

For when you are ready to start tapering:

About going off mirtazapine plus venlafaxine (Effexor) aka "California rocket fuel"

NEVER SKIP DOSES TO TAPER

 

The search function on this site doesn't work very well. To find things on the forum I find the easiest is to type "survivingantidepressants.org + what you're searching for" into a search engine.

 

This is your Introductory topic, where you can ask questions and connect with other members.  If you need any advice specific to you and your situation, please ask it here. Otherwise, feel free to join discussions on other threads. To make sure I or someone sees your question, tag them by writing @ and then start typing their username. A drop down menu will appear. Click on their username and it will turn blue. 

 

We're glad you found your way here.

Edited January 3, 2022 by Kiasofia

[EasyThereCowboy]

Does anyone else go through periods where they obsess about mistakes they've made?

[EasyThereCowboy]

Thank you, @KiasofiaI've made the adjustment to my signature.

Edited January 3, 2022 by EasyThereCowboy
wanted to correctly tag someone

[Kiasofia]

32 minutes ago, EasyThereCowboy said:

Does anyone else go through periods where they obsess about mistakes they've made?

Ruminating and having the same thoughts over and over again can be a withdrawal symptom. Many on the forum have reported obsessing about mistakes they've made. My mind was locked in a loop of regret when I was in withdrawal.

[EasyThereCowboy]

I got maybe 3.5 hours sleep last night, and have more or less been awake since 2am. At the moment the insomnia is the worst part. I went from 30mg of mirtazapine to 15mg fourteen days ago with only one 22.5mg step in between. So I've been sleep deprived for "only" one week, but last night was the worst. At least I'm a little less anxious at the moment.

 

It's been hard to get a feel for how long the worst of the insomnia lasts.

 

Yesterday also marks 5 weeks since my last dose of venlafaxine. It's only in hindsight that I realize I did too much too soon.

[EasyThereCowboy]

Thought I'd at least put down a symptom diary of a sort:

 

Monday, January 3, 2021

• 4:30 a.m. Woke with medium anxiety. Had an unpleasant dream.

• 7 a.m. Took 150mg sertraline

• 10 a.m. ate three slices of pizza, the most I've eaten for a meal in over a week.

• 12:30pm: somehow managed to get outside and shovel some snow

• 2pm: ate two more slices of pizza

• 3pm: feeling a little bit better

• 3:30pm: obsessing over mistakes I've made, how badly I've ***** up in the past.

• 6:30pm: the past catches up to me unexpectedly, and not in a good way.

• 7:00pm: ate a sandwich

• 8pm: took 15mg mirtazapine

• 8pm: went to bed

• 9pm: fell asleep
• 12:30am: wake up abruptly with burning skin sensations and generally unable to get comfortable. It really seems like I can feel the mirtazapine pulsing through my body. I don't recall having the sweats this time, though I am unable to get more than a doze in before 2am.

 

 

 

[Kiasofia]

I'm sorry your sleep is poor Have you seen this thread?

Tips to help sleep -- so many of us have that awful withdrawal insomnia

 

I'm glad you decided to post a symptom diary. Keep posting! It may help determine the best course forward.

[EasyThereCowboy]

Thanks, @Kiasofia

 

I've been taking melatonin at night. About 3mg. Should I add that to my signature? Also, reading through the links, it sounds like too much melatonin is counter productive. I'll keep that in mind. Otherwise I've been exercising pretty good sleep hygiene, but I'll focus on my routine to see if there are improvements to be made.

 

I am in a moment of despair. Is this truly mirtazapine withdrawal, or did I mess up when I took the clonazepam and lorazepam in December and am experiencing protracted benzodiazepine withdrawal? For the last eight days I've been sure it was the mirtazapine, but now I have doubts. What are some ways to find out?

[Kiasofia]

3 hours ago, EasyThereCowboy said:

I've been taking melatonin at night. About 3mg. Should I add that to my signature?

Yes, please add any supplements or vitamins to your signature and include them and the times you take them in your symptoms journal.

 

When did you take lorazepam? Please add to your signature also.

 

3 hours ago, EasyThereCowboy said:

but now I have doubts. What are some ways to find out?

Hopefully a week or so of journaling symptoms can help us see if you are reacting to what you are taking now and/or having withdrawal symptoms. But whether withdrawal symptoms are from mirtazapine dose reduction or benzos, I don't think it will be possible to tell.

[EasyThereCowboy]

Hi @Kiasofia I keep pretty thorough records of when I take my medications, so I can provide a very detailed list going back 6 - 7 months if that proves helpful.

[EasyThereCowboy]

Tuesday, January 4, 2021

• Have been awake since 2am. Getting desperate for sleep.
• 5:56 AM Anxiety begins. Stomach starts making noises and cramping
• 7:02 AM Took 150mg sertraline
• 8:48 AM Akathasia. I'm pacing around.
  • Some burning in my abdomen.
  • In general, anxiety seems down somewhat.
• 9:49 AM: just ate a bagel. some intrusive thoughts.
• 10:16 AM: big surge of anxiety
• 12:49 PM feel a little bit calmer after lying on the couch in a sunbeam.
• 1:00 PM despair sets in. I go outside to move around in the sunlight.
• 3:00 PM: helped for a bit, but now I'm truly worried that this is benzodiazepine withdrawal. How do I tell the difference?
• 5:04 PM: feeling a bit... lighter. Less morose. Window? No. Ends up being pretty bad despair.
• 6:20 PM: Skin on my back is burning. Unpleasant, sure, but bearable. What's not so bearable is the thought of having to go back to work still feeling this 'toxic shock'.
• 7:00 PM small sense of relief washes over me. I'll take it.
• 7:37 PM 6mg melatonin. Stomach hasn't hurt as much today, but I also haven't eaten more than a bagel with cheese.
• 8:00 PM 15mg mirtazapine
• 9:00 PM Fall asleep
• 11:45 PM Wake up to the mirtazapine flush. I am able to fall back asleep within about 15 minutes
• 2:45 AM awaken feeling rather rested - a nice change

[Kiasofia]

19 hours ago, EasyThereCowboy said:

I keep pretty thorough records of when I take my medications, so I can provide a very detailed list going back 6 - 7 months if that proves helpful.

It's more important to see how what you are taking now is affecting you.

[EasyThereCowboy]

2022-01-05

• 2:45 AM Wake up. Overall felt calmer and more relaxed as I dozed throughout the morning.
• 3:45 AM took 200mg magnesium
• 6:50 AM Still feeling physically very weak and trembly.
• 7:00 AM took 150mg sertraline
• 8:52 AM restlessness, intrusive thoughts, akathasia.
• 11:18 AM - Don't know if it was sleep last night, but today has seen some improvement. Which is scary, but I'll take it. Been trying to stay busy but not tire myself out too much.
• 12:06 PM chilly and going to hang out under the covers a while.
• 12:23 PM pulse 105bpm even though I'm lying down.
• 1:56 PM skin is burning. Bearable but unpleasant.
• 2:35 PM intrusive thoughts and the burning sensation in my abdomen sinking in.
• 4:32 PM a tiny dose of worry about paranoia.
• 5:00 PM well that window ended. Tense,
• 6:30 PM managed to eat some dinner.
• 8:00 PM took 15mg mirtazapine
• 9:00 PM fall asleep
• 1:00 AM woke briefly, but fell back asleep rather quickly

 

[EasyThereCowboy]

On 1/5/2022 at 12:49 PM, Kiasofia said:

It's more important to see how what you are taking now is affecting you.

As weird as it may seem, I'm going to hold out hope that it's the mirtazapine.

[Kiasofia]

Can you describe what akathisia is like for you?

 

You might want to consider a lower melatonin dose and spreading the magnesium dose throughout the day.

 

Quote

Magnesium is more effective taken in divided doses throughout the day. There's no need to take one large daily dose, you'll absorb it poorly. You might find you can take 50mg or 100mg magnesium 4 times a day or so and it will help you relax. Build up slowly.

Magnesium, nature's calcium channel blocker

 

 

Quote

if you take too high a dose -- we suggest 0.25mg or 0.33mg to start -- you may get headache, dizziness, nausea, drowsiness, or it may not help you sleep.

Melatonin for sleep: Many people find it helpful
 

[EasyThereCowboy]

43 minutes ago, Kiasofia said:

Can you describe what akathisia is like for you?

I'd have to say a deep inner restlessness with a physical need to move around. It's the kind of thing that's hard for me to describe when I'm not feeling it

 

Of course, I'm willing for it not to be akathasia, although I did end up spending some time walking around the kitchen during the aforementioned episode.

[Kiasofia]

19 minutes ago, EasyThereCowboy said:

I'd have to say a deep inner restlessness with a physical need to move around. It's the kind of thing that's hard for me to describe when I'm not feeling it

So the feeling comes and goes? How long does it last?

[EasyThereCowboy]

6 minutes ago, Kiasofia said:

So the feeling comes and goes? How long does it last?

I'd have to say just a few minutes. Half an hour maximum.

[EasyThereCowboy]

January 6, 2022

• 4:30 AM wake up, but doze. Feels like the mirt flush kicked in later than usual.
• 4:40 AM took 200mg magnesium.
• 7:00 AM took 150mg sertraline
• 7:18 AM sense of relaxation
• 10:17 AM anxiety, uncertainty, doubt
• 12:50 PM a little regret, and a little despair
• 2:54 PM cortisol spike (I think)
• 4:00 PM I'm angry at myself for being so close to avoiding this, and angry at the doctors who don't know what this stuff can do.
• 4:59 PM really tense. also still angry. need to chill somehow.
• 7:00 PM get ready for bed. Feeling a little more relaxed and window-ish.
• 8:00 PM took 15mg mirtazapine
• 9:00 PM fall asleep
• 12:45 AM wake briefly, but fall back to sleep. Dreams are vivid and weird.

 

[EasyThereCowboy]

January 7, 2022

• 4:35 AM awake. Heart rate elevated along with sweating. Still managed to doze, though I'm more tired than refreshed.
• 5:45 AM stay awake.
• 7:00 AM took 150mg sertraline
• 8:58 AM body, especially legs, feel more relaxed at the moment.
• 11:18 AM I think this is a window. Not the best kind, as there's still an edge of misapprehension and anxiety, but it's something I hope to build on.
• 12:20 PM yeah. I don't trust this feeling. Hard to explain. "False good"? If I felt better physically it might be a different story. Still have a few days of rest coming.
• 12:31 PM heart rate is elevated.
• 1:30 PM area around stomach burning.
• 1:45 PM took 200mg magnesium.
• 6:00 PM start to wonder if I'll be like this the rest of my life.
• 8:00 PM took 15 mg mirtazapine
• 9:00 PM fall asleep - minor disruptions until 5 AM, but very anxious

 

[Kiasofia]

Did you have a chance to read up on melatonin and magnesium? I suggest spreading the magnesium intake throughout the day.

You only took melatonin once since posting symptoms journals?

[EasyThereCowboy]

27 minutes ago, Kiasofia said:

Did you have a chance to read up on melatonin and magnesium? I suggest spreading the magnesium intake throughout the day.

You only took melatonin once since posting symptoms journals?

Hi @Kiasofia, the magnesium I have comes in a giant 200mg capsule. I do plan on lowering and spreading that throughout the day after my next trip to the market (today). With regard to the melatonin, I have not taken it the last two nights for sure. I also want to pick up a lower dose of that today.

==EDIT==

I see that I didn't include Wednesday's melatonin, which I should have at 3mg.

Edited January 8, 2022 by EasyThereCowboy
added melatonin note

[Altostrata]

Hello, @EasyThereCowboy

 

What are your goals? You've been taking psychiatric drugs continuously since 2000. In the last year, you've made frequent drug changes. You've been under the care of a psychiatrist, who supposedly is supervising all this activity.

 

It's very possible that you're having windows simply because you stopped changing your drugs. Also, by the way, when you take TOO MUCH benzo, you're likely to get paradoxical activation, which you may describe as akathisia.

 

We help people go off their drugs. Is that what you intend to do, or are you looking for a drug combination on which you'll be comfortable?

[EasyThereCowboy]

22 minutes ago, Altostrata said:

Hello, @EasyThereCowboy

 

What are your goals? You've been taking psychiatric drugs continuously since 2000. In the last year, you've made frequent drug changes. You've been under the care of a psychiatrist, who supposedly is supervising all this activity.

 

It's very possible that you're having windows simply because you stopped changing your drugs. Also, by the way, when you take TOO MUCH benzo, you're likely to get paradoxical activation, which you may describe as akathisia.

 

We help people go off their drugs. Is that what you intend to do, or are you looking for a drug combination on which you'll be comfortable?

That is my long-term goal. I'm tired of the merry-go-round and tired of not being told the whole truth about benzos and things like mirtazapine. I've made a conscious effort to not take any more benzos because I'd been working so long at tapering them. I wish I could go back in time two months, six months, and even two years to make better decisions, but that just ain't gonna happen.

 

So, goal one is to make it through this mirtazapine withdrawal. I know it's hard, if not impossible, to say that's what this is for sure, but my body is strongly leaning in that direction.

 

Goal two is to taper off the mirtazapine in a smart fashion so that my nervous system doesn't crash again.

 

Goal three is to get off the sertraline. Again.

 

Thank you, @Altostrata I'm happy to try and answer more questions.

[Altostrata]

Please continue to post daily notes, we need to see if there's a clear pattern.

[EasyThereCowboy]

January 8, 2022

5 AM wake up to sweats. I slept a lot more, but it wasn't restful. Anxiety is high.
7 AM took 150mg sertraline
11:00 AM very anxious. Would have hoped more sleep would help.
11:19 AM took 200mg magnesium
12:00 PM less anxious. Probably more to do with being in bed and focusing on research.
7:00 PM much less anxious. I stayed busy today, so that may have helped.
8:00 PM took 15mg mirtazapine
8:20 PM took 3mg melatonin
9:00 PM fell asleep

[Altostrata]

Do you feel better or worse after taking 150mg sertraline at 7 a.m.?

 

Good idea for everyone to get into the habit of looking at adverse effects of every drug you take. Mirtazapine is known to cause increased sweating. 

[EasyThereCowboy]

51 minutes ago, Altostrata said:

Do you feel better or worse after taking 150mg sertraline at 7 a.m.?

Initially (first 10 days) felt worse after taking it. The last few days there's been no noticeable difference that I can tell. This morning I was even able to eat a bit, so I took that as a positive sign.

[Altostrata]

Seems you're stabilizing. How may we help you here?

[EasyThereCowboy]

January 9, 2022

• 5:00 AM wake to sweats (which I can tolerate) and mild-to-moderate anxiety (which I can't); no memorable dreams. I doze off and on.
• 7:00 AM took 150 mg sertraline. Still anxious. I knew the mornings would probably continue to suck.
• 7:42 AM something about getting out of bed and doing some chores, then getting back into bed, is relaxing.
• 11:00 AM: my appetite appears to be returning; I ate two bagels with cream cheese without feeling nauseated. Unable to find magnesium in smaller doses (thank you, global supply chain), I take the 200mg capsule apart and add some to drinking water.
• 12:35 PM very anxious.
• 1:30 PM still very anxious. I've probably overdone it per activities and need to spend some time in a dark, quiet room.
• 4:45 PM getting pretty bad despair and anxiety. Skin on back of arms and back is burning pretty intensely.
• 6:30 PM abdominal burning. Anxiety still very high.
• 7:30 PM in bed. Anxiety has decreased somewhat, but I'm still feeling discouraged. Tinnitus has been raging the past two or three days, but it's not the sort of thing that bothers me anymore.
• 8:00 PM took 15mg mirtazapine. I feel like I can endure most of the physical symptoms save for the persistent weakness. It's the anxiety that really gets to me. Breathe in, breathe out.
• 8:20 PM took 3mg melatonin.
• 9:30 PM fall asleep

[EasyThereCowboy]

10 hours ago, Altostrata said:

Seems you're stabilizing. How may we help you here?

Thanks @Altostrata. Helping me research and understand the duration of this acute mirtazapine withdrawal/discontinuation? I still hold out hope that "tapering" from 30mg per day to 15mg per day is the root cause of my current situation, if hope is the right word to use for something so horrific.

[EasyThereCowboy]

Reading through this, it would seem that when I'm ready to start tapering, it might be a good idea to start with the sertraline since the mirtazapine is more sedating? I'm definitely not in any rush, just trying not to intellectually jump the gun.

[Kiasofia]

2 hours ago, EasyThereCowboy said:

Reading through this, it would seem that when I'm ready to start tapering, it might be a good idea to start with the sertraline since the mirtazapine is more sedating? I'm definitely not in any rush, just trying not to intellectually jump the gun.

Yes, but also take into account which drug is causing the most side effects. One option is to taper mirtazapine to a lower dose, hold there, and then work on tapering sertraline.

[EasyThereCowboy]

January 10, 2022

• 4:00 AM wake up to the usual: sweaty, some shivers, anxiety. Fall back asleep, however.
• 6:30 AM stay awake.
• 7:00 AM took 150mg sertraline.
• 8:31 AM work is a nice distraction, but I'm still worried about having to go in in-person.
• 9:00 AM took 200mg magnesium
• 10:30 AM feeling optimistic in the morning for the first time in recent memory.
• 11:41 AM cold and shivers. Heart rate up.
• 2:30 PM feeling a bit lightheaded. I've not eaten much today, so it could be that.
• 3:35 PM heart rate up.
• 5:12 PM would kind of like to go to sleep right now.
• 7:26 PM big surge of anxiety
• 8:00 PM took 15mg mirtazapine
• 9:00 PM took 3mg melatonin
• 9:30 PM fall asleep

 

[Altostrata]

On 1/10/2022 at 4:10 AM, EasyThereCowboy said:

Helping me research and understand the duration of this acute mirtazapine withdrawal/discontinuation?

 

What makes you think you have mirtazapine withdrawal and not Effexor withdrawal? It's more likely the later, since taking Zoloft seems to have resolved it.