Mango: Opinion on plan to taper Mirtazipine

[Mango]

I am 74 yrs old and have been on antidepressants and Benzos most of my life. In the past I don’t recall any trouble stopping or switching meds. But all that changed 3 years ago
 

2019  Paxil 20 mg, Clonazepam max 1mg - Traumatic episode which unearthed childhood trauma. Sank into deep depression, anxiety. Crying daily the entire year. Would feel all this pressure in my chest and I had to cry. Never experienced anything like that before. Using up to 1 mg Clonazepam to manage. Decided to get off Paxil. Had no guidance. 

2000-2020  paxil 20 mg, Clonazepam varied

January 2020 start Paxil taper using The Netherlands tapering strips. 

Dec 2020 Paxil Taper done, clonazepam as needed
January 2021 - August 2021 Started having severe symptoms : depression, anxiety, nerve pain, DP, DR, had no idea what was happening. Two Behavioral Health hospitalizations where I was cycled thru various drugs. Also Clonazepam for 20 yrs off and on. I have been suffering this whole year from what I think was PAWS from Paxil. Varied neurological issues, also Orthostatic hypotension, insomnia. Months of no appetite w weight loss, unable to leave the house, terror, incompacitated, couldn’t drive or take care of myself 
April 2021 - Mirtazipine 15 mg, clonazepam max .5 mg
May 2021 - Sertraline 25mg for anxiety, clonazepam .5mg
June 2021 - Reduced Mirtazipine to 7.5 mg, Clonazepam 2.5 - 1 mg , Buspar 5mg added for anxiety
July - started Pregabalin 25.mg for nerve pain symptoms 
Aug 2021 - clonazepam .5 mg, stop Buspar, increase Sertraline to 50 mg, Pregabalin 50mg
Sept - Taper off Sertraline by cutting in half, back on by end of month at 25mg due to withdrawal symptoms. 
Nov - stopped Sertraline, started Nortriptyline 25mg, 
Dec - stop Pregabalin
Jan 2022 - Nortriptyline 50mg at bedtime,Mirtazipine 7.5 mg at bedtime, Clonazepam .125mg morning and bedtime

 

I recognized back in August that my Autonomic Nervous system (ANS)was destabilized, was in sympathetic state 24/7  

I just couldn’t relax.  Because I have Complex PTSD, I tried a Stellate Ganglion block to reset ANS but no help.

I just keep going from one symptom to another. 
Except for neurological and orthostatic hypotension impairments, my mood is most stable it’s been in 3 yrs. 
I want off Mirtazipine because it can be factor in Orthostatic Hypotension. I attribute most of my suffering in 2021 to PAWS from Paxil. 
Looking for someone to review my plan because I do not want more withdrawal symptoms. 
I plan to get Tapering Strips for Mirtazipine from The Netherlands. 4 strips of 28 days each: 7.5 - 5.5, 5.5 - 2.5, 2.5 - .1

.1 - 0 so it will take me 4 months to be completely off Mirtazipine. 
Do you think that is slow enough?

(About month ago, psychiatrist said to take half,  so one night I only took 3.75 mg and was awake all night!). 
Thank you so much for guidance. 

[Kiasofia]

Welcome @Mango

Thank you for creating your drug signature. It seems likely that you were suffering from PAWS from Paxil. 1 year to taper off Paxil is too quick a taper for many. 4 months to get off Mirtazapine is also a very quick taper. We recommend tapering by no more than 10% every 4 weeks.

 

Have you noticed a change in symptoms after quitting Sertraline and starting Notriptyline? Why was this done?

 

Be aware of drug interactions:

https://www.drugs.com/interactions-check.php?drug_list=1734-0,1640-0,703-0

 

You have been through a lot of drug changes so it might be best to not taper mirtazapine until you know how quitting Sertraline and starting Notriptyline is affecting you.

 

About tapering:

Why taper by 10% of my dosage?

NEVER SKIP DOSES TO TAPER

Taking multiple psych drugs? Which drug to taper first?

Tips for tapering off mirtazapine (Remeron)

Tips for tapering off nortriptyline 

 

As there are common misconceptions about how these drugs work I found this post helpful to understand what is going on and why a slow taper, and not making many changes at once is important:

How Psychiatric Drugs Remodel Your Brain 

 

What is your goal with the rest of the drugs?

 

This is your Introductory topic, where you can ask questions and connect with other members.  We're glad you found your way here. Please stay in touch and let us know how you are doing.

 

Edited January 18, 2022 by Kiasofia

[Mango]

@Kiasofia 

Thank you for the quick response and helpful suggestions/ questions. 
I was having a lot of symptoms when I quit Sertraline. I was extremely anxious, not sleeping, sympathetic nervous system in high arousal 24/7. And then I developed Akathesia which was horrific. 
I was seeing a resident at local teaching hospital and felt he didn’t understand my condition so got name of another psychiatrist in larger city. He thought I sounded like classic Melancholic depression and had me wean off Sertraline. 
I have been on Nortriptyline for almost 3 months. It has really been good for depression and anxiety, and Akathesia stopped. 
So I am still on Mirtazipine with Nortriptyline.  I started having Orthostatic Hypotension last July and it has continued. 
current psychiatrist told me that both drugs can be a factor and since I didn’t want to be on multiple antidepressant he suggested starting to wean off Mirtazipine to see if that eliminates the Orthostatic Hypotension. We might have to wean the other one as well if  condition doesn’t improve. 
I currently see a Functional Chiropractic Neurologist to help w this condition and many other nervous system impairments as a result of all the neurological symptoms I have ( probably caused by PAWS from Paxil)@2

If I just did a 10% monthly taper for 7.5mg of Mirtazipine, it looks like it would take over 2 years to taper it. Does that sound right? I’ve got major brain fog so calculating it is tough. Because it’s such a small pill,  and doesn’t come in any lower dose, it don’t know how I’d do that. I could order tapering strips for each reduction but that would end up costing thousands of dollars. I don’t think I have the clarity and focus to be able to do it myself through Brass Monkey calculations. 
I had read about 10% and I don’t want withdrawal symptoms because I’ve already had a nightmarish year. I could do it 10% for 2 months as suggested and see if I her any symptoms. If not, then I could do it every 3 weeks for 2 months, check and reduce based on that. 
Big issue for me is, how do I do the reduction. Should I find a compounding pharmacy that might make a liquid?
 

Thank you so much for your help. I really want to minimize any further suffering but would like off of this due to Orthostatic Hypotension. 
 

[Kiasofia]

1 hour ago, Mango said:

If I just did a 10% monthly taper for 7.5mg of Mirtazipine, it looks like it would take over 2 years to taper it. Does that sound right?

Yes, a slow enough taper to avoid withdrawal can take that long. We advise making 10% cuts in the beginning and then assessing if it's possible to do slightly larger reductions. Some will find they need to make even smaller reductions than 10%.

 

A compounding pharmacy can make a liquid, or the doses you want. It is also possible to make oneself. Were you able to read this link?

Tips for tapering off mirtazapine (Remeron)

 

Pregabalin can be rough to quit. Did you taper that? If you start tapering Mirtazapine now it will be hard to tell if any symptoms are withdrawal from mirtazapine, or withdrawal Sertraline and/or Pregabalin.

[Mango]

@Kiasofia 

 

I tapered off Pregabalin 25mg in 8 weeks. Honestly, since I’m probably still having PAWS from Paxil, it’s hard for me to tell what’s a withdrawal symptom from recent drug and what continuing effect of stopping. Paxil. I just wonder if My body will ever feel good again. 
Because of the Orthostatic hypotension I really need to get off these drugs, but will start w Mirtazipine. Since they are older drugs, they cause very dry mouth and weight gain. I’m just tired of feeling so poorly, and I try every wellness program offered. In fact I’m going to start with Ozone IV therapy next week. So much energy goes into trying to have a life beyond medications but I often feel all I do is focus on my health. 

I would assume a compounding pharmacy would be costly like taper strips. I’ll read the link you sent me and see if I can focus enough to come up w an approach. I’ll post it once I do. 

thanks again for the support and guidance. 

[Kiasofia]

15 hours ago, Mango said:

I’m just tired of feeling so poorly, and I try every wellness program offered. In fact I’m going to start with Ozone IV therapy next week.

Very understandable. We urge caution with trying to "fix" the situation. "Helpful" treatments can often complicate matters further.

 

Keep it simple, slow and stable

[Mango]

@Kiasofia

 

I trust the Ozone therapy won’t complicate matters. I’ve developed real issues with the impairment of my autonomic nervous system. I guess all the extreme stress last year and drug changes has really caused a number of nerve issues with my gait, blood pressure and more. 
and I get this rush of energy/anxiety  like I would call a “flare”. Unsettling but I try and not panic with them. 
Believing I do have PAWS, does that ever quiet down especially since I’m back on antidepressants?

[Kiasofia]

1 hour ago, Mango said:

I get this rush of energy/anxiety  like I would call a “flare”.

This is a common withdrawal symptom.

 

What is withdrawal syndrome?

Dr. Joseph Glenmullen's withdrawal symptom checklist

 

 

1 hour ago, Mango said:

Believing I do have PAWS, does that ever quiet down especially since I’m back on antidepressants?

It gets better with time, but additional drugs and tapering means the brain has a lot of adjustments to make in the time ahead, not just heal from Paxil.

The Windows and Waves Pattern of Stabilization  

How Psychiatric Drugs Remodel Your Brain 

[Mango]

Has anyone put together and would share a schedule for tapering Mirtazipine (7.5) at 10%/month?  And also how to do tapering by solution of water and Mirtazipine.
I really wan to taper but I have such brain for that it’s hard for me to figure this out for myself. but I really want to get off this drug safely. Do not want to experience months of extreme insomnia and anxiety. 
 

Thank you. 
 

I know there is lot of info on this site but would just like it streamlined and specific to Mirtazipine. 
 

 

[Kiasofia]

I know this can all be overwhelming.

 

There are calculators here: How to calculate dosages and dilutions? Spreadsheets and calculators

 

The Mirtazapine group on Facebook might have more resources specific to Mirtazapine.

 

It is possible to get a liquid from a compounding pharmacy. Or make yourself using a tablet and water. The easiest is to make 1ml = 1mg. So 7.5ml water and dissolve a 7.5mg pill. Stir really well and remove the amount you are reducing by and drink the rest.

 

How to make a liquid from tablets or capsules

[Mango]

I spoke w my psychiatrist about tapering Mirtazipine. 
His schedule was wks 1-4. Alternate days of 7.5 M w 3.75 M

                               Wks 5-8 everyday 3.75

                                Wks 9-13 3.75 every other day

                                 Wk 14. Stop

Since I’ve read enough and experienced pain of withdrawal, I knew that what he considered a slow withdrawal was not. He said it’s much easier than SSRIs!  Well,I didn’t follow him but I did Wks 1-4 alternating 7.5 and 6.0 for 4 weeks. 
week 5 I started on 6.0 daily. 
well, I’ve done that for 5 days and every night my sleep has been affected as I can’t sleep past 4 and awaken w anxiety. Also, getting lots of those “flares”. So, I need to adjust but don’t know how. I don’t want to go back to 7.5. 
 

Any ideas what I should do now? I guess I could go back to 10% which would be 6.75. 

[Mango]

@Kiasofia

please see my recent post. Thank you

[Mango]

I went back to 10%, 6.75, and slept better. Stil flares of anxiety, depression. Body feels shaky inside and my walking is weighted (have had this for months)

[Mango]

Post Acute Withdrawl from Paxil 18 months ago

 

So, I’m wondering if I could still be experiencing PAWS from too fast withdrawal from Paxil. I took last dose December 2020   
I had tapered down from 20mg in Jan to 0 in December 2020. and had no idea that was too fast. My life fell apart in 2021 and I had no idea it was Withdrawl from Paxil. (I had been on it 20 years). Numerous hospitalization,  neurological conditions , insomnia.  A nightmare and I didn’t understand what it was until end of 2021 and neither did doctors. 
So I’m wondering if I could still be experiencing Withdrawal effects. I get these flareup of anxiety on my body 

I am still depressed and so,anxious (on Nortriptylin 50mg and Mirtazipine 6.0mg - I'm weaning off this, and .250 mg clonazepam).

I haven’t gotten my mental health back yet although i’m better than last year. 
Also, has anyone developed  neurological condition as withdrawl symptom?
I don’t get many good days or what I read are called “windows”.

 

thank you so much. 

 

Edited May 27, 2022 by ChessieCat
added Intro topic title before merging with intro topic

[Mark]

Simple response : After 20 years on this poison -> OF COURSE YES !!!!

[ChessieCat]

2 hours ago, Mango said:

Post Acute Withdrawl from Paxil 18 months ago

 

So, I’m wondering if I could still be experiencing PAWS from too fast withdrawal from Paxil. I took last dose December 2020

 

There is a possibility that you are still experiencing withdrawal symptoms from having got off Paxil too quickly.  And it is possible that the drugs you took after that were started because you were experiencing (unrecognised/undiagnosed) withdrawal from Paxil.  It is also possible that the drugs that were added after you stopped Paxil did not fully help with the withdrawal symptoms of Paxil.

 

BUT because you have started and stopped multiple drugs since you stopped Paxil, it is impossible to know what your current symptoms are caused by.  It is possible that it is caused one thing or any combination of them.  

 

Below is your current drug signature (at the time of me making this post).  I have bolded the first mention of each drug to highlight the number of different drugs you have taken; 7 different psychiatric drugs in a period of 2.5 years and that does not include the 10 years you took Paxil.  The effect of going on and off psychiatric drugs has a cumulative effect on the nervous system.  We have members here at SA who previously had no difficulty in the past chopping and changing drugs and going up and down in doses and sometimes doing cold turkeys (and sometimes multiple times) then one day they do the same thing that they did before and it doesn't "work" the same way because all the changes have finally caught up and their nervous system has become sensitised or "bruised".

 

Quote

 

2000 - Dec 2020, Paxil 10-30 mg, 20 mg  January 2020 when I started taper using Tapering strips from The Netherlands. Clonazepam .125 - 1 mg as needed 
Dec 2020 - End of taper, off Paxil,  Clonazepam .125 - .5 as needed
April 2021 - Mirtazipine 15 mg
May 2021 - Sertraline 25mg for anxiety
June 2021 - Mirtazipine down to 7.5 mg, Clonazepam 2.5 - 1 mg , Buspar 5mg 
July - started Pregabalin 25.mg 
Aug 2021 - clonazepam .5 mg, stop Buspar, increase Sertraline to 50 mg, Pregabalin 50mg
Sept - Taper off Sertraline by cutting in half, back on by end of month at 25mg due to WD
Nov - stopped Sertraline, started Nortriptyline 25mg, 
Dec - stop Pregabalin
Jan 2022 - Nortriptyline 50mg, Mirtazipine 7.5 mg, Clonazepam .25 mg

 

 

[Mango]

Thank you for your helpful comments. And signature doesn’t include the drugs they keep switching while inpatient. 
Like many of you I have been in this distressed state for so long, I can get so discouraged. Injury to autonomic nervous system, having also been in flight or fight for years, have created some neurological issues with my feet and walking. I just pray I’ll be able to get back to my 5 mile walks one of these days. 
I so appreciate this forum. 

[ChessieCat]

9 hours ago, Mango said:

Injury to autonomic nervous system, having also been in flight or fight for years, have created some neurological issues with my feet and walking.

 

Not all issues that arise whilst we are taking a drug/tapering are caused/related to the AD or the WD.

 

Even if you are not overweight you It think it would be a good idea to get tested for diabetes; a simple fasting blood test (you can drink water, which helps to keep the veins dilated; I used to think that I wasn't allowed to drink water and the nurse had trouble finding a vein) which includes HbA1c and ALT (liver function).  There are some Type 2 diabetics who are very slim so they don't think that they might be diabetic.

 

I was diagnosed with diabetes last October so I have done a lot of research on it.  I was shocked when I found out that it can cause people to lose toes/legs, kidney problems which might lead to needing dialysis and also blindness.  This is because the blood flow is reduced and these areas of the body have very small blood vessels.  Thankfully I was able to reverse/put my diabetes into remission by changing my diet (not low fat; low fat products take out the fat and replace it was sugar to make it taste good) and cutting out sugar and carbs (which turn into sugar), without medication.

 

From:  https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/foot-problems

 

Quote

 

 

How can diabetes affect my feet?

 

Over time, diabetes may cause nerve damage, also called diabetic neuropathy, that can cause tingling and pain, and can make you lose feeling in your feet.

 

 

 

[Mango]

How to become active in discussions again

 

How do I update my content and signature as I’ve been tapering Mirtazipine and want to get back in active interchange w members. 

Edited April 2, 2023 by Shep
added title after merging from another thread

[Gridley]

13 minutes ago, Mango said:

How do I update my content and signature

Use this link and when you're finished updating, press "save."  

 

Account Settings – Create or Edit a signature.

 

[Mango]

Thank you Gridley. When I add lines  to Signature, it doesn’t allow them if greater than 12 lines. Yet even when I combine items on one line and only have 12 lines, it doesn’t save it. 
 

Also, how do I add new content to my original posts so that I can get suppor?

 

 

[Gridley]

8 hours ago, Mango said:

When I add lines  to Signature, it doesn’t allow them if greater than 12 lines. Yet even when I combine items on one line and only have 12 lines, it doesn’t save it. 
 

I'll report this to the other staff.  They may have an answer.

 

8 hours ago, Mango said:

Also, how do I add new content to my original posts so that I can get suppor?

 

Can't be done.  You can only rewrite for a short time after you post.

Edited April 1, 2023 by Gridley

[Shep]

@Mango Please note I moved your latest posts from another Intro/Update thread and merged them here to your already existing Intro/Update thread. Please continue to ask questions here. 

 

Please list what you would like to have in your signature and place it in a post here. I'll add it to your signature for you. Thank you. 

[Mango]

Signature add:
April 2022 Nortriptyline 60mg, Clonazepam .125mg BID.    Mirtazipine taper 7.5 to 6.5 every other day per psychiatrist. When I tried to go from 6.5 to 6, couldn’t sleep. Mirtazipine started at 6.75  and started doing 10% taper every 4 weeks

April 2023 Mirtazipine at 1.85mg

Thank you Shep

[Shep]

16 hours ago, Mango said:

Signature add:
April 2022 Nortriptyline 60mg, Clonazepam .125mg BID.    Mirtazipine taper 7.5 to 6.5 every other day per psychiatrist. When I tried to go from 6.5 to 6, couldn’t sleep. Mirtazipine started at 6.75  and started doing 10% taper every 4 weeks

April 2023 Mirtazipine at 1.85mg

Thank you Shep

 

I'm assuming the line starting "April 2022 Nortriptyline" is really April 2023? 

 

I've updated your signature. In order to get you more line spaces available, I moved some of the information for each year onto the same line and added bolding to make it more legible. That may be the best way to do this so you're able to keep adding more information, although eventually, you may want to remove some of the narrative, especially for the older information. 

[Mango]

Thank you Shep    No, it is 2022. I was just showing what I was on when I started Mirtazipine taper. 

Although I just want to be off all of this, like everyone, after reading so much info on this site I am sure i am having significant PAWS from way too fast Paxil tapering. So, I am down to 1.85 mg Mirtazipine. My plan is to finish that taper so I’m interested to know at what dosage people typically finish off. I was thinking of a tapering strip for last segment whatever that is.  I appreciate any thoughts on this. 
After this I wanted to start to taper Nortriptyline since my doctor thinks it is causing blood pressure issues. I may go taper down to 50 mg and then give myself 3 month hold where I’m not tapering and hopefully help my body heal more. 

[Shep]

7 hours ago, Mango said:

No, it is 2022. I was just showing what I was on when I started Mirtazipine taper. 

 

Thanks, Mango. I've updated your signature. 

 

7 hours ago, Mango said:

My plan is to finish that taper so I’m interested to know at what dosage people typically finish off. I was thinking of a tapering strip for last segment whatever that is.

 

It's individual. You'll want to let your symptoms guide you. If symptoms catch up to you toward the end of your taper, you'll want to taper slower and / or incorporate more holds. So I would pay more attention to your symptoms. It's better to feel well and still be on a crumb of the drug than to taper too quickly or jump off too soon and feel sick. 

 

When to end the taper and jump to zero?

Experiences after tapering to zero

 

 It doesn't end at "O"

[Mango]

hi Shep, thanks for links. 

My doctor wants me to decrease the Nortriptyline from 60 - 50mg because she thinks I’m having blood pressure issues because of it. Would it be OK to just hold any more cuts to Mirtazipine and decrease the Nortriptyline bu 10% for 2 months which would get me to 50 mg?
 

I could even reduce Nortriptyline by just 5% which would then take about 3 months 

 

what are your thoughts on that?

Thank you. 

[Shep]

It's possible some of the symptoms may be due to a MAJOR drug interaction. See:

 

Drug Interaction Report - clonazepam, mirtazapine, nortriptyline

 

What time(s) of the day are you taking each of your drugs? Please list the time(s) o'clock and the dose. 

 

Which of your drugs is helping the most with sleep? 

 

It's possible you may benefit from spacing out your drugs. Once you list the time(s) you are taking them each day, we can look at a spacing schedule. I would do that first before making any decreases because changing the spacing is likely a faster way to lessen the drug interaction. 

[Mango]

hi Shep, thanks for links. 

My doctor wants me to decrease the Nortriptyline from 60 - 50mg because she thinks I’m having blood pressure issues because of it. Would it be OK to just hold any more cuts to Mirtazipine and decrease the Nortriptyline bu 10% for 2 months which would get me to 50 mg?
 

I could even reduce Nortriptyline by just 5% which would then take about 3 months 

 

what are your thoughts on that?

Thank you. 

[Mango]

10:00 a.m.

clonazepam .125 mg

 

Night around 9 p.m:
    Mirtazapine 1.85 mg

    Nortriptyline 60 mg

 

Night around 10:00 pm
clonazepam .125 mG

 

[Shep]

Thanks, @Mango When are your symptoms worse? Your mirtazapine is at a very low dose now, so you may not be getting much of a drug interaction. 

 

Switching over to reducing nortriptyline shouldn't be a problem as long as you don't go any faster than 10% per month, based on the prior month's dose. 

[Mango]

Shep, again thank you for your comments. I am so grateful for this site which is such a safe and trustworthy space to learn the truth, and for administrators like you who keep it alive and us with hope. 
 

I think I will reduce Nortriptyline from 60 to 50 over May and June so at least I’ll be only taking one 50 mg pill of Nor…at that point.  I’ll then continue Mirtazipine taper. 

[Shep]

12 hours ago, Mango said:

 

I think I will reduce Nortriptyline from 60 to 50 over May and June so at least I’ll be only taking one 50 mg pill of Nor…at that point.  I’ll then continue Mirtazipine taper. 

 

You may want to use the Brassmonkey Slide method of tapering. Instead of one large monthly reduction, you do small, weekly reductions which add up to no more than the recommended 10% reduction per month. Please see:

 

The Brassmonkey Slide Method of Micro-tapering

 

Many people find this to be gentler on the nervous system. You can adjust the weekly reductions to target your goal for the month. 

 

Please feel free to post if you have any questions regarding the math and we can help you set up your taper. 

[Mango]

How do I delete old narrative?

 

[Shep]

14 hours ago, Mango said:

How do I delete old narrative?

 

 

You're only able to edit a post for an hour after you post it. There's no option for members to delete posts. 

 

If you need to let us know of any changes, please post here in your thread.