PortugueseSea: metoclopramide, akathisia and mirtazapine

[PortugueseSea]

Slept well.

10:00 Wake up restless. Like I have a nervous ball of energy stuck inside my neck. Drink a protein yogurt, take the magnesium malate (500mg) and stay in bead, uneasy, until 12:00.

12:00 Get up and pace a bit, feel activated. Quite uneasy, neck feels the same.
13:00 Tried icing the back of my neck, at the time it didn't help but some time after the fact it got better and my levels of agitation lowered a bit, something to try again.
14:00 Levels of agitation go down. Get ready to leave for lunch with mom.
14:30 - 15:30 Lunch, eat grilled meat and a salad. An omelet was the appetizer. Levels of agitation relatively low but never felt comfortable. A sense of uneasiness (activation? akathisia?) remains.
16:00 Drive to Lisbon;  car movement is somehow soothing. Same sense of discomfort continues throughout the afternoon.
20:00 Take Mirtazapine 3.75mg.
20:30 Burning sensation in the back of the neck. Agitation very manageable, uneasiness lessens.
21:00 Take Mirtazapine 11.25mg. Watch youtube and slowly work on my taxes.
23:00 Go to bed.

[manymoretodays]

11 hours ago, PortugueseSea said:

I am healed from both the jetlag and my bad cold. I will start moving the dose up today and will post daily symptom logs for as long as you think it is necessary. Thank you so much. 

I think I am slowly healing as you said I would with the mirtazapine but the agitation, specially around late morning and lunch time, I still hard to bear.

 

This is good news.

And......hoping once you get your 3.75 mg of mirtazapine moved earlier, you might lose the agitation that comes late morning and lunch time.

 

Good good that you are starting to move that dose now.

 

Fingers and toes crossed for success.

 

L, P, H, and G,

mmt

[PortugueseSea]

Slept well

10:00 Woke up, had a protein yogurt and some cheese, had the magnesium malate. Best morning in weeks. Very toned down activation/uneasiness.
15:00 - 17:00 Lunch with mom and walk at the park, ate grilled meat with hummus accompanied by a salad, limited uneasiness. Limited dysphoria.
18:00 - 20:00 Arrive home, watch soccer on pc.
19:00 Take mirtazapine 3.75mg
19:30 Go out for dinner with dad, listen to soccer and go for a walk at shopping mall. Symptoms remain the same. Eat a Kebab followed by ice-cream.
20:30 Slight agitation increase, perhaps to blame on sugar?
21:00 Take mirtazapine 11.25mg, forget magnesium.
00:00 Take magnesium malate (500mg) and go to bed.
 

[PortugueseSea]

Slept well

10:00 Woke up, had a protein yogurt and some cheese, had the magnesium malate (500mg). Toned down activation/uneasiness.
10:30 - 13:00 Worked on my taxes.
13:30 - 15:00 Went for lunch with mom, had pork liver with salad followed by a chocolate mousse. Moderate dysphoria follow lunch.
16:00 Agitation worsens a bit but still at moderate levels. Watched soccer on PC and worked on taxes.
18:00 Take mirtazapine 3.75mg.
20:00 Eat soup, cheese, ham and smoked salmon for dinner.
21:00 Take mirtazapine 11.75mg and magnesium malate (500mg).
00:00 Go to bed.
 

[PortugueseSea]

Broken sleep, maybe 5 hours.

10:00 Woke up, had a protein yogurt and some cheese, had the magnesium malate (500mg). A sense of uneasy was felt from the get go.
10:30 - 13:00 Stayed in bed browsing the internet and texting
13:30 - 15:00 Went for lunch with mom, had pork steak with a salad followed by an almond desert. Previous symptoms remained, head paresthesia and a little chest pressure added.
16:00 Agitation worsens a bit but still at moderate levels. Watched soccer on PC and worked on taxes.
17:00 Take mirtazapine 3.75mg.
20:00 Eat soup, cheese, ham and smoked salmon for dinner. Mild agitation did not ease like normally.
21:00 Take mirtazapine 11.75mg and magnesium malate (500mg).
00:00 Go to bed.

[Altostrata]

What does "head paresthesia" mean?

 

How did you feel after taking 11.75mg mirtazapine?

[PortugueseSea]

On 11/5/2022 at 8:11 AM, Altostrata said:

What does "

head paresthesia" mean?

It varies quite a bit, it goes from feeling I have a fork stuck in the top or back of my head to a sensation that someone is putting pressure on my head, generally, yeah, top or back. To be honest, I am not even sure paresthesia is even the best word.

 

 

On 11/5/2022 at 8:11 AM, Altostrata said:

How did you feel after taking 11.75mg mirtazapine?

No changes from taking the 15mg at night. Feel a bit sleepy. the big change is around lunch time, since I have started moving the dose up, and I am not done yet, I have had a reduction of symptoms. Maybe it is just placebo as I am not done yet?

[PortugueseSea]

Friday
Slept well

10:00 Woke up, had a protein yogurt and some cheese, had the magnesium malate (500mg). Few symptoms early morning, just a sense of discomfort.
10:30 - 13:00 Took a shower, checked my e-mail and got ready
13:30 - 15:00 Went for lunch with mom, had steak with a salad, no desert. Discomfort and agitation started building, felt teary and a bit of despair.
16:00 Agitation calmed down a tad. Went for a walk and watched soccer on TV.
16:45 Take mirtazapine 3.75mg.
20:00 Eat soup, cheese, ham and smoked salmon for dinner. Mild agitation, kept easing.
21:00 Take mirtazapine 11.75mg and magnesium malate (500mg).
00:00 Go to bed.

[Altostrata]

35 minutes ago, PortugueseSea said:

I have had a reduction of symptoms.

 

Which symptoms have reduced as you have moved the split dose earlier in the day?

[PortugueseSea]

7 minutes ago, Altostrata said:

Which symptoms have reduced as you have moved the split dose earlier in the day?

Agitation and neuro-emotions (despair, sadness and anhedonia).

[PortugueseSea]

Saturday

Slept well, 7/10 day in my reckoning (0 - complete akathisia panic; 10 - no symptoms)

10:00 Woke up, had a protein yogurt and some cheese, had the magnesium malate (500mg). Few symptoms early morning, just a sense of discomfort.
10:30 - 13:00 Took a shower, worked and got ready to leave.
13:30 - 15:00 Went for lunch with friends, had steak with pickles and fries, mango mousse for dessert. 
16:00 Felt some uneasiness but not too much agitation, played with friend's pet
16:45 - 20:00 Take mirtazapine 3.75mg. Ate ham, cheese and bread with honey throughout the afternoon. Symptoms progressively eased.
21:00 Take mirtazapine 11.75mg and magnesium malate (500mg).
00:00 Go to bed.

[PortugueseSea]

Sunday

Slept Well, 7/10 day. I only started

07:30 Woke up with mild activation, went back to sleep.
10:00 Got up, had a protein yogurt and some cheese, had the magnesium malate (500mg). Few symptoms early morning, just a sense of discomfort.
10:30 - 13:00 Took a shower, worked and got ready to leave. At around 11:30 felt a burning sensation at the back of my head for around half an hour.
13:30 - 15:00 Went for lunch with mom, had lamb with fries and rice ( broke my diet, which I try not to do more than once a week...)
15:00 - 17:00 Saw soccer game at the stadium, lower league, actually enjoyed it. Take Mirtazapine 3.75mg at 16:00. Activation and agitation started building around 16:30.
17:00 - 19:00 Went to a coffee shop with mom, had linden tea and a pastry.
19:15 - 20:15 Holy mass; activation starts to settle down towards the end of the service. Still, that sense of unease lingered, hard to relax.
20:15- 21:00 Light dinner, beef and vegetables.
21:00 Take mirtazapine 11.75mg and magnesium malate (500mg).
21:00 - 22:00 Watch soccer on TV
23:00 Go to bed.

[PortugueseSea]

Monday

Slept well, 5/10. I can't help but think that I have felt worse today because of having overdone it with carbs. I broke my diet two days in a row and thus got a spike in symptoms, maybe?

10:00 - 13:00 Woke up agitated, drank protein yogurt and took the magnesium malate (500mg). Symptoms built up over the morning.

13:00 - 15:00 Lunch out with mom. Ate lamb with rice and potatoes, didn't realize those were the side dishes until it was too late. Agitation kept building.
15:00 Take mirtazapine 3.75mg. 
15:00 - 19:00 Watch soccer and play video-games at home to try and distract from the agitation.
19:00 - 21:00 Had dinner with dad, cheese, ham and blueberries.
21:00 Take mirtazapine 11.25mg and go to to bed early.

I realized I've been writing down 11.75 mirt, it's 11.25, 3/4 of a pill. Sorry.
 

[PortugueseSea]

Today I have lived through a complete rollercoaster. I woke up very agitated, it eventually evolved into fidgeting and terror. By lunch time I was a complete mess. It has been a while I was feeling that bad. Then, at 14pm, I took my 3.75mg of mirtazapine and by 3pm my symptoms were lessened by around 70%.

I take this is supportive of interdose withdrawal. What do you think Alto?

[PortugueseSea]

Tuesday; 4/10. Bad day with a morning filled with agitation, fidgeting and feelings of dread. I believe today revealed that there is indeed interdose withdrawal and thus justifies moving part of the dose to the morning as advised. I attribute the worsening to having consumed a substantial amount of carbs three days straight, it was negligent of me and will be more careful in the future as I seem to be sensitive.

 

10:00 - 13:00 Woke up agitated, drank protein yogurt and took the magnesium malate (500mg). Symptoms built up over the morning.

13:00 - 14:00 Lunch out with mom. Ate pork steak and salad.  Agitation kept building, I felt terror and dread. Bad dysphoria, started fidgeting, very restless.
14:00 Take mirtazapine 3.75mg. 
15:00 Start to feel symptoms calm down. Agitation, dread and dysphoria all reduce by around 70%. There is a feeling of burning in my neck and sedation, I attribute these to the mirtazapine.
15:00 - 19:00 Watch soccer and play video-games at home to try and distract from the agitation, snacked walnuts.
19:00 - 21:00 Had dinner with dad, vegetable soup.
21:00 Take mirtazapine 11.25mg, magnesium and go to bed early.

[Altostrata]

16 hours ago, PortugueseSea said:

I realized I've been writing down 11.75 mirt, it's 11.25, 3/4 of a pill. Sorry.

 

Thanks, I was going to ask about this.

 

After you take the 3.75mg in the afternoon, does the agitation continue to reduce throughout the evening, does it get a little lower but continue at the same level, or does it get worse?

[PortugueseSea]

7 hours ago, Altostrata said:

After you take the 3.75mg in the afternoon, does the agitation continue to reduce throughout the evening, does it get a little lower but continue at the same level, or does it get worse?

I've checked my notes, it either continues to reduce (3 of 8 days) or gets a little lower and then stabilizes (4 of 8 days), it has only worsened throughout the evening in one instance, in the aftermath of a stupid carb binge at lunch.

Agitation records (0 to 10):

1st of November: Morning 2; Afternoon 2; Evening 2;
2nd of November: 2; 2; 2;
3rd: 3; 3; 3;
4th: 3; 4; 2;
5th: 2; 3; 2;
6th: 2; 2; 4 (this was the single case where it worsened)
7th: 3; 5; 5;
8th: 5; 7; 3;

[PortugueseSea]

Wednesday; 5/10, okay day. I struggled during the afternoon with agitation, no pacing or fidgeting, I "just" had an unbearable sense of discomfort that made me want to crawl out of my skin. It started easing from around 4 or 5pm into the evening.

 

10:00 - 13:00 Woke up agitated, drank protein yogurt and took the magnesium malate (500mg). Symptoms built up over the morning. Worked on breathing exercises and watched youtube.
13:00 Take mirtazapine 3.75mg. 

13:00 - 14:00 Lunch out with mom. Ate beef steak and salad.  Agitation kept building, very uncomfortable in my own skin but yet no fidgeting or pacing.
16:00 Start to feel symptoms calm down. Agitation kept settling down over time.. There was a feeling of burning in my neck and sedation, I attribute these to the mirtazapine.
15:00 - 19:00 Watched soccer and played video-games at home to try and distract from the agitation, snacked walnuts.
19:00 - 21:00 Had dinner with mom, lamb, vegetables, drank nothing but water all day.
21:00 Take mirtazapine 11.25mg, magnesium malate (500mg) and go to bed early.

[ChessieCat]

Putting this here for member's history:

 

  

12 hours ago, PortugueseSea said:

I talked with Dr. Shipko over the phone regarding my metoclopramide induced akathisia.

He recommended... time. We argued that it was well I was on Remeron but should not stay on for too long, he advised rapid discontinuation or, if my condition rapidly deteriorated, starting a taper. Beyond that he recommended that I could take Klonopin to get through the unbearable days and, if I was desperate, be put on Klonopin which would eventually be tapered off. He also mentioned, and he does it again on the video I posted, that he knew nobody who hadn't recovered almost fully of akathisia after 6 to 7 years.

I am currently very slowly stabilizing and anxious to start my remeron taper. As per the advice of this forum, I have moved part of my dose to the morning and am doing a big better. Slow wins the race I guess...

 

[PortugueseSea]

10 hours ago, ChessieCat said:

Putting this here for member's history:

Thank you Cheesie Cat,

There has been something on my mind lately, I don't know if you would be able to provide input on this, it relates with what Dr. Shipko said, would love if Alto also chimed in:

I keep a general well-being scale (0/10) and another for my agitation/akathisia/restlessness (0/10). I was put on the mirtazapine to help with the agitation and I think it is doing it's job, on the other hand, I feel that being 6 months off the causative agent (metoclopramide) I likely won't heal until I'm off everything.

My (slow) improvements have meant fewer crises, no panic attacks, minor symptoms have gone and that's huge. But man, I miss being able to relax, having at least one hour a day, or 5 minutes, without any bodily tension or agitation. I never have that, I am "stable" but on edge. All the time, and that is what is winding me down. What would stable mean for me? Would a well being average of 6 or 7 out of ten, even though I am never ever ever at ten mean stable? I have read all the resources about stability I think and I am still not sure.

I am doing everything I can to deal with my chief symptom, fully knowing the day it goes I've won the war, I am able to ignore all other symptoms but this lingering persistent discomfort. I have been working on my diet, take long walks every day, try to distract myself, do breathing exercises and will start progressive muscle relaxation and possibly an anti-inflammatory supplement soon, maybe omega-3 or Vitamin E. I have also taken time off full time work.

My initial reaction was likely an adverse reaction, as I was only on the med daily for like 2/3 weeks, I wish I knew at the time the answer was to stay off everything. Instead, I went to the doctor and got the usual prescription cascade with the usual outcome, getting worse.

I know slow wins the race, but could I be sabotaging myself by staying on mirtazapine for too long? 

Thanks, I know you guys are busy and don't want to abuse your time or patience. Just trying to do the right thing for myself and my family.
I am currently getting all the materials needed for liquid so I can get ready for moving dosing around and future tapering.

Lots of love,

 

[PortugueseSea]

Thursday; 6/10, okay day. I struggled during morning and afternoon with agitation, no pacing or fidgeting, I "just" had the usual sense of discomfort that makes me want to crawl out of my skin. It started easing from around 4 or 5pm into the evening.

 

10:00 - 12:00 Woke up agitated, drank protein yogurt and took the magnesium malate (500mg). Symptoms built up over the morning. Worked on breathing exercises and watched youtube.
12:00 Took mirtazapine 3.75mg. 

12:30 Agitation keeps building, discomfort, uneasiness.

13:00 - 14:00 Lunch out with mom. Ate beef steak and salad.  Agitation stabilized after lunch, uncomfortable in my own skin but yet no fidgeting or pacing.
16:00    Symptoms start to calm down calm down. Agitation slowly settled down over time.. There was a feeling of burning in my neck and sedation, I attribute these to the mirtazapine.
15:00 - 19:00 Watched soccer and played video-games at home to try and distract from the agitation, snacked walnuts and dark chocolate.
19:00 - 21:00 Had dinner with dad, smoked salmon, blueberries and cheese, drank nothing but water all day.
21:00 Took mirtazapine 11.25mg, magnesium malate (500mg) and went to bed early.

[Altostrata]

On 11/10/2022 at 5:41 AM, PortugueseSea said:

10:00 - 13:00 Woke up agitated, drank protein yogurt and took the magnesium malate (500mg). 

 

Magnesium works better in small doses throughout the day. You might cut this tablet in half and take it morning and evening.

 

Suggest you move 3.75 mirtazapine back to 14:00, as on Tuesday, and keep taking it at that time for at least 7 days. Please let us know how you're doing.

[PortugueseSea]

8 minutes ago, Altostrata said:

Magnesium works better in small doses throughout the day. You might cut this tablet in half and take it morning and evening.

I got a capsule... I will get a different one and do that. Smaller quantities.

 

 

8 minutes ago, Altostrata said:

Suggest you move 3.75 mirtazapine back to 14:00, as on Tuesday, and keep taking it at that time for at least 7 days. Please let us know how you're doing.

Understood, today I forgot to take it at 11 and actually took it at 12, so I will just take it at 13 tomorrow and then at 14 the day after tomorrow.
As I had a crappy afternoon today, I also think 2pm is around the mark.

When I start tapering it would probably be best to start with the evening portion I assume. 
My liquid tapering tools are arriving soon. It will make it much easier to get accurate dosing.

Thanks Alto. Should I keep posting daily updates or should I just let you know of any relevant changes?
 

[Altostrata]

Please keep posting daily notes. Thank you.

[PortugueseSea]

Dear all, I am going to undergo emergency appendectomy today so the logs will be late. I have no luck.

Will post them once I am back from the hospital.

Pray that my agitation does not get much worse with the meds I am bound to get. I feel slightly worse after a contrast CT scan I had to undergo.

The hospital has been informed I cannot take nausea meds. Hope this does not set me back too much.

[Altostrata]

Sending you wishes for a trouble-free procedure and recovery.

[PortugueseSea]

Okay, I am alive and here are my logs:

Saturday; 5/10:

Broken sleep

04:00 woke up with bad pain at 4 am, stayed in bed trying to catch some sleep until 10.
10:00 - 11:00 skip breakfast and just work, no appetite
12:00 Go for lunch with mom, eat a burger paddy and some salad. Feel quite restless, decide that my pain warrants an ER visit.
12:00 - 14:00 waiting and pacing at ER, dysphoric and uneasy, pain is not too bad. Take Mirtazapine 3.75mg.
14:00 - 18:00 CT scan with iodine, restlessness gets worse, pacing and agitation. Appendicitis confirmed.
18:00 Get admitted, get COVID test.
18:00 - 20:00 Restless in ER bed but can cope, surgery gets postponed to the next day due to COVID. Started on Amoxicillin and Paracetamol every 8 hours; IV fluids.
21:00 Take Mirtazapine 11.25mg.

Sunday 6/10

Broken sleep

04:00 woke up with bad pain at 4 am, stayed in bed trying to catch some sleep until 10. Wake up agitated but less than the previous day.

06:00 Amoxicillin and Paracetamol
12:00 Appendectomy, administered propofolol and dexomethasone.
12:45 Wake up nauseous, surgery went well. Fell asleep and was not given the mirtazapine dose at 14pm.

14:00 Amoxicillin and Paracetamol
16:00 Wake up agitated, fidgety
16:00 - 18:00 uncomfortable, agitated in bed.
18:15 - 20:00 Get better, nice two hour window, sleep on and off.
21:00 Take Mirtazapine 11.25mg and go to sleep.

22:00 Amoxicillin and Paracetamol

Monday 7/10

Sleep well

06:00 Amoxicillin and Paracetamol
06:30 Wake up with little to no agitation. Talk with hospital roommate, stayed in neurology
06:30 - 21:00 Sleep on and off, felt slightly more agitated over time but nothing out of the ordinary.

14:00 Take mirtazapine 3.75mg. Amoxicillin and Paracetamol

21:00 Take mirtazapine 11.25mg and go to sleep.

22:00 Amoxicillin and Paracetamol

Tuesday 8/10 Bizarre, best day in a few weeks, was able to settle down and rest.

Sleep well; sent home, stopped antibiotics and continued paracetamol.

07:00 Wake up, ate simple breakfast, yogurts, milk and cereal bars. Mild to none agitation most of the morning. Take paracetamol.
14:00 Eat lunch, meat, rice and vegetables. Take mirtazapine 3.75mg and paracetamol.
15:00 Agitation starts building but manageable. Stay on the sofa, sleeping on and off.
21:00 Eat meat and vegetables for dinner, Take mirtazapine 11.25mg.

02:00 Wake up in pain and take paracetamol.

 

Wednesday 4/10 Agitation started moderate in the morning and got way worse around 3pm.

07:00 Wake up agitated, head discomfort bottom left side of the head, went away around 11:30.
08:00 Eat simple breakfast, yogurts, smoked salmon and milk.

12:00 Take paracetamol.
13:00 Suddenly get sleepy, malaise, eat meat, salad and french fries for lunch, some blueberries too.
14:00 Take mirtazapine 3.75mg.

15:00 Agitation and restlessness get really bad, have to go to the hospital to check my stitches and bandages, fidgety, uneasy, trouble distracting.
15:00 - 17:00 stiches and bandages are fine, over time discomfort lessened somewhat and moved from the sides of the head to the back of the neck, if that even makes sense.
17:00 Writing these logs.

[PortugueseSea]

What can I say? All in all I think I did fine given the circumstances. I found it very bizarre that my agitation was mild on the day of the surgery just to subsequently get a lot worse today. Specially given that it got really bad one hour after taking the mirtazapine at 2pm. It makes no sense, I guess with the chaos brought upon by the surgery it is no surprise and I should be "happy" it did not set me back substantially.

 

Finding it hard to rest with the discomfort, yesterday and the day before yesterday I was more or less able to.

Just tired of the agitation, 6 months off the causative agent sometimes I think the mirtazapine could be keeping it going? I don't know, it doesn't feel that way and I know that antiemetic/antipsychotic symptoms after kindling can last for a long time. 

One day at the time. Healing, hope I did okay, had trouble keeping track of everything in more detail. If there is any other information that might help, Alto, do tell.

[PortugueseSea]

On other news, I got my tools for my liquid taper. Wonder when I will be able to start. At this point, the agitation is my only bad symptom. Everything else has become toned down or actually gone, which is good news I guess!

[manymoretodays]

Hi PS,  Glad you fared okay with the appendectomy.  Happy continued healing.  And yes, this whole thing would be frustrating for anyone.  It will be good to see how tomorrow goes....fingers crossed for more restful after the 2 pm mirtaz.  Good on you...readying for liquid.  What are you going to use for a base liquid?  Best. L, 

P, H, and G....mmt.  Can't wait until this is a distant memory for you..and it will be.  Sending comfort, and hope during these more difficult days.

 

[Altostrata]

Good to hear you did well with the appendectomy. 

 

We will not be able to interpret your symptom pattern while you are recovering from surgery.

[PortugueseSea]

12 hours ago, manymoretodays said:

Hi PS,  Glad you fared okay with the appendectomy.  Happy continued healing.  And yes, this whole thing would be frustrating for anyone.  It will be good to see how tomorrow goes....fingers crossed for more restful after the 2 pm mirtaz.  Good on you...readying for liquid.  What are you going to use for a base liquid?  Best. L, 

P, H, and G....mmt.  Can't wait until this is a distant memory for you..and it will be.  Sending comfort, and hope during these more difficult days.

Thank you so much, I think I have done well all things considered. The base liquid is a water and sugar syrup ordered from a pharmacy. I am working on radical acceptance, I know I will get there, it will just take time.

 

5 hours ago, Altostrata said:

Good to hear you did well with the appendectomy. 

 

We will not be able to interpret your symptom pattern while you are recovering from surgery.

Thanks Alto, was that a curve ball or what... I was told I would be "back to normal" in a week or so. I am off everything except paracetamol. Should I restart posting daily logs on Monday or so?

[Altostrata]

9 hours ago, PortugueseSea said:

Should I restart posting daily logs on Monday or so?

 

Please post daily logs when you feel you are back to normal.

[PortugueseSea]

On 11/18/2022 at 7:19 AM, Altostrata said:

Please post daily logs when you feel you are back to normal.

 

I feel I am back to "normal". 5/10; I have also started Magneisum Carbonate, which is less bioavailable so I can take it three times a day. Anyhow, today I clearly felt an improvement in mood, also to a degree agitation wise after taking my afternoon mirtazapine. I wonder whether I would do better with dosing throughout the day? Say, 3.75 morning, 3.75 afternoon and then the rest in the evening. I also feel my taper would start with cutting the evening dose which, perhaps, is too high. I hope we will know more by the end of the week. Here is my first log:

09:30 Wake up and eat breakfast: blueberries, toast and hot milk.
10:00 - 11:00 Teach an online lesson; agitation starts building.
11:00 - 14:00 Leave the house for lunch, have a bad time feeling agitated and teary in the car. Eat steak with mushrooms for lunch.
14:00 Take mirtazapine 3.75mg. Head to the clinic to remove my bandages, nurse says I'm all set and fully recovered from both COVID and the appendectomy.
15:00 Agitation eases somewhat and mood improves, I feel this is clearly due to the effects of the small dose mirtazapine.
15:30 Head to the supermarket for some grocery shopping, chat with mom. Agitation remains mild to moderate.
16:00 - 21:00 watch soccer and played video-games to distract, snacked raisins and nuts.
21:00 Take a shower and eat meat with vegetables. Take mirtazapine 11.25mg, Magnesium Carbonate 500mg, drink herbal tea and watch a movie.
01:00 Go to bed.

[Altostrata]

You're feeling better after you take 3.75mg in the afternoon? Suggest you move it an hour earlier each day until you're taking it at about 9 a.m.

[PortugueseSea]

09:30 Wake up and eat breakfast: blueberries, toast and hot milk. Magnesium Carbonate 500mg
10:00 - 11:00 Teach an online lesson; agitation starts building.
11:00 - 14:00 Leave the house for lunch, growing agitation with head discomfort, moving from the top of the head to the sides, eventually to the neck.
14:00   Take mirtazapine 3.75mg. Magnesium Carbonate 500mg.
14:00 - 21:00 Play video-games. Feel generally uncomfortable, though the head discomfort gets better throughout the evening.
21:00 Take a shower and eat meat with vegetables. Take mirtazapine 11.25mg, Magnesium Carbonate 500mg, drink herbal tea and watch a movie.
01:00 Go to bed.