Lippy: Mirtazapine and Olanzapine - need help and advice

[Lippy]

Dear all,

 

I was being prescribed Mirtazapine 30mg, Olanzapine 2.5mg and Paroxetine 20mg in March 2021 for depression. After taking for a couple of months I began to taper down (without doctor's acknowledgement) by halving the dosages. I started tapering Paroxetine, then Olanzapine without any issues and able to stop them completely without any problem. I then tapered Mirtazapine by halving the dosage as well and decided to cold turkey when I reached 7.5mg. Unfortunately I went into bad insomnia for 2 days and feeling frightened I went back to see the doctor and was asked to reinstate all the 3 drugs at the original dose. This was during October 2021.

 

I got a second opinion from another doctor who advised me to just take 15mg of Mirtazapine and 2.5mg of Olanzapine (stopped Paroxetine), which I had been taking for another 3 months. It was until January 2022 that I developed very bad anxiety, due to the fear of dependency on these medications as I realized that I have developed dependency on them and I have lost the ability to sleep on my own. I was feeling anxious, frightened and loss of appetite everyday. The doctor then increased my dosage of Mirtazapine back to 30mg and added Lexapro to help with the anxiety. After 2-3 weeks on Lexapro I felt more calm but I experienced side effects like acne all over my back and extreme fatigue throughout the day. The doctor then stopped me on Lexapro. So since January 2022 until now I have been taking Mirtazapine 30mg and Olanzapine 1.88 mg.

 

I realized that the medicines are not really helping except for sleep, and also due to the fear of having to depend on them for sleep forever, I decided to taper them down. I thought my tapering journey would be as smooth as last year. However in March 2022, I attempted to reduce by 25% for Mirtazapine and cold turkeyed Olanzapine (one medicine per time) but both attempts failed as I had bad insomnia on the 2nd day. I then reinstated back to the previous dose. I recently made another attempt to taper Olanzapine by 50% but insomnia creeps back at day 10 and lasted for 3 days, I then updosed by 25% and sleep came back.

 

Recently I came across with some facebook support groups and learned about the 10% harm reduction taper. I am very keen to try out the harm reduction taper but as I researched I have some questions. I hope admins can help me with these questions:

 

1. How come I was able to do a large percentage reduction last year but this year even 25% seems so difficult? Is this due to the kindling effect?

 

2. Does kindling apply to stopping completely and reinstating back, or it can apply to increasing/decreasing a dose during taper?

 

3. If we've made a drop and experience withdrawal, how do we know whether we should hold and wait for withdrawal to pass, or to updose then make a smaller drop?

 

4. What is the safest/most accurate method of tapering? There's one Facebook support group that I joined doesn't advocate weighing and cutting/slicing pills as they claimed that the active ingredients are not evenly distributed in the pill hence we can't get an accurate percentage cut. Is this true?

For liquid tapering, how do we ensure an even distribution of the crushed pill in the liquid since it will settle down?

 

Thank you for taking your time to read my story and experiences. Looking forward to getting a reply from you.

 

Edited June 3, 2022 by Shep
removed extra space at end of post, updated amount of Olanzapine dose to 1.88 mg, per Lippy's request

[Shep]

Hi, Lippy.

 

Welcome to Surviving Antidepressants.

 

It looks like you're well into the research on these drugs. With a much slower taper going forward, I'm sure you'll be able to come off these drug.

 

On 5/25/2022 at 9:00 AM, Lippy said:

1. How come I was able to do a large percentage reduction last year but this year even 25% seems so difficult? Is this due to the kindling effect?

 

It could be due to kindling. But you also were on Lexapro for about a month, which is technically long enough to become dependent. So you may be dealing with a number of issues and withdrawals.

 

On 5/25/2022 at 9:00 AM, Lippy said:

2. Does kindling apply to stopping completely and reinstating back, or it can apply to increasing/decreasing a dose during taper?

 

Yes, it can apply to increasing / decreasing. Kindling is trauma to the nervous system as a result of abrupt changes.

 

On 5/25/2022 at 9:00 AM, Lippy said:

3. If we've made a drop and experience withdrawal, how do we know whether we should hold and wait for withdrawal to pass, or to updose then make a smaller drop?

 

If your symptoms are severe, it's worth trying a small updose to see if it helps. If the symptoms are mild, holding may be your best bet.

 

On 5/25/2022 at 9:00 AM, Lippy said:

4. What is the safest/most accurate method of tapering? There's one Facebook support group that I joined doesn't advocate weighing and cutting/slicing pills as they claimed that the active ingredients are not evenly distributed in the pill hence we can't get an accurate percentage cut. Is this true?

For liquid tapering, how do we ensure an even distribution of the crushed pill in the liquid since it will settle down?

 

Prescription liquid is really the most ideal method of accurate tapering, but it's not necessary. You can make a liquid for many of these drugs. If you using the weighing method, it's best to crush the pill since so the active ingredient is well distributed.

 

Some of these drugs are more soluble in water than others and there are liquids you can add that dissolve the pill.

 

Here is information on the two drugs you're currently taking:

 

Why taper by 10% of my dosage?

 

Tips for tapering off mirtazapine (Remeron)

Tips for tapering off olanzapine (Zyprexa)

 

 

On 5/25/2022 at 9:00 AM, Lippy said:

So since January 2022 until now I have been taking Mirtazapine 30mg and Olanzapine 2.5mg.

 

You may need to update your signature, depending on which is correct - the amounts you have listed here in your first post or the 1.88 mg Olanzapine you have listed in your signature.

 

Were you completely off of Paroxetine in October 2021 and no other SSRI added until January when you took Lexapro for a few weeks? Were insomnia and anxiety your only symptoms at that time? When you stopped the Lexapro, did you feel better or worse overall?

 

The reason I'm asking is to gauge if reinstating a small amount of an SSRI may be helpful or not. Please let us know your thoughts on that.

 

Please note there is a MODERATE drug interaction between your two current drugs:

 

Drug Interaction Checker - mirtazapine and olanzapine

 

What time(s) of the day do you take each of these drugs? If you're not already, you may want to space them apart by at least 2 hours to minimize the risk of the drug interaction.

 

Please continue to use this thread to ask questions and to document your taper.

[Lippy]

On 5/30/2022 at 6:33 AM, Shep said:

You may need to update your signature, depending on which is correct - the amounts you have listed here in your first post or the 1.88 mg Olanzapine you have listed in your signature.

 

The amount listed in the signature is the correct one. How do I edit my post?

On 5/30/2022 at 6:33 AM, Shep said:

Were you completely off of Paroxetine in October 2021 and no other SSRI added until January when you took Lexapro for a few weeks?

Yes.

 

On 5/30/2022 at 6:33 AM, Shep said:

Were insomnia and anxiety your only symptoms at that time? When you stopped the Lexapro, did you feel better or worse overall?

Yes insomnia and anxiety my only symptoms at that time. When I stopped Lexapro I noticed that my anxiety comes back a little but it was bearable.

 

On 5/30/2022 at 6:33 AM, Shep said:

The reason I'm asking is to gauge if reinstating a small amount of an SSRI may be helpful or not. Please let us know your thoughts on that

If possible I do not wish to reinstate another antidepressant as I'll be more worried of the possible withdrawals and having to taper another drug.

 

On 5/30/2022 at 6:33 AM, Shep said:

What time(s) of the day do you take each of these drugs?

I'm taking both of them at the same time, which is before bedtime as both of them cause drowsiness. 

 

 

On 5/25/2022 at 9:00 PM, Lippy said:

I recently made another attempt to taper Olanzapine by 50% but insomnia creeps back at day 10 and lasted for 3 days, I then updosed by 25% and sleep came back.

This is an URGENT question that I would like to seek help from, as mentioned above that I made a taper of 50% and updosed it by 25% and sleep came back. Would like to update that after 9 days (which is now), I'm having brutal insomnia for 3 days again. Do you have any idea why an updose this time causes insomnia? Should I updose it to the original dose before tapering? or should I hold and wait for the insomnia to pass? Does updosing causes withdrawal? Is there any danger/problems to updosing? 

 

Looking forward to your reply on the above question (last) as I'm now panicked and not sure what to do next. Thank you very much!

[Shep]

41 minutes ago, Lippy said:

The amount listed in the signature is the correct one. How do I edit my post?

 

Members only have one hour to make edits, so I changed your post to reflect the 1.88 mg Olanzapine dose. 

 

On 5/29/2022 at 6:33 PM, Shep said:

Were insomnia and anxiety your only symptoms at that time? When you stopped the Lexapro, did you feel better or worse overall?

 

 

46 minutes ago, Lippy said:

Yes insomnia and anxiety my only symptoms at that time. When I stopped Lexapro I noticed that my anxiety comes back a little but it was bearable.

 

I know you're understandably hesitant to reinstate Lexapro, but do you feel that Lexapro's effect on your anxiety may have helped with your sleep? 

 

The reason I'm asking is because you're now a little over 3 months off this drug and SSRIs are notorious for a delayed withdrawal. It's possible that your current insomnia may be a result of stopping the Lexapro three months ago. Many people stop SSRIs and don't have any withdrawal symptoms for several weeks to several months later. That's one reason antidepressant withdrawal has been very hard for doctors to understand. 

 

48 minutes ago, Lippy said:

This is an URGENT question that I would like to seek help from, as mentioned above that I made a taper of 50% and updosed it by 25% and sleep came back. Would like to update that after 9 days (which is now), I'm having brutal insomnia for 3 days again. Do you have any idea why an updose this time causes insomnia? Should I updose it to the original dose before tapering? or should I hold and wait for the insomnia to pass? Does updosing causes withdrawal? Is there any danger/problems to updosing? 

 

 

Has anything else changed? Are you eating healthy, avoiding caffeine and alcohol, keeping stress to a minimum? Many of us (myself included) tend to overdo things once we start feeling better, thinking we can handle being less careful. That can easily trigger a wave.

 

Have you added in any supplements or over-the-counter medications? 

 

Please let us know your thoughts on reinstating a tiny bit of Lexapro if you feel it had a calming effect earlier and may have helped your sleep. If this is a Lexapro late-onset wave, updosing Olanzapine may not help. While you're thinking about this, I'll go ahead and give you the threads for a reinstatement. 

 

About reinstating and stabilizing to reduce withdrawal symptoms

Tips for tapering off escitalopram (Lexapro)

 

How much Lexapro were you on? What dose did you stop at? Please note Lexapro is an EXTREMELY potent drug, so any reinstatement will be at a fraction of the dose you were taking back in February. Once you provide more information about your previous Lexapro dose, we can help you set up a reinstatement amount, if this is something you'd like to try. 

 

Please let us know your thoughts. 

 

 

 

[Lippy]

Hi if I’m don’t wish to reinstate lexapro, and if my insomnia is a lexapro late onset wave, how do I minimise the withdrawal? And how long does it take for withdrawal to pass? 

[Lippy]

My Lexapro’s dosage was 10mg in February 2022. If I were to reinstate, how many mg should I take? 

[Lippy]

Hi admin would appreciate if you could reply me sooner as I’m waiting for your advice on the lexapro dosage to be reinstated as I’m having brutal insomnia. Thank you so much. 

[Shep]

On 6/4/2022 at 7:04 AM, Lippy said:

My Lexapro’s dosage was 10mg in February 2022. If I were to reinstate, how many mg should I take? 

 

You may want to try 1 or 2 mg and see how you feel. The first post in this thread will show you how to get to that low a dose. 

 

Tips for tapering off escitalopram (Lexapro)

 

 

[Shep]

@Lippy Just a thought, but you may even want to try as little as .25 mg Lexapro to start and see how you feel. Since it's a very potent drug and you're already on another antidepressant, you may not need that much. 

 

Please post your thoughts. If you start very low and it has no effect, you can always increase.