OPD6: Mirtazipine

[OPD6]

I'm 30 years old, and only now coming to understand my mental health and some of the bad habits I've had in the past. For me, I've had really only two periods of mental health challenge.

I think it’s worth saying, that my life is average in a good way, no trauma from childhood or family issues. 

The first mental health challenge when I was around 21. I had to work away, after a few weeks I started struggling. My symptoms were physical more than mental. I would constantly feel nauseous, and had trouble eating and sleeping. At this time I didn't have the tools / knowledge to recognise that I was undergoing something more than simply dealing with stress. I would vomit most days, losing around 2 stone. Sleep became very troublesome and I would try to manage with coffee which only made things worse. This period lasted around 6 months, and only eased off when the I stopped working away from home.

Throughout this time I didn’t engage in any therapy, self help or medication. I didn’t recognise it at the time, but I believe talking to a GP (doctor) would have helped immensely.

Since then, life continued to be average in a good way for 9 years. I got married to the the girl I've been with since I was 18, we moved into our family home, and travelled some of the world. I regained the weight I lost, and eating and sleeping habits were normal.

Then, last year, our first child was born. In the lead up to her arriving, I didn’t experience any level of stress that I felt in the first period of challenge. However, 2 weeks after she arrived, I began to feel those same physical symptoms. This time I spoke with a GP and began down a route of Self guided CBT, some talk therapy and eventually some private therapy. During this time, the lowest point was going around 4 days without any proper sleep, and we called an emergency mental health NHS helpline to come out and assess me, as I was having intrusive thoughts, which is not something I’m used to! Again, I was feeling physically sick, this is my main debilitating symptom. This is the one symptom that I have real trouble with. 

Speaking with the GP, we first tried Sertraline. I really hated the side effects, brain zaps, intrusive thoughts. I still now can’t decide if this was my own rejection of starting an anti-depressant or the actual side effect, but I could not continue.

However, I eventually came to the decision I needed to try the medical intervention. This is when the GP suggested I try mirtazapine. I started on 15mg, and within 10 days, my body was calm for the first time in 6 months. My appetite slowly came back, and I began to put on the weight that I’d lost.

In the first days, I had some of the side effects listed; a slight twitch in one eye that lasted for a day or two, and drowsiness on a morning. I’ve now been taking 30mg of Mirt for around 6 months. Other than some morning drowsiness, I didn't experience any other symptoms, so I came to decision to reduce my dose with the aim of stopping.

I moved down from 30mg to 15mg on Saturday 28th May 2022. On Sunday evening, I began feeling nauseous. We have some big life events (first family holiday) in the next two weeks. I took the decision after 2 days of feeling sick that maybe I had tapered too fast? I spoke with the GP who said the symptoms appearing so quickly after the change mean they are linked with the drop.

I've now re-instated at 30mg, but still feeling nauseous. This symptom continues to be the most overwhelming issue. I have to work really hard on breathing, and focusing on eating.

I've joined this forum for some support, I'm very new to medical intervention and I haven't really got anyone around me who understands the challenges it presents. I think my aim is to stablise on 30mg. Engage in a slower taper in the future, maybe with the support of therapist or similar? 

Hope this hasn't been too much information!

[getofflex]

Hello, and welcome to SA.  We are a volunteer-run community of people who have been or are getting off of psychiatric drugs.  You have come to the right place.  I believe your symptoms were caused by making too big of a cut in your taper.  It's good that you updosed, and did it right away.  I agree with your plan to stabilize on the 30 mg of mirtazapine, before attempting another taper.  It takes a week for the updose to register with your system, so may take about that long to see improvement in your symptoms.  Are you having any other symptoms besides nausea?  Give this a lot of time, several months at least, if not longer, to stabilize.

 

Here is some important information about how these drugs actually work.  This explains why we get symptoms from going off of these medications, and why it's so important to taper slowly and carefully, and be very cautious about changing our doses: 

 

How Psychiatric Drugs Remodel Your Brain

 

 

This helps you understand what withdrawal syndrome is: 

 

Video on Recovery from Psych Drugs

 

Windows and Waves Pattern of Stabilization

 

 

Tapering is best done extremely slowly, and we generally taper by 10% of the current dose no more than once every 4 weeks, so that the reduction becomes exponentially smaller.

 

 Why Taper by 10% of my Dosage  

 

Tips for Tapering Mirtazapine

 

Here is a link with checklists of common WD symptoms: 

 

Dr Joseph Glenmullen Withdrawal Symptom Checklists

 

 

Here are some techniques to cope with symptoms: 

 

Non Drug Ways to Cope with Withdrawal Symptoms

 

Stability is really important when we are tapering off psych meds.  Please read the link about stability:

 

Keep It Simple, Slow, and Stable

 

 

We don't suggest many supplements, but 2 that many of us find helpful are magnesium and omega-3 fish oil. Here are the links for info about those. It is suggested to add one at a time, and start with a low dose to see how it affects you. 

Magnesium

Omega 3 Fish Oil

 

This link will give you information about reinstating - you did a variation of reinstatement by updosing.  I believe your risk level is low, since you updosed within a couple of days of reducing the dose. 

 

About Reinstating and Stabilizing to Reduce Withdrawal Symptoms

 

I've given you quite a bit of information here.  Please read through it, and mull it over, and we will take it from there. In the meantime, take care of yourself, and take heart.  We in this forum have been through this, and we understand first hand the pain and discomfort you are going through.  Please know that the brain is amazing in it's healing abilities.  It takes time, but healing can and will happen.