Stepup: Limerick Rocket Fuel - mirtazapine and duloxetine

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Hello

I have been on Anti Depressants since 2016. The only one that made any difference for a few months was Duloxetine 50mg. That stopped working for both depression and anxiety so I discontinued it back in 2019. I was ok for a couple of months but then started feeling anxious again, and the GP reintroduced it. Fast forward to 2021 and a bad dose of Long COVID, and I had to stop the Duloxetine as it was giving me heart disregulation. I then tried Escitalapram for a few weeks but was unable to tolerate it, so the GP prescribed me Mirtazapine. This was put up to 30mg in March 2022, then I developed severe anxiety and discontinued, having a cross taper to Duloxetine again. Whilst cross-tapering, I discovered that the combination of Duloxetine and Mirtazapine seemed to stop my anxiety and so the GP has prescribed this combo. I am only in week 1, but some days I feel fine, and then like today, all I want to do is crash out. I have no job at the moment and feel pretty hopeless. After reading the report in today's news regarding the lack of evidence for the Serotonin hypothesis, I feel like just binning the whole lot of antidepressants, and using diazepam to withdraw off the lot. However, every time I come off antidepressants, I feel like my symptoms rebound. I am starting to feel like a chemistry play set, and don't want to feel this way. I am 47, wife a family. 

[getofflex]

Hello, and welcome to SA.  We are a volunteer-run community of people who have been or are getting off of psychiatric drugs.  I don't blame you for wanting to get off the drugs.  Being as how you've had adverse reactions to these drugs in the past, it is probably best to get off.  I feel much better, now that I'm off my psych meds.  But, it needs to be done very carefully and slowly.  Not only that, we must find other means of addressing the issues that put us on the drugs in the first place, like anxiety, depression, etc.  

 

It sounds to me as if you are either having an adverse reaction to one or both of the drugs, or else the 2 drugs are not interacting well together, or both.  Can you please expound on what you mean by "all I want to do is crash out"?  Can you please describe what symptoms you have on these days in detail?  Thank you.  

 

According to drugs.com, there is a potential for a major interaction between your 2 drugs mirtazapine and duloxetine: 

 

Interactions between your drugs

Major

mirtazapine  DULoxetine

Applies to: mirtazapine, duloxetine

Using mirtazapine together with DULoxetine can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. 

 

Can you please give us specific information in your signature about your drug history for all drugs you are on and have been on, especially for the past 18-24 months?  It would be especially helpful to have the details of your drugs in a concise vertical list (no symptoms), only drug names, specific dates (as best you can say for example early March if you don't recall the day) and dosages of each medication decrease or increase.  Use this format:

 

Drug name: date, dose, date, dose, date, dose…

Drug name: date, dose, date, dose, date, dose…

Etcetera

 

Please read the link below for instructions.  This will allow us to give you the best guidance.  

 

How to List Drug History in Signature

 

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, and the symptoms of and recovery from adverse reaction are very similar:

 

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  

 

It is important to carefully decide which drug to taper first.  Read this link: 

 

Taking Multiple Psych Drugs - Which to Taper First

 

Here is a link with checklists of common symptoms of withdrawal and adverse reaction: 

 

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

 

Please let us know what you decide to do, and we can advise you how to taper off.  We look forward to hearing from you soon.