Adrasteia: mirtazapine and Wellbutrin

[Adrasteia]

Hi Everyone!

 

Found this site when looking for research on tapering off my medications, the history should show in my signature if I've updated it correctly (hopefully).

 

I was put on Mirtazapine around 10ish years ago after suffering unacceptable side effects of Fluoxetine. It's served me well keeping my relatively stable through the years at varying doses. In 2020, I burnt out in work and ended up being put on Wellbutrin alongside the Mirtazapine.

 

I tried to come off the Mirtazapine a few years back, circa 2018 (from 15mg), I had initially split the tablets to 7.5mg for I believe a month or so, I don't recall any overly negative effects. Slightly more erratic mood but nothing that was unmanageable.

 

I then started skipping doses to reduce the average (big no no! I didn't realise at the time how bad that was), I did speak to the doctor as my mood was becoming unmanageable and the doctor then moved me to compounded medication (the soluble versions aren't available where I live). Even moving to the compounded meds I had weeks where I was okay but still teeter tottering, I believe I had gotten down to 5mg per day but I think I dropped from 7.5mg - 5mg. My mood always seemed worse when I was 3/4 the way through the monthly bottle, from reading on these forums it sounds like it was losing its potency. 

 

After a rather horrible work trip where I was away from home and my support network the anxiety and weepiness were out of hand, I panicked and thought I was relapsing so called my Dr and ended up back on the Mirtazapine at 15mg.

 

When I started the Wellbutrin 150mg XR I was on 30mg of Mirtazapine but early 2021 (Jan/Feb) we upped the Wellbutrin to 300mg and dropped the Mirtazapine to 15mg (May) as I was tired all the time.

 

I'm aiming to taper off both medications but I'm not sure which to start with, I was planning on the Mirtazapine due to the length of time I've been on it as I figure will need to be slow. But not sure if the Wellbutrin alone will cause crazy anxiety as I've noticed I've had more general anxiety recently.

 

I've ordered some Ora-plus so I can compound it at home on a weekly/bi-weekly basis.  Not sure whether I should start the 10% decrease from 15mg or if I should try to drop to 7.5mg and taper from there.  Based on my calculations decreasing by 10% per month I'm looking at 1.5-2years, this seems like an extremely long time. Thoughts?  What dose have people jumped from on the Mirtazapine?

 

I ideally want to be completely med free in about 2 years as my partner and I want to start a family but I don't want to be on meds or have to transition to Fluoxetine as I really hated it.

 

I could absolutely keep writing and talking away to myself but i'll leave it there for now. 

 

Great to virtually meet you all!

[getofflex]

Hello, and welcome to SA.  We are a volunteer-run community of people who have been or are getting off of psychiatric drugs.  Thank you for providing us with a clear and concise drug history - this really helps.  I assume your Wellbutrin is still the XR extended release?  How have you felt since you started on the Adderall XR 15 mg. in June of 2022?  

 

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

 

 

I'm very glad you came to us for advice before you started your current taper.  This should help you mostly or altogether avoid withdrawal symptoms, if you follow our suggestions.  But just in case, these links help you understand what withdrawal syndrome is: 

 

Video on Recovery from Psych Drugs

 

Windows and Waves Pattern of Stabilization

 

We generally suggest you taper off the most activating drugs first, which would be the Wellbutrin.  This link will go into more detail about deciding which drug to taper first.  If you taper off the sedating drug first, you could go into major insomnia, anxiety, agitation, and other symptoms of an activated nervous system, which is no fun, to put it mildly.  

 

Taking Multiple Psych Drugs - Which to Taper First

 

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 Wellbutrin. Scroll down through the first post, and there is a step by step account of how to taper off 300 mg of Wellbutrin XL.  

 

Tips for Tapering Mirtazapine

 

Here is a link with checklists of common WD symptoms, in case you develop any: 

 

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

 

 

On 9/27/2022 at 6:49 PM, Adrasteia said:

Not sure whether I should start the 10% decrease from 15mg or if I should try to drop to 7.5mg and taper from there. 

I definitely would not suggest doing a 50% reduction of any psych med. Even though you got away with this in the past, as time goes on, and we go on and off more drugs, and change our doses, our nervous systems tend to become more sensitive.  You don't want to start off your taper by throwing off your nervous system by cutting your dose in half, especially because you've had quite a few drug changes (on and off several drugs, dose changes, skipping doses, etc) in the past several years.  All this tends to be cumulative, and the sensitization can last for a long time.  

 

I know I've given you quite a bit of information here, and it may be overwhelming.  Focus mainly on the links about how psych meds remodel your brain, and why taper by 10%.  Please let us know how it's going, and keep in touch. 

[Adrasteia]

Hi!

 

Getofflex - thank you so so much for all of the information you provided. I took the time a went through all of the links. I also purchased and read the antidepressant solution prior to making any adjustments to my meds.

 

Regarding your questions, you are correct it was the extended release version of Wellbutrin I was on. RE the Adderall I've honestly felt better since starting it, I started it mainly for concentration and executive dysfunction issues surrounding work and whilst the issues are still present it's not as bad as it was. I did notice that there were days where my anxiety was a lot worse but that was generally when I took the Adderall and Wellbutrin too close together on top of my morning coffee.

 

Following your advice I did look to decrease the Wellbutrin first due to the stimulating effect and I'm pleased to be able to say that since my last post I have decreased from 300mg XR -> 150mg XR -> 75mg IR over the course of 2 months. Dr Glenmullen's symptom tracker has been extremely helpful in these

step downs.

 

The first step down from 300mg to 150mg (Nov-Dec '22) wasn't fun in all honesty, and I know that is a big decrease and not the ideal 10%. (The Mirtazapine will be decreased much slower when we get there).

 

I thought about how I wanted to try to reduce it for a while before speaking to my Dr. After reading Dr Glenmullen's book as well I felt equipped that I knew what the expected withdrawal symptoms would be (tiredness and irritability) and I didn't want to unnecessarily extend the length of withdrawing off my meds if I was reacting okay to it given than I've got a whole other medication to come off after this one. Given that the withdrawal symptoms were unlikely to be the usual depression like symptoms (which I find the scariest and hardest to deal with) and that I couldn't do any other adjustment without changing the formulation (e.g. to SR or IR) of the meds I decided to make the jump down to 150mg.

 

I was really out of sorts for about 2-2.5 weeks, low energy is definitely the main symptom the first few weeks with headaches, irritability and mood swings. These symptoms peaked at day 7/8 with nausea and vomiting. I initially attributed the nausea/vomiting to withdrawal but I think I may have picked up a stomach bug . After day 9/10 most of those symptoms  subsided and my mood slowly stabilised. In hindsight, I perhaps should have waited another month as I changed my birth control a few months back and so I think that was attributing to the mood swings at the time.

 

Speaking with my Dr and showing her my symptom log and graph (I graphed a track of the count of symptoms vs the impact to my daily life), we agreed for me to decrease from 150mg -> 75mg. This transition has honestly been much easier for me, low energy has again been the biggest thing the first week it's hard to get up and moving but I learnt and took a few days off before Christmas (Day 6/7) so I could rest (working on the same timeline as the first step down). Besides the tiredness I've had headaches and mood swings but they've been far milder than the last decrease.

 

I'm now on day 16 of the latest decrease, i have been very tired the last few days with some minor mood swings but I think the tiredness is due to much later nights and the busyness of the holidays and caring for my partner with a bad first case of COVID. Overall I would say I've felt relatively stable and pretty upbeat the last week.

 

My next appointment with my doctor will be on Jan 10th where I will be talking to her about the next decrease. Given how much smoother this decrease was then I will likely look to drop to 0mg from the 14th January so I will be through withdrawal and fully off Wellbutrin by the end of Feb.  

 

I want to try to drop to 0mg next because I may be moving employers in early to mid-March and would not want to be adjusting meds following a job move for 6-9months and it would be a shame to be on 37.5mg if I could have come off it all together. That said I'm not opposed to going to 37.5mg if necessary or restarting at that dose if the decrease to 0mg didn't go as planned it's just not my preference.

 

I will try to do another update after my appointment with the Dr / around the next decrease.

 

Happy New Year!

- Adrasteia

[getofflex]

11 hours ago, Adrasteia said:

My next appointment with my doctor will be on Jan 10th where I will be talking to her about the next decrease. Given how much smoother this decrease was then I will likely look to drop to 0mg from the 14th January so I will be through withdrawal and fully off Wellbutrin by the end of Feb.  

We prefer not to give advice on cases where the doctor is involved in the drug taper.  In the vast majority of cases, the doctors advice on tapering is different, and conflicts with our advice.  Please choose whether you want to follow you doctor’s advice, or our advice here.  We have a harm reduction approach of 10% exponential taper, and most doctors have much faster tapers than this.  We cannot rescue you if you suffer by tapering too fast.  Going to the doctor and us for advise is likely to confuse you, and frustrate us and waste our time.  We have already given you the information on how to do a taper according to our protocol.

 

If you should decide to taper in the future based on SA suggestions, please let us know.  Good luck.

 

 

 

[Adrasteia]

Hi Getofflex, 

 

Thanks for the above - I unfortunately have little choice with this medication as the doctor is holding my medications hostage pending appointments but I appreciate what you're saying. Doctors definitely are not the most knowledgeable and often downright wrong.

 

I was intending to update my progress using this as a support group but it sounds like it's preferable if I don't whilst I'm working with my doctor? 

 

With the Mirtazapine I expect she'll just write me renewals without appointments so I will have more freedom there.

[j1290]

@Adrasteia

Hey there, fellow Wellbutrin taperer!   I always take a special interest in people getting off of this, and it's such a help to hear the experience of others.   I'm glad I'm not the only one that gets fatigue from this!  Fascinating to see how close your taper matches mine in certain ways.  Day 7 and 8 of a reduction are turning out to be my hardest ones for me as well with irritability and headaches, whatnot.  

 

I loved Dr. Glenmullen's book, and I use his checklist religiously!   It's turned out to be the cornerstone of my taper, it's been so useful.  

 

So 150-75 was easier than 300-150?  How so, just the symptoms were less intense?  I'm on my 5th cut, finally below 300mg, and I feel like it's getting a little bit easier, which isn't to say easy.