el94: coming off mirtazapine

[el94]

Hi everyone, my friend suggested this forum to me and it has been great reading some of your posts and I wanted to introduce myself. I hope I may be able to get some help with what I know I’m sadly not alone in experiencing. 
I stopped taking my last dose of Mirtazapine almost two months ago, and it has been a really challenging time. 
I have been on some form of antidepressant since the age of 18 and I am now 28. At times I have been prescribed other drugs alongside antidepressants such as Pregabalin and Diazepam but not for the last 3+ years. I was about 24 when I switched to Mirtazapine from Sertraline and at the age of 25 my mental health was miles better (after big lifestyle changes) so by age 27 I wanted to try and come off the Mirtazapine. 
With guidance from a GP (although different GPs gave different instructions on how fast to do this) I tapered from 45mg-30mg-15mg-7.5mg-0mg over the course of a year, leaving about 3-4 months between each reduction. 
Every time I lowered the dose, I never noticed any considerable changes. I felt very fortunate considering what I had heard of other friends’ experiences. I therefore felt optimistic about stopping altogether and followed my GP’s go ahead to go from 7.5mg to nothing (I did this after 4 months of being on 7.5mg). 
Then the nightmare began… by day 2 I had itchy, prickly skin and was not sleeping well. For the next 20 days I was physically unwell, with one week being in bed most of the time. My symptoms were: persistent, intense headache, nausea and some vomiting, dizziness, flu-like symptoms including losing my voice, muscle and joint pains, fatigue, brain-zaps, heart palpitations, twitching in my eye, humming sounds and sensations in my head, shooting pains in my arm and blurred vision. I also felt pretty rough mentally, as you do when physically unwell. After these 3 weeks, I started to and continue to feel much better physically. 
Then the anxiety really kicked in. For the past 5 weeks I have been experiencing extreme anxiety, to the point of having panic attacks which I had not experienced for years. I have also experienced what I believe to be dissociation, particularly after a panic attack, when in busy places or I start to feel overwhelmed with thoughts. Like the panic attacks, this is something I have not experienced for years. 

For the past 2 months I don’t feel like myself at all. There’s been the odd day here or there where I think ‘wow! It’s over! I’m me again!’ However, a day or two later, I’m back where I was, not recognising myself, feeling lost and anxious. My friend has explained the windows and waves to me and this really resonates with my experience.

My GP has advised I go back on Mirtazapine should I continue to find this too difficult, but are aware this is my last resort as I really am hoping to come out the other side of this. More recently my GP has offered the beta blocker, Propranolol to help manage the physical symptoms of anxiety, including the panic attacks. They explained this is not an anti-depressant type medication and does not need to be taken daily, just as and when but also agreed if I’m trying to avoid medication, it may not be the right option for me. I am also awaiting an appointment with a MH practitioner and practice yoga and meditation and generally try to look after myself as best I can. 
The past couple of days have been particularly tough. I had two bad panic attacks yesterday and spent most of today in bed. No one wants to feel like this, and I have recently started my final year of my degree and am worried I won’t be able to cope with how things are going.

It’s made me consider either going back on the Mirtazapine, or trying these beta blockers, but I am hesitant. Any advice is really appreciated and thank you in advance for reading this as I know it is pretty long! 
Hope everyone has a good day

Edited October 14, 2022 by Karma
Added username to title

[Altostrata]

Welcome, @el94

 

I am sorry you are experiencing protracted withdrawal from mirtazapine. Yes, taking a little mirtazapine might help, perhaps 1mg or 2mg. We have seen even these very low doses might alleviate withdrawal syndrome.

 

Do you have any tablets left? You can make a liquid with water in order to take a very small dose, as explained here Tips for tapering off mirtazapine (Remeron) or your doctor may be able to order the prescription liquid.

 

You'd stabilize on this for a while, then taper off by tiny amounts later. Please let us know how you're doing.

 

To help us out, follow these instructions Please summarize your drug and withdrawal history in your signature You may need to use a computer to do this.

 

[el94]

Hi @Altostrata, thank you for coming back to me and for your advice, I really appreciate it and hope you’re doing well.
 

I don’t have any tablets left and I saw a doctor a few days ago and he advised I did not go back on mirtazapine seeing as it has been a couple of months now. He did also say that he does not believe my symptoms are due to withdrawal from mirtazapine as this would be out of my system after a month… 

I said I believed my symptoms are very likely due to the withdrawal, considering I was on mirtazapine for 4+ years and antidepressants overall for 10 years, but he did not have much to say about that. 

Both him and another GP have now recommended the beta blocker, Propranolol  to help alleviate the physical symptoms of anxiety, in particular the panic attacks.
I’m still unsure whether to do this, do you or anyone else have any advice on taking beta blockers for protracted withdrawal? 

I had a window of feeling better not long after writing my first post. Today I have had a very intense headache, I vomited this morning and had clumps of hair coming out in the shower!! I have noticed a lot more hair loss over the past couple of months, but it was particularly bad today. No idea if this is linked? 

 

I am quite hesitant to try the beta blockers, and in this moment don’t feel like I need them. But if the anxiety kicks back in I know I will be tempted to give them a go. But then again, I don’t want to cause myself more problems adding something else to the mix. 

[ChessieCat]

It has nothing to do with the drug being "out of your system".  When we take a psychiatric drug the brain adapts to getting the drug.  When we reduce/stop the drug, the process has to be reversed.

 

You could always see a different doctor.

 

There is information in Post #1 of this topic which you could print and take with you:

 

how-to-talk-to-a-doctor-about-tapering-and-withdrawal-what-to-expect

 

[el94]

Both doctors I have seen about this so far didn’t seem open to this idea at all, which I was disappointed but not surprised by! When I made this point I was met with silence or “maybe”. 
 

I’ll check out the information and take some with me next time, thank you. If I have no luck, I’ll request to see a different doctor and see if I have any luck there. 

[Altostrata]

You probably won't get a doctor to agree with you about withdrawal. If you want to reinstate mirtazapine, I would tell your prescriber that you want to try mirtazapine again. Be firm and definite about your request, don't ask his opinion.

 

Before further discussion, Please summarize your drug and withdrawal history in your signature