Hopeful1987 - Remeron Taper and Insomnia

[hopeful1987]

Last night was like the previous 2 so it seems like there's progress. Im not where I'd like to be but I'm getting through the days just fine, despite some fatigue. So I'll try another week to see where things are at. If I'm in the same place, i may just hang here for the taper since it's tolerable. 

 

Do a lot of people improve in their symptoms as they taper? I'm sure it probably varies. 

[Altostrata]

People improve in their symptoms as they stabilize on one dose for a while.

 

You'd taper off 3.75mg mirtazapine by very small amounts that hopefully will not cause withdrawal symptoms.

[getofflex]

4 hours ago, hopeful1987 said:

Do a lot of people improve in their symptoms as they taper? I'm sure it probably varies.

I improved in my symptoms as I tapered.  However, 1) I came in here after tapering way too fast, and was destabilized from that, and 2) as I got lower and lower on my dose, I was even more cautious, and slowed down my taper.  I did periods where I would hold for up to 5 months, and waited 6-8 week between reductions many times.  I listened to my body, and waited until I was reasonably stable for a couple of weeks before doing another reduction.  

[hopeful1987]

Well overall this week was an improvement. 4.5-5.5 hrs each night. Though last night i was having a bit more trouble. In bed at 10:30pm (was sleepy) and was still awake at 1am, so i caved and took 10mg ambien. Was feeling a bit more anxious since i had been doing better in the week and now i was having a tougher night. Took about 45 min for me to sleep after taking ambien. Managed maybe 4.5 hrs. 

 

I plan to stay at 3.75mg for the rest of April, unless I'm advised otherwise.

[hopeful1987]

Btw, i know i shouldn't have taken the ambien. It was a moment of anxiety and weakness. I threw out the bottle. 

[Mcat]

Hi Hopeful; glad you're showing signs of stabilising. This recent bout of WD insomnia seems to have gotten inside your head (very understandable). I wonder if re-visiting The Effortless Sleep Method and giving managing any lingering insomnia with that protocol might not be a good idea. I've learnt through my insomnia travails that if I have enough sleep anxiety on board, nothing works, or at least nothing works well and that the mental (thought patterns) I get locked into around insomnia are as damaging as WD-induced insomnia and the combination is an absolute killer. In any event, it sounds like you're improving, which is excellent. And yes, sounds like holding where you are for a good spell would be wise. 

[hopeful1987]

Thanks for checking in Mcat and for the advice. Yes, I'm revisiting key concepts from the book. Don't know what it was. Just had a harder night and the sleep anxiety set in even though i knew id be ok. It's not rational.

 

Anyway, hoping the ambien didn't mess anything up. I feel fine and even started to doze on my couch today. Hopefully that's a positive sign. 

[Mcat]

Just put the Ambien behind you and start a new slate. I have found that sleep anxiety can be very sneaky (e.g., can be in play even if you don't think it is). I am working overtime with my thinking, challenging and re-framing negative thoughts/expectations around sleep, and it does help. If I feel even a twinge of that anxiety while lying in bed, I catch it and then do a reverse psychology thing where I tell myself I'm not trying or expecting to sleep, just resting, and then I focus on belly breathing with a little mantra to go with it: inhale rise, exhale calm, and I've been finding I drop off pretty quickly. It's super hard not to get attached to sleep well again when you have a couple of good nights after a spell of bad ones, but if you can try to keep an acceptance up that you may not get the sleep you want and that's okay, it really does help. It's a weird paradox and very hard to maintain (obviously much harder the rougher the sleep is; I'm fortunate in that I'm sleeping well atm), but that's what I'm working on. 

[hopeful1987]

Was doing alright, with 5 hr nights on average, until last night when i got maybe 1 hour of sleep. Not sure what the issue was. 

 

One thing i know is that using a scale is annoying with such a low amount to measure, so id like to switch to a liquid in May. But i dont know how stable i need to be for that. 

 

[hopeful1987]

So, assuming things are relatively stable for the rest of the month, I'm wanting to transition to the liquid May 1st. Since I'm on 3.75mg, this lends itself to transitioning to the liquid in thirds (e.g. 2.5mg pill & 1.25mg liquid for X days, then 1.25mg pill & 2.5mg liquid for X days, then 3.75mg liquid).

 

Does this sound like a good plan?

[Altostrata]

In what ways are you unstable? 

 

On 4/20/2023 at 2:59 PM, hopeful1987 said:

So, assuming things are relatively stable for the rest of the month, I'm wanting to transition to the liquid May 1st. Since I'm on 3.75mg, this lends itself to transitioning to the liquid in thirds (e.g. 2.5mg pill & 1.25mg liquid for X days, then 1.25mg pill & 2.5mg liquid for X days, then 3.75mg liquid).

 

Does this sound like a good plan?

 

Yes, you could do that.

[hopeful1987]

Well, I'm not sure what stability looks like in my situation. My only symptom is still insomnia. I'm getting 4-5 hrs of broken sleep each night. Could be worse but i think I'm in a place to start tapering. 

 

I'm nervous about the transition to liquid. Could i also up my dose from 3.75mg to 4mg, and transition in fourths? 

[RKroos]

I recommend you not to invent strange things.

Take mirtazapine 1 time at night, in liquid and start with 3.90 or 4 mg, from there I recommend you go down no more than 3% each time, for example 2.5 weekly or 3% every 10 days

[Altostrata]

@hopeful1987 since you reinstated March 7, you have reported halting but continuous gradual improvement. After less than 2 months of reinstatment, why are you anxious to go off mirtazapine?

 

If you're going to convert to a liquid form, I would allow at least a month to stabilize on that before starting to taper.

 

On 4/22/2023 at 4:46 AM, RKroos said:

I recommend you not to invent strange things.

Take mirtazapine 1 time at night, in liquid and start with 3.90 or 4 mg, from there I recommend you go down no more than 3% each time, for example 2.5 weekly or 3% every 10 days

 

I have no idea why @RKroos gave you these instructions. Increasing the dose might cause repercussions. If you use a liquid, you might as well taper from 3.75mg mirtazapine.

[hopeful1987]

It's not nervous about going off. I'm nervous about switching to liquid. I've just read some folks have difficulty, which I translate to mean an exacerbation of symptoms. My sleep is fragile so the idea that it could get compromised any more than it is makes me nervous. This is why I was wondering about upping to 4mg total and transition in fourths. But I'll stick with the original plan of staying at 3.75mg and transitioning in thirds. 

[Altostrata]

Why not wait another couple of months before experimenting with converting to liquid?

[hopeful1987]

Sorry, I misunderstood your original question. I'm anxious to get off because I just want to get the ball rolling on the taper and not be on the drug any longer than I need to be. Plus, I'm tired of cutting and weighing pills. The measurements aren't as accurate as they could be, which may be why I'm still experiencing fluctuations in sleep. As everyone says, a liquid is more accurate and much easier to measure. 

[Altostrata]

You tried liquid mirtazapine before and that didn't work, possibly because you were not yet stable enough to make changes in mirtazapine.

 

It wouldn't be any easier for you to measure 4mg mirtazapine by dry-cutting.

 

If it's a measurement problem, have you looked into a compounding pharmacy? They can make 3.75mg capsules up for you. If your prescription read "take 3.75mg twice a day", a compounded prescription for a month would contain 60 capsules.

[hopeful1987]

Yes, I tried the liquid for one night, but it was immediately after I was off the pills for 2 days. The liquid was also a different brand. So, all things considered, I was likely too unstable at the time. 

 

I have a compounding pharmacy nearby. They don't make remeron pills, but they can make me a suspension using my current pills, so I don't have to change brands. They do 2-week supplies of remeron suspensions. 

 

Basically, I'm approaching 2 months of stabilizing on the pill and I'd like to transition to the liquid suspension for the reasons mentioned above. It's just faster and more precise. I was just wondering about how to do the transition, but from what it sounds like, I should just stick to transitioning in thirds. Then once fully on 3.75mg of the suspension, I'd stay on that for a month. 

 

Does this sound like an ok plan at this point?

[Altostrata]

It's a way to transition to liquid, yes.

[hopeful1987]

It's been a little while since I posted. I transitioned to the liquid mirtazipine well, and stayed at 3.75 for a week. During that week I was doing alright with sleep. It was probably a 6/10, so it was manageable. After a week on 3.75mg liquid I dropped to 3.65, which was 4 days ago.

 

The 4 nights after the drop have been very different with sleep. 1st night I slept so so. 2nd night was better. 3rd night was so so. Last night was terrible; I didn't even get an hour of sleep. It appears that I'm one of the folks with a very sensitive nervous system. 

 

I'm wondering if I should go back to cutting pills since I seemed to do better on those or is that a bad idea since I've been doing the liquid for a while? Or should I hang out at 3.65mg liquid until I stabilize more?

 

Like so many, I just feel stuck, helpless, and discouraged about the long road ahead. 

 

Any counsel and encouragement would be appreciated. Thanks

[hopeful1987]

I was also thinking that perhaps i should go back to 3.75mg liquid and stay there until stable again? But i don't want to make a move until a mod chimes in.

[Altostrata]

6 hours ago, hopeful1987 said:

I was also thinking that perhaps i should go back to 3.75mg liquid and stay there until stable again? But i don't want to make a move until a mod chimes in.

 

Good idea. It takes about 4 days for a decrease in mirtazapine to take full effect. Your bout of sleeplessness was due to the dosage reduction.

 

You have made a lot of drug changes in the last few months. It might be a good idea for you to have a few months without any drug changes.

[hopeful1987]

Thanks alto.

 

Also, should i stay on liquid? I was doing a bit better with sleep on pills. Does it just take time to adjust to the liquid?

 

[Altostrata]

9 hours ago, hopeful1987 said:

I transitioned to the liquid mirtazipine well, and stayed at 3.75 for a week. During that week I was doing alright with sleep. It was probably a 6/10, so it was manageable. After a week on 3.75mg liquid I dropped to 3.65, which was 4 days ago.

 

You stabilized for only a week. You probably would have done better if you gotten used to the liquid for some time longer.

[hopeful1987]

Went back to 3.75 last night, but barely slept just like the night before. Maybe 30 minutes. Is that normal for someone in my situation? I thought upping it again would have at least given me a few hrs of sleep. 

[Altostrata]

It may take some time for your nervous system to settle down.

[RobertZ]

On 5/23/2023 at 1:29 PM, hopeful1987 said:

I thought upping it again would have at least given me a few hrs of sleep.

More is not always better. This reminds me when I was on mianserin (another tetracyclic, very similar to Remeron), I found low doses worked better for sleep and higher doses were more activating. It takes a very small amount of mirtazapine to achieve a significant H1 blockade. Beyond a certain level of H1 blockade, you will not become any more sleepy/sedated from Remeron.