Katyee8: Taper off 7.5 mg mirtazapine

[Katyee8]

I successfully tapered off .25 mg Clonazepam in April 2022. Had taken for 1.25 years for anxiety and sleep. Started doxepin June 2022 then added mirtazapine in late September 2022 to help me sleep. I don't feel it's still helping my sleep. Wish to go off it safely. Taking magnesium and melatonin which help my sleep. Want to start taper by taking 5.65 mg mirtazapine (3/4 of 7.5 mg).  

Edited June 24, 2023 by manymoretodays
name to topic title

[Shep]

Hi, @Katyee8.

 

Welcome to Surviving Antidepressants.

 

Please note there's a MAJOR drug interaction between doxepin and mirtazapine:

 

Drug Interaction Report - doxepine and mirtazapine

 

Please set up a signature so we have your complete history. Here is how:

 

Please summarize your drug and withdrawal history in your signature

 

A direct link to your signature is here - Account Settings – Create or Edit a signature

 

What time(s) of the day are you taking these drugs? Please list the time of day, the drug name, and the drug dose. 

[Katyee8]

Thank you, Shep. I am not taking doxepin as of Sept. 2022. I tried one night in Jan. 2023 to take both the doxepin and mirtazapine and it was not good so I stopped. I am taking neurontin 300 mg in the evening to relax before bedtime and magnesium, melatonin and the 5.625 mg mirtazapine. The magnesium and melatonin do help me sleep. Thank you for your help and your history. 

 

Blessings,

 

katyee8 

[Shep]

On 6/27/2023 at 7:45 AM, Katyee8 said:

I am taking neurontin 300 mg in the evening

 

Please update your signature to reflect the neurotonin, including when you started taking it, the dose, and any dose changes since you started. 

 

There's a moderate drug interaction between mirtazapine and neurontin: 

 

Drug interaction report - neuronton and mirtazapine

 

 

Quote

June 2022 5.625 mirtazapine

 

 

This is the last line in your signature. Should this be 2023 (not 2022)? When day in June did you make a reduction? If you just reduced from 7.5 mg down to 5.625 mg, please note this is a 25% reduction, which is likely too high a reduction. We recommend reducing no more than 10% off the previous month's dose (not the originally prescribed dose). 

 

Tips for tapering off mirtazapine (Remeron)

 

Why taper by 10% of my dosage?

 

What time(s) of the day are you taking your drugs? Please list the time(s) of day, the name of the drug, and the dose. Also list your supplements, along with the dose. 

[Katyee8]

Thank you, Shep. I don't know how to make the cut any smaller. The tablet is very small. I don't know where the signature is to revise it. Can you help? I don't see it in my profile. 

[Katyee8]

Shep, I updated by signature. Thanks for your messages and your help and support. I really appreciate it. 

[Shep]

Just now, Katyee8 said:

Thank you, Shep. I don't know how to make the cut any smaller. The tablet is very small. I don't know where the signature is to revise it. Can you help? I don't see it in my profile. 

 

Please read the first post of the link I just posted on "tips for tapering off mirtazapine." It explains how to get to the low doses and provides links for using a scale or making your own liquid. Everything is there. If you have any questions after you read that first post, please post here in your thread. 

 

 

4 minutes ago, Katyee8 said:

I don't know where the signature is to revise it. Can you help? I don't see it in my profile. 

 

A direct link to your signature is here - Account Settings – Create or Edit a signature

 

What date did you reduce the mirtazapine? Was it in June 2022 or June 2023? If it was June 2023, you may want to updose, especially if it was in the past couple of weeks. 

[Katyee8]

I don't understand why you suggest updosing on the mirtazapine. 

[Shep]

@Katyee8 You made a 25% reduction in your dose and as noted, we only recommend 10% reductions. Please read the links that have been posted. 

 

When did you start taking Neurontin? Please update your signature with the date you started taking it.

 

How often are you taking it periodically? Is it more like two to three times a month or more like two to three times a week? 

 

 

[Katyee8]

I understand but I feel I'm okay with the 25% reduction. I take the add'l neurontin 2-3 week. 

[Shep]

@Katyee8 Some withdrawal symptoms don't show up for several weeks or even months after reducing. It's your choice, of course, but I would urge caution. 

 

We don't recommend periodic dosing of psychiatric drugs because the fluctuations in the medication blood level tend to make it hard on the nervous system. Also, it may be masking withdrawal symptoms. If you notice you're needing the Neurontin more after this latest mirtazapine decrease, that's a sign that your nervous system isn't handling the reduction well. 

 

Here's more on Neurontin:

 

Tips for tapering off gabapentin (Neurontin)

 

The advice offered here is the best we know to offer within a harm-reduction protocol. Because withdrawal comes with such unpredictable, and sometimes with delayed symptoms, these harm-reductions protocols are meant to keep symptoms as minimal as possible over the entire course of your taper. In other words, what you do now may not show up for several months, so going gradually all the way down is best.

 

Also, as you get to these lower doses, please note this thread on why it's best to be extra cautious at the lower doses: 

Why taper? SERT transporter occupancy studies show importance of gradual change in plasma concentration

 

[Katyee8]

Thank you. I understand and I read the information you cited. I will use care at all times and will see how I feel at 5.625 mg. over the next few days. I'll check back shortly. I will also try not taking the additional neurontin during the day. I hesitate tapering by making it into a liquid or cutting smaller pieces because it's just too difficult to do. Thank you for your help.  

 

 

[Shep]

Please let us know how you're doing over the coming days. 

[Katyee8]

Thank you. I think my sleep is affected now. I woke in middle of night and didn't fall back to sleep. Poor sleep is what made me take mirtazapine in the first place. Did some breathing exercises and that helped some. Took 700 mg magnesium last night and may want to take more like 1,000 mg to help me sleep longer and possibly increase the melatonin from 3 mg er to 5 mg extended release. 

[Shep]

21 hours ago, Katyee8 said:

Took 700 mg magnesium last night and may want to take more like 1,000 mg to help me sleep longer and possibly increase the melatonin from 3 mg er to 5 mg extended release. 

 

I wouldn't increase by large amounts and definitely wouldn't change more than one supplement at a time.

 

The rule of 3KIS: Keep it simple. Keep it slow. Keep it stable.

 

You may already be taking too much melatonin. See:

 

Melatonin for sleep

 

On 4/6/2011 at 9:26 PM, Altostrata said:

Large doses of melatonin do NOT aid sleep -- they might cause your oversensitive brain to wake up, instead. I found when I took more than 2mg of melatonin, I was weepy in the morning. If you get this or a paradoxical reaction (waking) or are dopey in the morning, it's a sign you're taking too much.

 

 

[Katyee8]

Thank you for this advice, Shep. I will modify and go back down to 600 mg magnesium and may reduce the melatonin from 3 to 2 or 1 mg at a later date. I like the 3KIS plan to keep it simple, slow and stable. Very good. 

 

I went back up to 7.5 mg mirtazapine as I hurt my hand and am in a cast and healing from it is my priority and not tapering for now. 

[Shep]

@Katyee8 Sorry to read about your injury. Are you taking any pain or other medication? If so, you may wish to add that drug and your current one to the drug interaction checker to make sure there aren't any conflicts. 

 

Drug Interaction Checker

[Katyee8]

Thanks, Shep. I'm not taking any pain medication. Thank goodness I don't need it.