TaperingTapir: Tips for Mirtazapine taper?

[TaperingTapir]

Hello! As you can see in my signature, I’ve been tapering from Mirtazapine for a little over 2 years now. I’ve been using the information from this site the entire time, which has been super helpful. Unfortunately, I’ve hit a bit of a wall at 0.26mg. I’ve been trying to taper further but every time I do, the withdrawal symptoms become quite unbearable. The symptoms include: headaches, dizziness, lightheadedness, nausea, hypoglycemic like symptoms, tinnitus, unusual heart rate. I’ve also been dealing with long covid for the last 1.5 years or so, which has muddied the waters a bit as to whether my symptoms are from the taper, long covid, or both. I’ve decided to take a break from tapering for the next 6-12 months to give my nervous system plenty of time to settle but I was wondering if anyone had any advice for when I continue my taper. Any help/information would be greatly appreciated! Not sure if I missed any relevant information so I’m happy to answer any questions. Thanks! 

[LotusRising]

Welcome @TaperingTapir

 

14 hours ago, TaperingTapir said:

Unfortunately, I’ve hit a bit of a wall at 0.26mg. I’ve been trying to taper further but every time I do, the withdrawal symptoms become quite unbearable.

At what point did your symptoms get worse?

 

It looks like you started amitriptyline in June 2023? Could you please add this to your signature?

 

 

 

[TaperingTapir]

Hi @LotusRising - Thanks for responding! The symptoms usually get worse around 2 weeks after tapering so this last time it happened mid January so I updosed and I’m still waiting for them to improve. Yes I started Amitriptyline in June of last year. I see it in my signature (it’s in brackets after June ‘23) but please let me know if you can’t and I’ll try to edit it.

[LotusRising]

20 hours ago, TaperingTapir said:

withdrawal symptoms become quite unbearable.

So your symptoms started becoming unbearable in January 2024? I wonder if the increase in symptoms might be partially related to your accidental updose?

 

When did your chronic nausea start?

[TaperingTapir]

@LotusRising The symptoms have gotten unbearable a few times during my current taper. Each time it does, I’d usually updose and hold until they resolve before continuing to taper. The last time this happened was January 2024 but this also happened in September/October 2023 when I tapered below 0.26 and updosed back up to 0.26 in November 2023.

 

My chronic nausea started in 2016. I first started taking ADs around then after doctors couldn’t find an identifiable cause of my nausea. I’ve also been taking Zofran as needed for it. I wasn’t sure if this medication should be added to my signature since it isn’t an AD so I left it out, but I’m happy to add it in if helpful.

[LotusRising]

@TaperingTapir

 

It may be that you need to leave more time between your reductions or make smaller reductions, since it can get more difficult for some people as they get to those very low doses. 

 

Yes, please add the zofran. How often do you need to take it? - the amitriptyline was prescribed for this, but it isn't helping?

 

 

[TaperingTapir]

@LotusRising 

Oh okay, thanks! I’ll keep trying that. I held at 0.26mg from November to January then I tapered to 0.259mg, which is the smallest reduction I can do with the syringe I have, and my symptoms flared up. Perhaps the 2 month hold wasn’t long enough. 

Amitriptyline helps but it’s not perfect. It works better than mirtazapine and I experience less side effects with it, which is why my doctor recommended restarting amitriptyline. Sometimes the nausea gets worse and I may take zofran every day but sometimes the nausea will be mild and I’ll not take it for months. Besides stress and (since starting the taper) if I taper too quickly, I haven’t really found what causes it to get worse. 

[TaperingTapir]

@LotusRising 

Also, by the way, I did go vegan and gluten free just for the month of January. Not sure if that matters but January is the first time I experienced hypoglycemic symptoms, which has since improved somewhat since I’ve mostly gone back to my regular diet. I mention it in case the drastic change in diet could effect my taper.

[TaperingTapir]

@LotusRising Hi - I wanted to get your opinion on potentially doing an updose. To provide more detail, I tapered to 0.26mg on October 26, 2023 and held until I accidentally updosed to 0.34mg on January 2. I realized my mistake on January 4 and started taking 0.259mg as I originally intended. Since about January 13 I started experiencing worse and worse symptoms. So I decided to increase my dosage back to 0.26mg on January 23, which I’ve been holding. My symptoms have not improved much and I’ve been unable to do much working, going out, exercising or much of anything. In an earlier comment, you mentioned my resurgence of symptoms may have been due to my accidental updose. Do you think I should try updosing to something like 0.265mg or 0.27mg to improve my symptoms? I’m trying to find a sustainable steady state for my 6-9 month hold and the current state of my symptoms is not particularly manageable, which is why I’m considering an updose to find relief. Also, idk if this affects anything but I’m starting birth control in the next few weeks so I wanted to consider updosing  ASAP if needed so I’m only making one change at a time. Any feedback would be greatly appreciated!

[LotusRising]

@TaperingTapir

 

Have symptoms improved at all? If you've noticed nothing positive, you could updose. But if some symptoms have started to improve, you might want to hold and wait to stabilize at your current dose. It's difficult to know for sure since I'm not you, but going up to 0.27mg sounds like a small enough updose to me, if that's what you decide to do. 

 

49 minutes ago, TaperingTapir said:

Also, idk if this affects anything but I’m starting birth control in the next few weeks so I wanted to consider updosing  ASAP if needed so I’m only making one change at a time.

Yes, adding in birth control is a big change, so I would definitely updose sooner rather than later. And I would wait for symptoms to settle out before starting the birth control. If you get new symptoms, it will be much easier to know if they are in fact from the BC

[janep]

I have a question about Zofran. I also take it when the nausea becomes unbearable but it sedates me even more and it is very constipating. How do you handle it?  I have messed around with this drug over the past couple of years and caused kindling. Now I am stuck at 2 mg. I had gotten down to around 1.5 mg. but symptoms got really bad and I jumped up to 2 to try and hold. It's been almost a week and nothing has changed. 

[TaperingTapir]

@janep Sorry to hear that! I take Zofran pretty sporadically and I actually don’t experience side effects with it. At worst it doesn’t help the nausea. Maybe another member has advice? It’s also been taking a really long time for me to taper off mirtazapine. I’m currently on a long term hold at 0.27mg and hoping I can continue my taper at the end of this year. I’m sending you good thoughts and hope your symptoms have improved!

[janep]

@TaperingTapir. Thank for your response. Wow 0.27 and you are holding. You really are disciplined. It looks like your first taper was too quick.  I have done so much damage with my taper and I am now going to hold at 3 mg. I am hoping I will stabilize because right now I’m a complete zombie. The lower doses of this drug are supposed to be more sedating so it’s all a puzzle. Do you feel sedated? I hope your final taper go smoothly. You are doing it right.