YellowGrace: New here and I am about to start my journey off of Mirtazapine after 10 years- what are these symptoms?

[YellowGrace]

I have joined this forum after researching everything I can and preparing for my journey off of Mirtazapine 45mg which I have been on for exactly 10 years.  I will start the taper at the beginning of May 2024.  I am working with a nurse practitioner who has mentored under Dr Mark Horowitz who will assist me in tapering very slowly off. 

 

I have decided to try to come off because I also developed long covid in January 2022. I have tried many supplements and therapies to try to heal from that and the most effective thing for it has been my last resort- homeopathy.  But I’ve plateaued with it now and my homeopath thinks its possible we’ve hit a wall with the Mirtazapine blocking the rest of my healing. I don’t feel like I need the Mirtazapine anymore but I’ve just been too scared to come off. I had lots of crazy side effects going on to it.  

 

A bit of my past history- around 1994 I became depressed and went on Prozac.  I felt great on it and had a Dr support me going of almost cold turkey maybe 3 years later.  2 weeks after that last dose I crashed into a depression again. (Now I realize it was probably withdrawal).  When I tried to go back on Prozac it no longer worked.  So my Dr tried Paxil.  I tried that for months but it gave me a stomach ache so my Dr switched me to Serzone.  I stayed on that for a few years but I still felt down and anxious and decided to go off and try therapy and exercise instead. I don’t recall any ill side effects and managed for the next 13 or so years drug free. I had (have) OCD and generalized anxiety disorder which was especially bad during my pregnancies but I survived.   

 

 After some life shattering stressors, in 2013 my Dr and I decided I would go on Cipralex.  I think I was only on that for several months (less than a year) but it suddenly made my heart rate go really high. So I went off of it at a pace the Dr said to (so probably too fast) but I think I was fine until about 6 months later when out of the blue I had my first panic attack.  It started the worst mental period of my life.  I felt I had truly lost my mind as even in between panic attacks I felt this impending doom feeling.  Ominous.  And the world would turn all cartoon and didn’t feel real.  I couldn’t sleep.  It was all horrific.  My panic attacks seemed to stop but I was so rattled by this that my Dr put me on Mirtazapine right away.  And I soon went up to the highest dose of 45mg.  Getting on Mirtazapine I started sleeping better but I had brain zaps and dizziness, my body couldn’t be still, etc.  It felt yucky to get used to but I was so traumatized from the mental breakdown I had.  (It was 6 months after discontinuing Cipralex- could it have been some form of late withdrawal or just a random development of panic disorder after feeling okay?? Feel free to give your opinion). 

 

This brings me to today. I have been on Mirtazapine 45mg now for 10 years.   I feel like I didn’t even know myself back then but I have grown so much and am in therapy for things in the past and now feel like I understand all my parts and why I feel different anxieties etc.  I have had OCD for over 20 years but it feels manageable to where I am fine with it.  It doesn’t usually affect my life too negatively.  I am usually happy enough and have peace most of the time.  But I do get random shots of adrenaline sometimes when I lay down at night to sleep or sometimes if I nap. It's like as soon as my body tries to relax some adrenaline alarm goes off. I also can get waves of what feels like panic attacks but there is no fear with it.  I've learned to just ride the feeling and it really only feels like anxiety in my body.  My chest gets heavy, my heart may race etc but I don’t feel fear.  This has only been happening for the last several years.  

 

Now that I’ve shared my story is there any insight anyone can share on how they see my picture?  I wonder if I'm crazy to try going off of something when it feels like I’m stable and mostly content enough all the time.  Or is this the best time to try and go off?  Im in my late 40s and I have been thankful I’m at a point in life where I feel okay and now feel quite scared after reading all the horror stories.  I am also trying to discern what the adrenaline rushes could be and if that is actually anxiety which could get worse if I’m off meds or if it's somehow my Mirtazapine changing or causing symptoms over the years.  I don’t want to be on drugs my whole life.  I feel ready but also the horror stories are very scary.  Anyone have any comments on why I might be having these symptoms?   Do people try to get off antidepressants when they still have some level of anxiety?   Thank you for listening.  

Edited April 26 by Emonda
Name to tile

[Emonda]

Welcome @YellowGrace,

 

5 hours ago, YellowGrace said:

I wonder if I'm crazy to try going off of something when it feels like I’m stable and mostly content enough all the time.

 

Not crazy - the choice is yours. For me, I had developed unwanted side effects, so I made the decision to taper, and haven't looked back.

 

5 hours ago, YellowGrace said:

is this the best time to try and go off?

 

The best time to attempt to taper is when you are feeling stable...and you mentioned that you feel stable 👍

 

5 hours ago, YellowGrace said:

now feel quite scared after reading all the horror stories.

 

Have a read of the success stories, rather than the horror stories.

 

The way people have success tapering, is to do it very slowly: Why taper by 10% of my dosage? Each monthly reduction should get smaller and smaller: month 1 = 45mg, month 2 = 40.5mg, month 3 = 36.45mg etc.

 

If you taper too fast, WD symptoms are the likely outcome: Daily Checklist of Antidepressant Withdrawal Symptoms (PDF). Reading your story, it sounds like you've previously experienced WD symptoms.

 

It would be worth reading this link:

 

 

A few more helpful links to help you on your journey:

 

Windows and waves pattern of stabilization

 

Emotional Spirals

 

Non-drug coping strategies

 

Melatonin for sleep

 

We don't suggest many supplements, but two that many of us find helpful are magnesium and omega-3 fish oil. Here are the links for info about those. Add one at a time and start with a low dose to see how it affects you. 

Magnesium

 

Omega-3 fatty acids (fish oil)

 

Avoid alcohol. 

 

Don't change the manufacturer of your AD.

 

This is your own Introduction topic.  Each member has only ONE Introduction topic.  Your own Introduction topic is the best place to ask questions and the place to journal your progress.  This keeps your history in one place and means you do not have to repeat your story. 

 

Once again, welcome to S.A.

 

Emonda

 

 

 

 

 

[YellowGrace]

Thank you.  You say this thread is the best place for me to ask questions.  Will people see the message if I ask a new question here?  

I guess I am wondering if the adrenaline type feelings that sometimes happen when I lay down to relax could be the drug or rather some underlaying mental issue.  It feels very physical to me so I wondered if it was possible to be a side effect of the Mirtazapine that developed later.

[Emonda]

39 minutes ago, YellowGrace said:

Will people see the message if I ask a new question here?

 

Yep, everyone can see and read your thread here.

 

48 minutes ago, YellowGrace said:

adrenaline type feelings that sometimes happen when I lay down to relax

 

48 minutes ago, YellowGrace said:

I wondered if it was possible to be a side effect of the Mirtazapine that developed later.

 

There are many side effects from ADs, some really strange and random things, too. I experienced things 20 years ago that I have only now realised were side effects, reading the experience of others here.

 

I'd encourage you to use the search function in the Success Stories. Read up on those who have successfully tapered from your AD. You'll learn a lot and be encouraged. 

 

Also, use the search function in the Introduction & Updates section. Interact with others tapering from the same AD. Again you'll learn a lot / benefit greatly.

 

Importantly, if you develop unpleasant side effects from tapering, halt the taper, give yourself time to settle, and once stable, taper more slowly and by smaller amounts moving forward.

 

It's not a race. Slow is the way to go.

 

Keep us posted.

[YellowGrace]

Well I have officially started!  Tonight I took 37.5mg of Mirtazapine.  For 10 years I have taken 45mg.  Apparently at 37.5mg the "receptor occupancy" is only decreased by .8%.  I am still learning what all of it means but I guess this isn't that huge of a drop.  I have to say it was scary cutting pills.  I was prescribed a 30mg and then a 15mg to cut in half with a pill cutter.  I bought FOUR different cutters in an attempt to try and find one that will do a perfectly even split to this stupid oval shaped pill.  It cannot be perfectly down to the hair split perfect so I hope that is okay.  In the future I will try and get a compounding pharmacy to make a capsule of the correct dose. 

I know I shouldn't feel any side effects tonight but I know my mind will tell me to look for them. Which will cause anxiety in and of itself.  I am sure I will get used to this.  But tonight feels surreal.

[Emonda]

10 minutes ago, YellowGrace said:

Well I have officially started! 

 

Glad you were brave enough to make a start.

 

11 minutes ago, YellowGrace said:

Tonight I took 37.5mg of Mirtazapine.

 

You seem to have dropped by ~17% versus the recommended 10%. Dropping faster than recommended can catch up with you, and once you rock the boat, it can be hard to stabilise.

 

I'd suggest you stick to the 10%.

 

12 minutes ago, YellowGrace said:

I bought FOUR different cutters in an attempt to try and find one that will do a perfectly even split to this stupid oval shaped pill.  It cannot be perfectly down to the hair split perfect so I hope that is okay.

 

Yes, it can be tricky to cut them perfectly. I tried this at the start of my journey. I've learnt that consistency and accuracy are vital. 

 

Maybe have another read of this to see if you can be more accurate. There are some suggestions in the link:

 

 

16 minutes ago, YellowGrace said:

In the future I will try and get a compounding pharmacy to make a capsule of the correct dose.

 

Or, yes, you can do this if you aren't comfortable with the tips in the previous article.

 

Make sure you listen to your body. If WD symptoms tick up. Hold your taper. Don't rush it.

 

Best wishes.

 

[YellowGrace]

Okay. Thank you. Although now I’m scared. I emailed my nurse practitioner. She follows all this stuff and is a founder of a program to taper properly so I’m confused but I do see the math not adding up. Will it harm anything to leave it for tonight and go back up to 45mg tomorrow or until I hear back?  I have the 30mg tabs so what percentage would I ask her to prescribe from a compounding pharmacy to take with the 30mg pill to for a balance to equal %10?? 
Im so anxious now. But I appreciate you catching that. 

[Emonda]

21 minutes ago, YellowGrace said:

Although now I’m scared.

 

No stress, it was one tablet. You'll be fine 🤗

 

The monthly reductions would be:

• Start: 45mg
• Month 1: 40.5mg
• Month 2: 36.5mg
• Month 3: 32.8mg

Just keep multiplying the previous month's dose by 90%.

 

Maybe you should let your pharmacist know what you want (40.5mg), and they may be able to help. Although many doctors/pharmacists would dismiss tapering by 10% as not necessary. However, many members on this site have succeeded this way, whilst many others have experienced dreadful WD symptoms following a rapid taper plan recommended by their doctor.

 

You'll be fine. Be accurate, go slow, and listen to your body.

 

Best wishes.

 

[YellowGrace]

9 minutes ago, Emonda said:

 

No stress, it was one tablet. You'll be fine 🤗

 

The monthly reductions would be:

• Start: 45mg
• Month 1: 40.5mg
• Month 2: 36.5mg
• Month 3: 32.8mg

Just keep multiplying the previous month's dose by 90%.

 

Maybe you should let your pharmacist know what you want (40.5mg), and they may be able to help. Although many doctors/pharmacists would dismiss tapering by 10% as not necessary. However, many members on this site have succeeded this way, whilst many others have experienced dreadful WD symptoms following a rapid taper plan recommended by their doctor.

 

You'll be fine. Be accurate, go slow, and listen to your body.

 

Best wishes.

 

Okay. Thank you so much. I will ask to do this instead. And try to breathe and fall asleep now. 

[YellowGrace]

So an update after my first night at 37.5mg.  I had a horrific sleep.  I was hit with adrenaline like anxiety (which can sometimes be normal for me in small amounts, rarely) but this was different and worse.  I was concerned about the 17% taper instead of 10% so at first I thought it was just that.  It was hard to fall asleep but I did. However I woke up soon after at 3am from a terrible crazy nightmare.  (I never ever get nightmares). And continued to have bad dreams that were like reality morphing into dreams (like seeing the blinds of my window and then it turns into something weird and panicky).  I was basically awake most of the night.  I hardly slept.  Normally I sleep great.  I feel crazy. And a bit dizzy. I didn't think the drug could affect me so badly the first night of taking a smaller dose so I went back onto here and realized what the problem may be.  The 30mg pill I took (along with the 7.5mg pill) looks to be made by a different manufacturer than what I am used to!!  Could this affect me that badly?  It actually did feel like I was starting a new antidepressant with the weird vivid bad dreams and anxiety and adrenaline.  So I guess that would be a better thing than being due to one day of a 17% taper.  I am so rattled by this. Any thoughts?   I will go back to 45mg tonight. 😫

[Catwoman73]

On 4/26/2024 at 12:16 AM, YellowGrace said:

IThis brings me to today. I have been on Mirtazapine 45mg now for 10 years.   I feel like I didn’t even know myself back then but I have grown so much and am in therapy for things in the past and now feel like I understand all my parts and why I feel different anxieties etc.  I have had OCD for over 20 years but it feels manageable to where I am fine with it.  It doesn’t usually affect my life too negatively.  I am usually happy enough and have peace most of the time.  But I do get random shots of adrenaline sometimes when I lay down at night to sleep or sometimes if I nap. It's like as soon as my body tries to relax some adrenaline alarm goes off. I also can get waves of what feels like panic attacks but there is no fear with it.  I've learned to just ride the feeling and it really only feels like anxiety in my body.  My chest gets heavy, my heart may race etc but I don’t feel fear.  This has only been happening for the last several years.  

 

Now that I’ve shared my story is there any insight anyone can share on how they see my picture?  I wonder if I'm crazy to try going off of something when it feels like I’m stable and mostly content enough all the time.  Or is this the best time to try and go off?  Im in my late 40s and I have been thankful I’m at a point in life where I feel okay and now feel quite scared after reading all the horror stories.  I am also trying to discern what the adrenaline rushes could be and if that is actually anxiety which could get worse if I’m off meds or if it's somehow my Mirtazapine changing or causing symptoms over the years.  I don’t want to be on drugs my whole life.  I feel ready but also the horror stories are very scary.  Anyone have any comments on why I might be having these symptoms?   Do people try to get off antidepressants when they still have some level of anxiety?   Thank you for listening.  

Hi @YellowGrace!  I definitely think it's possible to get off antidepressants with some ongoing level of anxiety.  In fact, you've been on Mirtazepine for so long, I truly question whether or not it's even doing anything for you at this point!  I've learned that we do 'poop out' on antidepressants.  They stop working!  So there's a decent change that while you are still physiologically dependant on mirtazepine, it's not really helping with your anxiety anyway... and it follows that you are managing your anxiety or panic on your own even right now!

 

You are already in therapy, and say that you've been dealing with things past.  That's great news- maybe now, talk to your therapist about developing some tools to cope with the waves of anxiety.  Focus on that for now.  

 

Hang in there... you can do this!!!

[Catwoman73]

6 minutes ago, YellowGrace said:

So an update after my first night at 37.5mg.  I had a horrific sleep.  I was hit with adrenaline like anxiety (which can sometimes be normal for me in small amounts, rarely) but this was different and worse.  I was concerned about the 17% taper instead of 10% so at first I thought it was just that.  It was hard to fall asleep but I did. However I woke up soon after at 3am from a terrible crazy nightmare.  (I never ever get nightmares). And continued to have bad dreams that were like reality morphing into dreams (like seeing the blinds of my window and then it turns into something weird and panicky).  I was basically awake most of the night.  I hardly slept.  Normally I sleep great.  I feel crazy. And a bit dizzy. I didn't think the drug could affect me so badly the first night of taking a smaller dose so I went back onto here and realized what the problem may be.  The 30mg pill I took (along with the 7.5mg pill) looks to be made by a different manufacturer than what I am used to!!  Could this affect me that badly?  It actually did feel like I was starting a new antidepressant with the weird vivid bad dreams and anxiety and adrenaline.  So I guess that would be a better thing than being due to one day of a 17% taper.  I am so rattled by this. Any thoughts?   I will go back to 45mg tonight. 😫

Hi @YellowGrace- I think we posted at exactly the same time lol!

 

I'll leave it to the mods to tell you what the best course of action would be, because I don't know... but I will say that I've seen lots and lots of people on various forums say that they react very differently to the same drug made by different manufacturers.  So that could very well be an explanation for your terrible night. 

 

I do find it helpful to continue to remind myself that while crappy sleep is extremely unpleasant, it won't harm me.  That's been my mantra lol- I haven't slept well in years!!!

[Emonda]

8 hours ago, YellowGrace said:

looks to be made by a different manufacturer than what I am used to!!  Could this affect me that badly? 

 

This comment was towards the bottom of my first post:

 

On 4/26/2024 at 7:49 PM, Emonda said:

Don't change the manufacturer of your AD.

 

It has affected others. Best to stick with the same brand.

 

People can have a similar response moving from a pill to a liquid of the same drug as well.

 

I'm sorry you had a bad night. My wife always tells me, "You get to try again tonight." I'm not trying to make light of your experience. Sleep problems impact most of us tapering, me included.

 

Keep your reductions small (max 10% per month), and stick to the same manufacturer. BTW: there is nothing wrong with less than 10%. I found that 8% seems to be as much of a reduction in a month that I can manage. I achieve that by dropping 2% per week.

 

Stabilise, and try again 🙂

[YellowGrace]

Yesterday, the day after my horrifying night, was better.  That morning I felt rattled and weird.  Bordering on anxious.  But I think I had a weird relief that I merely survived through that wretched night.  The slightly foggy feeling and uneasiness gradually went away to where I felt pretty good in the afternoon and normal by evening.  Before bed I went back up to my 45mg dose.  Slept great!  What a bizarre experience.  Today I feel 100%.  Would it more likely be the manufacturer change or the taper itself given that i got better over time not worse??   I will stay on 45mg until I meet with my NP on Monday. I will ask for a slower taper and a pharmacy to fill it that will stick with my manufacturer.  Man, how fricken fragile are we doing this?  A scary reminder of the power of these drugs.  I have felt so stable for so long that this was very unnerving.  I REALLY hope that by adjusting it I will prevent the altered reality nightmares going forward.  But I know I got them going onto this so who knows.  I wish I knew what actually happened.  But I guess thats sort of what we sign up for.  The potential for a long haul of confusion and chaos. 

[Catwoman73]

16 hours ago, YellowGrace said:

Yesterday, the day after my horrifying night, was better.  That morning I felt rattled and weird.  Bordering on anxious.  But I think I had a weird relief that I merely survived through that wretched night.  The slightly foggy feeling and uneasiness gradually went away to where I felt pretty good in the afternoon and normal by evening.  Before bed I went back up to my 45mg dose.  Slept great!  What a bizarre experience.  Today I feel 100%.  Would it more likely be the manufacturer change or the taper itself given that i got better over time not worse??   I will stay on 45mg until I meet with my NP on Monday. I will ask for a slower taper and a pharmacy to fill it that will stick with my manufacturer.  Man, how fricken fragile are we doing this?  A scary reminder of the power of these drugs.  I have felt so stable for so long that this was very unnerving.  I REALLY hope that by adjusting it I will prevent the altered reality nightmares going forward.  But I know I got them going onto this so who knows.  I wish I knew what actually happened.  But I guess thats sort of what we sign up for.  The potential for a long haul of confusion and chaos. 

We are all fragile- our brains are very sensitive organs!!!  And I will say that none of us signed up for THIS.  We live in a tough society, that demonizes negative emotions, and glorifies quick and easy fixes.  What we signed up for is the promise of a safe drug to get us through the tough times.  That was the sell.  The drugs ARE super helpful in a crisis- I can say that at one time, I welcomed being a completely numb zombie.  If I had known the long term effects though, I might have chosen differently.  Or at least chosen to get off of them right away after the immediate crisis passed.  I don't think there's a person here who wouldn't agree with me on that front!!!

 

I, too, feel brutal in the morning, and almost normal by the evening.  It seems to be related to the early morning cortisol spike that prepares us to wake up in the morning.  I find it helpful to keep that in mind- knowing it's temporary makes it a bit more bearable.  

 

I'm glad you're feeling a bit more stable... one day at a time!  Sending hugs...