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Gabita: Seroquel and Mirtazapine tapering


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Posted (edited)

I was on Effexor 150mg since October 2022. I was then put on Mirtazapine 45mg in October 2023 and I was very naive to believe what the psych told me, that mirtazapine is easy to taper. It was the first time when I saw a psych and in a country like Canada where the access to psychs is limited to non-existent, I considered myself lucky.  I actually wanted to be switched from Effexor to something else as I felt Effexor was not helping me a great deal. The psych took my intense emotional deregulation for depression and I ended up with what I've only later learnt is called the California Rocket Fuel. 

 

Last February, I decided to start tapering Mirtazapine because of weight gain and thinking it's just too much AD for me. I didn't know much about tapering so I simply haved a 15mg pill and dropped 7.5mg. Five days later I was having the most horrendous WD: skin burning, skull itching, blurred vision, extreme depression and weakness, I just thought that this is how it feels to have heroin withdrawal. I got scared and went back to 45mg after two days. I waited one week or so to stabilize and then I've started a proper tapering, based on home made liquid, with information that I've found on a FB support group. However, the WD continued to be awful, physically, but mostly psychologically: depression, anhedonia, despair and lack of energy. I continued to taper down to 33mg. My psych somehow understood that I am extremely sensitive to tapering and helped me have compounded pills. In March ,he finally diagnosed me with BPD (I have actually told him that I thought to have BPD features), and mirt WD only worsen it. I was actually not aware of having it until a friend of mine told me about, and I have managed to keep most of the symptoms under control somehow and have had a successful career and stability for many years. The last two years came with many personal and professional challenges that ended up triggering the BPD as I have never lived it before. One of the symptom has been extreme agitation and restlessness, whether I don't know how much of it has been due to BPD or to mirt WD. 

 

By the end of May I got into a severe crisis and was admitted to the psych ward, this time with a different psych who didn't understand my sensitivity to drugs. As I told her I don't want her to touch to Mirt, she came with another "plan" and tried to cross-taper the Effexor to Sertraline so while introducing Sertraline 25mg they reduced Effexor to 112,5 mg. I still ended up with anxiety and I thought that reducing by 37,5 mg every week would be too brutal and against any reasonable tapering advice that I've taken from various sources. So I refused to continue with this scheme. 

 

But as I was very agitated in the morning, she put me on Seroquel 50mg XR to calm the agitation, and then, a few days later, because I was still agitated, she upped to 100mg. 

 

I have  felt the beginning of Seroquel 100mg a lot of anhedonia and a zombie like kind of feeling, so I tried going back to 50mg which ended up with me having a feeling of despair and suicidal ideation coming out of nowhere. One day I felt like I wanted to throw myself in front of a car. I got scared and upped to 75mg. I continued to have the next days rushes of despair and very dark moods and thoughts and a ripping pain in my chest, anxiety and agitation. Now I would say that I am definitely less agitated, but I'm feeling miserable, I have had days when I feel so depressed that I cannot bear anymore. 

 

It's been one month since I'm on this poison and now I don't know what to do. Should I start tapering Seroquel right away or instead continue tapering down Mirt? I am worried that because of how both of them impact the histamine receptors, I will never be able to properly sleep again. 

 

Thanks so much

Gabito

Edited by Emonda
Name to title

Effexor 37,5mg: 2017 to aug. 2022
Effexor 75 mg: aug 2022 to oct 2022
Effexor 150 mg: oct 2022 to now (tapered 37,5 mg last week)
Mirtazapine 45: oct 2023 to feb 2024 when I've started tapering
May 2024: admitted to psych ward with suicidal ideation due to withdrawal from Mirt
put on Sertraline 25 mg for 5 days before dropping Effexor by 37,5
Put on Seroquel 50 long release in June 2024
Prescribed Ativan for anxiety

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  • Emonda changed the title to Gabita: Seroquel and Mirtazapine tapering

I was on Effexor 150mg since October 2022. I was put on Mirtazapine 45mg in October 2023 and have tried tapering down since February 2024. I didn't know much about tapering so I simply cut a 15mg pill onto two and dropped 7.5mg. Five days later I was having the most horrendous WD: skin burning, skull itching, blurred vision, extreme depression and weakness. I got scared and went back to 45mg after two days. I waited one week or so to stabilize and then I've started a proper tapering, based on home made liquid. However, the WD continued to be awful, physically, but mostly psychologically: depression, anhedonia, despair and lack of energy. I continued to taper down to 33mg when I went into a big crisis and was admitted to the psych ward. They tried to cross-taper the Effexor to Sertraline and while introducing Sertraline 25mg they reduced Effexor to 112,5 mg. I still had anxiety for a few days. 

I have to say that I have been diagnosed with BPD now, at 48. I have always managed to keep the symptoms under control somehow and have had a successful career and stability for many years. The last two years came with many personal and professional challenges that ended up by triggering the BPD as I have never lived it before. One of the symptoms have been extreme agitation and restlessness, whether I don't know how much of it has been due to BPD or to mirt WD. 

So while I was in hospital, they put me on Seroquel 50mg XR to calm the agitation, and then they upped to 100mg. 

I have felt since the beginning a lot of anhedonia and a zombie like kind of feeling, so I tried going back to 50mg which ended up with me having a feeling of despair and sucidal ideation coming out of no where. I got scared and went back to 100mg and then 75mg. It's been a month since I have started Seroquel, and it's making me feel miserable, I have had days when I feel so depressed that I cannot bear anymore. The only pro is that indeed, I feel less agitated, but now I don't know what is worst.

Should I start tapering Seroquel right away as it's definitely making me feel so badly? Or should I instead continue tapering down Mirt? I am worried that because of how both of them impact the histamine receptors, I will never be able to sleep properly again. 

Effexor 37,5mg: 2017 to aug. 2022
Effexor 75 mg: aug 2022 to oct 2022
Effexor 150 mg: oct 2022 to now (tapered 37,5 mg last week)
Mirtazapine 45: oct 2023 to feb 2024 when I've started tapering
May 2024: admitted to psych ward with suicidal ideation due to withdrawal from Mirt
put on Sertraline 25 mg for 5 days before dropping Effexor by 37,5
Put on Seroquel 50 long release in June 2024
Prescribed Ativan for anxiety

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  • Moderator

Hi Gabita,

 

Welcome to SA. Thank you for summarizing your drug history in your signature but can you clarify your current dosage of Ativan and how often you are taking it?

 

On 7/7/2024 at 2:53 AM, Gabita said:

Should I start tapering Seroquel right away as it's definitely making me feel so badly? Or should I instead continue tapering down Mirt?

 

First, how are you feeling at the moment? We recommend being stable when starting a taper so would be good to understand your current symptoms.

 

We have a resource for deciding on which drug to taper first at Taking multiple psych drugs? Which drug to taper first?

 

Thanks,

 

Firefly

 

Pre- October 2022: Wellbutrin, Escitalopram, CitalopramSertraline, Adderall IR, Vyvanse, Propranolol, Buspar, Ativan, and Latuda

Oct 13, 2022 - Oct 24, 2022 and Oct 31, 2022 - Present: Zyprexa (2.5 mg). Jan 14, 2023 -> Began transition to liquid suspension. Jan 29, 2023 = 2.375mg -> Feb 12, 2023 = 2.25mg -> Feb 27, 2023 = 2.14mg -> Mar 12, 2023 = 2.025mg -> Mar 27, 2023 = 1.93mg -> Apr 10, 2023 = 1.82mg -> Apr 23, 2023 = 1.74mg -> May 7, 2023 = 1.64mg -> May 21, 2023 = 1.56mg -> June 4, 2023 = 1.48mg -> June 19, 2023 = 1.4mg -> July 2, 2023 = 1.33mg -> July 16, 2023 = 1.26mg -> July 31, 2023 = 1.2mg -> Aug 13, 2023 = 1.14mg -> Aug 27, 2023 = 1.08mg -> Sep 13, 2023 = 1.02mg -> Jan 22, 2024 = 0.97mg -> Feb 4, 2024 = 0.92mg -> Feb 19, 2024 = 0.87mg -> Mar 3, 2024 = 0.83mg -> Mar 17, 2024 = 0.78mg -> Mar 31, 2024 = 0.74mg -> Apr 14, 2024 = 0.7mg -> Apr 28, 2024 = 0.66mg -> May 12, 2024 = 0.63mg -> May 27, 2024 = 0.6mg -> June 9, 2024 = 0.57mg -> June 24, 2024 = 0.54mg -> July 6, 2024 = 0.51mg

Oct 14, 2022 - Present: Prozac (40mg) upped from 20mg on Nov 1, 2022.

Oct 31, 2022 - Present: Gabapentin (300mg 3x day) -> May 3, 2023 = 300mg 2x day -> Oct 1, 2023 = 570mg -> Oct 15, 2023 = 540mg -> Oct 29, 2023 = 510mg -> Nov 13, 2023 = 484mg -> Nov 27, 2023 = 460mg -> Dec 9, 2023 = 436mg -> Dec 24, 2023 = 414mg -> Jan 7, 2024 = 400mg

 

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Hi FireflyFyte

 

I take Ativan very rarely now, I am planning actually to have a few Neurofeedback sessions to calm my amygdala. I did some last year and it worked well for a while.

 

I have been stable for a few days only. I've struggled since February 2024 between short windows and long waves, that let me to being admitted to the psychiatric ward. I must say that now that I am stable, I have the feeling that Seroquel is calming my ricing thoughts. As many people here, I suffer for CPTSD and have recently diagnosed with Borderline Personality Traits. My main issues have been emotional disregulation and agitation, fear of abandonment and rejection, even before tapering mirtazapine. My coping mechanism has been working, and the last two years I have been extremely under-stimulated at work, which left place to rumination, anxiety, extreme emotional disregulation and agitation. I was misdiagnosed with major depression when I was prescribed mirtazapine, and only later the psych concluded that I have BPT because I actually told him that I thought I've had it. 

 

I have consulted the resource that you referred me to, and based on that, what I should taper first is actually Effexor. Am I right? 

 

Thanks so much

Gabita

Effexor 37,5mg: 2017 to aug. 2022
Effexor 75 mg: aug 2022 to oct 2022
Effexor 150 mg: oct 2022 to now (tapered 37,5 mg last week)
Mirtazapine 45: oct 2023 to feb 2024 when I've started tapering
May 2024: admitted to psych ward with suicidal ideation due to withdrawal from Mirt
put on Sertraline 25 mg for 5 days before dropping Effexor by 37,5
Put on Seroquel 50 long release in June 2024
Prescribed Ativan for anxiety

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  • Moderator
21 hours ago, Gabita said:

I have been stable for a few days only. I've struggled since February 2024 between short windows and long waves, that let me to being admitted to the psychiatric ward. I must say that now that I am stable, I have the feeling that Seroquel is calming my ricing thoughts

 

It is best to be stable for a longer period of time, I would say at least 4 weeks, before starting a taper. It would probably be best to hold for 2-3 months to give your system a few months without changes.

 

21 hours ago, Gabita said:

I have consulted the resource that you referred me to, and based on that, what I should taper first is actually Effexor. Am I right? 

 

Generally speaking, the recommendation is to taper the most activating drug first.

 

Pre- October 2022: Wellbutrin, Escitalopram, CitalopramSertraline, Adderall IR, Vyvanse, Propranolol, Buspar, Ativan, and Latuda

Oct 13, 2022 - Oct 24, 2022 and Oct 31, 2022 - Present: Zyprexa (2.5 mg). Jan 14, 2023 -> Began transition to liquid suspension. Jan 29, 2023 = 2.375mg -> Feb 12, 2023 = 2.25mg -> Feb 27, 2023 = 2.14mg -> Mar 12, 2023 = 2.025mg -> Mar 27, 2023 = 1.93mg -> Apr 10, 2023 = 1.82mg -> Apr 23, 2023 = 1.74mg -> May 7, 2023 = 1.64mg -> May 21, 2023 = 1.56mg -> June 4, 2023 = 1.48mg -> June 19, 2023 = 1.4mg -> July 2, 2023 = 1.33mg -> July 16, 2023 = 1.26mg -> July 31, 2023 = 1.2mg -> Aug 13, 2023 = 1.14mg -> Aug 27, 2023 = 1.08mg -> Sep 13, 2023 = 1.02mg -> Jan 22, 2024 = 0.97mg -> Feb 4, 2024 = 0.92mg -> Feb 19, 2024 = 0.87mg -> Mar 3, 2024 = 0.83mg -> Mar 17, 2024 = 0.78mg -> Mar 31, 2024 = 0.74mg -> Apr 14, 2024 = 0.7mg -> Apr 28, 2024 = 0.66mg -> May 12, 2024 = 0.63mg -> May 27, 2024 = 0.6mg -> June 9, 2024 = 0.57mg -> June 24, 2024 = 0.54mg -> July 6, 2024 = 0.51mg

Oct 14, 2022 - Present: Prozac (40mg) upped from 20mg on Nov 1, 2022.

Oct 31, 2022 - Present: Gabapentin (300mg 3x day) -> May 3, 2023 = 300mg 2x day -> Oct 1, 2023 = 570mg -> Oct 15, 2023 = 540mg -> Oct 29, 2023 = 510mg -> Nov 13, 2023 = 484mg -> Nov 27, 2023 = 460mg -> Dec 9, 2023 = 436mg -> Dec 24, 2023 = 414mg -> Jan 7, 2024 = 400mg

 

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I will listen to your advice, and hold it for a couple of months. I'm also going through significant life changes so I don't know if that's the most appropriate moment to make changes.

However, for the tapering, I was wondering if it would not be more appropriate to start (when I'm ready) with mirtazapine, given that both mirtazapine and Seroquel have an impact on my QTC? I was already having a prolonged QTC when they added the Seroquel.

Thanks

Gabita

Effexor 37,5mg: 2017 to aug. 2022
Effexor 75 mg: aug 2022 to oct 2022
Effexor 150 mg: oct 2022 to now (tapered 37,5 mg last week)
Mirtazapine 45: oct 2023 to feb 2024 when I've started tapering
May 2024: admitted to psych ward with suicidal ideation due to withdrawal from Mirt
put on Sertraline 25 mg for 5 days before dropping Effexor by 37,5
Put on Seroquel 50 long release in June 2024
Prescribed Ativan for anxiety

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