Kamila: Hypomania like symptoms from withdrawal? Please advise

[Kamila]

Hello,

 

I have been tapering several psychotropics for some time and have a curious problem, realy need advice and help, I feel completely trapped.

I am having nasty withdrawal symptoms all the time, but if I went slowly enough they were manageable.

But…. During PMS week I would not sleep for several days but if this would happen I would have no wd the day after I would feel great actually. But lately it started to be every day of PMS week and finally it is happening every day. I had PMS week with no sleeping did a drop of 3 percent of mirtazapine slept for two days nicely but had nasty wd and then it has started, no sleeping and no wd. It has been almost a week and I am exhausted both mentally and physically. By no sleep I mean that when I start to fall asleep I would get hypnic jerk, then after some time I start to fall asleep for 20 minutes then I would wake up and rinse and repeat all night, so I would get few hours of broken sleep. It reminds me some kind of hypomania. Other days I would be sedated and would sleep 9 hours, but now I am in completely different mode.:/ I am scared.

 

Some history:

No prior psychiatric history, no diagnosis in family.

In 2023 I started to have panic attacks probably withdrawal from herb called ashwaganda. I had a major chain of panic attacks and ended up in mental ER I was given escitalopram and trazodone. Had terrible reaction, couldn’t sleep, was having one panic attack after another, was pushed to endure longer, similar situation like it is now look like mania.. I would walk for hours even when I wasn’t sleeping much. Ended up with a serotonin syndrome after being told to up dose trazodone for sleeping. Trazodone switched to quetiapine, started sleeping for few hours. After eight weeks of this hell I was finally fed up enough to stop. But things didn’t get great, I started to sleep better but my sleep was broken and more symptoms started to creep in, like burning, IBS, dizziness, terrible brain fog and so on, probably PAWS or protracted wd. After two months of this was given pregabaline. Later mirtazapine, I actually stabilized. But dr pushed me to up dose mirta, that ended up badly, similar symptoms as on escitalopram, hypomania like, anxiety and insomnia. To fight this was given quetiapine again. It finally clicked after this and I realized that I don’t have some mysterious illness and I started to taper.

Mirtazapine is giving me hard time, but it was manageable till now. I feel I am in dead end with this new symptom. I currently don’t have any wd just this hypomania like state. From what I have experienced it is caused by excess of serotonin. I have also read that triggers for hypomania are stress, not sleeping and wd from antidepressants - in other words low serotonin can cause that brain tries to up regulate serotonin and overdo it. 

It was probably triggered by that last drop, since it started two days after it. But I don’t know what to do now, hold or drop to lower serotonin, because My brain is no longer in wd but in this excited state. I haven’t find anyone who has this.:/ I am in several mirtazapine tapering groups and no one experiences such thing. Problem is that I am also tapering quetiapine, because I feel they work in tandem with mirtazapine. 

Please any advice is much appreciated!

Thank you for reading.

 

Just to recap:

• Very sensitive to serotonin-had mania like state on SSRI and serotonin syndrome 
• Had protracted wd after 8 weeks and then CT SSRI
• Stabilized on Mirtazapine
• Had to add quetiapine to combat too much serotonin from updosing mirtazapine 
• Tapering for 7 months both mirta and quetiapine while having wd even with hyperbolic taper
• Now wd stopped started hypomania like state with insomnia 

 

My meds:

Pregabaline 50 mg

Mirtazapine 3.0 mg

Quetiapine 2.4 mg

Edited September 9 by Emonda
Name to title

[LotusRising]

On 9/9/2024 at 12:29 AM, Kamila said:

By no sleep I mean that when I start to fall asleep I would get hypnic jerk, then after some time I start to fall asleep for 20 minutes then I would wake up and rinse and repeat all night, so I would get few hours of broken sleep.

Hi @Kamila

 

These symptoms are very common in WD. I experiencing them myself and they came and went for quite a while. Have you seen the information on The Windows and Waves Pattern of Stabilization?

 

On 9/9/2024 at 12:29 AM, Kamila said:

Problem is that I am also tapering quetiapine, because I feel they work in tandem with mirtazapine. 

I'm not sure it's a good idea to taper both at the same time. If you're feeling the mirtazapine is causing the excitation, you may want to taper that one first, while holding on the quetiapine. The below thread might help you understand the reasoning.

 

 

Also, have you been following the 10% taper rate? See Why taper by 10%

 

Please let us know if you have further questions.

 

[Kamila]

Thank you for replying!

Yes I have read the windows and waves. I don't think that my hypomania like state is a window, I found few papers that very low serotonin can also start hypomania. Because normally hypomania/mania are caused by excess of serotonin, which happened for me when I was on escitalopram. My current hypomania ended 3 days ago and I went straight to the wd I was in when it started, like it was paused. No healing happened during this time. I am doing ~3 percents drops three weeks in the month and one week is pause. So it is even less than 10 percent per month. My wd was very predictable until now, I would do a cut after 2 days wd would start and it would clear after 5 days. But now it has changed and I don't know what to do. I am waiting to stabilize and then I plan to microtaper only mirtazapine. I have also booked a session with Mark Horowitz. I have read all possible information that I could find, asked in Facebook mirta taper forums I am in but nobody has this symptom. I am pretty scared that I will not be able to taper anymore.:/ My life has shrunk into complete misery and now it seems that I will not be able to get from this.:/