Treeguy: Polypharmacy Advice Please

[Treeguy]

Hello everyone 

I have been tapering mirtazipine for nearly two years. (Originally prescribed for insomnia). I am also taking 50mg Pristiq.

I started by tapering mirtazipine because of the negative symptoms it was causing me. I have been planning to taper mirtazipine first, then start on Pristiq.

 

However I recently read a multiple drug tapering guide here, which suggested one should ideally start with the more activating drug first. I am wondering if I will have strong insomnia once I’m done with mirtazipine and it will be more challenging to taper Pristiq.

 

Is it possible to pause my mirtazipine taper (holding on my current dose) and then fully taper Pristiq, before resuming mirtazipine? Or do I risk kindling and causing more suffering that way?
I have tapered Pristiq previously (much too quickly) without any problems. However I know it might not be so easy this time so I was planning a slow taper.

 

Edited September 18 by Emonda
Name to title

[LotusRising]

@Treeguy

 

Welcome to SA,

 

21 hours ago, Treeguy said:

I started by tapering mirtazipine because of the negative symptoms it was causing me.

Have the negative symptoms diminished as you've lowered your dose?

 

21 hours ago, Treeguy said:

However I recently read a multiple drug tapering guide here, which suggested one should ideally start with the more activating drug first.

Yes, that is the general recommendation. It can help to preserve sleep. Have you had any issues with insomnia while tapering mirtazapine?

[Treeguy]

Thanks for your reply.

my symptoms have improved in the last 6 months and have been fairly manageable. However I still have some waves that seem random. Currently having a bad wave.

 

I have experienced some issues with insomnia while tapering, but usually I have 1-2 bad nights every few weeks.  The mirtazipine still makes me quite tired even at a low dose.  So I suspect it will be more of an issue when I get to zero.