kmanmb: Mirtazapine side effects/withdrawal and suggestions

[kmanmb]

Hi everyone. I am a new user and found y’all in my search to figure out what has been going on with me the last few months. I am currently on a handful of psych meds including Lithium, Luvox, Buspar, and Mirtazapine. I successfully tapered off of Klonopin in June. 
 

here’s my problem. Starting in May I felt as though I was becoming very sensitive to the mirtazapine. I take 7.5 at 10pm every night and I started to notice restless legs within 45 minutes but I generally fall asleep and stay asleep til 4am. At this time I start to toss and turn badly. It feels like a drunk and groggy restless legs until I get up and I remain groggy until noon or so. Because of this I wanted to stop the mirt.

 

I reduced my dose by half in July and had a very anxious/panicked week as well as worsened morning restlessness and discomfort. 2 weeks later I reduced by half again and was rocked by the same symptoms. I realized it was most likely the mirt and went back up to the 3.75 dose. This time measuring my pills by weight. 
 

The problem is I have cycled in and out of these symptoms ever since. My doc thinks it’s anxiety but it so different these last two months. 
 

I am considering stopping the mirt cold turkey from 3.75 because I am feeling so horrible in the mornings but I don’t know what to do. I haven’t seemed to stabilize at 3.75. I have the option of using klonopin as needed to help me through. 
 

it just seems like it’s discomfort either way and I could use some tips. 
 

sorry this is so long and thanks in advance.

[Catwoman73]

Hello @kmanmb, and welcome to SA!  We are a community of volunteers providing peer support in the tapering of psychiatric medications and their associated withdrawal syndromes.  

 

Thank you for completing your drug signature.  And I'm so sorry for your struggles.  You're in good company here! 

 

I would not recommend cold turkeying off of any of these medications- rapid tapering and cold turkey stops put you at serious risk of severer acute withdrawal, and of protracted withdrawal, which could prolong your suffering by years.  Here at SA, we recommend tapering psychiatric medications by no more than 10% of your current dose, no more often than every four weeks (so an example: 10mg, 9mg, 8.1mg, 7.3mg and so on).  This is called hyperbolic tapering, and is very effective in minimizing withdrawal symptoms by giving your nervous system the chance to slowly recover from all the biochemical and genetic changes it has made as the result of the presence of the drug.  You can read more about hyperbolic tapering here:

 

Why taper by 10% of my dosage?

 

It looks like you tapered your Klonopin much quicker than this, which may have been the start of a downhill spiral for you.  Adding on tapering mirtazipine, also too quickly,  likely has you destabilized further.  Unfortunately, your doctor is dead wrong (as most are)- this is not anxiety, it's withdrawal.  The symptoms you describe are purely withdrawal related.  Check out this list of common withdrawal symptoms, for your reference:

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

We would not recommend using Klonopin (or any other psych med) to get you through any withdrawal symptoms from other medications.  It is quite common for those who have tapered quickly or cold turkeyed to become hypersensitive to previously tolerated medications, so there's a chance Klonopin could make you worse rather than better.  Not to mention, you would just have to taper the Klonopin down the road, thereby prolonging your suffering.  It's just not worth it. Read more about hypersensitivity and it's more serious cousin, kindling, below:

 

Hypersensitivity and kindling

 

I suppose the question at this time is, what to do next?  Well, given how quickly you tapered both drugs, I think you need a bit of a longer hold to give your nervous system a chance to catch up to the changes you've made.  Think many months.  Your body needs more time to stabilize.  A couple of months is a very short time frame when in withdrawal from rapid tapering.  It can take a very long time to find stability again.  This is a good time to start a symptom journal, and keep track of the severity of your symptoms from day to day.  It is absolutely normal to have good days/weeks and bad days/weeks while trying to stabilize.  It is actually a good sign that your nervous system is healing- we call this pattern the windows and waves pattern of stabilization.  You can read more about this in the link below.  Keeping a journal can help you identify your windows and waves, and keep you motivated to stay the course.  You say that you have cycled in and out of these symptoms- that means you are having windows and waves.  So you are healing!  That's fantastic!

 

Windows and waves pattern of stabilization

 

Once you stabilize more, and start seeing a consistent pattern of windows and waves, I would recommend you start tapering again, much more slowly, by following the hyperbolic tapering pattern recommended above.  We do recommend tapering one drug at a time here at SA, starting with the most activating drug.  Read here for advice on choosing which drug to taper first:

 

Taking multiple psych drugs? Which drug to taper first?

 

Insomnia and restlessness are very common around here.  I toss and turn most nights myself, and have had plenty of sleepless nights. It sounds like you are getting a decent amount of sleep, which is fantastic.  I know it never feels like enough when in withdrawal, but it is what it is.  Learning some degree of acceptance makes the journey much easier.  These days, when I can't sleep, I just shrug my shoulders, and get up and do something else. Since I've started working on accepting my symptoms for what they are, I've been much less frantic about them. 

 

There are a few things you can do to help you nervous system with healing.  Most are quite intuitive.  Eat a balanced, whole foods diet, stay well hydrated, engage in gentle exercise, and get as much rest/sleep as you need.  Avoid all neurologically active substances, such as caffeine, nicotine, alcohol and recreational drugs- all of these substances are like pouring gasoline on a fire for your symptoms.  And as I stated above, don't take psych meds to treat the withdrawal effects from psych meds.  The effects of these meds in withdrawal are not predictable, and can make you worse.  It's not worth the risk.  We only recommend two supplements here at SA- magnesium and omega-3 fatty acids.  Do be mindful though, it is quite common for those in withdrawal to become hypersensitive to all sorts of things, including medications, supplements and even foods.  So if you start any supplement, even those we recommend, start with a very low dose to see how you fare.  Increase slowly over time, only if you tolerate them.  Personally, I do not tolerate magnesium at all- it gives me brain zaps and insomnia.  So I'm a prime example of this hypersensitivity. 

 

You may wish to use your journal to track your foods and activities as well, in order to see if anything you are doing or taking might be aggravating your symptoms.  In addition to my magnesium sensitivity, I've discovered that I am extremely sensitive to coffee (even decaf), chamomile, refined sugar, and intense forms of exercise.  All of these things inevitably trigger a symptom wave for me, and I never would have identified this without my journal.  

 

I know all of this can be very difficult emotionally.  We do have many threads here on coping with emotional and cognitive issues during withdrawal- I will link some below.  It's really important to develop some non-drug coping mechanisms as early as possible in your journey.  I have found that practicing mindfulness every single day to be the most helpful thing I have done.  Guided meditation/yoga Nidra, recordings of nature sounds have also been very useful in helping me calm my nervous system.  Lots of deep breathing around here too!  I have also learned to recognize the negative thought patterns behind the emotions, and challenge and replace those negative thought patterns.  And on the really bad days, good old fashioned distraction is my best friend- I love to swim (I feel normal in the water!), cook, dance, and engage in all sorts of different artistic projects.  None of these things were magic- they required work and practice to make a difference.  But it's the most important work you'll ever do!

 

Non-drug techniques to cope with emotional symptoms

 Easing your way into meditation for a stressed-out nervous system

Music for self-care: calms hyperalertness, anxiety, aids relaxation and sleep

Ways to cope with daily anxiety

"Change the channel" - dealing with cognitive symptoms

Dealing With Emotional Spirals

Important topics about symptoms, including sleep problems

The importance of recognizing you're feeling good

 

I think my most important message to you is that you WILL heal from this.  It already sounds like your body is working hard to stabilize, since you are having some windows and waves.  Just take things very slow, be mindful with every move you make, and treat your body and brain really well right now in order to help things along.  You can get through this! ❤️‍🩹

 

This is your introduction topic- each member gets one intro topic.  Please post updates and questions here, on this thread.  But do explore the rest of the forum- there's lots of good info here!  And I would recommend you read and comment on the intro threads of other active members.  Withdrawal can be a lonely and long journey, and by taking advantage of the peer support model offered here, and making connections to people who really do understand, it's just a little bit easier.  Sending lots of love and hugs- you're not alone!

 

[Pharmacist]

Hello,

 

I'm also new here, and I'm having trouble with Mirtazapine as well. So far, I haven't noticed anyone discussing the precision of the content in dosage forms. For example, it can taper about 5 - 10%, while the content uniformity in tablets is 85-115% according to Pharmacopea. This means that even if you take tablets from the same manufacturer, you never have a guaranteed precise dose 95-105%, because AD are not Narrow therapeutical index drugs. But even the concentration of neurotransmitters (serotonin and norepinephrine) fluctuates throughout the day. So it's more about fluctuating around a given dose. But it's probably ideal to switch to a liquid form, although they are not always available. Do you have this option?

 

P. S. For your comfort, I can tell you that I have already successfully stopped Mirtazapine three times, only this time I was in a hurry. I'm on the same dose as you 🙂

[LukeUK]

On 10/3/2024 at 1:53 AM, kmanmb said:

I remain groggy until noon or so

 

This is absolutely classic mirtazapine, and one of the major reasons (among several) that I wanted to stop taking it.

 

I was unaware of withdrawal harms and this community forum until I had withdrawn it too quickly and suffered absolutely gigantic harm, including severe worsening of the fatigue, grogginess, feeling physically exhausted and awful etc.

 

I realise that you're in a situation where you want to be off it, because it is causing you to feel this way, but unfortunately the consequences of withdrawing too quickly can be very bad and often impossible to undo once you're in that situation.

 

The good news is that you have learned that mirtazapine can be tapered too quickly and have reinstated early enough to avoid being stuck in severe withdrawal at a time when reinstatement is very risky. I think your best bet is to wait a bit longer and see if you do stabilise more at the dose you're on, and then you can taper off of it much more slowly to hopefully avoid destabilising yourself much again, if at all.

 

 

 

 

[Pharmacist]

Thank you for your reply. At the beginning of September, I returned to 3.75 mg and within a week I was completely healthy. I reduced 10% but in a week I was sick and went back to 3.75 again and it took me a month (sometimes it was really terrible) to get better again. But again I felt completely fine, I decided to reduce it gradually this time. I started at just 4%. The tablets have a fluctuating content and the solution is not available in our country. But after a week I felt sick again. I came back again (yesterday) to 3.75, but it's not better. In the past, I successfully discontinued mirtazapine 3 times, but now it's different. Do you have any recommendations?