Pharmacist: Mirtazapine: 3 x success and failure story

[Pharmacist]

I'll write something about myself.

 

At the age of 9, I was diagnosed with primary insomnia and didn't sleep for a week. My mother was helpless. Only chlorprotixene helped me. Until I was 40, I hadn't tried any psychopharmaceuticals. At 40, I experienced stress and a long episode of insomnia, and I arbitrarily reached for Z-hypnotics. I took them for three years from a doctor (what a folly!). I couldn't quit by gradual reduction, and the doctor sent me to an addiction specialist. For half a year, I crushed the tablets, filled them into gelatin capsules, and reduced them by 10%, and I also got 100 mg of quetiapine. Because I didn't know that you can't quit, I gradually reduced the doses over about a year and quit it. I felt really bad, but I didn't know it was caused by the dose reduction. But I quit everything and fully recovered.

 

But I sometimes struggled with insomnia, and in 2014, the doctor prescribed quetiapine again. But I got EPS, and after quitting, I thought my head would burst. The doctor prescribed mirtazapine and trazodone, telling me to make a cocktail and take it however I wanted. I didn't know that you can't quit, so I kept experimenting with the doctor's consent. When I thought I couldn't survive anymore, I quit everything except mirtazapine 15 mg, and I felt good within a day. Nobody told me to reduce the doses, but I kept halving the tablets until I gradually quit mirtazapine. Without problems. I considered mirtazapine to be a problem-free drug.

 

In 2019, insomnia returned, so I started taking mirtazapine 15 mg again, the onset was terrible, and I felt like my head would burst. But I gradually quit it by 15% per week (I made hard gelatin capsules from the tablets) and in less than a year, I was out of everything. I considered mirtazapine to be a non-addictive drug (it is also stated in the professional literature).

 

In 2022, I started mirtazapine 15 mg again and quit it using the same mechanism. I experienced unpleasant symptoms, but I ignored it. Again, in less than a year, I felt completely fine, without any problems. Mirtazapine was simply the drug of choice for me. I also took it occasionally, as a hypnotic.

 

In 2024, I was dealing with insomnia again, this time 7.5 mg, and I decided to quit it faster, over the course of one month. For a total of three months, I felt bad, I had panic attacks every morning, so I started looking in the literature, which I had forbidden myself to do until then. Suddenly, I saw that I had intuitively quit three times something that probably can't be quit. So I started with 3.75 mg, and within a week, everything, including sleep, normalized. I continued like this for a total of 4 weeks without any problems. I then decided to reduce by 10% per week. For four days I felt completely fine, but suddenly agitation, akathisia,  anxiety ect. appeared, which scared me. These symptoms last about 2-4 hours a day (for five days now) and then subside.

 

I see that I was naive and irresponsible, but could someone advise me on how to proceed?

 

Thank you!

[Pharmacist]

I messed up the thread, so I'm posting it here:

 

I'll write something about myself.

 

At the age of 9, I was diagnosed with primary insomnia and didn't sleep for a week. My mother was helpless. Only chlorprotixene helped me. Until I was 40, I hadn't tried any psychopharmaceuticals. At 40, I experienced stress and a long episode of insomnia, and I arbitrarily reached for Z-hypnotics. I took them for three years from a doctor (what a folly!). I couldn't quit by gradual reduction, and the doctor sent me to an addiction specialist. For half a year, I crushed the tablets, filled them into gelatin capsules, and reduced them by 10%, and I also got 100 mg of quetiapine. Because I didn't know that you can't quit, I gradually reduced the doses over about a year and quit it. I felt really bad, but I didn't know it was caused by the dose reduction. But I quit everything and fully recovered.

 

But I sometimes struggled with insomnia, and in 2014, the doctor prescribed quetiapine again. But I got EPS, and after quitting, I thought my head would burst. The doctor prescribed mirtazapine and trazodone, telling me to make a cocktail and take it however I wanted. I didn't know that you can't quit, so I kept experimenting with the doctor's consent. When I thought I couldn't survive anymore, I quit everything except mirtazapine 15 mg, and I felt good within a day. Nobody told me to reduce the doses, but I kept halving the tablets until I gradually quit mirtazapine. Without problems. I considered mirtazapine to be a problem-free drug.

 

In 2019, insomnia returned, so I started taking mirtazapine 15 mg again, the onset was terrible, and I felt like my head would burst. But I gradually quit it by 15% per week (I made hard gelatin capsules from the tablets) and in less than a year, I was out of everything. I considered mirtazapine to be a non-addictive drug (it is also stated in the professional literature).

 

In 2022, I started mirtazapine 15 mg again and quit it using the same mechanism. I experienced unpleasant symptoms, but I ignored it. Again, in less than a year, I felt completely fine, without any problems. Mirtazapine was simply the drug of choice for me. I also took it occasionally, as a hypnotic.

 

In 2024, I was dealing with insomnia again, this time 7.5 mg, and I decided to quit it faster, over the course of one month. For a total of three months, I felt bad, I had panic attacks every morning, so I started looking in the literature, which I had forbidden myself to do until then. Suddenly, I saw that I had intuitively quit three times something that probably can't be quit. So I started with 3.75 mg, and within a week, everything, including sleep, normalized. I continued like this for a total of 4 weeks without any problems. I then decided to reduce by 10% per week. For four days I felt completely fine, but suddenly agitation, akathisia,  anxiety ect. appeared, which scared me. These symptoms last about 2-4 hours a day (for five days now) and then subside.

 

I see that I was naive and irresponsible, but could someone advise me on how to proceed?

 

Thank you!

 

[Pharmacist]

I was diagnosed with primary insomnia at the age of 9 and I did not sleep for a week (total insomnia). My mother was helpless. Protazine didn't help, only chlorprothixene. But I didn't try any psychopharmacs until I was 40. At 40, I experienced stress and a long episode of insomnia and voluntarily reached for Z-hypnotics and benzodiazepines. I took them for three years from a doctor (how stupid!) who prescribed me escitalopram twice too. I couldn't stop tapering and my doctor referred me to an addiction specialist. I crushed the tablets, filled them in gelatin capsules and reduced them by 10%, and I also received 100 mg of quetiapine. Because I didn't know that it was impossible to stop, I gradually reduced the doses for about a year and stopped. I was really sick, but I didn't know it was because of the dose reduction. The doctor diagnosed me with an anxiety disorder, which was not confirmed by a later neurological examination. I stopped all my meds and made a complete recovery.

 

However, I sometimes struggled with insomnia, and in 2014 the doctor again prescribed quetiapine. But I got EPS and thought my head was going to explode when I dropped it. The doctor prescribed mirtazapine and trazodone and told me to make a cocktail and enjoy it as you please. I didn't know you couldn't stop, so I kept experimenting with the doctor's approval. When I thought I couldn't take it anymore I stopped everything except the mirtazapine 15mg and I was fine. No one told me to taper off, but I kept cutting the tablets in half until I gradually weaned off the mirtazapine. No problems. I have found mirtazapine to be a problem free drug for me.

 

In 2019 the insomnia came back so I started back on mirtazapine 15mg, the onset was terrible and my head felt like it was going to explode. But gradually I stopped it by 15% a week (I made hard gelatin capsules from the tablets) and in less than a year I had everything. I considered mirtazapine to be a non-addictive drug (it is also mentioned in the professional literature).

 

In 2022 I restarted mirtazapine 15mg and stopped using the same mechanism. I experienced unpleasant symptoms but ignored them. Again, in less than a year, I felt completely fine, without any problems. Mirtazapine was simply the drug of first choice for me. I also took it as a hypnotic at times.

 

In 2024 I was struggling with insomnia again, this time on 7.5 mg and decided to stop it faster, within a month. For a total of three months I felt bad, I had panic attacks every morning, so I started searching in the literature that I had forbidden myself until then. I suddenly saw that I intuitively ended up with something that probably doesn't work anymore. So I started on 3.75mg and within a week everything was back to normal including sleep. I continued like this for a total of 4 weeks without any problems. Then I decided to reduce by 10% per week. I felt perfectly fine for four days, but then all of a sudden, restlessness, akathisia, anxiety, etc. appeared, which scared me. These symptoms last about 2-4 hours a day (five days now) and then go away.

 

I apologize for being naive and irresponsible, but could someone advise me on how to proceed?

 

 

[LotusRising]

Hi @Pharmacist

 

Welcome to SA,

 

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Have you completely finished your taper?

 

We recommend tapering by no more than 10% of your current dose each month, so your 10% per week near the end was much too fast. These medications can be much stronger at the lower doses.

 

I see you posted this almost 10 days ago. How are you doing now?

[Pharmacist]

Thank you for your answer. I went back to 3.75 mg and it took me a month (sometimes it was really terrible) to get better again. It was absolutely good! I decided to reduce it more gradually this time. I started at only about 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 went back to 3.75 again, but it's not better. In the past, I successfully discontinued mirtazapine 3 times, but now it's different. Do you have any recommendations? I am a pharmacist and I have some knowledge of pharmacology, but this is not taught anywhere.