Tombola Hello

[Tombola]

Hey, Im john56 yo based in the UK, and found the forum.

 

What a great resource and thanks for running it.

[LotusRising]

Hey @Tombola

 

Welcome to SA,

 

I see in your signature that you had to CT off sertraline. Is there a reason you needed to do this?

 

What is happening with mirtazapine?

[Tombola]

Hi LotusRising, 

The Sertraline I was 6 or so weeks in and kept having suicidal thoughts/ideation/better off not here, a burden etc etc on top of the more regular unpleasant symptoms, so I stupidly thought Id be ok stopping CT after 6 weeks, and was very wrong.

In general, its a long story but I felt I started them with docs advice an dit would be easy, but thought I could have done without them and gotten myself fixed with the therapy. This then started a chain reaction to where I am today, CT from the Sertraline, 6 weeks trying to feel better then put on Mirt where I am having the same or worse so am trying to Taper.

 

[LotusRising]

@Tombola

What happened when you CT'd sertraline?

 

Why were you prescribed mirtazapine, with increased dosages over such a short period of time?

[Tombola]

I found I was sort of manic after a few days CT, aswell as lethargy, headaches, emotion up and emotions down, I think I had PAWS , though some say it doesnt exsist, it does.

I got around 6 weeks in fighting it, regular exercise, mindfulness, meditation, and in a panic one day,  called the Private doctor (BUPA) here in the UK, and explained what I had done and could he give me anything, I mentioned in the past I had a hard time "getting on citalopram" but coming off was easy enough .

 

Thinking back I feel if I had just gone another week or so CT I may have come through it, but I didnt. 

 

He (the Bupa doctor on the phone) RX me a prescription for Mirtazapine said they are easier and a shorter time period to "get on them" and a week or 2 between upping dosage is fine.

I took them and called back as requested 2 weeks later then he said I can up to 30mg, I was quite cautious so decided to go 22.5 cutting them for a time first, even though all along I didnt feel right on them, crying to my wife, hopeless, embarrased, worthless, you know all the usual. But assumed upping the dose would fix it.

 

This all got me to a point where I am now and just want off them, before Im hooked in too far. if I could just get back to where i was before the meds, I cant take it from there.

 

On another note, my Brother in law has been round to see me today back from his holiday, he is a Psychiatric nurse, and said he doesn't like Mirt , they can turn people into "Zombies"

 

[Tombola]

So I am about to start a taper, and trying my hardest not to drop 5mg from 30 to 25, but having such a poor reaction to them.... I have read the other threads including the are we there yet.  thread https://www.survivingantidepressants.org/forums/topic/23081-are-we-there-yet-how-long-is-withdrawal-going-to-take/#comment-492490

I also might add, this episode of ADs all started back in June , when I went to the doctor having had a tough year in life and business, but seriously prior to this I thought I was bobbing along quite nicely mentally, until the death of my brother, and I had a diagnosis of barrets in the same week, the diagnosis was what put me in what I can only call shock/adrenaline/nervous even though it isnt a life threatening condition, it pushed me over the edge.

After a week or so of this panic, I asked the dr could he do anything, and told him the story, he prescribes diazepam for the calm down, and asked how everything else was. So I decided to mention that since my last episode on citalopram in 2016, Ive been feeling low in a morning mostly and find a quick workout or good long walk sets me up for the day, to which he prescribed me sertraline, and therein starts my journey to today from when I went CT off the sertraline in July for 6 weeks and started Mirtazapine.. (see signature) .

 

So the reason I want off the current Mirtazapine is they are upsetting me so much and I feel I could get back to where I was without the meds (before the sertraline prescription), Psychologically , worthless, crying(but now can't produce tears) Anger that I am holding back to frustration, extreme fatigue and shakes,insomnia the feeling of whatever is raging through my veins (was every day but now half days for the veins),  and physically draining, though I am exercising gently, getting fresh air, all forced of course. I have taken them 35 days and cant go on.

 

I am really hoping something more than 10% is worth trying after just building the Mirt up to35 days, but am unsure regards possible kindling (doubtful from what Ive read but my mind isnt functioning well) and the possible withdrawals.

 

Maybe 5% per week-10days to get me off. Ive also searched for info regards, the extra length of time Ill be on the Mirt if I do 10%, does that count to my overall time, I guess its obvious that it does

 

[LostInCanada]

hey @Tombola

I've been reading on the Maudsley Guide and I will share what is in there page 240:

Suggested taper schedules for mirtazapine A. A faster taper with up to 4 percentage points of α-2 occupancy between each step with reductions made every 2–4 weeks (approximate length: 5–10 months). Patients who have been on the medication for only a few weeks will probably be able to taper more quickly and might follow every second or third step of this regimen and make reductions every few days or so. Normally the duration of the taper should not be longer than the period that the patient has been on the drug for people who have only taken it for a few weeks. For example, if mirtazapine is taken for 3 weeks the taper should be less than 3 weeks.

 

So for you, being on Mirt for such a short time and having issues with it, you could try a faster taper. It may not be easy and there may be a flare up in withdrawal. You could slow it down to make it more comfortable and if you can get your hands on a copy of the Maudsley Guide that would be ideal.

The tapering schedule for a fast taper from page 241 is this:

30mg to 22.5 mg to 15mg to 11.25mg to 7.5mg to 5 mg(ml) to 3.1 mg(ml) to 1.8 mg(ml) to 0.8mg to 0

Can you get liquid mirt? If not you need to make it for yourself. My understanding it is available in the UK but the ratio is 2mg/ml. The liquid can be diluted safely with water to make the necessary smaller cuts.

Page 239 of the guide says this to help make your own solution:

Off‐label options: Guidelines for people who cannot swallow tablets (e.g. the NEWT guidelines in the UK,13 based on local hospital policies, and information direct from the manufacturer and similar US guidance14) suggest that mirtazapine tablets or orodispersible tablets can be dispersed in water for administration.13 This is an off‐label use.13 Water could be added to a 15mg tablet to make up a 30mL suspension (concentration 0.5mg/mL). Dispersal and suspension of the tablet may take some time. The tablet may be crushed with a spoon or pestle and mortar before mixing with water to speed up this process. The suspension should be shaken vigorously before administration. The suspension will have a bitter taste and a local anaesthetic effect on the mouth.13 As its stability cannot be assured it should be consumed immediately, and any unused suspension discarded.

 

There is always more risk in tapering faster and if too many withdrawal symptoms appear, you can slow it down.

[Tombola]

57 minutes ago, LostInCanada said:

hey @Tombola

I've been reading on the Maudsley Guide and I will share what is in there page 240:

Suggested taper schedules for mirtazapine A. A faster taper with up to 4 percentage points of α-2 occupancy between each step with reductions made every 2–4 weeks (approximate length: 5–10 months). Patients who have been on the medication for only a few weeks will probably be able to taper more quickly and might follow every second or third step of this regimen and make reductions every few days or so. Normally the duration of the taper should not be longer than the period that the patient has been on the drug for people who have only taken it for a few weeks. For example, if mirtazapine is taken for 3 weeks the taper should be less than 3 weeks.

 

So for you, being on Mirt for such a short time and having issues with it, you could try a faster taper. It may not be easy and there may be a flare up in withdrawal. You could slow it down to make it more comfortable and if you can get your hands on a copy of the Maudsley Guide that would be ideal.

The tapering schedule for a fast taper from page 241 is this:

30mg to 22.5 mg to 15mg to 11.25mg to 7.5mg to 5 mg(ml) to 3.1 mg(ml) to 1.8 mg(ml) to 0.8mg to 0

Can you get liquid mirt? If not you need to make it for yourself. My understanding it is available in the UK but the ratio is 2mg/ml. The liquid can be diluted safely with water to make the necessary smaller cuts.

Page 239 of the guide says this to help make your own solution:

Off‐label options: Guidelines for people who cannot swallow tablets (e.g. the NEWT guidelines in the UK,13 based on local hospital policies, and information direct from the manufacturer and similar US guidance14) suggest that mirtazapine tablets or orodispersible tablets can be dispersed in water for administration.13 This is an off‐label use.13 Water could be added to a 15mg tablet to make up a 30mL suspension (concentration 0.5mg/mL). Dispersal and suspension of the tablet may take some time. The tablet may be crushed with a spoon or pestle and mortar before mixing with water to speed up this process. The suspension should be shaken vigorously before administration. The suspension will have a bitter taste and a local anaesthetic effect on the mouth.13 As its stability cannot be assured it should be consumed immediately, and any unused suspension discarded.

 

There is always more risk in tapering faster and if too many withdrawal symptoms appear, you can slow it down.

Thanks, @LostInCanada I'd looked at the Maudlsey guide(thanks to the posts here)  and will get my hands on it. Can you or ayone confirm it is the maudlsey deprescribing guide isnt it?

Yes it correlates to what my wife and I spoke about in that 35 days on, then 200+ days coming off was daunting. 

thanks for the info appreciated. Ill keep this thread updated.

 

and also for anyone else who may stumble here , I found this great article by @Altostrata https://pmc.ncbi.nlm.nih.gov/articles/PMC7970174/

regards a whole host of reasons and information

[LostInCanada]

3 minutes ago, Tombola said:

Can you or ayone confirm it is the maudlsey deprescribing guide isnt it?

Yes it is👍

[Tombola]

1 minute ago, LostInCanada said:

Yes it is👍

Done on Kindle ( a new form of kindling LOL) 

many thanks

[LostInCanada]

5 minutes ago, Tombola said:

also for anyone else who may stumble here , I found this great article by @Altostrata regards a whole host of reasons and information

The link would be great. Sometimes it is tricky to do a link.

[Tombola]

apologies I meant to link it and didnt paste in https://pmc.ncbi.nlm.nih.gov/articles/PMC7970174/

 

prev post edited too

[Tombola]

Ive been thinking about this and have read Dr Maudsleys . And am doing the method suggested over a time that is less than the time I spent on Mirt, BUT....

What are the thoughts on reducing / shaving 1mg per day over a 30 day(ish) period, this then gives the same time frame but very very slight adjustments as suggested but not hyperbolic as such, unless at the end you spilt or liquid even more doeses? .

Obviously only in people who have been using a few weeks and thus shortening the periods even more than in figure C below?

Im commited to the method now but it just struck me that would this have been an option 

 

 

 

[LostInCanada]

On 10/17/2024 at 10:05 AM, LostInCanada said:

30mg to 22.5 mg to 15mg to 11.25mg to 7.5mg to 5 mg(ml) to 3.1 mg(ml) to 1.8 mg(ml) to 0.8mg to 0

I think this is suggested for good reason. As you get lower in dose the stress on your system becomes greater. Dropping more at the beginning will be easier. 

There is risk either way but doing daily cuts will keep your body in a total state of instability. Using the suggested taper gives you at least 4 days between drops. 

Please realize you may have to slow it down if it becomes too much. Listen to your body and symptoms as well. 

[Tombola]

yeah, makes sense 

[LostInCanada]

5 minutes ago, Tombola said:

yeah, makes sense 

On paper it looks easy but that may not be the reality. Treat yourself with kindness and acceptance. Your CNS is already destabilized. 

Make sure no alcohol. No caffeine even in chocolate or green tea, no msg, etc. 

Do all you can to be easy on your CNS. 

 

[Tombola]

23 hours ago, LostInCanada said:

CNS is already destabilized. 

Can you explain please, do you mean because of the previous sertraline or this episode of mirt.

 

I want to make this as easy as poss

[LostInCanada]

13 minutes ago, Tombola said:

Can you explain please,

Even though you successfully came off citalopram previously, I believe this leaves an imprint as well. The CT from sertraline wasn't helpful. So you are destabilized then you added mirt, which seems to have further destabilized you. 

No matter what, you will need alot of time to heal. It will not be a quick fix.

[Tombola]

Im wondering if need to go back up a dose.

 

Used Mirtazapine 35 days, it wasn't working out with no improvement and worse daunting anxiety, sweats, thoughts, plus the dry mouth and throat causing problems with my Barretts diagnosis, and a whole host of things.

I am somewhat following  the Dr Maudsley guide for a faster taper for those only used a few weeks, which says along these lines on page 239 to 241

 

The tapering schedule for a fast taper from page 241 for 
30mg to 22.5 mg to 15mg to 11.25mg to 7.5mg to 5 mg(ml) to 3.1 mg(ml) to 1.8 mg(ml) to 0.8mg to 0 

and here is his piece from the book
"Patients who have been on the medication for only a few weeks will probably be able to taper more quickly and might follow every second or third step of this regimen and make reductions every few days or so. Normally the duration of the taper should not be longer than the period that the patient has been on the drug for people who have only taken it for a few weeks. For example, if mirtazapine is taken for 3 weeks the taper should be less than 3 weeks" .

 

Day 1 I went from from 30 to 25, day 5 from 25 to 20, day 7 feeling very panicky irritable, ruminating, and had 3 of what I'd call anxious attacks this day, not major, first for 3 hours morning 2nd an hour in afternoon, and third I managed to head one off in the evening 10-15 mins.
Ruminating thoughts and feeling dread more than when on the 30mg, and generally unpleasant all day. But I felt unpleasant on the meds all day usually anyway.

 

Day 8 hit a bad day today, it came on at 10 this morning 3 hours after I woke, and I just cant shift it , its now 5pm and I have had the anxiety, rumination and "whatever it is" running through my arms and legs etc most the day, I took 5mg of diazapam 2pm that didnt hardly touch it( I rarely use this, this will be my 3rd tab in 2 weeks) as Im worried about dependency

 

I am wondering if the taper is too quick and should I go up a dose to 25 or even 22.5?

 

to summarise, day 1 to 5 went from 30 to 25, day 5 went from 25 to 20, day 7 hit problems, and am considering more use of Diazapam, (which isn't like me) to get me through but am worried too

 

Any advice appreciated

 

[Erimus]

32 minutes ago, Tombola said:

Im wondering if need to go back up a dose.

 

Used Mirtazapine 35 days, it wasn't working out with no improvement and worse daunting anxiety, sweats, thoughts, plus the dry mouth and throat causing problems with my Barretts diagnosis, and a whole host of things.

I am somewhat following  the Dr Maudsley guide for a faster taper for those only used a few weeks, which says along these lines on page 239 to 241

 

The tapering schedule for a fast taper from page 241 for 
30mg to 22.5 mg to 15mg to 11.25mg to 7.5mg to 5 mg(ml) to 3.1 mg(ml) to 1.8 mg(ml) to 0.8mg to 0 

and here is his piece from the book
"Patients who have been on the medication for only a few weeks will probably be able to taper more quickly and might follow every second or third step of this regimen and make reductions every few days or so. Normally the duration of the taper should not be longer than the period that the patient has been on the drug for people who have only taken it for a few weeks. For example, if mirtazapine is taken for 3 weeks the taper should be less than 3 weeks" .

 

Day 1 I went from from 30 to 25, day 5 from 25 to 20, day 7 feeling very panicky irritable, ruminating, and had 3 of what I'd call anxious attacks this day, not major, first for 3 hours morning 2nd an hour in afternoon, and third I managed to head one off in the evening 10-15 mins.
Ruminating thoughts and feeling dread more than when on the 30mg, and generally unpleasant all day. But I felt unpleasant on the meds all day usually anyway.

 

Day 8 hit a bad day today, it came on at 10 this morning 3 hours after I woke, and I just cant shift it , its now 5pm and I have had the anxiety, rumination and "whatever it is" running through my arms and legs etc most the day, I took 5mg of diazapam 2pm that didnt hardly touch it( I rarely use this, this will be my 3rd tab in 2 weeks) as Im worried about dependency

 

I am wondering if the taper is too quick and should I go up a dose to 25 or even 22.5?

 

to summarise, day 1 to 5 went from 30 to 25, day 5 went from 25 to 20, day 7 hit problems, and am considering more use of Diazapam, (which isn't like me) to get me through but am worried too

 

Any advice appreciated

 

 

It's difficult to tell whether you are experiencing side effects from the mirtazapine, withdrawal effects from the mirtazapine, or side effects from the sertraline episode.

 

My advice would be this: When you don't feel good, don't further reduce the dose, hold for a few days and see if things settle. I don't think updosing would be very beneficial given your short-term use.

 

The guidelines in the book are just that, guidelines, they are not a schedule you must follow. If something doesn't feel right then wait until you feel able to tolerate your next reduction. The brain dictates the pace at which we can taper, I learnt that the hard way.

Edited October 20, 2024 by Erimus

[Tombola]

Thanks, makes sense.

 

I cant believe all this after only 5 weeks use,

 

I never even thought it may have something to do with the sertraline ?

 

And to add, Ive done the walking, relaxing, mindfulness, breathing, but just had to do a 5mg diazepam to take the edge off (always worried about these)

thx for your prompt response

 

[Erimus]

7 minutes ago, Tombola said:

Thanks, makes sense.

 

I cant believe all this after only 5 weeks use,

 

I never even thought it may have something to do with the sertraline ?

 

And to add, Ive done the walking, relaxing, mindfulness, breathing, but just had to do a 5mg diazepam to take the edge off (always worried about these)

thx for your prompt response

 

I would advise disposing of the diazepam at your local chemist, so that you no longer have the urge to use them.

 

It only takes around a month for dependence to build, at which point your withdrawal experience is a complete lottery, based on a number of genetic factors we have no way of measuring.

 

Thankfully you arrived here and have the right information to perform a harm reduction taper from this point onwards.

Edited October 20, 2024 by Erimus

[Tombola]

Thanks, ill take it on board and get rid. 

ive had 5 from a pack in about a month, but see your reasoning. Today tho sprialled to almost full on panic.

 

what about the propronalol ive been given ? Similar advice ? I had used them when going up original doses but didnt seem to feel any effect .

[LostInCanada]

How are you doing?

[Tombola]

Not the best tbh, have got down to 20mg and am in a bit of trouble, think I may have to go back up and hold longer.

Dr has took me off Mort and advised Fluoxetine but Im scared to start taking it, plus he said go form 30 to 15 then 7, maybe 3.75 and stop over 2 months or so

[LostInCanada]

8 minutes ago, Tombola said:

advised Fluoxetine

Do not go down this path. Doctors are clueless. All he is trying to do is cover over your withdrawal symptoms because this is all they know. We have seen it here so many times...it is not successful. In 2 months your body will be dependent on this new drug. As you know from the mirt, getting off of these drugs is not easy despite the promises.

9 minutes ago, Tombola said:

Dr has took me off Mort

What does this mean? He will no longer prescribe mirtazapine? 

 

On 10/20/2024 at 9:34 AM, Erimus said:

It's difficult to tell whether you are experiencing side effects from the mirtazapine, withdrawal effects from the mirtazapine, or side effects from the sertraline episode.

 

My advice would be this: When you don't feel good, don't further reduce the dose, hold for a few days and see if things settle. I don't think updosing would be very beneficial given your short-term use.

 

The guidelines in the book are just that, guidelines, they are not a schedule you must follow. If something doesn't feel right then wait until you feel able to tolerate your next reduction. The brain dictates the pace at which we can taper, I learnt that the hard way.

This advice stands. There is no quick fix once the CNS is destabilized. It will take alot of time and patience. If you are feeling worse tapering it is always wisdom to hold till things resolve. I suggest holding because your body will have already made adjustments. Going up may cause kindling. 

Please update your signature with dates and exact dosages so we can better advise. Thanks 

[Tombola]

1 hour ago, LostInCanada said:

What does this mean? He will no longer prescribe mirtazapine? 

Thanks for the response,

No sorry he has swaped it out for FLuoxetine but told me quite casually, couple weeks on 15mg then 7.5mg then off, I said WHAT, no no, sensetive etc, he said ok then pill cutter to 3.75 for a short while.

1 hour ago, LostInCanada said:

Do not go down this path. Doctors are clueless. All he is trying to do is cover over your withdrawal symptoms because this is all they know. We have seen it here so many times...it is not successful. In 2 months your body will be dependent on this new drug. As you know from the mirt, getting off of these drugs is not easy despite the promises

I dont want to but am also worried Ill be left with a seretonin short brain or whatever, and back to my original state. I wanted to get off Mirt first and see how I was after a few weeks, if I needed something else. I dont think I will finger crossed though. Youjust dont know what this crap leaves you with

 

1 hour ago, LostInCanada said:

Please update your signature with dates and exact dosages so we can better advise. Thanks 

Sig updated  

thanks

[Tombola]

1 hour ago, LostInCanada said:

This advice stands. There is no quick fix once the CNS is destabilized. It will take alot of time and patience. If you are feeling worse tapering it is always wisdom to hold till things resolve. I suggest holding because your body will have already made adjustments. Going up may cause kindling. 

Please update your signature with dates and exact dosages so we can better advise. Thanks 

thanks, are we talking potentially days or weeks to ease off, today has been the worst. Ill hold at 20 and see where I am at.

 

HE DID however give me some extended propronalol for the anxiety last week, which was taking the edge off, but not today. It feels very like some days I had when "getting on" them, same feelings same crappy negative thoughts, all day, no escape. I had a rough time getting on citalopram but it was nothing compared to this.
 

I keep a mood spreadsheet with dosages etc etc, and they too were a big problem around the 20mg mark when increasing the dose bit by bit.

 

It P****s me off because I wanted off it a few weeks ago, when posting here, but couldnt get in to the doctors and was worried if I started tapering myself, but looking back i should have just started then, Ive lost 2-3 weeks

[LostInCanada]

6 minutes ago, Tombola said:

if I needed something else.

Trust me and the thousands on here, you do not need something else. Introducing anything to an already fragile CNS is asking for trouble. These drugs are harmful. You will add a world of pain. 

5 minutes ago, Tombola said:

give me some extended propronalol

He keeps handing you drugs like they are candy. 

 

[Tombola]

I Must add, the anxiety on these has me off the scale for me, (I was never an anxious person before and Doc says it cant be these dont cause anxiety..WELL they do for me) And I seemed to be ok on the 20s,(3rd day)  but it all fell in yesterday afternoon when I had a call from the hospital (unrelated) and it sent me into a panic, since then Ive been a "withdrawing" wreck. 

 

And I was on a plane last week and had a panic attack and wanted to get off just as they were closing the doors..Just managed to hold it together with the help of my wife. That just is NOT me

 

thanks for the advice

[LostInCanada]

Really alot of resources here...CBT, vagus nerve, mindfulness, etc

 

[Erimus]

36 minutes ago, Tombola said:

I Must add, the anxiety on these has me off the scale for me, (I was never an anxious person before and Doc says it cant be these dont cause anxiety..WELL they do for me) And I seemed to be ok on the 20s,(3rd day)  but it all fell in yesterday afternoon when I had a call from the hospital (unrelated) and it sent me into a panic, since then Ive been a "withdrawing" wreck. 

 

And I was on a plane last week and had a panic attack and wanted to get off just as they were closing the doors..Just managed to hold it together with the help of my wife. That just is NOT me

 

thanks for the advice

Your brain needs stability. Same dose, same time each day for a month or so. Reassess after that time has passed.

 

Propranolol is a beta-blocker which sometimes aids physical symptoms of anxiety. It blocks the action of adrenaline and noradrenaline. All these drugs carry risk, but propranolol is generally less of a risk than antidepressants, benzodiazapines, z-drugs and gabapentinoids.

[Tombola]

Felt better today ( I sometimes wonder whether the correct phrase is "not as bad") , woke this morning waiting for it to hit after the cortisol wake up, but I managed to keep it at bay, then hit me more around 4pm, windows and waves eh.

Still an improvement on the past days

[LostInCanada]

3 minutes ago, Tombola said:

improvement on the past days

Good news. Holding and not adding anything is key. 

[Tombola]

When we use the term "stabilise" what are we talking, is it "normal" "near to feeling a normal person" or not suffering Wds
 

As far as myself, I never feel no where near normal on these tabs (terrible in fact) which is why I wanted off, hence why I tried the faster taper approach, and need to try and balance the effects Vs Wds

[LostInCanada]

If you are developing more symptoms as you taper that means you are going to fast and need to hold. Your tapering has to be sustainable. It will not be if you keep stacking extra symptoms on top of old ones.

1 hour ago, Tombola said:

term "stabilise" what are we talking,

Basically you don't want to be getting worse or having new symptoms from tapering not resolving quickly.