curtis1512: Tapering off Mirtizapine

[curtis1512]

I'm 60 yr old. I developed anxiety/depression for the first time in my life 5 month ago. A job related issue created a huge burden and stress on my life. 

I also started losing weight. I went to my PC for some advice. She put me on Lexapro 5 mg. After 2 weeks she added buspirone. Both made me sick. I stopped the buspirone after 2 days then the Lexapro after 4 weeks, CT. Meanwhile I had insomnia. I was drinking and using cannabis at night to sleep. I would also take a small amount of Xanax to sleep. About .25 mg or less. This went on for 3 months. I lost about 35 pounds and was getting scared. My anxiety/depression never went away. As of 9/30/24 I stopped drinking, cannabis and Xanax. I started back on Lexapro 10mg. I had a really bad night 10/11/24 and went to the ER. The ER Psych DR  decided to put me on Mirtazapine 15 mg. after 20 days I started feeling really good. 10 days later I talked to the same ER DR. He said to start coming off it. I went from 15 mg to 7.5 mg. The first night my heart was pounding for 3-4 hours. I went back to 15 mg. The next week I started to teper by 10% a week. I'm finishing my 3rd week down 30% and out of nowhere my heart started to pound again. I also feel the anxiety/depression, not bad but I feel it.  

[Jane318]

Greetings @curtis1512 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.  Please update it to to reflect your taper from 15 mg mirtazapine down to your current dosage.

 

I am sorry for all you have been through, the life stress as well as side effects from these drugs.  I commend you for stopping alcohol, cannabis, and I am grateful you did not stay on the lexapro, xanax, or busiprone.  Doctors tend to prescribe a pill for every problem, apparently without considering long term effects.  Psychotropic drugs are very powerful, they change our brain's physiology and it takes only a few weeks for our bodies to become dependent upon them.  It can be difficult to stop, as you have experienced.  While our bodies strive to re-adapt to life without the drug, other activating substances including cannabis, alcohol, and even caffeine can further inflame our sensitized central nervous systems.

 

The racing heart, depression, and anxiety you describe are typical AD withdrawal symptoms, which can appear when we stop suddenly or even taper too quickly, even after short term exposure.  Your 10% per week taper is faster than we would recommend.  It is also possible that stopping lexapro after a month and xanax after a couple weeks could also be contributing to your symptoms.   Withdrawal can build up in the background with symptoms appearing weeks or even months later.  

 

Since you appear to have severe withdrawal symptoms right now, it would be best to hold where you are - or even do a slight updose - and sit there for a few weeks or so until you stabilize.  Then I would recommend you do a 10% reduction (based on prior dose) for a month.  If that goes okay, then you could try 15% the following month. The key with tapering is finding the plan that is right for you, there's no one-size fits all approach and each of us needs a custom schedule. The good thing about cutting by 10% and I then waiting a month is that you can see how your body reacts to the change, before adjusting your approach.

 

If you decide to updose and would like input on how to do that, let us know.  Whatever you choose to do, reflect on the WD checklist: Daily Checklist of Antidepressant Withdrawal Symptoms (PDF). DON'T ignore the warning signs.

 

You may want to read:

Why taper by 10% of my dosage?

The Brassmonkey Slide Method of Micro-tapering

 Important topics in the Tapering forum and FAQ  

Tips for tapering off mirtazapine (Remeron)

What is withdrawal syndrome.

 

About Reinstating and Stabilizing to Reduce Withdrawal Symptoms

How long does it take to stabilize after reinstating or updosing?

 

There are a things you can do to help your nervous system heal.   Eat a balanced, whole foods diet, stay well hydrated, engage in gentle exercise, and get adequate rest/sleep.  Avoid all neurologically active substances, like caffeine, alcohol, nicotine and recreational drugs- these are like pouring gasoline on a fire for your symptoms.  Avoid adding any further psychiatric medications to deal with your withdrawal from psych meds- the effects of these meds on a destabilized nervous system is unpredictable, and taking something else could make you worse.

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium (glycinate is a good form) and omega 3 (fish oil). Many people find these to be calming to the nervous system.

Magnesium, nature's calcium channel blocker 

Omega-3 fatty acids (fish oil) 

So if you decide to try a supplement, even those we recommend here, Add in one at a time and at a low dose in case you do experience problems.  If you tolerate it well, you can increase the dosage slowly over time.  

 

This is your introduction topic.  Each member gets one intro topic- please post updates and questions here, in this thread.

 

Let us know how we can help further.  Best wishes.  

 

 

[curtis1512]

@Jane318 Thank you so much for responding. I should have sensed something was going to happen leading up to yesterday. Even though I felt good, I could feel my heart beating throughout my body. I felt it in my ears. This was happening for about 2 days. That never happened before. It wasn't racing, just beating. Then yesterday happened. 

 

I did end up updosing to my last % drop. I feel better today. This dose is 20% off 15 mg. (I have a scale). I'll stick with the 20% drop for awhile now. 

As for supplements, I do take a Liver supplement. I will start the Omega and the Magnesium.

 

I really appreciate the time you put into your reply. 

[Jane318]

3 hours ago, curtis1512 said:

I did end up updosing to my last % drop. I feel better today. This dose is 20% off 15 mg. (I have a scale). I'll stick with the 20% drop for awhile now. 

I am  so glad to hear that updosing to your prior dose has helped!  And yes, you are wise to stick here for as long as it takes to stabilize - this might (probably will) take several months.

 

You might consider phasing out the liver supplement for now.  Introduce the Omega 3 and magnesium one at a time, and slowly.  There are several forms of magnesium, some people can tolerate one form but not others.  

 

I do recommend that you keep tabs on your symptoms as you hold and later, as you begin to taper again.  This will help you identify your windows and waves and reveal your progress, which is encouragement we need! And help you know how to adjust your taper.  You can use this list to track the severity of your symptoms over time:  Daily Checklist of Antidepressant Withdrawal Symptoms (PDF).

 

You may choose to also track your foods and activities to identify things that trigger symptoms as well.  Again, we do encourage people who are tapering to avoid caffeine, alcohol, and recreational drugs.  Many prescription and OTC drugs can cause problems too and should be avoided as much as possible. 

 

Keep us posted and let us know if you have more questions.  Best wishes.

[curtis1512]

Is there a certain brand of Omega 3 you can suggest?

[Jane318]

7 hours ago, curtis1512 said:

Is there a certain brand of Omega 3 you can suggest?

I'm not an expert, and I've taken several forms / brands.  Currently, I am taking Nordic Naturals cod liver oil.  I've also taken their high DHA Omega 3 capsules.  NowFoods is good too.  I consider The Weston A. Price Foundation a great resource for all things nutrition, you can also search their site for recommendations.  You don't want to take too much, of course, as with any supplement.

 

Perhaps other members can chime in.

[curtis1512]

@Jane318The dose I’m currently at is 12 mg. Do you know if that is still good for depression? I know 7.5 not so much. 

[Jane318]

@curtis1512 - Please update your signature to reflect all changes since 10/11/2024 so moderators can better assist you.  Can you also please include which form of each drug you are taking - i.e., XR or other?

 

1 hour ago, curtis1512 said:

Jane318The dose I’m currently at is 12 mg. Do you know if that is still good for depression? I know 7.5 not so much. 

I am not exactly sure what you are asking here.  ADs do cause changes in the brain that affect can numb our emotions and/or effect our emotions in other ways.  So we may feel less depressed or anxious for a while, until the drug stop working (this is called "poop-out" (Tolerance or "poop-out" or Tachyphylaxis).  However, this temporary relief comes at great cost, including dependency and side effects.  Further, the research shows that over the long term, outcomes of people who do not take psychotropic drugs is better than those who do.  (Anatomy of an Epidemic by Robert Whitaker)  So here at SA, we do not endorse the use of drugs to treat depression or any emotional/psychological problem.  

 

Depression is a common withdrawal symptom - that is, when we try to get off the drugs, especially with a cold turkey or too-fast taper - many people (including myself) become depressed.  Like other withdrawal symptoms, depression will follow the windows and waves pattern towards eventual healing.  Most doctors conflate withdrawal with relapse and will tell us we need to stay on the drugs.  In fact, with a thoughtfully, sufficiently slow taper along with developing non-drug strategies to cope with depression and other withdrawal symptoms, we can get off the drugs for good and be in a better state to address our problems with a clear mind.

 

I suspect that when you reduced too quickly to 7.5 mg, you became depressed.  That this improved upon updosing means it was withdrawal, not relapse.

 

I hope this answers your question, if not please let me know.

[Jane318]

@curtis1512 - One more thought - I want to make sure you understand that a 10% means that each cut is 10% less than the previous dose.  You say you are at 20% from 15 mg or 12 mg.  In the taper world, the first cut would be by 1.5 mg to 13.5 mg.  The next (20% cut) would be by 1.35 mg to 12.15 mg.  So the cuts get smaller and smaller.  This is necessary because the lower the dose, the faster the brain changes.  This is explained here:   Why taper by 10% of my dosage?

 

This is very important, because it is at the low doses that many of us start to experience severe withdrawal.  You do not want to be making big cuts here.

 

Let me know if you have any questions about this.

[curtis1512]

I didn’t make big cuts, I believe I didn’t hold the cut long enough. I’m trying to find out if Mirtazapine at 12 mg will still treat depression. I was given 15 mg for depression. I had it bad. The 15 mg helped me tremendously. I felt really good. I would say no sign of depression after 3 weeks. I’m now on 12 mg which was my second cut. I’m going to hold here for a while. My depression now is no way as bad as it was. I’m asking because, is 12 mg isn’t treating my current depression, why hold here. I’m trying to understand all this, this is all new to me. 

[curtis1512]

Not sure if this can be answered. Is 12 mg still effective for depression? I’m decreasing my dose to try to get off  the 15 mg I’m taking. I’m at my second cut, I cut 10% each cut. So 20% down which is equivalent to 12 mg. 

[Erimus]

3 hours ago, curtis1512 said:

 I’m at my second cut, I cut 10% each cut. So 20% down which is equivalent to 12 mg. 

Like Jane said above, you've been doing a linear taper.

 

10% every 4 weeks would look like this:

 

15mg --> 13.5mg --(4 weeks)--> 12.15mg --(4 weeks)--> 10.94mg --(4 weeks)--> 9.84mg --(4 weeks)--> 8.86mg etc.

 

3 hours ago, curtis1512 said:

Not sure if this can be answered. Is 12 mg still effective for depression?

We can't answer that. Each of us reacts differently to these drugs. The drug companies idea of "lowest therapeutic dose" is much different to our idea of "lowest effective dose".

[curtis1512]

Quick update. I'm a week holding at 12 mg, or 20% from from 15 mg. My depression is still here. Not as bad as before Mirt. 

My mood is basically the only symptom I have right now. It's not feeling happy about anything. Plus, maybe some sinus issues too..  

@Jane318 said I should hold here until I stabilize. Today my psych doc said I should go back up to 15 mg. and stay on it for a year. 

What's your thoughts on that? Overall I have been on Mirt for 7.5 weeks. I don't mind up dosing to 15 if it will help my depression. 

Will going up to 15 mg cause any worse symptoms. (I was on 15 mg for 30 days, at day 20 I started to feel better)

[Jane318]

@Erimus

4 hours ago, curtis1512 said:

Quick update. I'm a week holding at 12 mg, or 20% from from 15 mg. My depression is still here. Not as bad as before Mirt. 

My mood is basically the only symptom I have right now. It's not feeling happy about anything. Plus, maybe some sinus issues too..  

@Jane318 said I should hold here until I stabilize. Today my psych doc said I should go back up to 15 mg. and stay on it for a year. 

What's your thoughts on that? Overall I have been on Mirt for 7.5 weeks. I don't mind up dosing to 15 if it will help my depression. 

Will going up to 15 mg cause any worse symptoms. (I was on 15 mg for 30 days, at day 20 I started to feel better)

Here at SA, we provide support people in getting off psychotropic drugs.  While ADs do help some people with depression, it is a temporary fix and comes at a high cost (many side effects and dependency).  Getting off these powerful drugs and doing the work to develop non-drug strategies for dealing with emotional / psychological problems takes much longer than most of us wish it would, and it can be very hard.   If you are not committed to getting off these drugs for good, this may not be the best place for you.

 

The depression you are experiencing, since it appeared as you decreased dosage, is due to withdrawal, not relapse.  As noted above, doctors often confuse the two, so it is not surprising that your psych wants to put you back on full dose for at least another year (Interesting article:  https://www.psychologytoday.com/us/blog/side-effects/202412/the-costs-of-mistaking-antidepressant-withdrawal-for-relapse).  Prescribing pills is what psychs do.

 

You've been through a rapid tapers of three different drugs this year, putting your CNS into a tailspin.  My concern is that your CNS has become highly sensitized as a result and that increasing all they way back to 15 mg could possible induce kindling, which you can read about here: Hypersensitivity and kindling.  This can be very hard to recover from.  This is the reason we usually recommend updosing by a very small amount from the last dose, at least at first.  If symptoms improve, we recommend parking there for as long as it takes to stabilize.

 

Recovery from severe withdrawal is not usually fast.  Many people (including myself) take many months to stabilize after a too-fast taper or cold turkey.Have you read these links, which referenced above?

What is withdrawal syndrome.

About Reinstating and Stabilizing to Reduce Withdrawal Symptoms

How long does it take to stabilize after reinstating or updosing?

 

Tagging @Erimus for additional input if any.

 

Wish you the best in your decision. 

 

[curtis1512]

@Jane318 I'm continuing to hold at 12 mg. I just wanted to give you the info that my Psych doc told me. I'm trying my hardest to understand all this, plus I'm scared. Praying I stabile soon.  

[Jane318]

1 hour ago, curtis1512 said:

@Jane318 I'm continuing to hold at 12 mg. I just wanted to give you the info that my Psych doc told me. I'm trying my hardest to understand all this, plus I'm scared. Praying I stabile soon.  

Thanks for confirming you are continuing to hold and for sharing the input from your psych.  Our observation is that few in the mainstream healthcare community understand how powerful these drugs are and how to get off them safely.

 

I understand your confusion - it is so hard to try to understand all this new information even when we feel good, much less when our brains are in turmoil. 

 

I understand your fear too.  As hard as it is, I urge you to try to let go of that fear - it only works against you.  Keep reminding yourself this is temporary, it will get better.  These emotions / thoughts by themselves cannot harm you.  You can overcome.  Do your best to distract yourself away from negative thoughts.  Here are some forums that may help:

Cognitive Behavior Therapy (CBT) for anxiety, depression, withdrawal symptoms, insomnia

"Change the channel" - dealing with cognitive symptoms

 

You might find encouragement by reading some Success Stories.

 

Please keep us posted.

[Jane318]

@curtis1512 - How are you doing?

[curtis1512]

@Jane318 Thank you for checking in. Its been exactly 3 weeks since my WD symptoms occurred. I'm still not stable. Although it's manageable. 

I feel more anxious than depressed. My other symptoms revolve around my nose and nasal area. Running a lot, sores that scab up. This has been going on the entire time (3 weeks) and was one of the initial symptoms. I have good days and bad days. A week ago, Monday, I had a window day, then bad, then window. Then all bad until yesterday, it was a window. Today, back to wave. Praying I stabilize soon. 

[curtis1512]

Can you stabilize if you still have WD symptoms? Like my nasal inflammation which is not crippling me.

[Jane318]

Yes, you will stabilize, but may (probably will) take several more months.  That you are noticing windows is a great sign!  Time + Patience.  I hope you get relief from the nasal inflammation soon.

[Jane318]

How are you doing @curtis1512?  Wishing you the best for the holidays.

 

[curtis1512]

@Jane318 Thanks for checking in on me. It's exactly 4 weeks since my withdrawal symptoms popped up. 

I started feeling decent 4 days ago. My nose and nasal inflammation is just about gone. That was weird.

If I had a sore on the right side of my nose, the same sore would appear on the left side in the exact same spot. Still 

running a bit. But not as before. 

 

I still have some form or anxiety lingering. But the dreadful feeling of despair is gone. My doc wants me to take hydroxyzine

for the anxiety. I have 10 mg tablets. She said take as needed. I haven't taken them yet. They are sedative like Mirtazapine. 

I don't want to be drowsy all day. Any thoughts. 

 

@Jane318 Thank you for all you do. Taking the time to chat with people that are going through real hell and guiding them as best you can is a gift to people like me. HAPPY HOLIDAYS TO YOU AND YOUR FAMILY. 

[thenextguy]

On 11/26/2024 at 10:50 AM, curtis1512 said:

I'm 60 yr old. I developed anxiety/depression for the first time in my life 5 month ago. A job related issue created a huge burden and stress on my life. 

I also started losing weight. I went to my PC for some advice. She put me on Lexapro 5 mg. After 2 weeks she added buspirone. Both made me sick. I stopped the buspirone after 2 days then the Lexapro after 4 weeks, CT. Meanwhile I had insomnia. I was drinking and using cannabis at night to sleep.

 

Were you drinking and using cannabis prior to withdrawals? Definitely a good idea that you quit that. It could have contributed to your anxiety. How about caffeine?

[curtis1512]

27 minutes ago, thenextguy said:

@thenextguy

Were you drinking and using cannabis prior to withdrawals? Definitely a good idea that you quit that. It could have contributed to your anxiety. How about caffeine?

I haven't touched either since 9/30/24. No caffeine too. My withdrawal started 11/26. The anxiety feelings are far less than I ever experienced before. But I still feel anxious for no apparent reasons. 

[Jane318]

2 hours ago, curtis1512 said:

It's exactly 4 weeks since my withdrawal symptoms popped up. 

I started feeling decent 4 days ago. My nose and nasal inflammation is just about gone. That was weird.

If I had a sore on the right side of my nose, the same sore would appear on the left side in the exact same spot. Still 

running a bit. But not as before. 

This is such good news - very positive signs that you are healing, even after just 4 weeks!  

 

2 hours ago, curtis1512 said:

I still have some form or anxiety lingering. But the dreadful feeling of despair is gone. My doc wants me to take hydroxyzine

for the anxiety. I have 10 mg tablets. She said take as needed. I haven't taken them yet. They are sedative like Mirtazapine. 

I don't want to be drowsy all day. Any thoughts. 

So grateful to hear the dread / despair is gone!  This is huge.

 

Regarding hydroxyzine - you might try searching the site to see what others have experienced.  But SA does not ever support adding another drug to deal with symptoms.  It often adds another layer of issues and/or another drug to have to get off of.  Encourage you to explore non-drug strategies for coping with anxiety, such as https://www.survivingantidepressants.org/forums/topic/1101-cognitive-behavior-therapy-cbt-for-anxiety-depression-withdrawal-symptoms-insomnia/.  Search the site, also we have tons of information on how to cope with anxiety.

2 hours ago, curtis1512 said:

Thank you for all you do. Taking the time to chat with people that are going through real hell and guiding them as best you can is a gift to people like me. HAPPY HOLIDAYS TO YOU AND YOUR FAMILY. 

Thank you for the encouragement - we're all in this together!

 

[curtis1512]

@Jane318 Update. I guess I was experiencing a 6 day window From Dec 20 - 25. Dec 26 I was hit with the anxiety again. No window since. I'm also wondering if I have POTS. Sometimes when I rise I get heart palps. Sometimes a little dizzy. But not increased heart rate. I read where POTS is not a withdrawal symptom. 

[Jane318]

I am sorry you are dealing with a wave again.  This is always tough when we have experienced a window, to find the awful anxiety and other symptoms recur.  However, you will get another window, hopefully soon.  This is the somewhat cyclical pattern of recovery.  

 

Many people report POTS-like symptoms during withdrawal - compare with the  Daily Checklist of Antidepressant Withdrawal Symptoms (PDF).

 

You might search the site for POTS to read about other members' experiences.