jackwburns: Incorrect tapering off of Mirtazapine (Remeron)

[jackwburns]

Hello everyone, to briefly summarize my journey, I was placed on 20mg daily of Prozac and 15mg daily of Mirtazapine roughly 5-6 years ago. I tapered off of Prozac following the direction of a psychiatrist and experienced no notable symptoms. Roughly 2 months ago I tapered off mirtazapine with no direction and realize now it was much too quick, (over the course of a few weeks). For the first 1.5 months i noticed reduced appetite and welcome weight loss of roughly 10lbs, as well as slightly disturbed sleep. However within the last week or so I’ve noticed worsening to severe anxiety and persistent insomnia. Today was the worst so far, I had to leave classes easily and skip meetings. I am now concerned I may be in for withdrawals, I came here to document my concerns and seek advice and input. 

[Jane318]

Greetings @jackwburns 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 adding your drug signature.  If you could provide more specifics regarding your Prozac and mirtazapine tapers, this would be helpful.  Dates and doses for each cut.  Please also include any other prescription drugs or supplements you take on a regular basis.

 

2 hours ago, jackwburns said:

I was placed on 20mg daily of Prozac and 15mg daily of Mirtazapine roughly 5-6 years ago. I tapered off of Prozac following the direction of a psychiatrist and experienced no notable symptoms.

From your signature, it appears your Prozac taper was over only one month, correct?

 

2 hours ago, jackwburns said:

Roughly 2 months ago I tapered off mirtazapine with no direction and realize now it was much too quick, (over the course of a few weeks)

Yes, both your Prozac and mirtazapine tapers were much faster that we recommend.  

 

2 hours ago, jackwburns said:

For the first 1.5 months i noticed reduced appetite and welcome weight loss of roughly 10lbs, as well as slightly disturbed sleep. However within the last week or so I’ve noticed worsening to severe anxiety and persistent insomnia. Today was the worst so far, I had to leave classes easily and skip meetings. I am now concerned I may be in for withdrawals, I came here to document my concerns and seek advice and input. 

 

Here at SA, we recommend the hyperbolic taper method, which you can read about here:  Why taper by 10% of my dosage?  

 

Those that taper too quickly often develop very unpleasant withdrawal symptoms. It is not unusual for onset of symptoms to appear several months after stopping.   This Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) is a helpful summary of what many experience.   Specifically, "A very common withdrawal problem with mirtazapine is rebound insomnia, which reinforces the need for very gradual tapering."  (See: Tips for tapering off mirtazapine (Remeron))  It is possible that you are also dealing with the aftermath of a too-fast Prozac taper in July.

 

Suggest reading:

 

What is withdrawal syndrome.

Brain Remodelling 

Video:  Healing From Antidepressants - Patterns of Recovery

 

Since your symptoms appear to be worsening, I would suggest you consider reinstating mirtazapine at a very low dose.  Reinstatement of a very small dose of the original drug is the only known way to help alleviate withdrawal syndrome.  Reinstatement predictably works up to 3 months after last dose.  We usually suggest a much smaller reinstatement dose than your last dose.  These drugs are strong, and when reinstating it is better to start with a small amount and increase if symptoms remain unbearable. Your system has become sensitized and if you take too much it may be too much for your brain and can cause you become unstable.  Sometimes it can be hard to regain stability after this happens.  Then, once you've stabilized on that dosage, which can take several months, you can begin a 10% per month taper down to zero.   Please read:

About Reinstating and Stabilizing to Reduce Withdrawal Symptoms

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

Hypersensitivity and kindling

 

Please let us know what you decide and if you would like our input on a dose to reinstate.

 

There are a few 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 recommend only two supplements here - 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) 

 

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

 

Again, welcome to SA and best wishes on your path to recovery and a drug-free life!

[jackwburns]

The Prozac taper was over about 2 months it started in early June but I don’t remember the exact date and ended in late July I believe, the dosage was immediately reduced from 20mg to 10mg for those 2 months before being stopped completely. The Mirtazapine was reduced from 15mg to half so 7.5mg over the course of roughly two weeks in early October. Currently I’m taking magnesium

L-threonate and apigenin. I plan on contacting my healthcare provider tomorrow to discuss reinstating Mirtazapine and then creating a plan to taper off properly. Thank you very much for your reply. 

[Jane318]

@jackwburns

 

Thank you for the additional information.  It would help us if you could please edit your signature to include the taper information and supplements.

13 hours ago, jackwburns said:

I plan on contacting my healthcare provider tomorrow to discuss reinstating Mirtazapine and then creating a plan to taper off properly.

Would just caution you against reinstating at too high of a dose.  Should be less than the last dose you were on, in your case 7.5 mg.  May start with 2.5 mg.  Healthcare providers are generally unaware of the risks of kindling, as we've seen many times on this site.  If you have any mirtazapine left from your prior prescription, you might consider trying a low dose now.  

 

Best wishes - keep us posted.

[jackwburns]

Thank you, I updated my signature. I have a refill prescription coming this evening. I plan to cut the pills to 2.5mg as best I can until I can meet with a psychiatrist to discuss my concern, they were already very dismissive so I don’t know how helpful they will be with tapering off correctly. 

[Jane318]

7 hours ago, jackwburns said:

I have a refill prescription coming this evening. I plan to cut the pills to 2.5mg as best I can until I can meet with a psychiatrist to discuss my concern, they were already very dismissive so I don’t know how helpful they will be with tapering off correctly. 

I think this is a good plan.  If you find that 2.5 mg brings relief, that is a good sign and you might want to just park there until you stabilize.  

 

Cutting pills okay so you can start now, but dose accuracy is so important, especially at these low doses.  Best to weigh. 

Here is the digital scale I use and often recommended here, reasonably priced:  Gemini-20 Milligram Scale

 

Keep us posted!

 

 

Edited December 5, 2024 by Jane318
added last sentence.

[jackwburns]

December 3rd I reinstated 3.75mg of Mirtazapine, that was the most accurate I could achieve at that moment in time with the cutting pills method. Since then I have been able to sleep much better, and have seen an improvement in symptoms notably anxiety has become less severe although still present throughout the day. I’m journaling my symptoms and observations as well as dosage, and plan to do so for at least a month while I look into liquid forms of the medication or weighing doses. I have updated my signature to reflect these changes. The advice from this forum has been incredibly helpful so far. Thank you very much. 

[Jane318]

7 hours ago, jackwburns said:

December 3rd I reinstated 3.75mg of Mirtazapine, that was the most accurate I could achieve at that moment in time with the cutting pills method. Since then I have been able to sleep much better, and have seen an improvement in symptoms notably anxiety has become less severe although still present throughout the day. I’m journaling my symptoms and observations as well as dosage, and plan to do so for at least a month while I look into liquid forms of the medication or weighing doses. I have updated my signature to reflect these changes. The advice from this forum has been incredibly helpful so far. Thank you very much. 

This is such good news!  Yes, best to hold where you are now until you fully stabilize and then begin a 10% hyperbolic taper back to 0.  This may take several months.  You don't want to keep changing doses, as this could make things worse.  Thanks for the update, please continue to keep us posted.   

[Pharmacist]

Each tablet can have a content of 85 - 115% according to the pharmacopoeia. Mirtazapine are coated tablets, where the thickness of the coating can vary. If the tablets are crushed, the particle size of the active substance may change, which may affect bioavailability. To eliminate all this, it is good to crush at least ten tablets and weigh from this mixture, or make hard gelatin capsules according to volume: 

 

[Jane318]

How are you doing @jackwburns?  I hope you are continuing to see improvement / signs of stabilizing since reinstatement.  Wishing you the best for the holidays.

[jackwburns]

Thank you so much for asking, so far my condition has stabilized almost completely which I’m incredibly thankful for. I do still have some anxiety at times but I am able to cope with it. I am going to give myself one more month at current dosage before beginning my first reduction. I appreciate the responses and help during my difficult time. 

[Jane318]

This is such good news, thank you for sharing!  Wise to make wait a bit longer and ensure you are stable before resuming your taper.  We have a new saying at SA:  "Slow is the new fast."

 

Please keep us posted as you move forward with your taper - your experience / history benefits all the users of the site.

 

Best wishes and happy new year!

[jackwburns]

Heres some updates on my journey so far tapering down from mirtazapine. My current dosage is still 3.75mg, my current condition is overall stable but I've noticed I'm very susceptible to certain triggers which usually result in anxiety and nausea, sometimes throwing up. First, on December 26th, I absentmindedly took a small hit of marijuana, (something i have not done for years) which resulted in pretty severe anxiety and vomiting that evening as well as insomnia. Looking back I realize how dumb that was, but over the following week I have begun to slowly stabilize again, although I seem to be less stable compared to before. Sugar seems to be another trigger for me, I had a handful of candy from the holidays and again experienced pretty severe anxiety that evening. My sleep is good to the point I am oversleeping and averaging 8-12 hours of sleep per night and having trouble waking up. I am able to tolerate low doses of caffeine, which I take in the morning to help wake up. Today marks 1 month back on mirtazapine and my current plan is still to maintain current dosage for one more month, while paying extra attention to my diet and avoiding the triggers I mentioned. If I feel ready at the end of this month I will begin my taper.