lomekian - my intro and mirtazapine journey

[lomekian]

I hope that in time this will be not only a useful reflection for myself, but may prove useful to others down the line, given the way doctors who should know better throw pills at people.

 

Background:

Never had any obvious anxiety or depression or anything before Dec 2022 (aged 44), but now recognise lots of limiting beliefs, avoidant behaviour and ghosts of childhood that are borne of repeating mutli-generational wounds. Without getting into too much  self indulgent detail, the years 2019-2022 were one constant period of extremely high stress situations and events - proper big T trauma stuff - and I had my first panic attack early Jan 2023. Following 14 months of trying to get my head round having suddenly developed Panic disorder and generalised anxiety, I finally made the mistake of listening to my GP>>>>

 

Feb 24 - put on sertraline. Immediately got a LOAD of side effects, but no life endangering ones, so persevered on a lower dose with things only getting worse for 3 weeks. GP told me to quit CT - I did question if, even after only 3 weeks, I should reduce over a few weeks, given the sensitivity of my system but that was dismissed. This led to 

 

March 24- April - over the following 3 weeks I turned into an in pain, wailing mess, and ended up in the arms of the 'Crisis Team'. They immediately put me on 15mg Mirtazapine, told me how it would helpe me sleep and recover my temporary loss of appetite, but other than that it was sold as Lassie the wonder drug. After 3 weeks they upped it to 30 because 15 was too sedating. 30 was giving me panic attacks, but by then they had discharged me without waiting for anyone else to pick me up, so I decided myself to experiment coming down to 22.5mg in mid May. I know now that the idiot doctor I saw once took it upon himself to decide he knew better than the GPs, therapists and myself, and diagnosed me with depression without even telling me. For the record, I was unhappy at the time because I was in withdrawal from Sertraline, but was not and have never been depressed. I've been close enough to people who have to know the difference. 

 

May 24 - finally got referred to MINT (community mental health) team, and got to speak to someone in late May - who when I requested a medication review because I wanted to know what the plan was and didn't want to keep taking the meds. The request for medication review was refused, and they told my GP to up my dose to 45mg - without any doctor even speaking to me. I had a discussion with my GP as I refused to go up to 45 (30 was already too much), and they agreed I should stay where I was as 22.5mg was sitting ok with me in terms of the balance of improved sleep but not increased anxiety.

 

July 24 - end of this month I FINALLY got to see a doctor, a consulting pharmacist, who told me I shouldn't have been put on Mirtazapine, came up with a tapering plan - via bridging to escitalopram, but still following a slow Mirt taper. She used to work at the Maudsley, but seems not to be totally up on latest guidelines (by this time I'd managed to locate a pdf of the 2024 Maudsley guidelines). I wasn't sure about this but was open to it - then I got a concussion and everything went on hold.

 

Aug- Nov 24 - The consulting pharmacist she got sick, and I never heard from her again. The other staff in the building I had contact with didn't seem to know who she was, couldn't get hold of her, and as it turns out were incapable of asking their own reception staff, so didn't find out she was ill until November, by which time I'd already found out myself.  During this same time, I started to get symptoms which I attributed to the concussion (GPs know NOTHING about concussion or psych meds), particularly bouts of parasthesia (pins n needles) all over and numbness in hands - but the long awaited neck MRI showed me it wasn't the neck. This pointed back to nervous system - particularly as after a few benign months Aug-Oct, I was suddenly getting panic attacks, increased anxiety symptoms etc, culminating in terrible itching all over, particularly at bedtime. Also in Sept/Oct I had a chiropractor appointment that left me with crazy fatigue for 10 days and an ostepath appointment (both with minimal manipulation) that sent my nervous system crazy for a 10-14 days.

 

MINT team finally hooked me up with another Doc, who agreed Mirt wasn't for me, agreed to help me taper, but clearly had no knowledge of slow taper guidelines, and denied the existance of liquid. Either way, she agreed to prescribe 15mg tabs to help my slow reduction, so prepped myself by resarching tapering methods here and eslewhere, bought myself all the kit to make my own liquid and then the same day the stuff arrived....

 

Dec-24 - My nervous sytem went batshit crazy at the start of this month. Heart rate spikes, POTS like symptoms upon standing, sudden huge exercise intolerance, slightly tremoring hands, stiff fingers, anxiety suddenly though the roof, bouts of sudden crying out of nowhere, headaches, nausea, itching returned, involuntary shivers, temp regulation gone haywire, random muscle aches, sudden random muscle contractions, particularly in chest, reflux like symptoms in throat despite careful eating etc. These all come on over about 3-4 days. Have i hit tolarance or poop-out?

 

Went to hospital after first POTS like episode, ECG was fine and they gave me fluids which helped, but symptoms have persisted despite me drinking lots etc. Neither A & E doctors or GP were willing to venture any opinion and have just referred me to a 24 holter monitor (24hr ECG), but on the NHS I will be waiitng until end Jan 25. 

 

Yesterday I managed to get someone from the MINT team to see me after 2 weeks of being ignored, and it turned out the previous consulting pharmacist was back and has taken over my case again.

Her suggested solution is the same - start taking escitalopram at 10mg, see how that sits, then reduce Mirtazapine to 15mg, stabilise there, and slowly reduce mirt from there (though again not nearly as slowly as the Maudsely guidelines) while staying on the Escitalopram for at least 12 months.

My instinct is that this is a BAD idea, quite apart from Seratonin Syndrom drug interactions, as my system is super sensitive. Even on the occasions I have taken propranalol ad-hoc, (they prescribed me 40 3 times a day, 1x40 I was still feeling 3 days later, so i occasionally take 1/2 of one 10mg tablet). 

The difficulty is, there are literally no other options on the table. And my massively anti-pharma partner wants me to do it, because we can't maange if something doesn't change. My life is falling apart around me - I can't even go to the shops without feeling I'm going to collapse, I suddenly can't take my son to childcare, and work is suddenly almost impossible. I barely feel safe to be around my son at the moment as my system is on fire and I am triggered by everything, and a 3 year old is a noise, movement and physical interaction producing machine, on top of the late toddler power struggles!

 

I'm at a loss. I don't want to add more drugs into my  system, but if I don't work we don't eat, as the benefits system in the UK seems determined to screw anyone who is self-employed and not officially disabled. And I need to be able to look after my son - but at the  moment my previous tools of meditation, breathing exercises etc aren't even touching the sides. 

 

If I can get my system to settle I'm confident that I understand how to do a slow taper via the various methods, but if I have hit tolerance, I think I'm screwed. On top of that, the brand I'm on seems to only be available via one chemist within about 10 miles, and they've only 2 boxes of 30mg left - and the one occasion I changed brand in early July, I had 3 days of hell that immediately disappeared when I found my original brand. 

Head is spinning with the journey and the implications, so any wisdom that can land here would be great!

And assuming I don't go completely mad, I will update with progress!

 

[lomekian]

Hello - just wondering if I need to do anything else to get this approved?

[lomekian]

Hi there - I've done my intro - set up my signature after getting a reminder v soon afterwards on Tuesday, which I immediately did, but my intro topic is still waiting approval and is dropping down the pages. Is there is anything else I need to do in order to get it up and running, and to be able to post elsewhere? (there are a few informative topics I've read that I want to ask questions on 😉 )

[getofflex]

Hello, and welcome to SA.  We are a volunteer-run community of people who have been or are getting off of psychiatric drugs.  I'm sorry that you have been through all these issues with the psychiatric drugs.  We will try to help you unravel this, and come up with a plan to get out of this.  

 

Question: Prior to your nervous system going crazy at the beginning of December, did you have gradual improvements in your symptoms between May and November?  Even slight improvements count.  I know you mentioned poop-out, but you have not been on the drug all that long. I haven't experienced poop out myself, so I will see if we can get @brassmonkeyhelp, who has dealt with this personally.  

 

The other possibility, is that you are experiencing a wave because of your nervous system being destabilized by the previous drug changes.  Please read the information following, to understand more about how these drugs work, and what happens during withdrawal.  It will help you see that frequent/sudden psych drug changes can destabilize the nervous system.  It takes a long time to stabilize, and we can be OK for several months, and then experience a sudden onslaught of symptoms known as a wave.  

 

Here is some important information about how these drugs actually work.  This explains why we get symptoms from going off of these medications, and why it's so important to taper slowly and carefully, and be very cautious about changing our doses: 

 

How Psychiatric Drugs Remodel Your Brain

 

 

This helps you understand what withdrawal syndrome is: 

 

Video on Recovery from Psych Drugs

 

Windows and Waves Pattern of Stabilization

 

On 12/10/2024 at 9:21 AM, lomekian said:

Her suggested solution is the same - start taking escitalopram at 10mg, see how that sits, then reduce Mirtazapine to 15mg, stabilise there, and slowly reduce mirt from there (though again not nearly as slowly as the Maudsely guidelines) while staying on the Escitalopram for at least 12 months.

My instinct is that this is a BAD idea, quite apart from Seratonin Syndrom drug interactions, as my system is super sensitive.

 

I would tend to agree with you.  I have worked with many people on here who have been switched from one psych drug to another, and it almost always leads to worse problems, not improvements.  It's unfortunate that many/most doctors tend to depend so heavily on drugs, and are not aware of the dangers and pitfalls of them.  Making yet one more drug switch or adding one more drug is likely to further destabilize your nervous system, and make your symptoms worse.  

 

There is a possibility that you are experiencing a wave.   If you are in a wave, the thing to do is to be very patient, learn some non drug coping techniques, and hold steady on your current dose for a while, until the wave subsides.  Be very consistent with your medication - take the exact same dose each and every day, at the same time of day, never missing a dose.  Completely avoid alcohol and other mind altering substances!  These can trigger a wave.  Have you had any of these?  Many things can trigger waves - stress, weather changes, caffeine, sugar, unhealthy diet, too much exercise, changes in your routine, traveling, etc.  Have any of these happened recently?  Often a wave can appear without any outside trigger too.  

 

If you are in fact having poop out, then the thing to do is taper very slowly off the drug, using micro tapering techniques.  The only way out of poop out is to taper off the drug.  

 

Edited December 14, 2024 by getofflex

[getofflex]

Here is more information about withdrawal, and how to cope with it.  

 

Here is a link with checklists of common WD symptoms: 

 

Dr Joseph Glenmullen Withdrawal Symptom Checklists

 

 

Here are some techniques to cope with symptoms: 

 

Non Drug Ways to Cope with Withdrawal Symptoms

 

Stability is really important when we are tapering off psych meds.  Please read the link about stability:

 

Keep It Simple, Slow, and Stable

 

We don't suggest many supplements, but 2 that many of us find helpful are magnesium and omega-3 fish oil. Here are the links for info about those. It is suggested to add one at a time, and start with a low dose to see how it affects you. 

Magnesium

Omega 3 Fish Oil

 

Finally, here is information about tapering.  I suggest that you micro taper, since your system is very sensitive.  

 

Micro-Taper Instead of 10 or 5 Percent Decreases

 

Tips for Tapering Mirtazapine

 

 

[brassmonkey]

Hello and welcome to SA. I'm sorry to read that you are having such problems with your medications. It appears that your doctors have very little idea about how these drugs work and have been guessing about how to handle the situation.

 

Having been on the drugs for such a short time and having made so many changes it is pretty clear that you are not in poopout. What it looks like is an initial adverse reaction to the first drug, followed by a lot of switching around that has greatly confused you brain and body. You need to establish stability on one dose of one drug. I would not recommend changing to a new drug to cover the effects of the old one, that rarely works and frequently causes many more problems.

 

Please give us a bullet item time line of the different drugs and the doses you have been taking.

 

[lomekian]

2 hours ago, getofflex said:

Hello, and welcome to SA.  We are a volunteer-run community of people who have been or are getting off of psychiatric drugs.  I'm sorry that you have been through all these issues with the psychiatric drugs.  We will try to help you unravel this, and come up with a plan to get out of this.  

Thank you! 

2 hours ago, getofflex said:

 

Question: Prior to your nervous system going crazy at the beginning of December, did you have gradual improvements in your symptoms between May and November?  Even slight improvements count.  I know you mentioned poop-out, but you have not been on the drug all that long. I haven't experienced poop out myself, so I will see if we can get @brassmonkeyhelp, who has dealt with this personally.  

 

The other possibility, is that you are experiencing a wave because of your nervous system being destabilized by the previous drug changes.  Please read the information following, to understand more about how these drugs work, and what happens during withdrawal.  It will help you see that frequent/sudden psych drug changes can destabilize the nervous system.  It takes a long time to stabilize, and we can be OK for several months, and then experience a sudden onslaught of symptoms known as a wave.  

 

I did experience some improvement, partly due to enforced rest and time of work, both in May and early June, before a few minor waves of symptoms, and then particularly Aug-Sept when my minor concussion also forced me to take it easy, and I ramped up my non pharma anxiety approach - every day meditation, dietary improvement, more exercise etc, but I had bursts of anxiety symptoms and probably drug realted things like parasthesia etc in late Sept, through October and November, coming and going, before the end of November symptom explosion, which is like a more profound version of the withdrawal I had after 3 weeks on Sertraline, and broader and more profound than any of my pre-medication symptoms. 

Re the delayed wave, is it possible to be hit by the impact of 3 weeks on Sertraline at a low dose and then CT as much as 8 months later? I was on the higher Mirt dose for less than 2 weeks, and had no ill effects coming back down, and that was 7 months ago. 
 

2 hours ago, getofflex said:

 

I would tend to agree with you.  I have worked with many people on here who have been switched from one psych drug to another, and it almost always leads to worse problems, not improvements.  It's unfortunate that many/most doctors tend to depend so heavily on drugs, and are not aware of the dangers and pitfalls of them.  Making yet one more drug switch or adding one more drug is likely to further destabilize your nervous system, and make your symptoms worse.  

 

There is a possibility that you are experiencing a wave.   If you are in a wave, the thing to do is to be very patient, learn some non drug coping techniques, and hold steady on your current dose for a while, until the wave subsides.  Be very consistent with your medication - take the exact same dose each and every day, at the same time of day, never missing a dose.  Completely avoid alcohol and other mind altering substances!  These can trigger a wave.  Have you had any of these?  Many things can trigger waves - stress, weather changes, caffeine, sugar, unhealthy diet, too much exercise, changes in your routine, traveling, etc.  Have any of these happened recently?  Often a wave can appear without any outside trigger too.  

 

If you are in fact having poop out, then the thing to do is taper very slowly off the drug, using micro tapering techniques.  The only way out of poop out is to taper off the drug.  

 

 

I suppose the question is, how does one ascertain if its a Wave or Poop out in my circumstances? I'm pretty hot on consistency re dosage/timings, and never miss a dose. I also haven't drunk a drop in 2 years, and was hardly prolific before then, and have never touched anything significantly more mild altering than chocolate bars! 

Having never experienced what I am now before, I don't know if its a wave. I did have a couple of very stressful experiences prior to the real major crash, but both were isolated, and after the start of the creeping worsening of symptoms (itching, parasthesia, more broken sleep, GI issues). My bloods would suggest I was fighting off some kind of festive lurgy when things went really bad a fortnight or so ago, but that said, I never had any symptoms of anything bar the aforementioned symptoms.

I read up on brassmonkey's patented taper, and it seems eminently sensible to me. Ideally I want to start tapering yesterday, but I guess the crux is how to differentiate between a sudden large wave and poop-out, in order to determine the best course of action going forward....

[lomekian]

2 hours ago, getofflex said:

Here is more information about withdrawal, and how to cope with it.  

 

Here is a link with checklists of common WD symptoms: 

 

Dr Joseph Glenmullen Withdrawal Symptom Checklists

 

Already downloaded and started filling in the day by day in case i learn something!

 

2 hours ago, getofflex said:

 

Here are some techniques to cope with symptoms: 

 

Non Drug Ways to Cope with Withdrawal Symptoms

 

Stability is really important when we are tapering off psych meds.  Please read the link about stability:

 

Keep It Simple, Slow, and Stable

 

We don't suggest many supplements, but 2 that many of us find helpful are magnesium and omega-3 fish oil. Here are the links for info about those. It is suggested to add one at a time, and start with a low dose to see how it affects you. 

Magnesium

Omega 3 Fish Oil

 

Been taking Mag complex and Omega 3 for the last 18 months already - good to know they make sense! 

2 hours ago, getofflex said:

Finally, here is information about tapering.  I suggest that you micro taper, since your system is very sensitive.  

 

Micro-Taper Instead of 10 or 5 Percent Decreases

 

Tips for Tapering Mirtazapine

 

 

 

Thanks - for some reason the latter of these two links didn't work for me earlier in the week, but is now!

[lomekian]

1 hour ago, brassmonkey said:

Hello and welcome to SA. I'm sorry to read that you are having such problems with your medications. It appears that your doctors have very little idea about how these drugs work and have been guessing about how to handle the situation.

 

Having been on the drugs for such a short time and having made so many changes it is pretty clear that you are not in poopout. What it looks like is an initial adverse reaction to the first drug, followed by a lot of switching around that has greatly confused you brain and body. You need to establish stability on one dose of one drug. I would not recommend changing to a new drug to cover the effects of the old one, that rarely works and frequently causes many more problems.

 

Please give us a bullet item time line of the different drugs and the doses you have been taking.

 

Thank you!

As for bullet timeline - its the same as my signature:

Feb-Mar 2024: Sertraline 50mg - 2 weeks, Sertraline 25mg 1 week, CT on GPs advice

Mar-April 2024: Sertraline withdrawal for 3 weeks.

Start of April 2024: Mirtazapine 15mg - 3 weeks, 30mg 10 days

Early May 2024: Mirtazapine 22.5mg to present

I Can't remember the exact dates of each month, but I've only had Sertraline for a total of 3 weeks (Feb into March 24), and for the subsequent 8 months Mirtazapine at 15mg for 3 weeks, 30mg for 10 days, and 22.5mg Mirtazapine from approx end of first week of may. So only 2 medications ever, and the latter of which was a starter dose, a very short lived increase (less than 2 weeks) and a reduction to 1/2 way between the two doses by my 5th week on the medication, which has been stable for 7 months. Judging by the 2024 Maudsley guidelines, there should be v little difference in brain receptor occupancy between the 30mg & 22.5mg, and my understanding is that being on 30mg for only 10 days shouldn't be having such a big reaction from a relatively small decrease, delayed by 7 months. 

What gives me the thought of poop out is the progressive worsening of symptoms after a period of efficacy and stability. Based on what getofflex said, its possible that this is instead a pretty heavy wave, but I have no idea how to differentiate, and I'm disinclined to wait months hoping it resolves if there is a chance it is poop out. That said, most on here are certainly more experienced and knowledgeable than myself, so my mind is open to any wisdom available for sharing!

 

One thing that has also added to the symptoms in recent days is increased sensitivity to sensory input, which I presume is attributable to nervous system dysregulation as well.

[LostPhil]

Just wanted to wish you luck Lomekian. You've had a lot of stuff happening so try and take it easy and deal with one thing at a time where you can. I got off Mirt after being on it for 6 months or so at 30mg. It really knocked me around when I was on it and the withdrawal was tricky but doable. I hope you find some relief soon.

[lomekian]

8 hours ago, LostPhil said:

Just wanted to wish you luck Lomekian. You've had a lot of stuff happening so try and take it easy and deal with one thing at a time where you can. I got off Mirt after being on it for 6 months or so at 30mg. It really knocked me around when I was on it and the withdrawal was tricky but doable. I hope you find some relief soon.

Thank you - how did you taper? Your signature suggests a super quick taper. Did you have withdrawals long after that? How are you now?

[LostPhil]

Yeah I did taper pretty quick - I tapered basically as long as I was on it - 6 months. I just had to get off it - I was having akasathia (pacing, couldn't stay still) and felt completely dead inside - it was horrible. I did battle withdrawals that were really uncomfortable - incredibly tired, struggling to sleep initially, feelings of severe anxiety. That might have been exacerbated by the quick taper. WFH was a god send. I've been off it for about 2 and half years and definitely feel a lot better. But I still feel the effects of it - tiredness, general soreness in muscles, and sometimes feeling out of it or disconnected or weird and anxious all over my body. I feel like me being 50 makes it a bit slower to recover as your body doesn't have that same "rude health" and power. I try and ride the bad waves when they come knowing when I come out I'm even better yet again as that is definitely the pattern that plays out. When you feel like **** you think it will last forever but its the body flushing stuff out. I still don't feel like I'm the same, energetic person I was. But perhaps after another year or so  I'm hoping to have most of that fade away - cross fingers! 

[getofflex]

I seriously doubt you are having poop out. Brass monkey is very experienced with this, and is a senior moderator on the forum, and I would trust his input.  According to him, 

On 12/14/2024 at 2:28 PM, brassmonkey said:

it is pretty clear that you are not in poopout.

Not only that, you experienced some improvement between May and November.  This indicates that your nervous system is slowly stabilizing, which is a great sign, and is further proof that you are not in poop out.   

 

On 12/14/2024 at 4:25 PM, lomekian said:

Re the delayed wave, is it possible to be hit by the impact of 3 weeks on Sertraline at a low dose and then CT as much as 8 months later? I was on the higher Mirt dose for less than 2 weeks, and had no ill effects coming back down, and that was 7 months ago. 

I personally think it is possible.  You did a lot of switching around, and this confuses your brain, and it is not uncommon to have delayed reactions like this. It may also be that the shift into winter could cause a wave.  I would often get waves with changes in season.  

 

On 12/14/2024 at 4:25 PM, lomekian said:

I did have a couple of very stressful experiences prior to the real major crash, but both were isolated, and after the start of the creeping worsening of symptoms (itching, parasthesia, more broken sleep, GI issues).

There you go.  Stress is a major cause for a wave.  I know it certainly is for me, and most of us on here.  The start of the creeping symptoms could have been caused by winter starting, or some other unknown factor, and then the 2 very stressful experiences probably really ramped up the wave.  When our nervous systems are sensitized, any little thing can trigger a wave.  

 

On 12/14/2024 at 4:25 PM, lomekian said:

read up on brassmonkey's patented taper, and it seems eminently sensible to me. Ideally I want to start tapering yesterday

I strongly suggest you give yourself some time to stabilize and come out of this wave before you commence tapering.  You will set yourself up for failure if you try to taper while you are in a wave.  I would give myself a couple of months, at least, if not longer.  Wait until you have stability for at least 2 weeks before doing any reductions. 

Edited December 17, 2024 by getofflex

[lomekian]

10 hours ago, getofflex said:

I seriously doubt you are having poop out. Brass monkey is very experienced with this, and is a senior moderator on the forum, and I would trust his input.  According to him, 

Not only that, you experienced some improvement between May and November.  This indicates that your nervous system is slowly stabilizing, which is a great sign, and is further proof that you are not in poop out.   

 

I personally think it is possible.  You did a lot of switching around, and this confuses your brain, and it is not uncommon to have delayed reactions like this. It may also be that the shift into winter could cause a wave.  I would often get waves with changes in season.  

 

There you go.  Stress is a major cause for a wave.  I know it certainly is for me, and most of us on here.  The start of the creeping symptoms could have been caused by winter starting, or some other unknown factor, and then the 2 very stressful experiences probably really ramped up the wave.  When our nervous systems are sensitized, any little thing can trigger a wave.  

 

I strongly suggest you give yourself some time to stabilize and come out of this wave before you commence tapering.  You will set yourself up for failure if you try to taper while you are in a wave.  I would give myself a couple of months, at least, if not longer.  Wait until you have stability for at least 2 weeks before doing any reductions. 

Thanks for the response!
 

Having never had a major wave before, I don't recongnise what I am experiencing. Its like the sertraline withdrawal, the impact of the inital pre-med trauma, seasonal illness and the worst I've ever been prior to the start of my 'anxiety' all rolled into one, with some extra nasties in there for good measure. I am FAR sicker now than I have been at point in the past, both physically and in terms of mental stability, and my fight or flight is permenantly on max. Its debilitating, terrifying and none of my prevous nervous system practices are making any difference. To suddenly go from almost 10k steps a day to barely being able to walk to the shops without a nervous system freak out that leaves me on the floor for the rest of the day is overwhelming.

I was theorising poop out because I couldn't understand why a wave would be so so much more wide ranging and potent than my brief acute sertraline WD, and so much worse than my initial problem. That and the slow creeping of symptoms from end Sept that I couldn't find any explanation for. 

But then, on the contrary, one thing I had noticed previously with this medication is that it has been great for getting more sleep, and taking the edge off the little mundane stresses when things are going well, but any shock to the system is significantly amplified compared to where I was pre-medication. 

Based on what you and Brass Monkey have said, I'll see if things stabilise over the next couple of months before making any decisions - given the time to taper, and extra few weeks won't make a huge difference at this stage! Just got to work out how to keep the docs on-side without shoving more meds down my neck, so I can keep getting the mirtazapine. Annoyingly my pharmacy only has 2 boxes left of the same brand, which seems to have vanished from everywhere else, so there is another shock to the system likely coming down the road. I'm hoping things stabilise enough that I can reduce some before having to take another brand, but we shall see.

Thank you again for your time, and I shall slowly devour the rest of the resources you pointed me to!

[lomekian]

I hope you are all too busy having positive festive periods to read this, but will be grateful for any thoughts when it is seen!

 

Following on from above, symptoms are getting worse day by day - been pretty bed-ridden this week. Been totally unable to participate in Christmas, which has been very depressing, and is not great for my three year old son.

 

Waking up with panic every morning, at least one proper panic attack every day, lots of air hunger, exhuastion, very broken sleep, nausea, stomach upset, huge sensitiveity to sensory input, especially sound, people moving around or screens, occasional visual disturbances, POTS like symptoms upon standing, sudden huge exercise intolerance, slightly tremoring hands, stiff fingers, random shooting electiric shock like pains especially to elbow, bouts of sudden crying out of nowhere, headaches, itching every night, regular involuntary body shivers, temp regulation gone haywire, random muscle aches, sudden random muscle contractions, particularly in chest, reflux like symptoms in throat despite careful eating, sore throat, allergy like feeling in eyes and nose at times, random pins and needles.

Many of these symptoms I never had before medication, and at least half I haven't had before the last 5 weeks. 

Waiting for things to stabilise, but its literally significantly getting worse week on week, and I've not experienced anything like this before. Hard not to let the mind start creating explanatory scenarios....

[getofflex]

First of all, have you missed or skipped any doses, varied the doses, or taken it at different times of day?  

 

Have you had any alcohol at all, or any other mind altering substances, any major routine changes, any new stressors, any traveling, any weather or climate changes, etc?  

 

Have you had any illnesses, or started on any new drugs or supplements, or hormones, etc?  Any recent medical treatments of any kind?  

 

I would strongly suggest you start keeping a daily drug/symptom journal, to see if you may be having an adverse reaction to the mirtapazine 22.5 mg.  According to your signature, you have been on 22.5 mg from May 2024 until now?  Is this correct?  If not, please change your drug history accordingly.  Keep track of taking your drug, symptoms, eating, sleeping, etc.  Write the time on the left, and describe the event on the right.  Pay attention especially to how you feel before, and then after, you take your drug. Please do this for 24 hours, and post an entry in here for each 24 hour period.  Here is an example: 

 

January 31, 2023

6 AM woke with anxiety

8 am took 2.5 mg lexapro

10 am stomach is upset

10:30 am ate breakfast

11:35 am got a headache, lasted one hour

12:35 ate lunch

4 pm feel a bit better

5 pm took 2.5 mg lexapro

6 pm ate dinner

9:20 pm headache 

10:00 pm took 50 mg Seroquel

10:30 pm feeling dizzy

10:30 pm fell asleep 

2:30 am woke, took 3 mg Ambien

2:45 am fell asleep

4:30 am woke, but got back to sleep 

 

Please do this each day for at least 4 or 5 days.  We will see if we can find a pattern. 

 

Also, you might consider seeing a doctor to see if something else is going on medically.  

Edited December 26, 2024 by getofflex

[lomekian]

15 hours ago, getofflex said:

First of all, have you missed or skipped any doses, varied the doses, or taken it at different times of day?  

 

Have you had any alcohol at all, or any other mind altering substances, any major routine changes, any new stressors, any traveling, any weather or climate changes, etc?  

 

Have you had any illnesses, or started on any new drugs or supplements, or hormones, etc?  Any recent medical treatments of any kind?  

 

I would strongly suggest you start keeping a daily drug/symptom journal, to see if you may be having an adverse reaction to the mirtapazine 22.5 mg.  According to your signature, you have been on 22.5 mg from May 2024 until now?  Is this correct?  If not, please change your drug history accordingly.  Keep track of taking your drug, symptoms, eating, sleeping, etc.  Write the time on the left, and describe the event on the right.  Pay attention especially to how you feel before, and then after, you take your drug. Please do this for 24 hours, and post an entry in here for each 24 hour period.  Here is an example: 

 

January 31, 2023

6 AM woke with anxiety

8 am took 2.5 mg lexapro

10 am stomach is upset

10:30 am ate breakfast

11:35 am got a headache, lasted one hour

12:35 ate lunch

4 pm feel a bit better

5 pm took 2.5 mg lexapro

6 pm ate dinner

9:20 pm headache 

10:00 pm took 50 mg Seroquel

10:30 pm feeling dizzy

10:30 pm fell asleep 

2:30 am woke, took 3 mg Ambien

2:45 am fell asleep

4:30 am woke, but got back to sleep 

 

Please do this each day for at least 4 or 5 days.  We will see if we can find a pattern. 

 

Also, you might consider seeing a doctor to see if something else is going on medically.  

Not skipped any doses, varied any, and biggest time difference has been about 30 mins. 

 

No illnesses I'm aware of, no new drugs or new suppliments or medical treatments. Would have ingested a tiny bit of alcohol from Xmas cream, but probably less than 1 unit.

 

Yes at 22.5mg since May 2024 until now. I have noticed of late (last fortnight) a more immediate sedative effect from the medication when I take it at 8pm ish in the evening. And have been waking with terrible morning anxiety every morning

Have started writing diary and will upload

[getofflex]

3 hours ago, lomekian said:

Not skipped any doses, varied any, and biggest time difference has been about 30 mins. 

 

That's good.  

 

3 hours ago, lomekian said:

Would have ingested a tiny bit of alcohol from Xmas cream, but probably less than 1 unit

I believe that is roughly 2 teaspoons.  It is possible this could further upset a hypersensitive nervous system.  I would completely avoid all alcohol.  It is notorious for causing problems in destabilized nervous systems.  

 

And you are completely off sertraline since March 2024 correct? 

 

I suspect you may be dealing with recovering from an adverse reaction to sertraline, and perhaps complicated by a current adverse reaction to mirtazapine.  You seemed to have an adverse reaction to mirtazapine when you were on the 30 mg.  You reported anxiety and panic.  

 

When we see your notes, it will help us determine if you are having and ADR (adverse reaction).  We will take it from there.  I hope you have someone to help you take care of your young child.  

Edited December 27, 2024 by getofflex

[lomekian]

2 hours ago, getofflex said:

 

 

And you are completely off sertraline since March 2024 correct? 

YES!

 

I suspect you may be dealing with recovering from an adverse reaction to sertraline, and perhaps complicated by a current adverse reaction to mirtazapine.  You seemed to have an adverse reaction to mirtazapine when you were on the 30 mg.  You reported anxiety and panic.  

 

When we see your notes, it will help us determine if you are having and ADR (adverse reaction).  We will take it from there.  I hope you have someone to help you take care of your young child.  

26th into 27th notes:

 

Dec 26th 27th, 2024

 

Mirtazapine 22.5mg 8.15pm - within 10-15 mins more tired/relaxed

Sat with son till he fell asleep (approx 9.30). 

9.30 -Ate aforementioned alcohol infused cream Then read a light book till 11.

Lights out attempt to sleep 11pm on 26^th

Fell asleep sometime between 12.30 & 1 ish am

Woke at 2, 4 and a bit later but not for more than 20 mins at a time. Nothing particular of note

7 AM woke, but dozed & fell back asleep about 8 ish

10 am woke fully with strong anxiety (HR lying down at 103) air hunger - Did breathing exercises to calm my system

10.30-11.30 am - still in bed but feeling huge sensory overwhelm - noise of family even through closed door hugely triggering - during this time drank 500ml of water. Very stiff muscles.

11:30 am at some almonds, paid a bill online - couldn't open my parcel as felt too overwhelmed sensorially.

12:00 noon ate a banana - just entering the room of other people made me feel totally overwhelmed.

12-12:30 - did a meditation - found it hard but it helped

12.30 - went downstairs to collect an envelope - feel the desire to escape – v shaky

12.45-1.45 - felt so bad had to stay in bed. huge anxiety, sensory overwhelm, headache, pins and needles. Feeling of mild pressure behind left eye. Mild Electric shock feelings in fingers and toes at random. Nausea, really feeling the fear and not knowing what to do. Audible moaning. Neck and shoulder muscles like rocks! Chills for about 5 mins.

1.45 – everyone else went out so made camomile tea, porridge (oatmeal) and hotwater bottle. Checked this forum. Slight tremoring hands on keyboard, slight stomach upset after porridge. HR going up to approx. 120 on standing/ walking. Low 90s when sitting (until last few weeks this would be mid to high 80s standing and mid 70s sitting).

2.30pm – Felt a little sick after eating. Physical symptoms less intense.

3-4.30 – in bed – headache and eye discomfort worse, feeling of stiffness in hands and fingers

4-30 – attempted a meditation, but body sensations pulled me out of it

5pm – tried to get up and do stuff, but incredibly emotional – weeping for 10 mins.

6.30pm – ate dinner – salmon, steamed and roast veg – felt a little dizzy and nausea the whole time and afterwards. Probably as much to do with being in a well lit room with other people talking.

7.30pm – had to withdraw as dizziness etc too great and heart started racing and had to really focus on breathing

8pm Mirtazapine at 22.5mg

Will attempt to sleep approx. 9.30 (after son goes to sleep)

[getofflex]

These are excellent notes @lomekian.  Thanks for doing this.  

 

I would like you to try and pay especially close attention to how you feel in the several hours after you take your mirtazapine.  How do you feel before you take it, and how do you feel after you take it?  Please post this info in your notes.  Keep doing the notes each and every day, and post them in here - 1 post for each 24 hour period.  

 

I'm wondering if you are getting enough calories?  I know the nausea and symptoms make it hard to prepare food and eat, but low blood glucose can trigger the release of adrenaline and cortisol.  These 2 hormones are the flight or flight activating hormones, and in a destabilized nervous system this could trigger anxiety, and other symptoms of activation.  Sometimes at night I wake up in the middle of the night somewhat hungry, and can't go back to sleep until I eat an ounce of nuts.  Nuts are good, because the fats and proteins help to stabilize blood sugar.  You may want to add a whole grain to your salmon and veggies.  The salmon is very good, the omega-3 are good for your nervous system.  If your eating times are the same each day, you are fasting for a full 17 hours, which could cause your blood sugar to tank.  I suggest you try to eat some light meals/snacks every few hours, and see if this helps, especially in the middle of the night or early in the morning.  Almonds, banana, oatmeal, salmon, and veggies - this is only about 600 to 800 calories a day, probably not enough for an adult.  

 

Again, I strongly suggest you stop the alcohol infused cream.  This could very well be contributing to your problems.  

 

We will look at your notes again tomorrow and over the next few days.  Hang in there, we will walk through this with you.  In the meantime, here are some things to try for the anxiety and panic.  Especially listen to the Claire weekes material, she is very helpful.  Just remember this is only temporary, and someday, if you take proper care of yourself, and try to stay off the drug merry go round (don't go on the escitalopram the doc suggests, or other drugs), you will overcome this.  

 

video: Claire Weekes: Managing Anxiety

 

 

video: Claire Weekes on Anxiety and Panic

 

Claire Weekes - Hope and Help for you Nerves Audiobook  

 

Emotional Spirals

 

Acknowledge Accept Float

 

Music to Calm Anxiety

 

Breathing Technique for Anxiety

 

Anxiety Stuff - all kinds of stuff about anxiety attacks and things that help ...

 

Audio:  First Aid for Panic (4 minutes) Female voice - getselfhelp.co.uk

 

Audio:  First Aid for Panic (4 minutes) Male voice - getselfhelp.co.uk

 

Meditation

[lomekian]

11 hours ago, getofflex said:

I would like you to try and pay especially close attention to how you feel in the several hours after you take your mirtazapine.  How do you feel before you take it, and how do you feel after you take it?  Please post this info in your notes.  Keep doing the notes each and every day, and post them in here - 1 post for each 24 hour period.  

 

I'm wondering if you are getting enough calories?  I know the nausea and symptoms make it hard to prepare food and eat, but low blood glucose can trigger the release of adrenaline and cortisol.  These 2 hormones are the flight or flight activating hormones, and in a destabilized nervous system this could trigger anxiety, and other symptoms of activation.  Sometimes at night I wake up in the middle of the night somewhat hungry, and can't go back to sleep until I eat an ounce of nuts.  Nuts are good, because the fats and proteins help to stabilize blood sugar.  You may want to add a whole grain to your salmon and veggies.  The salmon is very good, the omega-3 are good for your nervous system.  If your eating times are the same each day, you are fasting for a full 17 hours, which could cause your blood sugar to tank.  I suggest you try to eat some light meals/snacks every few hours, and see if this helps, especially in the middle of the night or early in the morning.  Almonds, banana, oatmeal, salmon, and veggies - this is only about 600 to 800 calories a day, probably not enough for an adult.  

 

Again, I strongly suggest you stop the alcohol infused cream.  This could very well be contributing to your problems.  

 

We will look at your notes again tomorrow and over the next few days.  Hang in there, we will walk through this with you.  In the meantime, here are some things to try for the anxiety and panic.  Especially listen to the Claire weekes material, she is very helpful.  Just remember this is only temporary, and someday, if you take proper care of yourself, and try to stay off the drug merry go round (don't go on the escitalopram the doc suggests, or other drugs), you will overcome this.

Will do.
 

Recently I have noticed the Mirt has been making me feel slightly more relaxed and tired quite soon after taking it, more so than before the last few weeks. Will continue to post.

 

Eating is a bit sporadic, but I think I'm normally getting enough or close to enough calories. Normally would have brown rice as well, but there were a lot of left over xmas veg! Certainly having a breakfast and one big meal a day and snacking in smaller quanitities around that. Until last few days have been pretty solid 3 meals a day. Burning through my almond and hazelnut stores! apart from yesterday, typically my fast is about 12-13 hours overnight, but I could easily experiment with making that less. I have most days (not yesterday) been taking omega-3. Last night I tried not taking that or the magnesium to see if any difference, but none noted so far.

 

re alcohol infused cream only had on 25th & 26th. No more alcohol will touch my system - been avoiding xmas pudding etc. Possible I'm even more succeptible as was off alchohol even before I started Mirt. 

 

Thanks again for the feedback, the consideration, and the resources.

 

[getofflex]

On 12/14/2024 at 4:25 PM, lomekian said:

I did have a couple of very stressful experiences prior to the real major crash

I suspect that this may have a lot to do with your symptoms.  Stress can really mess with a destabilized nervous system.  Even 2 years off the drugs, when I get hit with extra stress, I tend to go in a mild wave.  

 

Let me know if eating snacks overnight helps you.  I will look forward to seeing more of your daily journals.  So far, I don't see evidence of an adverse reaction, but then I've only seen one journal.  It is possible that you are in a wave from the big stressors you've had recently.  Hopefully the links I gave on anxiety will help you. 

[lomekian]

Evening 27^th-28^th

Pre taking mirtazapine – (7.30pm-8pm) – dizziness and racing heart from overstimulation. Had to go and sit on my own. Managed to calm by 8pm

8pm  - Mirtazapine 22.5mg

8.30pm already a bit calmer, but possibly partly because some visiting family had gone to bed.

9.30pm -  had sat with son till he slept, listening to football on headphones. System slightly ‘up’ (ie slightly on edge, slightly elevated heart rate) which continued until.

10.15pm – Mirt munchies – ate 2 small pieces of baklava, a small bowl of salty popcorn and a gluten free biscuit.

11pm – partner joins in bedroom – try to go to sleep. Body still a little activated – lying down resting HR about 70 ish as opposed to 60. Finally fell asleep approx. 1am

Woke up several times for brief periods at about 2.30, 4 & 5.30. Nothing of note.

Woke up properly at 7ish. Mostly just felt super tired. Tried to get back asleep until 9am, but no joy.

9am – MORNING PANIC! Not as much panic and air hunger as day before, but heart rate 90-100bmp lying down. Slowly built until 9.30. Sore throat

9.30am-10.15am – did breathing exercises in bed (lying first then sitting). Helped a little, but still felt panicky with Slightly elevated HR when got breakfast

10.20 – Bowl of low fat Icelandic yoghurt, granola & touch of honey + lemon and ginger. Strong sense of sensory overload with lights and couple of conversations happening. Had to leave the room after breakfast

11am mild nausea, slight shakiness. HR still 15-20bpm above baseline.

11.30 – checked in on this forum as felt my system starting to calm.

11.45 – started a meditation on the floor – chills, pins and needles, random body shudders

12.30-1.30  chills still coming and going, nausea returned, sensory overload returned so have to close eyes. HR back up to 15-20bpm above baseline, worse when standing.

2.40 – really feeling on edge, POTS symptoms when standing – ate small banana, apple and handful of nuts and 2 herbal teas. 1 omega 3 capsule

3-4.00 felt a bit better after Vagus Nerve exercises – was able to hang out with my son and extended family until became overwhelmed after an hour.

5.15 learn a new breathing exercise and practiced for 20 mins – felt a little calmer afterwards though system still activated.

5.45 – eat – 2 fishcakes, broccoli, carrots, green beans. Was then able to watch most of a film with my son until 7

7pm – system quite activated, anxiety, muscle twinges, minor heart rate increase

7.40-8.25 – was able to give my son a bath, but had to be rescued for an overwhelm break half way through as had racing heart, shallow breath and inability to tolerate noise

8.30 – took 100mg of L-Theanine that had been suggested to help with morning anxiety.

9pm – hour later than normal – Mirt 22.5 – feeling quite anxious physically and stiff muscles before taking it. By 9.30 felt a little calmer, but may also be because my son fell asleep! Aching toe on right foot for started…

9.30 took 80mg of Wild Nutrition Magnesium (Citrate), with a gluten free cookie, handful of almonds & cup of chamomile & vanilla tea.

[lomekian]

7 hours ago, getofflex said:

I suspect that this may have a lot to do with your symptoms.  Stress can really mess with a destabilized nervous system.  Even 2 years off the drugs, when I get hit with extra stress, I tend to go in a mild wave.  

 

Let me know if eating snacks overnight helps you.  I will look forward to seeing more of your daily journals.  So far, I don't see evidence of an adverse reaction, but then I've only seen one journal.  It is possible that you are in a wave from the big stressors you've had recently.  Hopefully the links I gave on anxiety will help you. 

Entirely possible - however, I was getting a worsening of symptoms prior to stressors, and current wave far far worse than anything prior to or previously during medication, which were not without stressors. Thanks again for taking the time with this

[getofflex]

It could be a perfect storm of you already going into a wave, and then the 2 big stressors could have caused the wave to be extra bad. 

 

So far, I don't see any evidence in your notes of you having an adverse reaction to your mirtazapine.  Overall, on average, would you say you feel better, worse, or the same in the several hours after you take it?  Just a very brief answer to this please, not detailed explanations.  

 

Great job on the notes!  Very detailed yet concise.  Hope you can get some better sleep the next night.  I'm glad to see you using non drug coping techniques and eating a healthy diet.  Please keep doing the notes. 

 

Have you been doing any other techniques for the anxiety and overwhelm besides the breathing techniques? 

[lomekian]

14 hours ago, getofflex said:

It could be a perfect storm of you already going into a wave, and then the 2 big stressors could have caused the wave to be extra bad. 

 

So far, I don't see any evidence in your notes of you having an adverse reaction to your mirtazapine.  Overall, on average, would you say you feel better, worse, or the same in the several hours after you take it?  Just a very brief answer to this please, not detailed explanations.  

 

Great job on the notes!  Very detailed yet concise.  Hope you can get some better sleep the next night.  I'm glad to see you using non drug coping techniques and eating a healthy diet.  Please keep doing the notes. 

 

Have you been doing any other techniques for the anxiety and overwhelm besides the breathing techniques? 

I would say on average I feel slightly calmer just after I take it. The positive impact on my sleep has been declining for some time, and for abut 10 days the morning panic has been far worse than I have previously experienced. Hard to comment on several hours afterwards, as I'm either asleep or awake but in bed with zero triggers.

 

Sleep still broken. Morning panic this morning was really bad - nuked me for about 4 hours and woke up in a panic attack. Maybe because I had sugar before bed? Determined to try to avoid any more chemicals if possible. There may be days when I need to take a 10mg propranalol (or more likely half a pill 5mg) if I need to be functional, but there is always a catch up cost. 

 

Re anxiety and overwhelm still trying to learn new techniques, but hard due to last 10 days massive increase in screen intolerance and sensory overwhelm. Meditating every day, breathing exercises, tried a few visualisations. Hard when the body is freaking out 75% of the time I'm awake at the moment. old favourites like the 5-4-3-2-1 never really work for me.

 

Annoyingly since the onset of POTS like symptoms at the start of Decemeber, I can't really do any exercise bar gentle stretching and floor work.

 

Its only really the POTS like symptoms, the sensory overwhelm and the hardcore morning panics that don't want to subside that have me freaking out as both are proving very debilitating and I hadn't expereinced these before this month. I'd had morning panics before but not as bad and only occasionally and usually linked to obvious bad sleep or particular stresses. Certainly before medication I'd never had anything like this.

[Erimus]

What time do the morning panic episodes usually occur?

 

If it’s not til around 9am I’m thinking it’s more likely that is when the mirtazapine wears off.

I take mirtazapine at 9pm and tend to feel a bit better until around 1130 the next day, at which point it wears off and I’m returned to hell with severe sertraline side effects.

Edited December 29, 2024 by Erimus

[lomekian]

30 minutes ago, Erimus said:

What time do the morning panic episodes usually occur?

 

If it’s not til around 9am I’m thinking it’s more likely that is when the mirtazapine wears off.

I take mirtazapine at 9pm and tend to feel a bit better until around 1130 the next day, at which point it wears off and I’m returned to hell with severe sertraline side effects.

Interesting - usually between 7.45 and 10 am, not always the same time. That said, if it is when Mirt is wearing off, that may mean its wearing off sooner than before? Or it could be that at 22.5mg I get more of the noroadrenaline in the morning than if I was on a lower dose of say 15mg?

[Erimus]

38 minutes ago, lomekian said:

That said, if it is when Mirt is wearing off, that may mean its wearing off sooner than before?

Not necessarily, you'll find that some days/mornings are just worse than others. There's no rhyme or reason for it, it's just the way the nervous system heals from these drugs.

[lomekian]

43 minutes ago, Erimus said:

Not necessarily, you'll find that some days/mornings are just worse than others. There's no rhyme or reason for it, it's just the way the nervous system heals from these drugs.

Fair enough - its just that I've gone from almost zero morning panic to hardcore morning panic every day literally overnight with no other changes or events. Hopefully it will ease up soon!

[lomekian]

28^th-29^th

9pm – hour later than normal – Mirt 22.5 – feeling quite anxious physically and stiff muscles before taking it. By 9.30 felt a little calmer, but may also be because my son fell asleep! Aching toe on right foot for started…

9.30 took 80mg of Wild Nutrition Magnesium (Citrate), with a gluten free cookie & cup of chamomile & vanilla tea.

10.30-11pm – partner snoring so ended up getting up and foolishly giving into Mirt Munchies – had some salted popcorn, a couple of posh chocolates and about a small cup’s worth of ice-cream. Finally fell asleep shortly after midnight. A bit fitful at first

1.30-6.30 – Slept pretty soundly as far as I can tell, disturbed by nocturnal invasion by son at 6.30am!

 

8am – woke properly, was just waking naturally then disturbed by partner’s parents struggling with front door lock. 8AM-10.30AM – racing heart, air hunger, body aches, muscle cramps, sore throat, full body shivers/shudders.

 

11am -  had to give my son a bath, so only had time to grab a handful of nuts and a large glass of water. Smaller panic attack during bath, after which I had to sit quietly in his bedroom look and breathe first with eyes closed and then looking out the window for about 30 mins.

 

12 noon – family go out – already feel a bit better with the absence of any noise/sound. Bowl of bran flakes and milk, lemon and ginger tea. Feel pretty beaten up and can only look at computer (including this thread!) for about 30 mins before headache starts. Handful almonds.

 

2pm to 3pm – 20 mins of limited symptom panic attack, followed by lessening panic but lots of unpleasant sensations (muscle twingers, chills in legs, achy toes/fingers) – breathed through it and was able to function a bit better by 3pm.

3.30 – large noodle and mixed veg soup.

4-5.30pm – got involved in doing something complicated – HR elevated by 30-40bpm during task, culminating in a panic attack. Took me another 45 mins to bring my body and HR back down.

6.15 – Rice, ham and veg and with a glass of orange juice. Still feeling shaky, and a bit wobbly when walking

6.30-7.30 was able to watch tv with my son until my headache got too bad. Did the washing up but POTS-like symptoms meant I felt achy and tired afterwards.

 

 8.10 Mirtazapine 22.5mg. Felt tired and achy beforehand, and still a bit activated

 

8.25 – immediate headache after mirt and increase in tiredness, slight drowziness – mad that I’m starting to feel it so quickly now

[getofflex]

Lomekian, I think Erimus has a very good insight about the mirtazapine wearing off, and then your sertraline adverse reaction/withdrawal symptoms become unmasked.  

 

I do not see any evidence that you are having an adverse reaction to mirtazapine.  I believe you are probably dealing with a sertraline adverse reaction, and the symptoms are mainly from that.  Unfortunately, these can take many months to resolve, even if you were only on the sertraline for 3 weeks.  Here are some links about adverse reaction, and recover from it.  

 

Adverse Reaction and Recovery

 

Adverse Reaction

 

Since you were on the sertraline 3 weeks, it is possible your brain was partially dependent on it, and there is a withdrawal component in here as well.  

 

I encourage you to continue to do the daily journal, and post them in here.  Stick to a healthy diet, and eliminate sugary and processed foods.  This will help.  Continue to completely avoid alcohol, and any other mind altering substances.  I just want to reassure you that this is only temporary!  I think you are a trooper, which is an expression we use in USA to mean someone who is courageous and has a good attitude in the face of adversity.  It's good that you are using some non drug techniques to help with the panic and anxiety and overwhelm.  You might check out some of the Claire Weekes links I gave you.  Her ideas are very simple and easy to use, and effective.  Take care, and hang in there!  

[lomekian]

29^th/30^th

8.10pm Mirtazapine 22.5mg - Felt tired and achy beforehand, and still a bit activated

8.25pm – immediate headache after mirt and increase in tiredness, slight drowsiness – mad that I’m starting to feel it so quickly now

 

10pm went to bed, had ovaltine, couldn’t sleep

11pm got up, ate a croissant and drank some water

 

Fell asleep between 12.30 and 1am – had a couple of brief wakings after that, but only shortlived.

 

Woke by son at about 7.15am, fell back asleep about 8.30am

 

9.45 am Had a very stressful dream and woke with HR at about 100 ish lying down (normally 60-70), felt fairly calm mentally despite body’s best attempts to get me anxious! Drank a cup of water.

 

11am got up – body still quite activated, and immediately worse on rising due to POTS like symptoms (where sometimes HR shoots up to 120+ on standing and stays 110-125 when it would normally be mid-high 80s). Ate LARGE bowl of cereal at about 11.45, with cup of ginger tea

 

12.15-1.45 – ‘watched’ tv with my son, largely eyes closed as too stimulating otherwise. Had to do subtle breathing exercises periodically. Muscle cramps and twinges, occasional body shivers, cold and slightly stiff hands and feet, occasional pins and needles.

 

1.45 too overwhelmed sensorially – went to sort out some laundry but found it very difficuly. Sat on floor and had a little cry.

 

2.10 checked emails and this forum. Headache. After this felt shaky, nauseous, tired, tense everywhere – HR remaining a bit elevated

 

2.45-4pm – as with most days, (not yesterday!) body a little calmer mid afternoon – still not ‘normal’ but bar a few muscle cramps, the odd body shiver, sore throat, mild headache and still some POTS like symptoms on standing, not too bad!

 

4pm – Ate an apple, a banana, a handful of pecans and a handful of almonds

 

4-6.30 pm – managed to play with my son and his toys for the first time in a week, but felt utterly exhausted afterwards – then I had to give him a bath, which was triggering at times, but I got through it. Nervous system a bit activated afterwards (v much tired & wired) and a bit nauseous.

 

7pm – had to change my son’s nappy – he was not up for it (and tired) and started losing it, kicking, biting etc – I managed to stay calm through it, but afterwards my system went nuts a bit – HR up by 20bmp sustained, sore throat, nausea, muscle pain.

 

7.30pm – Pasta/pesto, broccoli, bacon. No reaction to food!

 

8.45 later taking mirtazapine 22.5mg tonight due to toddler having a meltdown (over tired methinks!). Still a bit activated beforehand, but largely over-tired. No immediate reaction to taking it bare a slightly weird sensation in my legs that I can’t quite describe (probably muscles either contracting slowly or relaxing slowly!)

 

9pm - a gluten free oaty biscuit!

 

So a better day but with some rubbish bits, and still worse than I was a 10 days ago, let alone a month ago.

[lomekian]

And for clarity  - I don;t think my sertraline experience would count as a traditional adverse reaction, as it wasn't immediate or even on teh first few days, but I did have a lot of the less serious side effects both during the 3 weeks and subsequently (particularly crippling insomnia) until I was clubbed to sleep by mirtazapine! 😉 

[lomekian]

30th/31^st

 

8.45 later taking mirtazapine 22.5mg tonight due to toddler having a meltdown (over tired methinks!). Still a bit activated beforehand, but largely over-tired. No immediate reaction to taking it bare a slightly weird sensation in my legs that I can’t quite describe (probably muscles either contracting slowly or relaxing slowly!)

 

In bed by 10.30 (little one took ages to go to sleep)

 

Finally fell asleep a little after 12am

 

Woken up by toddler invasion at 4ish – basically didn’t sleep properly after that.

 

8.30 am all the lovely symptoms kick in – excited HR, stiff fingers, chills, sore throat, blocked nose, periodical body shivers/shudders, general shakiness, random but unustained anxious thoughts

Breathed through the HR, but everything else stayed present.

 

10.45am – got out of bed, drank 0.5L of water, morning bathroom stuff, handful of almonds

 

11.15am – about to have breakfast but had a phone call from mental health team who decided I couldn’t have a face to face appointment any more – I put pharmacist in holding pattern re her wanting to give me more drugs, telling her that I should wait for outcome of 24hr heart monitor (re POTS like symptoms). I did tell her about rapid worsening of situation, and asked for some advice. She just said keep taking the meds and wouldn’t let me tell her my symptoms. Apparently I’m on my own until I get the 24 hr monitor in 4 weeks and even then the only offer is more drugs. This conversation and the way I was treated led to a surge in anxiety, not helped by my partner telling me ‘what did I expect?’ and that my illness 'was affecting my son too much so that if things don’t improve soon, I either need to find a drug free rehab place or somewhere else to live for the moment'.

 

12.00 - breakfast – large bowl of bran flakes – did washing up & put laundry on.

 

12.15-1.45 ‘watched’ TV with son. Felt body relaxing a little with the odd body shiver, finger/hand stiffness, cold feet.

 

1.45 – tried to get son to do some colouring/drawing – he acted up a bit, with mini-tantrum, which brought my stress level shootingup

 

2pm suddenly hit with a wave of new symptoms – eye pain, a slight burning sensation in forehead and near eye, booming headache. Nausea, dizziness and shakiness also kicked in. Felt like brain short circuited – had to just go in quiet room and put in ear plugs and close eyes for 40 mins

 

3pm – chickpea and turmeric soup and 2 slices of bread

 

3.30 was able to take bins out to bin store, but had an elevated HR on the way back and felt tired afterwards. More laundry!

 

4-5pm gave my son a bath – found the sensory input overwhelming towards the end, but was able to breathe through it – Lots of random body/muscle aches though

 

5.20pm – started to do some reading on PC – after about 20 mins brain felt fried so had to stop

 

7pm – cooked -  had battered cod, potato wedges and green veg. Herbal tea. Tv was on as family were watching a film and sensory overload had me feeling nauseous and dizzy.

 

7.30pm was able to ‘watch’ a half hour kids programme with my son. That was followed by pijamas tantrum and poo explosion, so I was v stressed by 8!

 

 

8.30 mirtazapine 22.5mg – beforehand tired but wired. Waves of v negative emotions – feeling pretty hopeless and alone, but trying to remember just one day! Ate Christmas gingerbread type biscuit with medication to help it down. More water & almonds and omega 3. Immediate aftermath of mirt = some parasthesia and muscles in legs tensing and releasing.

 

Much harder day than yesterday, symptoms wise, overwhelm wise and emotionally.

[Evelyne]

Hi @lomekian! I'm very sorry for you for having to deal with this. It's especially hard when people closest to you are not supportive. You have a tough period in your life, especially with family to take care of.

 

Most of the symptoms you have described are more or less familiar to me, so I can understand a bit of how you feel.
What I eat has had a huge effect on how I feel - with every type of symptoms. Our nervous system and neurotransmitter balances can throw our bodies off in so many ways. For example, sugar makes me very anxious. I've also noticed that following low histamine diet helps me, as does keeping my meal timing very steady. I've also cut down the amount of carbohydrates and I'm looking into getting more protein sources. I know you are probably very exhausted and thinking about specific foods and meal prepping can feel very heavy, but if you feel like it at some point, I think it could be worth of investigating for you.

 

The first post has some more links to look through.

I'm sending you all the well wishes! You will get better.❤️