1DayUMay: Mirtazapine, is there hope? Kindling?

[1DayUMay]

Hey guys, i feel like im stuck in a situation i really regret and dont want to be in.

I started mirtazapine in 2023, 15mg for 7 months. For bad insomnia/anxiety at the time caused by me being stupid and taking a bunch of herbs/supps and having a bad reaction that wouldnt calm down, until mirtazapine showed up and saved the day.

I didnt have insomnia before this situation, or major anxiety. Afterwards I had 7 months of good sleep and mental peace, no sides (maybe weight gain). When i decided to come off, i did a 4 month taper (25% cuts and holds) and didnt have withdrawls, until i was an idiot a month later and experimented with another herb schisandra, which made me feel great but then all of a sudden i cant sleep again and terror/anxiety was back. I shouldnt of touched any herbs/supplements, i did because they are my passion, i love naturpathy.

 

Iv soon realised that this was probably a delayed withdrawl, and i should of just reinstated a low dose.

I panicked and took 15mg, it instantly resolved my problem. No ill effects.

Decided id only take it for 2 days, but after 2 days i couldnt sleep again. 

Decided on 2 weeks, tried to taper.....no good. 

Decided on 6 weeks, tapered for a few days, had withdrawls again. This completely shocked me as i didnt experience withdrawls last time.

Decided to wait a few months and tried at the 6 month mark using my taper, did 25% reduction and once again had withdrawls the NEXT DAY. Reinstated, waited for 2 weeks until i felt stable and tried 10% drop instead. This worked better as the withdrawls were mild and took 5-7 days to clear. I then felt good. 3 weeks later i get smacked with severe anxiety out of the blue, a panic attack from hell with the feeling of pins/needles under my skin. Insomnia. Mood swings. I reinstated 15mg again, its taken 3 weeks to feel normal again.

Now, i feel like im stuck on this mirtazapine forever. Iv recently learned about kindling, and although i may or may not have done that, at the very least my system is very sensitive now. I feel like the worlds biggest jackass. Am i cooked ? How am i to get off this drug or am i stuck forever. I dont want to be on meds 😩

Does the fact i can stabalize after a few weeks prove theres hope and im not kindled to a painful process forever?

Im considering maybe just holding for another 6 months or longer to let things settle, then maybe try a hyperbolic taper at 5% reductions every 4 weeks? The withdrawls were brutal guys. Any ideas or wisdom? Sorry for the big rant, im literally heartbroken and confused, im never touching anything again

Edited Thursday at 08:16 PM by Emonda
Name to title

[Jane318]

Greetings @1DayUMay 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.

 

YES, there is hope for you!  You have been through a lot, but so have others on this site including many who are healed have shared their Success Stories - it may encourage you to read some of them.

 

Your journey to a drug-free recovery will take time, however, and patience.  You've been on several different drugs and through several cold-turkeys / too-fast tapers.  We've seen these are factors that tend to make it more challenging to get off the drug each successive time.  The keys to your success include: 

(1) Holding a while longer to make sure you are stable at your current dosage of 15 mg (please confirm this is your current dosage); then

(2) Tapering slowly at no more than 10% of previous dose no more often than every four weeks.  In your case, you may well need to taper even more slowly than this to keep your symptoms in check. 

(3) Also, as you describe it, you appear to now be highly sensitized to herbs and other supplements.  You will want to avoid them for now, with possible exception of magnesium and fish oil, as I will discuss further below.

 

21 hours ago, 1DayUMay said:

Does the fact i can stabalize after a few weeks prove theres hope and im not kindled to a painful process forever?

I believe it does!  I am not sure you were kindled - kindling symptoms tend to appear soon after taking a dose.  From your narrative, it seems to me you are suffering acute withdrawal from multiple too-fast tapers / dose changes.  Mirtazapine has long half-life (20-40 hours, depending on the form), which means onset of symptoms can be delayed.  You may well have been suffering withdrawal from one cut when you had already increased your dose.  At any rate, if you can tell you are already stabilizing after 3 weeks or so back on 15 mg, this is a very good sign. 

 

21 hours ago, 1DayUMay said:

Any ideas or wisdom? Sorry for the big rant, im literally heartbroken and confused, im never touching anything again

I'm only sharing SA's collective wisdom drawn from our experience with more than 20K members over nearly two decades.  Wisdom you had already figured out from your own research!  And yes, encourage you to shun all these pills - as many of us have had to learn for ourselves - there is no magic pill / herb or other remedy that will solve our problems.   At best, they perhaps dull the pain for a while, but lead to bigger problems in the long term.

 

Here is some more information you should find useful.

 

Withdrawal

What is withdrawal syndrome.

Brain Remodelling 

Video:  Healing From Antidepressants - Patterns of Recovery

 

Stabilizing.  

About Reinstating and Stabilizing to Reduce Withdrawal Symptoms

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

Hypersensitivity and kindling

 

Patterns of Stabilization.  As you continue to re-stabilize as you hold and later, as you taper, it is very normal to have periods where you feel better, and periods where you feel terrible.  This is what we call the windows and waves pattern of stabilization.  This is actually a good sign of healing!  Read more about windows and waves here:

 The Windows and Waves Pattern of Stabilization

 

Tracking Symptoms.   It’s important to keep tabs on your symptoms.  This will help you identify your windows and waves and reveal your progress, which is encouragement we need!  It will help you know when you are ready to begin tapering, and during the taper, and adjust your taper amount and schedule as needed.  You can use the following list of typical withdrawal symptoms 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. 

 

Managing your Symptoms. We have many threads on how to cope with symptoms – I encourage you to check out the various forums / links on the SA.org home page.  These may be of interest to you:

 

 Non-drug techniques to cope with emotional symptoms

Music for self-care: calms hyperalertness, anxiety, aids relaxation and sleep

Ways to cope with daily anxiety

"Change the channel" - dealing with cognitive symptoms

Dealing With Emotional Spirals

Symptoms and self-care

Getting Started With Mindfulness

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

Tips to help sleep -- so many of us have that awful withdrawal insomnia

 

Supporting your Healing.  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) 

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.  

 

Preparing to Taper.  Here is some information to review in preparation for beginning your (last!) taper to zero:

Here at SA, we recommend the hyperbolic taper method:  Why taper by 10% of my dosage?  With a hyperbolic taper, the reductions are based on the prior dose and so get smaller and smaller each month, for example: 10mg, 9mg, 8.1mg, 7.3mg etc. Importantly, if you develop unpleasant side effects from tapering, halt the taper, give yourself time to settle, and once stable, taper more slowly and by smaller amounts moving forward. The experience of others suggests that the lower you go in dose, the slower you need to go with tapering.  Given your history and apparently sensitized CNS, I recommend the Bassmonkey micro-taper method, which makes it easy to adjust the size and schedule for each cut:  The Brassmonkey Slide Method of Micro-tapering (Download calculator as Excel Spreadsheet here: https://www.survivingantidepressants.org/forums/topic/27883-the-brassmonkey-slide-method-of-micro-tapering/#findComment-412439)

See also:

Important topics in the Tapering forum and FAQ  

Tips for tapering off mirtazapine (Remeron)

 

In summary, for now - continue to hold.  Work on developing non-drug strategies for coping with your symptoms.  Support your body's healing as best you can.

 

This is your introduction topic.  Each member gets one intro topic- please post updates and any any other questions here, in this thread.   Please keep us posted on how you are doing and especially check in when you feel you are ready to begin tapering.  

 

Again, welcome to SA, and I look forward to following your journey, and helping out in any way I can.  Best wishes.

[1DayUMay]

Wow thank you for such a thoughtful, kind, supportive reply! amazing information thank you!

I wrote this a few weeks ago but you guys were closed for a bit so i couldn't sign-up, I'm currently at 6 weeks now after reinstating 15mg. Im still on this dose, and feeling even better now. More level headed and less confused.

I think i made a big mistake by cutting the big 25% first (followed by reinstating 15mg the next day after mild strange wd symptoms, triggered by a strong coffee by the way) then only waiting 2 weeks to stabilize before I tried a 10% cut, this backfired bigtime. When i reinstated the 15mg again it was extreme downs/anxiety in mood (with insomnia) for 3 weeks until it stabilized and i could function enough to feel human and go to work. 

I was so confused and disheartened as to why i used to be in the lucky 50% of people that barely felt any withdrawal, to now feeling it severely and quickly (extreme anxiety, panic, terror, insomnia, intrusive thoughts, prickly skin, you name it).

 

Was so disheartened, I thought it was kindled, but sensitization makes more sense. i just have to be very careful now. I feel like I'm stuck in an abusive relationship that i want to leave but cant. Almost like i went back to a bad ex partner, and now i cant leave.

 

Im thinking of just holding for 6 months or more, to improve my chances of stabilizing thoroughly and minimizing (or if I'm lucky, maybe reversing some) sensitization, have you ever seen this work before?

 

Thank you for your advice, my next cut will either be 5% or the brass monkey method (thank you for showing me this). 

 

You guys are great!

[Jane318]

20 hours ago, 1DayUMay said:

I'm currently at 6 weeks now after reinstating 15mg. Im still on this dose, and feeling even better now.

Great news!

 

20 hours ago, 1DayUMay said:

I was so confused and disheartened as to why i used to be in the lucky 50% of people that barely felt any withdrawal, to now feeling it severely and quickly (extreme anxiety, panic, terror, insomnia, intrusive thoughts, prickly skin, you name it).

We've seen that a history of prior CTs / too-fast tapers makes is more difficult the next time.

 

20 hours ago, 1DayUMay said:

i just have to be very careful now. I feel like I'm stuck in an abusive relationship that i want to leave but cant. Almost like i went back to a bad ex partner, and now i cant leave.

Good analogy!  But you are in the PROCESS of leaving!

 

20 hours ago, 1DayUMay said:

Im thinking of just holding for 6 months or more, to improve my chances of stabilizing thoroughly and minimizing (or if I'm lucky, maybe reversing some) sensitization, have you ever seen this work before?

I think this it is wise to set six months as an expectation.  I held for 5-1/2 months after updosing last summer.  Many hold for 4 to 6 months or even longer in some cases.  What is important is to pay more attention to how your body is doing than to the calendar.  

 

20 hours ago, 1DayUMay said:

Thank you for your advice, my next cut will either be 5% or the brass monkey method (thank you for showing me this). 

You are welcome.  I think 5% is a good place to start.  You may find you can go a bit faster, or you may need to go even more slowly.  You want to adjust as needed to ensure you make it to zero without another crash. It just takes time plus patience.  You'll get there.