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bkwjww only on remeron for 5 doses


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I am hoping to find some advice as to what I should do regarding my mirtazapine. Here is my hx:


At the beginning of March, I started having trouble sleeping--due to some anxiety producing things going on in my life (long story). Anyway, had never really had a problem with insomnia before. If I had a night her and there that I couldn't get to sleep, I would take .25mg xanax and would get to sleep and not need it again for maybe a month or so. However, this time the insomnia seemed here to stay for a while and I began having to take the xanax every night (spoke with my doc about it who said "no problem"--was only using .25mg and only at night.....I started to get worried about this though b/c I knew they were addictive--so MD gave me ambien and I used that for about 10 days....then went back to the xanax....tried to start lexapro (sliver of a 20 mg tab for four days--felt horrible--doc told me to quit)....they wound up giving me temazepam which I used for a couple weeks then tried to taper down and quit...thought I was over it after not being on it for a few days and had slept a tiny bit on my own for those few nights....but then the anxiety/insomnia/depression/anorexia was back.....sleep doc said the "safest" thing was ambien.....I didn't want to use it but I was desperate for sleep--anyway have been using that for the past week--but Pdoc wanted me to add in Remeron. So, last Wednesday I tried 7.5mg of Mirt/Rem.--still had to use 1/2 ambien. Then Thursday: 3.75mg Mirt/rem. and ambien. Friday:7.5mg mirt/rem. and 1/2 ambien (5mg), Saturday: tried Vistaril 25 mg and 1/2 ambien--didn't sleep that great--but no remeron that night. Sunday: 7.5mg mirt/rem and 1/4 ambien (2.5mg)- slept great and Monday (last night): 3.75 mirt/remeron and 1/4 ambien--slept great.....The reason I went back to the Mirt/Remeron is that it definitely helped with the anxiety and sleep and gave me back my appetite--had lost too much weight. It doesn't really "put me to sleep" but allows me to taper off the Ambien and once I'm asleep, I sleep pretty good. However, all I want to do is get off these meds and back to my normal self and after reading about problems coming off mirt./rem. I'm terrified to keep taking it.......I don't know how I will sleep without it, but I'm wondering if at this point (5 doses) I really need to taper.....? Again (Wed:7.5/Thurs:3.75/Friday:7.5/Sat: none/Sund:7.5/Monday:3.75).....? Any advise will be so much appreciated. Aren't there some who don't suffer w/drawals from this?

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  • Moderator Emeritus

Hi bkwjww,


Welcome to the forum.


I can see you've been on quite a few sleeping medications. It would be helpful if you could include your drug history in your signature so that we can see at a glance where you're at.


You should include each medication you're taking and the dates you started each medication, as well as past medications and dates. Here's a link that shows you how to do that:




Regarding tapering of Remeron, yes you might be one of the lucky ones who don't experience withdrawal symptoms - but even though you have only taken the medication for 5 days there is still a risk, especially because there are other medications in the mix. Add to that the fact that you have had multiple medication and dose changes, you're looking at a very complex situation that is potentially destabilizing your nervous system.


It's a personal choice, but as someone who is in the midst of a horrifying withdrawal wave I'd personally advise against Cold Turkeying any medication. Others may disagree.


In any case, here is some more information on tapering so you can make an informed decision:





I wish you the best of luck.

July 2001 prescribed 20mg citalopram for depression;
On and off meds from 2003-2006.
February 2006 back on 20mg citalopram and stayed on it until my last attempt at tapering in September 2011.
By far the worst withdrawal symptoms ever. Reinstated to 20mg citalopram
October 2012 - found this forum!
Nov 2012 to Feb 2013 did 10% taper, got doen to 11mg - was going great until stressful situation. Cortisol levels hit the roof, hideous insomnia forced me to updose to 20mg.
March 2016 - close to 100% back to normal!

****** I am not a medical practitioner, any advice I give comes from my own experience or reading and is only my perspective ******

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  • Moderator Emeritus

Hi bk--


If you have no prior history of taking an AD, after only 5 doses of Remeron you probably have a good chance of getting off it fairly easily. You may want to taper back down over a period of a few days.


I would be more concerned about the benzodiazepine and Ambien use. I suspect some of the recurring insomnia and the anxiety that you are experiencing may be due to going on and off those drugs. That is the sort of effect that they have. If there's any way you can taper slowly down off of those, that would be best.


There are other, nondrug ways to approach insomnia. It's called "sleep hygeine" and your doctor should either know about it or be able to refer you to sources that do. If you have already discussed this, you may want to give it a serious try. It's always best to start with behavioral and lifestyle approaches FIRST and only go to brain-chemistry-warping drugs as an absolute last resort, in my opinion.


Also, your doctor's information is not correct if he thinks that you won't get addicted to Xanax by taking 0.25 mg at bedtime every night. ANY benzodiazepine will produce dependence if taken regularly, at any dose, at any time of day. Xanax is not an exception.

Started on Prozac and Xanax in 1992 for PTSD after an assault. One drug led to more, the usual story. Got sicker and sicker, but believed I needed the drugs for my "underlying disease". Long story...lost everything. Life savings, home, physical and mental health, relationships, friendships, ability to work, everything. Amitryptiline, Prozac, bupropion, buspirone, flurazepam, diazepam, alprazolam, Paxil, citalopram, lamotrigine, gabapentin...probably more I've forgotten. 

Started multidrug taper in Feb 2010.  Doing a very slow microtaper, down to low doses now and feeling SO much better, getting my old personality and my brain back! Able to work full time, have a full social life, and cope with stress better than ever. Not perfect, but much better. After 23 lost years. Big Pharma has a lot to answer for. And "medicine for profit" is just not a great idea.


Feb 15 2010:  300 mg Neurontin  200 Lamictal   10 Celexa      0.65 Xanax   and 5 mg Ambien 

Feb 10 2014:   62 Lamictal    1.1 Celexa         0.135 Xanax    1.8 Valium

Feb 10 2015:   50 Lamictal      0.875 Celexa    0.11 Xanax      1.5 Valium

Feb 15 2016:   47.5 Lamictal   0.75 Celexa      0.0875 Xanax    1.42 Valium    

2/12/20             12                       0.045               0.007                   1 

May 2021            7                       0.01                  0.0037                1

Feb 2022            6                      0!!!                     0.00167               0.98                2.5 mg Ambien

Oct 2022       4.5 mg Lamictal    (off Celexa, off Xanax)   0.95 Valium    Ambien, 1/4 to 1/2 of a 5 mg tablet 


I'm not a doctor. Any advice I give is just my civilian opinion.

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  • Administrator

Welcome, bk.


I agree, I would step down off the Remeron over a few days or a week.


You may be experiencing paradoxical effects or rebound from the Ambien (a benzo-type medication) and Xanax, meaning they're making your sleep problem worse and more persistent. This is not unusual with these drugs.


How long have you been taking Ambien, Xanax, or both?


Now that you're taking 1/4 tablet Ambien, if I were you, I would not increase it. I would plan to go off it soon.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Thanks for the replies!

Alto--I have heard from others that you are a great source of help/support!

I have been taking something for sleep for about the last 2 and 1/2 months--either xanax or ambien (few weeks with temazepam)--always trying to stay at the lowest doses and tapering off as quickly as possible--but when trying to sleep on my own--have only been able to sleep 1-2 hours (if at all). I am seeing a psych....just went this morning. She thinks I should stay on the Remeron and increase to 7.5---but I told her that I am very afraid of the withdrawal from it and that I wasn't sure I could be comfortable doing that....I do know that right now I am probably going to need something besides 1/4 ambien to help me sleep. I think the only reason I was able to get the ambien down to 1/4 was because of the remeron. The remeron doesn't put me to sleep on it's own, but even 3.75 allows me to sleep better with a low dose of the ambien.....I wasn't sure what to do last night, so I took another 3.75 (so that is 6 doses:7.5/then3.75/then7.5/then none/then 7.5/then 3.75/then 3.75)---so what would you advise for tonight? Nothing or half the 3.75? Also--she mentioned that I could try Trazadone instead (50mg)---what are the thoughts regarding this? I have tried at 25mg and was kind of like the remeron--didn't put me to sleep but helped me sleep longer was I was asleep. Anyway--I'm hesitant to add that in--but I am less afraid of that than the remeron......tomorrow I have a follow-up ct/mri for recent cancer in my leg---I know sleep will probably be tough tonight anyway--but don't want to show up a mess tomorrow. Not sure what to do.....? What are the thoughts on Trazadone?

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  • Administrator

My thoughts are that all your sleep problems since early March are because of adverse effects of the drugs, rebound, and withdrawal from inconsistent dosing, and that you are becoming ensnared in the psychiatric drug web because of a symptom that you might have managed without drugs. This started with your taking Xanax every night.


Many people are caught in this trap.


No, I would not add trazodone or any other drug to the mix. Haven't you had enough bad experiences with them?


It seems to me you have a choice between Ambien or Remeron. On the theory you might be suffering somewhat from Xanax withdrawal or rebound, I guess I would go with a minimal amount of occasional Ambien and go off Remeron completely if possible.


Given your well-founded health concerns, you might accept it that you will have some sleepless nights and use them to practice mindful meditative breathing rather than worrying about your sleep. Otherwise, you are going to be caught in the drug trap for quite a while.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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