success Hibari: tapering Remeron and want to start tapering Lamictal

[Shep]

7 hours ago, Hibari said:

My thyroid was checked in June. I met with my primary care doctor yesterday and she reviewed it. Said it was normal. 

 

Thanks, Hibari. Just checking on the variables. Glad your thyroid is holding steady. 

 

2 hours ago, Hibari said:

Question: Do you think I should continue with 1 mg of Trazadone longer or since I'm experiencing the alerting, stop the 1 mg? 

 

I appreciate your time Alto. 

 

I'm not Alto, but since I'm here, I'll weigh in with a thought. I noticed you posted this:

 

On 10/25/2022 at 2:24 PM, Hibari said:

I take the Remeron, 7.5 in two stages about 1 hour apart as my nervous system seems to handle it better. 

 

When did you change the dosing for the Remeron? 

 

It's possible that may have upset the apple cart, so to speak, and caused your nervous system to hyper-react.

 

You could either hold and give your nervous system time to adjust to all of the changes or you could reduce the Trazodone down to 0.5 mg and see if you continue to hyper-react to it. The problem with continuing to make changes is the change may be more taxing to the nervous system than the higher dose. 

 

Please post your thoughts. 

[Hibari]

12 hours ago, Shep said:

 

Thanks, Hibari. Just checking on the variables. Glad your thyroid is holding steady. 

 

 

I'm not Alto, but since I'm here, I'll weigh in with a thought. I noticed you posted this:

 

 

When did you change the dosing for the Remeron? 

 

It's possible that may have upset the apple cart, so to speak, and caused your nervous system to hyper-react.

 

You could either hold and give your nervous system time to adjust to all of the changes or you could reduce the Trazodone down to 0.5 mg and see if you continue to hyper-react to it. The problem with continuing to make changes is the change may be more taxing to the nervous system than the higher dose. 

 

Please post your thoughts. 

Thanks @Shep

 

I thought I had tagged Alto. 

 

I've been dosing the Remeon that way for about 2 weeks and it has worked well. Doing it that way allolwed my nervous system to handle the dose. Taking the whole 7.5 can be too much at once. I didn't want to shake things up by only taking 3.75 after taking 7.5 to begin with. It would have registered as a cut. 

 

I think I will stay with the 1 mg for now and if I continue to have a hyper reaction, move it down to .05. 

[Shep]

1 minute ago, Hibari said:

Thanks @Shep

 

I thought I had tagged Alto. 

 

I've been dosing the Remeon that way for about 2 weeks and it has worked well. Doing it that way allolwed my nervous system to handle the dose. Taking the whole 7.5 can be too much at once. 

 

I think I will stay with the 1 mg for now and if I continue to have a hyper reaction, move it down to .05. 

 

Yes, you had tagged Alto, but her schedule with the site and other things is very tight right now, so she isn't always available. 

 

Sounds like you have a good plan going forward. Please let us know how you do.

[Hibari]

1 hour ago, Shep said:

 

Yes, you had tagged Alto, but her schedule with the site and other things is very tight right now, so she isn't always available. 

 

Sounds like you have a good plan going forward. Please let us know how you do.

@Shep

I will Shep. 

[Altostrata]

On 10/26/2022 at 7:59 AM, Hibari said:

I also am in Trazadone withdrawal, which I was on for a little less than a month.  Trying to stabilize on 1mg though it often makes me a little hyper. 

 

Why do you think your current symptom pattern is from trazodone withdrawal? How do you feel before you take it compared to later, after you take it?

[Hibari]

7 hours ago, Altostrata said:

 

Why do you think your current symptom pattern is from trazodone withdrawal? How do you feel before you take it compared to later, after you take it?

@Altostrata

 

I think part of it is because i will feel physical sysmtpms of withdrawal such as achy legs and joints.  When I take the Trazadone, those physical symptoms will ease but then I feel that hyper alerting state, which shows up as inner trembling and then mental rumination.

 

Granted Alto, I'm still in a big setback and rumination is one of my worst symptoms due to the anxious state my body is in. But it does get worse when I take the 1mg of Trazadone. 

 

So either I'm relaxed and then get hyper when I take the Trazadone or I'm already ruminating and it gets worse. This is on top of all trh symptoms I have from the setback. 

 

The 7.5 of Remeron is barely working and I've been on it 27 days. 

As I mentioned to Shep, I do think the rebound insomnia from getting off Trazadone is in the mix and also just the ongoing symptoms from the setback. 

 

I want to get off the Trazadone when I can and then when I'm stable from the setback, do a slow taper of the Remeron. 

 

I hope this wasn't too confusing and answered your questions.

[Altostrata]

Suggest you take slightly less trazodone, such as 10% less.

[Hibari]

@Altostrata

 

Okay. I'm using a scale so will aim for that. 

 

Thank you. 

[Hibari]

Just needed to write out my thoughts. 

 

After being med free for 17 months and 75% healed, it has been a shock to be sick again due to a setback from surgery and anesthesia. 

 

Even though I know why I started on Mirtazapine due to lack of sleep during this horrible setback, I have such sadness about being on it again.  

 

I now have been on it about month at a much lower dose than I was previously.  However, I spend a lot time reading up on how to get off of it. 

 

I know now is not the right time but I also know I want to only take it for as short a time as possible. No one can answer that for me but I'm hoping that as I continue to heal from this setback and I can then plan a slow and steady taper. 

 

If anyone can relate, I welcome your comments. 

 

[Bestill]

Hi there!  I read your success story because I needed a boost and it was very helpful.  Im sorry to see that you had a set back.  
 

Sometimes we need tools to survive.  I know a lot of people call antidepressants poison.  I could say the same thing about food that we eat and cleaning agents we use or beauty products.  Right now, you need a tool to help you feel better.  You WILL feel better and will taper once again.  We can do it together.  I have been tapering for 10 months now and will be for some time.  So when you are ready, we can cheer each other on.

 

You healed once, and you will again!  As hard as it is, try not to think about being on meds again.  Give your body permission to chill out a bit.  Be gentle on yourself.

 

Sending you a hug.

[Hibari]

1 hour ago, Bestill said:

Hi there!  I read your success story because I needed a boost and it was very helpful.  Im sorry to see that you had a set back.  
 

Sometimes we need tools to survive.  I know a lot of people call antidepressants poison.  I could say the same thing about food that we eat and cleaning agents we use or beauty products.  Right now, you need a tool to help you feel better.  You WILL feel better and will taper once again.  We can do it together.  I have been tapering for 10 months now and will be for some time.  So when you are ready, we can cheer each other on.

 

You healed once, and you will again!  As hard as it is, try not to think about being on meds again.  Give your body permission to chill out a bit.  Be gentle on yourself.

 

Sending you a hug.

Thank you so much for responding. 

Yes, its been hard to accept especially since the Mirtazapine is not really helping me sleep. Thats probably due to a number of factors, Trazadone withdrawal, the setback and who knows. 

 

I see that you have made great progress with your taper. I know you can do it. I will need your support when I taper again, which won't be for some months. 

 

I so appreciate your encouragement. 

 

Hibari. 

[Hibari]

@Altostrata

Hi Alto,

 

The lower dose is Trazadone seems to be working to stabilize me. I still have some symptoms that I feel such as burning skin, achy muscles and depression (though though this symptom is part of my setback too)..

 

I have a question regarding the Remeron 7.5 that I'm taking.  It is not helping me sleep at all and may be making things worse because it's a histamine at the lower doses. I can’t take Benadryl for this reason. When I was on it 5 yrars ago,  I was on a much higher dose, 41mgs and slept.

 

Its probably to soon to make a change but I wanted your opinion. 

 

Do you think making a small cut, 2% cut would be worth trying? If its not working, i would like to get off of it even if its at a snails pace. 

 

Thank you. 

 

[Altostrata]

Yes, if I were you, I'd go off mirtazapine very slowly.

[Hibari]

16 hours ago, Altostrata said:

Yes, if I were you, I'd go off mirtazapine very slowly.

Thank you.  I will have to be prepared for the rebound insomnia on top of the insomnia i already have. But, maybe I will feel better if I taper. 

[Hibari]

What I'm struggling with the most these days besides extreme insomnia and grief over my lost health, is acceptance.

 

It's been hard to accept that my good health is gone for now. Its been hard to accept that I'm back on medication again because I was deteriorating mentally due lack of sleep. I tried to keep it natural for so long.   Its been hard to accept that it will take time to get well again. 

 

I do think not sleeping night after night contributes to my depression. And the fact that I am still trying to recover from a bad setback, which created agoraphobia, anhedonia and anxiety as well.  

 

I'm hoping I can sleep tonight and that will help. 

[Hibari]

Mistake. 

 

Ended up taking double my medicarion due to fatigue and confusion

 

I took 15mgs instead of 7.5. 

From what I remember from.prvuos tapers, I just take my usual dose tonight yes? I don't think I take less to balance it out. 

 

At least I  now know that more medication is not the answer. 

 

 

[Hibari]

4 hours ago, Hibari said:

Mistake. 

 

Ended up taking double my medicarion due to fatigue and confusion

 

I took 15mgs instead of 7.5. 

From what I remember from.prvuos tapers, I just take my usual dose tonight yes? I don't think I take less to balance it out. 

 

At least I  now know that more medication is not the answer. 

 

 

PS My mood was better for a few hours and I slept about 3 hours. Have not been sleeping at the 7.5 dose. But I will go back to that dose tonight. 

[Hibari]

@Altostrata

Hi Alto,

I'm in a dilemma and I'm not sure what to do and there may not be a solution. 

I know I asked your advice about tapering Remeron because it does not seem unable to help me sleep at the dose I'm taking. I even took 5mgs of Ambien one night for the first time in my life. (will not do that again). 

Im struggling with severe insomnia and am not capable of doing the usual coping mechanisms due to my surgery/anesthesiasetback. My mind is not healed enough to watch TV, read or listen to affirmations. Those activities are too overwhelming for my brain as it tries to recover. 

So, I know tapering Remeron will cause insomnia even going slowly. 

I guess my question is, should I try going up to see if a higher dose would help me sleep, then stabilize more from the setback and then taper dose? Or go ahead an start the slow taper? 

I've pasted my sleep log below for you to review when you have a chance. You'll see there a few times when I lowered and raised the dose because I was trying to figure out what worked earlier in the process. 

Like I said, there may be no real answer here but I thought I would tap into your expertise. 

Hibari

Sleep Log 10/4-11/6

10/4 Mirt 7.5. Sleep 9 hours (1st dose)

10/5 Mirt 7.5. + 100 mgs Trazadone No sleep 

Everything going forward is without Trazadone till I reinstate 1 mg) 

10/6 Mirt 7.5. Sleep 9 hours 

10/7 Mirt 7.5. No sleep

10/8 Mirt 11.25  2 hours of sleep 

10/9 Mirt 7.5. Sleep 8 hours. 

10/10 Mirt 7.5. No Sleep

10/11 Mirt 7.5. Sleep 9 hours

10/12 Mirt 7.5. No sleep

(Reinstate Trazadone 1mg)

10/13  Mirt 7.5. No sleep

10/14  Mirt 3.75 No sleep

10/15. Mirt 7.5. No sleep

10/16 Mirt 3.75 No sleep

10/17 Mirt 7.5. No sleep

(These 6 nights were after I stopped Trazadone and had reinstated the 1 mg)

10/18 Mirt 3.75 Sleep 8 hours 

10/19 Mirt  7.5 No Sleep

10/20 Mirt 7.5 Sleep 8 hours 

10/21 Mirt 7.5.Mirt  No Sleep 

10/22 Mirt 5.50 6 hours 

10/23 Mirt 7.5 No sleep

10/25  Mirt 7.5. No sleep

10/26. Mirt 7.5. 9 hours 

10/ 27 Mirt 7.5. No sleep

10/28 Mirt 7.5. 3 hours

10/29  Mirt 7.5. 2-3 hours

10/30.Mirt 7.5 No Sleep 

10/31 Mirt 7.5. Broken sleep 5 hours?

11/1   Mirt 7.5. No sleep

11/2. Mirt 7.5. No sleep

11/3 Mirt 7.5./ 5mgs Ambien 5 hours

11/4 Mirt 7.5. No sleep

11/5 Mirt  15mg (mistake) 3 hours 

11/6 Mirt 7.5. No sleep

[Onmyway]

Hi @Hibari, 

looks like you are really struggling with sleep. 

But you are not helping yourself by experimenting with various sleep aids and medicines. When your nervous system is sensitized these drugs can have paradoxical effects and really mess you up much worse. You are witnessing that in your own experiment. And the longer you take them the worse you make your problem because you will then need to taper slowly from a drug that makes you miserable. I'd suggest you come off of all the sleep aids as Alto suggested. 

 

 

I had a similar issue when I first went off of my drugs and I was so scared that I would get a psychotic break from not sleeping (a friend had had a psychotic break unrelated to WD around that time) that I kept trying everything - antihistamines, benzos, herbal remedies. They would help for a few hours and then they would get me so wired and depressed at the same time I wanted to crawl out of my own body. The answer was really to not do anything. To not take anything. To just let my body find its new balance.

 

My anxiety over sleep (I had become obsessed with it) really came down when my GP convinced me that nothing would happen if I didn't sleep for a while (I used to sleep 1-2 hrs a night at that time with jolts of terror waking). He gave me the example of the parents of newborns who go sleepless (or very little sleep) for months and survive without any psychotic breaks. Once I calmed down about that and stopped all sleep aids my sleep actually improved quite a lot over the next month - to 4-5 hrs a night which while not ideal was sufficient for the next months. Now I can do close to 6 every night. Still not back to my ideal of 8 hrs (I am tapering from reinstatement for the last 3.5 yrs) but I am still around and it doesn't impact my days too badly. 

 

During the intense insomnia phase my body found ways to rest - I would dose off - half awake/half asleep to sleep hypnosis meditations (I liked Sleep Cove on Spotify at that time) or on the train for 15 min at a time. That was OK. 

 

The answer now may seem counterintuitive but it really is to let things go and allow your body to find its way. If it is to not sleep for a few days - that is fine. In the morning, thank your body for its efforts and doing what it needs to do to heal you and keep you safe and then go about your day - if your day is just lying in bed try to get as much distraction as you get (any kind of music?). If no distraction just let the hours pass however they will, this is temporary. You will get through this. Try not to obsess about this. That only makes things worse. This is out of your control now - your body knows better what to do. 

 

I found these couple of resources helpful.

 

 

 

Edited November 7, 2022 by Onmyway

[Bestill]

@Onmyway thank you.  That was helpful for me to read as well.  ❤️

[Hibari]

Thank you for your reply and all the resources. @Onmyway

 

I do want to come off all sleep meds.  I know they aren't good and I have made some choices lately out of fear and exhaustion. Everything you have said makes perfect sense.  I 

 

I don't know if you know my current situation but I am trying to recover from a severe setback due to surgery and anesthesia. Befoe that I was med free and thriving for 17 months. 

 

Because of the setback, I am not on stable ground emotionally, physically or mentally. I have only, after 3 months of being bedbound, been able to move around my home. Before that I was lying in bed with an eye mask and earplugs. 

 

I still have agoraphobia, chemical depression, chemical anxiety, trembling, grief and anhedonoa. I don't have access to all of my mind yet and what I mean by that is that my optimism, spark for life and at times determination is temporarily injured. Very different from where I was when I tapered other meds. So when I can’t sleep, I don't have that comforting, calm inner voice avaliable to me. 

 

I can barely distract and so I do rest a lot but have terrible rumination plus my body is locked in fight or flight. It won't let me nap in any way. I aslo can't watch TV, listen to music or read because its too overwhelming for my brain. I only recently have been able to do puzzle for kids. 

 

I'm sharing all of this not to be a victim but to reflect the true reality of my setback.  I'm not in the same place I had been when I tapered before. Now its like I'm in cold turkey benzo withdrawal without being on benzos. 

 

So, I take Alto's guidance very seriously and am trying to gear up to do a very slow taper while being so fragile. I know its the right thing to but its scary in my state. I have to taper the Mirtazapine at this point because stopping cold turkey would be dangerous for me even after only a month on it. I've just done that with Trazadone after only being on it month as well. 

 

I'm very familiar with the resources you have posted and appreciate seeing them again. The one on benzos and the brain is fantastic. 

 

I thank you for your support that I will get through this, I want to very much. 

 

Hibari

 

[Onmyway]

Hi @Hibari, 

what you describe sounds horrendous. I am sorry you are struggling that much. I also understand desperation. I just don't want you to injure yourself more in that desperation. Please be kind to yourself and opt for not changing or adding things for a while. 

 

Keeping you in my thoughts, 
OMW

[Hibari]

Thank you so much @Onmyway.

 

You'll laugh at this. Just go off the phone with a fairly new psychiatrist and when I told her the Mirtazapine wasn't working, she said well you can just stop it. 

 

I told her medications have to be tapered and she said not for long. 

 

Little does she know. 

[ChessieCat]

Putting this here for member's history:

 

  

3 hours ago, Hibari said:

I'm having this sleep issue as well.

 

I'm going though a bad period of insomnia even with using a sleep med. 

 

What I lie to down to sleep, my body is so tired but my mind is locked in q very fearful place and won't let go. Then my body fights the sleep med (Mirtazapine) and I'm up all night. My nervous system is so dysregulated right now. Very scary. 

 

 

 

[marie123]

Hi Hibari. I've had something similar happen when I was tapering trazodone. I would feel so tired and wired like the I was fighting the med. What I did was listen to a tv broadcast of Blue Planet on very low volume. Richard Attenborough had a very calm soothing voice and it did the trick and I would sleep. I did this for months. I was also trying to drown out the tinnitus. Maybe try to find something soothing to listen too at bedtime. Sorry for what you are going through but it will get better. Marie.

[Hibari]

16 hours ago, marie123 said:

Hi Hibari. I've had something similar happen when I was tapering trazodone. I would feel so tired and wired like the I was fighting the med. What I did was listen to a tv broadcast of Blue Planet on very low volume. Richard Attenborough had a very calm soothing voice and it did the trick and I would sleep. I did this for months. I was also trying to drown out the tinnitus. Maybe try to find something soothing to listen too at bedtime. Sorry for what you are going through but it will get better. Marie.

Thank you Marie. 

[Hibari]

@BrassMonkey 

 

I'm preparing to possibly do a slow taper off Mirtazapine in the next couple of weeks ans 1was wondering if you could check my math at your convenience. 

I'm currently taking 7.5 mgs but my doctor wanted me to go up to 15mgs and that is what I have in terms of pills. I will try to get the 7.5 again if I can. 

10, 15mgs pills weigh 1,509 grams on the scale.  Divided in 1/2 (for 7.5mgs) is 75.45, which I would round up to 76 grams 

A two percent cut of 76 grams is 74.48 grams, which I would round up to 75 grams. 

Does this look accurate to you?

Thank you. 

Hibari 

[brassmonkey]

Your numbers look right, but there is a problem with your units of measure. I'm just about to leave for a Dr. appointment, but I'll take a closer look when I get back.

[Hibari]

5 minutes ago, brassmonkey said:

Your numbers look right, but there is a problem with your units of measure. I'm just about to leave for a Dr. appointment, but I'll take a closer look when I get back.

Thank you.

I also realize I should have said that the pills range in weight from 147-152. 

[Altostrata]

Honestly, @Hibari, you're constantly changing your mind and your dosing. You went off trazodone? I though you were going to taper mirtazapine instead.

 

And, in essence, you're asking for help for insomnia caused by non-psychiatric drugs. We don't provide peer support for general insomnia problems.

 

Your symptom pattern shows that sometimes you get normal sleep. We cannot tell what drug is doing this, if any, because of all the drug changes you've made.

 

It's very possible you are in an early stabilization period and getting occasional good sleep that probably will get more frequent if you don't do anything to upset it -- like make more drug changes.

 

@marie123's suggestion was brilliant, I did something similar when I had withdrawal insomnia. I put the TV on at a low volume and watched documentaries about the national parks, all with fairly monotonous narration and low, gentle music. 

 

This also may help: Music for self-care: calms hyperalertness, anxiety, aids relaxation and sleep

 

I cannot advise you further about your drugs. Eventually, you'll taper off everything. You know how to do this.

 

 

[Ripley]

Hello @Hibari

 

I'm sorry that you've had such a setback from anaesthesia and I was wondering if you knew which drug/s you received that may have caused this? I'm sorry if you've mentioned it and I've missed it. Did you have propofal perhaps or some benzos?

 

I'd be very interested to know as I've also suffered from insomnia problems caused by withdrawal from mirtazapine/remeron which has been horrific at times. And I do need an operation at some point which I'm avoiding for as long as I can!

 

Like you, I've also experienced many nights of no sleep at all and things have always improved with time. I hope this might be of some comfort to you. It will all settle down if you give yourself some stability with the drugs. It looks like you've been able to have some good nights' sleep along with the bad and that is definitely a positive and a pattern I've experienced too. Slowly the bad nights will happen less and less and the good ones will become more regular. Hang in there Hibari.

 

[Hibari]

Hi @Ripley

Thank you for your kind message, it means a lot.

In terms of the surgery and anesthesia, I told the anesthesiologist not to use benzos, opiods or Fluoroquinolone antibiotics. 

But he used other stuff that affected me. Then he used a medication to reverse the anesthesia, which also harmed me. 

This is the list. 
clindamycin (CLEOCIN)
dexAMETHasone (DECADRON)
metoclopramide HCl (REGLAN) 
ondansetron (ZOFRAN) Last given 
propofol (DIPRIVAN)

In the benzo community propofol seems to be the one that people can use. Not medical advice but only what was I told. 

 

 I appreciate your perspective on Mirtazapine. Since I've been on it, it really hasn't given consistent sleep the way it did 5 years ago when I was on a higher dose. 

 

When you held,before tapering again, did you start to get more nights of sleep? I'd take every other night at this point. 

 

I'm going to hold for a bit before I start tapering. 

 

Thank you for your encouragement that it will get better. 

 

Hibari 

 

[Ripley]

Hi @Hibari

 

Thank you for your reply. Yes, I've also read that propofal is the best tolerated drug in these circumstances too. It sounds like your did your best to avoid the main ones that can be problematic so it's unfortunate that something else has caused problems. 

 

Like you, I found mirtazapine became no longer good for sleep once things had been destabilised. So I'm taking it now with absolutely no positive effects at all but the threat of total insomnia if I make a wrong move! 

 

My sleep absolutely became loads better after a good hold. Even though it has been dreadful at times, holding always improved things to the point of largely getting good sleep again by which I mean 7 or 8 hours a night. I still think it can be fragile when tapering or under stress but if I'm holding it's usually pretty good -eventually! I'd say I've also noticed huge improvements after about 2 months also in case that helps. 

 

I know it's incredibly hard when you can't sleep but try not to fret or fight it and accept you need a sofa day the next day. Just get through to bedtime as best you can and then rest and relax as much as you can and you will be improving all the time.

 

Also, give yourself plenty of time to stabilise. I caused a lot of problems by tapering before I was ready and not realising the damage as it was all delayed with mirtazapine! Again, things got way worse a couple of months later! 

[Ripley]

Hi again @Hibari

Just to clarify, ALL my problems have been cause by mirtazapine whereas I know there are other drugs/causes involved in your situation. Just bear that in mind. I hope I have helped though. X

[Hibari]

55 minutes ago, Ripley said:

good hold. Even though it has been dreadful at times, holding always improved things to the point of largely getting good sleep again by which I mean 7 or 8 hours a night. I still think it can be fragile when tapering or under stress but if I'm holding it's usually pretty good -eventually! I'd say I've also noticed huge improvements after about 2 months also in case that helps. 

@Ripley

 

Thanks again. 

 

Did you mean two months of holding or after you had been on it for 2 months? 

 

And are you doing liquid or dry cutting? The last time I did dry cutting till I got low and then switched to a compounding liquid. I don't know if my prescriber will do a liquid so I have to be prepared to dry cut. 

[Ripley]

Hi @Hibari

 

To answer your question, I think both. After I'd reinstated too high, things did improve after a couple of months noticeably and also when things had gone very pear-shaped! Everybody is different of course and it isn't a hard and fast rule but I think it indicates that things will get better with time if you can hold your dose, be patient and avoid more trouble. I wasn't stable after a couple of months holding but greatly improved. 

 

I'm taking the prescribed liquid mirtazapine by Rosemont and I feel lucky as it's very straightforward to taper. 

 

How are you doing?