freesalmon: Mirtazapine withdrawal or something else?

[freesalmon]

Hi everyone!

 

I started on 15mg of mirtazapine about 1year 3months ago for depression and acute anxiety (used to get up many times in the night with a racing heart). Dosage was increased to 30mg 3 months later and then reduced to 15mg a further 3 months down the road.

 

My psych doc finally agreed for me to stop the mirtazapine in late October as I had already tried experimenting with intermittent drop of dosages to 7.5mg before I had the go ahead from my doc.

 

She mentioned that I could go for a week on 7.5mg and then stop taking it altogether. I did as mentioned but a few days after stopping, had a mad rush of anxiety and insomnia. I went back to 7.5mg for 2 days and then dropped the dose down to 3.75mg for a further 3 days before stopping again.

 

While the anxiety came back again, it wasn't as intense. Over the next day or 2, the anxiety subsided and everything was fine. I felt great and began swimming and jogging and lost quite a bit of weight.

 

Then, 2 weeks later, it all went south. I started having sharp shooting, burning pains in my inner thighs and calves and numbness in both my big toes. Went to the Doctors and no one could diagnose what is causing it, with one doctor guessing it might be nerve related (which is hard to accept as it started so suddenly with no trauma) and tried putting me on Lyrica, which I refused.

 

It's been about 3 weeks since I stopped Mirtazapine. My anxiety and insomnia are elevated. The constant burning pain in my thighs and calves however, have subsided to intermittent electric shocks that come on randomly.

 

I still have intermittent numbness in my big left toe. The sensation in my big right toe has returned to normal. I had slight light sensitivity and ache in my left eye.

 

I am also waking up with what can only be described as hot flashes in the middle of the night when I do get to sleep. I feel like I am burning up but then the it subsides almost immediately and I perspire like mad after. I am also experiencing restless legs just when I am about to doze off.

 

And despite the insomnia, I feel quite active in the day and am unable to take any naps.

 

I do not have any depressive or suicidal thoughts like I did pre-mirtazapine though. So I don't think it's depression returning.

 

Are these withdrawal symptoms of Mirtazapine

 

My doc seems to think it's all just my anxiety returning,which I am not buying.

[ten0275]

freesalmon, hey.

welcome to the site from a fellow mirtazapine withdrawal sufferer. it absolutely sounds like you are experiencing withdrawal symptoms due to your rapid discontinuation of mirtazapine - very classic symptoms. after 15 months of regular use, your nervous system requires a much more gradual reduction. we suggest no more than a 10% reduction per month based on the last dosage you were stabilized on.

due to your only having discontinued mirtazapine three weeks ago, i would suggest reinstating mirtazapine immediately at no more than 3.75mg and holding there for some time. once stable on a dose, you can then taper by 10% every 4 weeks. with mirtazapine, you should feel the onset of reinstatement fairly rapidly when it comes to the anxiolytic effects - you should notice improved sleep. please let us know.

to help us better understand your complete situation, please include your drug history and any other medications or supplements you may be using in your signature. this link tells you how to do that:

http://survivingantidepressants.org/index.php?/topic/893-please-put-your-withdrawal-history-in-your-signature/

here are some other links that i think may help you currently:

about reinstating and stabilizing:

http://survivingantidepressants.org/index.php?/topic/7562-about-reinstating-and-stabilizing-to-reduce-withdrawal-symptoms/

about withdrawal syndrome in general:

http://survivingantidepressants.org/index.php?/topic/603-what-is-withdrawal-syndrome/

and tips for tapering from mirtazapine specifically:

http://survivingantidepressants.org/index.php?/topic/5301-tips-for-tapering-off-remeron-mirtazapine/

i think you are wise not to buy into your doctor's suggestion that it is the anxiety returning. that is a very common reaction/statement by doctors to withdrawal syndrome's presentation. most doctors are unwise to withdrawal syndrome.

hang in there, and welcome. i'm sure others will be along to welcome you soon as well.

dave

[Fresh]

Hi Freesalmon , welcome to SA.

 

As ten says , what you are experiencing are a range of symptoms common in the weeks following a too-fast taper.

The nature of withdrawal from ssri's/mirtazapine is delayed , so that your symptoms are likely to continue to

get worse before you start to get better (sorry).   

Reinstating a small amount , 1 or 2mg , should take the edge off the w/d , so that you can stabilize , then taper

off slowly and safely.

 

Best wishes ,  Fresh

[FunkyBaboon]

Hi freesalmon!! Welcome to the forum 

 

Your nerve related problems could be as a result of your rapid taper from mirtazapine.

 

When I performed a fairly rapid taper from Citalopram (another antidepressant) I suffered with constant neuropathic pain mainly in my right arm but at my worst point I had numbness and burning in both arms and both feet. There were a few days where I completely lost the sensation in my hands and feet couldn't feel anything. At the time I didn't know what was happening to me and the GPs and specialists (neurologist and rheumatologist) couldn't explain why I was experiencing these problems so they reinstated me on another anti depressant (Nortryptyline) and all of these problems started to abate and have now mostly resolved.

 

Like you, the majority of the doctors I saw wanted to blame my anxiety for troubles I was having but I was convinced there was more to it than that. The best explanation my neurologist could come up with for my problems was Functional Neurological Disorder and he pointed me at http://www.neurosymptoms.org/. Functional Neurological Disorder seems to be a fairly broad term to describe any neurological condition that a neurologist cannot explain due to absence of disease (my MRI showed that my brain was perfectly okay structurally). My rheumatologist diagnosed me with Raynaud's phenomenon (which started for the first time in my life during Citalopram withdrawal) and suggested that I might be suffering with Chronic Fatigue Syndrome or Fibromyalgia. I'm now fairly certain that all of my neurological problems were brought on by my coming off Citalopram too fast in conjunction with not taking very good care of myself - drinking too much alcohol and taking other recreational drugs (something that I no longer do). 

 

I think the above suggestion to reinstate at the lowest possible dose and then perform a really slow 10% (or maybe even less) taper each month would likely be the best way to find some relief from the nerve related problems you are experiencing.

 

Wishing you all the best for the journey ahead - you're not alone 

 

Funky

[freesalmon]

Hi ten0275, Fresh and FunkyBaboon  ,

 

Thanks so much for your replies.  Few things, which I left out in my earlier post, I'd like to share.

 

I've been considering reinstating the 3.75mg dose.  However, at the same time, despite the symptoms, I've noticed that my sleep is returning slowly (2-3 hours in the first 2 weeks of discontinuation to now about 4-5hours).  I do get up about twice at night with a burning sensation in my legs and pain but this goes away shortly after and I fall asleep. I've read that because mirtazapine hits the histamine receptors really hard, that there is a possibility that an overload of histamine could be causing these symptoms. Has anyone of you read any research on this?

 

One other odd thing happened last night.  I started sneezing quite badly and felt a cold coming on. I took a 4mg dose of chlorpheniramine and this quickly helped stop the sneezing and runny nose.  And I slept almost uninterrupted and woke up feeling a little drowsy. I've never had this reaction from taking a 4mg dose of chlorpheniramine ever before. This gives more weight to the idea of the histamine receptors being extra sensitive post mirtazapine.

 

Additionally, since I've gone off mirtazapine 5 weeks ago, I've lost about 10kgs/22pounds of the 12kgs/26.5pounds which I had gained while on mirtazapine. 

 

I was also diagnosed with unprovoked (no cause found, no dvts, etc) pulmonary embolism about 3 months ago (like i needed the extra stress!), for which I am on blood thinning medication and will have to be for at least 3 more months. My hematologist has ruled out my discontinuation symptoms in my signature as being blood thinning meds related. Obesity is a risk factor for blood clots and I can't help but feel that the weight I gained on mirtazapine might have contributed to the formation of blood clots. The weight gain is the only reason I'm resisting the idea of reinstating the mirtazapine dose as although the docs have yet to find a root cause, pulmonary embolisms can be fatal.

 

Thanks again for sharing your thoughts on this.  I'm extremely fortunate to have found this place. 

[Fresh]

If you're not going to reinstate , you'd best get used to the sneezing and runny nose . . . most people

have a period of flu' - like symptoms , including aches and pains as one of the early symptoms.

 

Your anti-histamine has a moderately adverse effect when taken with mirtazapine.

Could you put all your meds. into the interaction checker to see what it shows?

 

From www.drugs.com interaction checker:

Moderate chlorpheniramine  mirtazapine

Applies to: Chlorpheniramine (Allergy) (chlorpheniramine), mirtazapine

Using chlorpheniramine together with mirtazapine may increase side effects such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience some impairment in thinking and judgment.

[freesalmon]

Hi Fresh, thanks for the drug interaction check.

 

I've actually been off Mirtazapine since 5 Nov. Have not reinstated the mirtazapine in any way.

 

So the 4mg of chlorpheniramine I took yesterday was without any Mirtazapine.

 

I took paracetamol with the chlorpheniramine aside from my daily dose of Xarelto. No interactions for these on drugs.com interaction checker.

 

So I am stumped by the reaction. Gonna lay off the chlorpheniramine for now.

 

And see if the cold become worse.

[Fresh]

Good point , I jumped the gun there   .

[ten0275]

hi freesalmon,

thanks for filling in some of the blanks with your signature and replies, it's nice to hear from you again.

i want to comment on a couple of your replies.

 

 

One other odd thing happened last night.  I started sneezing quite badly and felt a cold coming on. I took a 4mg dose of chlorpheniramine and this quickly helped stop the sneezing and runny nose.  And I slept almost uninterrupted and woke up feeling a little drowsy. I've never had this reaction from taking a 4mg dose of chlorpheniramine ever before. This gives more weight to the idea of the histamine receptors being extra sensitive post mirtazapine.

you nailed that one. the histamine receptors, and particularly the H1, get hammered and post mirtazapine, they can be tricky. the lower i go on my dose, the more intense i find the histamine sensitivity to be. i have actually found that i am suffering from histamine intolerance (this developed within the past year) and my doctor has concluded the same. dietary modifications have helped address some of these issues.

 

 

I've been considering reinstating the 3.75mg dose.  However, at the same time, despite the symptoms, I've noticed that my sleep is returning slowly (2-3 hours in the first 2 weeks of discontinuation to now about 4-5hours).

i really want to encourage you to reinstate. i'm glad you are not experiencing the same level of discomfort that you encountered immediately after complete cessation. often however there is a "honeymoon period" of lessened symptoms that can last for weeks or even months - before the full intensity of withdrawal is realized - after which reinstatement is far less likely to be successful, if at all. you noted the sneezing (and subsequently ruled out the onset of a cold due to the affect of the chlorpheniramine) and that can indicate that new symptoms are presenting. it's how this whole thing works. you have a couple persistent symptoms that wax and wane in intensity, new ones come and go, and return again. slow tapering can spare you many of these. your nervous system has come to depend upon the mirtazapine for functionality and it needs care in withdrawing.

i get the sense that you are very intelligent and highly attuned to your body - you pay attention to how it operates and you know when something is awry. that will serve you well. my hope is that you will reinstate and possibly spare yourself from intensification down the path a bit. you've tapered too fast, without question.

keep us in the loop.

dave

[Altostrata]

Welcome, freesalmon.

 

It's good to hear your withdrawal symptoms seem to be abating. It's only been a short time; if they seem to get worse, please consider reinstating at a very low dose.

 

Many people find that occasional use of sedating antihistamines aids sleep in withdrawal syndrome.

 

FunkyBaboon, please start a topic in the Symptoms forum regarding http://www.neurosymptoms.org/ That is an interesting site. I have written the site owner pointing out iatrogenic causes of functional neurological symptoms, as these were omitted from his list of causes.

[freesalmon]

Thanks ten0275 and Altostrata.

 

A quick update on how I've been feeling from the last time I posted.

 

I was feeling pretty lousy on Thursday but continued to push through. Didn't sleep much at night (2hours) and got up on Friday morning with biting sensations all over my body. The intensity of this sensation went away when I began to do some deep breathing/relaxation exercises. It was still there, just less pronounced.

 

I had a window of sudden calmness and felt my mood really lift for a couple of hours on Friday morning. I was tired but could not take a nap with slight anxiety and hyperarousal which I have been feeling over the past 3 days.

 

I also noticed that my cold was starting to subside a little and I was beginning to noticeably perspire (something I was not doing much of since I cut Mirtazapine about slightly over 5 weeks ago).

 

By 8pm on Friday, I was yawning but still felt anxiety and hyperarousal. I decided to take .25mg of melatonin and went to bed at 10pm. While I could not get to sleep rightaway, I began some deep breathing exercises and shortly after, and amazingly, went to sleep. I woke up at 1.45am but felt positive that I had at least gotten some sleep. So I repeated this deep breathing and in all managed to get about 5-6 hours of sleep last night.

 

I woke up this morning feeling a lot more positive. The cold has pretty much subsided and the biting/itch in my legs and body has come to a point where it's not too noticeable.

 

I am however, experiencing a slight bout of nausea but it's feels better after breakfast.

 

I have to say that this is the best I've felt since the horrible withdrawal symptoms started about 3+ weeks ago. It's been almost 6 weeks since I've stopped taking Mirtazapine.

 

Diet wise, I have been eating mostly oats for my meals since Wednesday. And I have been supplementing with Vitamin B1, B6, B12 and C over the past few weeks.

 

I am going to hold off on going back on Mirtazapine unless it's absolutely necessary.

 

Thank you for your insights and advice. All the experiences shared on this site helps to keep me going.

[freesalmon]

Another update:

 

Yesterday started out with nausea and a feeling of grogginess mixed heartburn that went on for the whole day.

 

Hyperaroused and slightly anxious throughout most of yesterday but started to feel a little better towards bedtime.

 

Did not take melatonin before bed. Went to bed at 11pm but could not get to sleep as my body was itching with heart palpitations. Placed a pinch of sea salt on my tongue and began breathing exercises. Next thing I know, I woke up at 3.30am.

 

Took a little more salt and drifted off to sleep at 5am. Woke up at 7.30am this morning. Was coughing for a bit and then vomitted out some stomach acid. Felt much better after this.

 

Made myself a bowl of plain oatmeal and had no problems finishing it.

 

Numbness in my left big toe has pretty much subsided most of the day. The itching I notice comes on when I eat certain foods or get a little work up so this may be something I'll have to adjust to and keep a keen eye on.

 

In all, a pretty ok night's sleep of about just over 6 hours.

 

I think I might be hypersensitive to melatonin as I only took .25mg the night before and felt nauseas and groggy pretty much the whole of yesterday till the evening.

 

Prayer also helps keep me sane and calm during this crazy period of ups and downs.

 

I've lost a little more weight but it looks like it's slowing down. I am not too far away from my pre-Mirtazapine weight.

 

Thank you for following me on this journey and feel free to chime in with your thoughts at any time.

[JanCarol]

Hey FreeSalmon - 

 

I get hungover and next-day headaches with melatonin and cannot take it, but there are lots of people here who get benefit from it.

 

Please read here:  About Reinstating and Stabilizing to Stop Withdrawal Symptoms

 

There is a window of opportunity where the reinstatement will be most effective.  You are in that window of opportunity.  If you go too long, and the symptoms become unbearable, it may be too late to reinstate.

 

Wouldn't it be better to take a small reinstatement now - 3.75 mg - than to take the risk that you will have big trouble later?

 

I think of antidepressant withdrawal as like jumping off a cliff.  If it's soon enough, and you can reinstate, then you can gently abseil down to get off the drug.

 

But after a fast taper or cold turkey, you are in free-fall, and you may not know what the damage is until you get to the bottom.  With antidepressants, it might take 6 months to a year until impact - and then it may be too late to reinstate, because you might be shattered into tiny pieces at the bottom of a long cliff.

 

I'm not predicting that it will be like this for you - but it happens so often that I am hoping we can prevent this risk by gently tapering you down the rest of the way.

 

B vitamins can be stimulating during withdrawal, pay attention to how you feel after you take them.  Many people here have good results from Magnesium and Omega-3 fish oil.

 

Welcome to SA!

[FunkyBaboon]

Good call Altostrata, heading to the symptoms forum to start the topic on neurosymptoms.org now.

[Altostrata]

Freesalmon, good to hear you're getting such excellent results from your deep breathing exercises.

 

Could you start a topic in the Symptoms forum and describe how you do them? This will help a lot of people.

 

As JC said, if the symptoms get worse, you might consider reinstatement.

[freesalmon]

Thanks JanCarol and Altostrata!

 

I am considering the reinstatement to 3.75mg. However, I am unsure how I am going to taper to lower dosages as there is no liquid Mirtazapine option in my country. I was on the soltab, which crumbles rather easily. Any advice on how to taper with soltabs?

 

I would hate to go through what I've been through in the last 3 weeks again should. It was just pain and more pain.

 

Last night was bad with anxiety although I did get about 5 hours of sleep. My nose and throat feel like it's all jammed up with mucus that I am unable to clear, and I feel has impacted my appetite.

 

I have been back and forth to the sink to vomit a number of times since Sat afternoon.

 

I got a bad itch yesterday after dinner which only subsided when I managed to doze off.

 

The only good thing I see for now is that my windows of clarity and feeling better are beginning to last a little longer and the waves of pain seem shorter as opposed to when this all started when it was a week and a half of just pure pain.

 

Altostrata: Sure thing. I'll start a topic in the symptoms forum.

[Altostrata]

Please read Tips for tapering off Remeron (mirtazapine)

 

(Thank you, ten0125, for posting this earlier.)

[Fresh]

How did you go with that freesalmon?    

If you dissolve half a tab (7.5mg) into 7.5mls water , you have a 1:1 ratio.  So you can draw up 3.75 mgs/mls  

precisely.

[freesalmon]

 

 

How did you go with that freesalmon?

If you dissolve half a tab (7.5mg) into 7.5mls water , you have a 1:1 ratio. So you can draw up 3.75 mgs/mls

precisely.

Hi Fresh, I've yet to reinstate as I have been having the worst cold ever so have pretty much been in bed the whole time.

 

Btw, when it says flu like symptoms, does that mean allergy like itching and clear mucus?

 

I've been expelling a fair bit of yellow mucus. My doctor thinks it's an infection and wants to put me on antibiotics but I still have not been able to tell if this yellow mucus is just part of withdrawal or actually a cold/flu.

 

The itch has subsided but now I have a lot of phglem that's yellow and a slight cough. My mom, who was helping to take care of me, got really sick last week and has the same symptoms and I got sick shortly after. So it might be my weakened immune system from all that insomnia and stress from the 2 weeks before.

[freesalmon]

Hi everyone,

 

Another quick update and a message of hope for all those coming off mirtazapine.

 

Firstly, I did not reinstate mirtazapine as I wanted to see if this was a cold/flu or w/d.

 

I began to feel better from my cold/flu on Thursday morning.  Lots of yellow/mucus still but a whole lot better and I feel my body getting stronger.

 

Friday was a really good day. A slight bit of nausea in the morning but otherwise nothing really much that bothered me.

 

Last night, I got about 6 hours of sleep.  Woke up twice but the sleep was a really good, deep, restful one.

 

This morning is yet another beautiful one and I feel energetic and renewed.

 

Some of the things I've been doing over the past 1 week:

1. A daily dose of multi-vitamins prescribed by my doctor.

2. 1500mg of Vit C

3. Lots of water

4. Deep breathing exercises (Headspace)

5. Prayer

 

I'm now 2 days into my 7th week of stopping mirtazapine almost C/T and I am feeling tons better. So for all who are going through a tough time, be positive and hang in there. 

 

Do what is good for you, be positive, and keep on fighting.

[JanCarol]

Hey Free - good for you, lining up your personal support.  That is so important, to have personal practice to help you through the rough times.

 

I wonder if you would be helped by a saline rinse - I used to just use a teacup, put salt and water in it, and "snort" the water when there were no products available.  Now there are sprays you can buy that are just salt water.  Some of them "taste" different to others, so don't be discouraged if you get one that doesn't "taste right" - 

 

If you spray your sinuses with saltwater daily, that will soothe irritation, and keep the mucous clear. 

 

I'm glad you are feeling better - please keep in touch.  Hopefully there will be no delayed reaction in a few months time, and you can just walk away.  But if you do have some symptoms down the road, please remember they are probably withdrawal, not "mental illness."  

[freesalmon]

Thanks JanCarol!

 

A quick update of my progress.

 

I had a minor setback last Sunday.  I had a breakout of hives in the early morning of 20 Dec.  It was quite horrible but I struggled and made it through. I suspect it might have been my body still reacting to something in the dinner the night before. As a precaution, I stuck with mostly liquid and soup diet for 2 days after and started feeling better.

On Tuesday, I started by eating some homemade chicken soup and immediately felt an energy increase. Since then, I've started eating pretty much a normal diet with no issues at all.

 

Most of my w/d symptoms have pretty much subsided. My sleeping pattern is a little weird with days where I get 8 hours or more and days where I sleep for 5. My mood has lifted quite a fair bit.  Itching, which has been my most persistent w/d symptom  with mirtazapine has become really quite minimal. No more hyperarousal and very very littel anxiety if any.

 

My psych doc has advised that there is no need for me to go back on Mirtazapine. I do too. I feel about 95% of my pre-medicated self now. I am out and about doing a lot of things. 

 

The journey continues for me.

 

I wish each one of you here continued healing and a Merry Christmas.

[Petunia]

Thanks for the update freesalmon,

Its good to hear you are doing so well and feeling much recovered. You may have a few waves of symptoms arise over the next few weeks or months, but you might not, hopefully not.

 

Do stay in touch and let us know how you are, and please come back and add your story to our  Success stories: Recovery from withdrawal   forum.

[Martina23]

That is great, freesalmon, that you feel well. And after so short time. I am 6 month after stopping my drug altogether, but I consider myself better only maybe 40 percent. Good work!

[freesalmon]

Hi Everyone, thought I'd pop in and give another quick update.

 

It's been 3.5months since I've been off Mirtazapine. I can safely say that I am experiencing none of the withdrawal symptoms I initially had.

 

While I do get up once or twice in the middle of the night these days, I still manage to get about 6 hours of good sleep a night.

 

There are periods of anxiety and worry but I think this is normal for anyone. I have lost about 13kgs since I came off Mirtazapine and am back, weight wise, to where I was before meds.

 

I meditate daily for about 10 mins, eat as well as I can, and have been taking multivitamins.

 

I'll write up my full story in the success stories thread soon.

 

In the meantime, do stay positive and know that there is light at the end of the tunnel. We will all heal eventually. Hang in there!

[Sarabera]

freesalmon-soo good to hear that you are doing well! Continue to take care of yourself, and I bet you will be just fine.

Sarah

[freesalmon]

Hi everyone, it's coming up to 5 months since I took my last dose of mirtazapine.

 

Things are pretty much back to normal. No more withdrawal of any sorts.

 

I do get an occasional feeling of low mood, but this is normal.

 

I wish each of you a speedy healing. Stay positive.

[marie123]

Good for you Freesalmon. Thanks for coming back to post. It means a lot to all of us out there tapering. Now I have a Remeron success story that I can keep reading when I go thru my Rem taper. Good Luck. Marie

[SquirrellyGirl]

Hi Freesalmon, 

 

How are you traveling three months since your last update?  Are you ready to write your Success Story?

 

I hope all is well :-)

 

SG