Penfold on mirtazapine

[Fresh]

Hi Penfold , the best thing to do now is sit tight for a good couple of months before continuing to taper anything.

 

I don't follow how you tapered ... if you did decrease by 10% that would have taken you to 27mg as your first drop. If you went straight to 26mg , it may help to understand your reaction. Perhaps you could clarify.

 

With regard to continuing your taper , we recommend tapering the most activating drug first.

"The Mirtazapine is sedating , and therefore will act as a brake ." This is not correct.

Mirtazapine (ad's) are activating. Pregbalin (Lyrica , benzos etc.) are sedating.

 

""Accelerators" and "brakes"

If no one drug is clearly causing an adverse effect, "discontinue the more activating drugs first," I have been advised by a doctor who studies withdrawal syndromes and iatrogenic damage.

 

Antidepressants and ADHD drugs (most are amphetamine analogs) tend to be activating drugs, causing jitteriness, anxiety, or sleeplessness.

 

Benzodiazepines, the "Z" drugs for sleep, anticonvulsants (such as lamotrigine), Lyrica, gabapentin (Neurontin), and antipsychotics tend to be regulating or sedating drugs, causing drowsiness, sluggishness, or dopiness.

 

The two types of drugs can be thought of as "accelerators" and "brakes."

 

Many people have a sedating drug -- a brake -- added to an activating drug -- an accelerator -- to treat drug-induced anxiety or sleep problems.

 

In those cases, unless you are having clear adverse reactions from a particular drug, taper the antidepressant or stimulant first. Otherwise, you will experience activation from the other drug as you decrease the "brake."

 

I've joined your new thread with your main Introduction topic. One thread per member in the Introductions section.

 

bw , Fresh

[Penfold]

Hi, my mistake on the drops. I dropped down to 27mg first for four weeks. I bought a pill cutter so it was easier to do 2mg decreases. Next drop was to 25mg for four weeks. Then I dropped down to 23mg and felt awful & concerned I couldn't function if i carried on.

I reinstated back to 30mg because I didn't know what else to do 2 weeks ago but I still feel really low & very tired.

[Fresh]

I'd recommend staying on 30mg since it's been more than a few days. The less bouncing around the better.

As you may know , there are far worse symptoms than fatigue .

 

You'd be wise to in vest $30 in some digital jewellers' sclaes on ebay , so that you can measure doses more accurately. Better yet , you can make liquid from mirtazapine for precision dosing. See the Tapering forum.

 

If your cuts with a pill-cutter have been just 1 or 2 mg out , you've been bouncing for the last 2 months within a 4mg window.

[Penfold]

Unfortunately my memory & recall are not so great at the moment. I did purchase some tiny scales that weigh grams to make it more precise.

I visited a couple of rehab centres yesterday as I think if I am going to get off this medication I'm going to need a safe place & a lot of support. I don't have that as my close family are telling me to stay on it & I'm separating from my husband.

 

Fatigue isn't the worst withdrawal symptom but I won't go into them all now as I'm sure you've experienced them for yourself. Thanks for the advice though.

[JanCarol]

Mirtazapine is a unique drug, in that the less of it you take, the more sedating it is.

 

7.5 mg is more sedating than 15, and 15 is more sedating than 30.  Also, it can be sedating at higher doses until you get used to it.  Then, as you acclimate, as Fresh said, it becomes more activating.  I think it is a receptor thing - at low doses 7.5-30 it hits this antihistamine channels, but 30 and higher it hits the neurotransmitters.  You are right on the line.  It could be sedating, it could be activating, it could be both.

 

Alto recommended you start with the pregalbin first, as it will make you fuzzy, sleepy, dopey, and a few more extra Dwarfs.  I think if you tapered your pregalbin - on the schedule Alto recommends - and got it down to half, you will find that your head is much clearer, and this whole thing will be less confusing.

[leahy]

Hi Pen,

 

As you are going through a separation, a sale of a house and moving your stress level must be very high. That's three of the four top life stressors. I went through that and it is a life altering experience for sure. Perhaps now is not the time to be tapering? 

 

In case you don't already know this - Mirtazapine is notorious for weight gain in humans and animals, particularly cats. I've gained 50 pounds over 16 years which was my original reason for wanting to get off of it. I quickly learned my other reasons for wanting off shortly thereafter.

 

If you decide to put your taper on hold, I wonder at one point (since you already have a scale) perhaps settling on 29 mg of mirt and holding? It's always nice to be a tiny bit down. It shortens the drop when you are stable. I can't speak about pregabalin since I have never taken it.

 

After being on very high doses and suffering for 17 years while on mirt and suffering even more the past 13 months of wd, if I had the luxury of time, micro cuts would have been helpful to me. It is often said that lower doses of mirt are more sedating but I have not noticed being more tired at lower doses. I am not more tired at 9 mg than I was at 30, 60 or 90 mg. I wish I did feel more sedated because getting decent sleep is my biggest hurtle. Just my thoughts...

 

Right now I'm sure you'll need to be strong and regroup from your life changes. Wishing you good health and happiness.

 

Leahy

[Fresh]

I hadn't read this post from November 2015 from Alto: "If the pregabalin isn't helping, if I were you, I'd go off it, perhaps 25% every 4 days. All it's doing is confusing your situation."

 

Sorry if I confused things ... did you consider following Alto's recommendation?

[Penfold]

I took 27mg of Mirtazapine & felt better today. Will take the same tonight. I have put on 2 stones since taking Pregabalin!!

[Fresh]

" did you consider following Alto's recommendation?"

[Penfold]

Going to get house move sorted out first & I've asked my mum if I can stay with her while I reduce pregabalin at 10% reductions. Still got to convince her that I'm not mentally ill & it's the drugs!!

[Penfold]

What do people think of rehabs?

[Penfold]

The hardest thing about the withdraw is getting other people to believe that how I'm feeling is not really me.

My family keep saying to me they can't understand how I've turned into a completely different person. When I try to explain why they say I'm being negative or making excuses. Do they not realise how devastating it is for me feeling like a different person?

[leahy]

The hardest thing about the withdraw is getting other people to believe that how I'm feeling is not really me.

My family keep saying to me they can't understand how I've turned into a completely different person. When I try to explain why they say I'm being negative or making excuses. Do they not realise how devastating it is for me feeling like a different person?

I totally get what you're saying. No, apparently family cannot understand what we are faced with here. I'm sure it's hard for ppl to understand when they have no clue what this is like. Especially when withdrawal is not even acknowledged by the medical field. Honestly, I find my wretched wd hard to believe myself yet I am going through it.  No one believes me either. Not even my doctor.

[leahy]

I was glad to see you settled on 27 mg Remeron. It's that much less of a fall down that slide when you decide to taper.

[Penfold]

If the mirtazapine 'pooped' out on me Jan 2015 does that mean I have been having withdrawal symptoms since then?

[Penfold]

25% every 4 days to come off pregabalin just seems like a very quick taper to me.

[KarenB]

We have some discussion about rehab here:  http://survivingantidepressants.org/index.php?/topic/5366-inpatient-detox-or-rehab/ - generally it seems to be quite unhelpful because they go too fast. 

 

A safe taper is about giving your brain and Central Nervous System time to adjust and rebuild as you go.  It takes a decent length of time.  It's not just about getting drugs out of your system.

 

Have a look at these, because understanding the process will help you to make better decisions:

 

Brain Remodeling

 

Withdrawal Syndrome

 

Karen

[Penfold]

I wasn't functioning well on these drugs hence my reason for coming off them. I am not stable on 27mg of Mirtazapine yet. Should I increase to 28mg? I am seriously thinking of asking my dr for a very low dose of another antidepressant as my mood & motivation are so low. Then I will have 3 drugs to come off of!!! What are peoples views?

[KarenB]

Now that your Central Nervous System is destabilised, any changes you make will add in to that cumulative effect of making it all worse.  That includes trying other meds.  You really need to get clear about why you want to come off, so that you won't be side-tracked by complicating ideas. 

 

You will also need to look at the non-drug alternatives for coping with emotional symptoms.  You can learn to manage motivation issues/depression without drugs. 

 

How long have you been trying to stabilise on 27mg mirt?  (Please put this info in your sig. so we can see it whenever you post).

 

Best wishes,

Karen

[Penfold]

I have been taking 27mg for the last 5 days. The mornings are definitely the worst. I wake up late due to the heavy sedation I'm having with a real terror & sense of dread.

I haven't even started to taper the pregabalin yet! The hardest thing by far is having to admit that I can't look after my children while I'm trying to do this. I'm going to stay at my mums while I attempt to get off this stuff.

 

On another note does anyone know of any drs in the UK that are knowledgeable about withdrawal?

[KarenB]

I'd give it a few weeks at least to allow your CNS time to settle before considering a change in dose.  5 days is relatively short (though I know it feels long when you are suffering).

 

Have a scan through this to look for doctors in your area:  http://survivingantidepressants.org/index.php?/topic/988-recommended-doctors-therapists-or-clinics/

[Altostrata]

It's too late to do a fast taper off pregabalin, I made that suggestion months ago when you had been on it about a month. You will have to taper it slower now.

 

What is your worst symptom? Is it feeling dopey during the day?

 

Read

 

Tips for tapering off Lyrica (pregabalin)

 

Tips for tapering off Remeron (mirtazapine)

 

I was prescribed pregabalin (a tiny amount) for sleep. It would have been impossible for me to take it during the day. What you might do is -- over a long weekend -- move the time you take half of the pregabalin (100mg) an hour or later in the day, until you are taking it before bed.

 

This may help you taper off mirtazapine, as it (hopefully) will help you sleep.

 

What time do you take mirtazapine?

 

As leahy noted, mirtazapine is notorious for causing weight gain. It's probably not the gabapentin's doing.

 

It's very important that you read the responses to your posts carefully and answer questions so we know how you're doing.

[Penfold]

I stayed on the pregabalin stupidly at the advice of the CPN I was under. As I said I wanted to come off mirtazapine so they advised to come off that first but stay on Pregabalin.

 

I'm glad I didn't take her advice and take the pregabalin 3 times a day. I was initially taking it twice a day but stopped the evening dose after about a month because it made me very sleepy on top of taking Mirtazapine at night.

[Altostrata]

What do you think of moving your pregabalin dose?

 

What time of day do you take mirtazapine and pregabalin? It's very important that you answer these questions.

 

Good point about taking in twice a day, that might put you out all day. How about moving the entire 200mg backward a few hours at a time until you are taking it at bedtime?

[Penfold]

I think I should stabilise on 27mg Mirtazapine & when I feel ready reduce the pregabalin by 10%.

 

I recently ran down the pregabalin until I didn't have the pill to take in the morning & just missing that morning dose made me feel bad. As soon as I picked up my prescription that afternoon & took it I was ok.

I'm not dismissing your idea just might be good to see how I react to a reduction first.

[Altostrata]

That is correct. You are dependent on the pregabalin as well, you cannot just quit it, you will need to taper to go off it. Moving the dose backwards into the nighttime should not cause withdrawal symptoms from pregabalin.

 

If you continue to take it during the day, you will continue to feel groggy from it. This will occur throughout your taper of mirtazapine, which could take many months.

 

You still haven't answered my questions. Please put ALL the drugs you take in the Drug Interactions Checker http://www.drugs.com/drug_interactions.html

and copy and paste the results in this topic.

[Penfold]

I take Pregabalin at 11am & mirtazapine at 10pm. I find it extremely difficult to get up in the mornings. My concern with moving the pregabalin to the evening would be would it be too much with the mirtazapine and make it even harder to get up?

Would you advise staying where I am with the mirtazapine & withdrawing the pregabalin or carry on very slowly with tapering mirtazapine?

[Penfold]

Unfortunately I do seem to be very sensitive to withdrawal effects.

The people closest to me are saying I don't know why you don't have the faith to put the lot in the bin. As if that thought hadn't crossed my mind a million times & I wish it was that simple!!

[AliG]

Please do , as Alto suggests. Put all your drugs in the Drug Interactions Checker.

[Penfold]

Using mirtazapine together with pregabalin may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination.

[Penfold]

I'm really struggling. I haven't stabilised on the 27mg of Mirtazapine and I am not functioning. Should i try to go back up to 30mg or now that I am in withdrawal keep tapering the mirtazapine. I feel terrible and this is making me very agoraphobic and isolated.

[Fresh]

Penfold , you've been offered a number of suggestions by staff in the past month , and ignored them all  (reinstate at 30mg , fast taper off the pregbalin , move the pregbalin throughout the day).

 

You have all the information.  I'm not clear why you ask for advice then do whatever you feel is best anyway.

[Penfold]

I genuinely don't want to annoy anyone on here as I am feeling very alone with all this as it is. I did try to reinstate back to 30mg of Mirtazapine but for the two days that I did I felt extremely spaced out & not with it at all.

I know it's not going to be easy but I've already lost so much as a result of these drugs & now my children are going to live with their dad because I'm not well enough to look after them.

Today I tried not taking the Pregabalin til 5pm but all day I have really struggled. When I took it I started to feel better.

I appreciate all the help you are trying to give me but I seem to be very sensitive to any changes.

[Penfold]

I am starting to feel like there is something wrong with me. This scares me as I don't want to go back to the drs as they will only offer more drugs or refer me to a psychiatrist again.

I would be happy if I never see another psychiatrist as long as I live!!

[Fresh]

Well that was a bit silly.  Alto clearly recommended moving it throughout the day so you take it later by one or two hours at a time.   Not taking any till 5pm is a great way to create withdrawal.

 

You really need to try and get your head around this Penfold.   Do not skip doses (particularly the a.m.

dose , when you are most at risk of triggering withdrawal).  This is recommended precisely BECAUSE you are sensitive to changes.

 

Post 60: " How about moving the entire 200mg backward a few hours at a time until you are taking it at bedtime?"

 

Please re-read and reconsider this discussion.  Moving the pregbalin will have a significant impact on how functional you are during the day.

You might make a plan like the following:

Day 1  preg. 9a.m.

Days 2-5  . . . 11 a.m.

Days 6-10 . . .1 p.m.

Days 11-14 . . 3 p.m.

Days  15-20 . .5pm

Days 21-25 . . . 7p.m.

Days 26 - 30 . . 9 p.m.

[Penfold]

My mistake I misread the moving the pregabalin a few hrs at a time until it's taken at bedtime. I will follow the plan above & see how I go.