Laughing: Hello!

[Laughing]

Hello dear everyone!

I am here to learn about tapering. So far I like the slow method that I am reading about. It does seem to be daunting though, trying to learn how to make a liquid and measuring in ml, and the reductions ect. But I am willing to learn and hope you all dont mind me asking questions so I can can get it all straight in my head.

Also I am very stable right now, and dont know if I should try this, as it seems to be a difficult thing to do.

In fact I am feeling better than I have for years. I am hoping I make the right decision.

In a few months I will see my doctor and hopefully get a tapering prescription. So I have awhile to figure this all out.

Now if I can figure out how to attach my signature,

Sincerely,

Laughing

[AliG]

Hi Laughing .  Welcome.  Great name . Off to a good start !   .   

Tapering could seem daunting now , but with help & encouragement , you will be fine.  Feeling stable will help , as well . It's a good place to start from .  Thanks for adding your signature. Are you on Cymbalta and Remeron  ( both )  now ?  What dosage ?  

You don't necessarily need your doctor's approval to taper.

The recommended tapering method here is  a 10 % dosage reduction , every month , with the 10 % calculated on the last dosage. The amount of decrease is proportionate to the dosage and keeps getting smaller.

http://survivingantidepressants.org/index.php?/topic/1024-why-taper-by-10-of-my-dosage/

 

We don't recommend tapering two drugs at once. Since Remeron ( Mirtazapine ) is more sedating , I would think that you would taper Cymbalta , first . However, that can be decided later.

http://survivingantidepressants.org/index.php?/topic/2207-taking-multiple-psych-drugs-which-drug-to-taper-first/

 

This is your Intro thread / journal to ask questions and monitor progress.  Have a read of the links / site and come back with any other questions you might have.

Ali

[nz11]

Welcome Laughing.

Nothing to add just wanted to say this is your lucky day finding sa.

nz11

[Laughing]

Thanks for the welcomes!

I am currently on 45mg of remeron and 60mg of Cymbalta.

For some reason I got it into my head to do the remeron first. I have heard that there is less of a chance of withdrawal symptoms with the remeron than the cymbalta? Also it seems easier to deal with the tablet form of the remeron than the capsule form of the cymbalta with all the little beads and such. I wanted to do the easier of the two first. Sucess builds sucess?

Also I forgot to mention about 10 years ago I was on remeron for about 3 years. I apparently got off of it fairly easy, my memory of those years are a bit foggy.

I certainly feel the sleepy effects of the remeron. It knocks me out cold. I don't wake in the middle of the night for anything. It actually concerns me that I can sleep so soundly and not hear anything.

So Ali, you think doing the cymbalta first, would be helpful?

[AliG]

Laughing.  I say that because you might need the " sleepy effects" of Remeron , as you are tapering.  Sleeplessness,  can be hard to deal with . If you read the link I gave you on  which drugs to taper first , you will see what I mean . It acts as a brake.

[PoetJester]

hey Laughing

 

Whereabouts in the Midwest are you from?

 

PoetJester

[Laughing]

Hello, Poet Jester. I would rather not say, if u don't mind!

[nz11]

There is only one Laughing and i can tell you now, no one is .

 

Interactions between your selected drugs

Major mirtazapine duloxetine

Applies to: Remeron (mirtazapine), Cymbalta (duloxetine)

Using mirtazapine together with DULoxetine can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should seek immediate medical attention if you experience these symptoms while taking the medications. Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Other drugs that your selected drugs interact with

• Cymbalta (duloxetine) interacts with more than 500 other drugs.
• Remeron (mirtazapine) interacts with more than 300 other drugs.

Interactions between your selected drugs and food

Moderate mirtazapine food

Applies to: Remeron (mirtazapine)

Alcohol can increase the nervous system side effects of mirtazapine such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with mirtazapine. Do not use more than the recommended dose of mirtazapine, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Switch to professional interaction data

Moderate duloxetine food

Applies to: Cymbalta (duloxetine)

DULoxetine may cause liver damage, and taking it with alcohol may increase that risk. You should avoid or limit the use of alcohol while being treated with DULoxetine. Call your doctor immediately if you have fever, chills, joint pain or swelling, excessive tiredness or weakness, unusual bleeding or bruising, skin rash or itching, loss of appetite, nausea, vomiting, dark colored urine, or yellowing of the skin or the whites of your eyes, as these may be symptoms of liver damage. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

Duplication Antidepressants

Therapeutic duplication

The recommended maximum number of medicines in the 'antidepressants' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'antidepressants' category:

• duloxetine (active ingredient in Cymbalta (duloxetine))
• mirtazapine (active ingredient in Remeron (mirtazapine))

Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

[Laughing]

Hi. I read the link on how to use a scale for measuring out beads in capsules. I am assuming that is what I might have to do for the cymbalta capsules.

Can a scale be used for tablets too?, instead of converting tablets to a liquid?

I am hesitant in converting the tablet to a liquid, as I might metabolize the liquid different that the tablet. Has anyone here used a scale to taper a tablet instead of converting to a liquid? Is there any links on this subject?

[nz11]

Sure thing

Using a digital scale to measure doses

[Laughing]

Thanks!

[Laughing]

So if I crush a tablet and then weigh out the powder, and then scrape the correct amount of powder in a cup and then and a little liquid and gulp it down, does this sound doable?

The above link seems to talk about making a liquid dosage which I do not want to do. I want to make a powder dosage.

[Fresh]

Hi Laughing ,  welcome to the site.

 

Yes , a scale can be used for tablets and tablet fragments and dust.   As your dose goes down , it's actually easier

and less fiddly to make a liquid.

 

If you weigh your dose out , there's no need to make a liquid - just wash it down with a mouthful of water.

(swipe it with your finger and wipe it on your tongue).

 

Please could you add dosages and dates to your sig. , so we can see where you're at each time you post.

 

Best wishes , Fresh

[Laughing]

Or if I take the weighed powder and scrape it into a gel cap and then swallow that?

[Fresh]

You're making it more complicated than it needs to be.

[Laughing]

Thanks Fresh!

I will go to my settings and try to adjust my signature.

[Fresh]

Thanks Laughing.

 

I feel I should point out the following thread , which talks about how to choose which drug to taper first.

It suggests we should decrease the more activating one first , which for you is cymbalta.

 

You may choose to go part way on the remeron taper , and then hold that for 6 months while you

taper cymbalta for while.

You don't need to decide now , just something to keep in mind.  Lots of people taper like this , alternating

so that they're bringing down 2 or more meds. concurrently.

 

Taking multiple psych drugs? Which drug to taper first?

[Laughing]

Hi Fresh! I was reading your history. Looks like u were off of cymbalta and about 6 months later u had withdrawal? Any advice? Do u think u tapered too fast?

[Fresh]

Yes , I did taper too fast.   And I didn't know about holds then . so I charged ahead , thinking the sooner I got off

the drugs  the better.

 

My advice is to go slow.  Do a cut , and give yourself 4-6 weeks if needed to recover before cutting again.

 

I wish I'd found this site sooner , but for whatever reasons , I guess the w/d was something I had to go through.

 

I've tapered from 50mg to 22.5mg in the past 12 months , and it's been the best , most stable , calm , fun

12 months I can remember.  I'm recovering as I go , developing new social connections , growing into the self

I was meant to be.  

[Laughing]

Oh I am glad u are doing good now. You sound well! (As well as u can sound over the internet, hee hee)

[nz11]

Hi Laughing any decisions on tapering?

[blazesboylan]

Or if I take the weighed powder and scrape it into a gel cap and then swallow that?

 

If the pill is hard then what you might do is shave some off with a sharp knife until it's the required weight. That's what I have been doing anyhow.

 

However, if the pill is a capsule containing powder then it wouldn't be possible to do that I suppose. In that case perhaps you could mix the powder with a half a pint of water, and mix it well. Then drink 90% of the water and throw the rest down the drain! I'm not sure if that is advisable or not so see what other members think?

[scallywag]

blazes -- Cymbalta beads have an enteric coating required so that the medication isn't destroyed by stomach acid.  Creating a liquid isn't an option with Cymbalta (duloxetine)

[Laughing]

What is going on? (topic moved from the Symptoms and Self Care Forum)

 

Hello everyone, I have been having alot of wierd symptoms and I do not know if it is withdrawal or not, or what in the world is going on. For 5 years I have been tapering off of cymbalta and remeron. I have gone from 60 mg of cymbalta down to 3 mg and 45mg of remeron to 15mg. The last time I tapered was in July. In October I started having these bizarre symptoms.  And what is really weird is that it happens every other day...sometimes it might vary every 2 days, but almost like clock work every other day.

I become extremely agitated,   and anxious. I start pacing the floor or rock back and forth. I sometimes feel suicidal.  I feel so desperate at these times. It can last an hour up to 6 hours or so.

My question is? Is this withdrawal? I want so much for a doctor to diagnose me, but I am not sure what doctor to go to.

I dont know if I should hold my meds (which I am doing) or up my meds, or try to finish tapering. I keep going around  and around about what to do.  If I taper are the symptoms going to get worse? I can't handle this anymore, it has been going on for 3 months and I dont know what to do.

 

 

Edited May 11, 2022 by ChessieCat
added topic title before merging with intro topic

[Gridley]

10 hours ago, Laughing said:

I have gone from 60 mg of cymbalta down to 3 mg and 45mg of remeron to 15mg.

We recommend tapering only one drug at a time.  Otherwise (as may be the case in your situation) if there are problems you won't know the cause.  We recommend tapering the activating (stimulating) drug first, leaving the sedating drug for later tpering in order to preserve sleep.

 

Taking multiple psych drugs? Which drug to taper first?

 

10 hours ago, Laughing said:

In October I started having these bizarre symptoms.  And what is really weird is that it happens every other day...sometimes it might vary every 2 days, but almost like clock work every other day.

Symptoms come and go.  There's no way to predict their timing.

 

The Windows and Waves Pattern of Stabilization

 

10 hours ago, Laughing said:

I dont know if I should hold my meds (which I am doing) or up my meds,

I would hold where you are until you stabilize, which mean that symptoms are more or less the same every day without big swings or changes.  Once you've stabilized, I'd suggest you complete your Cymbalta taper while holding on the Remeron.  Once you've completed the Cymbalta taper, hold for 2 to 3 months, then (if you're feeling stable) you can resume the Remeron taper.

 

10 hours ago, Laughing said:

If I taper are the symptoms going to get worse?

If you are unstable, it is better to hold than to continue tapering.  Continued tapering will likely worsen symptoms.

 

10 hours ago, Laughing said:

t has been going on for 3 months

Unfortunately, three months isn't that long for withdrawal symptoms to continue.  

 

What is withdrawal syndrome.

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

When we take psychiatric medications, the CNS (central nervous system) responds by making changes over the months and years we take the drug(s). When the medication is discontinued, the CNS has to undo all the changes it made. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur.  

 

These explain the healing process really well.

 

Brain Remodelling 

 

Video:  Healing From Antidepressants - Patterns of Recovery

 

How fast did you taper the Cymbalta and Remeron? We recommend tapering by no more than 10% of your current dose every four weeks.  

 

Why taper by 10% of my dosage?

 

Some have taper more slowly.  Tapering two drugs at once complicates the situation.  

 

When you're ready to begin tapering the Cymbalta, this link is specifically about tapering Cymbalta.

 

Tips for tapering off duloxetine (Cymbalta)

 

10 hours ago, Laughing said:

I want so much for a doctor to diagnose me, but I am not sure what doctor to go to.

Doctors, including psychiatrists, know nothing about safe tapering and don't believe that withdrawal from antidepressants exists. See a doctor if you think that will make you feel better.  Be wary if you they want to put you on more psychiatric drugs.  

 

10 hours ago, Laughing said:

 

I become extremely agitated,   and anxious. I start pacing the floor or rock back and forth.

 

Agitation and inner and outer restlessness are typical withdrawl symptoms.

Akathisia vs restlessness, anxiety, agitation - Symptoms and ...

 

 

 

 

 

[Laughing]

Thank you so much for your reply. Yes I was only tapering cymbalta this past year.

I realize that I need to do only 1 med at a time. Thanks again for all the info. God bless you. 

[Onmyway]

Dear Laughing, the lower doses are particularly hard to taper as the drug's effects do not diminish proportionally but rather a small dosage has a big effect and then as you add more drug the additional effect is smaller. So as you peel that away when tapering, getting down from 15 to 14 is not the same as going down from 3 to 2. You seem to be doing the right thing going very slowly and holding when needed. I want to reassure you that it is likely just a bump in the road and things will get better.  Try to hang on! 

 

Hope you are already feeling at least a bit better. This is tough but you are tougher! 

[Laughing]

Want to taper, please advise.

 

Hello, I want to taper off of remeron and want to make sure that this tablet med is ok to cut/crush for a taper? And I understand that it might be wise to make it into a liquid form....but first want to make sure  a person can cut and/or make Remeron into a liquid as I have heard that some meds are altered if crushed/cut?

 

Thank you in advance! 

 

 

Edited May 11, 2022 by ChessieCat
added Intro topic title before merging with intro topic

[ChessieCat]

Hello Laughing and welcome back to SA,

 

I have moved the new Intro topic to your original Intro topic, which is the place to ask questions specific to your situation and where you can also journal your progress.  This keeps your history in one place and means you don't need to repeat your story.  Only ONE Introduction topic per member.

 

Please note that I have also moved another topic which your created and put it with your Introduction topic, for the same reason, to keep your history in one place.

 

Please update your drug signature to show all the changes since 2020.  Thank you.  This link will go straight to your own drug signature and remember to Save. 

 

Account Settings – Create or Edit a signature

 

Post #1 of this topic explains ways to get non standard doses:

 

Tips for tapering off mirtazapine (Remeron)

 

[Laughing]

Thank you Chessie! Just what I needed. God bless you! 

[Laughing]

Hello,

I was wondering if anyone here could answer my concerns.

I am having some symptoms that are greatly bothering me and I was wondering if its just the meds causing them or because I am tapering? I am at such a low dose (7.5 mg of Remeron) that I was hoping I would see improvement,  I have had this off and on for a long time. Its just starting to bother me greatly again.

Its kind of hard to explain, 
Its kind of like a feeling of apathy or lethargy. 
I have to push myself to do things and keep busy and sometimes this helps, but this feeling is always in the back ground.  Sometimes the feeling is so great it causes me to be restless and agitated.
I am becoming very discouraged. 

 

Edited July 27, 2022 by ChessieCat
Resized font

[ChessieCat]

At lower doses Remeron is more sedating.

 

Other members have had the same thing happen to them as their dose got lower.

 

Please update your drug signature.  There is no mention of Remeron 7.5mg.

[ChessieCat]

  

MIrtazapine is more sedating at lower the doses.  There is mentioned of it in Post #1 in this topic:

 

tips-for-tapering-off-mirtazapine-remeron

 

Unfortunately the link where the quote was taken from is broken.  The staff are trying to find it.

 

However, this provides the same information from:

 

https://www.psychdb.com/meds/antidepressants/nassa/mirtazapine

Why Do Lower Doses of Mirtazapine Cause More Sedation?

Quote

Mirtazapine acts mainly on 3 receptors: histaminergic, noradrenergic, and serotonergic receptors. However, at low doses (e.g. - 7.5 mg), mirtazapine has a higher affinity to (and thus preferentially blocks) the histamine-1 receptor, compared to the other 2 receptors.^[2][3] At higher doses, this antihistamine activity is offset by increased noradrenergic transmission, which reduces its sedating effects.^[4][5] Although sedation is expected at low doses, it is usually most noticeable in the first few weeks of therapy and diminishes with continued treatment.^[6]

 

 

 

[Laughing]

Thank you ChessieCat! I updated my signature. God bless.

[ChessieCat]

Please don't try and taper off it fast otherwise you might make things worse if you get withdrawal symptoms

[Laughing]

Hello,
    I am getting discouraged. I hope ya all dont mind me talking about it and trying to figure all this out.  I guess I am just feeling awful...and dont know if its just a med brain and I need to keep tapering or is it because of tapering and I need to hold?  It is hard to even describe what I am feeling as its not any drastic withdrawal symptoms.  I just feel awful.  I know thats vague....I will try to explain more....I just feel something is terribly wrong.    .....sometimes it just feels like my brain doesn't work or I just feel yucky.

     I also have the insulated feeling....of not being able to connect with others...the zombie type of feeling...which is the meds...but this other feeling is just.... maybe depression? 
      If these meds goof up your brain chemistry how will it ever go back to normal? I just dont see how I can possibly heal after years of meds......
I am scared and feel stuck. 
I made a cut in my meds last night ...after waiting over a month since my last cut...
I hope I made the right decision. 
I just want to be able to connect with others again....I am tired of feeling like I am living in a fish bowl, behind glass, cut off from everyone else.
Thanks for listening.