Bridgetini: tapered mirtazapine, now venlafaxine

[Bridgetini]

I made another cut in Mirtazapine on 9 October, from 1.5 mg to 1.4 mg. I am using a homemade solution of 0.5 mg/mL and measuring it with a 5 mL syringe from the pharmacy, so increments smaller than 0.2 mL (0.1mg) are not visible on the syringe. I am a bit up and down at the moment, but not as bad as I have been many times before, and better than would be expected given all that has happened in the last few months.

 

I have an appointment with the local psychiatric day hospital service in the morning. I am glad, as I need to get a prescription for meds, but I am apprehensive as:

1) I have lost all faith in the biomedical model of psychiatry.

2) My G.P. read me an excerpt from the most recent letter he had from the psychiatrist (from March 2017?) "patient shows no sign of depression". If that were the case, why would I need to be on the max dose of Venlafaxine PLUS Lorazapam for 3 years PLUS Mirt?

3) That psychiatrist has retired, and the new senior psychiatrist at the hospital is one of the creators of the "California Rocket Fuel" combo of Venlafaxine + Mirtaxapine that I am on. So I foresee fireworks.

4) I had a big argument on the phone in August with the receptionist and the senior nurse when I tried to schedule an appointment - they were super rude and told me that if I needed help that badly, to go to the Emergency room at the local hospital. I was not in crisis, but was asking to be transferred back into their service after a stint working and living in a different city.

 

 

[ChessieCat]

It might be better to use a smaller syringe:  Where to get oral syringes

 

These are good topics to read before seeing a medical professional:

 

How do you talk to a doctor about tapering and withdrawal?

What should I expect from my doctor about withdrawal symptoms?

[Bridgetini]

Thanks, @ChessieCat. Always good to know that someone is reading a post and that I am not alone, shouting into oblivion. I will look for syringes for smaller increments.

 

The appointment at the day hospital went really well today!

There have been a lot of changes, physical, personnel, and organisational, since the change in command. There was more information posted about the services they provide and new groups for interaction of and with service users.

The doctor I met was really understanding, and we had a chat about benzos - she really does not like to prescribe them, and only does so for patients who are already on them long term and would go into crisis without them. She recommended that I start reducing Lorazepam and will facilitate me getting smaller tablet dose sizes. She also will get the staff person who organises the meetings of groups and links into other services to call me to help get me interacting socially more.

It was a good meeting, I feel good about my decisions, and I have a prescription for 3 months. 

Yay!! Phew!!

[Bridgetini]

I just noticed a tapering graph in a post (from ChessieCat?) so I drew up one for my Mirtazapine withdrawal as I am recording it in an Excel spreadsheet anyway. 

Every time I make a reduction and go through the waves, I notice not only my digestion improving, and my interest in life, but COLOURS! are Brighter! I am addicted to looking at pics on Instagram, particularly #yarnporn. I started knitting again as I love the tactile sensation of nice soft woollen fibres, and the colour, and the softness, and the sense of incremental acheivement, and the fact that I have to sit still to do it instead of constantly doing housework. 

 

I was approached by two companies locally last week who brought me for interview, so I am probably going to start back at work very soon. It is exciting - I find working very rewarding in so many ways - socially, economically, validating..

I really want to make another cut today as I have been 28 days on this taper - but it might put me in a rough place just when I would be starting the job - 

 

[Bridgetini]

Well expletive expletive.

I started the job - it sucks. I felt burnt out after 7 days there so I called in sick yesterday and today and just handed in my resignation.

I AM Just. Not . Able. for a pressurised job that takes up all the daylight hours and forces me to do all the household chores at the beginning or end of the day.

I know: "Welcome to the real world". But I Just CAn't

 

By chance I had an appointment with an occupational therapist yesterday and I talked to her about it - she was quite understanding. I went from zero to full throttle - maybe I need to cut back and take smaller steps.

I was so exhausted and weepy yesterday, then tossing and turning all night. My spouse is really supportive of my decision, whatever. So now we have to go back to the usual state of uncertainty over finances.

 

BUT despite all that, I made another cut to my Mirt after 3 weeks on the previous dose - I am wary of rushing but so look forward to the upswings each time. 

[Bridgetini]

[Bridgetini]

I am back working at my new job. I am really fortunate that my boss agreed to let me work shorter days to reduce the stress! I am trying it out on 5-6 hours a day instead of 7-8. It still is a cjallenge, balancing home life as well. But I am feeling a bit better this week.

[Bridgetini]

Lots of ups and downs over the last six months..

I finished my 6-month work contract so am off work and at home for the summer. I don't qualify for any kind of income support or benefit, but I have a spouse who supports the family.

I have been tapering down Mirt still and am now down to 0.8 mg at night, while keeping other psych medications the same.

I had a gynaecological event in April - a procedure I had last summer was not successful, so I was put on a progestin steroid to stop me haemorraging - it has a side effect of causing depression, but was completely neccessary. I am waiting for a date for a different surgical intervention. C'est la vie...

 

[SkyBlue]

3 hours ago, Bridgetini said:

Lots of ups and downs over the last six months..

 

I have been tapering down Mirt still and am now down to 0.8 mg at night, while keeping other psych medications the same.

 

Thanks for checking in. 
 

Lots of ups and downs seems to be par for the course, given the windows and waves patten of healing. : )

I wish you the best in your continued healing. 

[Bridgetini]

Thanks for your support, Sky Blue.

I had gynaecological surgery at the start of July and am recovered now, but I have been put on another Mirena IUD coil (my fourth in 13 years). This releases levonorgestrel. It should help with my uterine problems, but it has been shown to cause depression in a proportion of women. I am weepy and finding it difficult to make decisions at the moment. I also continued ramping down my Mirtazapine: dropped last week to 0.7 mg/ day.

 

Indecision /apathy / joylessness is causing friction in my marriage as my spouse is trying to get me to engage with a camping and sailing vacation. So much energy required with so little enjoyment. 

 

Peace to everyone out there.

[Pepper88]

Hey Bridgetini,

I found your intro in search of others going down the remron w/d route. I just started so I'm hoping to gather more info on what to expect. I definitely feel PMS'y basically all the time. Ugh! I can also relate to the ups and downs with starting and stopping work due to mental health things, w/d, and fatigue  Relationship things are also beginning to challenge me due to my sensitivity/ agitation. You're not alone here. Wishing you well

[Bridgetini]

Hi @Pepper88, thanks for stopping by. I have been offline for a while and only logged in today. Hope you are doing ok.

I am struggling along with windows and waves - some actual times of overwhelming emotion in a POSITIVE way, for a change, which is great.

I have started to get more involved in my local mental health association peer support group, and it is great to meet honest people who support me.

At the same time, I have a lot of physical pain related to some chronic issues, and I need to prioritise gentle exercise to address this. I feel tired a lot of the time and have started needing daytime naps again.

Tomorrow is the anniversary of my father's death, so I guess that I am probably subconsciously affected by that. 

I am still plugging away at reducing my Mirtazapine.

I am due to see the psychiatrist for my 3-monthly check next week.

 

Peace to everyone out there.

 

B. x

[sunnygirl12]

Hi Bridgetini,
Looks like you are almost finished with your Mirtazapine taper. I should be free of it in just a few weeks myself! Congrats.
 

[Bridgetini]

Hi @sunnygirl12

Glad to hear you are nearing the end. I have had a few side-effects over the last few days: tiredness,  diarrhea,  frustration at hitting a wave.

I have been reading more about Mirtazapine and its effects and biological receptor binding. It seems to hit a lot of different systems. I am going to have to continue sloowwly with tapering off. That is frustrating,  but the only way to do it successfully.

And then I can start my benzo taper, yay 😀

[Bridgetini]

I just had my clinic visit to the psychiatrist. As usual,  it is a different one as they seem to do 6 months rotation in the role. This one introduced himself by name (Not Doctor!) and had a different perspective to others.

It was quite a long session. He really strongly recommends that I get off Mirt soon instead of continuing a slow taper. He,  like his colleagues,  mentioned addiction to benzos  (twice) and would like me to start reducing that in January, with his support: by reducing doses by half. His urgency to reduce Mirt is because it is delaying starting the benzo reduction. It seems to me that there is a plan in the health service to get people off of benzos as there is an epidemic on the streets here. There are empty benzo blister packs allover the footpaths, alleys and green spaces.

The doc implied that maybe I was over-involved in managing my microtaper of Mirt and blaming it for normal life stuff (like diarrhea, exhaustion) that could be down to stress. And said that none of those symptoms are life-threatening, so that is not a reason to keep on with Mirt.

He also pooh-poohed getting advice online from forums like this.

(I tried to explain it but he is not familiar with SA and presumably thinks we are all cranks)

[bubble]

Hardly surprising.

 

Having such doctors (and most even a lot worse) is what forced us to seek advice and support online.

 

You didn't mention what course of action you will take.

[Bridgetini]

Yes, @bubble, I haven't decided yet what to do. It is 10 days since my last Mirt taper and the physical symptoms seem to have subsided, so I might try to reduce it every two weeks instead of every month, to hopefully be off it by the end of 2018. 

From reading advice here, I would do better to reduce my Venlafaxine BEFORE reducing Lorazepam.  But I will need to convince the prescribing psychiatrist. Maybe I should bring some literature to support my argument.

 

[Gridley]

One thing to consider is that at the lower doses, it is often better to slow your taper (or at least not speed it up).  It's much better to err on the side of caution and not let your tapering speed be dictated by a calendar goal.  You're doing well and I would hate to see you rush it and risk destabilization.  Members who have rushed it and had to updose or undergo a lengthy hold end up taking longer to taper than those who kept their taper slow.  Rushing the Mirt taper only to plunge into a too-fast taper of Lorazepam is not a good idea.  

 

Yes, you would do better to reduce the activating Venlafazine before reducing the sedating Lorazepam.

 

Taking multiple psych drugs? Which drug to taper first?

 

I too am on 1.5mg Lorazepam and very likely that will be the last of my drugs to taper.

 

I understand the difficulty in convincing the prescribing psychiatrist.  Unfortunately, very few doctors know anything about slow tapering or withdrawal.  They will usually suggest a far-too-fast taper, and his plan to reduce your Lorazepam by half is alarming.    Here are some tips for taking with your doctor.

 

How do you talk to a doctor about tapering and withdrawal?
 
What should I expect from my doctor about withdrawal symptoms?

 

 

[Bridgetini]

Thanks, @Gridley. I definitely have to own my recovery and do what is best fir me, so I will read up on how to deal with the medics.  

@Alexjuice has a great post on "Six Mistakes I made in Withdrawal"  (sorry, I don't know how to link to his post) which has reminded me not to trust my psychiatrist.  Regardless if medical opinion,  I am the expert in my recovery.

He also mentions the phenomenon of having a window day and trying to do EVERYTHING and make up for lost time, make plans for the future.. Then the wave hits and we can barely get off the couch.

This happens to me a lot: I take on a new job, volunteer, make promises to people, commit to things... And then have to go back and cancel/ pull out. It is humiliating and desperate. The guilt is terrible.

Today I pulled out of two things I recently agreed to (applying for a job, and public speaking about mental health). But the stress of either is too much for me at the moment.

Maybe when the next window arrives....😂

 

 

[Gridley]

Please don't feel guilty.  You have to take care of yourself.  

[Bridgetini]

Thank you. 

[Bridgetini]

Had a nice window yesterday. I was able to do several hours of voluntary work which involved thinking, planning, writing, meetings. I walked to a meeting and back (25 mins each way, in drizzle).  I got home before 10 p.m. and took my meds and warm water and had a snack of plain tortilla chips and a modest piece of cheese. Then... I opened a bar of dark chocolate,  and slowly ate all 100g of it whilst watching TV. Went to bed just before midnight (usually I am asleep around 10:30).

Fast forward to 4 a.m., when I awoke, buzzing, crazy colours all around my eyes, feeling totally weird. I suspected that it was due to sugar/ caffeine/ theobromine messing with my system, so I took some deep breaths and fell asleep again. 

Reading today on the SA symptoms and self-care forum, the chocolate ( so much!) was a bad idea and not to be repeated.

 

This morning I slept late and have a headache, so I will try to include some exercise and relaxation in my day to re-equilibrate my system.

[Carmie]

Hi Bridgetini, 

 

Good to hear you’re getting some windows. I’m sure the chocolate was yummy but too much caffeine affects our CNS. Maybe find something with carob in it instead😀. Too much sugar is not good either for the same reason. 

 

I hope you find some other yummy tasting foods you like. I’m a big fan of fruit as a treat. There is such a wide variety out there. 

 

Hope you get many more windows, sending hugs🤗

 

 

[Bridgetini]

Hi,  I have had a few weird days, several windows. I have been active socially at a party and a few public events for Mental Health Week. I was good at chatting to people for two hours straight. But that is about my limit. I have been to bed late a couple of nights (midnight or 1a.m.), and have had to take my meds much later than usual so that I don't fall asleep while driving home. So my body clock is a bit messed up. Today and yesterday I had to go straight back to bed after breakfast and sleep for 2 more hours.

Otherwise I am feeling good. Headaches, some tingling allover my body, occasionally feel weepy but don't cry.  Now if I feel a wave coming I either try to sleep/ rest, or do a word puzzle to distract my mind, or sit quietly without stimulation, or walk the dog outdoors.

 

I have had some more conversations with my husband about tapering and sent him links with information about it (which he didn't read). He still thinks that tapering WD symptoms are psychosomatic. I am going to have to continue this process with the support of you guys here, but not him.

 

Hope everyone out there is having a reasonable day today.

Remember,  you got this! 👌

[powerback]

1 hour ago, Bridgetini said:

Hi,  I have had a few weird days, several windows. I have been active socially at a party and a few public events for Mental Health Week. I was good at chatting to people for two hours straight. But that is about my limit. I have been to bed late a couple of nights (midnight or 1a.m.), and have had to take my meds much later than usual so that I don't fall asleep while driving home. So my body clock is a bit messed up. Today and yesterday I had to go straight back to bed after breakfast and sleep for 2 more hours.

Otherwise I am feeling good. Headaches, some tingling allover my body, occasionally feel weepy but don't cry.  Now if I feel a wave coming I either try to sleep/ rest, or do a word puzzle to distract my mind, or sit quietly without stimulation, or walk the dog outdoors.

 

I have had some more conversations with my husband about tapering and sent him links with information about it (which he didn't read). He still thinks that tapering WD symptoms are psychosomatic. I am going to have to continue this process with the support of you guys here, but not him.

 

Hope everyone out there is having a reasonable day today.

Remember,  you got this! 👌

I should never of opened my mouth and reach out like I did B to family and friends because they simply didn't have the ability to understand this process ,I now fear and hate pity ,its the worst feeling if I'm pitied  .in that aspect I wouldn't judge your husband for not understanding ,stick to normal life with him ,I pushed it to hard with my  partner and it hasn't been pretty ,im getting better every day at shutting up .saying that it is very easy for others to say psychosomatic when not experiencing this ,we never come off well. 

I do some work with a guy that's very cocky and lately I'm not able for the banter like before ,painfully sensitive but I try and switch my focus .

before I got bad, I was very self deprecating and it was a nice place to be other   than this horror show I'm living.

Take care and yes we support each other and for that im eternally grateful. 

I 

[Bridgetini]

Hi all, big shout out to @powerback: hope you are doing ok this week. Hopefully this article will give you a lift/ some hope for more cooperation on tapering in the future from medics: 

https://www.madinamerica.com/2018/10/systematic-review-finds-antidepressant-withdrawal-common-potentially-long-lasting/

If the UK changes its guidance,  hopefully other countries will take note.

[Bridgetini]

I cut from 0.6 mg Mirt/day to 0.5mg/day last week. Today is day 4.

I am keeping a symptom chart (Dr. Glenmullen's) every day to follow progress. 

This cut (11%) is bigger than recent cuts, as I am keen to see if I get highly perceptible withdrawal symptoms. I discussed it at length with my husband so that he can keep an eye on me. I know that bigger cuts are riskier, but I am also trying to gauge how close to the end of tapering off I am. Maybe some of my withdrawal effects at this lower dose range are due to anxiety about tapering? 

The recent literature about withdrawal syndrome has given me new hope.

 

To help deal with the anticipated wave around day 7, I got a lot of easy-to-fix food stuffs in that will keep my nutrition levels up without much great effort. (soup, pasta, cheese, yogurt, juice, cereal, fresh and frozen fruit, vegetables, fish). 

Hope everyone out there is doing okay today. X

[Bridgetini]

I actually miscalculated the level of my most recent cut - instead of from 0.6mg to 0.5mg, I only dropped to 0.55 mg (8.3 % reduction).

That was 27 days ago. I have been keeping a full symptom record (Dr. Glenmullen's chart) every day and can see that I had major waves at days 11 and 18.

I am strongly considering another cut, by 9%, down to 0.5 mg, this week. The waves were pretty crappy, but manageable, and the windows are getting better all the time.

I am conscious of the fact that as winter develops my neurological system will be changing (cold, low light levels, expectations to socialise and party and eat cr@p), but I am doing pretty well so far with recovery.

Peace to everyone out there.

 

Bridgetini x.

[Bridgetini]

[Bridgetini]

Happy New Year to everyone!

I hope that anyone reading this is doing okay.  

I had a fairly sedate holiday, which suited me fine. I did sing at two Christmas carol concerts and went to a rock concert. I spent some time with my family of origin,  but in manageable chunks of time. 

I am feeling good about 2019: I think that I am about ready to jump off Mirtazapine. I have been tracking symptoms for several months, and the main withdrawal symptoms I get are headache and other pains that I could manage by exercising more. I have problems with my joints and have joined a health club so that I can exercise in water ( swimming,  aqua aerobics), do yoga classes, and use the hot tub. 

I have been taking part in local workshops on mental health recovery and setting healthy boundaries, and reading a lot about guilt, shame and anxiety (See Peter Breggin, MD). 

There is so much to know, and work on, but I have more energy and enthusiasm than I have had in years, so I feel optimistic about the future. 

Obviously I am angry that I still on two other meds that mess with my brain, and I am meeting the psychiatrist next week (most likely a different one again). I am going to prepare information on my symptoms and future self-care plan to bring with me as I want to start reducing Effexor down from my current 375mg/ day to the "lowest effective dose"  rather than cutting out my 1.5 mg Lorazepam.  

 

I still have times when I feel utterly exhausted, and when I do I try to take a nap. 

 

Sending you all good wishes for 2019.

Love,

Bridgetini. 

[Altostrata]

Good to hear from you, Bridgetini. How much mirtazapine are you taking now? Love your chart.

 

What's your current daily drug schedule?

 

Happy 2019!

[ChessieCat]

42 minutes ago, Altostrata said:

Love your chart.

 

Me too. 💜  A picture is definitely worth a thousand words. 

[Bridgetini]

Thanks, Alto and Chessiecat. 

Thanks also for the lovely New Year's email message from SA.

Thank you and all the volunteers for their great work.

 

My current regimen is:

Mornings (7-8 a.m., with breakfast):

Venlafaxine 375 mg

Lorazepam 1.0 mg

Multivitamin (Vivioptal)

Acidophilus

 

Evenings (8-9 p.m.)

Lorazepam 0.5 mg

Mirtazapine 0.45 mg (from a home-made solution of 0.25 mg/ml in 50:50 water :maple syrup)

Senokot (2 tablets, for constipation)

Calcium and magnesium supplement 

[Bridgetini]

I finally jumped off the end of my Mirt taper!

I had an appointment with the psychiatrist looming and was preparing information and questions to bring with me. My husband was very supportive and I gave him key information on withdrawal syndrome to read. He came to the appointment with me.

It was, as usual, a brand new psychiatrist on 6- month rotation.

 

I had been tapering Mirt for almost 2 years and was down from the original 7.5 mg/day to 0.40 mg/day. I kept very detailed daily records over the last few months of tapering,  and the main sideeffects of reduction were aches and pains and some digestive upset. All can be managed with exercise,  relaxation, and diet. 

So we all agreed that jumping off probably wouldn't cause much of a problem.

 

So my last dose of Mirt was last Wed. night: I am on day 5 post- Mirt. I feel pretty good so far: a slight headache today, and my skin feels itchy. Whenever I feel odd/ stressed, I try to breathe through whatever the problem is.

 

I am doing more exercise - walking, housework, Pilates, aquaaerobics. My energy levels are pretty good! I also have booked a psychotherapist to make sure that I am getting mental assistance. 

 

The next plan is to hold here for about 5-6 weeks,  and then start 10% monthly reductions of Ativan.

I am glad that my husband and the psychiatrist and I are all in agreement with the plan. I was ready to do it alone, but having support is great.

 

Peace to everyone out there! 

Xx

[Altostrata]

Thanks for that update, Bridget. If you get a few bumps from mirtazapine withdrawal, you might try a crumb here and there to get you past the rough spots. (Love the addition of maple syrup to your homemade liquid, please add that tip to Tips for tapering off Remeron (mirtazapine)

 

On 1/3/2019 at 4:52 AM, Bridgetini said:

My current regimen is:

Mornings (7-8 a.m., with breakfast):

Venlafaxine 375 mg

Lorazepam 1.0 mg

Multivitamin (Vivioptal)

Acidophilus

 

Evenings (8-9 p.m.)

Lorazepam 0.5 mg

Mirtazapine 0.45 mg (from a home-made solution of 0.25 mg/ml in 50:50 water :maple syrup)

Senokot (2 tablets, for constipation)

Calcium and magnesium supplement 

 

It could be the mirtazapine was causing or adding to the constipation. A little extra magnesium citrate with water tends to loosen bowels as well.

 

Why did you decide to go off lorazepam before venlafaxine? Are you taking 37.5m venlafaxine or 375mg, which would be a remarkably high dosage?

[Bridgetini]

Hi Alto,

I am on 375 mg Venlafaxine,  which is the maximal dose.

I am going to cut Lorazepam first because a) it should be a relatively short duration to taper as I am on 1.5 mg, and b) the psychiatric services here are keen to get patients off benzos,  especially long term use.

I understand that if I stayed on Lorazepam and began tapering Venlafaxine that the Lorazepam's anxiolytic effect would help to buffer the withdrawal. But I am working on building up my non-pharma anxiety reductions tools during the next 6 months so that I am more resilient and chilled when I do start tapering Venlafaxine. 

I rely on my psychiatrist for prescriptions for my meds (otherwise I would have to pay €60 each visit to my family doctor) and I am happy to keep them happy by coming off Lorazepam. 

They would then be happy for me to stay on a maintenance dose of Venlafaxine for the rest of my life. I may not even discuss tapering it with my psychiatrist, just do it myself.