elle: help tapering Remeron

[savinggrace]

Elle,

 

I agree with Fresh in that this is a really aggressive taper, considering all your brain/body is dealing with.  Well, it's actually rapid for most.  I think you should really try to find a doctor to work w/ you even if it was to secure a few month's pills.

 

Just to help you out with the digital scale...

 

Read the link that Fresh sent you.  Scroll down to the bottom of that link because the top part is talking about using powder and beads, which you are not.

 

I have watched my husband do it, so I could if I had to. Follow all the guidelines provided in the link.  Make sure you use the tweezers provided with the scale when handling the pills.  They are so small, some will come off on your hands.  Be gentle.  These pills break easily.  You may want to weigh each dose 2-3 times to be sure.  If you are being careful, you should get the same number each time.  Don't lean on the table, or touch anything around it.  Press "tare" to reset the scale to zero before you weigh each pill to be extra careful.  My husband closes the lid on the pills, though i don't really understand why this matters. 

 

I am not surprised the 2 pills weighed a slightly different amount.  There is a small margin of error w/ generic drugs and also with using this scale.  It is not an exact science but it is pretty close.  My dose is 4 mg. so we are dealing with a small piece like you are.

 

One 15 mg. pill weighs .159g.....the formula is this....159g/15mg =x/3.75  (x=.159 x 3.75 divided by 15)  the answer is .0397 or .04g. (aim for between these two numbers...it's really hard to get it exact when this small)  To distill this down, 3.75mg. weighs .04g.

 

BTW, it is almost impossible to cut one perfect piece.  We often have to put two pieces together (tiny pieces) to get a dose.  We use a razor blade to shave the pills down ever so slightly.

 

What else is confusing you?  Please don't be shy about it.  It is over-whelming and hard to understand when you first do it but it gets easier.

 

Stay calm and good luck.  Don't give up on finding a doctor who will help you properly.

 

Grace

[elle]

I am trying to taper Remeron...   If I mix the coated pills in water, how long will the solution last?  I need to try and conserve my pills because my doctor will stop perscribing them so If I mix a pill in water and pull out my dose for tonight, how long can the remainder last?  thanks  

 

Also can someone tell me about when the symptoms hit?   and when do they start to calm down?  Please and thank you

[Fresh]

Please read "How To Make a Liquid ...." here http://survivingantidepressants.org/index.php?/topic/2693-how-to-make-a-liquid-from-tablets-or-capsules/

"Most homemade solutions may keep for at least a few days, refrigerated. Drugs tend to be degraded by heat and light, which is why pharmacy containers are tinted."

 

Some sites say the solution is good for 2 weeks. I tend to use one week as a guide. You can buy liquid suspensions from pharmacies to use instead of water that keep the solution good for one week.

 

Some people get w/d symptoms witjhin hours , for some it's a few days. There's no general pattern , it's a very individual thing.

 

Please update your signature to show what you are currently taking.

 

.

[elle]

Guys, I really need your help..  3am

 

The symptoms are hitting me TOO hard.  probably because its also my "girl time" coming up and benzo w/d seems to get much worse during that time anyway, then add on the remeron drop (bad timing)   not sure what to do, but I can't go on like this..  I've already endured too many years of suffering from the benzo.  I don't have the strength to do this again.   Pacing the floor all night (its 3 am) and I will not sleep one minute tonight because the panic/akathesia is so bad.   wow, Im really scared.  Please help me thru this..  what do i do?

[Fresh]

I'm not able to suggest anything without knowing your current dose and recent cuts.

 

You have cut too much too quickly. Your best bet is to go back to the last dose you were stable on.

[elle]

I was on 4.5 mg and cut to 3.75 7 days ago..  My cut was large because this medicine is dangerous for me..  however,  I need to stabilize fast and come up with a better plan.   how much should I updose at this time?

[Fresh]

Thank you. Rather than go all the way back up , because I understand you want off asap , how about you go to 4.25mg?

I don't think that 4mg will be enough to stop the w/d developing , and that's what we need to focus on just now.

[elle]

How should I do this?  take the extra remeron right now? (since its 430am and I already took my 3.75 last night) or wait until my tonights dose?  Actually I don't think I can wait until tonite, Im being tortured... but just need to make sure.  thank you for helping me.. Don't know how to keep enduring this...  ANY thing else I can do right now for relief???

[Fresh]

Take the extra 1/2 mg now. It will take 4 days for the updose to fully kick in , so you will need to be

patient.

 

Remind yourself that this is from drug withdrawal , it's temporary. Most of us here have had something similar ,

and the thing is that it ALWAYS settles. Do anything just to help the time pass , watch tv , youtube , listen to

relaxation tracks in the Symptoms section. It doesn't matter if you can't sleep , try to rest your body if you can ,

lay down.

 

Take magnesium if you have some there (not too much or you'll get the runs). Maybe a magnesium bath?

The main thig is - don't allow yourself to panic. Lots of soothing , calming self-talk.

 

It's going to be okay elle. Go take the extra 1/2 mg now.

[elle]

I took the updose, several hours later and I am still being tortured..  Not just "wait it out" and endure or distract but TRUE torture..  I cannot endure this much longer.  already tried magnesium ..  Please give me any other ideas to help..  Any ideas..  Should I double the dose of remeron for just one day?  Im really desperate here.   My body cannot endure this...  Cant go to ER because they will pump me with a benzo      PLEASE any other ideas to stabilize????

[elle]

This akathesia is too much for my frail body..  I don't think this is "just from remeron drop.. I think I must of hit a wave.  I could really use some help please   Im really scared.

[savinggrace]

Elle,

 

I think this is probably the remeron drop that was just too big for your brain/body to handle.  It has been about a week since you made the cut so your brain now recognizes that you dropped .75 mg and is trying to stabilize.  As Fresh said, take a hot bath (only thing that helps me really) listen to some soothing music, and if the restlessness can be channeled into some sort of boring but purposeful task, do that.  I have been where you are many times.  You feel like you are in hell.  Keep telling yourself you will feel better tomorrow, because it is likely you will.  When I have had to do what you did today, by reluctantly taking a small up-dose, I have always felt better the next day.  Your brain just has to have time to recognize it is getting what it needs.  I am not minimizing your suffering by any means...I just know you will survive this.

 

Grace

[Fresh]

How are you going elle?    Has it settled down at all?

 

Please continue to stay on 4.25 mg - it takes 4 days to reach a steady state in your blood stream.  Rest when you can.

Do you have anyone to help you if you need to stay at home for a week or so?

[JanCarol]

Hey Elle - I'm sorry the 3.75 cut didn't work, but it was a lot larger than I recommended. 

 

Your mutation means you will be MORE susceptible to withdrawals, more sensitive to changes - so "getting off the drug fast" is simply not an option for you.

 

I'm so sorry you've been hit with akathisia.  It's the worst.  Fresh is the akathisia expert - and SavingGrace has some excellent ideas, too.

 

Please stay on the 4.25 mg that Fresh recommends for at least 4 days - and probably now, a month or more since you've had a reaction.

 

Once you've had this kind of reaction, it is harder to put you back together.  That is why we were so careful about telling you to go slowly.  But I guess you know that now, and I'm sorry that you do, that you are suffering.

 

Write all you want in here - try pacing if you can, or do you have a rocking chair or yoga ball that you can rock on?  A lot of people say that helps a lot.

 

Most important is to keep steady, keep calm.  If you need to go to a doctor, you need to present as calmly as possible, to prevent further drugging.  A doctor is more likely to believe a calm person describing symptoms, than a person thrashing around in an emotional state - they are trained to drug that second person.

 

Please keep us posted as to how you're going.  Please stay as calm as possible - akathisia is AWFUL, but it won't last, and it won't damage you.  It's not permanent.  Just remind yourself, it's a symptom, it will pass.

 

http://survivingantidepressants.org/index.php?/topic/10964-the-dr-claire-weekes-method-of-recovering-from-a-sensitized-nervous-system/

[elle]

Savinggrace..THANK YOU!! for being here for me!!  The akathesia is finally stopped.  That one is the worst and I had it often with benzo w/d.  thank you for letting me vent here..   

 

Fresh/JanCarol  = thank you for your guidance.  I am alot better today.  I don't think I had as bad of a "hit" from the remeron drop as it was also my "girl time" and that actually happens to me every month from benzo healing that I am still enduring.. (i almost forget it happens every month because my brain is so clouded)  Altho I did updose to 4.25 and will hold for awhile just in case.

 

Today is not as bad as the past two days, but still crappy and bedridden from all the ongoing symptoms..  thanks to you all for your kindness

[savinggrace]

Elle,

I am so glad you feel better today. You know, I just realized that I ended up on benzos way back in 2002 when RLS was about to drive me out of my mind. I got the RLS from Seroquel, an anti-psychotic, which I discontinued shortly after I was on them. Unfortunately, I trusted my doctor who kept increasing the dose of the benzo.

 

I still occasionally get mild RLS and read that remeron can be prescribed for it and can also cause it. It really is an awful condition.

 

I send you positive energy and strength for healing.

 

Grace

[elle]

guys, I am still suffering really badly..  altho I don't think it is just the remeron drop.  I got black blood work showing I am very low in progesterone, (i am in peri menopause also)  my doctor wants me to start HRT to protect my heart and bones.  I think this is a good idea because I do not ever sleep.  but have read many stories about progesterone being bad when healing from a benzo??  I already asked some people on the Benzo boards and could really use everyones opinion here too..  thank you

[AliG]

Elle.  I wouldn't take any thing " synthetic" , but would look into " Bio- identical  hormones ". Do some research, and see what you think . I don't believe in the  "Premarin"  etc, but Bio - identical hormones , are more naturally absorbed.  There is some controversy however, so you need to do your homework Personally, I'm prepared to take the risk , however everyone is different . It is worth studying up on .

Ali

[savinggrace]

Hi Elle,

It is good to hear from you.  I have been worrying about how you are doing.

 

This is my experience, and yours possibly could be different.  I am 61 but suffered through peri-menopause symptoms and then menopause at the age of 53 for many years.  I always tested extremely low for progesterone, estrogen (all forms) and testosterone.  My last test, several years ago, measured no detectable levels of hormones.

 

If I wasn't on all these drugs I want off of, I probably would have done much better on hormones.  Unfortunately, every single time I tried even a small dose of the bio-available hormones (even just progesterone) it interfered w/ the metabolism of my other meds, and I stopped taking it w/i a few days.  I would get extreme symptoms, including insomnia, night sweats, etc. almost immediately.  I am a bit of a aberration as far as how quickly side effects show up, and no doctor believes me, but I do know that I had no reason to imagine that everything got worse.

 

The point is, for me, my health is suffering in other ways, but mostly it is the drugs causing most of the stuff I suffer with.  I do not take any other meds or supplements as my goal is harm reduction, or in your case, to be free of the drugs that are probably throwing a lot off things off kilter.  

 

I suspect that the remeron w/d is making you feel worse.  You have probably been low in hormones for quite some time, but if your symptoms have worsened since you started taking remeron, it is undoubtedly (to me) w/d.  Of course, you can always try low-dose supplementation right now, but if it were me, in the fragile state you are in, I would not want to add in any other complicating factor.

 

Again, I am one of the unlucky ones.  My body just says no to anything else.  I am deficient in so many vitamins and hormones.  I try to mitigate the damage by clean living.  it's surprising how much what we eat can affect our entire system.

 

This has been my experience.  I wish you some stabilization soon.

 

Grace

[savinggrace]

Hi Elle,

 

Just checkig in to see if this last week brought you a bit more stabilization?  I am rooting for you.

 

Grace

[elle]

Still struggling with non stop akathisia..  Im going to have to go on Amitriptoline if this does not stop..    Can anyone tell me if L-Tryptophan is ok??  I would think its got to be safer than another antidepressant..  PLEASE HELP.. im desperate for relief

[SquirrellyGirl]

Generally speaking we don't recommend taking serotonergic supplements while in withdrawal because it can go paradoxical or make things worse.  If you are still taking ANY AD, then they are contraindicated because the combo can cause serotonin syndrome!

 

When I went off Effexor, I took tryptophan and Sam-e to replace the serotonin, not understanding what these drugs due to the neurons and the subsequent healing that takes place in withdrawal.

 

Well, the supplements did nothing to stop things from getting really bad, to the point that 7 months out I decided perhaps I should go back on the Effexor.  I stopped the supplements and the next day took a fraction of a tablet.  By the third day of being back on Effexor I was suffering from DP/DR, increased heart rate, shaking, chills, nausea, diarrhea, and fever and realized I may be in serotonin syndrome, though not severe enough to go to the ER - close, though!  I stopped everything for three days at which point I saw my p-doc, and he put me on a very low dose of Remeron.   I have since seen that Remeron is used for serotonin syndrome, though I can't remember where.

 

The moral of this story is that even close proximity of the supplements and an SSRI/SNRI can cause SS!

 

Could you update your signature to reflect what you are now taking and when the last cut was?  For instance:  4/30/16 5 mg Remeron, last cut from x mg on such and such date.  Thank you.

 

SG

[elle]

I am currently on 4 mg of Remeron and thinking of updosing or taking a small dose of L-tryptophan???  Please help me as the akathasia and absolutely NO sleep for over a week now is going to send me to the hospital.. where Im sure they will drug me up more...  I cannot hold out any longer

[ChessieCat]

Hi elle,

 

As SG has already said taking tryptophan is risky.  I've put the drug you are currently on plus the 2 you have mentioned in the drug checker:

 

Interactions between your selected drugs

 

Major amitriptyline mirtazapine

Applies to: amitriptyline, Remeron (mirtazapine)

Using amitriptyline together with mirtazapine 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.  ...

 

Major amitriptyline tryptophan

Applies to: amitriptyline, tryptophan

Using amitriptyline together with tryptophan 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.  ...

 

Major mirtazapine tryptophan

Applies to: Remeron (mirtazapine), tryptophan

Using mirtazapine together with tryptophan 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. ...

 

Please update your signature.  This will allow us to see your drug history at a glance so we are better able to offer suggestions.  If you do decide to updose please only do so with a small amount.  Once we have your tapering details we can offer a suggested dose.

[elle]

OK  I updated my signature..  Please tell me if I should updose another 10% (or more??)  because after 3 weeks symptoms are horrific..  or If I can take a SMALL dose of L-tryptophan (which would be better than adding another AD)   Need relief please - 

[savinggrace]

Hi Elle,

 

I took amitriptyline for 20 years or so.  It worked for a while and then it stopped working and, I think, it contributed to the steady decline of my health, causing me to prematurely retire at the age of 48.  I was switched to remeron shortly after going off the amitriptyline, but have not ever really felt well.  Prior to that I tried to go off amitriptyline many times with no success.  All the remeron did was help me get off the amitriptyline and then I was unsuspectingly.caught in the grips of remeron.

 

If I have followed this thread correctly, on April 14 you were on 4.25 mg. of remeron and the akathisia was gone and things were not good but they were better. Now you are on 4 mg. which is a 5% decrease 2 weeks later.  I am wondering if you were not ready for this decrease?  With your genetics and its concurring complications, this was probably too much too fast.

 

I sense that you are much like me with your sensitivity to drugs.  (we share a MTHFR defect)  I am equally sensitive to supplements, herbs, etc.  I do not take ANYTHING because everything interferes with the metabolism of my drugs and cause me to become unhinged very quickly, so I would not take the tryptophan.  Years ago, not knowing better and desperate for sleep, I tried tryptophan, it did nothing for me, in fact, I think it worsened the insomnia.

 

If you go to the hospital, you absolutely know what they will do... they will give you drugs.

 

I do not feel qualified to tell you to go back to 4.25.  Perhaps a more experienced moderator could give their opinion?

 

I am sorry you are in such torture.  I am all to familiar with it.

 

Grace

[KarenB]

Hello Elle,

 

Just checking that I've got it right that you were on 4.5, dropped to 3.75 for a week, then up-dosed to 4.25 where you have now been for 2-3 weeks?  I see you recently updated your signature, but if you could add these details in, along with dates, it would save us reading through your thread each time. 

 

We also need to know:  Since you up-dosed, did things get worse or stay the same? 

 

When we know those things we can make better suggestions for you.  Hope to hear from you soon, as I know it's feeling awful for you. 

 

Hugs,

Karen

[SquirrellyGirl]

Hi Elle, 

 

Please see this post from above:  http://survivingantidepressants.org/index.php?/topic/11789-elle-help-tapering-remeron/?p=219871

 

So you are currently on 4.25 mg?  A few posts ago you said you were on 4.0 mg.  We need to know where you are at and what has happened since this post I linked to.  At that point you said the akathesia had gone away and that maybe it was more due to your time of the month.

 

What changes have taken place between then and now?  What was your symptom pattern after that improvement? 

 

It helps us to know these details so we can determine the next best move.  Thanks!

 

SG

[elle]

Im having a hard time doing the calculations because I mix my remeron with water... I dropped 20% of it and the akathasia has not stopped and I cannot sleep at all..  I need to know how much to updose to stop this PLEASe..   Im sorry but my anxiety is so severe that I cannot think..  please just tell me what to do..  I am desperate and afraid I will be taken to the hospital soon.  

[SquirrellyGirl]

Hi elle, 

 

You're going to be ok, and we'll figure this out.  I think you are getting yourself worked up with secondary fear and that only makes things worse, so first and foremost try to take some deep breaths, focusing on the sensations of the rise and fall of the belly.  It may help to recite "Know it will pass" over and over again.

 

Ok, how much Remeron do you mix with how much water?

 

How much of that solution are you taking?

 

You dropped 20% and that caused the akathesia?  And then going back to 4.125 didn't stop it?  That updose was how many days ago?

 

Just stay with us here.  It takes four days for an updose to reach a steady level in the blood, and another few days to know whether it is really helping.  What changes have occurred after the updose, good or bad?

 

Please try to breath and answer each question, ok?

 

Would you be able to take a hot bath, with epsom salt preferably?  Are you taking magnesium and fish oil?

 

SG

[elle]

I have felt really no relief from updosing 10%... but I haven't felt worse.  thats why im wondering if I should updose more???     Dont think i could worse..

[SquirrellyGirl]

I am wondering if this isn't a benzo wave triggered by the 20% Remeron cut since you said the akathesia was like your benzo withdrawal and i have not seen akathesia present in people in withdrawal from Remeron, though that doesn't mean it can't happen.  Are you having any other symptoms?  Headaches, nausea, diarrhea?  

 

It would be good to know exactly how you are making your liquid, and how much you are taking (mls).  Do you shake the solution really well before drawing up your dose?  How exactly do you go about mixing and measuring, step by step?  How long are you keeping the solution?  If there is any chance that the dosage is varying accidentally day to day, that could lend towards the instability.

 

SG

[elle]

Yes I do think this is also benzo withdraw that could have been affected by dropping too much remeron too quick..    so it takes only 4 days for the updose to level out??  I thought it would take longer??  should I take more??  please help.. Im suppose to take my dose now.  I mix it fresh in water every day

 

also when i take my dose I seem to get more burning skin????  could this be from the remeron??  Please don't leave me..  Im afraid of what to do right now...

[KarenB]

Hey Elle,

 

I think you should keep your dose the same for now, especially as you mentioned getting burning skin when you take it.  So for this next dose, just keep things the same.  Once some of our more experienced mods check in I'll get them to look at this and we'll help you make a long-term plan.  For now, just hold that dose steady.

 

Your aim right now should be to keep calm and soothed as possible.  CC's idea of a hot bath is a good one.  You can get through this - it's surprising how much strength we really do have. 

 

When we have more details from you we can help better.  My impression is that you've been changing things up and down a lot, and that has caused this destabilisation. 

 

We've had members here who have lived through these symptoms, and they are now okay.  The important thing is not to try to 'fix' it by more dose changes. 

 

Hugs

Karen

[SquirrellyGirl]

I replied but saw KarenB beat me to it!  My thoughts are that this is a benzo wave triggered by the remeron cuts, and updosing remeron won't fix the wave since it isn't really about remeron withdrawal.  That is my hunch.  So, holding on is really the best option and finding ways to calm your mind is of utmost importance right now.  You are already under a lot of stress with the akathesia and lack of rest, so adding secondary fear on top of it all will only prolong this wave.  It's time to double down on self-care, nurturing yourself like you would one of your kids who is feeling ill.  Make that your mission now.  Each time you feel youself struggling against your situation, stop yourself (your thoughts) and b-r-e-a-t-h-e!  Mindfulness will be really helpful now.  

 

Mindfulness could be as simply as doing a body scan, bringing your attention to each part of your body, right side palm, thumb, wrist, elbow, shoulder, back against the seat if you are sitting, right ball of the foot on the ground, thigh against the seat, knee cap, etc.  Just work over your entire body, breathing as you go.  Allow yourself to do this.

 

Hang in there, Elle!

 

SG

[elle]

thank you for your help... yes this is so hard.  trying to do mindfulness is almost impossible with my mind spinning so fast.    I know that I am still healing from the benzo at 15 months out..  and think dropping the remeron too fast has caused a severe wave..  How long will this last before I settle down..  Trying to be strong but its so hard