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Remeron88

Remeron88: greetings - need some help

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Remeron88

Hi all.  I have been on a combo of Risperdal and Zoloft since 2012.  I reached 3mg risperdal and 200mg zoloft in early 2016, tried to taper off both starting in June of that year, and had a bout of insomnia in November, at which time I reinstated along with an additional 15mg remeron.  Adding the remeron, I've learned, was a huge mistake and most likely unnecessary.

 

Since then I've slept at most 6 hours instead of my usual 8.  For the first 2 months on remeron I avoided caffeine and tobacco.  Then, after picking up both again, my sleep suffered, and I eventually had nights with 2-3 hours.  I've since learned that caffeine and tobacco induce the enzyme CYP1A2, which metabolizes remeron, explaining this.  By abstaining from both, my sleep has returned.

 

I have also tried shaving a sliver off my 15mg pill with no luck...getting a full night without sleep.

 

I would like to be able to drink coffee and smoke again.  That leaves me with 2 options, get off the remeron (seemingly impossible) or tolerate the lack of sleep.  If I do the latter, will my sleep eventually not recover even when abstinent due to repeated withdrawals?  I had been planning to use coffee and cigs only sporadically, letting my sleep return before using them again, or using only on the weekends.

 

If I that is not sustainable, then how do you recommend I get off the remeron, given my sensitivity to even a small dose decrease?  My doc has suggested trazodone as a replacement, but that med interacts with my other meds and a post about it here scared me away.

 

Thank you so much for your help.

Edited by ChessieCat
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Remeron88

Hi All,

 

See history in my signature.

 

My dilemma is as follows.  I abstained from all caffeine and tobacco for the first 2 months I was on 15 mg remeron.  Then I started to smoke and drink coffee.  I went from sleeping 6 hours of marginal sleep quality to gradually less and then 2-3 hours a couple nights.  When I stopped both substances my sleep returned, usually the next day or two.  I have done this cycle a handful of times.  The last couple times have been bumpier.

 

The issue is that caffeine and tobacco smoke induce the enzyme CYP1A2, which metabolizes remeron.  Therefore each time I smoke and drink coffee the level of remeron drop, precipitating withdrawal.

 

I am fighting not to give up my vices.  I have tried to wean off remeron, shaving off a small fragment of my 15 mg pill, to no avail and a night without any sleep.  I am trying instead to take an extra quarter of a pill on days I do drink coffee and smoke.

 

By continuing this cycle, am I playing with fire, perhaps so eventually my sleep will not return in a dependable way?  Even if I do it once a week?

 

Other question: given that I am very sensitive to a dose reduction, is there any hope I can wean off remeron without waving bye bye to my sleep forever?

 

Thank you so much for your guidance.

Edited by scallywag
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Petunia

Welcome ramza97,

Thank you for filling in your signature. I'm sorry your sleep has been disrupted. Its difficult to know exactly what's going on, but it seems to me that your nervous system may have become sensitized by all the drug changes you have made over the last several years.

 

How did you taper when reducing doses?

 

When our nervous system becomes sensitized, often, one of the first things to be effected is sleep. We can also start having unusual reactions to substances which had no or little effect previously.

 

Jumping around with doses from day to day is also not a good idea. The nervous system thrives on stability and you most certainly are 'playing with fire' if you continue this cycle.

 

I'm not sure what to suggest apart from staying away from coffee and tobacco, if they make your symptoms worse.

 

If you are wanting to come off your medication, we can help you with that. All psychiatric medications need to be tapered carefully. We suggest reducing by no more than 10% of the current dose every 4 weeks, this reduces the risk of withdrawal symptoms arising. Please read through this which will explain why:

  

Why taper by 10% of my dosage?

 

If you taper remeron slowly enough, and abstain from substances which disrupt your sleep, you should be able to come off it without too much problem. Then perhaps you could reintroduce your vices slowly, if that's what you want to do.

 

Here is our remeron tapering topic:  Tips for tapering off Remeron (mirtazapine)

 

Please read through the links and come back here to your thread if you have any questions.

 

But for now, I would stop making any changes and try and stabilize on regular doses. Take the same dose of your medications at the same time every day for at least a month, stay away from substances which make symptoms worse and then re-evaluate your situation. Once you are stable, then you might consider starting a proper taper off Remeron.

 

Here is some general information about tapering and the importance of stability: 

The rule of 3KIS: Keep it simple. Keep it slow. Keep it stable.

Feel free to write whenever you want, you will find a lot of friendly help and support here. Please stay in touch and let us know what you decide.

 

Petunia.

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scallywag

Remeron -- Welcome to Surviving Antidepressants (SA)

When a someone is taking multiple medications, we ask that that you post an interactions report. Follow the link below to get your report. Just select the text, copy it and paste it in a post here.
Drugs-dot-com Drugs Interactions Checker.

Also, it may be useful for you to read our discussion Taking multiple drugs? Which to taper first.

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Remeron88

It showed no interactions between caffeine and mirtazapine, but that is not true.  I'm unsure as to whether caffeine increases or decreases levels of mirtazapine, as it was found to increase levels of olanzapine and clozapine, which are both metabolized by CYP1A2 as well.  Other studies show that it induces CYP1A2, thereby decreasing levels of CYP1A2 substrates.  Does anyone know what effect it has (increase or decrease levels of remeron)?

 

There was no option for tobacco, only nicotine, which does not interact.  However tobacco smoke is a known and potent CYP1A2 inducer, thereby decreasing levels of mirtazapine.  In one study smokers were found to have 25% less mirtazapine in their system.  I'm curious as to others' experiences with mirtazapine, caffeine, and tobacco.  Many people maintain a steady habit, whereas I started smoking and drinking coffee after 2 months of acclimating to mirtazapine, which is the reason I may have problems and not others.

 

Petunia, you say I should have no trouble getting off mirtazapine, but so many stories here suggest otherwise, as does my experience with trying to taper.  However I did shave off about 20-25% of the 15 mg pill, and I have yet to try 10%.

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scallywag

Please post the interactions report here in your intro topic. Just cut and paste from the other site.

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Remeron88

Interactions between your selected drugs

Major sertraline  mirtazapine

Applies to: sertraline, mirtazapine

Using sertraline 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. 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

Moderate sertraline  risperidone

Applies to: sertraline, risperidone

Using sertraline together with risperiDONE can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a relatively rare side effect. You may be more susceptible if you have a heart condition called congenital long QT syndrome, other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting). Talk to your doctor if you have any questions or concerns. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications, whether together or alone. 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

Moderate risperidone  mirtazapine

Applies to: risperidone, mirtazapine

Using risperiDONE together with mirtazapine 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. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. 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

Minor nicotine  caffeine

Applies to: nicotine, caffeine

Consumer information for this minor interaction is not currently available. Some minor drug interactions may not be clinically relevant in all patients. Minor drug interactions do not usually cause harm or require a change in therapy. However, your healthcare provider can determine if adjustments to your medications are needed. 

 

For clinical details see professional interaction data.

Interactions between your selected drugs and food
Moderate sertraline  food

Applies to: sertraline

You should avoid or limit the use of alcohol while being treated with sertraline. Alcohol can increase the nervous system side effects of sertraline such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. Talk to your doctor or pharmacist if you have any questions or concerns.

Switch to professional interaction data

Moderate risperidone  food

Applies to: risperidone

RisperiDONE oral solution should not be mixed with tea or cola. It may be taken with water, coffee, orange juice, or low-fat milk. You should avoid the use of alcohol while being treated with risperiDONE. Alcohol can increase the nervous system side effects of risperiDONE such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. Talk to your doctor or pharmacist if you have any questions or concerns.

Switch to professional interaction data

Moderate mirtazapine  food

Applies to: 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

Minor caffeine  food

Applies to: caffeine

Consumer information for this minor interaction is not currently available. Some minor drug interactions may not be clinically relevant in all patients. Minor drug interactions do not usually cause harm or require a change in therapy. However, your healthcare provider can determine if adjustments to your medications are needed. 

 

For clinical details see 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 Central Nervous System (CNS) Drugs

Therapeutic duplication

The recommended maximum number of medicines in the 'Central Nervous System (CNS) Drugs' category to be taken concurrently is usually three. Your list includes four medicines belonging to the 'Central Nervous System (CNS) Drugs' category:

  • caffeine
  • mirtazapine
  • risperidone
  • sertraline

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.

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:

  • mirtazapine
  • sertraline

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.

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Altostrata

Welcome, Remeron.

 

I merged your two accounts and two Intro topics -- only one account and Intro topic to a member.

 

What times of day do you take each of your drugs?

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Remeron88

I take the remeron and risperdal at night, generally 10 pm or 12 on weekends.  zoloft i take after waking up. from 8:30 on weekdays to 11 am on weekends.

 

Am I a good candidate for tapering remeron given my history of insomnia?  I have slight occasional tinnitus as well.  I plan to put away the cigs and coffee and make a good attempt at getting off remeron.

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Remeron88

I am trying to anticipate the consequences of tapering off remeron.  do appetite and sleep return eventually?

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Altostrata

When did tinnitus start? Why are you taking Risperdal?

 

Rebound insomnia is common when you reduce Remeron. We recommend a 10% per month reduction to make this change very gradual, to minimize rebound insomnia and other withdrawal symptoms.

 

Please read the links Petunia gave you.

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Remeron88

My tinnitus is mainly when I lie down in bed. It started probably a week ago.  Risperdal is for schizophrenia, but the increases in dose were needless (my fault as well as my psychiatrists).  Zoloft is for "OCD" but also needless.

 

If I taper and encounter w/d symptoms, even with say a 5% taper, am I looking at a life of misery for years and years?  Is it even worth tapering?

 

Also, is liquid formulation from a compounding pharmacy the way to go?  Do they provide instructions and syringes?  It seems the only way to get accurate doses.  I am overwhelmed by the complexity of this whole process.

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scallywag

Rem88 -- Nobody can predict how your CNS (central nervous system) will react to dosage drops. Some people can handle 10% reductions every 3-4 weeks without batting an eyelash; others need to go more slowly.  Some people can do 10%/month at the start and then need to make smaller percentage decreases as the dose gets lower. 

 

What's important is paying attention to your symptoms -- emotional, cognitive and physical.  This topic has several download files of a list of many -- but not all -- common withdrawal symptoms:

Glenmullen’s withdrawal symptom list.

 

Keeping track of your symptoms allows you to see patterns and progress.

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Remeron88

update: I am pretty sure caffeine increases mirtazapine levels, as it has been found to increase olanzapine and clozapine levels

 

I can't be sure what the net effect of smoking and coffee have on mirtazapine levels.

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Altostrata

If you have had symptoms and behaviors in the past that led to a diagnosis of schizophrenia, you will want to be very careful going off Risperdal. Withdrawal can trigger psychosis-like symptoms even in people who have never had them before, and you don't want to destabilize your nervous system and end up in the hospital.

 

We can't answer your questions about smoking, we don't "balance" drug cocktails including nicotine and caffeine. If smoking or caffeine make you feel worse, don't indulge in them.

 

We recommend a very gradual taper to minimize withdrawal symptoms. We can't predict what rate of taper is best for your own personal nervous system. You'll have to feel your way, don't go too fast, and track your own symptoms. If you get withdrawal symptoms, the taper is too fast.

 

Please let us know how you're doing.

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Remeron88

Last night my tinnitus was constant.  It only started when I lied down in bed.  I am afraid I may have this for a while.

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scallywag

Unfortunately some symptoms persist longer than we'd like. The best known cure is time, and while you're waiting, distracting activities.

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Aelius

From the beginning I noticed a wierd sound in my left ear

 

My tinnitus is mainly when I lie down in bed. It started probably a week ago.  Risperdal is for schizophrenia, but the increases in dose were needless (my fault as well as my psychiatrists).  Zoloft is for "OCD" but also needless.

 

If I taper and encounter w/d symptoms, even with say a 5% taper, am I looking at a life of misery for years and years?  Is it even worth tapering?

 

Also, is liquid formulation from a compounding pharmacy the way to go?  Do they provide instructions and syringes?  It seems the only way to get accurate doses.  I am overwhelmed by the complexity of this whole process.

When my tinnitus started I only noticed in bed after taking Mirtazapine. In the morning it was gone. Two weeks after stopping Buspirone it remained permanent. Everytime I take Mirtazapine I hear a weird noise in my ears. I have fear that my right ear will be affected soon too. It gets worse when I`m more anxious.

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Remeron88

I recently updosed from 15 to 22.5 mg remeron to try to alleviate my tinnitus. no luck, have been at the new dose for 12 days. Is it too late to go back down to 15? Am I risking further tinnitus issues if I do so?

 

Also, does anyone know if using remeron in conjunction with high dose zoloft and medium dose risperdal raises the amount of risperdal?  Studies show using remeron together with risperdal doesn't affect either but with a large dose of zoloft (200mg) added in things could be different.

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Altostrata

Hello. 

 

Very sorry it's taken so long to respond to this post. 

 

If the updose isn't helping, you might step back down to 15mg over a couple of weeks by reducing 2mg every 4 days. (If you get symptoms from this, stop reducing and let us know.)

 

As you can see from your Drug Interactions Checker report, Zoloft and mirtazapine do interact in a way that can be overstimulating.

 

A large dose of Zoloft can be overstimulating on its own.

 

If you take the mirtazapine in the evening, the adverse effects of the combination might well come on when you lie down.

 

It could be the Zoloft that's causing the tinnitus. Please add your recent history with mirtazapine to your signature.

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Remeron88

I have been using magnesium (taken at 5 pm) for about a month and the last couple nights I have been wide awake, only getting 3-4 hours of sleep.  I have read that magnesium has an antacid effect that when taken together with drugs like my risperidone, reduce absorption.  Has anyone heard of this happening and causing withdrawal to set in?  I take it at least 5 hours before I take my meds so it shouldn't matter, yet I haven't had insomnia since I tried reducing my meds late last year.


I also missed a dose of magnesium once and woke up with vertigo.  I should mention I am also taking remeron at night and zoloft in the morning.  I am therefore afraid to discontinue the magnesium.

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scallywag

How much magnesium in mg are you taking?

What form of magnesium are you taking? (oxide, chloride, citrate, glycinate, etc.)

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Remeron88

500 mg of oxide, taurate, citrate, & orotate.  Doesn't say what fraction of each on the bottle, but would presume oxide is most.

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scallywag

Next time you get magnesium get something that doesn't have the oxide. You'll pay more for it but are likely to have fewer problems.

 

The insomnia could be a "wave".  Please read The Windows and Waves pattern of stabilization.

 

I've had periods where a few nights running when I had difficulty getting to sleep or didn't sleep altogether.  I've found the tips in this topic helpful:

Tips to help sleep.

 

The combination that works reliably for me is getting out in morning sunlight without sunglasses, walking gently for 30 minutes in the evening, avoiding TV, computer, and phone screens in the evening, and a small dose (250 mcg) of melatonin a few hours before my planned bedtime.  I can usually reset my sleep cycle after the first day of this routine, but I keep it up (morning sunlight & melatonin) for 3-4 days.

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Remeron88

i'm not tapering any drugs so I shouldn't be having waves.  Could the magnesium really be affecting the level of drugs in my system?

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scallywag

People have waves of symptoms while on medications or when decreasing dose. People experience insomnia even when they've never taken a psychoactive medication. Your insomnia could be the result of that. Human physiology is complicated; and modern life, even without pharmaceuticals, adds more complicating factors.

 

Magnesium can function as an antacid and as a laxative. The only way to know if it is affecting you and decreasing the absorption of your medications is to decrease the amount of magnesium or stop taking it.

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Remeron88

I’m in a bit of a bind. I believe the magnesium is affecting the level of the drugs in my system. I got tested for drug levels before and after taking magnesium. However, I took the second test 2 hours earlier than the first. My first test levels were as follows:

 

risperidone: 24.5; mirtazapine: 18; zoloft: 99

 

second test:

 

risperidone: 24.3; mirtazapine: 22; zoloft: 72

 

All figures in ng/ml

 

I think the zoloft is so low because it takes longer to reach a peak and the first test I took 2 hours later around 1 pm. However, the risperidone is slightly lower, and would probably be lower still if I had gotten tested at 1 pm instead of 11 am. The mirtazapine is a big ? as it may be higher or lower had I tested at the correct time. I started on the magnesium around the end of May, and for a couple of nights a couple weeks ago I had minor insomnia, but nothing since. I am afraid I am due for withdrawal in the future from one or all of the meds. My doctor refuses to order another blood test so I can have a proper comparison, so I am left guessing what to do. I am hoping the mirtazapine will cover me for withdrawal with its strong antihistamine effect. I am afraid to stop the magnesium because I experienced vertigo the last time I skipped it which leads me to believe it is increasing the level of the remeron. I am really stuck.

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scallywag

Remeron, it could be that you are a "fast metabolizer" of Zoloft. Some people eliminate certain drugs faster than average. As you've written without a comparison test with the opposite situation (either taking magnesium or taking no magnesium), it's difficult to know. 

 

What form of magnesium are you taking, e.g. oxide, chloride, citrate, glycinate, aspartate?

 

Run your medications + magnesium in the interactions checker. Have a look at the interaction effects/symptoms listed.  If you're having any of those symptoms, it might make sense to reduce magnesium slowly.

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Remeron88

I am willing to taper off mirtazapine over a period of 2 years to minimize w/d.  However I have no easy way of getting precise and incremental doses.  I am in the US and likely cannot get mirtazapine liquid.  I have read that the pills are not water soluble, so making a home solution is not really viable.  What is the best way to get precise doses in increments of .5 mg?  I am at 22.5 mg and started mirt in Dec 2016.

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Altostrata
On 3/4/2017 at 1:50 AM, Petunia said:

If you taper remeron slowly enough, and abstain from substances which disrupt your sleep, you should be able to come off it without too much problem. Then perhaps you could reintroduce your vices slowly, if that's what you want to do.

 

Here is our remeron tapering topic:  Tips for tapering off Remeron (mirtazapine)

 

Please read through the links and come back here to your thread if you have any questions.

 

But for now, I would stop making any changes and try and stabilize on regular doses. Take the same dose of your medications at the same time every day for at least a month, stay away from substances which make symptoms worse and then re-evaluate your situation. Once you are stable, then you might consider starting a proper taper off Remeron.

 

Instructions for making a liquid are contained in the link above.

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Remeron88

Anyone develop tinnitus?  I really need some help...

 

Late last year I went off zoloft completely for around 2 months and reinstated after some insomnia.  I also added remeron for sleep.  I believe going off zoloft sensitized me to substances because after drinking coffee and smoking in march I developed tinnitus, which worsened to random beeping after I again smoked/drank coffee.  I'm barely sleeping/tolerating it and can't afford for it to get worse.  However, I have numerous things I want to do: fish oil, magnesium, running, occasional caffeinated soft drink, spicy food, etc. which I'm afraid made my tinnitus worse recently after months of doing them. Fish oil, magnesium, soft drinks, spicy food affect dopamine and serotonin which is why I'm hesitant to keep doing them (even though it is significantly less so than smoking and coffee).  I also would like to go off remeron and/or risperidone but I think my tinnitus would only worsen.  Among those who have developed tinnitus, have you noticed that any of the above things (fish oil magnesium etc.) made your tinnitus worse?  I'm even hesitant to eat chocolate because it contains caffeine.  Anyone with similar experiences?

 

update: it seems to still be getting worse.  i've been using the exercise bike instead of running, which the ent says could still be a culprit, due to head jarring.

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Altostrata

If I were you, I would avoid anything that seems to aggravate the tinnitus.

 

Fish oil and magnesium supplements may help, see
http://survivingantidepressants.org/index.php?/topic/36-king-of-supplements-omega-3-fatty-acids-fish-oil/

http://survivingantidepressants.org/index.php?/topic/1300-magnesium-natures-calcium-channel-blocker/

 

 

Try a little bit of one at a time to see how it affects you. Effects on dopamine and serotonin are not considerations.

 

As tobacco smoking can affect the circulation in your ears and around your hearing nerves, reducing your smoking may very well help.

 

Tinnitus is a known adverse effect from drugs, also a known withdrawal symptom. Has your tinnitus changed at all since you went off Zoloft?

 

Please see our discussions of tinnitus in the Symptoms and Self-care forum

 

Please update your signature with your current drugs and dosages.

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Remeron88

At my worst period I was taking 3mg Risperdal, 5mg olanzapine...I took that combo for 6 days and but have otherwise been on 3mg Risperdal for 2 years, 1-2mg for 4 years before that.  My entire head is now completely numb (to all feelings) and literally feels numb (scalp especially).  It is physical torture.  Anyone else experience this from antipsychotics?  Is there a way out?

 

I first started becoming numb in 2014 and gradually lost all response to alcohol, and now after taking 3mg Risperdal 5mg olanzapine end of 2016 for 6 days, and also adding remeron I have had this physical numbness to boot.  I was taking fish oil and magnesium for a while but had to stop due to tinnitus.  It has been getting worse it seems and now it is almost unbearable.  Any help is much appreciated.

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Remeron88

Is skipping a dose, say, every two weeks the same as taking 1/14th off every pill?  Does skipping doses as a means of tapering work just as well?

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Altostrata

DO NOT SKIP DOSES TO TAPER.

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Remeron88

Ok, just curious why though?

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