Remeron88: greetings - need some help

[Remeron88]

Ok, just curious why though?

[ChessieCat]



Skipping Days vs Every Day Dosing Graph

 

On 6/27/2014 at 8:00 PM, Altostrata said:

3.a. Do not suddenly quit taking your drugs. Do not skip doses to taper. These big, fast changes are the opposite of providing stability for your nervous system. Skipping doses causes the amount of the drug in your bloodstream to go up and down. Do not do this for any psychiatric drug.  See this graph which compares skipping days vs daily dosing.

 

Edited December 1, 2019 by Shep
fixed outdated link

[Remeron88]

I really need some help right now.  Here's the backstory: I went off zoloft in late 2016 (off of 200mg, a max dose, was on for 5 years before that), was off completely for around 2-3 months.  I decided to go back on the full amount and add 15mg of remeron due to insomnia after about the third month of being off zoloft.  Three months later I began smoking and drinking coffee, and after about a month tinnitus started.  I kept it up, and the ringing progressed to additional tones.  I quit all substances until January 2019, when I started having copious amounts of alcohol and caffeine (no cigs).  After 5 weeks, crickets were added to my tinnitus repertoire.  I cut back to tiny amounts of caffeine, and eventually had 1 shot of whiskey in July, then another sound (high pitch whine) was added.  No more substances after this.  On 8.5 I started hearing tones and beeps over music.  Then a week ago I started noticing a sensitivity to normal volume music which sounded loud.  This could be the beginning of hyperacusis.  I think going off zoloft and back on and maybe adding remeron made me sensitive to serotonin, which is why substances both started and worsened my tinnitus.  Now my ears are getting worse without anything majorly serotonergic (I get mild exercise by golfing and walking, sunlight, etc.)  I am afraid that continuing to take the zoloft is why I continue to worsen, as if my brain were overloaded with serotonin which it has not re-acclimated to after going off zoloft (and possibly adding remeron).  There may be a dysfunction with serotonin, and it is known that serotonin is bad for tinnitus.  I have seen a tinnitus specialist and they cannot determine whether the meds are making it worse, so I am turning to this forum for advice on whether I may need to reduce my dosage of zoloft.  It seems like it will continue to worsen, but am not sure whether I need to go down on zoloft (or remeron or both).  There is so much uncertainty and I need a way to stop it from worsening further, as hyperacusis is much worse than tinnitus.  Please help me out.  Thanks.

[ChessieCat]

Q:  Are you still taking risperdal?

 

Please update your drug signature:  Account Settings – Create or Edit a signature

 

 

If you are currently taking Remeron and Zoloft there is a major interaction.  The tinnitus may be caused by serotonin toxicity.

 

I experienced mild seotonin syndrome when taking 100mg Pristiq.  My diastolic blood pressure increased and I had bad tinnitus.  As my dose got lower the tinnitus started reducing and now I hardly notice it.

 

Interactions between your drugs

Major

sertraline mirtazapine

Applies to: Zoloft (sertraline), Remeron (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.

[Remeron88]

Yes, I'm still on 3 mg Risperidone.

 

I don't think I have even mild serotonin syndrome, no other symptoms besides tinnitus.  If it is a case of too much serotonin, which AD do I reduce, and how do I avoid adding another debilitating problem to my plate due to w/d?  Are there other ways to prevent worsening than tapering off drug(s)?  Thank you again.

[Shep]

5 hours ago, Remeron88 said:

Are there other ways to prevent worsening than tapering off drug(s)? 

 

We are a site for coming off psychiatric drugs, but I'm not sure that's your goal.

 

Please let us know - are you here to taper? If not, please work with your doctor to deal with unpleasant side effects. 

[Altostrata]

Rem, the drug combination can cause serotonin toxicity short of serotonin syndrome.

 

What times of day do you you take each of your drugs, at what dosage? Do you feel better or worse after taking each drug?

[Remeron88]

200mg zoloft in morning, 3mg risperidone and 22.5mg remeron at night before bed.  I don't feel any better or worse after taking them.

 

It's odd that before 8.5.19 only caffeine, alcohol, and cigarettes made my tinnitus worse.  The worsening on 8.5 could be due to a number of serotonergic things, as well as the development of sound sensitivity.  It seems just living and doing stuff is making it worse.  How do I determine what actions to take with the drugs without making things worse overall?  I'm scared to death of messing with drugs and risking nightmarish permanent w/d symptoms.  How do I even know if reducing zoloft or remeron is the right action?

[ChessieCat]

 

Please update your drug signature:  Account Settings – Create or Edit a signature

 

We have some members here who have successfully managed to get off their cocktail of drugs.  And others who are currently in the process of doing this.

 

success-stories-recovery-from-withdrawal

 

GiaK - withdrew from a cocktail of 6 psychiatric drugs that included every class of psych drug.

 

Shep - Drug free and at peace as of 2015 (history of:  antipsychotics, benzos, z-drugs, antidepressants, and stimulants used for 30 years).

 

 

If you are now thinking it would take too long to get off your drugs, yes, it will take a long time.  However, it is important to realise that reducing your drug load would probably help you to feel better than you do now.  200mg Zoloft is a huge dose alone.

 

And you are concerned about withdrawal symptoms.  That is understandable, especially when you have experienced them previously.  It can make you reluctant to go through them again.  When you got withdrawal symptoms before it was probably because you reduced too quickly or stopped them cold turkey.  However, tapering no more than 10% of the current dose with at least a 4 week hold allows the brain to adapt to not getting as much of the drug.  It is important to listen to your body and symptoms and not reduce again if you aren't feeling stable.  Even though you may still experience withdrawal symptoms they are usually mild and don't last long.  If you find that they are worse than mild then it means that you are reducing too much or too soon.
 

 

[Remeron88]

Thank you, but what drug (remeron or zoloft) is likely most contributing to my tinnitus and hyperacusis and which should I reduce?

[ChessieCat]

8 hours ago, Remeron88 said:

200mg zoloft in morning, 3mg risperidone and 22.5mg remeron at night before bed. 

 

Current drug signature information: 

 

nov 2016: insomnia after reducing from 3 mg to 2.7 mg risperdal.  reinstated 3 mg risperdal, 200 mg zoloft, plus 15 mg remeron.

 

Please update your drug signature.  I've already requested this twice.  Please update this information so that we can see your current drugs and doses as a glance.  Include the date that you increased from 15mg to 22.5mg Remeron.

 

Account Settings – Create or Edit a signature

 

On 9/17/2019 at 1:14 PM, Remeron88 said:

Three months later I began smoking and drinking coffee, and after about a month tinnitus started.  I kept it up, and the ringing progressed to additional tones.  I quit all substances until January 2019, when I started having copious amounts of alcohol and caffeine (no cigs).

 

From https://www.mayoclinic.org/diseases-conditions/tinnitus/symptoms-causes/syc-20350156

 

"High blood pressure. Hypertension and factors that increase blood pressure, such as stress, alcohol and caffeine, can make tinnitus more noticeable."

 

12 minutes ago, Remeron88 said:

Thank you, but what drug (remeron or zoloft) is likely most contributing to my tinnitus and hyperacusis and which should I reduce?

 

It may be a side effect of one or more of the drugs you are currently taking, or it may be the interaction from the drugs.

 

Taking multiple psych drugs? Which drug to taper first?
If you're not having an adverse reaction from the other medications, taper the most activating drug first. This is usually an antidepressant or stimulant (ADHD drug).

 

You are taking a huge dose of Zoloft.  Zoloft is an activating drug.  Remeron is used for insomnia.  It is important to preserve your sleep as best you can.  I think reducing the Zoloft would be the best option.  If you find as your Zoloft dose gets lower that you start to feel sedated throughout the day, you might consider stopping the Zoloft taper and taper the Remeron to get to a lower dose of that so that you aren't feeling sedated.  You could then return to the Zoloft taper.

 

Why taper by 10% of my dosage?

 

Tips for tapering off Zoloft (sertraline)

 

Tips for tapering off Remeron (mirtazapine)

 

Dr Joseph Glenmullen's WD Symptoms Checklist

[Remeron88]

I probably have to reduce my zoloft.  Is there likely permanent 'damage' (in regards to tinnitus) that reducing the meds won't alleviate?  I'm worried I haven't acted in time for my tinnitus to heal itself.

[Remeron88]

Today I've been woozy, slightly dizzy and disoriented, and have loss of balance.  Why is this happening after years of staying on the same doses?  Is it temporary or a sign of things to come?

[ChessieCat]

My personal opinion is that you may be experiencing mild serotonin toxicity.  The alcohol and caffeine might have made things worse.

 

If the combination of drugs you are taking is causing unwanted side effects then it makes sense to me to reduce the drugs.  Unfortunately nobody knows what will happen as you reduce your drug/s, but the only way to find out is to taper carefully reducing by no more than 10% of the current dose followed by a hold of about 4 weeks which allows the brain to adapt to not getting as much of the drug.

 

As I said previously I've had mild serotonin toxicity myself.  My diastolic blood pressure increased by a lot (doctor didn't make the connection to the increase from 50mg to 100mg Pristiq and just upped my BP med), I was sweating a lot even in the middle of a cold winter day (in Australia), I was experiencing confusion, agitation, anxiety, stiff/tight calf muscles when walking, having skipped/missed/flipping heartbeats, having to have a 2 hours sleep almost every day and still sleeping through the night, tinnitus.  Some of these symptoms I didn't relate to the drug until the symptoms started to ease, and of course the knowledge that I gained from SA.  Once my dose got lower the ST symptoms reduced.

 

As mentioned by Shep SA is a site for getting off/reducing drugs.  If you want to do this then we can provide information about which drug to reduce first and how to do this.  However, if you don't wish to taper at this time, then there isn't really much we can help you with.

 

The site is staffed by volunteers and the site is very busy with lots of members who want to taper.  Please let us know if you want to taper now and we will assist you.  Or perhaps now isn't the right time for you to do this.  When you are ready, please let us know and we will assist you then.

 

 

[Remeron88]

I was on a cruise for 2 weeks and am now staying in Venice, and I just began to experience a rocking/swaying sensation.  I've been in Venice 2 days and it only began today while walking around.  I have been trimming off some of my Zoloft for the past couple weeks, but just 4 or so minor reductions total.  Could this be a new symptom?  Will it subside if I resume taking the med again?

[Remeron88]

It probably isn't Mal de debarquement syndrome because it only started the 2nd day after the cruise ended.

[Shep]

20 hours ago, Remeron88 said:

  I have been trimming off some of my Zoloft for the past couple weeks, but just 4 or so minor reductions total.  Could this be a new symptom?  Will it subside if I resume taking the med again?

 

You may want to updose, since your last reduction was so recent. This could be a withdrawal symptom. Please see:

 

Dizziness, vertigo, light-headedness, rocking or swaying sensations

[Remeron88]

So my hearing continues to get worse.  9/29 I started hearing ambient sounds as fluctuating in and out, and recently I started being unable to hear parts of songs, and other parts are barely audible.  My ear doc doesn't know if going down on zoloft will make me better or worse.  Please help me out, I'm really upset and can't afford to lose any more hearing.  Would making a small reduction be enough or would I have to go off completely?  Is there another way?

[Shep]

What drug(s) are you taking now? When was your last reduction?

 

Please update your signature to reflect your current drug(s) and doses. The last information in your signature regarding this information is from April 2017. Everything after that is just information about tinnitus. A direct link to your signature is here:

 

Account settings - Create or Update Your Signature

 

Without more information, it's impossible to offer any advice. Tinnitus and other audio issues can be both side effects and withdrawal effects of these drugs. Are you still drinking? Per your signature, alcohol is ramping up your symptoms. 

[Remeron88]

I haven't made any med changes since April 2017.  Currently taking 200mg zoloft 22.5mg remeron and 3mg risperdal.  I haven't touched alcohol or caffeine since july.

[Shep]

18 hours ago, Remeron88 said:

I haven't made any med changes since April 2017.  Currently taking 200mg zoloft 22.5mg remeron and 3mg risperdal. 

 

On 11/7/2019 at 10:59 AM, Remeron88 said:

I have been trimming off some of my Zoloft for the past couple weeks, but just 4 or so minor reductions total. 

 

Did you make these 4 or so minor reductions and than updose back to 200 mg Zoloft? I'm confused about your latest post stating you "haven't made any med changes since April 2017."

 

As ChessieCat has mentioned, you may be getting serotonin toxicity. This is a dangerous combination of drugs - there's a MAJOR drug interaction between Zloft and Remeron, as Chessie and Altostrata have both posted about. 

[Remeron88]

Yes, I have been taking half a dose on just Saturday the last couple months and full dose the rest of the week.  I am trying to take as little zoloft as possible without setting off withdrawal.  It hasn't prevented worsening of my hearing.

 

I"m feeling pretty screwed here, not sure I have any good options.  Please let me know what you think is best.

[Shep]

On 11/29/2019 at 7:09 PM, Remeron88 said:

Yes, I have been taking half a dose on just Saturday the last couple months and full dose the rest of the week. 

 

On 11/29/2019 at 7:09 PM, Remeron88 said:

Please let me know what you think is best.

 

As Alto and ChessieCat have previously posted in your thread, we don't recommend skipping doses. This is very hard on your nervous system and sends you into withdrawal when you skip doses. 

 

Please see this post - DO NOT TAKE YOUR MEDICATION EVERY OTHER DAY TO TAPER.

 

You also risk kindling by doing this. Kindling is trauma inflicted on your already injured nervous system by unpredictable dosing. As another moderator, JanCarol, likes to say, it's like playing basketball with your brain. 

 

It's important to take the same amount of these drugs every day at the same time(s) of the day. 

 

[Remeron88]

Ok, I agree with that.

 

How do I mitigate further damage to my hearing?  Is it necessary to completely taper off?

[Shep]

We cannot predict the future. You may want to make your goal about reducing your overall drug burden instead of coming all the way off. If you feel better on a reduced dose, you may want to come all the way off or you may want to hold and see how you do. 

 

We can't tell you if this is a side effect or a withdrawal effect. We can't tell you at one point you won't have this symptom. All we can do is guide you in a safe taper at a safe rate with what we currently know - no faster than 10% a month, plenty of holds to give your nervous system time to adjust, and no skipping doses. These are just the basic guidelines. As you proceed with your taper, you'll make adjustments to slow down as you need to, hold as you need to, and learn non-drug coping techniques to get you through your symptoms. 

 

If you have concerns that this may be something other than withdrawal, please touch base with a doctor to get checked out. 

[Remeron88]

I talked to Stuart Shipko and he did not recommend going off completely as it has been greater than 5 years on it (8 years total), but rather reducing carefully and seeing if things improve.

 

Unrelated question: I have begun to taper off sarcosine, a supplement that increases NMDA receptor activation, and suddenly feel clear headed...which makes me suspect.  I have been taking it for 2.5 years at 2 grams.  Could it potentially cause withdrawal?

[Shep]

Any supplement can cause withdrawal, so you may want to slowly taper it. It's best to only make one change at a time, so if you're tapering the supplement, you'll want to keep all other supplements and drugs the same. 

 

Dr. Shipko is cautious with his patients who wish to taper. We have numerous people who've successfully tapered after more than 5 years. So see how you do with a slow taper and decide later if you wish to come all the way off or stay on a low dose. Quality of life is important either way. 

[Altostrata]

What drugs are you taking now, at what times of day and dosages? Please update your signature with all current drugs, including psychoactive supplements such as sarcosine.

[Remeron88]

I have been taking 1.5 g sarcosine instead of the full 2 g for the last 8-10 days.  I'm not sure whether I want to taper off, so am considering reinstating tomorrow...has this likely produced any physiological changes in my receptors such that reinstating is ill-advised?  Do you really think sarcosine can produce dependence and w/d?  I haven't found any mentions of either online.

[Shep]

I'm not familiar with sarcosine and I didn't find much about it here on this site, so you'll need to do some research if you need more information. 

 

That being said, anytime you're dealing with a destabilized nervous system, any type of drug or supplement can have unpredictable results. Your nervous system is reacting to change. So it's important to remove drugs and supplements slowly and carefully. 

[Remeron88]

I started tapering Zoloft on 12/17, reducing from 200mg to 187.5mg, a 6% cut.  I think I am going to increase my reduction to 12.5% tomorrow, to 175mg, in order to get ahead of things before my hearing gets worse.

 

Which AD do you think is more responsible for my tinnitus/hearing loss, Zoloft or Remeron?

[Shep]

11 hours ago, Remeron88 said:

I started tapering Zoloft on 12/17, reducing from 200mg to 187.5mg, a 6% cut.  I think I am going to increase my reduction to 12.5% tomorrow, to 175mg, in order to get ahead of things before my hearing gets worse.

 

Hearing problems are also a withdrawal effect, not just a side effect. Please note - we do not recommend tapering faster than 10% from the previous dose each month. 

 

Many people report tinnitus months and years after coming off these drugs and those who go too fast have the worst symptoms, so I would stick to 10%. 

 

 

11 hours ago, Remeron88 said:

Which AD do you think is more responsible for my tinnitus/hearing loss, Zoloft or Remeron?

 

All psychiatric drugs can cause tinnitus and other hearing problems. 

[Remeron88]

So if reducing can make my hearing worse, and staying on can make my hearing worse, what is the best option?

[Shep]

We can't tell you what you should do, Remeron. All we can do is give you a best practice, harm reduction method of tapering off, if that's what you decide to do. 

 

Most people come into this forum already destabilized. The goal is to taper off slowly enough that withdrawal symptoms are manageable. 

[Remeron88]

I am holding at 175 mg zoloft for the time being.  Does anyone know what the mechanism by which zoloft causes tinnitus/hearing loss?  Is it via serotonin?  I have always assumed it is serotonin which makes it worse, which is why caffeine/alcohol/nicotine made it worse.  There are a bunch of supplements that protect the ears but they all raise serotonin in some degree so I am hesitant to take them.  If this is not just an excess of serotonin and just ototoxicity from the drugs themselves then I can start taking those supplements.  I have checked online and asked around and nothing is coming up, except for the following case report: https://www.researchgate.net/publication/287758683_Hearing_Loss_and_Tinnitus_During_Fluvoxamine_Treatment_A_Case_Report which states that 'The hearing loss in our patient might be due to the interference of fluvoxamine with facial nerve functioning or the effects of serotonin on the auditory sensorineural transmission.'  I really need to clear this up so I can be doing everything in my power to prevent worsening.

[Remeron88]

I'm still at 175 zoloft and my hearing seems to be getting worse, and I'm unsure whether to reduce the remeron.  I'm worried if I reduce the wrong one it could make me worse.  This may have something to do with serotonin, and since the 2 drugs have different effects on serotonin, it is hard to know which one is the right one to reduce.  Here are all the factors that are aiding my decision, starting with an excerpt from a conversation I had with Marcus Williams from Quora:

 

I am massively confused about the mechanism behind the hearing loss/tinnitus.  There are a couple studies that hint at serotonin and related dysfunction as being the root cause.

The following case report https://www.researchgate.net/publication/287758683_Hearing_Loss_and_Tinnitus_During_Fluvoxamine_Treatment_A_Case_Report states that 'The hearing loss in our patient might be due to the interference of fluvoxamine with facial nerve functioning or the effects of serotonin on the auditory sensorineural transmission.' 

This study  https://www.researchgate.net/publication/319247108_Serotonergic_Modulation_of_Sensory_Representation_in_a_Central_Multisensory_Circuit_Is_Pathway_Specific is the study cited in google results when you type 'tinnitus serotonin'.  From that study: "The DCN receives a dense serotonergic input, originating predominantly from the dorsal and medial raphe nuclei...Importantly, aberrant 5-HT signaling is implicated in tinnitus, a condition associated with hyperactivity of the DCN...In this way,the principal cell becomes consistently more responsive to multisensory input while its response to auditory signals is stymied by increased feed-forward inhibition."

Mirtazapine screws with this pathway.  From google -  "Mirtazapine disinhibits serotonergic neurons in the dorsal raphe, leading to increased serotonin release in the cortex.   It increases serotonergic cell-firing in the dorsal raphe and 5-HT release in the hippocampus as measured by microdialysis."

So it could be more the Mirtazapine.  I have been talking with Dr. Neil Bauman from this website  https://hearinglosshelp.com/about-us/ who seems to think it is not serotonin related but rather just pure ototoxicity.  He referred me to this page:  https://www.tinnitusformula.com/library/ask-barry-questions-on-tinnitus-october-2019/ which states that "SSRI antidepressants cause tinnitus not because they create serotonin but because they are synthetic drugs that are foreign to our bodies. As synthetics, they have numerous side effects and one of those is ototoxicity. They are toxic to the neurons in the auditory system."  However the mechanism may be 2-fold: ototoxicity from the drug itself as well as sensitivity to serotonin.

Something that happened by chance seems to confirm the serotonin sensitivity hypothesis.  Right before I quit alcohol for good, I tried taking my Remeron before having a drink.  Since Remeron is a serotonin antagonist, it would seemingly nullify the serotonergic effect of alcohol.  This experiment yielded no effect on my tinnitus.  However, the very next, and last time I drank I didn't take Remeron before, and the next day I woke up to a new tinnitus sound.  So it could be coincidence or confirmation that it is the serotonin which is making things worse.

However, alcohol, caffeine, and nicotine are all listed as ototoxic drugs, which confounds things further.  They all clearly made my tinnitus worse.

 

There is one case report mentioned in this study (https://new.hindawi.com/journals/crips/2016/1790692/) of a person who acquired tinnitus after an ssri, which persisted after stopping it, yet disappeared after introducing remeron.  So remeron could be 'helping' me and reducing it may aggravate things.  My ear doc mentioned that it is about finding the right level of serotonin rather than more = bad.  That is about all I have to make my decision.  Should I start reducing the remeron?  Its been 4 weeks since my last zoloft cut.