Remeron88: greetings - need some help

[Remeron88]

In the last week or so I've felt woozy and slightly off balance at times.  One night i woke up and was stumbling to the bathroom.  The woozy feeling is persisting while the off balance  has mainly went away, although i feel slightly off key at times.  I also notice blurry vision and dizziness when scrolling down a pig webpage.  Is this likely from reducing the zoloft, or a continuation of ototoxicity?  Could this be a precursor to dizziness/vertigo?

 

I haven't gotten a reply the last 2 times I posted.  I need to know if it makes sense to reduce the remeron, and which AD is more responsible for my hearing loss/tinnitus/distortion/etc.

[Armorall]

If you want a mod to look at it, you have to tag them. For instance, if you wanted me to look at it, you would put @Armorall. Does that make sense?

[Shep]

14 hours ago, Remeron88 said:

In the last week or so I've felt woozy and slightly off balance at times.  One night i woke up and was stumbling to the bathroom.  The woozy feeling is persisting while the off balance  has mainly went away, although i feel slightly off key at times.  I also notice blurry vision and dizziness when scrolling down a pig webpage.  Is this likely from reducing the zoloft, or a continuation of ototoxicity?  Could this be a precursor to dizziness/vertigo?

 

I haven't gotten a reply the last 2 times I posted.  I need to know if it makes sense to reduce the remeron, and which AD is more responsible for my hearing loss/tinnitus/distortion/etc.

 

@Remeron88 Please re-read your thread, especially ChessieCat's posts here and here. We don't know which AD is more responsible, and the AD to taper first is the most activating drug. We've already recommended tapering the Zoloft first. 

[Shep]

13 hours ago, Remeron88 said:

Thank you for your help thus far.  I have a few questions.  Is my wooziness and off balance as well as computer screen scrolling dizziness likely from tapering the zoloft?

 

I re-read my thread and you seem to think it is serotonin toxicity.  If this is the case, reducing the remeron is more tenuous since it is a serotonin antagonist, and therefore reducing it can result in a resurgence of serotonin, which could make things worse.  Is this true?

 

There are a few ways to lower my serotonin, such as taking dopamine supplements and stuff like phenylalanine, an inhibitor of serotonin synthesis.  Is this likely to help?

 

Thank you again, I am trying to avoid a progression of symptoms.  One story I read online of a person who had tinnitus, hearing loss, balance issues, oscillopsia, double vision, and nystagmus from remeron.  I am afraid of this happening to me, since my issues have been building in the past 6 months.

 

Remeron, I'm answering your PM here in your thread so all your information is in one place. 

 

We don't recommend adding in dopamine supplements. The only supplements recommended here are magnesium and fish oil. 

 

Quote

 

current drugs: before bed - 3 mg risperdal, 22.5 mg remeron morning - 175 mg zoloft

current supplements: before bed - 1 g NAC, danshen, 200mg magnesium, lion's mane mushroom | morning - 1 g NAC, beta carotene, l-lysine, 1 g sarcosine

 

 

You are taking an antipsychotic and two antidepressants, along with a lot of supplements and herbal remedies. As far as what's causing your symptoms, it's likely a mix of withdrawal issues, side effects, and / or interactions. Risperdal can also cause tinnitus, so hyperfocusing on the serotonin drugs to the point where you aren't able to taper any of your drugs is not to your advantage. And continuing to play around with your drugs (as in taking them off and on as you posted about a few weeks ago) and adding in supplements is really complicating your taper. 

 

If you want more targeted advice, please start a daily drug and symptoms journal as listed below. Please also:

• list when you have a cigarette, since nicotine plays a role
• post the number of hours you sleep each night. 

 

On 9/27/2016 at 2:49 PM, Altostrata said:

In the course of discussion in your Introductions forum topic, you may be asked to keep notes on paper of your daily symptom pattern, including when you take your drugs, their dosages, and any symptoms. We ask this because there may be something we can do to reduce the symptoms.

 

What we need to see for every single day over several days is what symptoms you get before and after you take your drugs. If you're not taking any drugs and have withdrawal symptoms, we still need to see your symptom pattern throughout the day:

 

The time of day, dosage, and severity of symptoms are essential information. Include

 

- Time and dosage for all drugs taken throughout the day, psychiatric and non-psychiatric.

- Following each dose, note any symptoms. If you are having a reaction to the drug, it may take hours for a symptom to show up -- that's why we ask you to keep notes all day long.

- If you're not taking any drugs, your symptoms throughout the day.

- Your sleep pattern. Since so many drugs disturb sleep, if you find you're waking in the middle of the night, it could be from a drug you took earlier in the evening. If you're not taking any drugs, there may be ways you can improve your sleep.

And so forth. A diary, in chronological order, looking something like this:
 

Example:

DATE:

 

6 a.m. Woke with anxiety
8 a.m. Took 2.5mg Lexapro
10 a.m. Stomach is upset
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Feel a bit better
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Feeling dizzy
10:30 p.m. Fell asleep
2:30 a.m. Woke, took 3mg Ambien (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke but got back to sleep

 

 

[Altostrata]

On 3/4/2017 at 4:39 PM, Remeron88 said:

Interactions between your selected drugs

....

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.

....

 

 

On 1/30/2020 at 3:20 PM, Remeron88 said:

I need to know if it makes sense to reduce the remeron, and which AD is more responsible for my hearing loss/tinnitus/distortion/etc.

 

You're taking 3 powerful psychotropic drugs, plus other stuff. Any of these or their combination may cause your symptoms.

 

Since you joined 3 years ago, what has your doctor said about the adverse effects of your drugs?

[Remeron88]

I'm not playing around with my drugs or consuming any alcohol, caffeine, or nicotine.

 

I need to know what's causing what before I can make decisions regarding the meds.  I thought someone would have answers but apparently no one can know which drug is the culprit, or if tapering one will make things worse as opposed to better.

 

My doctor doesn't attribute any of my issues to the drugs.

 

So what is a good plan as far as tapering?  I know that going slow and holding is necessary, and am doing that.  I mean as far as whether to taper one or both ADs and maybe even the AP.  Is it a good idea to taper the Remeron at all, given it is a serotonin antagonist and doing so would likely increase serotonin?

 

As far as the wooziness, can anyone make an educated guess as to whether it is a withdrawal or side effect?

 

Thank you.

[Remeron88]

@Altostrata @Shep @ChessieCat

 

My woozy and off balance feelings seem to be getting worse.  They started around 1/22/2020.  I am afraid things will keep getting worse to the point of dizziness/vertigo and other issues.  Do these sort of issues wax and wane or is this a clear downward trajectory?  I realize you can't predict how long they will last, but if temporary, how long can I expect them to last?

 

I probably shouldn't make any more med changes until this passes.

 

Please answer my other questions regarding the Remeron and whether these issues are from withdrawal or continuing use.

[Shep]

6 hours ago, Remeron88 said:

Please answer my other questions regarding the Remeron and whether these issues are from withdrawal or continuing use.

 

We've answered this multiple times, Remeron. Re-read your thread. 

 

Again, if you want more targeted advice, you'll need to start a daily drug and symptoms journal (see my post here). 

 

 

[Remeron88]

I am really looking for specific answers based on educated guesses or at least information that can help me come to a conclusion.  It appears the wooziness and imbalance is from reducing the zoloft, and I was wondering if anyone agrees with this assertion.  The answer "it's likely a combination of xyz" does not provide much additional information.  I am just going to assume it is from reducing the zoloft.

 

If this is true, will it keep getting worse or is it likely not to change?  It's been nearly 4 weeks since the symptoms began and its relatively constant, although fluctuating.  How long until it improves?  Also, what can be done to treat it, or to prevent it from getting worse?  Thanks.

[Shep]

1 hour ago, Remeron88 said:

The answer "it's likely a combination of xyz" does not provide much additional information. 

 

We've asked multiple times for a drug and symptoms journal if you want more information.

 

We can only give you information based on the information you give us. 

 

Quote

 

nov 2016: insomnia.  reinstated 3 mg risperdal, 200 mg zoloft, plus 15 mg remeron. april 2017: 22.5 mg remeron. | dec 17 2019: 187.5 mg zoloft | dec 24 2019: 175 mg zoloft

 

current drugs: before bed - 3 mg risperdal, 22.5 mg remeron morning - 175 mg zoloft

 

 

The above is from your signature. You joined the forum in March 2017, nearly three years ago, and only started tapering in December 2019. 

 

On 11/27/2019 at 8:20 PM, Remeron88 said:

So my hearing continues to get worse. 

 

On 11/28/2019 at 9:35 PM, Remeron88 said:

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

 

Before you started tapering, you were getting worse side effects. So some of what you're dealing with are side effects, not just withdrawal effects. 

 

Again, if you want more information, you'll have to post a drug and symptoms journal as listed here. Otherwise, you're wasting your time and the staff's time. 

 

[admike]

Hi Remeron88, I am in similiar situation like you. In my case tinnitus has appeared after quitting venlafaxine old turkey and then reinstating after 4 horrible days. My opinion is that tinnitus is caused by serotonine disbalanace, not possible to say whether there is too much of it or too little. Here is a study with interesting results: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3357564/. 

I hope serotonine induced tinnitus is not permanent- you can see sometimes it is better, sometime worse and there is no physiological, only chemical reason. Getting obsessed with that makes it worse definitely, we need to learn stop thinking about it.  I think the best bet would be to stick with what you are taking for at least couple of weeks, and not change anything too quickly. Fast tapering will make it worse I guess. Brain need time to adjust itself to different of chemicals and patience is the key to heal.

 

 

 

[Remeron88]

I experienced tingling and burning in my hands and feet twice today, first after eating a bowl of cereal for breakfast and then after eating dinner (steak and potato).  Is this a sign of diabetes or a discontinuation effect?  I am 6'1 210 lbs and no family history of diabetes.

[Shep]

You may be reacting to the carbs in the cereal and potato. Many people report trouble with blood sugar regulation during withdrawal and many of us go on diets that are low glycemic and low to no sugar.  Processed foods can also cause problems for people going through withdrawal.

 

You can find more information here:

 

Food sensitivities

 

 

[Remeron88]

Thank you @Shep.  I spoke with my ear specialist today and he thinks the Remeron is the more likely culprit in my ear issues, due to more anecdotal evidence and greater proportional evidence of problems.  He said I wasn't wrong in tapering the Zoloft first and that I wasn't 'doomed' if I stayed on the Remeron in the meantime.  Are you inclined to agree with him?

[Shep]

I don't know if it's Remeron or Zoloft causing your ear issues, but I do agree that you're not doomed. 

[Remeron88]

I am down to 150 mg zoloft from 200.  The hearing distortion just got worse a couple days ago.  My last reduction was on the 11th of May. Is this worsening more likely from going down or continuing use?  Should I continue to taper the zoloft?

[Shep]

On 12/1/2019 at 8:40 PM, Shep said:

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. 

 

Remeron, this is what we've been saying again and again. We don't know if this is a side effect or a withdrawal symptom. 

[Remeron88]

What is the best course of action then?

[Shep]

On 2/17/2020 at 5:49 AM, Shep said:

We've asked multiple times for a drug and symptoms journal if you want more information.

 

We can only give you information based on the information you give us. 

 

@Remeron88 If you want more information, you'll need to provide this. 

 

Keep daily notes of drug schedule and symptoms to track patterns and progress

[Remeron88]

@Shep @Altostrata Last night the tinnitus (tones and crickets) became noticeable over all the music I was listening to.  It happened to occur after I had some chocolate ice cream and fudge.  It's been only a month since the last worsening.  I'm still holding at 150 on the zoloft.  I need to come up with a plan of attack because I'm running out of time.  All these changes have been permanent, and I don't consume any psychotropic substances besides the meds.  Just food.  The tinnitus and hearing distortion don't fluctuate once they've set in, and don't change after I take my meds.  If there is any information that you specifically want that I haven't given you in this post, please tell me because my days are pretty basic.  I go on walks which do not affect the tinnitus at all.  Please just tell me what you think is the best course of action with the meds, because I need to know what to do ASAP.  Thank you, I pray you can give me a solid plan.

[Altostrata]

It's possible the tinnitus is an adverse effect of a drug or the drug combination you're taking. We can't tell without those daily notes. The SSRIs are well-known for causing tinnitus.

 

You are still taking a rather hefty drug cocktail.

 

From now on:

On 6/3/2020 at 4:22 AM, Shep said:

If you want more information, you'll need to provide this. 

 

Keep daily notes of drug schedule and symptoms to track patterns and progress

 

[Remeron88]

I know its the meds.  Please just tell me what I should do.  What is a journal going to accomplish at this point?  It's been getting worse consistently for months now.  I need guidance immediately before this gets any worse.

[Remeron88]

@Shep @Altostrata There should be enough information in my thread to make a recommendation regarding tapering.  All the minutiae of a journal is immaterial in comparison to the main things I've laid out.  I am literally at my wits end, and I need some kind of help in making a decision regarding tapering.  I'm sorry if I'm blunt but I don't have the luxury of journaling or waiting.

[Altostrata]

You would like advice and I want information. I don't get paid for this. Don't make it difficult for me. Daily symptom notes before further discussion.

[Remeron88]

I've told you, my symptoms don't fluctuate.  Once a new one comes, it stays, for instance, the latest one which is tones/crickets over music.  I will go through the process of notes but they will not add anything meaningful to the discussion.  I have already lost the ability to enjoy music waiting for some advice.  I am pretty sure vestibular symptoms will soon follow.  I'll do the notes, but I need quick recommendations what to do with the meds.

[JanCarol]

I haven't had a chance to read your whole thread - but why are you taking 22.5 mg remeron in the morning?

This is a drowsy dose, and should be moved to nighttime (but separate from your risperdal).  If you are having dizzy and drowsy during day, this could be a huge contributing factor.

My doc gave me remeron to help me SLEEP, and it's one of those paradoxical ones that the lower doses are more drowsy inducing than the higher doses.  It's my understanding that anything under 30 mg should be sleep inducing.  And that 7.5 mg is positively a knock-out dose.  

So - while you are working on getting your daily symptoms up - this is the first change I would consider.

[Remeron88]

You misread my signature, it means to say before bed - 3mg risperidone, 22.5 mg remeron /// morning - 150 mg zoloft.

[Remeron88]

The last 2 times I exercised I felt woozy and slightly off balance after.  The first was a long walk, the second a round of golf.  The feelings passed after a couple hours.  Could this mean dizziness/vertigo is approaching?

[ChessieCat]

It appears like your body is telling you that have been overdoing things.  The fact that the same thing has happened after each incidence of exercise/exertion is a fairly good indicator of it being the cause.  We do need to listen to our bodies and respond accordingly.  When you walk next time, don't walk so far, fast and/or as energetically, or take rest breaks along the way.  If you play a round of golf, either reduce the number of holes and/or go slower and/or take rests in between.

 

The fact that the feeling passed after a few hours is a good sign.  It probably means that you have only over-exerted by a small amount and need to do a little bit less.  Some members do something physical and they are wiped out the whole of the next day.

[Remeron88]

Since 7/18 the wooziness has been more or less constant.  Is this likely to progress or is this a temporary w/d symptom like my 6 weeks of occasional wooziness/imbalance in January/February of this year?

[ChessieCat]

I think you've answered your own question.  You noticed improvement of it before.

[Remeron88]

Wooziness has more or less gone away.  I am considering making another cut to the Zoloft, or perhaps the Remeron.  Not sure which one is better to reduce given reducing the Zoloft by 25% thus far hasn't stopped my tinnitus from getting worse.  I think going down on the Zoloft made me more sensitive to things like sugar and carbs because the last worsening of my tinnitus occurred right after I had some ice cream on 6/27.  I am trying to cut out as much carbs and sugar as possible.  Does anyone know why sugar/carbs/gluten/etc. can make tinnitus worse?  Is it via inflammation or the uptick in serotonin?  My blood sugar is high, close to pre-diabetes.  I might start taking cinnamon extract to lower it. I'm pretty sure the last worsening was due to sugar.  Please help me make another step in the right direction @Altostrata @Shep @ChessieCat

[Altostrata]

Good to hear of the improvement. 

 

Clearly, eating sugar is not good for you. Don't count on cinnamon, effect is very slight. Your symptoms may be due to stress on your insulin system. Nothing to do with serotonin.

 

Do you remember this? This interaction may still be occurring, you're taking significant dosages of all your drugs.

 

On 9/16/2019 at 8:34 PM, ChessieCat said:

....

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.

 

 

Here is the interactions report for all your drugs https://www.drugs.com/interactions-check.php?drug_list=2057-1348,1640-0,2019-0

 

When did you add each of the supplements?

[Remeron88]

I've been taking NAC since February 2018, beta carotene since late August 2019, Lion's Mane Mushroom since June 2019, L-Lysine since August 2017.

 

The majority of my hearing/tinnitus symptoms arose from consuming things.  First tobacco and caffeine, then alcohol, now something as slight as sugar.  The only times I couldn't pin it to anything were Aug 5, 2019 (started hearing tones over music) Sep 29, 2019 (hearing became distorted), and May 29, 2020 (distortion worsened), which may have been from ongoing use.  Dropping off Zoloft in 2016, reinstating, adding Remeron, and now reducing the Zoloft again is probably why I am so sensitized.  I know I have to be careful with what I eat/drink, and now I'm just trying to figure out which drug to reduce and how much.  Thank you @Altostrata.

[Remeron88]

Lion's Mane was probably May 2019.

[Altostrata]

7 minutes ago, Remeron88 said:

First tobacco and caffeine, then alcohol, now something as slight as sugar.

 

We have seen all of these, particularly alcohol, to cause worse symptoms in systems sensitized by withdrawal.

 

I take it your original problem was sleeplessness? Has your tinnitus changed since mid-July?