Remeron88: greetings - need some help

[ChessieCat]

21 minutes ago, Remeron88 said:

Please, no more "I don't know". 

 

We are not omniscient and we can't magically solve your drug issues.  If we say we don't know, we don't know.  I doubt that you would like it if we suggested something and it made you much worse?  Sorry, but we don't do that at SA.  We are very cautious because we know (yes, that is something that we do know) that we are making suggestions that can affect a member's well-being, and possibly for a long time, if we get it wrong.

 

Please re-read Shep's post.

 

15 hours ago, Shep said:

 

You're on 3 drugs that can cause dizziness and I'm not familiar with all of your supplements, which may also be causing problems. 

 

 

Do some research about everything you are taking including the supplements.

 

3 drugs:  check the interactions and the side effects

 

Supplements: before bed - 1 g NAC, lion's mane mushroom | morning - 1 g NAC, beta carotene, 500 mg l-lysine

 

 These may have turned paradoxical or as Shep said, causing problems.

 

15 hours ago, Shep said:

 

You'll need to decide if you wish to come off these drugs or not. Some of the symptoms that are side effects may get ramped up when you taper, but you'll have to manage them. Since you've been holding since May, you may want to make a small decrease of 3 - 5% and see how you do. 

 

 

Shep did make a suggestion.

 

Please make sure that you read what the mods post.

 

I suggest you go back and re-read your topic.  I suggest you take notes and then get a piece of paper, draw a line down the middle and putting pro and con either side of the line.  And then do some brainstorming.

 

REMEMBER:  only make one change at a time, so don't stop taking a supplement and making a reduction at the same time.  Or stop two or more supplements together.

 

the-rule-of-3kis-keep-it-simple-keep-it-slow-keep-it-stable

 

[Altostrata]

On 11/27/2019 at 5:20 PM, Remeron88 said:

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?

 

Do you by any chance have a pre-existing inner ear condition?

 

Today is Friday. The last time you posted your daily drug and symptom notes was Wednesday. 

 

We have been asking for DAILY notes since February 1. We're not omniscient or miracle workers. Daily means daily. We need to see those notes every day, to find out what's causing this symptom.

 

On 6/28/2020 at 7:04 PM, Altostrata said:

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.

 

Although we have been discussing the possibility you are having adverse reactions to your drugs for months, and requesting DAILY notes, you have not been forthcoming with this essential information -- yet you demand answers.

 

This is a site for going off drugs or dealing with withdrawal syndrome. You're still taking fairly hefty amounts of 3 drugs; it's very possible you're suffering from adverse effects -- as we've reminded you repeatedly. It's not our job to get you comfortable on your cocktail, that's what your doctors get paid to do.

 

You might also have an inner ear condition. We don't treat those here. 

 

Do not under any circumstances tag me again to look at your problems.

[Remeron88]

I am having trouble reducing the Zoloft past 150 mg.  I tried a reduction to 137.5 a month ago and my tinnitus went through the roof.  I went back up 8 days later and my tinnitus returned to baseline.  My tinnitus has always worsened in response to serotonergic substances.  It began and worsened after caffeine, cigarettes, and alcohol.  I believe reducing the Zoloft has made my tinnitus even more sensitive to serotonergics including food.  Sugar, gluten, and carbs have all made it worse since I began reducing, and they all spike serotonin levels.

 

My recent attempt at reducing further failed because doing so increased my sensitivity so far that my already low carb, limited diet failed to prevent minor spikes in serotonin from causing my crickets and tones to worsen.  I am not sure how to reduce beyond the 150 mg mark without causing undue sensitivity.

 

I believe reducing Zoloft, by lowering serotonin levels, increases receptor sensitivity and leads to tinnitus in response to serotonergic influences.  This article (https://www.jneurosci.org/content/35/11/4540) seems to support my theory.  Hence I am looking for a way to reduce the Zoloft while keeping my serotonin levels the same, such as adding in a serotonergic supplement.  However, this seems impossible to execute precisely.

 

Since 11/25/20 I have had ear fullness and increasingly muffled hearing.  I fear the advent of hearing loss if I do not continue reducing.  Therefore I am not sure how to proceed besides maybe reducing again and restricting my diet even further while keeping serotonin in check with DLPA and tyrosine.  I am not sure if I can reduce the other 2 meds, Risperdal and Remeron, as they are both serotonin antagonists and doing so would be serotonergic in some ways -- there are case reports of people who stop a serotonin antagonist while on an SSRI and get serotonin syndrome.

 

I am wondering if anyone on this forum has had similar experiences or knows how to tackle this tricky situation.  Thank you.

[Remeron88]

On 1/26/21 I started taking magnesium citrate 100 mg and 1000 mg taurine and upped the doses to 200 mg and 2000 mg over a week.  Then a few days ago I switched to 200 mg magnesium malate and started feeling flushed/warm.  Last night the flushing/warmth became a fever and disorientation which has persisted until this morning (101 F).  I also had a brief period of chills, and I now have a headache as well as calf twitching.  I believe this may be a case of mild serotonin syndrome caused by the magnesium.  @ChessieCat do you know if this is correct or is this something else?  I may be extremely sensitive to serotonin.  Thanks.  I am stopping the supplements.

[ChessieCat]

It's interesting that this happened after you changed from mag citrate to mag malate.

 

If that is the only thing that was different then it is possibly one of two things, either the change in magnesium type OR a coincidence and you have a virus.

 

The only way to know with a reasonable amount of certainty would be to stop the mag malate and than restart it.  If it was me I wouldn't, I'd be going back to mag citrate.

 

Stopping the supplements is the sensible thing to do.  If/when you restart them, it is better to start one at a time at a low dose and build up.

[Remeron88]

I am scared of getting the covid vaccine since I have or have had lots of symptoms on the vaccine side effect list (ear fullness, muffled hearing/loss, multi-tone tinnitus, and multiple bouts of wooziness/off balance plus one episode of vertigo back in 2017), so I am afraid it may trigger dizziness/vertigo, hearing loss, and/or worsened tinnitus due to my many latent conditions and being almost at 50% of my original dose of Zoloft.

Are there any mods that can gauge my relative risk?  @Shep@ChessieCat How have people with my issues been responding to the vaccine?  Thank you.

[ChessieCat]

There is a Covid topic.  The easiest way to find things on SA is to use an internet search engine and add site:survivingantidepressants.org to the search term.

[Altostrata]

How are you doing, @Remeron88?

[Remeron88]

I'm down to 112.5 on the Zoloft, probably going to reduce to 100 in the next couple days.  I am considering either that or beginning to reduce the Risperidone.  The problem is that reducing the Risperidone will probably make my tinnitus worse, but the Risperidone may be the cause of my hearing loss.

[Remeron88]

@Altostrata@Shep@ChessieCat

 

I made a bad mistake...from May 26 to June 1, I reduced to 100 mg from 112.5 on Zoloft.  I decided to go back up to 112.5 on June 1st because I was afraid of sensitization.  Well a few days later on June 4, my tinnitus worsened after my daily exercise.  Now I am afraid to exercise again as I believe going down to 100 has sensitized me further (I am already sensitive to carbs, alcohol, caffeine, supplements, basically due to the spike in serotonin they cause) so that I can't do the things which combat my clogged ears and muffled hearing (exercise, hot showers, fasting, and 8 hours sleep).  I'm also afraid I eventually won't be able to go golfing as being outside in the sun elevates serotonin directly and by increasing vitamin d (even with sunscreen).  I've read that once there is kindling, the sensitivity to the stimulus persists indefinitely. 

 

https://neuro.psychiatryonline.org/doi/pdf/10.1176/jnp.12.3.328 “Permanence of Sensitization The enhanced susceptibility to behavioral seizures persists for the lifetime of the kindled animal. Once an animal is kindled, it remains hypersensitive to the stimulus, even months to years after the last kindled seizure. One may propose more broadly that once sensitization occurs, it may be permanent.”

 

I have no idea how to reverse the kindling or sensitization besides waiting for months and years...I don't expect it to reverse because my sensitivity to alcohol and caffeine did not abate even after 2+ years back on the full dose of 200 (2017-2019).  How can I reverse things?  Should I never attempt exercise again?  I'm also not sure how to reduce the other 2 meds without further sensitization.  Please help, thanks so much.

[AdviceNeeded]

I’m no expert but am unsure how well a model of kindling seizures in animals relates to the concept of nervous system sensitisation in AD usage, mismanagement and withdrawal in animals.

 

I’ve no doubt sensitisation occurs, it’s well documented on this site (and appears to have been recovered from by a fair few in the success stories). But as to the actual mechanism behind it? Who knows? It could well be that receptor levels have over-compensated/struggling to reach equilibrium rather than a specific, permanent increase in NMDA receptor density. 
 

Sensitisation in the context of ADs does seem to diminish in time though, so it seems unlikely it’s permanent.

 

If anyone more knowledgeable would like to weigh in and set me straight I’d be happy for clarification.

 

I’m sorry I can’t be of anymore help, hang in there.

[AdviceNeeded]

There’s also the concept of ‘long term potentiation’. Neuronal connections that fire together become strengthened... which I suppose could account for sensitisation. 
 

But it has its opposite, ‘long term depression’, where neuronal connections that are used less, or only weakly stimulated, weaken over time.

 

So once AD levels drop and chronically stimulated serotonin neurons get a break, over time we could assume they’d become less excitable and sensitisation would reduce.

 

Again, I’m no expert and this is all just speculation... I just want you to see that the situation isn’t hopeless. There’s so much we don’t know.

[Altostrata]

On 6/21/2021 at 8:42 PM, Remeron88 said:

from May 26 to June 1, I reduced to 100 mg from 112.5 on Zoloft.

 

How did you feel over these 4-5 days?

 

It sounds like you're scaring yourself about sensitization.

[Remeron88]

@Altostrata I felt fine.  Also, my tinnitus worsened slightly during that time which is partly why I went back up to 112.  My only problem since early 2020 has been tinnitus and hearing loss/distortion, the former of which has gotten more and more sensitive to substances and now it seems, exercise/sunlight, as I've tapered.

 

The tinnitus seems to be getting worse, today I started hearing it more in the supermarket and during a shower.  I think it may be from golfing and/or my diet, which is already low carb (I only eat around 15 grams net carbs max in one sitting).  Golf is the only pleasurable activity I have left (music was too until this latest mishap), and I'd hate to lose it as well.

 

Maybe the reinstatement in addition to the reduction is what triggered the further sensitization.  I only first noticed my tinnitus get significantly worse on June 4, after a few days back at the original dose.

[Altostrata]

16 minutes ago, Remeron88 said:

 I felt fine.  Also, my tinnitus worsened slightly during that time which is partly why I went back up to 112.

 

Is it possible the tinnitus worsened because of something else?

 

How about a smaller reduction than 12.5mg?

 

 

15 minutes ago, Remeron88 said:

The tinnitus seems to be getting worse, today I started hearing it more in the supermarket and during a shower.  I think it may be from golfing and/or my diet, which is already low carb (I only eat around 15 grams net carbs max in one sitting). 

 

Why do you think this? If either is aggravating your tinnitus, you should change your habits.

[Remeron88]

It's possible, but not likely given the fact that only serotonergic perturbations on top of w/d induced sensitivity make it worse.

I think I may try reducing the risperidone instead of another sertraline reduction, but that too would likely sensitize me.

What I think has happened is that I've become more and more sensitive to serotonin as I've tapered off, such that things like carbs, supplements, etc. worsen my tinnitus by causing spikes in serotonin.  Exercise, sunlight, fasting, showering all raise serotonin as well and before my latest short-lived reduction, were innocuous in regards to my tinnitus.  Now, I'm not so sure they are ok, but I am not willing to sit inside all day and give up on my life.  I've already quit exercising since 6/4; I'm not willing to give up golf, my only remaining pleasure.  I can cut back further on carbs, but I already barely eat any.  What are your thoughts on how to handle this?

[Remeron88]

@Altostrata

[Altostrata]

On 6/24/2021 at 7:55 PM, Remeron88 said:

the fact that only serotonergic perturbations

 

This is not a fact. I don't see your serotonin argument at all. It is unknown why withdrawal might cause tinnitus, which can also be an adverse effect of drugs and drug combinations.

[Remeron88]

@Altostrata @Shep @ChessieCat

 

UPDATE: The tinnitus is still worse, and I’ve been fasting 12–13 hours a day, which might have agitated it a little. My ears are still clogged and I experience a dull feeling in both ears along with muffled hearing, so I think I need to do something soon. I’m thinking about reducing the risperidone or the mirtazapine, and just hoping it doesn’t sensitize me further. I’ve read that the sensitization from reducing an SSRI is a result of downregulation of serotonin receptors coupled with lowered serotonin from reducing, so perhaps freeing up some receptors from reducing a serotonin antagonist like risperidone/mirtazapine will counter that and allow me to do so without further sensitization.

 

My other options include supplements and exercise, which are risky. I’m not sure which supplements to take as there are so many and virtually all increase serotonin. Perhaps taking one with a long half life or taking multiple doses a day of shorter half life ones will keep serotonin constant enough to not cause perturbations. I think it’s all about not spiking serotonin temporarily.

 

I came across this: https://www.reddit.com/r/Nootropics/comments/gis45v/nacetyllcysteine_an_overlooked_neurotoxin/ in browsing reddit and it gives a worrisome account of NAC, of which I take 2 grams a a day, even going so far as to label it ototoxic. I’m curious what you make of it, since so many studies find NAC protective. I don’t have an easy substitute for NAC, so I’m still taking it in the meantime.

 

Should I risk things with exercise and/or supplements, or just reduce the risperidone/remeron and hope it pans out? I also have another option - acupuncture - which I am hesitant since it also enhances serotonin. Maybe there is something else I can do I haven’t thought of?

 

I think I’ve exceeded my limit for reducing any med by going down so far on sertraline that further reductions in any med, sertraline included, will provoke tinnitus sensitivity to even the slightest of influences. I probably should have split my reductions between sertraline and risperidone. My main questions are how to reduce the risperidone without further sensitization, as well as how to reduce the sensitivity itself. I really need a way to do one of those 2 things. All I can think of is doing the reverse of what has happened thus far, i.e. increasing serotonin receptor density and/or increasing serotonin content.

 

How do I approach things going forward? Will reducing the risperidone/mirtazapine induce sensitization just like reducing the sertraline has?  I'm also assuming I can't go back up on sertraline to free up 'room' for reducing the risperidone/mirtazapine.  I probably need to reduce the risperidone or mirtazapine or risk going deaf.

 

Thank you so much.

[Altostrata]

Is tinnitus still your greatest concern?

 

Please review this:

On 8/19/2020 at 2:32 PM, Altostrata said:

Please consult Dr. Google about tinnitus. Yours might have very little to do psychiatric drugs.

 

Also check whether the supplements you're taking are good for tinnitus, NAC and lysine particularly.

 

We don't provide general medical advice and can't help you with tinnitus from loud music.

 

Always check the supplements. Also, in what way might your diabetes be affecting you?

[Remeron88]

The tinnitus as well as current and potential hearing loss.

 

I don't think this is just a random case of tinnitus, the timing with going off and back on Zoloft was too suspicious.

 

I don't have diabetes.

 

Do you know if reducing the risperidone/mirtazapine will cause further sensitization?

[Altostrata]

Sorry, I misinterpreted an earlier exchange about diabetes.

 

You may have tinnitus as a withdrawal effect, as an adverse reaction to something you're taking now, or you could have developed it independently of psychiatric drugs, with the timing being coincidental. Did you read up on tinnitus?

 

Your history of tinnitus:

 

On 9/16/2019 at 8:14 PM, Remeron88 said:

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.

 

According to your signature, "oct 2016: went off zoloft | nov 2016: insomnia.  reinstated 3 mg risperdal, 200 mg zoloft, plus 15 mg remeron".

 

So it wasn't merely going off Zoloft and going back on that caused the tinnitus, there are a lot of other factors that might have caused it or contributed to it. You might be experiencing tinnitus as an adverse effect of Risperdal, for example.

 

Are you still doing this?

On 8/19/2020 at 1:55 PM, Remeron88 said:

I didn't.  I do however listen to somewhat loud music (70-75 db) for 3-6 hours 3-5 times a week.

 

If the nerves in your ears are sensitized by withdrawal, you could be irritating them more with a noisy environment.

 

As explained earlier, we cannot treat tinnitus. We cannot identify the cause of your tinnitus. Any of your 3 psychiatric drugs, or a combination of them, or a supplement may be causing tinnitus -- or it may have been brought on by smoking and exacerbated by other of your habits.

 

This is not to blame you for tinnitus, but to point out again there may be many reasons for your tinnitus unrelated to Zoloft. Your theory of serotonin somehow being responsible is baseless.

 

As we cannot tell which of your drugs, if any, is causing the tinnitus, we cannot suggest reduction of a particular drug to reduce the tinnitus. Your guess is as good as anybody's in that regard.

 

If you choose to reduce a drug, we can help guide you in tapering, but we cannot guarantee that your tinnitus would not become worse from tapering or that it would be resolved by your going off any of your drugs.

 

Of the 3 drugs your'e taking, Risperdal is the one that's worst for general health. Were you prescribed it for symptoms of psychosis?

[Remeron88]

@Altostrata

 

Yes.

 

All I know is that after I attempted to get off drugs in 2016 and since I've been reducing the sertraline in 2019 my tinnitus has been triggered and worsened by what I consume, be it substances or recently, even food.  I think tapering the drugs has made me sensitive to what I put in my body.  I am now rapidly losing my hearing, and my ears feel fuller and fuller.  I believe I need to reduce either the risperidone or the mirtazapine to prevent further hearing loss.  What I need to know is whether reducing the risperidone/mirtazapine will further sensitize me to substances/food, and if so, how to avoid that happening.  They are a different class of drugs than the sertraline, and reducing them may or may not sensitize me.  Please answer this one question for me as I need to an outside opinion before I start reducing one of those 2 drugs.  Thanks.

[Altostrata]

You were prescribed risperidone for symptoms of psychosis? What were those symptoms?

 

1 hour ago, Remeron88 said:

What I need to know is whether reducing the risperidone/mirtazapine will further sensitize me to substances/food, and if so, how to avoid that happening.

 

I don't know. We recommend gradual tapering as a way to sneak off the drug without your nervous system becoming upset.

 

Mirtazapine has a long half-life, it's more likely you'll feel small, gradual reductions in mirtazapine less than reductions in risperidone or Zoloft.

 

Please note your tinnitus may also be aggravated by sertraline, the supplements you're taking, or an interaction among your drugs.

 

As explained repeatedly, we cannot predict how any drug changes you make will affect your tinnitus.

[Jayy]

On 8/20/2020 at 3:04 AM, admike said:

I do have tinnitus as well- developed by venlafaxine cold turkey and going back on it couple days later. I can tell you, it's very likely linked to your medications in your case as well, there are lot of similar reports https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3357564/ for instance. These studies show that tinnitus  can be caused by administering antidepressants, but even cured by it. Serotonine is important player with tinnitus, but other chemicals and brain processes act too. Altostrata is right, there is no wonder treatment or supplement. It is too difficult system which we can't simply control in other ways than stupidly wearing noise making devices in your ears:( But I can tell you this: the less you focus on tinnitus, the less it bothers you- try to use psychology instead of psychiatry, it requires some work but at least it won't do any more damage.

I developed tinnitus on desvenlafaxine, Pristiq 50mg, And it is killing me. I am so angry. I only took pritiq for 1 month and stopped because I couldnt handle the side affects and tinnitus scared me. I didn't think that I would deal with the constant ringing after stopping, and now 6 months later it is still ringing and I am scared that it is permanent. I am desperate to make the ringing stop. i dont know what happened if it was ototoxicity or the increased serotonin, because I read that the tinnitus should go away in 1-2 weeks after stopping but its BEEN 6 MONTHS. Will it ever go away? Am i in withdrawal? I pray that it is not permanent, becasue I can not live a live with a dentist drilling in my brain constantly. 

[Jayy]

4 hours ago, Altostrata said:

I don't know. We recommend gradual tapering as a way to sneak off the drug without your nervous system becoming upset.

 

Mirtazapine has a long half-life, it's more likely you'll feel small, gradual reductions in mirtazapine less than reductions in risperidone or Zoloft.

 

Please note your tinnitus may also be aggravated by sertraline, the supplements you're taking, or an interaction among your drugs.

 

As explained repeatedly, we cannot predict how any drug changes you make will affect your tinnitus.

Hello Legend,

 

Thank you for making this forum it has given me hope many times as I constantly seek advice on what happened to me when I took Pristiq and the consequences I suffer to this day from taking the AD. 

 

I took pristiq 50mg for 1 month, and developed tinnitus, as well as other adverse affects and I could not sleep. I quit cold turkey after noticing the tinnitus and how I did not feel better on the drug. I have been struggling with tinnitus for 6 months drug free now and I am worried it is permanent. 

 

I have never had tinnitus before, and quit frankly I am regretful I took the Antidepressant, since I usually wont even take Tylenol. I am super sensitive and Im not sure what happened, if it was ototoxicity am it damaged my auditory hairs cells, or if serotonin hyper-activated my brain cells, and they wont go back to normal? I am desperate for the ringing to stop. I am wondering if it will ever go away.  I am trying everything, exercising (which makes it worse), fish oil, magnesium, and sleeping well enough to heal. But the tinnitus is still ringing loud and constant. It is the only side affect I believe I am dealing with, I am terrified I will have to deal with it the rest of my life. does tinnitus ever go away from taking an antidepressant for a shot amount of time? I read it should resolve after stopping the drug in 1-2 weeks but its been 6 months. I can not find stories of anyone who is suffering from tinnitus long term ever getting rid of it, making me more terrified I am stuck with it. 

[Altostrata]

Hello, @Jayy You may wish to post in 

 

 

This is Remeron88's topic; your antidepressant-induced tinnitus is a lot clearer than his situation.

[Remeron88]

@Altostrata@Shep@ChessieCat

 

My hearing has been getting a lot worse recently along with the ear fullness and I need to reduce either the Remeron or the Risperidone.  However, I am not sure which is more responsible.  Remeron may be more ototoxic than Risperidone but I am hesitant to taper it for the following reason: it targets the same receptors as Risperidone, yet binds more loosely to them than Risperidone, so that reducing it will not change receptor occupancy much, as Risperidone is likely edging out the Remeron at each receptor anyway due to its tighter binding. So reducing the Remeron will therefore have less impact on my brain chemistry than reducing the Risperidone and this might not reduce whatever 'damage' is going on. Is this concern valid? Do these drugs cause ototoxicity by receptor antagonism and brain modulation or merely by directly coming into contact with and damaging the ears/brain? If it is the latter then I can reduce either and benefit equally.

 

What drug in your opinion is more responsible for my reduced hearing and ear fullness? It may be combination of Zoloft w/d and the Remeron/Risperidone: my research on this site revealed that ear fullness is usually a result of going off serotonergic drugs, so my almost 50% reduction in Zoloft may be contributing -- however, I haven't made a reduction in Zoloft in almost a year, and the fullness has seemingly gotten worse recently. I've also found that hearing loss is also associated with discontinuing serotonergic drugs, including serotonin antagonists like antipsychotics, and there are a few cases of Risperidone and Remeron causing hearing loss (from taking them, not withdrawing them). I think both the Remeron and Risperidone increase the availability of serotonin by blocking serotonin receptors (and also antagonizing alpha 2 receptors), so reducing either of them will lower my serotonin levels further and potentially worsen the hearing issues.  So I'm not sure if reducing either will produce a net positive effect, although it is my only option at this point - besides attempting to bring my serotonin levels back up with supplements, which usually worsens my tinnitus.

 

Thank you so much. I'm really concerned about this hearing loss, muffled hearing, and ear fullness and it's been almost 15 months since they began (11/25/20) and almost a year since my last cut in meds (down to 112.5 mg Zoloft on 3/10/21, so I need to make a change immediately. My attempt to reduce to 100 mg Zoloft on 5/26 caused tinnitus sensitivity and worsening, so I abandoned it, and have been afraid to reduce any med since the same would probably happen again.

 

[Altostrata]

On 8/23/2021 at 4:26 PM, Altostrata said:

I don't know. We recommend gradual tapering as a way to sneak off the drug without your nervous system becoming upset.

 

Mirtazapine has a long half-life, it's more likely you'll feel small, gradual reductions in mirtazapine less than reductions in risperidone or Zoloft.

 

Please note your tinnitus may also be aggravated by sertraline, the supplements you're taking, or an interaction among your drugs.

 

As explained repeatedly, we cannot predict how any drug changes you make will affect your tinnitus.

 

[Remeron88]

@Altostrata@Shep@ChessieCat I reduced my remeron to 20mg from 22.5mg for 3 days (took 3 doses of 20) and then reinstated to 22.5 because I felt that my issues were mainly from reducing my zoloft. However my ear fullness and muffled hearing have gotten a lot worse since my reinstatement. Do you think my reduction and reinstatement of remeron caused kindling and my hearing is now getting damaged from the remeron? Is 3/4 days at a reduced dose and then a reinstatement enough to cause this reaction and therefore ongoing damage at 22.5mg, or is this worsening temporary and might die down in a few weeks? I read one account of a guy who was on and off remeron multiple times and the last time he took it he almost went totally deaf. Could this sort of thing be happening to me? I'm not sure if I should go back to 20mg and stay there or wait it out. Kind of panicking right now.

[Altostrata]

11 hours ago, Remeron88 said:

However my ear fullness and muffled hearing have gotten a lot worse since my reinstatement.

 

Appears to an adverse effect of the mirtazapine increase.

 

11 hours ago, Remeron88 said:

Is 3/4 days at a reduced dose and then a reinstatement enough to cause this reaction

 

Clearly, it is.

 

11 hours ago, Remeron88 said:

is this worsening temporary and might die down in a few weeks?

 

I don't know. We know that fluctuations in dosing causes odd symptoms. Did you get any benefit from the updose?

[Remeron88]

@AltostrataThanks for your reply. I didn't get any benefit from the updose because there was no harm done from the 3 day reduction. I'm wondering if this is just a temporary uptick in symptoms or a new source of ongoing damage due to the kindling effect of reduction and reinstatement. If the latter then I need to return to 20 mg. Please advise. Thanks.

[Altostrata]

If you had no adverse effect from reduction to 20mg, why didn't you stay at 20mg?

[Remeron88]

@AltostrataBecause I wanted to avoid further w/d issues such as sensitization and focus on non-tapering strategies like supplements, acupuncture, and lifestyle. I think my ear fullness and muffled hearing is merely from zoloft w/d and don't want to compound it by tapering more drugs. Guess I have to go back to 20 mg because my reduction and reinstatement may have made the remeron become ototoxic when before it was not, or is this just a temporary blip?

[Altostrata]

I don't understand why you flipped back and forth from 20mg to 22.5mg. If a reduction works without a problem, why make it more complicated?

 

I think the drug changes down and up were somewhat destabilizing. I don't know what you should do. I don't know if the increase in the ear symptoms is temporary or if mirtazapine is responsible for some of your ear symptoms.

 

I would pick a dose and stay there for a while.

[Remeron88]

@Altostrata@Shep@ChessieCatI have been back at 22.5 mg remeron since I reinstated Mar 18 after 3 days at 20 mg. This morning I woke up to vertigo and nausea. It mainly occurred when I turned my head while lying down. I'm feeling better now, but it was happening for a few hours since waking up, mainly when lying down or sitting and turning my head, but also when standing and turning my head downward.  I threw up whenever it happened.

 

Should I go back down to 20mg or hope this goes away? Is the remeron now causing this because I reduced for those 3 days and reinstated? 

 

Here’s some useful information: the last (and only) time this occurred was June 14, 2017, and it didn’t last long. That was 2+ months after I updosed from 15mg remeron to 22.5 (on April 3, 2017). It has been 46 days since I reinstated after my 3 day reduction to 20mg. So it could be a temporary effect of increasing the dose, although this time it’s only a 2.5 mg updose, not a 7.5 mg updose, and it came after I decreased the dosage.

 

I am afraid it is not merely that, and that I’ve triggered the ototoxic potential of the remeron by reducing and reinstating. I would happily go back to 20mg if that’s the case. Please let me know your thoughts.  Thanks as always.