Remeron88: greetings - need some help

[Remeron88]

Last night the vertigo set in soon after I took my pills, but without nausea. I did experience more severe vertigo and nausea when I sat down on the toilet which resulted in vomiting, however. The vertigo was still there when I woke up this morning, without nausea again. However when I got up and moved around I was extremely dizzy and woozy, which gets worse when I turn my head. I still am dizzy when I walk around hours later. Therefore I would say things are getting worse. What do you recommend I do?

[Altostrata]

Have you looked into positional vertigo? Your doctor can help you with these exercises. If one works, your symptoms may not be from withdrawal.

 

https://www.healthline.com/health/exercises-for-vertigo

[Altostrata]

On 8/18/2020 at 10:20 PM, Altostrata said:

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

 

On 9/5/2020 at 4:57 AM, Altostrata said:

 

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.

 

 

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]

@AltostrataI tried the Epley maneuver and it didn't work. I am afraid by going down to 20 mg remeron and back up to 22.5 mg I have made the remeron suddenly become ototoxic at the full dose (22.5) and now my ears are being damaged.  Do you think that is possible? I've heard of cases where multiple courses of a drug eventually cause damage...things have not improved since 5/4 (the day after it started when it first got worse) and may be getting slightly worse still.  Please tell me if you think I need to go back down to 20 mg.

[Remeron88]

@Altostrata Yesterday the dizziness seemed to be wearing off. Then at night I took my meds and I could barely walk…like stumbling around, still am this afternoon. My head is extremely woozy. I am afraid I need to go back down. Please let me know your thoughts.

[Altostrata]

I'm sorry, I don't know much about drug-induced tinnitus.

 

You'll need to decide if you felt better at 20mg mirtazapine. If so, you may want to go back to it.

 

It would not be unusual for someone to become disoriented and stumbling after taking 3mg Risperdal with Remeron.

[Remeron88]

@Altostrata I have some good news and bad news.  Good news is the dizziness/vertigo was due to a loose ear crystal, and I received treatment in a trv chair which cleared it up.  Bad news is my father has covid, and since I live with him I am afraid I may be infected too. I have a couple tests tomorrow to verify if I have it. My question to you is does covid worsen medication withdrawal and side effects or cause new ones? Thanks.

[Altostrata]

Covid probably would not make a person experiencing withdrawal symptoms feel any better. If you get covid, you get it and you'll have to cope with however it may affect you.

 

I would not continue to taper a psychiatric drug while suffering from covid.

[Remeron88]

@AltostrataThanks but in your experience perusing this site since the start of the pandemic, has covid caused members' w/d symptoms and side effects to worsen in general or does covid act independently of w/d?

[Altostrata]

Nobody has reported that covid makes them feel better! We cannot tell what's covid and what's "independent" of it.

[ChessieCat]

I have been off Pristiq now for 7 months after a 6 year taper.  I got sick with a virus 2.5 weeks ago (2 covid tests and an RSV fluA/B tests all negative).  It's been bad but not really bad, and I'm still not 100%.  I have no idea if any of my symptoms were WD symptoms. 

 

I just felt awful, and still don't feel good yet.

 

If there have been any WD symptoms it is what it is, I cannot do anything about it anyway.

 

Edited June 17, 2022 by ChessieCat

[Remeron88]

@Altostrata @ChessieCat @Shep

 

I screwed up and may have have forgot my sertraline dose yesterday. I take it at 2 pm everyday and last night I could not remember if I had taken it, so I opted to wait to 8 am this morning to take the next dose. I have no ostensible symptoms as of yet but I am worried there may be delayed effects as the last sertraline reduction and reinstatement (from 112.5 to 100 mg and back to 112.5 5/26/21 - 6/1/21) came with a delayed sensitivity and worsening of tinnitus that lasted over a month. However this missed dose is a full 112.5 mg rather than merely 12.5 mg back in 2021 and I am worried the magnitude of it may really hit me hard in a few days to a week. I am debating whether to take the next dose at 2 am with my other meds (which could be problematic if I didn't actually miss my dose yesterday) or just keep taking it at 8 am for a few days until concentrations reach a steady state. Please let me know what you think the best course of action is.  Thanks.

[Altostrata]

If you didn't feel any withdrawal effects in 8 hours, you probably took it but forgot.

[Remeron88]

@Altostrata

 

Hey, some good news and not so good news - my hearing and tinnitus are roughly the same as before the missed dose incident. I am holding off on exercise at the moment and plan to resume in a couple weeks.

 

Not so good - I was repeatedly counting the number of risperidone tablets to be sure they’re all accounted for and my hands were sweaty - therefore, some of the tablet could have rubbed off on my fingers. I know the tablet is film coated, composed of carnauba wax, hypromellose, macrogol, and titanium dioxide, but I couldn’t find out the exact thickness of the coating. Tablet coatings range in thickness between 20 and 200 or 400 microns, and the thickness of a sheet of paper is roughly 100 microns. Do you think I could have decreased the dose of the tablets, or altered their pharmacokinetics in any way? I counted them a bunch of times and am not sure how much rubbed off because I washed my hands afterwards.

[Altostrata]

Don't worry about the coating rubbing off on your fingers. Be sure to store your drugs according to instructions on the package.

[crazydiamond]

How are you feeling now?

[Remeron88]

@Shep

 

I really appreciate any advice or knowledge you or anyone can give me and am not sure who to turn to. I'm really stuck.

 

I forgot to take one dose of my sertraline (112.5 mg) on 7/29/22. I had tapered down to that level from 200mg since Dec 2019.  I have had escalating hearing issues including tinnitus, hearing distortion and loss, ear fullness, and muffled hearing since I first came off sertraline in 2016 and reinstated the full dose (200mg), adding mirtazapine as well. The tinnitus first appeared after the reinstatement (3 months out in response to coffee/cigs) and was stable (after ditching all substances) until I started taking half my sertraline dose on Saturdays from Aug to Nov 2019, and then decided to start tapering the sertraline in Dec 2019, and since then the other hearing issues have appeared. The distortion first appeared 9/29/19 and the fullness appeared one day before I started tapering the sertraline on 12/17/19. After getting to 150 mg in May 2020, my tinnitus began to worsen in response to carbohydrates, so I began to eat a keto diet.

 

I tried reducing to 100mg on 5/26/21 for 6 days but reinstated (reason being wanting to try other meds/strategies first), which was my last reduction (besides a 3 day cut and reinstatement in mirtazapine to 20mg from 22.5mg in Mar 2022) until four days ago, when I figured that the missed dose had sensitized me to my current 112.5 mg dose and was causing further hearing distortion/loss and worse fullness/muffled hearing than usual.

 

FYI, the worsened hearing distortion became evident on 1/3/23, while the ear fullness/muffled hearing began Nov/Dec 2022 and wore off mid January of this year. My tinnitus has also been seemingly getting worse since mid Jan 23, after initially worsening due to hot/cold showers.

 

I reduced to 100 mg on 2/3/23 and in 3 hours I had hyperacusis type symptoms of discomfort to loud sounds and then later on (within 6-12 hours) my tinnitus/distortion got noticeably worse. The next day I reinstated 112.5, and now my hearing is worse than before the reduction.

 

I am afraid the missed dose may have kindled me to further sertraline reductions...is this possible? Is the immediate slew of symptoms post reduction from the reduction itself or from ongoing damage due to missed-dose induced hypersensitivity? I am worried I may need to reduce the sertraline as the missed dose may have sensitized me to 112.5 mg but I am now unable to do so without permanently worsening my hearing/tinnitus...Thank you.

[Altostrata]

Sorry, are you still worrying about a missed dose in July 2022?

 

We cannot rewind and go back before that missed dose. All you can do is deal with your current situation.

 

Any number of things may be affecting your tinnitus, including that you're still taking 3 psychiatric drugs. Any of them could be causing tinnitus, or it may be from a drug interaction. Changing the sertraline dosage might affect that interaction.

 

On 8/20/2021 at 1:40 PM, Altostrata said:

....

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?

....

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.

....

 

 

[Remeron88]

@Altostrata

 

Please focus on my questions, which were did the missed dose of sertraline sensitize me to my long-standing dose of 112.5 mg and/or kindle me to further sertraline reductions, and if so, what to do about it. Another bit of info is that post missed-dose, my tinnitus has become more sensitive to things like exercise, hot/cold showers, and other previously benign things.  My tinnitus I believe is a result of my initial full taper of the sertraline in 2016 as well as slow taper starting Dec 2019, which has caused hypersensitivity to serotonin-stimulating things (substances, carbs, etc.). It's been proven over and over...I'd like to move beyond that to my muffled hearing, hearing loss, and hearing distortion, which are more threatening and which I believe have gotten worse since the missed dose, meaning it could have sensitized me to my current dose. @Shep, maybe you could shed some light on this?

[Shep]

2 hours ago, Remeron88 said:

@Shep, maybe you could shed some light on this?

 

I think you're dealing with health anxiety, Remeron. 

 

Health anxiety, hypochondria and obsession with symptoms

 

Continuing to ask the same questions is taking up too much staff time. Please work with a trauma-informed therapist to deal with this or research it on your own for techniques to calm and self-soothe. 

 

 

[Remeron88]

@Shep @Altostrata

 

I have worsening symptoms which are related to my medication use or its tapering...there are a lot of similar cases on this site...I'm not being hysterical, just justifiably concerned for my wellbeing and future...I may be losing my hearing. I just wanted to ask a few relevant questions. I won't be asking any more questions from now on but will be combing the site for any information I can find regarding my specific situation...

[Altostrata]

I do not think kindling is your problem. It's far more likely this is your problem:

 

 

 

As said before, we can advise you about tapering techniques but we cannot tell you what's going on with your tinnitus. This is beyond the abilities of peer support here.

 

Up to you if you want to continue to taper any of your drugs. 

[Remeron88]

@Shep@Altostrata

 

My hearing continues to decline, with new distortion types arising as well as muddled low frequencies and worse ear fullness, etc. etc. I still believe this is a result of my missed dose of sertraline 7/29/22, which is causing increasingly frequent worsenings of hearing (first occurred 5 months out, then another 3 months to the next wave).

 

I think the missed dose did in fact cause kindling to dose reductions and hypersensitivity adverse reactions simultaneously because when I attempted to reduce by 10% on 2/3/23 I instantly had hyperacusis and worsened distortion (the same exact reduction on 5/26/21, which I aborted after 6 days, produced no ill-effects), and my hearing decline in the past 3 months is unprecedented (before the missed dose I had relatively stable hearing with no increasing instances of distortion and hearing decline). I also saw the same pattern of worsening distortion when I was dose skipping intentionally in August-November of 2019.

 

If you disagree, this is just my own conviction...I am trying not to take up too much of your time but I am in a really bad situation where holding at my current dose is destroying my hearing but reducing my dose could cause horrible problems as well like the hyperacusis I experienced briefly at the lower dose. I also experienced mild vertigo after my 2/3/23 reduction and reinstatement so I am not sure what to do....I am trying to wait this out in hopes the hypersensitivity to my current dose goes away but things are accelerating, also hoping the kindling reaction to dose reductions abates in time so I can reduce without causing new issues, but I may have to go ahead and reduce now anyway.

 

Please just let me know that if, hypothetically, the the missed dose did in fact cause kindling/hypersensitivity, will things settle down and in what timeframe, and whether the potential issues from reducing are temporary and a better deal than holding at my present dose. Once again, I'm sorry for the repeated questions but this is just an update, and I have no other outlets of support who are as knowledgeable about drug w/d as you.

[Shep]

@Remeron88 Please update your signature with your changes made since March 2021. 

[Remeron88]

@Shep updated. all of my changes since march 2021 were reductions and then reinstatements and they're all listed. I also listed the missed dose.

[Altostrata]

Kindling occurs when one INCREASES a drug or adds another drug.

 

If you think that tapering any of your drugs makes your tinnitus worse and you want to avoid this, don't reduce your drugs.

 

You may recall:

 

On 8/19/2020 at 3:32 PM, Altostrata said:

Not sure what you're looking for here. We help people taper off drugs. If that doesn't help the tinnitus, we're not miracle workers who can cure everything.

 

As explained before, you are still taking a significant amount of risperidone, mirtazapine, and sertraline. Any of those or in combination may cause or exacerbate tinnitus.

 

Or you may have tinnitus from exposure unrelated to drugs. Many people have tinnitus from listening to music over headphones -- you could look it up. I have had tinnitus for decades from an ear infection.

 

What we can help you with is reducing your drug burden. We cannot cure tinnitus.

 

Meanwhile, please review potential drug interactions.

 

 

[Altostrata]

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

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.

 

There are conditions short of serotonin syndrome that can result in quite serious symptoms. Serotonin toxicity means you are too stimulated from too much serotonin.

 

Psychiatric drugs are well-known for CAUSING tinnitus. This article explains a scientific study about how antidepressants might cause tinnitus VIA EXCESSIVE SEROTONERGIC STIMULATION. https://www.sciencedaily.com/releases/2017/08/170822123836.htm

 

Summary from an ear specialist:

Quote

 

However, some antidepressants elevate serotonin levels, and there are nerve cells in the brain that become hyperactive when exposed to these increased levels of serotonin. This can raise anxiety levels and can result in tinnitus.

....

It is also very important to know that, even though underlying emotional problems are common in tinnitus sufferers, antidepressants should not be used to treat tinnitus.

 

 

 

Note that you increased mirtazapine to 22.5mg in mid-March 2022 and missed a dose of Zoloft on July 29, 2022. It could be that you already had relatively unnoticeable tinnitus from the mirtazapine, or missed dose was enough to sensitize you to a drug-drug interaction -- an effect from the added MIRTAZAPINE -- that had been borderline before.

 

Further, each of your drugs may cause tinnitus on its own. As we age, our bodies are less and less resistant to adverse drug effects. It could be the addition of mirtazapine followed by changes in the Zoloft dose triggered tinnitus from any of your drugs or a combination of them.

 

Or your tinnitus could be from something else entirely -- it can develop spontaneously, or from long exposure to loud noises, or from an illness such as covid, or from an ear disease.

 

On 6/16/2022 at 1:49 PM, Remeron88 said:

@Altostrata I have some good news and bad news.  Good news is the dizziness/vertigo was due to a loose ear crystal, and I received treatment in a trv chair which cleared it up.  Bad news is my father has covid, and since I live with him I am afraid I may be infected too. I have a couple tests tomorrow to verify if I have it. My question to you is does covid worsen medication withdrawal and side effects or cause new ones? Thanks.

 

You were worried about covid in mid-June 2022 and you say your tinnitus started in July 2022. Is it possible you had covid? 

 

You know what your options are. If you wish to taper any of your drugs, we can help you with that, but we cannot predict whether it will resolve your tinnitus or tell you how to cure your tinnitus, period. We don't do otolaryngology here.

 

[Remeron88]

@Altostrata My tinnitus started in March of 2017 and is not the main issue I am having now, which is hearing loss/distortion/muffling. I have never had covid. My tinnitus has been under control for a while now and I am trying to prevent the non-tinnitus issues from getting worse. The increase in mirtazapine to 22.5 on 3/18/22 was after a 3 day reduction to 20 from my long-standing dose of 22.5, basically an aborted  reduction and my first ever attempt at reducing the mirtazapine. It didn't cause any issues.

 

The thread below, started by @Shep, especially the last sentence in the following excerpt from that thread seems to suggest it is possible that a skipped dose or missed dose may cause kindling and/or hypersensitivity: 

 

"Some short half-life benzos (such as Halcion) and z-drugs used for sleep may cause kindling because much of the drug is eliminated in between nightly doses. Over time, this traumatizes the nervous system with repeated exposure and withdrawal in between doses. The same may be true of the short half-life antidepressants, each successive drug dose causing a hyper-reaction. The same may also be true from skipping doses."

 

I am trying to prevent further reduction in my hearing quality and am needing to know if my missed dose could have caused both kindling (making future reductions harder) and hypersensitivity to taking my sertraline which would explain the very recent decline in hearing, and whether that kindling/hypersensitivity goes away, and how quickly. It seems like it is not going away since my hearing deterioration has been accelerating, yet my last attempt at reducing the sertraline was met with immediate hyperacusis (debilitating hearing sensitivity) and worsened distortion, so my options of either holding and waiting it out or reducing are not easy ones to choose, which is where you may have some insight as to whether the issues caused by reducing are likely to be temporary or long lasting or perhaps limited in some other way. I apologize if I was not clear in my update.

 

[Altostrata]

23 minutes ago, Remeron88 said:

My tinnitus started in March of 2017 and is not the main issue I am having now, which is hearing loss/distortion/muffling. I have never had covid. My tinnitus has been under control for a while now and I am trying to prevent the non-tinnitus issues from getting worse.

 

Thank you for clarifying that your hearing issues started before you ADDED A THIRD OTOTOXIC DRUG, mirtazapine, on 3/15/22 and missed a dose of Zoloft on 7/29/22.

 

You have reported no issues not related to tinnitus, which occurs in your hearing system, as do the symptoms you did report.

 

Making changes in your drugs, including reductions, would, of course, also affect your hearing system, and may even cause tinnitus. You have a zillion drug changes from January 2012 to March 2017. YOU HAVE BEEN ON AND OFF OTOTOXIC DRUGS. Any of the drug changes up or down could have triggered tinnitus.

 

You appear to have progressive hearing loss that could be related to adverse drug effects that emerged prior to March 2017 and another zillion drug changes after that, including  a single incident that occurred 7/29/22. 

 

You can believe anything you want. However, I still don't do otolaryngology and cannot resolve your hearing problems. Reduce, don't reduce, it's up to you. In my opinion, your situation is too complex for peer support.

 

Please talk to your doctors about your hearing problems possibly caused by a long career on OTOTOXIC DRUGS. Ask them to look up stuff like https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4118547/

 

If you don't mind, I will not be responding again to your posts. Another staff member may be willing to answer your questions.

 

[Shep]

7 hours ago, Remeron88 said:

so my options of either holding and waiting it out or reducing are not easy ones to choose, which is where you may have some insight as to whether the issues caused by reducing are likely to be temporary or long lasting or perhaps limited in some other way.

 

We're not fortune tellers or psychics. We cannot tell you how long your symptoms will last. 

 

You've been a member here since March 2017, so 6 years. Instead of obsessing over your symptoms, you could have been well off these drugs by now. 

 

This is what you wrote back in 2020:

 

On 8/19/2020 at 4:55 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.

 

Are you still doing this? 

 

This is from the CDC - What Noises Cause Hearing Loss?

 

Quote

The U.S. Environmental Protection Agency (EPA) and the World Health Organization (WHO) recommend maintaining environmental noises below 70 dBA over 24-hours (75 dBA over 8-hours) to prevent noise-induced hearing loss. 

 

I agree with Alto here:

 

7 hours ago, Altostrata said:

Reduce, don't reduce, it's up to you. In my opinion, your situation is too complex for peer support.

 

I would advise you stop asking us repeatedly about your hearing issues if you wish to get feedback on your taper, if you ever decide you wish to taper off this dangerous cocktail. 

 

[Remeron88]

@Altostrata @Shep You have both been unhelpful and rude to me repeatedly, and I will therefore not be asking any more questions...it seems you both have a vendetta against me. Simple questions that don't require clairvoyance are ignored repeatedly. You also have the experience of witnessing hundreds if not thousands of w/d cases you could use to give educated and informed responses to my questions that deal with uncertainty.

 

I don't make risky decisions like tapering off drugs I've been on for decades without foreknowledge and acceptance of the downsides, to which there are many that make doing so not worth the trouble. I don't want to end up a cripple in w/d for the rest of my life, and would be happy to just mitigate the hearing issues which is why I am trying to gauge the present situation, something you have been unwilling to help me with.

 

I would be continuing to taper had the sensitization not occurred, which has jeopardized my ability to get off all 3 drugs as well. I hope you at least have the decency to not ban me so I can continue trawling this site for the necessary info I have needed for years which you have refused to give me.

[Altostrata]

It appears you probably have progressive hearing damage from the ototoxic drugs, particularly mirtazapine, that you have been taking for 12 years, perhaps with listening to loud music contributing.

 

(Reviewing your early posts, it also appears you were not taking your drugs on a strict schedule. The variation can contribute to nervous system sensitization.)

 

We advised you of risks of your drug burden on March 4, 2017

 

On 5/10/2017 at 11:01 PM, Altostrata said:

....

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.

....

 

I presume that you reviewed these cautions with your prescriber. You and your doctors should have taken steps to address adverse effects of your drugs on your hearing when you first noticed hearing symptoms in March 2017.  But you decided to continue your drug regimen, even at times increasing Zoloft while fiddling with mirtazapine, for another 6 years.

 

We cannot advise you about how to continue taking your drugs without further hearing damage, we simply do not know how to do this. We can suggest ways to taper but, as it seems your tinnitus increases when you reduce a dose, we do not know how you can avoid increase in tinnitus or hearing loss while you're tapering. There may be no way to do this.

 

We cannot advise you about how to go off your drugs to resolve your hearing damage AND avoid withdrawal symptoms. This may not be possible, and it's your doctor's responsibility anyway.

 

If you want to avoid further iatrogenic hearing loss, you may need to be hospitalized to go off your drug cocktail quickly. We cannot take responsibility for your possible drug-induced hearing loss, otolaryngological treatment, or fast reduction of your hefty drug cocktail. We have told you this repeatedly for 6 years.

 

I must remind you again, the emergence of your hearing symptoms is not our doing or responsibility, neither is remedying the adverse effects of your drug treatment. That is your doctors' responsibility. You need to speak to them and stop asking us for a solution to your problem. We cannot help you.