Geecee: Advice on discontinuing mirtazapine (Remeron)

[Geecee]

I'm hoping for some advice from other members with experience / knowledge of stopping mirtazapine.  If you have any thoughts about what the possible best way forward for me this would be much appreciated.  

 

I've been off mirtazapine now for 10 weeks, after 6 weeks at a half dose (7.5 m.g), in accordance with my doctor's advice.  Around week 3/4, I had some acute withdrawals (insomnia, nightmares, headaches, rage) but these have largely settled (aside from sleep, which although improved, remains limited - approx 6.5 hours) . However, as the weeks have gone I've been experiencing periods of very low mood and prolonged tearfulness, sometimes very severe.  My anxiety levels have also increased, and I have a slightly elevated heart rate which feels like it's pounding in my chest.  My doctor has prescribed zopiclone and diazepam to help manage insomnia and anxiety, which I've been taking very sparingly and only when I feel I really need them.  I also have propranolol, which I've used for many years for a phobia.  In relation to the depression, I've been using other self-help techniques to try to manage this (exercise, good diet / supplements, talking therapies, meditation and other forms of self-care).  

 

My doctor's view is that my current depression, anxiety and limited sleep are not withdrawal symptoms but a return of original mental health issues.  He is urging me to re-instate the mirtazapine at a 15 mg dose. I'm very reluctant to do this as I actually feel I've done quite well overall, am open to adopting any other helpful strategies and really, really don't want to have to go through the withdrawals again in the future.  Also, although I do have a long-standing history with anxiety (specific, not generalised), I have no history of sleep disorder prior to the period of exceptional difficulty which precipitated being prescribed anti-depressant.  I do have some history of depression, but again this was mainly in response to very stressful circumstances.  I was stable and off anti-depressant for some 8 years (and hardly ever visited my doctor) prior to going back on in 2014.  I am also fortunate enough to have the time off work at present to devote to my recovery and am very motivated to find strategies to manage other than medication.  

 

Many thanks for any advice you can give. 

 

 

Edited October 7, 2017 by baroquep

[Altostrata]

Welcome, Geecee.

 

I'm sorry your doctor was not more concerned about your withdrawal symptoms a month ago. When that happens, we suggest reinstatement of a low dose of the drug rather than fostering dependence on other drugs such as zopiclone and diazepam, both of which are truly addictive. You are wise to use them very sparingly.

 

If you look at other topics in the Introductions forum, you will see many people here have withdrawal syndrome for far longer than doctors are aware. It's entirely possible you have mirtazapine withdrawal syndrome.

 

You might try reinstating a low dose of mirtazapine, such as 3mg. We find that even this tiny dose can stop withdrawal symptoms. You'd stabilize on this for a month or a few, depending on how you feel, then taper very carefully off by tiny amounts.

 

See 

Why taper by 10% of my dosage?

 

Tips for tapering off Remeron (mirtazapine)

 

Before you do this, though, you need to resolve your affairs with zopiclone and diazepam. It would be best if you tapered off them. How often have you been taking each?
 

 

[Santino]

HI GeeCee...

I fully agree with Altostrata. This is the best way in order to regain stability. Then after getting stable on the 3Mg of Mistrazapine you can taper slowly later. Tapering from 3Mg later is long but not very complicated. I am tapering with the 10% rule from 15Mg currently to 0.15Mg and am able to preserve stability.

Please try to stay away from benzos such as diazepam. They are very dangerous and the body creates a fast dependency on them. 

All the best

Santino

[Geecee]

I haven't had any diazepam or zopliclone for a almost week. I'm very wary of both drugs and haven't been taking them more than once or twice a week at any point.  The zopiclone was helpful to get some respite from persistent insomnia but I'm now experimenting with different non-pharmaceutical solutions to improve my sleep, which seems to be working (up to almost 7 hours). For anxiety I've now replaced the diazepam with propranolol when my pounding heart generates anxiety at work, but again I'm using this infrequently. 

 

I will consider restarting on 3mgs of mirtazapine. Just one question? Is there a window in which this is likely to be effective. I would like to to persevere for another week or so to see if things settle. If I do is there more of a risk that this won't work and I'll have to restart on a higher dose. 

 

Thanks for your views. 

[Geecee]

I posted on October 7th for advice on difficulties I was having withdrawing from

mirtazapine (night time anxiety, palpitations and related insomnia). It was suggested that I restart the

antidepressants and do a slow taper but I instead stupidly decided to try to tough it out. Now, after 18 weeks off, my difficulties have, if anything, intensified and my doctor agrees this may be withdrawal syndrome.  (When I did take a dose of mirtazapine everything resolves. Also I didn’t have these issues before starting mirtazapine). He proposes helping me stabilise by prescribing trazodone (50mg) for a period rather than reinstating a low dose of mirtazapine 7.5mg), given that it seems to have caused the problem in the first place.  Does anyone have a view on whether there is any advantage in going back on the mirtazapine instead of trazodone to stabilise then slowly tapering off that?  Or are there any other better options? 

 

Any views you can give me are much appreciated. 

 

Regards

 

Geecee

[nz11]

Just a gentle reminder its only one thread per intro topic per person.

4 hours ago, Geecee said:

When I did take a dose of mirtazapine everything resolves

Sounds like you have answered your question yourself.

 

 

 

 

[nz11]

4 hours ago, Geecee said:

given that it seems to have caused the problem in the first place

May I ask what problem you are referring too.

 

Are you referring to protracted withdrawal syndrome. Then that is a possible outcome of all psychoactive drug exposure.  Pity no one is informed or warned of this at the beginning 

 

4 hours ago, Geecee said:

my doctor agrees this may be withdrawal syndrome

Your doctor sounds like he has read a bit more than the drug wrapper....great going good for him.

[nz11]

Oh one more thing ...its really important so I'm putting it in a separate post ...

Are you able to do a drug signature. 

 

nz11

 

[Geecee]

Sorry - I’m very new to this and not sure how things work. What’s a drug signature? 

 

Also the problems I’m referring to are mainly insomnia, nighttime anxiety and palpitations. I didn’t have these before taking antidepressants. 

[Gridley]

Geecee,

 

Here's how to do a drug signature.  Read the instructions first then go to the link.

 

Account Settings – Create or Edit a signature

 

 •    Please leave out symptoms and diagnoses.
 •    A list is easier to understand than one or multiple paragraphs. 
 •    Any drugs prior to 24 months ago can just be listed with start and stop years.
 •    Please use actual dates or approximate dates (mid-June, Late October) rather than relative time frames (last week, 3 months ago)
 •    Spell out months, e.g. "October" or "Oct."; 9/1/2016 can be interpreted as Jan. 9, 2016 or Sept. 1, 2016.

 

[Geecee]

Many thanks Gridley

[Undiagnosed1]

I'm a mirt and trazodone victim myself. Trazodone will not stop your mirt withdrawal. I am 10 months off a cold turkey of mirt 15mg and am still suffering some things have improved but some have not and I still consider going back on a minute dose. It only gets worse in horrible waves. I suggest you reinstate before things get really bad. The worst of my anxiety and akathisia didn't hit until months 6-7. Let's put it this way before all these meds I suffered Stevens Johnson's syndrome that almost killed me. I would rather suffer sjs many times over that what I have endured and continue to endure this past year. 

[Altostrata]

Hello, Geecee.

 

I merged your Intro topics. Please bookmark or follow this topic so you can find it again.

 

Since you have mirtazapine withdrawal, a little mirtazapine is more likely to alleviate your withdrawal symptoms. Be careful not to overdo the dosage. We suggest trying a very low dose at first in case your system is sensitized to it.

 

This topic explains how to take a small dose of mirtazapine Tips for tapering off Remeron (mirtazapine)

 

Please post in this topic and let us know how you're doing.

[nz11]

2 hours ago, Undiagnosed1 said:

Let's put it this way before all these meds I suffered Stevens Johnson's syndrome that almost killed me. I would rather suffer sjs many times over that what I have endured and continue to endure this past year. 

UD did the drugs cause SJS ?

in your opinion how did you get it?

[Geecee]

7 hours ago, Undiagnosed1 said:

The worst of my anxiety and akathisia didn't hit until months 6-7.

This sounds like an awful experience. For me, I think antidepressants saved my life and helped me cope with trauma so I don’t regret using them. I just wished I knew more about the possible hazards in coming off them.  This might have avoided the very difficult time I’ve been having recently. Has this community been of help to you? It certainly makes me feel less alone with all this.  

[Geecee]

6 hours ago, Altostrata said:

Hello, Geecee.

 

I merged your Intro topics. Please bookmark or follow this topic so you can find it again.

 

Since you have mirtazapine withdrawal, a little mirtazapine is more likely to alleviate your withdrawal symptoms. Be careful not to overdo the dosage. We suggest trying a very low dose at first in case your system is sensitized to it.

 

This topic explains how to take a small dose of mirtazapine Tips for tapering off Remeron (mirtazapine)

 

Please post in this topic and let us know how you're doing.

 

 

 

Apologies for posting in the wrong sections. Hopefully I’ll get the gist soon. 

 

Re reinstating mirtazapine, my doctor recommended 15mg. However when I tried this last week I was knocked sideways. I then tried 7.5mg a week later which left me a bit sleepy but my mood and anxiety levels were good and felt normal for the first time in ages. Two days ago I tried 3mg which allowed me to sleep reasonably well but I struggled badly the next day with anxiety.

 

My plan is to reinstate at 7.5mg in order to stabilise. Then begin a gradual taper in 4 - 6 week’s. Does this sound like an advisable plan? 

 

[Santino]

Hi Geecee

This sound like the best plan for your situation. You are lucky to feel good at 7.5 so just stick to it for a while until you feel stable and then start 10% deductions every 4-6 weeks.

I wrote you a message my friend.

All the best Santino

[Gridley]

If at the end of 4-6 weeks you feel you should hold longer in order to stabilize, you should do so.  Listen to your body.

[Geecee]

15 minutes ago, Gridley said:

If at the end of 4-6 weeks you feel you should hold longer in order to stabilize, you should do so.  Listen to your body.

Many thanks. I will not be so hasty to stop next time as this has been hell. I will resume my medication tonight. I just need to get through today! Feeling very washed out by trying different drugs and dosages. 

[Undiagnosed1]

7 hours ago, nz11 said:

UD did the drugs cause SJS ?

in your opinion how did you get it?

Sjs was caused by bactrum an antibiotic. I have pictures it was more than horrific. 

[Undiagnosed1]

2 hours ago, Geecee said:

This sounds like an awful experience. For me, I think antidepressants saved my life and helped me cope with trauma so I don’t regret using them. I just wished I knew more about the possible hazards in coming off them.  This might have avoided the very difficult time I’ve been having recently. Has this community been of help to you? It certainly makes me feel less alone with all this.  

Sadly I didn't listen to there advise and am paying dearly.

[Altostrata]

Sounds like 3mg-7.5mg might work. 5mg might be a happy medium, that does not leave you sleepy in the morning.

 

Taking 3mg one time does not reveal much. If you took it regularly, it might be enough, as it builds to steady-state in your bloodstream over 4 days or so.

 

If I were you, I would take 3mg for 4 days and see what happens. If it's not enough, take 5mg for 4 days.

 

It's best to reinstate at the lowest effective dosage, you'll have less to taper later.

 

Please let us know how you're doing.

[Geecee]

23 hours ago, Altostrata said:

If I were you, I would take 3mg for 4 days and see what happens. If it's not enough, take 5mg for 4 days.

 

It's best to reinstate at the lowest effective dosage, you'll have less to taper later.

 

Please let us know how you're doing.

Very many thanks for this advice. I took roughly 5mg last night and didn’t sleep well (woke up around 3am with palpatations / panic and unable to get back to sleep). Perhaps ill-advisedly I took a sliver more along with a shot of vodka which got me back to sleep.  Today I’ve felt dreadful. Dopey and super anxious and depressed. I think I got more immediate relief from a higher dose. I realise this means having to take much longer to taper off but I think it’s worth it if I can feel ok sooner. Currently I feel like I’m in hell! 

[Geecee]

I’m on day two of having restarted mirtazapine. My anxiety levels are through the roof - way worse than before. Any advice on whether I should persevere, increase dose, change to trazodone or something else. This is almost intolerable. 

[Altostrata]

On 12/20/2017 at 10:39 AM, Altostrata said:

If I were you, I would take 3mg for 4 days and see what happens. If it's not enough, take 5mg for 4 days.

 

 

Geecee, the reason we advise taking a very low dose is because people who have had adverse drug reactions often have sensitized nervous systems. A little will go a long way. 

 

I've given this advice to thousands of people, many of whom, like you, insist on taking too much and then regret it. Sigh.

 

When you get tired of getting an adverse reaction to 5mg or more, reduce the dosage.

 

PS Drinking alcohol while one's nervous system is sensitized is not a good idea.

[Geecee]

Thanks for your advice. I really appreciate this. Yesterday I spoke with my Doctor and he asked me to stop the mirtazipine and change to trazodone (100mg) taking that consistently until next week when he will review it. He’s also prescribed valium to cope with the panic. I find it very hard to ignore my doctor’s advice but I fully understand there rationale for reinstating the original meds at a low dose and persevering. From what I understand trazodone is unlikely to deal with the withdrawal from mirtazipine. I will try to get through the festive period without having a complete breakdown and speak to my doctor again next week. This surely one of the most unpleasant experiences of my life and I so regret previous decisions. 

[Altostrata]

Yes, of course your doctor told you something different. If doctors could deal with tapering and withdrawal syndrome, this site would not exist. I would be so happy if that were so!

 

You need to decide which way to go.

[nz11]

Geecee  your doctor is just guessing. He is adding and switching to other potent drugs and has no way of knowing how you will react to it. For many its a journey from bad to worse.

Your situation has reminded me of another member here in whose footsteps you are about to follow.

If I were you I would follow Altos advice and try to stabilize on the remeron alone.

I would not switch or add more psych drugs to the mix including the prop. or valium. or alcohol.

It is a very slippery slope. 

 

[nz11]

8 hours ago, Geecee said:

I find it very hard to ignore my doctor’s advice

Ask your doctor if he has ever taken any of this stuff for several months.

If not ask why not. 

This is a site full of people who have been harmed by ignorant doctors.

So here's the thing who knows more about these drugs ....someone who has never taken them or those or have or are.

 

 

 

[PsychologicalSafe15]

@Geecee Did your vivid dreams subside  ? how long did it take to subside ?