downtime: Difficult mirtazapine 30 mg taper

[downtime]

Peace and best wishes to all -

 

I've been lurking on SA for about 10 weeks and have found the resources on SA to be a huge help.  Thank you for this wonderful website!  

 

I'm finding Mirtazapine to be incredibly difficult to taper, much more difficult to taper than the benzo which I've been tapering.   Because I've been taking mirtazapine for insomnia I therefore judge my success in a dosage decrease by how much sleep I get, and I'm not having any luck getting any sleep below 28.5 mg.  Is this because mirtazapine has a short half-life?   I've read to not decrease the dosage by more than 5% - 10% per month, and I've gradually been decreasing my dosage to these levels.  I understand that this suggestion is a guideline, yet a good benchmark coming from others who have experienced AD tapers themselves.  

 

Any suggestions as to how I can successfully decrease the dosage past the 28.5 mg level?  Thank you in advance for any and all suggestions.  

 

 

[baroquep]

Hi Downtime,

 

Welcome to Surviving Antidepressants (SA), I’m glad you found this site before continuing on with your taper.  Unfortunately few doctors have any idea how to safely taper off of these drugs and often recommend tapering plans that are far too fast.  When a drug is removed abruptly, doses are alternated/skipped or reduced too quickly it throws our central nervous system into chaos and results in withdrawal syndrome. You don't mention how quickly you have been tapering since finding SA 10 weeks ago, but I have a feeling that you may have been tapering too quickly.  As well, because you are taking multiple medications, it is recommended that you taper only one drug at a time and from what you have written it looks like you are tapering Mirtazapine and Flurazapam concurrently which will add to the disruption your central nervous system is experiencing, i.e., lack of sleep.  Please pay special attention to the link below regarding tapering multiple drugs.  

 

Surviving Antidepressants has a separate benzodiazepine forum.  I would recommend that you also post an introduction topic in that forum as well so that you can find guidance with respect to Flurazapam, but for now, and until we have a completed withdrawal history signature (see below), I would suggest that you postpone tapering both of these drugs until you have a proper plan in place to help you get off of these drugs safely.  I am attaching a link to the Benzo Forum below:
 

Members Only Benzo Forum

 

At SA, it is recommended that a person taper by no more than 10% of their current dose with at least a four week hold in-between decreases.  The 10% taper recommendation is a harm reduction approach to going off psychiatric drugs.  Some people may have to taper at a more conservative rate as they are sensitive to even the smallest drops.
  
As I mentioned, before being able to provide you with any recommendations specific to your situation we will need to have a completed withdrawal history signature.  We ask all of our members to fill out a signature so that all of your information can be read at a glance.  This helps moderators determine you current situation and we would ask that you follow the instructions at the link below.

 

Instructions:  Withdrawal History Signature

 

To get you started, and familiarized with the protocols followed by SA, I am linking a few topics so that you have a better understanding of what is recommended here. 

 

Before you begin tapering what you need to know
Why taper by 10% of my dosage?

Taking Multiple Psych Drugs - Which Drug to Taper First

Tips for Tapering off Mirtazapine / Remeron

[downtime]

Thank you baroquep for your reply!

 

I did include a sig file with the details of my tapers up to now, please let me know what else I should have added.

 

I haven't contacted my doctor about tapering as he's clueless about tapering and doesn't have an interest in learning.  My taper schedules thus far have been on a trial and error basis, yet using the 5% - 10% per month decrease as my benchmark.  I've been wildly successful in tapering the flurazepam, yet this benzo has a very long half-life which seems to make tapering somewhat "easier".  Mirtazapine is a different animal from flurazapam and I find the mirtazapine to be infinitely more difficult to taper down the dose than the flurazepam, perhaps because mirtazapine has a much shorter half-life.  This is my guess.  I've been micro-tapering the mirtazapine thus far.

 

Thank you also for introducing the benzo forum.  Being a new member, I didn't know that SA had such a forum.  I've lurked on benzobuddies.org for educating myself about benzo tapers.  I had used an Ashton taper schedule for temazapam for my flurazapam taper as temazapam is a somewhat similar benzo to flurazapam, yet probably because of flurazapam's long half-life I've successfully tapered more quickly up to now.  Trial and error has made me begin to micro-taper this benzo since 13 Nov 2017.  

 

Your suggestion to not taper two meds at the same time is one which I've read and will now follow.  I'll continue the benzo taper as I no longer have access to this medication, and once I'm finished (whenever that may be) I'll then continue my mirtazapine micro-taper where I am now (28.5 mg).  I'll essentially do a long hold of mirtazapine at 28.5 mg.  I know, I should have already followed this "one med at a time" guidance!  

 

Thank you again for your suggestions and links!  

  

 

[baroquep]

Sorry I do see that you completed a very good summary of your history ... dealing with brain fog big time since my last taper.  I have a feeling that your sleeplessness may have more to do with the large decreases and quick taper from Flurazapam.  I would strongly encourage you to join the benzo forum right away and get guidance and advice on this taper as I'm worried that you may find that continuing to decrease at this rate is going to destabilize your central nervous system.  

[downtime]

No worries baroquep!  

 

I've been forced to do a fast taper of flurazepam due to having my future supply taken away from me.  I'm now at a dosage that I can hold for awhile and have the supply to updose as well.  Mg scales are a lifesaver!  I've noticed that when I decrease the dosage of flurazepam too quickly the WD symptoms return.  This is when I have updosed as needed.  Such is my experience with trial and error.  I wish that I could have made a proper taper schedule, but this wasn't possible due to having a limited supply of flurazepam.  Other than sleep issues, the other WD symptoms have fortunately not returned at my current dosage.  It's actually been a relatively smooth ride to my current dosage.  

 

Thanks so much for your concern and I'll focus on the flurazepam taper for now.  I've taken a look at the benzo forum and will introduce my tale of woe there soon!

 

 

 

 

 

[downtime]

I'm sorry baroquep, I should have included (and forgot to include) this info. about flurazepam and mirtazapine:  flurazepam was prescribed to help me fall asleep and mirtazapine was prescribed to help me stay asleep as I have a problem of waking up soon after falling asleep.  Now that the flurazepam is at a very low dose, I'm using melatonin to help me fall asleep.  I'm not usually into supplements, yet the melatonin does help to take the place of the flurazepam.  I'm keeping the melatonin at a low dose (1.5 mg), so far so good.

 

I can tell when I've lowered the dosage of mirtazapine too quickly by whether or not I wake up soon after falling asleep.  If I do, then I've likely decreased the mirtazapine dosage too quickly.  If I don't wake up soon after falling asleep, then the mirtazapine dosage is fine. 

 

Again, I'll follow your advice and focus on the flurazepam taper and hold mirtazapine at my current level.

 

Thank you!!  

[Altostrata]

Welcome, downtime.

 

Please be aware any doctor can prescribe these drugs. If you're having problems communicating with your current doctor, perhaps there's another doctor who will be more willing to work with you in going off flurazepam. (I should think they'd be happy about that!)

 

As baroquep pointed out, changing more than one drug at a time makes it very difficult to interpret adverse reactions. Please do not taper mirtazapine until you have stopped changing your flurazepam dosage. (That said, if you were not forced to go off flurazepam by current circumstances, you might want to taper mirtazapine first instead.)

 

Good to hear melatonin is working for you.

[downtime]

Thank you Altostrata!   No pharmacy near me carries the flurazepam anymore, my regular pharmacy seems to have been the last to stock it.  They called every pharmacy they could think of, including other branches of their pharmacy, and couldn't locate a pharmacy that still stocks it.  Flurazepam seems to be an older medication that just isn't stocked any longer.  After 10 weeks of tapering I'm no longer interested in trying to get an online prescription.  I'm doing quite well with the flurazepam taper.

 

The mirtazapine taper is proving to be much slower going.  I'm holding at my current level until I'm off of the flurazepam.  I can tell a difference between the two medications and how they affect sxs.  Anyway, I'm micro-tapering the flurazepam from 1.0 mg with no return of sxs.  The melatonin really does help to replace the flurazepam in helping me to get to sleep.

 

I've learned so much from your many years of posting on this website.  You are truly a lifesaver!