CGHolding: tapering off mirtazapine

[CGHolding]

Hi, I am new to the site. I am looking forward to sharing my experiences and reading and learning from others.

A little about me, I am in my 40's now and have been on Mirtazapine for 10 years. It's a powerful drug and I expect it to be challenging to taper from.
I have recently tapered from valium once at 30 mg's per day down to about 1 mg per day now. A few weeks ago, there was a major health scare with a family member and I feel it is time for me locate new supports other than anti-depressants. I have initially made a reduction of 10-15% from 45mgs to 40 mgs and I can feel the effects emotionally and physically both the positive and the negative, the painful and the joyful.
I expect a long road and I'm here for the journey.

CG

[Gridley]

Hello, CGHOLDING and welcome to SA.  I'm happy you found your way here.  And congratulations on tapering so far down on the Valium.

  

We ask all members to create a drug signature.  This'll enable the moderators to give informed advice about your Mirtzapine taper.  Please follow this format:

Summarize your history in a signature - ALL drugs, doses, dates, and discontinuations & reinstatements, in the last 12-24 months particularly? 

• 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.
• Link to Account Settings – Create or Edit a signature.

At Surviving Antidepressants, 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.  Please be sure to include in your signature how fast you have been tapering Valium and when you began your taper.  
 

You mentioned it is time for you to look for supports other than ADs.  If you Google "survivingantidepressants non-drug coping skills," you will find many helpful suggestions.

While we are waiting for you to complete your withdrawal history signature, and to get you familiarized with the protocols followed by SA, I am linking a few topics below so that you have a better understanding of what is recommended.  Please let us know if you have any questions or need any clarification.

What is Withdrawal Syndrome?

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

Preparing to taper

Tips for tapering off Remeron (mirtazapine)

 

 

Edited December 3, 2017 by Gridley

[CGHolding]

Hi Gridley and Thank you for your kind welcome. I added my signature. As you can see I am new to antidepressant withdrawal.
I would like to find support here and will strive to be supportive of others.

 

CG

 

 

[Gridley]

CGHOLDING,

 

Thank you for posting your signature.

 

It is fine to have a goal of 18 months, but it is important to listen to your body as you taper rather than adhere to a schedule. Sometimes your body, by way of withdrawal symptoms, may tell you it's time to slow down the taper or to hold.   Eighteen months may well be realistic, but I just wanted to caution you at the outset that sometimes tapers don't conform to what we expect.

[CGHolding]

I am in agreement with you. I have noticed significant changes since my initial cut to 39 mg's and feel my body adjusting to this new dose.

My symptoms are more profound than anything I have experienced on benzo withdrawals but I am in a fortunate position where I can manage them.

It is a serious drug, despite what doctors might say, and I expect that it will take a year at least to come off of the dose I'm on.
I have decided to hold on my mirtazipine dose as present and wean myself off the remaining amount of diazepam, 1 mg, and review my situation in Feb.
 

[CGHolding]

Gridley, may I ask, how long in your experience does it take the body to adjust to a tapered dose (in my case 39 mgs)?

 

[Gridley]

If you are using a 10% reduction per month with a four week hold, as recommended generally by SA, we are are talking about 8 weeks from the drop to stabilize.    

 

Brassmonkey, one of our moderators, has written an excellent definition of "stability": "Stability is not the absence of WD symptoms, but rather a steady state of feeling crappy without any major swings either direction."

 

Brassmonkey goes with a 2-week hold, rather than 4-week, and says:  

 

"When a person makes a drop there will be several weeks of increased symptoms. Once these symptoms have settled back to an average "dull roar", then it's time to make another decrease.  In general it takes six weeks from the time of the decrease to the point where things are stabilized enough to do it all again."

 

 Of course, "in general" means just that and may vary according to the sensitivity of the individual.

 

Brassmonkey devised a variation on the standard taper called the Brassmonkey Slide Taper.  Instead of a 10% drop once a month, this taper cushions the blow by dropping

2 1/2% every week for 4-weeks, with a 2-week hold.  I have been using this method in my taper of Lexpro and find myself usually stabilized by the end of the 2-week hold.

Brass Monkey Slide 

 

 

 

 

[CGHolding]

That makes sense. I am new to this and it is presenting a different challenge to benzo w/d's.

Thank you for responding.

[Kitson]

Hi CG,

 

I'm also tapering Mirtazapine. I started this February and I'm down to 16 mgs right now. I too, was hoping to taper faster. I'm currently tapering at 6% of my last dose. My CNS seems to do well at this percentage drop. At this rate, I'm looking at being off of mirt somewhere around 2024. If I attempt a 10% reduction and do well, I'm looking at being off of mirt somewhere in the year 2019. Sucks, but it is what it is. I would rather feel reasonably well as I taper- I tried to push it a little bit and I ended up getting a small taste of withdrawals and it wasn't nice.  Please listen to your body as you go along - it will tell you if you are tapering too fast. Maybe you will be one of the lucky ones who can taper faster.

[CGHolding]

Hi Kitson,

Thank you for your advice. It good to meet you. Going from 30 mgs to 16 mgs is no small feat, well done. 
I have learned from my valium taper that it is wise to attempt the larger reduction at the higher amount so I have reduced my dose 10-15% to test the waters.
I know that I will lower the rate at lower dosages, hopefully to 10% but like you say, it isn't a race it's about listening to your body and going at a pace that is manageable.

 

[CGHolding]

Just a short update. I have decided to put my Mirtazapine taper on hold until I am off the valium for one month. 
I am currently at 1/2 mg valium once daily and expect to make the "jump" in the next couple of weeks.
I will revisit this thread in early March to resume my Mirtazipine taper. 
Well wishes.

[CGHolding]

Hi all. I took a break from my Mirtazapine taper to take care of my valium withdrawal. I am now a couple of months benzo free and I can honestly say that I rarely think of it though it may be wise to check in it regularly. I am ready to resume my antidepressant reductions. I have been taking 37.5 mgs once a day.

I cut to 33.75 mg on Friday last and hope to continue reducing my dose for the next year. I noticed that my last reduction caused quite a shock to the system and it was about 10 days for it hit hard. The most alarming one was tinnitus and imbalance. I hope that by reducing at a lower rate that my symptoms will be less.

 

Peace and goodwill

 

CG HOLDING

[CGHolding]

I cut to 33.75 mg at the start of June. It was a really rough cut but manageable. 

I had my first symptoms after about 5/6 days. That seems to be the time when w/d's kick in. I had a cough for about 3 weeks and ongoing sinus pain.
It subsided on week 4. 

I made the decision to cut to 30 mg's on Friday last. I feel a bit weepy this morning but nothing that's not manageable. 
I will check in again in a few days.

[Carmie]

5 minutes ago, CGHolding said:

I cut to 33.75 mg at the start of June. It was a really rough cut but manageable. 

I had my first symptoms after about 5/6 days. That seems to be the time when w/d's kick in. I had a cough for about 3 weeks and ongoing sinus pain.
It subsided on week 4. 

I made the decision to cut to 30 mg's on Friday last. I feel a bit weepy this morning but nothing that's not manageable. 
I will check in again in a few days.

 

Hi CGHolding, 

 

Hope your taper goes well. When I taper the symptoms usually start hitting around days four to six too. 

 

Its weird how we get all these symptoms that we would never know were withdrawals until we find we find out how many other people get the same symptoms. I had teeth pain in the past and earaches n I thought they were infections. Nope, withdrawals.

 

Now every time I get a new symptom it’s usually due to withdrawals, no matter how unrelated it may seem. Our whole body seems to be connected to our CNS, so anything in our body can be affected.

 

Take care💚

[CGHolding]

4 hours ago, Carmie said:

 

Hi CGHolding, 

 

Hope your taper goes well. When I taper the symptoms usually start hitting around days four to six too. 

 

Its weird how we get all these symptoms that we would never know were withdrawals until we find we find out how many other people get the same symptoms. I had teeth pain in the past and earaches n I thought they were infections. Nope, withdrawals.

 

Now every time I get a new symptom it’s usually due to withdrawals, no matter how unrelated it may seem. Our whole body seems to be connected to our CNS, so anything in our body can be affected.

 

Take care💚

Hi Carmie,
What you say is absolutely spot on. I think because the antidepressant depresses the whole CNS, a flare up can occur anywhere as a rebound symptom.
And because we have endured being on an antidepressant, I think it's possible to endure the withdrawal symptoms.

Thank you for your kindness,
Be well
 

[CGHolding]

12 days at my current dose at what was a 10% reduction. I have noticed some lightheadedness in the morning.

Also psychological re-adjustments to be made, It's like dipping one's hand into the pool for the first time.

Symptoms usually kick in after 5-10 days and there have been little so far. 

I need to address my psychological needs. Playing music helps.

Goodwill,

CG

[Carmie]

On 7/26/2018 at 11:31 PM, CGHolding said:

Hi Carmie,
What you say is absolutely spot on. I think because the antidepressant depresses the whole CNS, a flare up can occur anywhere as a rebound symptom.
And because we have endured being on an antidepressant, I think it's possible to endure the withdrawal symptoms.

Thank you for your kindness,
Be well
 

 

 

Hi CG, 

 

Yes, it certainly is amazing all the weird symptoms we get that seem totally unrelated to withdrawals but that are.

 

On 8/1/2018 at 7:10 PM, CGHolding said:

12 days at my current dose at what was a 10% reduction. I have noticed some lightheadedness in the morning.

Also psychological re-adjustments to be made, It's like dipping one's hand into the pool for the first time.

Symptoms usually kick in after 5-10 days and there have been little so far. 

I need to address my psychological needs. Playing music helps.

Goodwill,

CG

 

You’re doing well staying at your current dose. My symptoms usually start to kick in around day four or so, but again it’s not linear and they can happen anytime. 

 

I agree that music music definitely helps. I love my music n I go to lots of concerts. Saw Celine Dion recently n Imagine Dragons a few months back. My taste in music is so varied. 

 

Yes, we all need to work on our psychological well-being. I think nearly everyone of us has gone through something in our lives, on top of withdrawals, that needs sorting out. We are all works in progress.

 

Sending hugs🤗

[Carmie]

Hi CG, 

 

How are you doing?💚

[CGHolding]

2 hours ago, Carmie said:

Hi CG, 

 

How are you doing?💚

Hi Carmie, 
I'm doing ok. What has been unusual about this cut is that up to now, my symptoms have been for the most part physical. With my reduction to 30mg I would say that my challenges have moved from the suffering of the body to the suffering of the psyche. Sadness comes up without warning which I guess is a sign of the body wanting to be heard. 

Thank you for asking.

I read your sig. No small feat. well done for tapering as you have done. 
 

[Carmie]

22 hours ago, CGHolding said:

Hi Carmie, 
I'm doing ok. What has been unusual about this cut is that up to now, my symptoms have been for the most part physical. With my reduction to 30mg I would say that my challenges have moved from the suffering of the body to the suffering of the psyche. Sadness comes up without warning which I guess is a sign of the body wanting to be heard. 

Thank you for asking.

I read your sig. No small feat. well done for tapering as you have done. 
 

 

Hi CG, 

 

Im glad you’re doing okay. That’s great you don’t have too many physical symptoms at the moment. The emotional symptoms can be hard though, it’s like these meds have got our brains captive!

 

We will escape these shackles one day💚

[CGHolding]

3 weeks at new dose of 26.25. Different challenges for me at this amount. Cuts from 45-30 mgs have prompted physical withdrawal symptoms.
At this new amount, I have noticeable cognitive dissonance. Feelings of despair come up and grief is becoming deeper as is joy.

I think this will be a long journey and I'm in it for the length that it takes. My next cut will be this week before taking stock over Christmas.
I am looking towards the end of next year to be drug free but If it takes six to twelve months longer, I am willing for that as well.
 

Depth and Blessings,

CG

[PH1]

Hang in there CGH.   I too am tapering Mirtazapine and the slower I go the better I feel.    Just take it very slow, listen to your body and symptoms, and adjust accordingly.   You seem to be on the right track.

Here's to full healing and recovery for you in due time!

[CGHolding]

Thank you PH1. I agree, patience is key.
Do you find the supplements help with tapering Mirtazapine?

[ChessieCat]

The only supplements which SA recommends are Magnesium and Omega-3 Fish Oil.  Try a small amount of them, one at a time, to see how you respond.  Only make one change at a time.   Keep it Simple, Slow and Stable

 

There are many existing topics about supplements.  I suggest your research before trying anything.  I like to use google and survivingantidepressants.org to my search term.

[PH1]

CGH,

I take several supplements and I'm feeling okay but am not sure which ones are helping the most.  I'd stick to what ChessieCat said and try magnesium and fish oil as those seem to work well for many folks here.

All the best!

[CGHolding]

I made the cut to 22.5 mgs on 28th November. I'm still in the "honeymoon" week. Usually it's 10 days before w/d's begin to show. 

I feel much better, less groggy, more alert.  

 

Blessings,

CG

 

[CGHolding]

It is three weeks since the last cut. I have had some symptoms but nothing that is not manageable. Co-ordination is something to be aware of. 

 

Well wishes

[ChessieCat]

Good to hear that things are going well.  Please update your drug signature so it remains current:  Account Settings – Create or Edit a signature

[CGHolding]

Stabilised over the Christmas period which as it transpired has proved wise. I decided to cut to 18.75 mgs as of yesterday January 11th. I will report here again in 7-10 days. 

Wishing everyone strength,
CGHolding

[CGHolding]

There has been a shift in withdrawal affects. I have noticed some physical wd's such as restless legs but psychological/mental withdrawal symptoms are more evident. I have noticed my mind is more loose which presents challenges of its own. Fortitude is a requirement at this point.

 

CGHolding

[ChessieCat]

Mirtazapine:

                                         Reduction %

June 18  33.5 mgs                             

July 18   30 mg             10.447%

Oct 18    26.25 mg        12.5%       

Nov 18    22.5 mg         14.286%

Jan 19    18.75 mg       16.66%

 

SA recommends tapering by no more than 10% of the current dose followed by a hold of about 4 weeks to allow the brain to adapt to not getting as much of the drug.  Why taper by 10% of my dosage?

 

I have seen several members of SA who have tried to got too fast and ended up having to updose and/or hold for longer.  It ended up taking them longer to reduce their drug than if they had gone slower.  Many members also find that as their dose gets lower they need to go slower by reducing less than 10% and/or holding for longer.   Why taper paper: dose-occupancy curves

 

Getting off psychiatric drugs is not a race and it has nothing to do with how strong we are as a person.  I remind myself of this by saying that it is not me it's my brain needing the drug.  The aim is to get off with minimal discomfort.  If you continue making large cuts, you may end up suffering worse withdrawal symptoms and the worst case scenario is that you might not stablise.  Some members who have gone too quickly have ended up having to leave their job, have become bedridden and/or had to move in with relatives. 

 

Here's some additional information which might help you to understand what is happening:

 

Recovery isn't linear it happens in a Windows and Waves Pattern

 

Withdrawal Normal Description

When we take a psychiatric drug, we are adding chemical/s to the brain.  The brain then has to change to adapt to getting the chemical/s.  It might have to change something to do with A and then once that change has been made it affects B so another change has to be made and so on down the line.  It is a chain reaction, a domino effect.

 

The same thing happens when we take the drug away.  That's why it's possible to experience such a vast array of withdrawal symptoms, and they can change, and be of different intensity.

 

These explain it really well:

 

Video:  Healing From Antidepressants - Patterns of Recovery

 

are-we-there-yet-how-long-is-withdrawal-going-to-take

 

On 8/31/2011 at 5:28 AM, Rhiannon said:

When we stop taking the drug, we have a brain that has designed itself so that it works in the presence of the drug; now it can't work properly without the drug because it's designed itself so that the drug is part of its chemistry and structure. It's like a plant that has grown on a trellis; you can't just yank out the trellis and expect the plant to be okay. When the drug is removed, the remodeling process has to take place in reverse. SO--it's not a matter of just getting the drug out of your system and moving on. If it were that simple, none of us would be here. It's a matter of, as I describe it, having to grow a new brain. I believe this growing-a-new-brain happens throughout the taper process if the taper is slow enough. (If it's too fast, then there's not a lot of time for actually rebalancing things, and basically the brain is just pedaling fast trying to keep us alive.) It also continues to happen, probably for longer than the symptoms actually last, throughout the time of recovery after we are completely off the drug, which is why recovery takes so long.

 

AND

 

On 12/4/2015 at 2:41 AM, apace41 said:

Basically- you have a building where the MAJOR steel structures are trying to be rebuilt at different times - ALL while people are coming and going in the building and attempting to work.

It would be like if the World Trade Center Towers hadn't completely fallen - but had crumbled inside in different places.. Imagine if you were trying to rebuild the tower - WHILE people were coming and going and trying to work in the building!  You'd have to set up a temporary elevator - but when you needed to fix part of that area, you'd have to tear down that elevator and set up a temporary elevator somewhere else. And so on. You'd have to build, work around, then tear down, then build again, then work around, then build... ALL while people are coming and going, ALL while the furniture is being replaced, ALL while the walls are getting repainted... ALL while life is going on INSIDE the building. No doubt it would be chaotic. That is EXACTLY what is happening with windows and waves.  The windows are where the body has "got it right" for a day or so - but then the building shifts and the brain works on something else - and it's chaos again while another temporary pathway is set up to reroute function until repairs are made.  

 

[CGHolding]

I thank you for the information.

If you wish to discuss tapering rates on another thread, I will discuss it with you there.

Please try to understand that here, this is the log of my journey.

CGHolding

[ChessieCat]

SA works differently to many other forums.  Each member has an Introduction topic which is the place where they can ask questions about their own situation and journal their progress.

 

It is also the place for mods and other members to offer suggestions, provide information to a member, as well as support and encourage them.

 

The history of a member, including the information and suggestions provided to them, is best kept in one place.  The mods can easily see what other mods and members have posted so information and suggestions are not repeated unnecessarily.  Other members and guests can also see the information and suggestions and may find the information helpful.

 

The moderators are volunteers who have or are going through their own journey to get off psychiatric drugs.  This site was started in 2011 so a wealth of information has been gathered from the experiences of the many members here.  I have personal experience from both a cold turkey and reducing too quickly so know what can happen.  It would be remiss of me not to pass on information to members that may help them not to end up suffering bad withdrawal symptoms.

 

I CTed citalopram and felt great for a few months then got hit with the withdrawal flu and was bedridden for 2.5 weeks and lost 8kgs.  It wasn't until I joined SA that I made the connection that it was withdrawal.  I ended up on Pristiq.

 

I reduced my Pristiq from 100mg to 50mg and for 2 weeks I experienced severe cog fog, and even walking took my whole concentration.  I joined SA but didn't updose as suggested because I was trying, through the brain fog, to learn about what was happening.  A couple of days after joining I got to the stage that I was unable to type.  Having been a typist for 40+ years I knew that something was really wrong.  I was very thankful for SA's suggestion.  I went and took extra Pristiq.  Astoundingly after only about 4 hours I was able to type again and the brain fog was lifting.  Because I had a benchmark I knew that it was because of the drug.  After stabilising I have been following SA's protocol and I'm now down to 4.75mg and only experience mild withdrawal symptoms.  During times of stress, even good stress, they do ramp up a bit, and I sometimes find that after a reduction my anxiety increases a small amount for a few days.

[ChessieCat]

On 4/11/2012 at 10:07 AM, Altostrata said:

 

A very common withdrawal problem with mirtazapine is rebound insomnia, which reinforces the need for very gradual tapering.

 

 

We have members trying to get off mirtazapine who experience insomnia.  Once insomnia hits it can make withdrawal so much worse.

 

Google search to find members:  survivingantidepressants.org mirtazapine insomnia

[CGHolding]

I understand but you see I never asked for all the "red flags" you are waving. I simply come here to log my progress, if I can help someone on the way I am happy to do so. I didn't ask a question like you mention so your response seems inappropriate in this case. 
As the thread title says, this is my journey tapering off of Mirtazapine. If someone wishes to post a question to me here, they are welcome to so. If I am in distress and have conveyed that, I would welcome support.

It serves little purpose that I know of posting so many red flags at once, particularly when they are not asked for. I have no doubt that my journey will have challenges and I would hope that I could come here and report them when they arise. As can be deduced from my recent posts, I am fortunate in that at the present time I am ok with my tapering pace.

 

Thank you for being an admin, I imagine that it requires a significant amount of work. 

[CGHolding]

3 weeks at current dose. I have noticed an increase in feelings of sadness. I think because an antidepressant typically covers such feelings, now that my dose is at a lower amount, these feelings have air to resurface. Also experiencing feelings of joy and contentment. 
I will review again next week.

Depth and Blessings,

CG