alphainc: Severely fatigued - 18 months

[alphainc]

Started off on Clonazepam 0.5mg twice a day in Nov 2015 due to acute panic attacks linked to relationship and work related anxiety. Felt okish.
Was put on prozac 10mg at night, additionally. Wasn't feeling all that great. 
By January 2016, started getting counseled by a psychologist at work. She tried to help me take a deep dive into the core reasons of my sudden, debilitating anxiety. It did help as I started working on them steadily. 
She then referred me to another psychiatrist who stopped clonazepam and Prozac and put me on escitalopram 10 mg at night and etizolam 1mg in the mornings. I was improving but nowhere close to being totally normal. He said it'll take 6-8 weeks, I ignorantly believed him  and continued. In the meanwhile, got everything related to my palpitations and blood pressure checked. Things were ok except slightly high BP, which then made me insanely fear blood pressure readings and get more worked up and increase the anxiety more so.
By May 2016, had issues with my sleep cycle so he added mirtazapine 3.75mg (1/4th) for my sleep. Continued this and the sleep got better but the anxiety plateaued and didn't improve
(Should've realised the real reasons by now, sadly I didn't). On my next visit, he changed the whole prescription and I was put on chlordiazepoxide 5mg twice a day, zoloft 50mg at night for 2.5 months. Felt ok finally and by Dec 2016, in my haste to stop the meds( hated taking any sort of medicine), I quit taking any of them. Didn't know about any withdrawals whatsoever. Never visited the doctor again.

After about 1.5 months (mid Jan 2017), suddenly woke up one morning feeling totally disoriented and severly sleepy even after 8 proper hours of sleep. Never had the slightest idea of what was happening. Continued in such severe misery for 5 months. Had sleep studies done (mild apnea), and tried some sleep apnea "gadgets" for 2 months. No relief. Nov 2017 and I was told I had moderate PLMD. Tried pramipex 0.25mg at night until March 2018. No change.

 

Visited a psychiatrist in April 2018 and he started my back on escitalopram 10mg and lorazepam 1mg (temporarily to help my chronic insomnia since Dec 2017). I felt better initially as I slept more but was fatigued during the day. Felt better in the evenings. He put me on mirtazapine (AGAIN!) as my sleep wasn't getting better. I was taking 3.75mg (1/4th) and then 1.875 mg (1/8th). I felt close to 85% normal but had notoriously put on 4 pounds in a month during Apr-May 2018. He thought of stopping it as I was on a vry low dose. Put me bk on escitalopram 5mg, supposedly low. I feel disgusting again after I wake up.

 

Don't trust doctors at all now. Did my own research and am using Mg transdermal, omega 3, B12 and D3 supplements. Have started excercise to lose weight. Should I stop escitalopram and start mirtazapine 1.875 mg again? That's what seemed to help me maybe

[Petunia]

Welcome alphainc,

Thank you for joining and posting an introduction, it sounds like you have been through a lot of drug changes over the last few years, unfortunately, the nervous system can often react chaotically when it reaches its tolerance for change, causing some of the symptoms you have described.

 

I'm a little confused about your recent history, it would be helpful if you made a signature to summarize it. We ask members to put their drug and withdrawal history in the signature section. It appears below each of your posts and helps us to help you. Here are instructions for how to do it:

 

Please put your withdrawal history in your signature

 

What are you taking currently? Are your symptoms getting better, worse, or staying about the same? I wouldn't make any more changes for now, but monitor your symptoms for a few weeks and see how you feel then. It can be difficult to know if you are experiencing withdrawal symptoms or adverse effects from a drug you are taking, especially if there have been a lot of recent changes. Sometimes the nervous system just needs some stability in order to settle down.

 

Please don't just stop these kinds of drugs cold turkey, they need to be tapered. We suggest reducing by no more than 10% of the current dose every 4 weeks, this reduces the risk of withdrawal symptoms arising. Please read through this which will explain why:

  

Why taper by 10% of my dosage? 

 

You will get off these drugs eventually, but it needs to be done slowly and safely, in order to avoid withdrawal symptoms. Doctors generally see withdrawal symptoms as being a return of your illness, or a new illness and will prescribe more drugs. If you are going to become drug free, you need to come off them carefully so you don't end up being re-medicated.  

 

Its a good idea to rate your symptoms daily to help you keep track of how you are doing. Withdrawal symptoms can distort our memory and make it difficult to accurately recall how we felt days and weeks ago. Here are some tips on how do do this:  

 

Rate symptoms daily to track patterns and progress

 

Keep notes on paper

 

Dr. Joseph Glenmullen's withdrawal symptom checklist

 

The rule of 3KIS: Keep it simple. Keep it slow. Keep it stable. 

 

When we have a better understanding of your situation, we may be able to offer some suggestions. Please read through the links I've posted and come back here to your thread with any questions.

 

Please feel free to write whenever you want, you will find a lot of friendly help and support here.

 

Petunia.

[alphainc]

Hey guys,

 

Posting today after a couple of months after I started taking meds again.

My meds history is in my signature just as I was instructed last time. So posting again with my history and current situation.

 

So I started off in Nov 2015 and stopped cold turkey in Dec 2016 (was on Zoloft 50mg*2 a day). Was feeling perfectly ok back then. Didn't know nothing about withdrawal, had been taking zoloft for a month after I was perfectly ok in Nov 2016, so thought maybe I had negated the withdrawal effects.

Come mid January 2017, woke up one morning and felt severely fatigued and sleepy even after 8 perfect hours of sleep. There was nothing of that sort the day before or the week before.

 

I was severly fatigued EACH DAY. Had sleep apnea tests done, for a month or two used CPAP machines too. Nothing, no apnea still the same.

Had another sleep study in Dec 2017, that showed that I had a lot of micro-arousals while I was asleep. These were coupled with some PLMs but not all of the arousals had co-relations. So the doctor suspected maybe PLMD and started me on a very low dose of 0.25 mg Pramipexole for it for 2 weeks. Nothing much changed. He thought I may have the micro-arousals because of the stress I had since the start of the year. Told him my meds history, he said nothing looks odd!!

 

Finally, visited a psychiatrist in April 2018 and he started me on Lexapro 10mg and Mirtazapine 3.75mg as I had by then gotten severe insomia too. He told me my problems were due to the suddenly stopped Zoloft. I felt noticeable difference right the next day, but was still sleepy quite a bit. Accidentally forgot to take Lexapro for a couple of days and I noticed I was almost 75% normal only on the mirtazapine. Took lexapro back and got back to square one again, so stopped it and only continued Mirtazapine 3.75mg till today.

 

Its been 45 days, and I'm better, maybe 50% of what I normally was. Initially thought it may take time but its almost been 2 months that I;ve been the same 50% I was on day 1. And not taking mirtazapine makes me become the same horribly fatigued person.

 

What should I do, continue as it is or start back on zoloft or Lexapro like my doctor wants me to? Im completed perplexed here, I somewhere firmly believe that all this HAS to have something to do with those micro-arousals. Any thoughts/suggestions would be very very helpful. I'm just 27, cant live like this!

[Songbird]

Hi alphainc - I merged your new topic into your original introduction topic.  Please post all your updates and questions about your situation here in this topic.

 

Thanks for adding your signature.  Did you start armodafinil in May along with the escitalopram?  Are you still taking armodafinil each morning?

[alphainc]

Hey Song,

 

Thanks! I started armodafinil around June last week and only take 75-150mg as req, if I feel groggy and fatigued on a morning by 11am ish. Helps me get thru the day at work, most times.

 

I did try escitalopram 10mg for 15 days in Apr 2018, waiting for it to settle down and maybe reduce the sleepiness side effect. Didn't find any luck with that so stopped it totally as it was making thimgs worse. The mirtazapine arnd 1.875-2mg seems to work a bit, totally dont understand why/how. But thats the closest I've gotten to feeling unzombied after waking up each morning. so have been on it since April 28. 2018. Though I do have days when I'm kinda moderately sleepy till 6pm but it's not as remotely close to how bad I was without it.

 

I've been reading up on the forum these days whenever I get the time and have the following queries:

 

-The micro-arousals in my sleep study maybe partly due to the WD?

-I have a feeling that the mirtazapine thing maybe is great only as an adhoc, till I dont quite make up my mind about reinstating if required at all that is. Thoughts?

-If at all, should I choose escitalopram or sertraline for the reinstatement and safe taper journey? God knows if the reinstatement would even work, now that its been almst 17 months since the onset of WD symptoms. It took 50 days for me to experience WD sysmptoms after CTing btw if tht info helps.

 

I'd be hugely indebted for any amount of help on this. I intend to start attending graduate school next year, one final time. This thing has been making me postpone or maybe even cancel my plan altogether, which makes me very annoyed and irritated each time. Feel helpless

 

 

 

 

[Altostrata]

Hello, alpha.

 

We still need your daily symptom pattern. Please keep daily notes on paper about your symptoms, when you take your drugs, and their dosages.

 

What time do you go to bed, and what time do you wake up? When you don't take armodafinil, are you able to nap?

 

How often do you take armodafinil?

[alphainc]

Hello Alto, thanks for going thru my case.

 

In addition to the info and queries above, following are my daily symptoms:

 

1. Prior to April 2018, when my shrink started me on Mirta 1.875mg, the glaring DAILY WD symptom I had was chronic fatigue. By that I mean, I used to sleep like I do normally but used to wake up still feeling VERY sleepy and utterly groggy, disoriented with almost 10% of normal cognitive abilities (since Jan 2017 to April 2018). The other not so daily WD symtoms like anxiety, nausea were not a huge bother albeit they were occasionally felt.

 

2. I take 1.875mg Mirtazapine at 730pm everyday and sleep arnd between 1-2 am for atleast 9hrs daily. After I wake up arnd 11am, I do feel just a BIT sleepy, but nowhere close to what I felt prior.

IF I am feeling sleepyish arnd an hour after I wake up (maybe 12pm), I take anywhere between 75-150 mg armodafinil. I've taken it 5 times in the last week, just to give you a perspective about my usage. I need to prepare for my GRE hence need the armod, else cudv maybe been just ok with caffeine+taurine like I normally do.

 

3. As for the naps, actually the naps helped me initially during my WD when I didn't know it was all because of my ADs. I used to nap in the afternoons on weekends and wake up COMPLETELY refreshed howsoever groggy I felt in the morning. But napping isn't feasible now due to work. I do try to nap if I can and feel impeccably normal after it. I've never been a napper my entire life so its kinda difficult for me at times to nap howmuchever I'd want it. Plus an occasional post lunch coffee to keep me functional, spoils it.

 

Do let me know if you all need anymore info to be able to help me find a solution to this mess.

[Altostrata]

You go to bed at 1 a.m. and wake at 10 a.m. - 11 a.m.? Is there a reason for this?

 

Why do you take mirtazapine at 7:30 p.m., doesn't it make you sleepy shortly after?

 

Sleepiness is not the worst symptom of prolonged post-discontinuation syndrome; much more often, people have a grueling sleeplessness.

 

Your nervous system is telling you it wants to sleep. Sleep is good, it's healing. Is there a way you can get to bed earlier and get up earlier? The normal sleep-wake cycle is roughly from nightfall to dawn, if you matched up a little better than this, it might get your nervous system on the right track faster.

[alphainc]

Thanks for the prompt response Alto.

 

Yea, I work in a shift from 12pm to 830-9pm in office. Can't come home and sleep right away most times. But I'm trying hard to sleep by 1130 and be up by 730-8ish. Will happen slowly, been a late riser for over 5 yrs so.

 

It's not sleepiness that is my symptom actually, I sleep decently. Its the grogginess, disoriented feeling, loss of most cognitive abilities, total lack of concentration after I wake up, like I never slept for days. Like in my worst times, I could not follow instructions to open a bottle of wine. That happened till April 2018, almost 18 months. I've gotten better, maybe like 20% from the highest intensity of these symptoms but it was still difficult for me to even write an email, I remember in April. Hence went to the shrink again. He wanted me on Escitalopram 10mg and Mirtazapine 3.75mg. 

 

The Escitalopram 10mg was too much for me to handle and made me even more groggy, like I was chronically fatigued. Even got my cortisol levels checked, mostly came bk normal or just a "little" off normal he said. 

 

Somehow the Mirtazapine helped me, but not 3.75mg or for tht matter a 7.5mg std dosage. It makes me too drowsy. So I tried and tested and have settled arnd 1.875mg (1/8 th tablet), which is the best I felt in over 18 months.

 

I have no idea how or why its helping, or is there a better way like reinstating from maybe 1-2mg of Lexapro or zoloft whatever. I have my GRE arnd Sept hence did not stop the Mirtazapine  as I can atleast study for 1-2 hrs on this. I stopped taking it for a couple of days when I was at my aunt's last month because I forgot carrying them, and hell broke lose. Again the same grogginess, disorientation, forgetfullness. Couldn't cross the street properly. Took 4-6 days of remeron 1.875 mg, to get bk to the stage when I had left for my aunts.

 

I DONT TRUST THE DOCTORS AT ALL NOW, SO NO POINT GOING BK. Kinda a dead end for me, quite perplexed. 

[Altostrata]

Thanks for the clarification. Would "foggy brain" be a good description?

 

Are you on the computer at work, until at least 9 p.m.? Do you use the computer after that time?

 

How often do you take armodafinil?

 

Have you tried melatonin? See

 

What is the sleep cycle?

 

Melatonin for sleep: Many people find it helpful

 

TV or computer use in evening can disrupt sleep: Bright light signals the brain that it's daytime

 

[StephanieHello]

Hi, I also have sleep issues.  My twin sister and 1st cousin have been diagnosed with Narcolepsy.  My sleep study did not show enough REM to qualify, but I was given Idiopathic Hypersomnia and Delayed Sleep Phase Syndrome diagnosis. It sounds like you could use a really good sleep doctor.  I probably wouldn't trust doctors either with your history of so much medication that made you feel awful.  However, I just want to encourage you to keep at it and find a doctor specializing in those sleep issues, because once I was seen, I felt validated for the first time that my issues were not my own laziness.  I tried Provigil and it did nothing for me.  Right now, Ritalin and caffeine helps the most.  The brain fog you describe is one of the major symptoms as well and definitely the worst one.  It is much worse for me now as I am withdrawing from Paxil.  For years and I mean years, I would sleep during the day whenever I got a chance in between classes and work.  And til noon or 1 on the weekends.  Now I am making myself stick to a sleep schedule.  The sleepiness and brain fog are still there, but I do not nap during the day anymore so at least that's a start!  I take Sonata at night and it helps the most of any that I've tried.  I don't have any real advice, just encouragement to keep fighting and you may be able to find some relief.  

[alphainc]

Exactly! Extereme fogginess/haziness. I started Armodafinil very recently. Dont quite know if its even helping as I take half the recommended dose of 150mg. thinking of replacing this with L-theanine+caffeine, dont know if I should.

 

I do use my computer till arnd 9pm, yes. I have suffered the blue light side effects and regularly use high intensity filters on all my device screens. Hopefully the mitigate the blue light, but I'm still working on reducing the screen time. Will happen over the course. Have tried melatonin, does'nt work quite well for me. Need 3mg+ everyday for it to work and with that dosage, coupled with Mirta, it creates more sleepiness. Hence use nothing which will make me sleepy even slightly.

 

Before Mirta in April 2018, I tried a number of thing in the 18 months I had. Right from melatonin to ashwagandha to calm me down. Nothing helped me with my brain fog. Maybe I'm already calm and there is something else troubling my brain during sleep.

 

Hence I underwent a couple of sleep studies and also to check for UARS. The sleep studies did show I had a huge number of micro-arousals in sleep (right after quitting my SSRI regimen CT.  Maybe due to the shock of WD)which resulted in my sleep being VERY fragmented. And hence the fog maybe. None of the micro arousals were respiratory related, no sleep apnea or UARS. So after all this, I "safely" concluded that my suffering maybe only due to the ADs withdrawal and started looking for help.

 

I maybe completely wrong, but I think the arousals are a part of maybe the shock adjustment that my brain is trying to make to return back to normal after quitting. I have to either stop/reduce the arousals or maybe sleep thru them and not let my brain wake up 20 times an hour!

 

I think that the Mirtazapine is maybe doing the latter, even though my dose is 1.875mg, maybe because my CNS is too sensitive right now. These are all assumptions I have after researching quite a lot on all this.

 

I have no idea how or why its helping, should I continue with Mirtazapine or is there a better way like reinstating from maybe 1-2mg of Lexapro or zoloft ? Or maybe something else?

 

If at all, should I choose escitalopram or sertraline for the reinstatement and safe taper journey?

 

 

 

[Altostrata]

1 hour ago, StephanieHello said:

Hi, I also have sleep issues.  My twin sister and 1st cousin have been diagnosed with Narcolepsy.  My sleep study did not show enough REM to qualify, but I was given Idiopathic Hypersomnia and Delayed Sleep Phase Syndrome diagnosis. It sounds like you could use a really good sleep doctor.  I probably wouldn't trust doctors either with your history of so much medication that made you feel awful.  However, I just want to encourage you to keep at it and find a doctor specializing in those sleep issues, because once I was seen, I felt validated for the first time that my issues were not my own laziness.  I tried Provigil and it did nothing for me.  Right now, Ritalin and caffeine helps the most.  The brain fog you describe is one of the major symptoms as well and definitely the worst one.  It is much worse for me now as I am withdrawing from Paxil.  For years and I mean years, I would sleep during the day whenever I got a chance in between classes and work.  And til noon or 1 on the weekends.  Now I am making myself stick to a sleep schedule.  The sleepiness and brain fog are still there, but I do not nap during the day anymore so at least that's a start!  I take Sonata at night and it helps the most of any that I've tried.  I don't have any real advice, just encouragement to keep fighting and you may be able to find some relief.  

 

Stephanie, when people have been on and off psychiatric drugs, they quite frequently have sleep problems that get shoehorned into elaborate diagnoses by sleep specialists and other doctors. You and your relatives may or may not have narcolepsy, I wouldn't know. But please be careful on this site because most likely the people here have iatrogenic symptoms, not narcolepsy or idiopathic whatever (which means they don't know).

 

Thanks for starting your own Introductions topic.

[Altostrata]

14 minutes ago, alphainc said:

The sleep studies did show I had a huge number of micro-arousals in sleep (right after quitting my SSRI regimen CT.  Maybe due to the shock of WD)which resulted in my sleep being VERY fragmented. And hence the fog maybe. None of the micro arousals were respiratory related, no sleep apnea or UARS. So after all this, I "safely" concluded that my suffering maybe only due to the ADs withdrawal and started looking for help.

 

Yes, we see this quite often here. It's related to withdrawal syndrome.

 

Please read

 

What is the sleep cycle?

 

Melatonin for sleep: Many people find it helpful

 

TV or computer use in evening can disrupt sleep: Bright light signals the brain that it's daytime

 

before further discussion. Melatonin is one of those things where more is not necessarily better.

[StephanieHello]

6 minutes ago, Altostrata said:

 

Stephanie, when people have been on and off psychiatric drugs, they quite frequently have sleep problems that get shoehorned into elaborate diagnoses by sleep specialists and other doctors. You and your relatives may or may not have narcolepsy, I wouldn't know. But please be careful on this site because most likely the people here have iatrogenic symptoms, not narcolepsy or idiopathic whatever (which means they don't know).

 

Thanks for starting your own Introductions topic.

But it sounds like his sleep issues started before his tapering which is why I encouraged him to see a sleep specialist.  From someone who lived with years of issues, I know what it's like to give up on having doctor's help and then finally find someone who can.  Most people with narcolepsy and I.H. (which is very real, BTW, despite not having a known cause) go 10+ years after onset of symptoms before being diagnosed.  I don't know if he has it, of course, but I do encourage people with symptoms to get help.  If I wasn't under the care of a sleep doctor, I would definitely not be successful with getting through withdrawals. 

[Altostrata]

Perhaps alpha can clarify, but so far there's no evidence of alpha's sleep issues before psychiatric drugs, which is quite common here.

 

Having seen hundreds of people go barking up all kinds of specialist trees, and done quite a bit of such barking myself, I don't reflexively tell people to seek such solutions.

[alphainc]

Hey Stephanie,

 

Thnaks for pitching in. I did try talking to atleast 3 diff sleep specialist over the course of the last 2 years. Had long discussions with them where I was told that I have a racing mind and have to stop thinking or worrying about things in bed. I was prescribed clonazepam, alprazolam, zolpidem etc etc and also asked to meditate. I did try all those compounds and it hardly helped. After a lot of soul searching and intense reading about the subject, I came to three conclusions and solutions:

 

1. Having a racing mind (anxiety) does cause acute sleep issues. And meditation and cognitive restructuring are the best way to deal with this. Sure some medication might help but after taking quite a lot, I WOULD STRONGLY URGE NOT TO TAKE ANY. Just in case someone's too eager, maybe melatonin as Alto pointed out.

 

2. Acute insomnia can turn into chronic sleep issues because of many reasons possible, but the most important contributor is the OBSESSIVENESS ABOUT SLEEP. Once this kicks in, it forms a viscious cycle, quite difficult to break. Being inquisitive is good but too much obsession especially with sleep will surely wreak havoc. No hyperbole.

 

3. There are tons of free resources available on the web that can be used for relaxation and cognitive restructuring in order to alleviate sleep issues. These sure take time, but work guaranteed. Just in case one does'nt have the luxury of patience or access to interent, should one consider visitng sleep doctors for Insomnia.

 

I have learnt this the hard way and am still finding my way through some sleep issues I had in the past. All I said maybe incorrect but the idea of visitng sleep "specialists" for Insomnia, I think, is futile. Mindfulness, Cognitive restructuring, self hypnosis are probably a way better bet.

 

P.S. After all my sleep specialists failed to understand and pin point the cause of my symtoms literally each one prescribed me ADs.

[alphainc]

30 minutes ago, Altostrata said:

 

Yes, we see this quite often here. It's related to withdrawal syndrome.

 

Please read

 

What is the sleep cycle?

 

Melatonin for sleep: Many people find it helpful

 

TV or computer use in evening can disrupt sleep: Bright light signals the brain that it's daytime

 

before further discussion. Melatonin is one of those things where more is not necessarily better.

 

Thnaks again Alto, went through them. May try 0.25 mg to melatoning tomorrow onwards, lets see how it goes.

 

As for the ADs, should I maintain status quo with Mirta for now or maybe try reinstating 1mg of lexapro which I already was prescribed so have in abundance?

[alphainc]

Hey Alto and others,

 

Pls excuse me if I'm bugging, but I desperately need advise on reinstating with lexapro 1-2 mg and see how it goes. Should I, after 18 months of CT? Is there a better alternative than reinstating? My current meds are in my history and have detailed my case in this post. 

Looking forward anxiously.

[alphainc]

My daily diary as asked for:

 

July 7

Time and dosage for drugs taken in morning: None
- Time and description of any symptoms in the morning: Woke up at 10 am. Moderate sleepiness after waking up, moderate brain fog
 
- Time and dosage for drugs taken in afternoon: None
- Time and description of any symptoms in the afternoon: Hazy, not able to concentrate properly
 
- Time and dosage for drugs taken in evening: Mirtazapine 1.875mg at 830pm
- Time and description of any symptoms in the evening: Same as the afternoon, no change in the intensity. Went to bed at 1230am

 

 

 

July 8

Time and dosage for drugs taken in morning: None
- Time and description of any symptoms in the morning: Woke up arnd 950 am. Moderate-High sleepiness after waking up, High brain fog
 
- Time and dosage for drugs taken in afternoon: None
- Time and description of any symptoms in the afternoon: Groggy, not able to concentrate properly. Tried napping, cudnt
 
- Time and dosage for drugs taken in evening: Mirtazapine 1.875mg at 845pm
- Time and description of any symptoms in the evening: Same as the afternoon, no change in the intensity. Went to sleep arnd 1245am. Trying melatonin 0.5mg two hrs before bed. Stopped armodafinil as I used up my prescription quantity.

[alphainc]

July 9

 

10am: Woke up, felt ok, had a coffee

1pm: Brain fog, a little sleepy

6pm: Brain fog, quite sleepy

9pm: Took 1.875mg Mirtazapine, 1.5mg Lexapro

1230am: Slept

 

I woke up at 10am today and still felt I could sleep more and wanted to not get out of bed. Kept sleeping till 130pm

 

 

Is this normal with Lexapro?  Should I continue 1.5mg of it and see for a week or so? Kindly let me know

[Altostrata]

It will take at least 4 days for the 1.5mg Lexapro to ramp up to full strength. Please let us know how it goes.

 

Sleepiness is not a bad outcome to begin with. If it continues, you may be able to decrease mirtazapine.

[alphainc]

 

Hey Alto,

Almost 3-4 days with Lexapro 1.5mg at 9pm daily. I feel better on the whole with reduced brain fog and better cognition but am quite sleepy throughout the day even after 10hrs in bed.

Have stopped using armodafinil from the last 3 days too.

Been taking 1.25mg Mirtazapine after I started Lexapro, still sleepy. Maybe will reduce it by 0.25mg every 2-3 days and see if I reach a steady not-so-sleepy state on Lexapro.

Is this the correct approach of switching from the Mirta 1.87 to Lexapro 1.5mg?

[alphainc]

Still a bit sleepy after 10 hrs of sleep a day. Have reduced the Mirtazapine to 0.5mg

 

Does the sleepiness persist for a week or two or am I taking a larger dose of lexapro (1.5mg) than I currently should?

[Altostrata]

On 7/12/2018 at 4:40 PM, alphainc said:

Been taking 1.25mg Mirtazapine after I started Lexapro, still sleepy. Maybe will reduce it by 0.25mg every 2-3 days and see if I reach a steady not-so-sleepy state on Lexapro.

Is this the correct approach of switching from the Mirta 1.87 to Lexapro 1.5mg?

 

Doesn't seem like you need the mirtazapine now. I would reduce by 0.10 every 3 days. Don't push it, we don't know how the mirtazapine is interacting with the Lexapro.

 

Please let us know how you're doing.

[alphainc]

Completed 5 weeks of lexapro reinstating, starting from 1.5mg to a stable 2.5mg per day after lunch. Have been able to stop the Mirtazapine for the past two weeks as it was making me too sleepy.

The WD symptoms have almost become nil, but it turns out that the lexapro is making me wake up right in the middle of the night and then making it very difficult for me to have sound sleep, like the classic SSRI insomnia side effect. Have been patient for 5 weeks for it to resolve, still the same. Had the same side effects the first time I started an SSRI back in 2016.

 

Any advice? My doctor wants me to take a sedating benzo on a low dose to help my sleep, till it stabilizes.

[alphainc]

Hey guys, 

Kindly advice on the above-mentioned. Looking forward.

[ChessieCat]

On 8/18/2018 at 8:09 PM, alphainc said:

Had the same side effects the first time I started an SSRI back in 2016.

 

Q:  Did it resolve back then?

 

I'll ask the other mods for their thoughts.

[ChessieCat]

Please update your drug signature - please include dates:  Account Settings – Create or Edit a signature

 

Edited August 21, 2018 by ChessieCat

[alphainc]

It did get resolved back then, but I was on zoloft the last time when I quit CT and the WD followed. But for reinstating, the doctor prescribed lexapro istead of it. Didn't quite understand why, maybe because lexapro has less severe side effects, don't know.

 

I'll wait for other mods to advice. Have updated my signature.

[ChessieCat]

47 minutes ago, alphainc said:

Have updated my signature.

 

Please use dates or beg (for beginning, mid (for middle) or end of month and add when you stopped mirt.

 

2018: Apr- Mirtazapine 3.75mg (felt least 50% better)
          May- Reduced Mirtazapine to 1.875mg in the evenings

          July- Started a low dose of 1.5mg Lexapro, reduced Mirtazapine to 1mg

August- Lexapro 2.5mg in the afternoon.

[alphainc]

Changes made.

[Altostrata]

alpha, if you take the Lexapro earlier in the day, it may not interfere with your sleep. I would move it earlier an hour or two every day until you're taking it in the morning.

 

Please keep daily notes on paper about your symptoms, when you take your drugs, and their dosages. Use a simple list format with time of day on the left and notation (symptom, drug and dosage) on the right.

[alphainc]

As adviced I moved the Lexapro to arnd 1030am since Aug 23. Been a slight improvement in my sleep.  I still feel like I've not quite slept well after waking up and feel a bit cranky all day. This is nothing close to the "not slept well" feeling I had during withdrawal, but the sleep's still not fully optimal after 8 weeks of reinstatement. Anything I'm missing here, or should I keep at it and wait?

[alphainc]

Hey guys, 

Kindly advice on the above-mentioned. Should I change the dosage a bit, just in case or is it something else maybe? Your experience would help here.

[ChessieCat]

You could try moving your dose earlier by another 2-3 hours.  Good sleep hygiene is important:  Sleep problems - that awful withdrawal insomnia

 

Your sig says you stopped mirt 18 July.  That's only 8 weeks ago.  If things are reasonable I would be loathe to change anything with your dose.

 

You could try some Magnesium.   Only make one change at a time.  Keep it Simple, Slow and Stable