EnglishSteve: Help needed - Mirtazapine

[EnglishSteve]

Hi. I Hope someone can help. I have been on 15mg Mirtazapine for 8 months, I started it the end of of September 2017.

 

Stupidly, I went cold turkey for 4 days,  didnt like withdrawals (lack of sleep, aches and pains) etc, so I reinstated back to full-dose .

 

After nine days back on 15mg  I still had not stabilised. I was improving, but getting dizzy spells, some anger and anxiety.

 

So I reduced my dose to 7.5mg and have been on this dosage for the passed 6 weeks and  have been through hellish withdrawals.

 

At present  I sleep about 4 or 5 hours and wake with akathisia (anxiety) everyday. This lasts till  about 12 midday and then turns to deep depression with  some suicidal ideation  and general low mood till about 7pm when I start to feel normal again.  I did not have this morning anxiety, low mood previous to the drop-in dosage, indeed  I have never suffered from anxiety.

 

IS IT TO LATE TO REINSTATE BACK TO 15mg ?  as I really can't handle this morning anxiety any more.

 

In summery :

15mg Mirtazapine for 8 months

cold turkey 4 days

reinstatement 15 mg for 9 days

reduced dosage 7.5mg for passed 6 weeks.

 

 I must also add that prior to being put on Mirtazapine I was on seroxat (Paxil) for 14 years. It pooped out. My gp cross tapered me from one to the other over 4 weeks.  So virtually a cold turkey off  the seroxat. After six weeks  off the Seroxat I crashed so tried to reinstate that but only lasted 10 days my body just couldn't take it.

 

 Whilst the last eight months  haven't been great on just 15mg of Mirtazapine due to sensitised  CNS from seroxat withdrawal, they were a dam site better than  the last 6 weeks.

 

 In retrospect  I think I should have persevered with the original updosage back to 15mg of Mirt for longer than nine days but I panicked as  I thought after only 4 days off I should have stabilised  after 2 or 3 

 

In short, after 6 weeks on 7.5mg is it to late to reinstate back to 15mg of Mirt and if I do, how long would it take to stabilise ?.  Or should I not rock the boat any further and just stay on 7.5 and hope for things to improve,  but symptoms are pretty much unbearable at the moment, I am a complete mess . Please help.

 

Any advice would be much appreciated.

 

Edited June 20, 2018 by ChessieCat
added spacing

[EnglishSteve]

 Is there anyone out there with any advice please.  I’m in a desperate state  .

[Songbird]

Hi EnglishSteve, welcome to SA.  Sorry to see that you're having a rough time.

 

It would be helpful if you could create a signature with your med history, including all drugs, doses and dates (starting and stopping).  This will help us to help you as best we can.  You can edit your signature under your Account Settings.  See this topic for more info: Please put your withdrawal history in your signature

 

I think you are right in that waiting only nine days to restabilise on 15mg was not enough time - restabilising usually takes at least a few weeks, sometimes longer.   However, you've been at a much lower dose for six weeks now, so a sudden increase back to 15mg could also cause problems.  In general, it's best to make dose changes small (whether up or down) as your system will find small changes easier to adjust to.  If your symptoms are unbearable, you might try a small updose (e.g. just 1 or 2 mg) to see how that goes for a while and then re-evaluate.  You may need to use liquid or a digital scale to measure doses accurately.  More information about mirtazapine can be found here: tips for tapering off mirtazapine remeron

 

Please post your updates here in your introduction topic.

[EnglishSteve]

 Hi Songbird thanks for your advice. The problem is I’m in such a state right now I am incapable of making a liquid formulation.

 My nervous system is completely shot to bits.  Would you definitely advise against reinstating at 15.  The pills are so small I can’t really chop them up more than half a pill It’s only been six weeks,  surely there is a chance of me stabilising at 15 .

  Once again thanks for your advice Songbird

[Songbird]

3 minutes ago, EnglishSteve said:

 Would you definitely advise against reinstating at 15.  The pills are so small I can’t really chop them up more than half a pill It’s only been six weeks,  surely there is a chance of me stabilising at 15 .

 

The problem is that it is unpredictable.  The bigger the change, the bigger the risk.  Yes, there is a chance of stabilising at 15mg.  It's only been six weeks, so you might be lucky.  There's also a chance it could make things worse.  If you decide to take the risk and try it, and have an adverse reaction, then you'll know it was too much and to reduce dose again.  We can give you information, but we can't predict outcomes, and we can't tell you what to do, it's your decision. 

 

There are various options for measuring doses.  If you can't make a liquid, you could get a digital jeweller's scale to weigh doses.  If you can't cut pills, you could file them with a nail file, or crush them and put the powder into capsules.  More information in these topics:  using a digital scale to measure doses

how to calculate dosages and dilutions - spreadsheets and calculators

 

Please can you create a signature so that we can see your situation at a glance and not have to read from the top of the topic, thanks.

[EnglishSteve]

 Hi Songbird thanks for your reply. I tried to write a signature but I’m not sure where to do it.  As there is no reference to signature in account settings. Is it under the edit profile part  ?

[Songbird]

Clicking this link should take you to your signature.

[EnglishSteve]

I just wrote a signature Songbird and saved it, can you see it ?

[Songbird]

Yes, it looks fine.

[EnglishSteve]

 I suppose it’s just awaiting game now Songbird  to see if anyone else has any experience of this or advice . 

 I’m in a right old state. I don’t know whether to throw up or run down the street screaming. I’ve never been this bad

[EnglishSteve]

 Is anyone about the SA site who wants to talk. I’m really struggling

[Survivor1]

Hi EnglishSteve,

 

Sorry you are struggling so much.  I agree with Songbird's advice to increase your dosage by a few mg's only.  If you go up to 15, it is possible that you could have an adverse reaction and then it would be even more terrible than now if you have to discontinue from 15.

 

I have been using a liquid for many of my meds, and it is really not difficult to do.  I think most pharmacies would carry a 10 ml syringe, which would work for you for now.  Just fill one and a half times with water (15 ml), and empty it into a container to dissolve 15 mg mirtazepine (to give a 1:1 ratio).  Then, using the same syringe, measure out and discard 5.5 ml (if you are updosing to 9.5mg, say), and drink the rest.

 

You can buy larger syringes at a later date, when you are more stable to get even more precise measurements.  Just ask here for advice on that at that time.

 

Be aware that updosing may not bring immediate relief, so just be prepared to stay the course.

 

Unfortunately most of us on this site have been where you are; know that there are better times ahead, although it may not seem so right now.   I hope this helps. Best wishes.

[EnglishSteve]

Hi  Survivor.  Thanks very much for your kind advice,  it really is appreciated and  I may well follow it but my pills aren’t dissolvable.

 Do you just crush them and put them in the water and shake 

 My mind is all over the place at the moment and I don’t think it’s possible to feel worse than I do right now. The thing is if I went up to 15 mg how would I know if I was having an adverse reaction. Are their symptoms to look out for.

 

 

 

 

[Survivor1]

Hi ES,

 

When I was on mirtazepine, my pills were not dissolvable either.  I just put it in water, without even crushing, and let it disintegrate on its own.  Mine had a coating that did not disintegrate as well as the rest of it.  But after a sitting in water for a while (don't remember how long, but it did not seem to take a long time) I just stirred it up and withdrew the amount I needed while the suspension was still swirling.  That worked very well.

 

16 minutes ago, EnglishSteve said:

if I went up to 15 mg how would I know if I was having an adverse reaction

I think this is tricky.  If you feel worse that may be a sign, but not always! Also with an adverse reaction, you may not be able to stabilize.  To hedge against all the uncertainties, I would advise the small updose, but it is up to you.

 

Try to stay as calm as possible; this is really hard to do as I know you are feeling terrible.  In my experience, when I panicked (often, unfortunately), I made the worst decisions.

 

 

[EnglishSteve]

 Your advice is spot on survivor. Right now I’m in a real irrational place. Feels like I’m having a nervous breakdown. 

 Still I’ve just managed to run out the house to the nearest pharmacy and bought a 15 mg syringe and a 5 mg syringe. 

Do you think updosing to 10 mg is a bit  to much. ? 

I know everyone is different but how long do you think it would take to stabilise.?

 

[Survivor1]

35 minutes ago, EnglishSteve said:

bought a 15 mg syringe and a 5 mg syringe. 

Be careful with the measurements.  This totals 20, be sure to use only 15 (or a multiple of 15).

 

36 minutes ago, EnglishSteve said:

Do you think updosing to 10 mg is a bit  to much. ?

Choose an updose that "feels right" to you.  10 is definitely better than 15!

 

38 minutes ago, EnglishSteve said:

long do you think it would take to stabilise.?

I can only tell you of my experience reinstating.  I was off seroquel for 3 months, reinstated at 0.5 mg and took another 3 months to stabilize, with few windows during that time.

 

If you read this site, one of the techniques it advocates is acceptance.  This might sound like a bunch of hooey (Texas parlance), but it really does work.  I was given the advice by one member to treat my symptoms as a companion not as an enemy, and this was a major shift for me.  Instead of fighting, I accepted the negative aspects of WD.  This acceptance was the best way I found to help me not panic.  

 

There are other techniques to tide you over the worst.  I pace a lot in my house/yard, while talking to myself; hearing the vocalizations seem to distract me somewhat (one day, I checked my fitbit, and I had paced for 1/2 mile!).  Search this site, there are a lot more you can do to help you cope.

 

 

 

 

 

[EnglishSteve]

 Hi survivor. Acceptance is something I will have to practice. I’ve had a look round the site but I’ve got to be careful what I read as some of the stories on here have put me a real tailspin. 

 Three months is a long time to wait for stabilisation. It must’ve took a lot of faith to believe that you would eventually stabilise.  I take it you’ve been on a cocktail of meds then ?

Do you find your feel better after 7 PM of an evening ?. I find I do, it’s really quite strange.

[Songbird]

6 hours ago, EnglishSteve said:

how would I know if I was having an adverse reaction. Are their symptoms to look out for.

 

 

You would suddenly feel much worse - existing symptoms becoming more severe, or new severe symptoms suddenly appear.

 

6 hours ago, EnglishSteve said:

 Do you think updosing to 10 mg is a bit  to much. ? 

 

It sounds reasonable, and a lot lower than 15mg. 

I'm not experienced with making liquids, but there is a topic about it here:  how to make a liquid from tablets or capsules

[EnglishSteve]

 Help, Seven weeks ago now I rather stupidly reduced my dosage of  Mirtazapine  from 15 mg to 7.5 mg .

 And for the past week and a half I’ve started suffering with severe  Akathasia. It starts when I wake in the morning  with a deep inner unrest. I can’t keep still or relax, my arms and legs have to keep moving.   I find I have to leave the house and just walk really fast for about 4 to 5 hours  then generally calms down towards late afternoon. It’s way worse than just being anxious. I never ever had the symptoms prior to reducing my dose. Has anyone got any suggestions on how to combat this. I’m in real desperate state

Steve.

[EnglishSteve]

Hi. I’m not sure on posting in the correct forum as it’s taking me awhile to work out this site. But I will state my problem anyway.

 

 Seven weeks ago I rather stupidly reduced my dosage of Mirtazapine

 From 15 mg to 7.5mg.

Over the last week  I’ve started developing akathisia. I wake in the morning to deep state inner unrest I can’t relax or sit still, or keep my legs or arms still and find I have to walk for 4 to 5 hours to ease the symptoms. It’s way worse than general anxiety.

 Has anyone got any suggestions how I can remedy this.

 I’m in a desperate state 

Steve

 

[Songbird]

Steve, what dose are you currently taking?  Are you still at 7.5mg, or did you updose as we discussed above?

 

I have experienced severe akathisia and it is horrendous.  What helped me was doing relaxation exercises several times per day.  I used David Swenson's "Just Relax" yoga DVD (I think it's on YouTube).  I found it was better for akathisia than other forms of relaxation (there was no way I could lie still and meditate or whatever) because it begins with movement.   Gradually my system would calm down and I would start to feel better.  At first I was doing this DVD three times a day, every day and it made a big difference.

[EnglishSteve]

Hi Singbird thanks for getting back to me.

I didn’t reinstate I’m still on 7.5 but I think I’m going to have to do as I’m not going to make it feeling like this. I’ve just been for a 7 mile walk and I’ve just got back home and I’m completely on edge and still can’t relax.

 I’m pacing up and down in my house crying.

what can I do I’m in a bad way.

 

[EnglishSteve]

Please help . Why has the subject been merged  i’ve put it in tapering ,I was hoping for as many people to see as possible and get some suggestions

[EnglishSteve]

Are you about Songbird. What caused your akathasia if you don’t mind me asking ?

[ChessieCat]

9 hours ago, EnglishSteve said:

Why has the subject been merged

 

SA works differently to other sites which you might be familiar with.  Each member has 1 Intro topic and is the place to ask questions about your own situation.  You can also journal your progress.  This keeps your history in one place and also allows members and guests to see the responses you receive to your questions.

 

There are many existing topics on this site.  You can use the site search function or a search engine and add survivingantidepressants.org to the search term.  Eg survivingantidepressants.org akathisia   These is a discussion on this topic with ideas for coping with it.

 

BTW please note the correct spelling akathisia.  I usually get it wrong!

[Songbird]

Steve, I merged your topics, sorry I forgot to mention it last night.  The Tapering forum is for general tapering information.   Your introduction topic is for questions about your specific situation.

 

To answer your question, I got akathisia after a dose drop of paroxetine. 

 

It's possible you may need a higher dose, but it's a good idea to make only small increases at a time so as not to further shock your system.  Are you able to get mirtazapine liquid?  If not, you could make your own liquid  (see How to make a liquid from tablets or capsules) or get a digital jeweller's scale and cut/file/crush pills and weigh your doses (see Using a digital scale to measure doses).

[EnglishSteve]

Hi brass monkey. 

 My doctor took me off  Seroxat that I was on for 14 year in the space of 4 weeks. It stopped working.

That was 7 months ago.   I had no idea about proper tapering methods.  Having read your above article which is very informative I guess I’m screwed. Do you think it’s way too late for me to reinstate.

[EnglishSteve]

MOD NOTE:  Post moved from the Are We There Yet? topic.

 

Dear me I feel lowest I’ve ever felt after reading the above article. 

 

Edited June 25, 2018 by ChessieCat
mod note

[EnglishSteve]

 Hi Songbird did you Optos when you got the akathasia

[EnglishSteve]

 Sorry that was meant to say updose. 

 Please is anyone else out there with some experiences what I’m going through  ?

[brassmonkey]

Hi Steve-- this is a fairly common situation around here.  The medical community is very poorly informed on how these drugs work, their interactions and how to manipulate them.  Being off the paxil for seven months puts you in a tough place to try and reinstate, which is compounded with the addition and changes in the Mitrazipine.  Right now you shouldn't be trying to reduce anything, but rather need to hold for an extended time to let thing stabilize.  If you're still interested in trying to reinstate the paxil we have an excellent discussion of that here:

 

About reinstating and stabilizing to reduce withdrawal symptoms 

 

Brassmonkey

[EnglishSteve]

 hi brass monkey. Thanks forgetting back to me. It’s really appreciated.   Think it probably is too late to reinstate the seroxat

But  i’ve got a quick question for you. Seven weeks ago I reduced my Mirtazapine  from 15 mg to 7.5mg,  huge mistake. It’s completely destabilised me. What would be your opinion on  me reinstaing that. The reduction has put me in a really bad placeThe reduction has put me in a really bad place

 

Edited June 25, 2018 by ChessieCat
unbolded

[Songbird]

On 6/20/2018 at 11:21 PM, Songbird said:

you've been at a much lower dose for six weeks now, so a sudden increase back to 15mg could also cause problems.  In general, it's best to make dose changes small (whether up or down) as your system will find small changes easier to adjust to.  If your symptoms are unbearable, you might try a small updose (e.g. just 1 or 2 mg) to see how that goes for a while and then re-evaluate.  You may need to use liquid or a digital scale to measure doses accurately.  More information about mirtazapine can be found here: tips for tapering off mirtazapine remeron

 

22 hours ago, Songbird said:

It's possible you may need a higher dose, but it's a good idea to make only small increases at a time so as not to further shock your system.  Are you able to get mirtazapine liquid?  If not, you could make your own liquid  (see How to make a liquid from tablets or capsules) or get a digital jeweller's scale and cut/file/crush pills and weigh your doses (see Using a digital scale to measure doses).

 

Steve, please reread my posts.  Instead of jumping back to 15mg you could make a small updose to somewhere in between.  There are various options to measure your dose: get liquid mirtazapine, make your own liquid, get a jeweller's scale and cut/file/crush the pills.

[brassmonkey]

A very small updose on the Mirtazapine  might help a bit, but it would be best to keep it very small.  Like only increase 1mgai (milligram active ingredient).  The thing is that all the changes you did last year have left your body/brain sensitized to the drugs and any additional changes will be very unpredictable.  If you think it may help then give it a try.  There may be some immediate relief which would be a good thing but,  It may take several weeks for things to kick in and then several more months for things to stabilize.  Right now stability is your target.

[EnglishSteve]

Hi brass monkey, thanks for your advice

 After reading it I must say it’s done me, I feel completely and utterly distraught. On the verge of giving up. “Several months to stabilise”.  I’ve read many other slightly more encouraging and positive posts  by Altostrata where people  in withdrawal  are advised it might be better to reinstate a small dose rather than tough it out. That’s where I got the idea.

 It’s not that I think it might work to up dose,  it’s more that feel I have no choice, as I live on my own, have no support network, I’m mainly housebound due to symptoms and suicidal. 

 So  i’m dammed if I don’t, and judging by the tone of your reply “might help a bit”, “several months to stabilise”, more a less dammed if I do.

Still, I asked your opinion, you’re only bluntly stating the the hardcore facts as you see then. If it has a negative impact on my already unhinged fragile mind then that’s my fault. 

I shouldn’t have halved my dose six weeks ago.

If only I knew..

 

 

 

 

[EnglishSteve]

On 6/25/2018 at 7:35 AM, EnglishSteve said:

MOD NOTE:  Post moved from the Are We There Yet? topic.

 

Dear me I feel lowest I’ve ever felt after reading the above article. 

 

Quick qustion. Has the above comment been moved from where I posted it ?