mrsb16: coming off Mirtazapine

[mrsb16]

Hi all!

 

I've just found this site after deciding to come off Mirtazapine and looking for information about withdrawing.

 

A bit of background- I've suffered from anxiety for years after a difficult childhood. Possibly depression although I wouldn't call it severe, I enjoy life and I feel that I have a purpose. My depression/anxiety gets worse when I can't sleep. I've also suffered from insomnia on and off as long as I can remember. My mood is so much better when I sleep. When I do sleep it's fine, I feel rested, refreshed and happy. This goes on for months then I'll have one bad night which sets my anxiety off and the one bad night becomes two bad nights, a bad week, a bad month and so on. 

 

I was put on Citalopram around 5 years ago because of anxiety. I can't even remember why but I stopped cold turkey. I don't remember any bad side effects (I don't remember it messing with my sleep anyway) other than head zaps/fuzzy head. 

 

My latest bout of insomnia started after Christmas last year. It was awful. I was so miserable. I was unable to function, depressed and at times suicidal. My doctor had previously given me Promethazine which was fantastic for sleep but the effects didn't last. Then she put me on Mirtazapine. After the first couple of weeks I felt great. I was sleeping, the effectiveness of the Mirtazapine wasn't wearing off like the Promethazine, everything was good. I've been sleeping well for months (up until this last month for some reason) and I've been feeling good. But the weight gain. Oh the weight gain... I'm also trying to get pregnant and both me and my husband feel like being off medication is going to be better if possible.

 

So that's where I am now. I've recently changed doctors and have only seen my new doctor once when we agreed it's time to come off the meds. I'm only on 15mg so maybe I've got it easier than some. The new doctor suggested taking one pill every other night. My husband is a psychiatrist and said he thinks half a tablet every night is a better plan and I agree. My doctor (I'm in the UK) says it isn't possible to get tablets with a lower dose here? Is that right? I haven't thought to ask my husband this actually and will when he gets home. It seems like it's easier to taper more gradually than this though?

 

My main worry is about the insomnia returning which I've read is common when coming off this medication. I keep telling myself it will be fine, I just have to work through it but I'm worried about not being able to cope and ending up back on the meds which I don't want. 

 

But maybe I'm getting ahead of myself because I haven't even started to come off them yet!

 

One day at a time!

[Gridley]

Welcome, mrsb16.

 

It's very good you found us before you started your taper.

 

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.  Halving the tablet to 7.5mg is a 50% drop and far in excess of our recommendation.  We strongly advise against alternate-day dosing.

  

Before you begin tapering what you need to know

Why taper by 10% of my dosage?

 

Brain Remodelling

 

Tips for tapering off Remeron (mirtazapine)
 

The following excerpt from the link above explains how to get smaller doses, either by splitting and weighing tablets or using a liquid.  It also discusses insomnia.

 

Reduce by splitting tablets
Request that your prescription be filled with the lowest dosage tablets or combination that includes the lowest dosage and split them into quarters for the smallest decrements. (A quarter of a 7.5mg tablet would be 1.875mg.) If you are very sensitive to dosage reductions, you may wish to weigh tablet fragments, see Using a digital scale to measure doses

Reduce by titrating a liquid

In the UK, mirtazapine liquid is available from Rosemont Pharmaceuticals in Leeds.

This is your introduction topic -- the place for you to ask questions, record symptoms, share your progress, and connect with other members of the SA community.  I hope you’ll find the information in the SA forums helpful for your situation.  I'm sorry that you are in the position that you need the information, but I am glad that you found us.

 

 

 

[mrsb16]

Thank you! That's really helpful as I hadn't really done much research on whether or not it is possible to get lower doses here. My husband wasn't sure as he's a child psychiatrist and says he doesn't regularly prescribe Mirtazapine. I'll be asking my doctor this. I also hadn't considered quartering the tablets (I'd only thought of halving them).

 

I'm starting to think maybe I shouldn't drop to 7.5mg straight away and should speak to my doctor/a pharmacist about this first? From what I've been reading on here halving the dose straight away seems to be too much and will almost guarantee failure.

 

I had planned to half my pill last night but I wasn't feeling confident about it. I'd been at an event till late and had had a glass of wine. I felt like this was likely to affect my sleep anyway (wine and getting home to bed late) and didn't want to start off on a bad night before I'd even taken less of my meds. But maybe I'm just making excuses. 

 

So if a pharmacy doesn't have a certain brand of a medication in stock is it possible to request that they order another one? Or is it a case of going to different pharmacies until you find one that does have it?

 

I'm seeing my doctor on the 18th. I'm wondering if maybe I should wait till then and discuss this further before just halving the dose straight away.

[BuddhaMama]

Hi Mrsb, 

I just wanted to say hello and welcome you to the Mirtazipine withdrawal club! I was put on 15mg nearly two years ago for post partum anxiety and insomnia when my baby was a month old. I began tapering after only using it for about 4 months. If I had known how long it was going to take to come off it, I never would have taken it. But, I was desperate and didn't know any better at the time. After an unsuccessful first attempt at tapering (I reduced by 1/4 tablet every night for a week), I decided to switch to a liquid and taper much more slowly. I have my tablets turned into a liquid at a local compounding pharmacy. There are also instructions on this site for how to make your own liquid solutions. 

I took cues from BrassMonkey on this site and chose to decrease by 2% every week rather than 10% every month. This method has served me well for 19 months and I am down to 2.6mg. I'm doing a long hold at the moment (coming up on three weeks) because my decreases are getting bigger (3.7% was the last one) and my symptoms are ramping up. I've learned a lot along the way, so I'm happy to help if you have questions. Good luck!