EnoughAlready: advice needed please

[EnoughAlready]

Hi everyone, thank you for having me.

Im looking for advice about updosing to try to stabilize. 

 

Prescribed Mirtazapine February 2018 for  insomnia caused by over medication of thyroid.

 

(The thyroid medication caused a severe upset to my nervous system- I had every symptom of hyperthyroidism for weeks, even after I ceased my thyroid meds completely. Going hyperthyroid caused my Cortisol to go high especially at night. It took 6 months for the effects of the over medication of thyroid to wear off. My theory is that the thyroid over medication sensitized my nervous system.)

 

Mirtzapine only worked for a few weeks for sleep. I started at 7.5mg and then after 3 weeks increased to 15mg which again only worked for 3 weeks before the sleep effect wore off. Luckily I found some herbs that helped for sleep but they only worked for a few months. I also increased my dose of Luvox to help with sleep. 

 

I took temazapam and zolpidem a few times but was not keen on using them as I’d heard about addiction. Went to psychiatrist he told me to increase mirtzapine to 30mg. I reluctantly did this. Again it only worked for sleep for 3 weeks. But I started getting terrible side effects- crying all the time and internal tremors. So I dropped the dose back down to 15mg. I was only on 30mg for 3 weeks.

 

Withdrawals hit straight away. Worsening at 4 weeks after the drop, and then worsening again at 3 months after the drop. I have not tried to reduce again since this first drop from 30mg-15mg. It has been 8 months of terrible symptoms. DR/DP didn’t hit until the 3rd month after the reduction. 

 

I wondered if it would be too risky to updose by 1mg of mirtzapine after this long (8 months since the drop). That would make my dose 16mg. Or should I just try to wait longer? I don’t know what to do.

 

Some symptoms, like nausea, have gone, and the internal vibrations have lessened in intensity. 

Other strange symptoms seem to have stopped, but the DR/DP and low mood has been happening since the 3rd month. Low mood is perhaps not as severe. S ideations less intense, and anxiety still all over the place. A feeling of being numbed out - in terms of sensations in my body and my skin and since month 3 as well. 

It seems important to me that one of the side effects when I first started the mirtzapine -and which accompanied each increase briefly- was a level of Derealisation and numbing out sensation. This would pass after a week or two, but I’m assuming this makes sense as to why I have the symptoms I have in withdrawal.  

 

Thank you in advance 

[ChessieCat]

Hi EnoughAlready and welcome to SA,

 

Thank you for creating your drug signature.  Please include the temazepam and zolpidem in your drug signature, as well as any other drugs you have taken.  This is the preferred format:

 

Keep it simple.  NO diagnoses or symptoms please - thank you.

• details for last 2 years - dates, ALL drugs, doses
• summary for older than 2 years - just years and drug/s

Account Settings – Create or Edit a signature

 

 

Q:  How did you taper your doses? 

 

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?

 

When the drug is taken away too quickly we can get withdrawal symptoms:  Dr Joseph Glenmullen's Withdrawal Symptoms

 

Please put all the drug you are currently taking in the Drug Interactions Checker .  Copy and paste the results in a post here please.

 

Tips for tapering off Remeron (mirtazapine)

 

Tips for tapering off Luvox (fluvoxamine)

 

I will provide some more information in the next 2 posts.  This is your own introductions topic where your can ask questions about your own situation and journal your progress.

[ChessieCat]

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.  

 

[ChessieCat]

During any taper, there will be times of discomfort.  We strongly encourage members to learn and use non drug coping techniques to help get through tough times.

 

Understanding what is happening helps us to not get caught up with the second fear, or fear of the fear.  This happens when we experience sensations in our body and because we don't understand them we are scared of them and then start to panic.

 

This document has a diagram of the body explaining what happens in the body when we become anxious:

 

https://www.getselfhelp.co.uk/docs/AnxietySelfHelp.pdf

 

Anxiety Stuff - all kinds of stuff about anxiety attacks and things that help ...

 

Audio FEMALE VOICE:  First Aid for Panic (4 minutes)

 

Audio MALE VOICE:  First Aid for Panic (4 minutes)

 

Non-drug techniques to cope

 

dealing-with-emotional-spirals

 

Dr Claire Weekes suffered from anxiety and learned and taught ways of coping.  There are videos available on YouTube.

 

Claire Weekes' Method of Recovering from a Sensitized Nervous System

 

Audio:  How to Recover from Anxiety - Dr Claire Weekes

 

CBT Course:  An Introductory Self-Help Course in Cognitive Behaviour Therapy

 

Resources:  Centre for Clinical Interventions (PDF modules that you can work through, eg:  Depression, Distress Intolerance, Health Anxiety, Low Self-Esteem, Panic Attacks, Perfectionism, Procrastination, Social Anxiety, Worrying)

 

On 4/28/2017 at 4:03 AM, brassmonkey said:

 

AAF: Acknowledge, Accept, Float.  It's what you have to do when nothing else works, and can be a very powerful tool in coping with anxiety.  The neuroemotional anxiety many of us feel during WD is directly caused by the drugs and their chemical reactions in the brain.  Making it so there is nothing we can do about them.  They won't respond to other drugs, relaxation techniques and the like.  They do, however, react very well to being ignored.  That's the concept behind AAF.  Acknowledge, get to know the feeling involved, explore them.  Accept, These feelings are a part of you and they aren't going anywhere fast. Float, let the feeling float off as you get on with your life as best as you can.  It's a well documented fact that the more you feed in to anxiety the worse it gets.  What starts as generalized neuroemotinal anxiety can be easily blown into a full fledged panic attack just by thinking about it.

 

I often liken it to an unwanted house guest.  At first you talk to them, have conversations, communicate with them.  After a while you figure out that they aren't leaving and there is nothing you can do to get rid of them.  So you go on about your day, working around them until they get bored and leave.

 

It can take some practice, but AAF really does work.  I hope you give it a try.

 

 

[EnoughAlready]

https://www.drugs.com/interactions-check.php?drug_list=1128-9754,1640-0

 

drug checker interactions link. 

[EnoughAlready]

Thanks so much for responding ChessieCat. Mirtzapine I was only on for 3 weeks at 30mg so dropped back to 15mg. So 50% drop. Of course I had no idea 10% was the safe option. 

 

Luvox I was dropping 25mg each time. No problems doing this at all. I also held each drop with Luvox for 3-4 months before I dropped again. I didn’t have any issues tapering over the 3 years but accept that it may have factored into what happened with mirtz. 

 

I have held mirtz at 15mg for 8 months. Just need to know whether updosing is worth trying or too risky or if I need to keep holding? 

 

Edited January 13, 2019 by ChessieCat
removed quote

[EnoughAlready]

Thank you for all the info  

 

 

Edited January 13, 2019 by ChessieCat
removed quote

[ChessieCat]

Interactions between your drugs

 

Major

fluvoxaMINE mirtazapine

Applies to: Luvox (fluvoxamine), mirtazapine

FluvoxaMINE may significantly increase the blood levels of mirtazapine. This may increase the risk and/or severity of side effects such as dizziness, drowsiness, restlessness, confusion, difficulty concentrating, impairment in thinking and judgment, dry mouth, constipation, low blood pressure, and heart rhythm abnormalities. In addition, combining these types of medications can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea.
 

Duplication

Antidepressants

Therapeutic duplication

The recommended maximum number of medicines in the 'antidepressants' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'antidepressants' category:

• Luvox (fluvoxamine)
• mirtazapine

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

 

side effects such as dizziness, drowsiness, restlessness, confusion, difficulty concentrating, impairment in thinking and judgment, dry mouth, constipation, low blood pressure, and heart rhythm abnormalities.

 

serotonin syndrome symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea.

 

Q:  Are you experiencing any of these?

 

I suffered mild serotonin toxicity when taking 100mg Pristiq.  It wasn't until my dose got lower and the symptoms lessened that I recognised some of the symptoms.  I knew that I had been sweating a lot even in winter, but I hadn't realised that I had been experiencing agitation, confusion and my diastolic blood pressure had increased after my dose went from 50mg to 100mg.

 

6 hours ago, EnoughAlready said:

I have held mirtz at 15mg for 8 months. Just need to know whether updosing is worth trying or too risky or if I need to keep holding? 

 

Q:  Are your current doses:  mirtazapine 15mg, and Luvox 130mg?

 

Because of the risk of both serotonin toxicity and increased and/or severity of side effects, I don't think it would be wise to increase the dose of either the mirtazapine or the Luvox.

 

In fact, I think the exact opposite might be a preferable way to go.

 

Please keep daily symptoms notes on paper for the next 3 days and post them here in your topic so we can assess them.

 

Example:

 

6 a.m. Woke with anxiety
8 a.m. Took 2.5mg Lexapro
10 a.m. Stomach is upset
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Feel a bit better
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Feeling dizzy
10:30 p.m. Fell asleep
2:30 a.m. Woke, took 3mg Ambien (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke but got back to sleep

[Altostrata]

On 1/10/2019 at 11:19 PM, EnoughAlready said:

Prescribed Mirtazapine February 2018 for  insomnia caused by over medication of thyroid.

 

How was your thyroid hormone adjusted?

 

Please put dosages of everything you're currently taking in your signature.

 

On 1/10/2019 at 11:19 PM, EnoughAlready said:

Mirtzapine only worked for a few weeks for sleep. I started at 7.5mg and then after 3 weeks increased to 15mg which again only worked for 3 weeks before the sleep effect wore off. Luckily I found some herbs that helped for sleep but they only worked for a few months. I also increased my dose of Luvox to help with sleep. 

 

 

What were the steps and dates of your Luvox increases? When was the last time you changed it? Did an increase help you sleep?

 

At this point, it could be your system has recovered from over-medication of thyroid and your sleep problem is caused by adverse effects of the drugs you're taking, plus withdrawal syndrome.

[EnoughAlready]

12 hours ago, ChessieCat said:

Interactions between your drugs

 

Major

fluvoxaMINE mirtazapine

Applies to: Luvox (fluvoxamine), mirtazapine

FluvoxaMINE may significantly increase the blood levels of mirtazapine. This may increase the risk and/or severity of side effects such as dizziness, drowsiness, restlessness, confusion, difficulty concentrating, impairment in thinking and judgment, dry mouth, constipation, low blood pressure, and heart rhythm abnormalities. In addition, combining these types of medications can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea.
 

Duplication

Antidepressants

Therapeutic duplication

The recommended maximum number of medicines in the 'antidepressants' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'antidepressants' category:

• Luvox (fluvoxamine)
• mirtazapine

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

 

side effects such as dizziness, drowsiness, restlessness, confusion, difficulty concentrating, impairment in thinking and judgment, dry mouth, constipation, low blood pressure, and heart rhythm abnormalities.

 

serotonin syndrome symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea.

 

Q:  Are you experiencing any of these?

 

I suffered mild serotonin toxicity when taking 100mg Pristiq.  It wasn't until my dose got lower and the symptoms lessened that I recognised some of the symptoms.  I knew that I had been sweating a lot even in winter, but I hadn't realised that I had been experiencing agitation, confusion and my diastolic blood pressure had increased after my dose went from 50mg to 100mg.

 

 

Q:  Are your current doses:  mirtazapine 15mg, and Luvox 130mg?

 

Because of the risk of both serotonin toxicity and increased and/or severity of side effects, I don't think it would be wise to increase the dose of either the mirtazapine or the Luvox.

 

In fact, I think the exact opposite might be a preferable way to go.

 

Please keep daily symptoms notes on paper for the next 3 days and post them here in your topic so we can assess them.

 

Example:

 

6 a.m. Woke with anxiety
8 a.m. Took 2.5mg Lexapro
10 a.m. Stomach is upset
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Feel a bit better
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Feeling dizzy
10:30 p.m. Fell asleep
2:30 a.m. Woke, took 3mg Ambien (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke but got back to sleep

Thank you 

 

12 hours ago, ChessieCat said:

Interactions between your drugs

 

Major

fluvoxaMINE mirtazapine

Applies to: Luvox (fluvoxamine), mirtazapine

FluvoxaMINE may significantly increase the blood levels of mirtazapine. This may increase the risk and/or severity of side effects such as dizziness, drowsiness, restlessness, confusion, difficulty concentrating, impairment in thinking and judgment, dry mouth, constipation, low blood pressure, and heart rhythm abnormalities. In addition, combining these types of medications can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea.
 

Duplication

Antidepressants

Therapeutic duplication

The recommended maximum number of medicines in the 'antidepressants' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'antidepressants' category:

• Luvox (fluvoxamine)
• mirtazapine

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

 

side effects such as dizziness, drowsiness, restlessness, confusion, difficulty concentrating, impairment in thinking and judgment, dry mouth, constipation, low blood pressure, and heart rhythm abnormalities.

 

serotonin syndrome symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea.

 

Q:  Are you experiencing any of these?

 

I suffered mild serotonin toxicity when taking 100mg Pristiq.  It wasn't until my dose got lower and the symptoms lessened that I recognised some of the symptoms.  I knew that I had been sweating a lot even in winter, but I hadn't realised that I had been experiencing agitation, confusion and my diastolic blood pressure had increased after my dose went from 50mg to 100mg.

 

 

Q:  Are your current doses:  mirtazapine 15mg, and Luvox 130mg?

 

Because of the risk of both serotonin toxicity and increased and/or severity of side effects, I don't think it would be wise to increase the dose of either the mirtazapine or the Luvox.

 

In fact, I think the exact opposite might be a preferable way to go.

 

Please keep daily symptoms notes on paper for the next 3 days and post them here in your topic so we can assess them.

 

Example:

 

6 a.m. Woke with anxiety
8 a.m. Took 2.5mg Lexapro
10 a.m. Stomach is upset
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Feel a bit better
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Feeling dizzy
10:30 p.m. Fell asleep
2:30 a.m. Woke, took 3mg Ambien (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke but got back to sleep

ChessieCat thank you. The problems really only started when I went up to 30mg of mirtzapine for 3 weeks (and on 100mg Luvox at that time). I started having bad side effects - crying and feeling like I was going to have a breakdown, weird internal shaking, weird head feeling (hard to describe) and anxiety. This is why I dropped back down to 15mg of Mirtz. Prior to increasing mirtz to 30mg, I had been stable on 15mg mirtz for 3 months (and on 100mg Luvox). There didn’t seem to be any problems with that. 

 

Currently looking at the side effects lists of combining mirtz and Luvox I have slight constipation and some impairment in judgement and memory but that seems to be linked to DR/DP. 

 

From the serontonin toxicity list, I think I’ve felt quite hot at times off and on. 

 

I will keep a dairy and post it here. 

[EnoughAlready]

10 hours ago, Altostrata said:

 

How was your thyroid hormone adjusted?

 

Please put dosages of everything you're currently taking in your signature.

 

 

What were the steps and dates of your Luvox increases? When was the last time you changed it? Did an increase help you sleep?

 

At this point, it could be your system has recovered from over-medication of thyroid and your sleep problem is caused by adverse effects of the drugs you're taking, plus withdrawal syndrome.

Altostrata I had to completely stop taking my thyroid medication. The hyperthyroid reaction lasted months and was very severe. I have not taken any thyroid meds since February 2018 when I went severely hyperthyroid. (I have a complicated story about my thyroid which is really only considered to be very mildly underactive). I will adjust the details in my signature to include the thyroid meds.

 

luvox adjustments - 25mg luvox December 2017- 15 February 2018, 16 February 2018 increase to 50mg luvox, 23 Feb 2018 increase to 75mg luvox, April 7 2018 increase 100mg luvox, June 29 2018 increase to 125mg luvox, June 18 2018 increase to 150mg luvox for 4 days and dropped back to 137 mg luvox on June 22 2018 (sorry I will correct my signature). 

 

Yes luvox did help me sleep. The sleep issue slowly improved as my Cortisol dropped back down to normal at night but that took 6 months!! 

 

 

[ChessieCat]

2 minutes ago, EnoughAlready said:

luvox adjustments - 25mg luvox December 2017- 15 February 2018, 16 February 2018 increase to 50mg luvox, 23 Feb 2018 increase to 75mg luvox, April 7 2018 increase 100mg luvox, June 29 2018 increase to 125mg luvox, June 18 2018 increase to 150mg luvox for 4 days and dropped back to 137 mg luvox on June 22 2018

The short version.  Don't forget to include the year the next time you make a change.

 

Luvox:  Dec 2017 to 15 Feb 2018, 25mg; 16 Feb, 50mg; 23 Feb, 75mg; 7 Apr, 100mg; 29 Jun, 125mg; 18 Jun, 150mg; 22 Jun, 137mg;

[ChessieCat]

Mirtazapine 15 mg February 2018 to present day 

Increased from 15mg of 30mg of mirtzapine for 3 weeks in May 2018, then reduced back to 15mg

 

Mirtazapine:  Feb 2018, 15mg; May, 30mg (3 weeks); May/June, 15mg;

[EnoughAlready]

5 minutes ago, ChessieCat said:

The short version.  Don't forget to include the year the next time you make a change.

 

Luvox:  Dec 2017 to 15 Feb 2018, 25mg; 16 Feb, 50mg; 23 Feb, 75mg; 7 Apr, 100mg; 29 Jun, 125mg; 18 Jun, 150mg; 22 Jun, 137mg;

Sorry do you mean I need to write the dose changes in my signature? Will put the year in too. 🙂

[ChessieCat]

Luvox:  Dec 2017 to 15 Feb 2018, 25mg; 16 Feb, 50mg; 23 Feb, 75mg; 7 Apr, 100mg; 29 Jun, 125mg; 18 Jun, 150mg; 22 Jun, 137mg;

Mirtazapine:  Feb 2018, 15mg; May, 30mg (3 weeks); May/June, 15mg; 

 

If these are accurate dates and doses you can copy and paste them into your drug signature.  You only need to add the year for the first occurrence of it.

 

These were the instructions previously given:

 

Keep it simple.  NO diagnoses or symptoms please - thank you.

• details for last 2 years - dates, ALL drugs, doses
• summary for older than 2 years - just years and drug/s

Account Settings – Create or Edit a signature

[EnoughAlready]

Day 1

 

8.50am : woke. Hot and very sweaty, fell back asleep. Muscles in neck stay tense/stuck for 30 seconds

12.30pm: woke. Ear ringing, Apathy, DR/DP , S Ideation, numb head and parts of face, lack of sensation in body, numbed out stress response 

1 pm: lunch rice cakes and banana, salad and chicken

2pm: internal trembling in tummy until 2:15pm

3pm: Snack- steamed veggies. Small portion of beef. Some anxiety

4:30pm: feel like cant go on, S ideation 

5.23pm: internal trembling down left leg until 5:40pm S ideation

6pm: Small dinner-  chicken and salad. Can't taste properly (numbed out sense of taste), 

6:10pm: exhausted and spaced out

6.17pm S ideation, feeling like I cant go on

7pm: anxiety, worried about losing it

8pm: feeling a bit better. All symptoms seem a bit less intense

8:15pm snack: fried mushrooms and steamed veggies. small amount of beef.

10:30pm Luvox 137mg

11:30pm Mirtazapine 15mg

12am sleep

 

 

 

 

[EnoughAlready]

Day 2

 

10:30am woke. Ear ringing, DP/DR, some apathy, numb head and parts of face, lack of sensation in body, numbed out stress response (these are all day symptoms)

11am breakfast- rice cakes with banana

11:50am S ideation

12pm lunch, small portion of beef mince with salad. Some internal trembling in tummy.

12.44pm head pain

2.13pm internal trembling in tummy

2.30pm able to leave the house and go to shop briefly, though very anxious.

3:30pm snack- salad and rice cakes

3.50pm low mood

4pm S ideations

4:15pm Exhausted and very drowsy, internal trembling

6pm: Dinner, small portion of beef and steamed veggies

6:22pm s Ideations, head pressure and feeling like my head is blocked

6:42 more drowsy, S ideations

8pm S ideations

9pm: snack frozen mango and frozen blueberries and coconut yogurt

10.30pm Luvox 137mg.  S ideations, anxiety

11pm internal trembling

11:30pm mirtazapine 15mg

1am sleep

 

[EnoughAlready]

Day 3

 

9.50am -woke. ear ringing, DP/DR, some apathy, numb head and parts of face, lack of sensation in body, numbed out stress response (these are all day symptoms)

11:30am -S ideations, feel like Im going to lose it, terror and anxiety, internal trembling

11:40am breakfast. Banana and rice cakes.

2pm- lunch, beef with veggies. Some head pressure. crawling feeling on my skin. S ideations.

2.24pm- feels like some of my memory is coming back of things I did in the past (before withdrawal).

4pm S ideations, internal trembling.

4.10pm went to get petrol for car. Very anxious.

4.45pm feeling like I cant go on, S ideations.

5.50pm S ideations, anxious.

6pm dinner- beef with salad.

8pm snack- coconut yoghurt, frozen mango

10.50pm s Ideations

11pm internal trembling

11.41pm internal trembling

2.30am had trouble falling asleep. anxiety.

 

[EnoughAlready]

Perhaps an updose of 0.5 mg might be safer?

I am coming up to nearly 9 months since I made the drop from 30mg mirtzapine to 15mg.

 

The hardest to cope with is the DP (loss of identity, numb emotions) and the lack of internal feelings in my body, as it is fairly consistent and I don't get a break from it. It hit at the 3 month mark. I feel like I can't go on. I haven't been able to see any of my friends for the last 6 months as the DR/DP makes me feel too weird and anxious. I'm so withdrawn. I can't leave the house much, I cant go shopping to get groceries. I have't told many people how bad it is because I cry when I talk about it. I've been feeling like I cant cope since the DR/DP hit at the 3rd month. I would not be considering updosing a tiny amount if I wasn't desperate. I just don't feel like I can keep going with this. I have kids I need to look after and I am barely present.

 

There have been improvements over the months- in that the low mood is not as bad, and there are other symptoms like mental torment that are better. The DP/DR was worse earlier on when it first hit, in that I had a month where things looked flat (2D) quite a bit and the light looked like it was wrong- like in a sci fi movie or something. 

 

When I first started on mirtzapine, I started at 7.5mg and it numbed out my stress response a lot which really upset me. But it passed. At 15mg I felt some derealisation, and it felt like my head was cut off from body. I also had anger. Those side effects passed after a few weeks, but I'm assuming that this is why I have the lack internal sensation and DR/DP issues- the same receptors have been effected in withdrawal.

 

I did not think that only being on 30mg for 3 weeks could cause such a mess. But at 30mg, the dose felt too strong and started making me cry all the time, caused weird anxiety and internal shaking. I dropped back down to 15mg as I was scared by the side effects. 

 

A couple of things I think are important is that the sleep affect wore off after 3 weeks each time I raised the mirtzapine. So Im assuming my body must have down regulated in that short time (3 weeks). I did notice that it only took me 3 days to adjust to my increases in luvox in the past. I could feel the down regulating/brain adjusting happening. I also want to mention I believe I am sensitive to medicine. Luvox doses are usually 50mg increases and I could only do 25mg or less and I really felt it. The same when I increased from 15mg mirtzapine to 30mg mirtzapine. I really felt it. I had no side effects from Luvox, apart from feeling tired. While mirtazapine had lots of side effects to start with.

The other thing is that when I went hyperthyroid from my thyroid meds in feb 2018, I feel like it hit my nervous system very hard as I had symptoms for months...in way I feel like it kindled my nervous system. At least that is my gut instinct.

 

I appreciate you reading this and taking time to consider advice about updosing. 

[Altostrata]

14 hours ago, EnoughAlready said:

The other thing is that when I went hyperthyroid from my thyroid meds in feb 2018, I feel like it hit my nervous system very hard as I had symptoms for months...in way I feel like it kindled my nervous system. At least that is my gut instinct.

 

Yes, that is what too much thyroid hormone would do.

 

Did you see the interaction between Luvox and mirtazipine? Is there any reason you take these drugs at the same time at night?

 

Please be sure to include time of day for your drug dosing in your daily notes.

[EnoughAlready]

Thank you for replying Altostrata. Yes, I saw that there is a possible interaction. So nice to have NOT been told this by the drs at the time! I think I googled it myself a while ago and asked them about it, but they dismissed it- as there was “only” 2 cases. One of which was a helpful augmentation. 

The only reason I take them both at night is because they make me tired (or used to), but luvox less so, and I’m not actually sure mirtz makes me tired now anyway. I will try spacing them apart more- perhaps one in morning one at night. Thank you for bringing that to my attention. 

 

If I do space them apart like that, is it worth trying a very minuscule updose?

 

[ChessieCat]

9 hours ago, EnoughAlready said:

I will try spacing them apart more- perhaps one in morning one at night.

 

The gentlest way to do this is to move one by 1 hour each day.

[Altostrata]

Yes, please move the Luvox by one hour earlier each day. Please keep daily notes showing the times of day you take your drugs and your symptoms. If we see an improvement in your symptom pattern, that will confirm you are suffering an adverse drug reaction and that you are fixing it.

 

Please post your daily notes here.

[EnoughAlready]

On 1/21/2019 at 4:19 AM, ChessieCat said:

 

The gentlest way to do this is to move one by 1 hour each day.

Yes that’s what I was thinking- 1 hour back a day. Which is what I started doing, so hopefully it helps.

[EnoughAlready]

On 1/21/2019 at 5:19 AM, Altostrata said:

Yes, please move the Luvox by one hour earlier each day. Please keep daily notes showing the times of day you take your drugs and your symptoms. If we see an improvement in your symptom pattern, that will confirm you are suffering an adverse drug reaction and that you are fixing it.

 

Please post your daily notes here.

Thanks Altostrata. There didn’t seem to be any problem taking the 2 close together from feb to May. The problems only started after the drop. But it’s defienly worth a try. 

[EnoughAlready]

Just looking for your thoughts about the small updose I tried. I tried 0.375mg increase of mirtzapine. I noticed I had internal vibrations/trembling start within about 20-30mins of taking that increase. It does stop after a a couple of hours. Does this mean I shouldn’t try an updose any higher? I’ve tried the updose for 4 days. Should I wait a week and see? 

Thank you in advance. 

[EnoughAlready]

Hi again, just hoping to have an admin reply to my last post. 😊

[Sassenach]

Hi Enough

It takes 4 days for any up dose to reach the brain  and a further 3 days to reach full state in the blood.

you should therefore keep at the present dose for a total of 7 to 10 days from the start before you know whether the up dose is working.

In the meantime could you please update your drug signature to include what is happening this year .

Sassenach

[ChessieCat]

Just now, Sassenach said:

It takes 4 days for any up dose to reach the brain  and a further 3 days to reach full state in the blood.

 

@Sassenach

 

It's the opposite.  It takes about 4 days for a dose change to get to full level in the blood and a bit longer for it to register in the brain.

[EnoughAlready]

Thank you. So I’m just wondering if the vibrations/shaking I got straight away after the small updose is a sign that I shouldn’t continue? It starts within half an hour of the updose.

[EnoughAlready]

I’m just trying to figure if that shaking/vibrating qualifies as an “adverse reaction”. 

[EnoughAlready]

Hi guys, I just need to know if I’ve done the right thing. 

I tried to updose by 0.375mg of Mirtzapine and stayed with it for 8 days. 
 

It caused the vibrations and they got a bit worse after 4 days, then at day 6 and 7 and 8 I started getting weird nasty anxiety in the morning. I dropped back down to 15mg and the symptoms stopped. 
 

Does that indicate the updose wasn’t going to work? 

I included the updose in my signature. I hope that I did it correctly? 
 

thank you 

[EnoughAlready]

Just bumping this to get some advice 

[Gridley]

On 1/6/2020 at 1:54 PM, EnoughAlready said:

It caused the vibrations and they got a bit worse after 4 days, then at day 6 and 7 and 8 I started getting weird nasty anxiety in the morning. I dropped back down to 15mg and the symptoms stopped. 
 

Does that indicate the updose wasn’t going to work? 

Given the fact that the vibrations got worse and that when you dropped to 15 the symptoms stopped, it looks like the updose. is not going to work.

[EnoughAlready]

Thanks Gridley. It seemed that the vibrations weren’t a significant “adverse effect”, so I wasn’t sure whether it was significant enough.