BfromNJ: mirtazapine taper

[BfromNJ]

23 minutes ago, ChessieCat said:

 

It is a fact that fluvoximine has a half life which is less than 24 hours.  That means that there will most likely be interdose withdrawal.  If you happen to be a fast metaboliser then you would experience a longer period of interdose withdrawal.  Someone who is a slow metaboliser would experience a shorter period of interdose withdrawal.

 

If it was me, I would be splitting my dose.  Note that you will be still taking the same dose.  Even though splitting your dose is classed as a change, it is only a very minor one, with the aim of eliminating interdose withdrawal which, if you are experiencing this (which I think is very likely because of the regularity of the symptom/improvement times you mentioned previously) then you will still be experiencing this if you continue on one dose and hold for a few months.

 

If you are concerned about doing this instead, of moving a portion by 1 hour each day you could move by 1/2 hour each day, or even 1/2 hour every second day or longer. 

 

Or even 1/4 hour (15 minutes) every day.  I know that sounds a bit fanatical, but if it lessens your anxiety about dose splitting then you do what you are comfort with doing and it will achieve the goal.

I see what you are saying. I do want to do this so I will seriously consider it.   I was just so fearful to rock the boat since I am doing better.  Thanks for this information.  Very helpful 

[Colonial]

1 hour ago, BfromNJ said:

the aim of eliminating interdose withdrawal which, if you are experiencing this (which I think is very likely because of the regularity of the symptom/improvement times you mentioned previously)

 

I agree.

 

And the good news is you would likely not have to wait until your dose is completely split apart by 12 hours to start seeing improvement, only as many hours as it takes to cover whatever is the interdose  deficit. You may find moving half of it back to 5pm covers the interdose and then you can move the rest of it back half an hour every 5-7 days or so. 

 

I completely understand not wanting to rock the boat if you think you are just starting to settle.

The problem is anything as simple as an ear infection needing antibiotics can come along and knock you for a loop. Covering the interdose is the best way to make sure something does not come along and send you for a rough time.

 

Good to hear from you! 

 

[BfromNJ]

15 hours ago, Colonial said:

 

I agree.

 

And the good news is you would likely not have to wait until your dose is completely split apart by 12 hours to start seeing improvement, only as many hours as it takes to cover whatever is the interdose  deficit. You may find moving half of it back to 5pm covers the interdose and then you can move the rest of it back half an hour every 5-7 days or so. 

 

I completely understand not wanting to rock the boat if you think you are just starting to settle.

The problem is anything as simple as an ear infection needing antibiotics can come along and knock you for a loop. Covering the interdose is the best way to make sure something does not come along and send you for a rough time.

 

Good to hear from you! 

 

So if I take it now at 10 pm, I would take 1/2 at 5 pm and 1/2 at 10 pm without gradually moving to the 5 pm?  Just straight up move it?  Or did you mean slowly move up to 5 pm ? Then start moving the 5 pm dose up earlier each day thereafter when i see fit? 

[Colonial]

I would start taking half of it earlier than 10pm but I would not go more than 1 hour to start.

Half 9pm, Half 10pm.

I would wait 3 days and note any symptom changes.

As long as nothing is too out of the ordinary, after 3 days move to:

Half 8  pm, Half 10pm, etc.

 

You can expect some symptoms as you are changing 50% of your med, that is normal.

The only issue is how much of a change You notice.

If nothing too out of the ordinary occurs make another change in 3 days.

 

As Chessie says, if you think the 1 hour change was too much, make the next change only half an hour earlier and wait 3 days.

 

The issue is since everyone's metabolism is different, there is no guarantee when you will cover the interdose mark completely. You do want to get to the 50% every 12 hours as soon as reasonably possible since even taking 50% only 6 hours apart will still give you 2 dips in brain chemistry close together which is not optimal for stabilization but the point was you shouldn't have to get 12 hours apart to see improvement.

 

As per my post on the 14th

 

Posted July 14 (edited)

If you are taking it at night, 11pm, than it would make sense to work the other way.

Otherwise, you'll be forcing yourself to get up in the night to take it.

 

If You start taking half at 10pm, then half at 11pm.

Then, after a few days, move it to 9pm and 11pm,

Then, after a few days, move it to 8pm and 11pm,

 etc.

 

Keep very good notes on symptom change since as Chessie said, if you go too fast you can get temporarily worse, but keeping good notes will also show improvements over time IF your issue is, Atleast in part, the interdose WD. 

Edited July 28, 2021 by Colonial

[Colonial]

Also, it seems since the 14th you've changed the timing of your dose from 11pm to 10pm.

 

This is fine per se, but once You start moving 50% of your dose back, your going to need to be consistent on when BOTH of your dosages are.  If it's up to an hour off from night to night, this will exacerbate any symptoms from the split dosing as now you may in effect be doing a 1 to 2 hour difference depending on what night it is.

 

Once you eventually get to the 50% every 12 hours and are stabilized, being off a bit here or there will not be as big of an issue, but it could be now at the beginning of changing a good portion of the dose. You don't want to accidentally make it harder than it needs to be and end up accidentally blaming your moving the earlier dose too fast when its the 2nd dose that's inconsistent pushing you over the edge into being symptomatic.

 

 

[BfromNJ]

33 minutes ago, Colonial said:

Also, it seems since the 14th you've changed the timing of your dose from 11pm to 10pm.

 

This is fine per se, but once You start moving 50% of your dose back, your going to need to be consistent on when BOTH of your dosages are.  If it's up to an hour off from night to night, this will exacerbate any symptoms from the split dosing as now you may in effect be doing a 1 to 2 hour difference depending on what night it is.

 

Once you eventually get to the 50% every 12 hours and are stabilized, being off a bit here or there will not be as big of an issue, but it could be now at the beginning of changing a good portion of the dose. You don't want to accidentally make it harder than it needs to be and end up accidentally blaming your moving the earlier dose too fast when its the 2nd dose that's inconsistent pushing you over the edge into being symptomatic.

 

 

I take it anywhere from 10- 11, depending on when I'm going to bed.  I'll have to be more consistent but I take it same time as my quietipine and that is dependant on when I go to sleep.  

[Colonial]

You could continue to take the quietipine  whenever you go to sleep. 

 

But getting the Flux stable at 10 or even 10:30 would be great until your stabilized.

Then when your morning dose is stabilized at 10am ish being  so strict on the night time may or may not be necessary.

 

Some people notice they are symptomatic for being just an hour or 90 minutes late one day.

Granted, You don't want to obsess and make yourself psycho somatic over the timing but it is important during changeovers to eliminate other reasons for destabilization.

 

[BfromNJ]

On 7/28/2021 at 7:27 PM, Colonial said:

You could continue to take the quietipine  whenever you go to sleep. 

 

But getting the Flux stable at 10 or even 10:30 would be great until your stabilized.

Then when your morning dose is stabilized at 10am ish being  so strict on the night time may or may not be necessary.

 

Some people notice they are symptomatic for being just an hour or 90 minutes late one day.

Granted, You don't want to obsess and make yourself psycho somatic over the timing but it is important during changeovers to eliminate other reasons for destabilization.

 

 

Okay. I have been taking it now at 10 pm.  And trying to be diligent on that.  Ideally Id like to take it at like 8 pm.  That way when i do split the dose i can take it 8 am and 8 pm.  Makes sense to do so before leaving for work.  

 

On another note - I am deficient in Vitamin D as evidenced by my recent bloodwork.  Dr wants me to take D.  I was taking it a few months ago for a short time during covid and being in the house more, I just thought it was a good idea.  But when i started having withdrawal issues and such a few months ago I decided to stop it.  I didnt pin point that it was causing any issues, but I wanted to err on the side of caution.  But I am wondering if some of my symptoms I am now experiencing are related to the deficiency.  So my point im bringing this up is that I think I will hold off on starting to move half my dose up and split it until I see how I do with the vitamin D.   I dont want to make more than one change at a time. 

[BfromNJ]

I am in a bad wave right now.  And I have to go to an appt with my new psych nurse today since my inpatient in June.   My anxiety is up because of some physical issues I have going on again. Have been to neurologist and I am going to be having an mri.     The pgad flared as well and im uncomfortable in my own skin.   I just know she will just tell me I need more meds.   Which of course is not going to happen.   Not looking forward to this at all.    

[ShiningLight]

Have you thought about saying something like, 'thanks for your thoughts on that.' Rather than saying how you really feel about it? Sometimes that can be very empowering and makes the person feel "appreciated" which shuts them up.

[Colonial]

These are usually great opportunities to share what we've learned here with those sort of "professionals" who aren't as informed. I did have a head scan because the migraines were so bad, and it was a "just in case" sort of thing, but I declined the neurologist since by what I had learned here I knew it was WD and as long as the MRI of my head was fine, my primary doctor was content with that.

 

To some extent, you will have to jump through "some" hoops with some tests to prove to the people writing your prescriptions that it really isn't anything other than WD.  If they just keep writing you scripts and you complain of serious symptoms and they don't suggest a specialist or scans and then you die of a brain tumor, their negligent. So to some extent a few basic tests to clear anything major is understandable but getting too bogged down in chasing a cause for every symptom, especially neurological ones tends to not be as productive.

 

While it is true that new symptoms can come at any time, since you haven't changed your dose, your wave and new physical symptoms still seem classic for inter dose WD.

 

The vitamin D, to my knowledge of reports, has never caused an issue so that should not be a problem.

 

Good luck!

 

[BfromNJ]

1 hour ago, Colonial said:

These are usually great opportunities to share what we've learned here with those sort of "professionals" who aren't as informed. I did have a head scan because the migraines were so bad, and it was a "just in case" sort of thing, but I declined the neurologist since by what I had learned here I knew it was WD and as long as the MRI of my head was fine, my primary doctor was content with that.

 

To some extent, you will have to jump through "some" hoops with some tests to prove to the people writing your prescriptions that it really isn't anything other than WD.  If they just keep writing you scripts and you complain of serious symptoms and they don't suggest a specialist or scans and then you die of a brain tumor, their negligent. So to some extent a few basic tests to clear anything major is understandable but getting too bogged down in chasing a cause for every symptom, especially neurological ones tends to not be as productive.

 

While it is true that new symptoms can come at any time, since you haven't changed your dose, your wave and new physical symptoms still seem classic for inter dose WD.

 

The vitamin D, to my knowledge of reports, has never caused an issue so that should not be a problem.

 

Good luck!

 

The neurologist was concerned enough to send me for an mri.   As im having burning on one side of my head.   He wants to check the trimengal nerve.    Also the tremors will show up if they are anything to be concerned with.      And if its clear so be it better safe than sorry I suppose.  This could be hormonal too since I'm heading into menopause.   I just dont want to also write everything off as WD in case something is wrong.  I did fine at the psych nurse appt.   She didn't push me into any new meds.   I said I'm sticking where I am.   If I find she starts to head that way ill move on.  

[Colonial]

You may find this thread of assistance to read through before your next visit since many of us do end up referred to neurologists.

 

It has a great list of symptoms of all the things we can suffer when our brains are short circuiting doing the recovery process and rebuilding new neural networks.

 

Neurologist's diagnosis of Functional Neurological Disorder and referral to http://neurosymptoms.org - Symptoms and self-care - Surviving Antidepressants

 

Welcome - neurosymptoms.org

[BfromNJ]

16 hours ago, Colonial said:

You may find this thread of assistance to read through before your next visit since many of us do end up referred to neurologists.

 

It has a great list of symptoms of all the things we can suffer when our brains are short circuiting doing the recovery process and rebuilding new neural networks.

 

Neurologist's diagnosis of Functional Neurological Disorder and referral to http://neurosymptoms.org - Symptoms and self-care - Surviving Antidepressants

 

Welcome - neurosymptoms.org

Thanks ill check it out.    I still want to try splitting my dose but just don't feel stable.   And im also confused on how it could be interdose withdrawal if I feel better the farther out I go from my last dose.   I know its got a short half life but wouldn't I feel worse the longer it goes? 

[BfromNJ]

As an add on to my above post @Colonial maybe feeling better later in the day the result of reduction in cortisol?   

 

But now that I think of it, sometimes my day can be up and down, so who the heck knows?  Its maddening really.  Lol 

[Colonial]

 

3 hours ago, BfromNJ said:

 And im also confused on how it could be interdose withdrawal if I feel better the farther out I go from my last dose. 

Your taking it at night.

A great majority of people report feeling better in the last few hours of their day before sleep.

 

3 hours ago, BfromNJ said:

I still want to try splitting my dose but just don't feel stable.

Understood, but if the reason your not stable is from interdose wd, you can be prolonging feeling better.

 

3 hours ago, BfromNJ said:

 I know its got a short half life but wouldn't I feel worse the longer it goes? 

 

These meds really arent completely like that.

There not like aspirin where you take it and feel better and then the pain comes back when they wear off.

 

Your brain and body is used to you taking it once in a 24 hour period, as well as the other meds.

When we have interdose wd,  symptoms are a result of that.

 

23 minutes ago, BfromNJ said:

maybe feeling better later in the day the result of reduction in cortisol?   

Whatever the process, the last few hours of a persons day are often their best, regardless of when certain people are dosing their meds.

 

Your symptoms are classic for the wd process, and while it is true depending on when your taking the med, morning or night, can affect what type of symptoms you have and when, it does not hold that interdose wd symptoms will always be worse the further out from the dose.  Your body is trying to continually compensate for the issue. It's causing the cortisol spikes in the morning when you still have it in your system.

 

Anyway, I wont bring it up again. I don't want to seem like I'm badgering you to do something your not yet comfortable with. All I can say is I have never seen someone report getting worse if they go about it properly, say one hour at a time every few days. Only better.

 

[BfromNJ]

2 hours ago, Colonial said:

 

Your taking it at night.

A great majority of people report feeling better in the last few hours of their day before sleep.

 

Understood, but if the reason your not stable is from interdose wd, you can be prolonging feeling better.

 

 

These meds really arent completely like that.

There not like aspirin where you take it and feel better and then the pain comes back when they wear off.

 

Your brain and body is used to you taking it once in a 24 hour period, as well as the other meds.

When we have interdose wd,  symptoms are a result of that.

 

Whatever the process, the last few hours of a persons day are often their best, regardless of when certain people are dosing their meds.

 

Your symptoms are classic for the wd process, and while it is true depending on when your taking the med, morning or night, can affect what type of symptoms you have and when, it does not hold that interdose wd symptoms will always be worse the further out from the dose.  Your body is trying to continually compensate for the issue. It's causing the cortisol spikes in the morning when you still have it in your system.

 

Anyway, I wont bring it up again. I don't want to seem like I'm badgering you to do something your not yet comfortable with. All I can say is I have never seen someone report getting worse if they go about it properly, say one hour at a time every few days. Only better.

 

Oh you are far from badgering me.   If anything im doing the badgering.  Lol.  You have been a big help and great resource of information.   Thank you.  I just need to decide on a time to do it.   I'm reassured that you say you have not seen anyone report getting worse doing so.  So splitting such a small dose im on is not an issue?  

[Colonial]

I just meant it's important for all of Us to feel comfortable with a move before we make it, otherwise if we even have a little bit of extra anxiety about it, we can raise our cortisol more and accidentally be the reason we make ourselves worse. 

 

It's hard to know when you should continue to recommend something if continued posts seem to reiterate what you may think is happening and when you've crossed the line into being bossy. 🙂 

 

That being said, nothing is a complete cure all, but any positive relief and every bit closer we can get to stabilization really helps the positive thinking and self assurance, which helps lower the stress and becomes a positive feedback loop.

[BfromNJ]

16 hours ago, Colonial said:

I just meant it's important for all of Us to feel comfortable with a move before we make it, otherwise if we even have a little bit of extra anxiety about it, we can raise our cortisol more and accidentally be the reason we make ourselves worse. 

 

It's hard to know when you should continue to recommend something if continued posts seem to reiterate what you may think is happening and when you've crossed the line into being bossy. 🙂 

 

That being said, nothing is a complete cure all, but any positive relief and every bit closer we can get to stabilization really helps the positive thinking and self assurance, which helps lower the stress and becomes a positive feedback loop.

Thank you again.  I jut noticed your picture - this too shall pass".  Ive been saying it to myself and trying to make it my mantra.  gotta be a sign.  

[BfromNJ]

@Colonial

@brassmonkey

@ChessieCat

so i think I want to get this splitting of my dose started.  Although I don't feel very well right now and Im in a wave, I figure how much worse can it get?  I am on such a small dose right now of it (10 mg), so my concern was it being so tiny of a dose if it made sense.  Meaning - would taking such small doses twice a day do more harm?  Does that make sense?  My thought was that its not enough at each dose.  I will admit i am scared.  I feel like i my brain will be looking for the full amount at a given time and I am only going to be giving it half.  How can that not induce worse withdraw? 

 

But I hold out hope that this will be beneficial.  

 

So, if I move up half by one hour, how many days do i do that for?  3 or 4?  longer? 

 

I was reading online that fluvoximine is usually split in two doses when the doses is 100 mg or higher.  Thats why my question above about the doses being so small.  

 

And I assume I will be holding on making any decreases for a while now if I am going to do this.  

 

I hope this helps! 

 

 

[BfromNJ]

@colonial

@ChessieCat

@brassmonkey

Sorry to be a bother again.  lol.  Since I will be splitting my dose soon and going down pretty low at each dose, I wanted an opinion on the scale that I have been using for some time now.  It seems to have worked quite well.  What do you all think?  Its okay for getting to low doses?  The Gemini one i had trouble with.  2 of them quit on me very early into using.  

https://www.amazon.com/gp/product/B07WDVDNX6/ref=ppx_yo_dt_b_search_asin_title?ie=UTF8&psc=1

 

 

[brassmonkey]

You want to move it every few days, like three or four. 

 

Those scales should work fine, but Amazon lists them as "unavailable".

[Colonial]

5 hours ago, BfromNJ said:

I am on such a small dose right now of it (10 mg), so my concern was it being so tiny of a dose if it made sense.  Meaning - would taking such small doses twice a day do more harm?  Does that make sense?  My thought was that its not enough at each dose. 

 

Phrases like "small dose" is relative from one med to another and can be misleading.

10 mgs can be doing a lot more in a brain than we realize.

For many of these meds, each mg is not interacting equally with your brain.

 

I can't find a chart off hand about your med but you can look at this one for reference and understanding:

The beginning mgs are interacting with more receptors than the latter.

Only 1 mg of prozac is needed to lockdown 30% of the brain,

while doubling from 10 to 20 mgs only moves from 72 to 78 percent interaction.

 

This is why reinstatement at small amounts can be sufficient to stabilize out of WD.

 

5 hours ago, BfromNJ said:

So, if I move up half by one hour, how many days do i do that for?  3 or 4?  longer? 

 

As for the questions on timing, please refer back to my posts on July 14 and the 28th and Chessie's post on July 27th, it's all answered there. GOOD LUCK!

 

 

 

Prozac blockage chart

 

% of 1 pill(20 mg)	Dosage in mg Prozac	% blockage serotonin receptor (SERT)
100	20	78
50	10	72
25	5	62
12,5	2,5	48
10	2	44
7,5	1,5	37
5	1	29
4	0,8	25
3	0,6	20
2	0,4	14,5
1,5	0,3	11
1	0,2	8
0,5	0,1	4
0,25	0,05	2
0,1	0,02	0,9
0,05	0,01	0,5

 

As for the questions on timing, please refer back to my posts on July 14 and the 28th and Chessie's post on July 27th, it's all answered there.

[BfromNJ]

3 hours ago, brassmonkey said:

You want to move it every few days, like three or four. 

 

Those scales should work fine, but Amazon lists them as "unavailable".

Actually that is the scale I'm using.  Just wanted to see if it was ok. 

[BfromNJ]

13 hours ago, BfromNJ said:

Actually that is the scale I'm using.  Just wanted to see if it was ok. 

@brassmonkey.  I am down to 10 mg (or so) with the pill weight being .052 on the scale.  Are these scales accurate enough when you get down really low?  at one point should i be concerned?  

[BfromNJ]

@brassmonkey

@Colonial

@ChessieCat

 

I am having a hard time crushing my current fluvoximine pills.  I have the 50 mg ones now because that is the last thing they prescribed to me.  And the coating on them is thicker and harder to crush then the 25 mg i had.  I end up with big chunks of it mixed in with the powder.  I use a pill crusher, then i pour it out and crush it with a spoon on paper.  But i still cant get it all crushed up evenly.  This wont affect the amount that i am pouring into each capsule will it?  will it make it uneven? Should i just cut with a razor instead of crushing?  I feel like crushing is better?  

 

Not comfortable with going to a liquid. 

[Colonial]

You can try cutting the rest with the razor blade so that you can mix the entire pill well before separating it up into the capsules. Can you Inquire if You can get a new script of the lower dose if that was easier for you?

 

[BfromNJ]

1 hour ago, Colonial said:

You can try cutting the rest with the razor blade so that you can mix the entire pill well before separating it up into the capsules. Can you Inquire if You can get a new script of the lower dose if that was easier for you?

 

Yes I will do that.  Good idea.  

[brassmonkey]

Those scales should be accurate down to about 0.005mg on the readout. So you have a ways to go before you really need to be concerned. I would really start paying attention at about 0.010 on the readout.

 

Crush the pills as best as you can. If there are big pieces of just the coating they can be picked out and thrown away. Because you are using the powder as a "supply pile" that will make no difference in the dose.

[BfromNJ]

4 minutes ago, brassmonkey said:

Those scales should be accurate down to about 0.005mg on the readout. So you have a ways to go before you really need to be concerned. I would really start paying attention at about 0.010 on the readout.

 

Crush the pills as best as you can. If there are big pieces of just the coating they can be picked out and thrown away. Because you are using the powder as a "supply pile" that will make no difference in the dose.

So by paying attention what do you mean?  What do I need to be concerned about?  It won't be accurate? 

[brassmonkey]

When you get to the smaller doses the scales can be more erratic in their readout so it is harder to hit the exact number you are trying for. Putting the calibration weight on them and pressing TARE will help put the scales in the middle of their range which is more stable and tends to be a little more accurate.

[BfromNJ]

10 minutes ago, brassmonkey said:

When you get to the smaller doses the scales can be more erratic in their readout so it is harder to hit the exact number you are trying for. Putting the calibration weight on them and pressing TARE will help put the scales in the middle of their range which is more stable and tends to be a little more accurate.

Do I then leave  the calibration weight on it and add the med? Or do I remove it then add my med?  Do I need to do it each time a measure a dose?  I realize I may be jumping the gun a bit.  

[brassmonkey]

Yes, the weight stays on the scale while you weigh out the dose, and you do it each time you make up a new dose.

[BfromNJ]

@Colonial

 

Started the dose splitting tonight.  Hope all goes well .  I just hope its long enough after my last dosing change.    I was updosed alot inpatient about 7 weeks ago but only four days at 50 mg .  I then went back down to 10 mg.  I wasn't sure if I have given enough time for things to settle. Hopefully I'm good. 🤞

[Colonial]

I don't think it's too much an issue of "waiting enough time to settle" if the reason your not settling is partly the inter dose WD.  Again, this isn't a cure all and we're not blaming all of your symptoms on the inter dose but done properly we have never had anyone report drastic problems.

 

As long as You don't rush it you'll be fine, your only reallocating 50% of your dose.  It's not like your changing all of your dose to the morning in only a weeks time. Just keep the evening dose as rigid as you can and you'll do great! 🙂

[BfromNJ]

17 hours ago, Colonial said:

I don't think it's too much an issue of "waiting enough time to settle" if the reason your not settling is partly the inter dose WD.  Again, this isn't a cure all and we're not blaming all of your symptoms on the inter dose but done properly we have never had anyone report drastic problems.

 

As long as You don't rush it you'll be fine, your only reallocating 50% of your dose.  It's not like your changing all of your dose to the morning in only a weeks time. Just keep the evening dose as rigid as you can and you'll do great! 🙂

I have set a timer on my phone for both doses.  lol.   I hope to see some relief as I move closer to the am dose, even maybe before getting all the way there.