BfromNJ: mirtazapine taper

[Colonial]

For most meds it's not too many hours to cover the lapse.

 

The one med I was on was 19 hours, so once you cover that 5 hours one can see improvement before getting the dose all the way spread out, even though it is still best to do so, since you don't want 2 drops in chemistry close to each other.  If one is taking a 19 hour med every 12 hours, your 2 drops in concentration are further apart than if your taking them closer together.  

 

(Edited)

Edited August 19, 2021 by Colonial

[BfromNJ]

18 hours ago, Colonial said:

For most meds it's not too many hours to cover the lapse.

 

The one med I was on was 19 hours, so once you cover that 5 hours one can see improvement before getting the dose all the way spread out, even though it is still best to do so, since you don't want 2 drops in chemistry close to each other.  If one is taking a 19 hour med every 12 hours, your 2 drops in concentration are further apart than if your taking them closer together.  

 

(Edited)

Mine is only 12-13 hours I think, so i really wont get down to the point of covering the difference until I am at 10 am.   Im just still really nervous because I feel like ive messed up so bad with my dosage up and downs the last 6 months or so.  I really hate the uncertainty.  And then of course I go online and I read.  One place I saw was that fluvoximine is given in two doses only if its over 100 mg a day.  And under that its once a day.  Which I dont understand.   Or alot of sites say just one dose at bedtime.  But maybe they are referring to the extended release? I would like to see on here people who have changed their doses to twice a day and how they have done.  do you know any off hand or how i would search it?

 

Also, I think you originally sugested i do one hour each night (or maybe chessie did).  I am doing every 3 days.  Is that okay or is it too prolonged? 

[BfromNJ]

@Colonial

 

As an addition to my above post, I wanted to share that the last two days I have had a lessoning of symptoms and some improvement in how i feel.  So maybe just maybe i am finally settling down since my last reduction.  Yay!  This  of course makes me question whether I shouldnt just leave things where they are right now.  I dont think that just splitting my dose and moving up for one hour for two nights would give me relief that fast.    I hate how i question so much, but its just how my brain works.   These drugs and the uncertainty just plain scares me.  Ill admit it.  Its so nice to have a window of feeling better.   I thank you again for all your help and guidance.  

[Colonial]

On 8/17/2021 at 4:00 PM, Colonial said:

 

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.

 

On 8/17/2021 at 7:21 PM, BfromNJ said:

On 8/17/2021 at 3:25 PM, brassmonkey said:

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

 

That's great your having a window.

You will have some of those for hours or days and then the waves again.

 

If your med only stays in your system 12 hours, now that your sensitized it's likely to cause Inter dose issues.  Recommendations for Dosing at 100mg levels has to do with what the manufacturer "believes" is revolving around therapeutic issues. It doesn't really have much to do with treating WD. or a sensitized nervous system.

[BfromNJ]

37 minutes ago, Colonial said:

 

 

That's great your having a window.

You will have some of those for hours or days and then the waves again.

 

If your med only stays in your system 12 hours, now that your sensitized it's likely to cause Inter dose issues.  Recommendations for Dosing at 100mg levels has to do with what the manufacturer "believes" is revolving around therapeutic issues. It doesn't really have much to do with treating WD. or a sensitized nervous system.

Okay. I think its just fear that am going to get worse, having had a really hard couple of months.    And i wanted to ensure ive waited long enough after my updosing and reduction messes from 7 weeks ago.  I was trying to find some members on here who had success in splitting and I couldnt.   I did happen to see someone who did this with paroxitine and they had a bad experience and went back to once a day.  Not sure if it was because of the split or maybe this particular person had other things going on.  I know its not a good idea to not believe everything you read, but I try and look for sucess stories. Do you know any other members whom this worked out for?  

[Colonial]

It's worked for me and many other members we've suggested to.

I don't remember anyone getting worse from JUST split dosing properly.

 

If they were doing too many things at once or just happened to have a wave at the same time?

It's possible. But we also have people "mis diagnosis" their issues as to what is making them worse as well. 

Because the suffering is so bad, people tend to want to blame the very last things they did as the reason a new wave hit them, without realizing a wave can just as much be a sign of healing as the brain starts making new connections and pathways.

 

I don't have a list per se, but my concern is your too worried about the outcome of others cases in deciding what is best for you.  There's always going to be a negative story somewhere for any move attempted, it's just the law of averages and other people's cases are all one of a kind. People aren't always completely honest with what they've done and we can find out down the line the issue most likely wasn't the med adjustment but the fact they went out and binge drank alcohol all weekend, etc. Other people's stories are only as reliable as other people are honest in their reporting, and many times people don't know what they should or should not be mentioning or are too embarrassed to do so.

 

All I can say is spreading your meds out evenly has always seemed to give the best reward in the quickest amount of time with the least amount of members saying it backfired and without needing an up dose.  The key is to go slow with moving the 50% and knowing the change will give some changes is symptom patterns, but that's to be expected and will even out over time.

[BfromNJ]

1 minute ago, Colonial said:

It's worked for me and many other members we've suggested to.

I don't remember anyone getting worse from JUST split dosing properly.

 

If they were doing too many things at once or just happened to have a wave at the same time?

It's possible. But we also have people "mis diagnosis" their issues as to what is making them worse as well. 

Because the suffering is so bad, people tend to want to blame the very last things they did as the reason a new wave hit them, without realizing a wave can just as much be a sign of healing as the brain starts making new connections and pathways.

 

I don't have a list per se, but my concern is your too worried about the outcome of others cases in deciding what is best for you.  There's always going to be a negative story somewhere for any move attempted, it's just the law of averages and other people's cases are all one of a kind. People aren't always completely honest with what they've done and we can find out down the line the issue most likely wasn't the med adjustment but the fact they went out and binge drank alcohol all weekend, etc. Other people's stories are only as reliable as other people are honest in their reporting, and many times people don't know what they should or should not be mentioning or are too embarrassed to do so.

 

All I can say is spreading your meds out evenly has always seemed to give the best reward in the quickest amount of time with the least amount of members saying it backfired and without needing an up dose.  The key is to go slow with moving the 50% and knowing the change will give some changes is symptom patterns, but that's to be expected and will even out over time.

I know.  Dont always believe what you read on the internet.  lol. My therapist tells me this.  its actually my homework for the week, to stop googling certain things and worrying.  But when you have an issue that is pretty debilitating (such as pgad), its really hard not to have fear that it will get worse.   

 

Is it possible I am already feeling better just from the move up one hour?  Probably not right?  

[Colonial]

I doubt it if it's only a 12 hour mediation unless taking action is having a positive effect in lowering your anxiety as your taking proactive steps to better health.

 

But no one is going to be able to tell you when you should or should not start feeling better or how long it's going to take.

 

Be happy Your having a nice wave and hopefully as you get closer to evening out the med half way and the lower the amount of time your system is going without it You should continue to improve.

[BfromNJ]

3 minutes ago, Colonial said:

I doubt it if it's only a 12 hour mediation unless taking action is having a positive effect in lowering your anxiety as your taking proactive steps to better health.

 

But no one is going to be able to tell you when you should or should not start feeling better or how long it's going to take.

 

Be happy Your having a nice wave and hopefully as you get closer to evening out the med half way and the lower the amount of time your system is going without it You should continue to improve.

One more question - sorry.  lol.  Is it better to go faster when splitting, like an hour a day, or longer like every three days?  I wasnt sure if longer is better or not like with a reduction . Thanks! 

[Colonial]

Once again, I'm going to have to ask you to go back and read the posts from Chessie and myself from July.

 

[BfromNJ]

5 minutes ago, Colonial said:

Once again, I'm going to have to ask you to go back and read the posts from Chessie and myself from July.

 

I did.  I just saw a few different suggestions.  I was only wondering if when one is splitting if its better to go faster, as a general rule.  .  Like if there is  If its different than a reduction.    Im sorry im bothering you.  Im a nervous nelly.  Im under alot of stress so I want to ensure I can handle the change. I mean no harm. Lol.  

[Colonial]

I reposted a quote from Brassmonkey just an hour ago, did you see it?

 

[BfromNJ]

21 minutes ago, Colonial said:

I reposted a quote from Brassmonkey just an hour ago, did you see it?

 

I did. 3-4 days.   Sorry yes it was more a question of generally whats the better way faster or slower with a split.   But i guess that is also dependant on the individual.   Thats all.  Sorry again to be a pest.  Im experiencing stressors in my life, i may lose my job due to vaccine mandating and its not helping with also trying to manage my med changes.  Not making an excuse just its not helping to get me in the right mindset.  

[BfromNJ]

@Colonial

@ChessieCat

So I panicked last night over the split and just took my dose as regular at 10pm instead of 9 and 10.  I realize I need to get past my fear.  So if I wanna still do this can I proceed?  Do I need to wait maybe I messed myself up? 

 

Very bad symptoms today but I hope its just a coincidence.   

[Colonial]

 

It seems your letting your fears run your decisions and until that is worked out even the best advice will not help if your not able to stick to a regime and realize waves and windows are going to come of their own accord and not necessarily be a result of the last move you made. First you were asking if the good day you had was the result of moving half of it forward one hour and now your wondering if todays bad symptoms are connected. 

 

The problem is until your secure in wanting to commit to a certain move, this sort of back and forth can make you worse and not better.  If your going to "panic" that will make your symptoms worse. This is why I mentioned I don't want to be trying to talk you into doing something before your ready or this is what can happen. You have to be making changes that you believe are in your best interest, otherwise if you go through a rough spot your going to let the anxiety double guess your decisions, you'll panic and be making non productive drug changes

 

Now, Missing one night is not a problem if you want to continue to restart the moving tonight, you only just started. But you need to make up your mind one way or another.  If your not ready to commit to doing this yet, then hold off, you haven't  done anything yet to be problematic one way or the other but if you get 2 weeks into this and have half your med moved 5 hours that is different.

 

I'm not really sure what else I can offer You in the way of peer support on this, since I think it's counter productive to try to examine every fear or possibility that comes along because it gives power to the fear and that produces the symptoms. You also ask questions that really have no firm answers and we aren't trained psychotherapists to know the best way to assist you outside Our small window.

 

 

 

 

[BfromNJ]

30 minutes ago, Colonial said:

 

It seems your letting your fears run your decisions and until that is worked out even the best advice will not help if your not able to stick to a regime and realize waves and windows are going to come of their own accord and not necessarily be a result of the last move you made. First you were asking if the good day you had was the result of moving half of it forward one hour and now your wondering if todays bad symptoms are connected. 

 

The problem is until your secure in wanting to commit to a certain move, this sort of back and forth can make you worse and not better.  If your going to "panic" that will make your symptoms worse. This is why I mentioned I don't want to be trying to talk you into doing something before your ready or this is what can happen. You have to be making changes that you believe are in your best interest, otherwise if you go through a rough spot your going to let the anxiety double guess your decisions, you'll panic and be making non productive drug changes

 

Now, Missing one night is not a problem if you want to continue to restart the moving tonight, you only just started. But you need to make up your mind one way or another.  If your not ready to commit to doing this yet, then hold off, you haven't  done anything yet to be problematic one way or the other but if you get 2 weeks into this and have half your med moved 5 hours that is different.

 

I'm not really sure what else I can offer You in the way of peer support on this, since I think it's counter productive to try to examine every fear or possibility that comes along because it gives power to the fear and that produces the symptoms. You also ask questions that really have no firm answers and we aren't trained psychotherapists to know the best way to assist you outside Our small window.

 

 

 

 

I understand. You are right.  Sorry again.  My concern really is if my symptoms are interdose or side effects.   Feeling better as the day goes on throws me off.   And if its side effects will splitting help or hurt?  That's where I am really at.  And I need to be certain of my decision I guess regardless.  

[ChessieCat]

Side effects are dose related, so the higher the dose the more side effects you might get.  If you are taking a high dose of a drug then dividing the dose MIGHT help to reduce the side effects a bit, but you would most likely still experience side effects.

 

Interdose withdrawal is related to when the drug is taken, not the total dose.  When you split the dose over a 24 hour period you are still taking the same dose.  This might help you to understand interdose withdrawal.  This analogy uses food.  Calories = energy for the body.

 

You are allowed to eat 2000 calories each a day (a 24 hour period).  You eat all of those calories at one sitting and it takes 6 hours to use the energy that it provides.  There will be 18 hours where your body is not receiving any energy from food.

 

The sensible thing would be to divide up the calories to eat throughout the day.  Ideally you would consume 500 calories every 6 hours.  In reality when we sleep our body does not require as much energy so it is okay and more convenient to split the 2000 calories into amounts to eat throughout the waking part of the day.

 

At this time you are taking your drug at one time.  We know that you are taking a drug with a half life that is less than 24 hours.  This is a fact.  You may also be experiencing side effects.  This is not a fact but a possibility.  Because the drug gets to a lower level in your body before the end of the 24 hour period, there is a period of time during the 24 hours where the dose of the drug "dips".  This can be compared to how we get "dips" during the day when our blood sugar levels drop.

 

Splitting your dose is very low risk, especially when moving by no more than 1 hour or less each day or every few days.  Splitting your dose is to correct something which is a known fact, the half life shorter than 24 hours.

 

Once you split your dose and so reduce or eliminate interdose withdrawal then it will be easier to work out whether you are experiencing side effects of the drug.

[ChessieCat]

Another way of understanding it.

 

My drug Pristiq, when taken as a standard tablet dose, is formulated to last for a 24 hour period so interdose withdrawal does not occur.  Sometimes I would forget to take my tablet and I would get brain zaps, which was a withdrawal symptom for me.  This is interdose withdrawal.  However we think of it as missing a dose or skipping a day, not interdose withdrawal, but it is exactly the same thing.

[BfromNJ]

19 hours ago, ChessieCat said:

Another way of understanding it.

 

My drug Pristiq, when taken as a standard tablet dose, is formulated to last for a 24 hour period so interdose withdrawal does not occur.  Sometimes I would forget to take my tablet and I would get brain zaps, which was a withdrawal symptom for me.  This is interdose withdrawal.  However we think of it as missing a dose or skipping a day, not interdose withdrawal, but it is exactly the same thing.

Thank you.   You ended up splitting your dose right?  Did you do everyday or every other day move up? I am going to get the split going again.   Making my pills up today.   I did want to ask -  i crush and put my powder in capsules now.    When you get lower or just in general,  what is the more "accurate " method?  Crushing or just cutting the tablet with a razor.    I want to ensure I'm being as accurate as I can be.  

[Colonial]

2 hours ago, BfromNJ said:

 Making my pills up today.   I did want to ask -  i crush and put my powder in capsules now.    When you get lower or just in general,  what is the more "accurate " method?  Crushing or just cutting the tablet with a razor. 

 

Please review your thread from the 18th:

 

8/18/21 BdromNJ:  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?

 

On 8/18/2021 at 1:47 PM, 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.

 

Brassmonkey: 

Posted Wednesday at 03:24 PM

 

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]

6 minutes ago, Colonial said:

 

Please review your thread from the 18th:

 

8/18/21 BdromNJ:  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?

 

On 8/18/2021 at 1:47 PM, 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.

 

Brassmonkey: 

Posted Wednesday at 03:24 PM

 

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.

I do recall. It was just a general question as to what the more accurate method was.  In general.  This previous post was because I was having an issue with my tablets and was afraid it wouldn't be accurate because of the large chunks of coating  .  I didnt think was asking the same thing .  

[Colonial]

There really is no one most accurate method per se.

Whatever works best depending on one pill to the next and the tools you are using.

 

 

 

[BfromNJ]

2 minutes ago, Colonial said:

There really is no one most accurate method per se.

Whatever works best depending on one pill to the next and the tools you are using.

 

 

 

I'm getting 25 mg pills from doctor as I think you or maybe brassmonkey suggested . So they will be easier to crush up.  Thinner coating like I used to have 

[BfromNJ]

A bad wave of two days.   Still planning the split dosing tonight.   Off to the races.  Therapy Tuesday to help with my fears.  🙏

[BfromNJ]

I seem to be on day 3 of a really bad wave right now.  I am hoping its not from the few split dose days I did.  i split dosed on 8/18, 8/19 got nervous about it because of feeling still unstable,  then went back to regular dose 8/20 & 8/21.  And last night split dosed again.  Which I plan on continuing.  I need to get over the fear and just have failth it will be for the best.  but these last 3 days have been awful.   I shouldn't feel much difference already right at just an hour apart for a few days?  It is probably just a wave and a coincidence?  I only ask because I dont want to go to the negative thinking of "oh this is from the splitting.   It cant be already that I would feel like this from such a small change?  I know there is no way to know for sure but im trying to approach this change as a positive one.  and that this wave is just a coincidence.  The pgad is really the worst of it.   I can ride out the other stuff.  

 

I am doing 1/2 @ 9 pm and 1/2 @ 10 pm.  

[BfromNJ]

I am still contemplating whether i want to go an hour up each day in my dose split or maybe every other day or every 3 days.    I know its slow and steady with a reduction, but for dose splitting it does seem like its important to get there sooner than later?    If i do everyday can I always slow it down or do i need to proceed at that pace?   

[ChessieCat]

I am going to be very blunt.  You are overthinking this dose splitting issue.

 

You have been given a lot of excellent information about how to do this and also detailed explanations of the differences between interdose withdrawal and side effects.

 

The sooner you get your doses split the sooner you will be eliminating interdose withdrawal as an issue and I imagine that you will start to feel some improvement fairly quickly.  Please note that you may still experience side effects, but they will most likely reduce as you reduce you dose later on, ie not at this time.

 

DO NOT make any other changes at the same time as moving your doses.

 

BUT the reason you do it in small steps is so that the brain is less likely to notice the dose time difference.

 

I think the simplest way for you to do it is to move part of your dose by 1/2 hour every day.  I also think that this would be the better way for you to do it to reduce the anxiety you have about doing it.

 

As Colonial posted before, you need to make the decision to move it and to keep doing it.

 

If you have every missed taking your dose for one day, ie skipped a day completely, then that is really bad.  Moving a part of your dose by 1/2 hour each day will most likely not even be noticed by the brain.

 

You also need to keep yourself as calm as possible during the dose splitting process.

 

And to answer your question.  I did not bother moving my doses apart gradually.  I did it in one go with no issues.  It might be okay for other members to do the same thing, however we usually suggest that it is done as a gradual process to reduce the risk.  It also reduce the anxiety that a person might feel about splitting their dose.

 

If you are still unsure about what to do I suggest that you get a pencil and paper and work through your topic from the beginning and jot down notes.

 

You could also divide a page into 2 columns and write pros and cons about the dose splitting.

 

Sometimes we need to get the thoughts out of our brain so that we can think more clearly.  When the thoughts go around and around inside our brain it can be difficult to work out what we need to do.  It seems that you might be trying to "think out loud" with the posts that you are making.

 

Even just the act of writing down the dose schedule for the process might help because it will be a solid plan on paper.

 

As previously stated you have been given all the information that you need to do the dose splitting.

 

Only you can make the decision about what and how to do it.

[BfromNJ]

I understand.  Also understand your bluntness.. ive already done one night at an hour. Tonight I'll move that up 1/2 hour.  Alarms are set!  

 

Thank you.   Sorry to be a nuisance.  Pgad is a hard symptom to deal with.  

 

 

[BfromNJ]

I tried to search for it and the link to it may have been posted by someone on my thread, but I cant find the subject about how to talk to your doctor about withdraw, etc.  I think there is a forum subject on it?  Ill keep looking but not having luck for some reason.  

 

update - nevermind i found it - i didnt know how to delete this comment. 

[brassmonkey]

Let's keep your question and this answer incase someone else is looking:

 

https://www.survivingantidepressants.org/topic/20161-how-to-talk-to-a-doctor-about-tapering-and-withdrawal-what-to-expect/

 

[BfromNJ]

Oh how i cant wait to see if this dose splitting gives me some relief, cause time alone sure isn't helping.  I am trying my best to think positive and have faith in it.  

[BfromNJ]

@ChessieCat

@Colonial

 

I've been keeping track of my symptoms and pattern.   I dont seem to be getting the nice window in the evening  I used to get and my sleep is worse.  Pgad is also alot worse and more consistent which is causing alot of anxiety.  All over feeling very unwell, shaky. Last night I thought the bed was shaking and it was me with tremors.  😒   I shouldn't be this affected by the splitting of the dose right this soon right?  It's only been a few days but maybe because I am so sensitive?  I haven't felt this bad in a while but maybe im just having a bad wave.   Last night split was 8pm and 10 pm.  .  I'm still trying to stay positive that this is just a fluke.  Feeling terrible though from lack of sleep and pgad. Its really affecting me.  Thanks for all your help.  

[BfromNJ]

Also having an mri today and doctor ordered with contrast. I did search on here and see some others situations with it.  But I am a bit nervous about the contrast.   A few years ago I had one and was ok.   But im more sensitive now I think. Yikes.   

[BfromNJ]

Boy id love to speed up the splitting process and just get there already and see if I get relief.   If I find i feel better  could I speed it up or should I stick to a set time interval, which right now is 1/2 hour a day 

[ChessieCat]

8 hours ago, BfromNJ said:

Also having an mri today and doctor ordered with contrast.

 

Q:  What is your reason for having the MRI?

 

Q:  How long have you had this problem (for which you are having the MRI)?

 

Q:  When did you find out that you would be having the MRI?

 

Personally I think it is more likely that the worsening of symptoms is related to this (the issue and the procedure) and NOT the dose splitting.  It is normal for people to have trouble with their sleep when they have an upcoming procedure.  From what I can recall from your previous posts your PGAD worsens when you are stressed.

 

Please re-read the posts which have been made explaining about the dose splitting.

[ChessieCat]

1 minute ago, BfromNJ said:

Boy id love to speed up the splitting process and just get there already and see if I get relief.   If I find i feel better  could I speed it up or should I stick to a set time interval, which right now is 1/2 hour a day 

 

It was said right from the beginning that you could move the partial dose 1 hour per day.  The reason for me suggesting only 1/2 hour was to try to reduce any anxiety you have about it.