BfromNJ: mirtazapine taper

[BfromNJ]

1 minute ago, Colonial said:

I have been thinking this member may have been having a reaction to the Luvox for a week now, seeing as how the ear issue becomes worse after both dosages.

 

Looking back I see this was already suggested to this member in 2019.

 

At that time, the member was only taking it once a day in the morning.

At some point they ended up switching it to the night.

After the recommendation to do split dosing to see if interdose wd may be the issue, the pattern has returned.

 

• Administrator

•  

Posted April 5, 2019

Thanks, BfromNJ.

 

Your journal is very helpful.

 

  On 4/5/2019 at 7:39 AM, BfromNJ said:

4/2

 

11:00- 25 mg fluvoxamine (luvox)
12:30-  feeling of being off balance, dizzy, disconnected.   zinging/buzzing, ringing in head major increase, feels like it's all around me. like static.   head feels very thick, noise is distorted and tinny sounding. 

 

  On 4/5/2019 at 7:39 AM, BfromNJ said:

4/3

 

11:00- 25 mg luvox
11:30- ringing is bad, sounds like whole room is filled up with it.  causing me distraction.
feeling again of being far away from my surroundings, out of it, not part of what is going on.   pretty much same  as yesterday at this time. 

 

  On 4/5/2019 at 7:39 AM, BfromNJ said:

12- lunch -luvox 25 mg
1:00- starting to feel worse.  ears ringing way more, buzzing and foggyness, feeling disconnected from surroundings, same as previous days.   bad head pain, feels like someone is squeezing it, and the vibrating sensation.  increase in throat sensation.

 

You are dealing with mirtazapine withdrawal, which is what landed your in the hospital last month and you're now on this cocktail of drugs. But it looks like you're having an adverse reaction to Luvox - you take it around 11 or 12 every day and about an hour later, you're feeling disconnected, among other symptoms. 

 

The feeling of being "disconnected from surroundings" is depersonalizaton / derealization:

 

Derealization or depersonalization (DP/DR)

 

This is a very common side effect and withdrawal effect from these drugs. 

 

From what you've posted (including what is in your signature), it sounds like you've had adverse reactions to not only Luvox, but also Prozac, Lexapro, and Cymbalta.

 

Do you feel this is true? 

 

I'm going to re-post Alto's earlier post:

 

  On 3/20/2019 at 11:14 PM, Altostrata said:

 

Yes, Luvox would go first, as you want to maintain sleep with the other drugs (if they help sleep). Since you've been on it for more than a month, you are at risk for withdrawal symptoms. As it's been only 35 days, you might try a 25% reduction to start, but you'll have to put it up right away if you get withdrawal symptoms.

 

Read Tips for tapering off Luvox (fluvoxamine)

 

Expand  

 

It's now been 51 days, but if you feel this is an adverse reaction, you might want to go ahead with the 25% reduction. With adverse reactions, you may be better off with a more rapid reduction.

 

 

Yes then I did reduce it by 25%.   And I took it in the evening.   I held off on tapering it because I started to taper gabapentin, which was suggested to me then.  I'd have to look back as to why at the time we thought that was the way to go.   At the time those symptoms above did get better. 

[Colonial]

Yes, it's possible when it was changed to the night time it helped "mask" the worse of the reaction once you fell asleep.

 

Since it's the only thing your still on other than the Seroquel, the fact that now that the pattern has switch to twice a day since the split dosing, it could indicate that that particular med is the bigger of the 2 evils for you at this point.

[BfromNJ]

5 minutes ago, Colonial said:

Yes, it's possible when it was changed to the night time it helped "mask" the worse of the reaction once you fell asleep.

 

Since it's the only thing your still on other than the Seroquel, the fact that now that the pattern has switch to twice a day since the split dosing, it could indicate that that particular med is the bigger of the 2 evils for you at this point.

That's what I was thinking.  Which direction do I go at this point?  Do you have any suggestions?  

[Altostrata]

@BfromNJ what exactly are you taking now, at what times of day and dosages?

 

When did you last change gabapentin?

 

If you're complaining of symptoms, we see an adverse reaction in your symptom pattern, and we suggest you might reduce the drug, it doesn't matter if it's a reinstatement or not. 

 

You're going to keep getting an adverse reaction to that dosage of Luvox as long as you're taking that dosage of Luvox.

[Colonial]

You claimed in 2019 the tinnitus started after the FIRST fast taper of the gabapentin in Dec. of 2018.

 

Since Shep originally saw a conglomeration of these sorts of symptoms coming back and getting worse in 2019, you did start to drop it, but eventually it became changed to night time.

 

Alto suggested over a week ago to drop the morning dose to 4mgs when she suspected the adverse reaction again. Since the symptom pattern has returned to as it was in 2019 I think both Shep and Alto were right. It seems that would be a good first step, it would be a total of 10% of the total your taking now.

 

Sleep issues can be related to adverse reactions. 

That being said, your sleep seems to get worse AFTER you try melatonin, Vistiril, etc.

 

Your so sensitive right now I wouldn't recommend any other additions of herbs or teas.

 

[BfromNJ]

5 minutes ago, Altostrata said:

@BfromNJ what exactly are you taking now, at what times of day and dosages?

 

When did you last change gabapentin?

 

If you're complaining of symptoms, we see an adverse reaction in your symptom pattern, and we suggest you might reduce the drug, it doesn't matter if it's a reinstatement or not. 

 

You're going to keep getting an adverse reaction to that dosage of Luvox as long as you're taking that dosage of Luvox.

8am- luvox 5 mg

8pm- luvox 5 mg

10 pm- seroquel 25 mg

 

When Luvox dose was once a day in evening I didnt have this symptom pattern and it was 10 mg.   As Colonial said I may have slept through it.  

 

I finished tapering gabapentin in December. 

 

[Altostrata]

Well, we're back to whether you're willing to reduce your morning Luvox dosage to reduce the adverse effects.

 

If you're not willing to do this, there is no point in continuing to post your daily notes. You'll just have to cope with the adverse effects.

[BfromNJ]

1 minute ago, Colonial said:

You claimed in 2019 the tinnitus started after the FIRST fast taper of the gabapentin in Dec. of 2018.

 

Since Shep originally saw a conglomeration of these sorts of symptoms coming back and getting worse in 2019, you did start to drop it, but eventually it became changed to night time.

 

Alto suggested over a week ago to drop the morning dose to 4mgs when she suspected the adverse reaction again. Since the symptom pattern has returned to as it was in 2019 I think both Shep and Alto were right. It seems that would be a good first step, it would be a total of 10% of the total your taking now.

 

Sleep issues can be related to adverse reactions. 

That being said, your sleep seems to get worse AFTER you try melatonin, Vistiril, etc.

 

Your so sensitive right now I wouldn't recommend any other additions of herbs or teas.

 

It did, but it worsened when I went back on gabapentin and started luvox.   I had also moved the luvox to the evening so like you said I slept through it. 

 

So its a bad idea to go back to taking it in the evening only again?   Then taper from there?  

 

Okay no tea.  I'm trying everything I can for sleep without anything.  Real tough.    

 

 

[BfromNJ]

10 minutes ago, Altostrata said:

Well, we're back to whether you're willing to reduce your morning Luvox dosage to reduce the adverse effects.

 

If you're not willing to do this, there is no point in continuing to post your daily notes. You'll just have to cope with the adverse effects.

I will.  But I was just wondering if going back to the evening only would help.   So if I only reduce the morning dose, what about the adverse reaction to that same dose at night? 

[Colonial]

If your having an adverse reaction,

it would seem the last thing you would want to do is take so much of it at once.

It likely could make your sleep even worse again.

 

Try dropping the morning to 4mg, keep your own notes and see how your symptom pattern changes over the next 3 weeks.

 

Edited September 19, 2021 by Colonial

[ChessieCat]

8 minutes ago, BfromNJ said:

It did, but it worsened when I went back on gabapentin and started luvox. 

 

From https://reference.medscape.com/drug-interactionchecker

 

• fluvoxamine + gabapentin

  fluvoxamine, gabapentin. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coaadministration with CNS depressant may result in fatal respiratory depression. Use lowest dose possible and monnitor for respiratory depression and sedation.

[BfromNJ]

1 minute ago, Colonial said:

If your having an adverse reaction,

it would seem the last thing you would want to do is take so much of it at once.

It likely could make your sleep even worse again.

 

Try dropping the morning to 4mg, keep your own notes and see how your symptom pattern changes over the next 3 weeks.

 

Okay. Just thought that since I was taking it that way before without noticing these reactions  it would be okay to go back that way.  So uneven doses are okay?  

[Altostrata]

Luvox has a half-life of 12-13 hours. If you reduce your morning dose, you will be reducing the evening blood level of the drug, too. This could relieve some of the adverse effects you get with the evening dose.

 

The idea is to do one thing at a time. You are taking 10mg Luvox per day. To reduce by 10%, you can reduce the morning dose by 1mg (and thus relieve the more intense symptoms you get during the day) or both doses by 0.5mg (which may or may not be enough to reduce the adverse reaction from each dose).

 

I suggested what I thought would be easiest for you. There's been 25 pages of this type of discussion. You are wearing us out. You need to step up and make some decisions. Otherwise, you'll just have to cope with the adverse drug effects you're getting now.

[BfromNJ]

1 minute ago, ChessieCat said:

 

From https://reference.medscape.com/drug-interactionchecker

 

• fluvoxamine + gabapentin

  fluvoxamine, gabapentin. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coaadministration with CNS depressant may result in fatal respiratory depression. Use lowest dose possible and monnitor for respiratory depression and sedation.

I didnt see an interaction on drugs.com.     I'm off gabapentin .  One good thing I guess! My goodness.  

[Colonial]

What part of:

 

"take 4mgs in the morning dose to see for changes in symptoms" do you not understand?

 

Masking the symptoms is NOT what we are trying to do, we are trying to determine if the drop helps with the day time effects and to what extent.

 

If you do not like our suggestions, and do not follow them, why do you keep asking week after week?

 

If you know better, than do ask you wish.

You do not need us to agree with what you want to do.

 

But if you are not going to attempt what we suggest, than please stop wasting everyone's time asking.

 

[BfromNJ]

25 minutes ago, Colonial said:

What part of:

 

"take 4mgs in the morning dose to see for changes in symptoms" do you not understand?

 

Masking the symptoms is NOT what we are trying to do, we are trying to determine if the drop helps with the day time effects and to what extent.

 

If you do not like our suggestions, and do not follow them, why do you keep asking week after week?

 

If you know better, than do ask you wish.

You do not need us to agree with what you want to do.

 

But if you are not going to attempt what we suggest, than please stop wasting everyone's time asking.

 

I am going to do this. It was just a thought . .  Sorry.  I followed when I split my dose. 

 

If im getting the same symptoms after the evening dose at 8 am. should I move it back to closer to bed or ride it out?  I moved it because alto said maybe the jerks were interaction.   They had improved but im getting them again. 

[Altostrata]

@Colonial, let's be straightforward, but not let frustration take over.

 

@BfromNJ, could you please try following instructions instead of this endless doubting and second-guessing? We have to see what happens before we can advise you on next steps.

 

If you don't want to do this, that's okay. There's no need for anyone to continue to look at your daily notes.

[Colonial]

One change at a time.

It's the only way to keep the issues in a "control setting" to know why the results are what they are.

[BfromNJ]

1 minute ago, Altostrata said:

@Colonial, let's be straightforward, but not let frustration take over.

 

@BfromNJ, could you please try following instructions instead of this endless doubting and second-guessing? We have to see what happens before we can advise you on next steps.

 

If you don't want to do this, that's okay. There's no need for anyone to continue to look at your daily notes.

I will do this. 

[Colonial]

21 minutes ago, BfromNJ said:

I moved it because alto said maybe the jerks were interaction.   They had improved but im getting them again. 

 

I think they were a temporary reaction to the double dose Seroquel- vistiril interaction.

Others on Higher doses of Seroquel have had this as a reaction.

 

I had symptoms on and off for 7 weeks after a reaction to eye drops and almost 3 months to an antibiotic.

And they were both pre WD so it just takes time.

 

 

[BfromNJ]

1 hour ago, Colonial said:

 

I think they were a temporary reaction to the double dose Seroquel- vistiril interaction.

Others on Higher doses of Seroquel have had this as a reaction.

 

I had symptoms on and off for 7 weeks after a reaction to eye drops and almost 3 months to an antibiotic.

And they were both pre WD so it just takes time.

 

 

I have had them come and go.  My goodness eye drops?  😳  so would it be safe to move it back to 10 pm or just leave it?  Maybe I can find i bit of relief when I go to sleep.   Hopefully I dont get a pgad flare with this reduction.  Its been good. There seems to be a correlation, but I cant be 100% sure.  May be menopause.     We really can't win. 🙄

[Colonial]

1 hour ago, BfromNJ said:

so would it be safe to move it back to 10 pm or just leave it?  Maybe I can find i bit of relief when I go to sleep.

 

No.

 

1 hour ago, Colonial said:

One change at a time.

It's the only way to keep the issues in a "control setting" to know why the results are what they are.

 

 

[BfromNJ]

42 minutes ago, Colonial said:

 

No.

 

 

 

Okay.  Maybe I'll just go to bed earlier before the worst hits.  🤔 🤞

[BfromNJ]

The last 3 nights I am getting about 2 hours or less sleep. It hasn't been great for  months upon months  but at least I had been getting 4 hours here and there.     I fall asleep and then wake up 2 hours later then nothing.  So my break from the severe tinnitus and other luvox symptoms  is no more because then they are there.   I can feel my restlessness and anxiety rise as I lay there.  I had used to be able to fall back asleep some.   I think the seroquel is pooping out on me?  

 

I will be reducing the morning dose of luvox this morning.    

[BfromNJ]

15 hours ago, Colonial said:

 

No.

 

 

 

Its like 4 days or so for the brain to recognize a reduction?   I tried to find it there is just a lot of information on here.  

[Colonial]

 

 

1 hour ago, BfromNJ said:

 I tried to find it there is just a lot of information on here.  

That question has already been answered in your thread. And yes, There certainly is a lot of information here. As we have discussed privately it has been the same questions asked repeatedly over and over for almost 3 years now, which is why this thread is so lengthy.

 

I will suggest once again what I suggested to you by pm on thursday, going back to page one of your thread and taking notes- copy and pasting answers, etc.  You should be able to get through all of it in the time before your due to make another med change in a month from now. You would be pleasantly surprised how many of the questions you continue to ask have already been answered. You should be able to condense these 25 pages down to 7 or 8 and then have then to review each week.

 

It's been 4 days since I gave that suggestion, have you even started doing that?

 

Your thread is so long at this point, it's almost impossible for staff to dig back and find where the info is that we have already dealt with the Luvox adverse reaction with you. You have had all of the relevant information we have to give you by the end of your first year as a member here. But this has gone on so long, other staff members don't even remember they've already gone through all of this with you before.

 

As peer support we can only do so much for you. We have given you over and over the basic tools to make the best decisions and where to go to look for the answers you need. If you choose other decisions and to keep going back to other medications, herbs, teas, melatonin etc., that is your choice.  All we can do is offer you the info we have already supplied numerous times.

 

If you choose to do otherwise, which is your right, there really is no reason for you to continue to come back and ask us to manage the 'fall out" of your continued drug cocktails. That is for you and your doctor, we don't provide help with that.

 

I have already asked you to please stop tagging Me. I have already privately discussed with you that we are not trained psychotherapists with the ability to decipher how much of these continual repeated questions are just attention seeking behavior and you are just looking for someone to hold your hand all day long wondering about ever thought that comes into your head.  

 

But the psychological attention seeking behavior your using as an emotional crutch is only going to make your process worse and continues to waste staff time.

 

I started here in July of 2015, 6 years and 2 months ago.

My personal thread is only 11 pages.

I have made about 211 posts in my own thread in those years.

The majority of my posts have been as mentor, almost 53 of which have been now in your thread

 

You on the other hand, have only been a member here since Jan of 2019

2 years and 8 months

Your thread is now 25 pages long.

And You have made an astonishing 543 posts in your own thread in that short time.

Asking the same questions over and over.

 

211 posts in over 6 years in my thread

526 posts in just under 3 years for You

 

Perhaps you can discuss it with the therapist, more positive ways of moving forward than constantly trying to pull others in for sympathy with attention seeking behavior.

 

You may do better at www.patientslikeme

 

It is a site for people who plan to take drugs and need support doing that. It's also better for people as yourself who need constant emotional reassurance every day about what they should or should not be doing, and need constant input to make sure whatever new symptom pops up that week is normal.

 

We aren't an emotional support network for people who panic and continue to ask the same questions week after week, month after month.  I'm not sure you appreciate how much of that you do on a regular basis here. Come in a post repeated questions on things we have already addressed. And sense you are not able to stop going back to meds, we really aren't the appropriate network.

 

www.patientslikeme is designed for people in your position.

You may find that a better fit for your needs.

 

[Altostrata]

@Colonial, please stop following BfromNJ's Intro topic.

 

@BfromNJ, did you have difficulty with indecision before you initiated psychiatric treatment?

[BfromNJ]

11 hours ago, Altostrata said:

@Colonial, please stop following BfromNJ's Intro topic.

 

@BfromNJ, did you have difficulty with indecision before you initiated psychiatric treatment?

I dont think I did.      Was it my recent question about seroquel pooping out?  I was just wondering if it can happen with that drug because my sleep is so poor.  

 

  I am sorry to be any trouble.   I have not slept well for months and its just gotten worse,, 2 hours a night now.  It was 4.   I'm used to like 7-8.   I fall asleep and up two hours later.   It does affect my thought process and ability to cope with things.   I'm not functioning well at all and I feel like i am going to crash.   Its going to get  hard to tell even what is med related or lack of sleep symptom wise.      I know its always suggested to pay attention to sleep on here so I thought it was relevant.   

 

[BfromNJ]

@Altostrata

So I made the reduction of my am dose of luvox due to possible adverse reaction. 3rd day.  Since it is a reduction, would I still expect it to be rough  and feel some withdrawal before it gets better since its still a change?   Or should I feel just  relief since we think im having an adverse reaction in the first place?  Just so I know how I feel is expected and to ride it out.   I am tracking symptoms and will post .  

 

Still having the same symptoms  after my nighttime dose as the am one, since I take it earlier now and im not sleeping much.   I cant get more than 2 hours now.  🙄 if I could sleep more it may not be so bad. 

 

 

 

 

 

[Altostrata]

You may not feel anything from reducing your daily Luvox dose by 10mg.

 

Please post daily notes. You should understand by now that tracking your symptom pattern is essential to answering your questions.

[BfromNJ]

3 hours ago, Altostrata said:

You may not feel anything from reducing your daily Luvox dose by 10mg.

 

Please post daily notes. You should understand by now that tracking your symptom pattern is essential to answering your questions.

I will I was waiting for a few days.

 

I do think I felt better when I took it once a day i was sleeping better for some reason. 

 

Thank you.    

[Altostrata]

No daily notes, as requested many times, no responses from me. Is this clear? We're serious about the daily notes.

[BfromNJ]

9/20-

- 2 hours of sleep (3rd day)

7:30am- mild tinnitus.  

8am- 4 mg luvox (1st day of this dose)

10:30am- dizzyness/disconnection.  Increase in tinnitus & noise sensitivity 

12- anxiety spike

4:30- anxiety spikes more with agitation,  restlessness.   Cannot rest but exhausted

6:00- slight pgad flare- settles quick

8pm- 5 mg luvox

9 pm - tinnitus gets severe.  Anxiety spikes more 

9:30- dizzyness

- 25 mg seroquel

10 pm - bed with severe tinnitus

 

9/21- 

- only slept 2-3 hours (4th day)

6am- tinnitus noticable laying in bed. 

6:30- tinnitus calmed, does increase an hour or so later

8 am- 4 mg luvox 

12:30- tinnitus spikes

Dizzy/disconnected 

- calmer in afternoon than usual,  but very depressed, no emotions, feel numb.  

5pm - anxiety spikes rest of evening.   

8pm- 5 mg luvox 

9:30- 25 mg seroquel 

10- bed.  Anxious, dizzy/disconnect

 

9/22- 

2 hours sleep (5th day)

12:30am- woke up with severe tinnitus

- hearing weird noises in head (like a door slamming) , body jerks

- tinnitus is calm 

8am- 4 mg luvox

9:30am- tinnitus spikes with noise sensitivity(spikes thru day but seems overall better) 

10 am - dizzy/disconnected (not as bad as usual) 

3pm- tried to rest but body feels activated,  anxious, disoriented, flushed feelings thru body

4:30- anxiety increases 

6-8- calmer.  Able to rest a bit with head back.  

8pm - 5 mg luvox- 

8:30- tinnitus spikes- very bad by bedtime 

10- 25 mg seroquel 

 

9/23- 

- slept more than in a while.  

7 am up

-tinnitus very calm 

- electrical type sounds/feelings, zinging sound with noise 

8 am - 4 mg luvox 

12pm- anxiety spike with restlessness,  fear.  Continues a few hours but not as bad as usual.   

5:30- mild anxiety spike thru evening but milder

8 pm- 5 mg luvox 

10pm- 25 mg seroquel.  

This was an overall much better day.   Maybe a window.  

 

9/24-

-slept maybe 5 hours

7 am- up.   Slight tinnitus. 

-electrical type sounds/feelings, zinging sound with noise. Lots of anxiety upon waking.    

8am- 4 mg luvox.  

8:30- noise sensitivity 

 

- still having body jerks sporadically, not as bad.  

- now more low mood/blunted emotions

 

 

 

 

 

 

 

 

 

[BfromNJ]

After a really good day yesterday,  Today is startinh out to be a really bad day symptom wise.  The zinging, electrical type noise/feeling in head is  worse.   Ear pressure,   Sensitivity to noise, extreme dizzyness and disconnection, anxiety, agitation,  restlessness and weird thoughts.   

[Altostrata]

From your notes, it appears that reducing Luvox is going in the right direction, but you are still having adverse effects from Luvox.

 

Please post a few more days of notes. Reducing the evening dose by 1mg may be the next step.

[BfromNJ]

1 hour ago, Altostrata said:

From your notes, it appears that reducing Luvox is going in the right direction, but you are still having adverse effects from Luvox.

 

Please post a few more days of notes. Reducing the evening dose by 1mg may be the next step.

Okay.   Today is a terrible day.  Symptoms as above with awful tinnitus.    I was thinking from the reduction finally registering.    I feel like I'll need time for this to settle.  But I will see how the coming days go.   Two changes close together (splitting and reducing) when I was already sensitive from back in June and prior with going to fast.   I assume I can hold here a while right?  Do I need to reduce the evening dose to even the doses out?  I wasn't sure if its a problem taking two different amounts, if it needed to be even.