tsranga: intro and withdrawal

[tsranga]

Hi all

 

I was prescribed mirtazapine for sleep deprivation and anxiety that developed after I quit smoking (a light 3-4 /day smoker for 25 years) cold turkey in Jun 2017. Sleep anxiety was triggered by my IBS flare up that consistently woke me up every night for a couple if weeks before mirtazapine helped me stay asleep.

 

I am coming off mirtazapine 3.75mg (cold turkey since Feb 2019) after being on it for about 18 months, the first six months at 7.5mg. 

 

Been dealing with typical withdrawal symptoms of insomnia, anxiety, fear, adrenaline rushes falling asleep, agitation, leg fatigue, temperature/pressure sensitivity, GI issues.

 

Over the last week, I mostly have had good consistent sleep and most of my other symptoms have been mild and occasional (once in 2-3 days). There is a consistent correlation between gut distrurbance (mainly gas/bloat/burping) and sleep onset, and sometimes it can take until 3-4am before it settles down enough to be able to sleep. Keeping my stomach light at night and avoiding trigger foods (mainly sugars like fructose, fructans) helps stabilize the gut.

 

However, there are a couple of symptoms that are a bit worrying. I have lost 26lbs since I stopped mirtazapine (175 to 149) 3 months ago. I had a similar loss before I started mirtazapine after I had stopped smoking. But this time, I have been eating well and have a good appetite, although I am off sugars, alcohol, and gluten. In addition my heart rate at night is dropping down to mid 50s. I also have had some occasional dizziness when I stand up. 

 

Are these changes normal and if not, what additional testing / specialists would you suggest that I check out?

 

Ranga.

[Gridley]

Hello, strange, and welcome to SA.

 

To give members the best information, we ask them to summarize their medication history in a signature -- drugs, doses, dates, and discontinuations & reinstatements, in the last 12-24 months particularly.

 

Account Settings – Create or Edit a signature.

 

It appears you have your withdrawal well under control.  We sometimes suggest a very small reinstatement of the original drug to help alleviate withdrawal symptoms, but since your symptoms are mild that likely isn't necessary.

 

Regarding the symptoms you are concerned about, dizziness is a common withdrawal symptom.  Weight loss is also a recognized effect of withdrawal.   The following link deals with heart issues during withdrawal, though low heart rate isn't mentioned.  This is something you might want to have tested.

Irregular heartbeats, palpitations, tachycardia, bradycardia ...

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Please research all supplements first and only add in one at a time and at a low dose in case you do experience problems.

 

Here are some helpful links dealing with insomnia.

 

Tips to help sleep - so many of us have that awful withdrawal insomnia

 

Relaxation exercises, guided meditations, calming videos, sleep hypnosis

 

Trick and tips to fall asleep faster

http://articles.mercola.com/sites/articles/archive/2017/02/16/tips-tricks-fall-asleep-faster.aspx?utm_source=dnl&utm_medium=email&utm_content=art1&utm_campaign=20170216Z1&et_cid=DM133787&et_rid=1889748952

 

Some members have found Melatonin helpful with insomnia.   

 

Melatonin for sleep   

 

It's best to start at a very low dosage, such as .25mg, and gradually increase if needed to the lowest effective dose.  

 

Here are some links on dealing with anxiety.  The Claire Weekes links are particularly helpful.

 

Audio:  How to Recover from Anxiety - Dr Claire Weekes

VIDEO:  Peace from Nervous Suffering - Claire Weekes (1 hour) (http://sendvid.com/vgquc1dg)

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

10 minute Restorative Yoga for Relaxation | Up the wal

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[tsranga]

Thank you for the suggestions and links.  

 

The last couple of days I have noticed a spike in day time anxiety, numbness/temp intolerance in my hands and feet, and muscle pain.  This is probably another wave..  

 

Does anyone know if this is a neurotransmitter regulation issue, or a receptor issue?  And are there ways of alleviating the symptoms? 

 

I am already taking Magnesium (100mg at night), vit d (5000 iu) and vit b complex (afternoon).

 

[tsranga]

Update on 5/30/19

 

Sleep continues to get better and more consistent, although its still  averages around 5 hours. Weight loss continues and I am now at 142 (7 lbs this month). I am eating more than I did before stopping mirtazapine, but the weight continues to drop.  Still have some daytime anxiety between and 10AM and 3PM but it is manageable, unless I am affected by change in temperature (today was a hot day, and I was miserable with hot & cold flashes)

 

Went through a colonoscopy which was clean, and a whole bunch of blood tests, and the only abnormality was total testosterone level of 200 (drop from 296 in 2017).  Whatever I have read say it should drop 1-2% per year, and weight loss / testosterone levels are inversely related.

 

Any thoughts on what could be on

 

 

[ChessieCat]

2 hours ago, tsranga said:

Folks

 

I have been reading through this thread and I just want to confirm that my symptoms are still withdrawal related.

 

No prior diagnosis of mental illness before I was put on low dose 7.5 mg mirtazapine for sleep. I was also diagnosed with GAD and possibly PTSD at that time. I have had one panic attack in 2010 that related to feeling alone, and have been dealing with existential thoughts in my mid life transition, but nothing that ever affected my executive functioning ability.

 

On mirtazapine, I did a 50% cut to 3.75mg after a year and then did a C/T in Jan 2019. Since then I have been dealing with withdrawal and overall it is getting better, with almost all areas physical and mental improving. I have also been diagnosed with SIBO, so I am on treatment since last week.

 

Since last week, I have been noticing a pattern in sleep, anxiety and mood swings that appears to be alternating.

 

It mostly starts with a gut disturbance, which affects sleep (3-4 hours) and then the next day, I am more restless, irrational fear, stuck on one thought and feeling trapped, before it gets better in the evening and I am able to get a solid 6-7 hrs of sleep.  The day after a good night's sleep, my anger is disportionate to the cause (there is a lot of frustration/inability to communicate calmly), but other than those bursts, I am more relaxed during the day, but I am unable to fall asleep  quickly.. 

 

My brother (an MD, who is on AD) advised that  I get checked for bipolar II,  and my half brother is bipolar. There is no other history of mental illness in maternal/paternal family tree.

 

Feedback? Does this eventually go away or at least get more consistent rather than this alternating pattern?

 

 

 

 

are-we-there-yet-how-long-is-withdrawal-going-to-take

 

 

 

 

[tsranga]

Hi all

 

It's now been almost 18 months since I C/Ted and by most parameters, I am doing well.

 

I gained 5lbs back during the winter, and was able to handle most foods, even the occasional gluten or diary.

 

In April,  many of my withdrawal symptoms returned, and I lost those 5lbs again.

 

The main symptoms have been increased food intolerance, which manifests as burping, flatulence, hand and feet numbness. Most of these symptoms are worse at night (between midnight and 6am) and to a lesser extent between 2-6pm, and the flare-ups last one night. 

 

Going back to a strict low fodmap diet has helped, as I find it's the sugars (lactose, fructans, raffinose) in veges, legumes and fruit that cause a reaction. 

 

During a flare-up, my thought patterns are also affected - brain fog, obsessive thoughts that trigger a negative reaction (judgement, comparison, suspicion, fear etc.).  As soon as the flare-ups subside, the brain returns to stability.. 

 

I was wondering if there is a connection between seasonal change and symptoms returning? Could there be an autoimmune component (mast cell triggered serotonin/histamine activity) post withdrawal that is in play? 

 

Prior to mirtazapine withdrawal, I have had no  issues with allergies , or food intolerances except dairy intolerance only to dairy in the USA.

 

 

[ChessieCat]

 

Thank you for coming back to update us on your progress.

 

8 hours ago, tsranga said:

In April,  many of my withdrawal symptoms returned

 

Since early this year we have members who have reported unexpected and/or worse waves which could possibly be from the Covid situation.  The stress from it may be the cause or contributing to it.

 

Here's SA's topic:  auto-immune-diseases-triggered-by-ssri-withdrawal-mast-cell-activation

 

[tsranga]

Thanks. I am actually dealing covid pretty ok. I did read through the mcas thread.. thanks.

[ChessieCat]

We have a topic called "Are We There Yet?" but it is currently being updated.

 

It's not unusual to still experience waves even this far out.  Your nervous system can be fine tuning itself for several years after you stop the drug.  From what has been observed in other people the waves will reduce in severity and length and be further apart as time goes by.

 

Have you had a course of antibiotics recently or drunk any alcohol?  Or introduced any new supplements, eg probiotics?

[tsranga]

Nope.. no changes.. the only potential factors could be a season change, or a take out meal (both my daughter and I had  GI symptoms, even though we had different dishes). But since then, I had my non GI symptoms reappear, although in lesser intensity and lost weight (5lb).

 

 

[tsranga]

8/11/2020 update

 

So for the past two months I have been doing much better on the mental symptoms and the non-GI symptoms, with the addition of a couple of ayurvedic adaptogens.

 

However, I am still going through phases of GI flare-ups and it's been very hard to identify what is causing them. The consistent pattern is the gas that comes on when I lie down to sleep, and it can keep me burping or/and farting all night long.  A low-FODMAP low-histamine diet goes a long way in keeping the gas manageable. During a flare-up, I also experience pain/neuropathy in my extremities (hands and feet/calf).

 

Interestingly enough, lying down with my back up on the couch helps me greatly in keeping the gut calm.  The other non-GI symptoms that show up randomly are the orthostatic hypotension (mainly in the afternoons when the heat is up, or I am not hydrated enough), and the stuffy sinuses, burning eyes/ears. 

 

I have also noticed that on the days that I have some alcohol, usually when there is a social gathering, I am able to get great sleep (both REM and deep). This has been consistent in the 2-3 times in the last 2 months that I have had a small (20ml) amount of whisky.

 

Has anyone looked at how GABA plays a role in sleep, digestion and metabolism and how they are affected in withdrawal? I am wondering if GABA has an effect on the GI motor activity, postural hypotension and the lack of weight gain in withdrawal despite a very good appetite. I have lost 40lbs and have not been able to gain any weight in withdrawal.

 

It also seems to me that the nervous system goes through recovery one system at a time, and can come back to the same system to fix something else, and this is part of the whole wave/window process, there seems to be no consensus on how intense or long lasting the wave can be even at 18 months off.

 

 

[Altostrata]

On 6/22/2020 at 11:23 AM, tsranga said:

take out meal (both my daughter and I had  GI symptoms, even though we had different dishes)

 

I got mild food poisoning twice from take-out. Some restaurants are not doing enough business and serving food cooked the prior day (or earlier).

 

You may have to vary your diet to see which foods are causing gas. Food poisoning bacteria could be acting on anything with fat or oil in it.

 

It sounds like you're mostly recovered. Which of your symptoms do you associate with withdrawal syndrome?

[tsranga]

2 hours ago, Altostrata said:

 

 

It sounds like you're mostly recovered. Which of your symptoms do you associate with withdrawal syndrome?

 

I feel like I am mostly recovered, and the sneaky thing about recovery seems to be that just when you think you are good,  the symptoms come back. 

 

For me, the most consistent pattern that I associate with withdrawal is the following - 

 

Being wide awake at night when its time to fall asleep,  slow build-up of gas (either burping/flatulence or both),  being awake the whole night,  pain in the extremities and then return to normal for a while.. sometimes the period between the window and the wave is 2-3 weeks, and the wave lasts a day, sometimes the wave lasts a week with alternating days of flare-up followed by sleep..   I am finding that  food intake doesn't seem to correlate with the flare-up, although how long it lasts and how severe it is can be affected by food type, quantity.

 

Also, there are other symptoms that can pop up during the day - typically its stuffy sinuses/nose/ears, facial vasodilation that can occur on wake-up, and they stay for a few days (typically this follows a sleepless wave/gut flare-up), orthostatic hypotension in the mid-morning/afternoon.  

 

Mentally, I have been mostly fine the last two months, except for the odd inability to focus (ruminating thoughts). The last two days, I have seen  a return of a jittery feeling during the day combined with facial vasodilation, that usually start with a low mood in the mornings, and then again I cant focus on anything other than staying with the sensations and thoughts until they pass.   I haven't had the jitters for a couple of months, and usually the gut is also acting up, but the gut seems to be pretty good the last week or so, and I haven't had bloat in weeks. Usually when bloat/gas happens, the mental state also changes.

 

Could this just be that the ANS is finding its way through the different systems as it heals?  

 

[Altostrata]

That sounds like food sensitivities. Are you on an exclusion diet?

[tsranga]

3 minutes ago, Altostrata said:

That sounds like food sensitivities. Are you on an exclusion diet?

 

3 minutes ago, Altostrata said:

That sounds like food sensitivities. Are you on an exclusion diet?

 

I thought they were food sensitivities..  but there is no consistent pattern to when it flares-up.  Some days the same foods will not react, while on others I may have a flare-up.  I am already on a low FODMAP, low histamine diet..  BTW, I never had food sensitivities with this severity until I came off mirtazapine in Feb 2019.  I thought it was getting better in Jan-Mar 2020, but it came back in April. 

 

[tsranga]

Also I have been practicing yoga and meditation for the last year and they have been transformative in dealing with the symptoms. I have also tracked my diet and symptoms very closely, so it's easier to identify a food sensitivity, but there are many times when there is no correlation, which takes me down the histamine path.. 

 

posture also seems to be making a big difference. Lying down flat on my back triggers gas movement, burping and flatulence.. if I sleep with my head up, I seem to be able to fall asleep and stay asleep. Also, the hypotension in the day..  something seems to be messing with my GI motor activity and is sensitive to posture.

 

 

[ChessieCat]

Could the additional stress of the worldwide weird 2020 be contributing?

[tsranga]

54 minutes ago, ChessieCat said:

Could the additional stress of the worldwide weird 2020 be contributing?

 

I have actually been in the best mental state post withdrawal for the last 3 months. This seems purely driven by physiological states..  and autonomic dysfunction post withdrawal seems to be the most likely cause. 

 

If it was food sensitivities, the symptoms should be consistent. Secondly there should be no difference in when the symptoms hit - my GI symptoms 9/10 times are between 12am-6am.  

 

It definitely appears to correlate with posture. Supine positions immediately cause GI activity.. possibly as the different spincters relax. Apparently GABA receptors in the gut control them.  Nicotine and mirtazapine both release GABA, and alcohol as well, which may possibly explain why my sleep and gut were fine when I was on them, but started causing issues when I stopped.  My blood pressure always has been on the lower end of normal, and when dehydrated, I have had incidences of fainting (4-5 times many decades ago), which is also to an extent impacted by GABA. The hypotension has returned more frequently since I stopped mirtazapine.

 

I am wondering if the body is working the GABA/glutamate balance in withdrawal..not just from mirtazapine (2019) cessation, but also from nicotine (2017) and alcohol (2019) cessation.

 

[composter]

4 hours ago, tsranga said:

I have actually been in the best mental state post withdrawal for the last 3 months. This seems purely driven by physiological states..  and autonomic dysfunction post withdrawal seems to be the most likely cause. 

It’s good that your mental state has been strong and you’re feeling much better. 
 

I have experienced GI issues as a withdrawal and wave symptom—mainly lack of appetite, diarrhea/nausea, and food aversions. One thing I felt that helped was incorporating probiotic-rich foods in my diet. Things like sauerkraut, kimchi, kombucha, and coconut or almond non-dairy yogurt. Have you tried this? It may be worth a shot. I found these foods were calming to the gut and were well-tolerated. 
 

I think there’s a definite connection between withdrawal and gut issues given the sheer number of neurotransmitters involved in the gut as well as the autonomic dis-regulation that happens. The gut-brain connection is indeed strongly linked. Perhaps feeding the gut bacteria with good probiotics can help ease some issues. 

[tsranga]

1 hour ago, composter said:

It’s good that your mental state has been strong and you’re feeling much better. 
 

I have experienced GI issues as a withdrawal and wave symptom—mainly lack of appetite, diarrhea/nausea, and food aversions. One thing I felt that helped was incorporating probiotic-rich foods in my diet. Things like sauerkraut, kimchi, kombucha, and coconut or almond non-dairy yogurt. Have you tried this? It may be worth a shot. I found these foods were calming to the gut and were well-tolerated. 
 

I think there’s a definite connection between withdrawal and gut issues given the sheer number of neurotransmitters involved in the gut as well as the autonomic dis-regulation that happens. The gut-brain connection is indeed strongly linked. Perhaps feeding the gut bacteria with good probiotics can help ease some issues. 

 

Yes.. I have been having them mainly from food rather than supplements, but I need to be very careful as they can aggravate symptoms. As I mentioned before,  it has improved to a point where I do not have any GI symptoms during the day, on most days, even if I have had a flare-up at night. It only happens when I lie down flat on my back, and peaks at night, when I  go to sleep.  I have had reflux oesophagitis since 1992, and then IBS since 1999 and predominantly had only bloating/burping as my main symptom, but nothing else. It really started affecting my sleep when I quit smoking in 2017,  following which I was put on mirtazapine, and when I stopped mirtazapine, it relapsed along with food sensitivities.  Apparently the spincters relax at night, so if the volume of gas gets high enough (which could  come from fibre/FODMAP or high histamine /fermented food), I start burping/have flatulence when I lie down.  The amount of gas peaks at night, so depending on how much, I can stay awake the whole night.  I get lower leg and hand pains on these nights as well. Other less frequent non-GI symptoms are orthostatic hypotension, and facial pressure/vasodilation/flushing with occasional stuffiness.  The fact that it got worse after nicotine cessation, and then peaked after mirtazapine cessation makes me suspect a combination of  autonomic dysfunction,  mast cell/histamine intolerance, GABA/Glutamate imbalance and possibly gut dysbiosis is in play. 

 

Since nicotine, mirtazapine, and alcohol impact GABA, and GABA along with histamine affect wakefulness and gut motility along with a host of other autonomic functions, and IBS has been treated with Histamine antagonists and GABA agonists,  it does appear that a combination of gut motor function and faulty neurotransmitter regulation post withdrawal is the crux of the issue, and it may take some more time before it stabilizes.  

 

The good news is that my chronic IBS symptoms (prolonged burping, bloating, multiple visits to the restroom, incomplete evacuation etc.) have almost resolved. The new symptom post mirtazapine is the food sensitivity causing  night flare-ups, but have reduced to once in 7-10 days,  with waves lasting a week of 3-4 nights with flare-ups. 

 

I am still unable to put on any weight, even though I am eating well. Lost 40lbs, and probably off 15-20 lbs from my ideal weight.

 

[tsranga]

Coincidentally, tonight happens to be one of those nights with a flare-up.   There was some burping, followed by a BM around 11:30PM-12AM, and usually that's enough release for me to sleep. But on some nights like tonight, as I am falling asleep, I am startled awake by some sensation in my gut that translates to either a burp or flatulence. I am sleepy, and its almost like I am directly going into REM sleep as I get pretty random thoughts as I lose consciousness, and I get the leg/hand pains. Its not  a hypnic jerk, it definitely arises from the gut, and most nights,  unless I clear out the gas, I can't go back to sleep. 

 

In terms of food, the only possible trigger is more than my normal/daily dose of peanuts. The quantity of food matters more than the type of food when it comes to sensitivity. 

[Altostrata]

Maybe you might stop eating peanuts for a while?

[tsranga]

On 8/13/2020 at 4:10 PM, Altostrata said:

Maybe you might stop eating peanuts for a while?

 

I can.. and I will..  But I can never tell for sure..  last night I had a flare-up again, without any peanuts.. and I had a great night of 8+ hours of sleep  the previous night, following a flare, and a very good bloat free day.   I had steel cut oats and a banana after a few weeks, and had the same flare-up all night.   My guess is it is anything that has high fibre, or sugars (FODMAP) that trigger gas, but its not clear what triggers a major flare-up as opposed to being "mild" enough not to affect sleep.  Also, sleep debt appears to be powerful enough to get the gut/brain relaxed enough to sleep. 

 

I have been reading protracted withdrawal in general for all types of drugs, and it appears that nocturnal myoclonus, especially when falling asleep, muscle twitches, pain in the extremities, and food intolerance are pretty typical withdrawal symptoms, and I guess the only option available is to keep food to a very strict and limited regimen for a while. I was wondering why having alcohol doesn't cause a flare-up even if I have the offending foods. My guess would be the depressant effect it has on the nervous system - essentially calming it down temporarily. 

 

Also, there appear to be recommendations for melatonin and GABA agonists for calming the gut, especially for chronic IBS.. Wonder if anyone has tried them post withdrawal?

 

 

 

[tsranga]

There definitely seems to be a link to posture and symptoms..   Fortunately, my gut has been mostly  calm this week

 

Whenever I am lying down, I have no bloat, can breathe well, and my gut relaxes which results in more noise, and gas..   On the other hand, standing up increases bloat, but reduces burping and gas..  I can also have the bloat come and go within minutes when standing.

 

Also, standing up for too long and then sitting down, or lying down for too long (oversleeping) can both trigger symptoms - blurry vision, lack of focus, dizziness etc..  This basically feels like orthostatic intolerance,  that could possibly be caused by withdrawal.

 

https://www.autonomicneuroscience.com/article/S1566-0702(18)30052-3/pdf

 

Anyone else experience this? At  19 months off? 

[tsranga]

The last week or so my gut has been more stable and food intolerance has reduced, which is a good sign.

 

However,  my heart rate readings seem to indicate POTS..   I had this dizziness when standing up and fluctuating heart rate (30 bps from 60 to 90 and back) early in withdrawal, which resolved with electrolytes and salt augmentation last year.  It has reappeared this summer, 15 months since C/T of mirtazapine.  I am now 19 months off.

 

Just a couple of other data points -  I had vasovagal syncope in adolescence,  but have never fainted since then except once 15 years ago when due to severe dehydration. I also developed IBS  & reflux oesophagitis about 30+ years ago when I also started smoking. My IBS  flared-up after I quit smoking in 2017, for which I was prescribed mirtazapine. I have been off mirtazapine since 2019. 

 

Is it possible that my underlying symptoms are primarily due to iatrogenic withdrawal & should eventually resolve? Or could this be a progressive deterioration in my autonomic dysfunction that nicotine (which mimics acetylcholine) kept in abeyance? 

 

Overall, I am probably at 60-70% of my pre-mirtazapine function. My mental health is definitely better and the gut is also stabilizing, so its these POTS like symptoms and some lack of focus/blurred vision during the daytime that seem to still linger. I have also not been able to gain any weight ( I am about 20-25lbs off my normal weight). I was better in fall and winter on both counts, which is why I am perplexed at the recurrence in spring/summer.   

 

For those that have been off more than a year or two, did anyone experience seasonal variations in symptoms? 

[tsranga]

On 8/13/2020 at 4:10 PM, Altostrata said:

Maybe you might stop eating peanuts for a while?

 

@Altostrata

 

It appears that high fodmap and fibre foods are the cause of my symptoms.. definitely made worse by withdrawal.

 

When do food sensitivities resolve?  I don't expect that I will magically be able to tolerate foods that I have always had issues with, but I am hoping that I can atleast eat what I tolerated before, without losing sleep over it. I am still sleeping only about 15-20 days a month since I stopped mirtazapine 20 months ago.

 

I am also a patient of akil's since 2018, and he treated me for SIBO last year, but didn't really help.  He's ordering a gi-map test to check for pathogens.

 

I have been on a restricted low fodmap, low fibre diet since May, but I find that the longer I'm  on it,  i react to reintroductions even at smaller quantities. I thought these diets were temporary.. 

 

Unlike typical IBS/SIBO where folks report daytime symptoms, my gas is mainly at night, appearing like clockwork at midnight, and it got worse in September after my gluten meal. Seasonal/weather changes also seem to have an impact.

 

I was able to put together 6 consecutive nights if sleep by avoiding any trigger foods for dinner, and sticking to soups. I reintroduced mung beans tonight, and I am still up with gas.

 

 

[Bruci]

On 10/16/2020 at 7:24 AM, tsranga said:

When do food sensitivities resolve?  I don't expect that I will magically be able to tolerate foods that I have always had issues with, but I am hoping that I can atleast eat what I tolerated before, without losing sleep over it. I am still sleeping only about 15-20 days a month since I stopped mirtazapine 20 months ago.

Back to food insensitivity. I’ve been withdrawing for only three weeks and I am already experiencing a return of food intolerance that I thought I was over with 20 years ago. I guess the SSRI was either masking it or the withdrawal is bringing it back. 
 

I eat a very good, very healthy Mediterranean diet but I fear that I may be reacting to some foods because of this withdrawal. So I am contemplating going back to an elimination diet using an elemental nutrient formula I used in the past. It is a very effective way to wash out food you may be reacting to and then to test foods one by one as you add them back.
 

If anyone is interested, here is the product that helped me. I have no affiliation with this company.

http://www.nutramed.com/alphaenf/alphaenfholiday.htm

 

[tsranga]

Update:

 

It has been almost 2 years since I CTed of Mirtazapine.

 

In 2019 

-------

Lost 40lbs

Averaged 4-5 hrs of fragmented sleep

Daytime anxiety, temperature dysregulation, POTS like symptoms, muscle/nerve pain/twitches/spasms in the legs/feet/hands 

Akathasia, Parasthesia, tactile hypersensitivity

No special diet or supplements.

Treated for SIBO, but tests indicated no change in numbers although symptoms improved slowly.

 

In 2020

--------

Had 3  months (Jan-Mar) of mostly symptom free days, gained 5 lbs, averaged 6-7 hours of sleep, better food tolerance.

Symptoms flared up again in Apr 2020, lost 5lbs.

More food intolerances through the year after I went on a strict low-FODMAP diet.

Sleep declined to 4-5 hours average.

Jun - On Ayurveda treatment to heal the gut.

Sept - Another flare where I lost another 5lbs.

Nov - Added Ashwagandha  for adrenals

Dec - Started with Black radish for Gut dysbiosis

 

Current Symptom Status -

Sleep still fragmented / inconsistent due to frequent flare-up of symptoms - cannot sleep uninterrupted for more than 4 hours, and have issues returning to sleep.

temperature sensitivity before bed, early AM awakening causing most of the sleep issues.

Daytime anxiety, blurry vision, brain fog

Better food tolerance after starting on black radish.

Symptoms are  more frequent, but of lesser intensity and duration compared to 2019.

Better mental flexibility through meditation to cope with symptoms, bounce back quicker.

 

Questions - 

 

1. Is it typical for sleep and temperature sensitivity to worsen over time? 

 I have actually been more diligent about my food and sleep hygiene this year and these two are probably my most common symptoms that I experience almost daily.

2.  Does autonomic dysfunction also worsen over time or do the symptoms change in frequency but with less intensity or duration?

My frequent BP fluctuations seem to be coinciding with both the daytime anxiety & occasional dizziness, and feeling cold/hot at night. This seems to be related to some postural variation that I am hypersensitive to. 

 

[ten0275]

 

 

Quote

Hi @ten0275

I had a question about emotional spirals.. do you still have them? How have you handled them? I had a bad one last night.

 
It usually starts with some trigger on a deep underlying belief (eg. Feeling like nobody cares, or not being occupied productively)..  and it can build up over a few days.

Someone presses a button with a comment saying you don't do anything.. or  it maybe a no interaction day after a weekend of wonderful social interaction..  

Once this starts, it can usually end with a explosion of anger, self deprecating statements, or feeling stuck and hopeless..

I haven't this in quite a few months..

It comes on full blast in the early morning accompanied by other physical issues, so you are stuck in a weird state of wakefulness where you are feeling everything, but still in some light or REM sleep. Almost always, having a bowel movement, and yoga helps calm the brain..My gut was also off yesterday, so it could also be a gut-brain interaction..

 

@tsranga

 

Answering this question here on your thread.

 

I don't really have the emotional spirals at all anymore. I have emotional responses to life situations, but not that sort of unregulated emotional responses that I had when in withdrawal.

 

When my emotional responses were less regulated, I don't know as there were any amazing secrets as to how to stop them from spiraling. For me, it took a lot of mindfulness and some facets of cognitive behavioral therapy-type thought-restructuring to pull me through.

 

I found that over time, my ability to deal with emotional input strengthened and in so doing, changed my emotional output in response.

 

Hang in there,

Dave

[tsranga]

@ten0275

 

Thank you. Fortunately it resolved quickly. 

 

I have another question on Windows and waves.. 

 

The last few months, my typical pattern has been early morning awakenings, ruminative thoughts, with some anxiety that gets better in the evenings. Essentially I have a wave in the morning and a window in the evening.

 

But as you know, these patterns are always changing in subtle ways every day. 

 

The ones that are challenging are when you have an old symptom return out of the blue, or you get a very rare window for a few hours in the morning like yesterday with no anxiety and feeling normal, before the typical wave pattern returns.

 

This usually triggers a bout of overthinking into problem solving - what did I eat, what did I do or not do to trigger it, how can I ensure I can get more consistent windows in the morning.. etc. and that can spiral into fear/hopelessness if I don't catch it early.

 

What works for me is to keep saying - the symptoms come and go, I accept both the wave and windows as a sign that I am healing.. 

 

But some days I can't help but feel disappointed or frustrated that the windows don't last, and are so rare. Fortunately I am getting better at not letting it spiral.

 

Do you have any other suggestions for dealing with it?  Especially getting out of problem-solving mode? 

[ten0275]

5 hours ago, tsranga said:

@ten0275

 

Thank you. Fortunately it resolved quickly. 

 

I have another question on Windows and waves.. 

 

The last few months, my typical pattern has been early morning awakenings, ruminative thoughts, with some anxiety that gets better in the evenings. Essentially I have a wave in the morning and a window in the evening.

 

But as you know, these patterns are always changing in subtle ways every day. 

 

The ones that are challenging are when you have an old symptom return out of the blue, or you get a very rare window for a few hours in the morning like yesterday with no anxiety and feeling normal, before the typical wave pattern returns.

 

This usually triggers a bout of overthinking into problem solving - what did I eat, what did I do or not do to trigger it, how can I ensure I can get more consistent windows in the morning.. etc. and that can spiral into fear/hopelessness if I don't catch it early.

 

What works for me is to keep saying - the symptoms come and go, I accept both the wave and windows as a sign that I am healing.. 

 

But some days I can't help but feel disappointed or frustrated that the windows don't last, and are so rare. Fortunately I am getting better at not letting it spiral.

 

Do you have any other suggestions for dealing with it?  Especially getting out of problem-solving mode? 

 

@tsranga

 

I'm glad it resolved quickly for you.

Your methods for dealing with the windows and waves are really spot on from my vantage point. This is an excellent mantra.

 

Quote

What works for me is to keep saying - the symptoms come and go, I accept both the wave and windows as a sign that I am healing..

I tried to hone unreactivity. It was part of my challenge with patience. I would literally sit down, particularly in the mornings when symptoms - physical or emotional - would hit hardest, and I would just do my best to not react. Muscles twitching, I wouldn't react. Surge of raw adrenal anxiety rushing through me, I wouldn't react. That wasn't easy. I was used to getting up, pacing, walking to the mirror to check myself out, over-analyzing.... chasing my tail basically. But when that unreactivity was deployed with any degree of efficacy, the "response-emotions" that would typically amplify the actual symptoms would starve themselves out. And as a result, the suffering would be less. I tried not to let the arrows of fear pierce me. Symptoms, you can't stop actual symptoms. But the response-emotion, it can be dampened, it can me deflected.

Hang in there, it sounds like you are doing good things as you can.

Dave

 

[tsranga]

10 hours ago, ten0275 said:

I would literally sit down, particularly in the mornings when symptoms - physical or emotional - would hit hardest, and I would just do my best to not react. Muscles twitching, I wouldn't react. Surge of raw adrenal anxiety rushing through me, I wouldn't react. That wasn't easy. I was used to getting up, pacing, walking to the mirror to check myself out, over-analyzing.... chasing my tail basically.

This is so much like my journey.. I spent most of my first year pacing.. 

[tsranga]

I just had a consult with an autonomic function specialist at Stanford yesterday, and his initial findings were that there was something going on with my abdomen (postural induced burping) and feet (lack of sensitivity to soft objects) based on his testing.  I am due for a thermoregulatory sweat test and a TILT test as well. 

 

His opinion is that drug withdrawal induced autonomic dysfunction is unlikely to last this long.  Being on this group, and reading through the experiences of so many others, I find so much similarity in symptom patterns, I am not sure how to handle this with the physician. 

 

@Altostrata  Are there recent studies that I can share with him?  

 

 

 

[Altostrata]

 

Look in the Journals section for other papers.

[tsranga]

9 minutes ago, Altostrata said:

 

Look in the Journals section for other papers.

Thanks. I have this one..

[tsranga]

Update on 5/26/2021

 

Food tolerance has improved, but I still need to be cautious with fiber/high-FODMAP foods as they can trigger flare-ups at night. 

 

Main symptoms now  - 

 

Early AM (4-6AM), Early PM (4-6PM), 11:30PM-1AM

Anxiety, stuffy sinuses on wakeup - usually subsides after bowel movement. 

Sudden bouts of fatigue/sleepiness  

Stuck intestinal gas/reflux usually 2-3 hrs post meal. 

Sinus / Head pressure / Brain fog / Blurry vision /  Hyperawareness - intermittent.

 

Flare-ups - typically during drastic weather changes - dips or spikes in temperature more than 10-15 deg, humidity dips <30% or spikes > 80%.  Flare-ups typically mean no/poor sleep, either with late sleep-onset or early AM awakenings or both. 

 

It takes a day or two to adapt to the shift in weather before symptoms subsides. Main symptoms during flares originate from the gut - stuck intestinal gas / distension, altered BMs, burping, visceral sensitivity, reflux etc. sometimes combined with increased temperature sensitivity, being stuck in hot/cold mode, anxiety, sleep/wake confusion, ruminative/negative thoughts on wakeup, blurry vision, brain fog, hot upper body / cold extremities

 

For the record, I had none of these symptoms except burping/bloating after meals, and frequent BMs before I went on Mirtazapine. 

 

Anyone dealing with similar hypersensitivity to weather 27 months post CT?