Rapini: preparing to taper off of mirtazapine / Remeron

[Rapini]

I tried to taper off of Mirtazapine in March by skipping pills; I was not aware how dangerous this was at the time. My withdrawal symptoms were mild because I was lucky. I had some anxiety in April, but nothing major.

 

I went cold turkey after my prescriber told me that I didn’t need to taper Mirtazapine. He also pressured me into taking Effexor, which caused me to develop severe full-body itching. I was taken off of the pills immediately because it was suspected that I was allergic to them.

 

I suffered from severe withdrawal symptoms during the week where I wasn't taking any medication (sweating, diarrhea, anxiety, heart palpitations, shivering, lack of appetite, nausea, dizziness, flu-like symptoms, and insomnia). I tried to speak with my prescriber about tapering and withdrawal symptoms, but he insisted that everything I was experiencing was my ‘anxiety’ and put me back on Mirtazapine.

 

I am now preparing to taper off of Mirtazapine properly. I came here to learn how to do this as effectively as possible.

[Gridley]

13 hours ago, Rapini said:

 

I am now preparing to taper off of Mirtazapine properly. I came here to learn how to do this as effectively as possible.

 

Hello, Rapini, and welcome to SA.  I'm glad you found your way here.  Thanks you for completing your signature.

 

As you learned, skipping is days is never advisable.  And contrary to what your doctor said, Mirtazapine does have to be tapered slowly.

 

The symptoms you described are very typical withdrawal symptoms.  Doctors, almost without exception, know nothing about psychiatric drug withdrawal and in fact don't even believe it exists.  How are you feeling now that you've restarted the Mirtazapine?  Have the withdrawal symptoms improved?

 

So you have an understanding of what you experienced, here is some information on withdrawal.

 

What is withdrawal syndrome.

 

Glenmullen’s withdrawal symptom list.

 

Regarding tapering, we recommend tapering no more than 10% of your current dose every four weeks.  So your first taper would be your current 15mg minus 10% of 15mg (1.5mg) = 13.5mg as you first taper.  After four weeks you could subtract 10% of 13.5 (1.35mg) 13.5 =12.15.

 

Why taper by 10% of my dosage?

 

This link is specifically about tapering Mirtazapine and explains how to obtain these smaller nonstandard doses.  Your choices include cutting and weighing tablets, making a liquid from the tablets, or having a liquid prescribed or compounded.

 

Tips for tapering off Remeron (mirtazapine)

 

Since you did a cold turkey plus had an adverse reaction to Effexor, your system may be a bit destabilized and fragile.  Here is some information on two tapers that are somewhat slower and more gentle than the 10% taper.

 

A micro-taper is the gentlest way to come off these drugs. 

 

Micro-taper instead of 10% or 5% decreases

 

The Brassmonkey Slide is a way of making micro-taper reductions weekly, as opposed to a larger reduction once a month. 

 

The Brassmonkey Slide Method of Micro-tapering

 

You can decide which method you feel most comfortable with. 

 

Please don't hesitate to write in with any questions you have.  Please continue to use this thread to document your taper, ask questions and connect with other members.

 

 

 

 

 

 

 

[Rapini]

My withdrawal symptoms have improved significantly since I restarted Mirtazapine. I still have some issues with insomnia, appetite loss, fatigue, heart palpitations, and temperature regulation, but they are very, very mild. I would give my symptoms a 1 on a scale of 1-5.

 

Thank you for telling me about microtapering and the brassmonkey slide method. I was afraid of experiencing withdrawal symptoms once I begin tapering again. These methods make the process seem less intimidating.

 

How long should I wait for my nervous system to stabilize before I taper?

[laydefish]

Hi @Rapini & Welcome to the Group! Congratulations on wanting to get off these awful drugs- Stay Strong!

[Rapini]

Thanks ladyefish! I had no idea what I was getting into when I started taking this horrible drug. Going through withdrawal has been an overwhelming experience for me.

 

I know that I'll get over this, but some days it is really hard.

[Gridley]

On 5/16/2019 at 11:35 AM, Rapini said:

 

How long should I wait for my nervous system to stabilize before I taper?

 

I would wait at least 3 months, maybe a little longer.  See how you feel.  

[Rapini]

I have been experiencing some troubling symptoms since I began transitioning to from capsule to liquid. I want to know if I should wait it out, or resume taking capsules. My dosage is exactly the same (15mg).

 

I switched from capsule to liquid on July 16th at 7:00pm. I made a complete transition because I’m an idiot. I felt okay until the 20th at around 12:00pm when I became fatigued, irritable, anxious, dizzy, and had difficulty concentrating. I visited this message board, read a post about transitioning from capsules to liquid gradually, and decided to take 1/2 of my dosage in capsule form, and 1/2 in liquid (because I’m an idiot).

 

I was fine on the 21st (except tinnitus), but the above symptoms reemerged on the 22nd, so I began taking only 1/4 of my dosage in liquid form, and the other 3/4ths as a capsule. I had no symptoms on the 23rd. On the 24th, I began to feel irritated, and tired again, and these symptoms continued the following day.

 

The irritation abated on the 25th, but since then I have been experiencing insomnia and itching. I have noticed that I tend to feel tolerable until the afternoon, and then I start to feel terrible.

 

Should I continue with taking my medication as 1/4 liquid and 3/4ths capsule or should I resume taking my medication entirely in capsule form?

 

I don’t know if this is important, but I am making the mirtazapine liquid myself by adding water to the tablets, as I was not able to obtain a prescription from a compounding pharmacy.

 

Thank you.

[Altostrata]

On 7/26/2019 at 9:43 PM, Rapini said:

Should I continue with taking my medication as 1/4 liquid and 3/4ths capsule or should I resume taking my medication entirely in capsule form?

 

Hi, Rapini. How long have you been taking those B vitamin supplements? What time of day do you take them? How do you feel before and after taking them?

 

If I were you, I'd go back to the capsule form. Don't worry about tapering for a while, stabilizing may take a couple of months.

 

Please let us know how you're doing.

[Rapini]

Hi Alostrata,

 

I've been taking the B vitamin supplements for three months. I take them at 7 o'clock in the morning after breakfast. I don't notice any symptoms after taking them.

 

I feel better today. I was able to sleep last night, which I have not been to do over the last two days, so I don't feel as tired. I still had issues with concentration at work this morning, but it was not as bad as yesterday, and the anxiety and the irritation are gone. The tinnitus is still present, and I had mild heart palpitations at 2:00pm, which lasted for a few minutes. 

 

I agree that I should stabilize for a while.

[Rapini]

I have not made any changes to my dose since I last posted here... I was feeling well for quite some time, but three days ago, I suddenly began to experience insomnia, heart-palpitations, anxiety, and body aches. They are a lot milder than when I was in withdrawal, but it's strange that they've appeared so suddenly. 

 

Is it possible that my CNS is just overly sensitive due to going through withdrawal before? I have noticed that I feel worse whenever the temperature rises, and the temperature here has become quite a bit higher over the last few days...

 

I have noticed that people on here have mentioned being sensitive to B-12 vitamin, so I have decided to stop taking it. Has psyllium husk caused problems for other people during withdrawal? I began taking it for digestive issues three days ago when my symptoms started.

 

Am I panicking over nothing?

Edited September 12, 2019 by Rapini
Added Details

[Santino]

Hey friend

I believe you are panicking over nothing in fact. You try to check what have you done wrong during the last days to have such set of symptoms. Anyway you yourself are saying that they are very mild so why feeding the ruminating brain with more worries.

Just let those mild symptoms be there and continue with your life. If i was you i would continue tapering with the 10% rule. You have enough stability to do that. 

All the best

Santino

[Rapini]

Thanks Santino. I feel much better today. 

[Rapini]

I have been experiencing dizzy spells and insomnia since I made my most recent decrease from 14.1  to 13.8 on December 20th. The dizziness started on the 22nd, but was very mild until the 24th. I had intended to hold on this dose until my symptoms abated, but my symptoms seem to come and go instead of slowly abating. My insomnia is currently my worst symptom.

 

I have been dealing with several new stressors in my life since the 8th of December. I’m wondering if these might be partially the reason why my symptoms have become so much worse. It’s definitely impacting my sleep.  

 

I also think I was making a mistake when I was preparing my liquid medicine, since there was some white residue on the bottom of the jar after I took my dosage. I figured out how to solve this problem after reading this message board, but I feel like an idiot for ignoring this for so long.

 

 

I am including my daily notes for the past several days below (please note that I must get up at 3:30am daily for work, so I will always be awake at this time):

 

January 8th 2020
3:00am. Heart palpitations & anxiety.
3:30-4:30am. Dizziness, heart palpitations, anxiety.
6:30am. Ate breakfast.
8:00am. Dizziness when standing.
10:00am. Emotional lability / Excessive crying. Dizzy upon standing. Ate lunch.
11am-3pm. Listlessness.
2:00pm. Ate dinner.
3pm-5pm. Asymptomatic and energetic.
5:30pm. Anxiety.  
9pm. Took mirtazapine.
9pm-3am. Insomnia. Burning feet.

 

January 7th 2020
2am-3:00am. Asymptomatic.
7:00am. Ate breakfast.
10am. Ate lunch.
2:00pm. Ate dinner.
3:30pm-5:30pm. Fatigue and listlessness.
8:pm. Took mirtazapine and slept.
12:am. Awoke with heart palpitations and anxiety.
1:00am. Returned to sleep.

 

January 6th 2020
3:30am. Asymptomatic.
7:00am. Ate breakfast.
10am. Ate lunch.
11am. Fatigue.
2:00pm. Ate dinner.
3:30pm-5:30pm. Fatigue.
8pm. Took mirtazapine.
9:30pm-2am. Slept.

 

January 5th 2020
3:30am-8pm. Fatigue.
7:00am. Ate breakfast.
10am. Ate lunch.
2pm. Ate dinner.
8pm. Took mirtazapine.
10pm-2am. Slept.  

 

January 4th 2020
7:00am. Ate breakfast.
10am. Ate lunch.
2pm. Ate dinner.
8pm. Took mirtazapine.
Didn’t sleep at all.

 

January 3rd 2020
3:30am-4:00am. Fatigue, dizziness, and hot.
6:30am. Ate breakfast.
7:00 Symptoms improved, but still persisted.
9:30am. Became dizzy after walking.  
10:00am. Had lunch.
2:00pm. Dinner.
3:00pm. Started to feel better.
3:30pm-5:30pm. Symptoms disappeared.
6pm-8pm. Energetic!
8pm. Took mirtazapine.
9pm-1am. Slept.

 

January 2nd 2020
Completely asymptomatic.

January 1st 2020
7:00am. Ate breakfast.
10am. Ate lunch.
2pm. Ate dinner.
4pm-7pm. Itchy skin.
8pm. Took mirtazapine.
Didn’t sleep at all.

 

December 31st 2019
3:30am-7pm. Itchy skin. Dizziness. Fatigue.
7am. Ate breakfast.
10am. Ate Lunch.
12pm. Symptoms improved.
2pm. Ate dinner.
8pm. Took mirtazapine.
8pm Horrible tinnitus.

 

December 30th 2019
3:30am-4pm. Dizziness.
4pm. Dizziness and hot flashes
6pm. Itching.
Didn’t sleep.

 

 

 

[Mirthazard]

Rapini, is your burning feet in the soles of the feet? Or the entire feet?

[Rapini]

The soles of the feet.

[Mirthazard]

Arghh you are having the symptom as i am but i have it 24/7 what about you

[Rhiannon]

It sounds like you have been tapering sensibly. That usually means that withdrawal symptoms, if they do appear with a cut, will stabilize and settle down over time without any nasty surprises in wait. Do you think you can deal with your symptoms the way they are for a few more weeks if they last that long?

 

If you can still function, work and do what you need to do in your life, even if you're not feeling very good, it seems to me that just staying right where you are and allowing your CNS to continue to settle down would be the best course of action. Once the symptoms settle down you may want to hold a little longer than you had originally planned before making your next cut. Sometimes we need to take extra breaks. Your body is the wise expert on this.

[Rapini]

Mirthazard: My feet hurt sometimes. It doesn't seem to happen very often with me. I'm sorry that you have to deal with foot pain 24/7.

 

Rhiannon: Thank you for your advice. I think I can deal with the symptoms for a few more weeks. I feel much better today than I did yesterday. I will hold for at my current dose for the time being.

[Jingyd40]

On 1/10/2020 at 12:51 AM, Mirthazard said:

Arghh you are having the symptom as i am but i have it 24/7 what about you

I get burning feet this last 2 years. Every night it flares up. They feel hot all over the toes and soles of feet. Then sometimes the toes go really red on the top and slightly on top of foot beneath the toes. I knew it was mirt Gp dismissed it and put it down to me resting a lot due to the fatigue. 

[Rapini]

Is it normal for symptoms to come and go arbitrarily while in withdrawal? My symptoms mostly went away on January 23rd, and I was fine until February 1st when my symptoms suddenly became horrible. They began fading the next day, but I still feel much worse than I felt on January 23rd. I have not made any changes to my dosage. I’m still stuck at 13.8mg.

 

I tend to feel worse at work, which is physically demanding and tends to aggravate my symptoms. I making a lot of mistakes at work, and I have a lot of anxiety about losing my job. Has anyone been in a similar situation? What have you done about it?

 

Thank you

[Carmie]

1 hour ago, Rapini said:

Is it normal for symptoms to come and go arbitrarily while in withdrawal? My symptoms mostly went away on January 23rd, and I was fine until February 1st when my symptoms suddenly became horrible. They began fading the next day, but I still feel much worse than I felt on January 23rd. I have not made any changes to my dosage. I’m still stuck at 13.8mg.

 

I tend to feel worse at work, which is physically demanding and tends to aggravate my symptoms. I making a lot of mistakes at work, and I have a lot of anxiety about losing my job. Has anyone been in a similar situation? What have you done about it?

 

Thank you

Hi Rapini, 

 

Yes, that’s normal in withdrawals. They are all over the place, it’s just the normal windows and waves patterns. My withdrawals are all over the place too, and sometimes I get additional symptoms that come and go like tooth aches, earaches, sore throat, temperature disregulation. Every time I get a new symptom I’m like it’s probably withdrawals and it nearly always is. Before I knew about all the symptoms one could get in withdrawals I always thought I was coming down with something or that I’ve got something else wrong with me. I’m already really sick with a chronic illness. 
 

I remember going to the dentist with a toothache and he said there’s nothing wrong with my teeth. He thought it was psycho somatic. Nope, it was withdrawals.
 

I remember once too I had a burning mouth for two months and at the time I thought I had burning mouth syndrome. I didn’t find out until later on it could be a symptom of withdrawals. Pretty much anything that can happen in the body can be due to withdrawals because everything is connected to the CNS. If you don’t know that all these things are caused by withdrawals you start thinking you’ve got more things wrong with you.

 

Stress can ramp up symptoms as well. I’m unable to work due to my illness. I’m sorry you have to put up with the stress at work.

 

Sending hugs🤗

[Santino]

Hi Rapini

 

I was in your shoes during the WD. I would try and do more things on the good days at work. On the bad ones i would try to just avoid or push through waiting for the good days again. It is a bit of a rollercoaster but it can be done. I am sure you will prevail my friend.

 

All the best

[Rapini]

Thank you so much Carmie and Santino.

 

Carmie: I didn't know that withdrawal could be so random, or that waves could last this long when one tapers sensibly, so I was feeling very upset and frustrated. I see that I need to be more patient with this process.

 

Santino: Thanks for the advice on about work. I tend to push myself too much on bad days.

[Carmie]

Hi Rapino, 

 

Yes, withdrawals can definitely be all over the place, even when you’re tapering slowly. I’m tapering under 4% and I still get waves, and I mentioned I get all sorts of different symptoms that come and go. 
 

It is frustrating, but it’s part of our brains trying to heal. It is a long and arduous process, but we will get there in the end. I’m at 5.60mg at the moment, but my body is so sensitive and it will take me nearly a decade to get off this amount. If I go any quicker I get such severe, unbearable akathisia. 
 

Sending hugs🤗

[Shebon]

Hi Rapini:

 

I am trying another taper off the mirt.  I tried the liquid route 2x in 2018....first crushing then adding to the oral solution...then crushing and adding to maple syrup.  I did not make it past my first reduction.

 

I am currently at 3.25 mg. mirt (started at 3.75 mg) and have been trying to follow the CITA schedule, albeit revised.  I take 1.87 mg. (1/8 tablet) on Wed. and Sat. nites, and the remaining nites are 3.75 mg. dosages.  I have done the math and this works out to a less than 10% reduction over the 7 days.  I made my first reduction to 3.5 mg. (only one night in the week with 1.87 mg.) and stayed on that for a good 30 days.  Now I have just started the 3.25 mg.  I have had some symptoms such as the teeth aches, diarrhea, headaches, nite sweats, and some insomnia.  Hopefully, I can continue to do this every month and ease down slowly.  My goal is to get to the 1/2 mirt milestone or 1.87 mg. mirt, restabilize, and then start again with 1/2 of 1.87 mg. one nite a week and so on.  Hope this makes sense....I have been on mirt since 3/2013, but only at 3.75 mg.

 

Let's stay in touch... support is always a good thing!!

 

Shebon😄

[PH1]

Rapini,

How are you doing these days?    All the best to you on this journey

PH1

[Rapini]

Do some people experience face and teeth pain in withdrawal? My face began hurting suddenly on September 25th. The pain tends to go away in the mornings, and it gets worse throughout the day. Eating and speaking worsen the pain. Ibuprofen helps slightly, but the pain just comes back.

 

 

 

PH1: I'm sorry that it's taken me so long to see your comment. I hadn't been frequenting the board for a long time because I had been doing well, or at least felt that I was able to manage my symptoms. Until recently, I was just very tired. 

 

 

[Rapini]

My pharmacy no longer carries the brand of mirtazapine that I have been using (auro-mirtazapine), and suddenly switched me to what I think may be a generic brand (I'm assuming that it's generic because no brand is listed). Has anyone had this happen to them during? What should I do?

 

Also, the face pain has mostly abated since October 22. It was pretty awful when I had it, but at least it didn't last very long.

[ChessieCat]

Do you still have any of the old auro mirtazapine?  If yes then you might consider doing a cross over.  See:

 

cross-over-changing-form-eg-tablet-to-liquid-of-drug-or-changing-brand-of-same-drug

 

If not, do you have other pharmacies that you might try to get the same brand so that you can do a cross over.

 

In the future, I suggest that you get your prescription before you run out of the type you are taking so that if you are not able to get the same type then you can do the cross over.  Or before the prescription is due, contact the pharmacist and ask what type they have and if it is the same, ask them to hold a box for you.

 

Please note that it would be better to be able to get the same type all the time.

 

[Rapini]

Thank you. I have seven pills left, so I will try to do a cross over. There isn't another pharmacy that I can get auro mirtazapine that I know of... I was purposefully sticking to the same pharmacy during my entire taper so that the brand would always be the same. They've given me the same brand consistently for over two years, so I never considered that they would suddenly have a supply issue...

 

I will make sure to stock up more quickly next time, and call pharmacists in advance from now on.

[ChessieCat]

Do not make a reduction or start/stop anything else at the same time.

 

Listen to your body/symptoms.

[Rapini]

I didn't plan to. I plan to take it easy for the next week or two. Thank you for your support.

[Rapini]

Has anyone had to do shift work during withdrawal? I just got a new job offer that would require shift work, but would also provide me with more pay and stability than my current position. I have been debating if I should take this job since I am afraid that the shift work would worsen my withdrawal symptoms, which have been significant even with my slow taper, especially insomnia. Does anyone else have experience with this?