cathnz: tapering off Remeron / mirtazapine

[cathnz]

Hi there, I'm new to this site but need help! Have had 15 years of AD use, which include a couple of changes due to 'poop outs'. My last change was 9 weeks ago when the 15mg paroxetine that I'd been on for 7 years pooped out. Ended up under crisis team and physchiatrist switched me to 15mg Mirtazapine (straight switch from one day to the next).

I had done a similar switch back in 2007 when my lexapro pooped out (tapered down over 2 weeks then switched straight over to the paroxetine). 

Over the last 6 weeks on Mirtazapine,  the physchiatrist titrated me up to 45mg as I was in a bad state. 45mg WAY too high for me and caused akathisia, so he dropped me back to 30mg (after 3 weeks on 45mg). Akathisia better, but still lingering, so he wants to drop me down to 22.5mg.

What do I do... I need this akathisia to stop ASAP, so a drawn out taper seems like far too long to wait! But I'm sure my body is in crisis from the med switch and titrating up then quick drop back down. Also used benzos over 4 weeks during switch, and titrated off them.

Am I better to put up with the akathisia and do a slow taper? He thinks that drop percentage is fine (25%), but after reading this site combined with the weird experiences I'm having I'm too scared  (so I'll need to enlist the help of a chemical compounding pharmacy) . 

Am I better to do that drop (25%) to stop the akathisia quickly, or just let my body settle down? Do 10% in another 2 weeks time (so that will be 4 weeks after my drop from 45mg to 30mg).

I don't know what to do... I have been under the care of the crisis team and been going along with the plan, but can't help but feel these side effects are worse than having no treatment! 

I'm only 43 with a beautiful husband and son, but I'm scared that I've screwed my poor body up for life. I need advice, and stories of hope (and of easy withdrawls, not just horror stories, to give me hope). 

P. S Could my akathisia actually be paroxetine withdrawls even though I went straight onto another med? 

[cathnz]

Sorry for this post, but I made my very first post a few weeks ago but not sure if it has been recieved. 

[cathnz]

Help please. I am stuck and don't know what to do going forward. Situation as per following... 

2004-2007 Aropax. Gradual taper over months but in bigger increments ( 20, 15, 10, 5). No adverse effects while tapering.

6-12 months later depression and anxiety returned when pregnant. Began Lexapro 10mg (so late 2007). Used for 4 years until it 'pooped out'. Switched to paroxetine (switch done over a few weeks going in 5 mg decreases, no withdrawl probs). 

15mg paroxetine from 2007 - 2019 until it 'pooped out'.

Sept 19, straight switch from 15mg paroxetine to 15mg paroxetine (under care of crisis physchiatrist). Over next 6 weeks titrated up to 45mg, but had major side effects (akathisia) and dropped to 30mg after 3 weeks on 45mg). Have been on 30mg for 2 weeks and still some milder akathisia so physchiatrist suggests drop to 22.5mg. Need akathisia to stop ASAP BUT don't want to drop that big that fast! 

Being under the care of crisis team, and in a very bad mental state (with anxiety and depression) I need the meds at this stage to get stable. But if mirtazapine not working and can't get stable first (before tapering) what do I do? I'm so terrified of changing /increasing /decreasing I feel stuck like a deer in the headlights. I need hope please. 

[Sassenach]

Hi Cath.

 

I apologise if we missed you, will try and see why, but for now.

 

Did you admit yourself voluntarily to the crisis unit?

12 hours ago, cathnz said:

15mg paroxetine to 15mg paroxetine

Do you mean change to Mirtazapine?

 

12 hours ago, cathnz said:

45mg, but had major side effects (akathisia) and dropped to 30mg after 3 weeks on 45mg)

Was this a one step drop or fast taper?

 

12 hours ago, cathnz said:

I need the meds at this stage to get stable.

You are right you need them but you need a steady dose.

We recommend a maximum taper of 10% of current dose.

45 to 30 mgs is a massive 30% drop which has sent you into withdrawal.

12 hours ago, cathnz said:

I'm so terrified of changing /increasing /decreasing I feel stuck like a deer in the headlights. I need hope please. 

You need to hold your current dose for the moment.

Do you have anyone at home to help?

Please read the links below which will explain what is happening to you.

the-windows-and-waves-pattern-of-stabilization/

why-taper-by-10-of-my-dosage/

dr-joseph-glenmullens-withdrawal-symptom-checklist/

https://www.youtube.com/watch?v=KQtO6HXJfjw

the-dr-claire-weekes-method-of-recovering-from-a-sensitized-nervous-system/

 

I it important to understand doctors and psychs know little or nothing about withdrawal from the drugs they prescribe.

If something is not working their answer is to pile on more drugs and higher doses which is the exact opposite of what is needed.

For the moment do not allow them to change your doses any further and do not allow them to introduce further drugs to help you with the symptoms.

Additional drugs are usually Benzos which are highly addictive.

13 hours ago, cathnz said:

mirtazapine not working

The reason it is not "working" is because of the way it was introduced.

 

13 hours ago, cathnz said:

can't get stable first

You can get stable by making no more changes.

 

Please read the links above and get back to me with the answers to the questions.

 

Sassenach

[Sassenach]

Hi Cath

 

I can see you are looking at this thread, please stay here for the moment.

 

Sassenach

[Sassenach]

Got it now you are at home under the care of the crisis team, is that correct?

[cathnz]

Thank you for your help with this...

 

Did I take myself willingly to the crisis unit? 

Yes I did. When my 15mg paroxetine 'pooped out' after 7 years, I tried for 6 weeks to get myself through, but fell further and further down with anxiety and depression.  Eventually went to my Dr but didn't feel like I had enough support so went into crisis team (not hospitalised though). I willingly switched to Mirtazapine because in the past (7 years ago) when I'd had Lexapro poop out I switched to paroxetine and it worked well. 

 

Did I mean paroxetine to Mirtazapine? 

Sorry, yes, that was a typo... 15mg paroxetine to 15mg mirtazapine, straight switch. 

 

Was the 45mg mirtazapine to 30mg mirtazapine a quick taper out one step drop?

One step drop from 45mg to 30mg unfortunately 😔 I know that's not ideal at all but situation was pretty dire. I had been on 45mg for 3 weeks (but under the cover of Diazapam... when that was tapered down the akathisia that I was experiencing on 45mg was insane). They dropped my dose quickly to resolve symptoms and it did for the most part. I couldn't have gone another day like I had been on the 45mg.

 

Do I have help at home? 

Yes I do, I live with my husband and 12 year old son. 

 

I know this situation isn't ideal at all and things feel like such a mess right now that I can't undo I don't know how I'm gonna get myself out of this mess.

 

P. S In my original post forgot to add that I was using Diazapam over the period that Mirtazapine dose was increased from 15mg to 45mg. This was tapered off. 

 

P. P. S Not everything I am experiencing is new (but some is). Alot of my symptoms were there when my paroxetine 'pooped out'. 

 

Basically when a stressful situation hits, I don't cope well. I tend to fall flat on my face. Anxiety. Then depression. 

[cathnz]

4 minutes ago, Sassenach said:

Got it now you are at home under the care of the crisis team, is that correct?

Correct. Weekly appointments and daily contact with care team. 

[Sassenach]

Hi there, I'm new to this site but need help! Have had 15 years of AD use, which include a couple of changes due to 'poop outs'. My last change was 9 weeks ago when the 15mg paroxetine that I'd been on for 7 years pooped out. Ended up under crisis team and physchiatrist switched me to 15mg Mirtazapine (straight switch from one day to the next).

I had done a similar switch back in 2007 when my lexapro pooped out (tapered down over 2 weeks then switched straight over to the paroxetine). 

Over the last 6 weeks on Mirtazapine,  the physchiatrist titrated me up to 45mg as I was in a bad state. 45mg WAY too high for me and caused akathisia, so he dropped me back to 30mg (after 3 weeks on 45mg). Akathisia better, but still lingering, so he wants to drop me down to 22.5mg.

What do I do... I need this akathisia to stop ASAP, so a drawn out taper seems like far too long to wait! But I'm sure my body is in crisis from the med switch and titrating up then quick drop back down. Also used benzos over 4 weeks during switch, and titrated off them.

Am I better to put up with the akathisia and do a slow taper? He thinks that drop percentage is fine (25%), but after reading this site combined with the weird experiences I'm having I'm too scared  (so I'll need to enlist the help of a chemical compounding pharmacy) . 

Am I better to do that drop (25%) to stop the akathisia quickly, or just let my body settle down? Do 10% in another 2 weeks time (so that will be 4 weeks after my drop from 45mg to 30mg).

I don't know what to do... I have been under the care of the crisis team and been going along with the plan, but can't help but feel these side effects are worse than having no treatment! 

I'm only 43 with a beautiful husband and son, but I'm scared that I've screwed my poor body up for life. I need advice, and stories of hope (and of easy withdrawls, not just horror stories, to give me hope). 

P. S Could my akathisia actually be paroxetine withdrawls even though I went straight onto another med?

[Sassenach]

What drugs are you currently taking and at what dose?

What symptoms are you currently experiencing?

Are you taking any supplements?

dr-joseph-glenmullens-withdrawal-symptom-checklist/

the-windows-and-waves-pattern-of-stabilization/

rule-of-3kis-keep-it-simple-keep-it-slow-keep-it-stable/

Please answer the above to enable us to see where you are now.

I will be posting again but may take up to 30 minutes, can you stay online?

 

[cathnz]

I'm currently taking 30mg Mirtazapine. 

 

Also taking turmeric and b6 and magnesium (these all helping). Was concerned b6 might be too stimulating but haven't had this problem. I think it may have helped with akathisia. 

 

Main symptoms are feeling internally restless, like there is an electrical wire buzzing though me, nerves sensitive, tinnitus (and super sensitive to noise). Also moments of huge overwhelm  and fear that I'm going to lose control and give in to this being too hard and do something impulsive to myself... not really wanting to though. (some passive suicide idealation i. e having a heart attack right now would be a blessing). 

Other symptoms (detachment, not eating properly, foggy head, excessive ruminating, panic attacks) have been with me since before switch (i. e when paroxetine started to 'poop out'). 

[Sassenach]

Formal intro.

 

Hello    cathnz    and welcome to SA.

 

This site is run entirely by volunteer Administrators and Moderators, all have been through or going through withdrawal.

There are no commercial interests or influences  involved .

 

I am sorry you are having such a rough time but you are now in the right place.

 

To begin we need information regarding your drugs.

 

I understand how ill you are feeling but in order to determine the best way forward we need to know your full drug history, particularly for the last 24 months.

It is particularly important as you have Benzos not just A/Ds to take into account. I realise you are no longer taking them but they are involved in your recent history.

Once complete this history will appear below every post so the mods can see your it at a glance.

The site is extremely busy and mod time is precious.

It is also necessary so we can ensure that all info is in one place and accurate.

Please add a signature.  Include drugs, doses, dates, and discontinuations & reinstatements in the last 12-24 months. Also include supplements. This will help us give you the most accurate advice we can. 

• Any drugs and supplements prior to 24 months ago can just be listed with start and stop years. 
• Please use actual dates or approximate dates (mid-June, Late October) rather than relative time frames (last week, 3 months ago) 
• Spell out months, e.g. "October" or "Oct."; 9/1/2016 can be interpreted as Jan. 9, 2016 or Sept. 1, 2016. 
• Please leave out symptoms and diagnoses. 
• A list is easier to understand than one or multiple paragraphs. 
• This is a direct link to your signature

http://survivingantidepressants.org/index.php?/settings/signature/

 

If you have problems please let me know and I will help.

24 minutes ago, Sassenach said:

Could my akathisia actually be paroxetine withdrawls even though I went straight onto another med?

It is definitely W/D brought on by too many changes of meds and doses.

The good news you can and will get better, the bad news it can be a long road.

33 minutes ago, cathnz said:

Basically when a stressful situation hits, I don't cope well. I tend to fall flat on my face. Anxiety. Then depression. 

It is also going to be necessary to deal with this as you do not need a repeat when you get through W/D.

You will need to learn coping strategies.

We have that info. on the site when it becomes relevant.

For the moment we need to help you deal with the W/D.

You should be aware that your crisis team will not agree with the advice we will give you.

I suggest you browse other members threads and decide for yourself which advice to follows.

We all trust our doctors and they do good work with physical illness but are not taught about W/D.

As soon as we get your history/ signature sorted I will also ask one of our senior mods who is a Benzo specialist to assess your situation.

You are young so time is on your side.

As soon as we recieve the drugs info. we can assess your situation.

In the meantime DO NOT MAKE ANY CHANGE TO YOUR CURRENT MEDS please.

Please feel free to browse the site, it is a wealth of info.

 

 

Again welcome.

 

Sassenach

[cathnz]

Thank you. I am so scared. It's been 4 months since my paroxetine pooped out (and about 3 months since change)... I feel as despondent today as I did since it pooped out. I don't think I can keep going like this. The overwhelm is HUGE. 

[RachelSusan]

Hi Cathnz,

 

I see that a moderator answered you somewhere else on this site.  I hope you saw it as well.  I wanted to wish you good luck.  You've come to the right place for help.

 

Warm wishes,

Rachel

Edited October 14, 2019 by RachelSusan
typo

[cathnz]

Hi

10 hours ago, Sassenach said:

Formal intro.

 

Hello    cathnz    and welcome to SA.

 

This site is run entirely by volunteer Administrators and Moderators, all have been through or going through withdrawal.

There are no commercial interests or influences  involved .

 

I am sorry you are having such a rough time but you are now in the right place.

 

To begin we need information regarding your drugs.

 

I understand how ill you are feeling but in order to determine the best way forward we need to know your full drug history, particularly for the last 24 months.

It is particularly important as you have Benzos not just A/Ds to take into account. I realise you are no longer taking them but they are involved in your recent history.

Once complete this history will appear below every post so the mods can see your it at a glance.

The site is extremely busy and mod time is precious.

It is also necessary so we can ensure that all info is in one place and accurate.

Please add a signature.  Include drugs, doses, dates, and discontinuations & reinstatements in the last 12-24 months. Also include supplements. This will help us give you the most accurate advice we can. 

• Any drugs and supplements prior to 24 months ago can just be listed with start and stop years. 
• Please use actual dates or approximate dates (mid-June, Late October) rather than relative time frames (last week, 3 months ago) 
• Spell out months, e.g. "October" or "Oct."; 9/1/2016 can be interpreted as Jan. 9, 2016 or Sept. 1, 2016. 
• Please leave out symptoms and diagnoses. 
• A list is easier to understand than one or multiple paragraphs. 
• This is a direct link to your signature

http://survivingantidepressants.org/index.php?/settings/signature/

 

If you have problems please let me know and I will help.

It is definitely W/D brought on by too many changes of meds and doses.

The good news you can and will get better, the bad news it can be a long road.

It is also going to be necessary to deal with this as you do not need a repeat when you get through W/D.

You will need to learn coping strategies.

We have that info. on the site when it becomes relevant.

For the moment we need to help you deal with the W/D.

You should be aware that your crisis team will not agree with the advice we will give you.

I suggest you browse other members threads and decide for yourself which advice to follows.

We all trust our doctors and they do good work with physical illness but are not taught about W/D.

As soon as we get your history/ signature sorted I will also ask one of our senior mods who is a Benzo specialist to assess your situation.

You are young so time is on your side.

As soon as we recieve the drugs info. we can assess your situation.

In the meantime DO NOT MAKE ANY CHANGE TO YOUR CURRENT MEDS please.

Please feel free to browse the site, it is a wealth of info.

 

 

Again welcome.

 

Sassenach

Thank you. I have tried to do my signature but it didn't all fit on 12 lines so added it as a file. Not sure I've done that correctly. Here it is anyway.

 

Aug 2004 - Dec 2006: Aropax (doses ranged from 20mg - 30mg). Tapered over about 6 months. No withdrawal problems.

 

Aug 2007: Fluoxetine (for 3 weeks). Side effects terrible so switched to Lexapro (straight switch).

 

Sept 2007 - July 2012: Lexapro (doses ranged from 10mg - 20mg). Pooped out July 2012. Titrated down off Lexapro over 3 weeks and switched to Paroxetine (with Xanax to cover switch for 2 weeks). 

 

Aug 2012 - Aug 2019: Paroxetine (titrated up to 20mg in first few weeks, but experienced akathisia, so dose reduced to 15mg over next few weeks). Stayed at 15mg for 7 years until it 'pooped out'.

 

4th Aug 2019 - Reduced dose  of paroxetine to 10mg (for 1 day) - under phychiatrists directions. Last dose of paroxetine.

 

5th Aug 2019 - Switch to 15mg Mirtazapine. 

 

5th Aug - 15th Aug 2019 - 15mg Mirtazapine plus intermitent use of Lorazapm (0.25- 0.5  once a day every few days or so). Also used 12.5mg Quetiapine for 3 nights for sleep.

 

23rd Aug 2019 - Ended up in crisis team. Mirtazapine increased to 30mg. Diazapam 10mg twice daily.

 

30th Aug 2019 - Mirtazapine 30mg + Diazapam reduced to 7.5mg twice daily

 

6th Sept 2019 -  Mirtazapine 30mg + Diazapam reduced to 5mg twice daily

 

13th Sept 2019 - Mirtazapine increased to 45mg. Diazapam increased back up to 10mg twice daily. 

 

20th Sept - 29th Sept 2019: Mirtazapine 45mg. Diazapam being reduced from 10mg down to 0mg this week (in 2mg increments couple of days).

 

30th Sept - Thursday 3rd Oct 2019: Mirtazapine 45mg. WORST ANXIETY EVER. Akathisia. Couldn't stay still. Suicidal idealization. 

 

Friday 4th October - present: Reduced from 45mg to 30mg (straight drop to alleviate akathisia - reduction definitely helped alot but still not gone completely)

 

Friday 4th October - Friday 11th October: 45mg Mirtazapine

 

Friday 11th October - present: 45mg Mirtazapine, Vit B6, Curcumin, Magnesium (no adverse effects from adding these supplements - have helped akathisia somewhat).

 

* Everything done from 23rd August under care of outpatient crisis team management.

[cathnz]

Following on from my post... I'm confused. While I know what I'm experiencing now is definitely not cool, I did have many of these symptoms when my paroxetine 'pooped out' i.e. BEFORE the switch. And in that instance I had been ok for 7 years prior. So how do I know what is my own actual anxiety and depression (which had most definitely resurfaced prior to the switch BIG TIME) and what are WD's? All I know is that I am NOT GOOD and can't keep going like this. Its been 4 months of crap (3 of those being since the change of meds, and a month prior going through poop out).

[cathnz]

And another question... are people who have been on antidepressants for severe clinical depression for 15+ years able to live full happy lives off them? Or am I just kidding myself? I owe it to my family to be the most well version of me. My life stressors aren't going to go away. My parents are aging (and mother, who is my best friend, is in the early stages of dementia). And my son is becoming a teenager. I'm heading into a stormy part of life and not sure I'll survive without my floaties (the meds). But right now these damn things aren't giving me any quality. STUCK STUCK STUCK and feeling sooooo hopeless 😞

[composter]

Cath, you’ve been through a lot of med changes in the past year and many years prior to that. I hope you have found the time to read through the links the mods have posted above, the information on this site is invaluable and I urge you to take the time to read and learn.

 

Just a side note, most of us on here don’t believe in labels like “severe clinical depression” or even bipolar, we tend to take the view that many of these labels and diagnoses were slapped onto moments that were more situational in nature. Many, many people on this site have been able to safely taper off their drugs after being on them for decades. I urge you to check out the Success Stories section of this site for inspiration. 

 

If it’s any encouragement, I’d like you to know that I have been there with the feelings of inhuman levels of anxiety and depression, the absolute despondency and hopelessness. Unlike anything I had ever experienced before going on my AD. It all feels totally real and totally dark, and it is all caused by these drugs and the withdrawal. But you must find a strength and resilience inside yourself that you never thought you had. Lean on your support system, listen to your body, and keep things simple and stable.

[Sassenach]

Hi Cath.

13 hours ago, cathnz said:

I did have many of these symptoms when my paroxetine 'pooped out

You would have, poop out or tachyphylaxis to give the official title is defined as follows

"rapidly diminishing response to successive doses of a drug, rendering it less effective. The effect is common with drugs acting on the nervous system"

When the drug poops out you enter W/D despite the fact you are still taking the med.

13 hours ago, cathnz said:

And another question... are people who have been on antidepressants for severe clinical depression for 15+ years able to live full happy lives off them

On 10/13/2019 at 5:00 PM, cathnz said:

Basically when a stressful situation hits, I don't cope well. I tend to fall flat on my face. Anxiety. Then depression.

Depression is just that sticking labels on it does not help as Composter said above.

There is no definitive answer but certainly most people are better off meds, as long as they put coping strategies in place.

This is certainly one area where convential medicine can help.

Cognitive behavioural therapy could be organised by your doctor.

See below

http://www.getselfhelp.co.uk/docs/SelfHelpCourse.pdf

"I don't cope well. I tend to fall flat on my face."

Has this always been the case, if it changed when and why? ( you do not have to answer this question )

All the above is some way down the road, for now we need to get you to stability which will be

13 hours ago, cathnz said:

I owe it to my family to be the most well version of me.

Stabilty will be that version for now and the rest will come later.

Is that a plan?

 

Sass

 

[cathnz]

Hi there, I'm getting ready for a future reduction in Mirtazapine. It won't be any time soon (I need to get stable first) but am just wondering how I will go about this. I live in NZ and Mirtazapine only comes in the form of tablets (i.e not liquid or capsules with beads). 

I have 2 options... getting a compounding pharmacy to make up capsules (very expensive), or getting some gemini scales and shaving the tablets. All the info I can find on here is about taking beads out of capsules (which isn't possible with a compacted tablet). Is the shaving off and weighing on a gemini scale an option? And the pink coating that is on the tablet... is this part of the active ingredient too? 

[Altostrata]

Welcome, cath.

 

You have options, you can make a liquid. See Tips for tapering off Remeron (mirtazapine)

 

The pink coating is not an active ingredient.

Edited September 2, 2020 by DataGuy

[cathnz]

13 hours ago, Altostrata said:

 

You have options, you can make a liquid. See Tips for tapering off Remeron (mirtazapine)

Hi @Altostrata, is making a liquid my only option to do it myself (for some reason doing it this way makes me extremely nervous) 🤔

Is the shaving and using scales an option? At this stage I'd just be going down from 30mg to 27mg (and intend to hold there a long while). When I get to lower doses I'll prob enlist a compounding pharmacy.

Has anyone used the Dutch company that makes the tapering packs? 

[manymoretodays]

Introductions all merged. 

[Rhiannon]

Cath I read the file you uploaded to your signature, it says you reduced to 30 mg mirt but also says that you are currently taking 45 mg of mirt. Can you check that and clarify?

 

I also note that you took your last dose of paroxetine August 4th and ended up in the crisis care team August 23rd. To me that would indicate the possibility that paroxetine withdrawal is contributing to what you're going through now.

 

[Altostrata]

Please change your .docx file to a text file or pdf or link to a Google doc so we don't have to download anything.

 

Exactly what are you taking now, at what dosages and what times of day?

 

What do you mean by akathisia? What are your current symptoms? Are they better or worse at any particular time of day? How's your sleep?

 

On 10/13/2019 at 8:50 PM, cathnz said:

And another question... are people who have been on antidepressants for severe clinical depression for 15+ years able to live full happy lives off them?

 

If you've been taking antidepressants for more than 15 years, why would you assume you've still got "clinical depression"?

 

No, your "clinical depression" does not immediately bounce back after you quit the drugs, what you are more likely to get is withdrawal syndrome, which can include very low emotions.

 

Pill shaving is an inexact method of tapering that become more and more inexact as you get to lower dosages. Read about techniques here Tips for tapering off Remeron (mirtazapine)

and other methods of tapering in

 

We're giving our best advice. If pill shaving was a good idea, we'd recommend it to everyone.

[cathnz]

2 hours ago, Rhiannon said:

Cath I read the file you uploaded to your signature, it says you reduced to 30 mg mirt but also says that you are currently taking 45 mg of mirt. Can you check that and clarify?

 

I also note that you took your last dose of paroxetine August 4th and ended up in the crisis care team August 23rd. To me that would indicate the possibility that paroxetine withdrawal is contributing to what you're going through now.

 

Hi @Rhiannon, oh my gosh that just goes to show how foggy headed I am... I proof read that several times and didn't notice. Yes it was meant to say 30mg (what I'm currently on). 

 

Aug 4th was last dose of paroxetine (15mg) and Aug 5th first dose of Mirtazapine (15mg). From date of switch I continued to go down hill (had already gone downhill when my paroxetine 'pooped out', but got worse when meds changed - hence taking myself to crisis team on 23rd. 

[cathnz]

47 minutes ago, Altostrata said:

Please change your .docx file to a text file or pdf or link to a Google doc so we don't have to download anything.

 

Exactly what are you taking now, at what dosages and what times of day?

 

What do you mean by akathisia? What are your current symptoms? Are they better or worse at any particular time of day? How's your sleep?

 

 

If you've been taking antidepressants for more than 15 years, why would you assume you've still got "clinical depression"?

 

No, your "clinical depression" does not immediately bounce back after you quit the drugs, what you are more likely to get is withdrawal syndrome, which can include very low emotions.

 

Pill shaving is an inexact method of tapering that become more and more inexact as you get to lower dosages. Read about techniques here Tips for tapering off Remeron (mirtazapine)

and other methods of tapering in

 

We're giving our best advice. If pill shaving was a good idea, we'd recommend it to everyone.

 Hi @Altostrata,

 

I'm away from my pc at the moment (am on mobile phone) so will change file as soon as I have access to pc. 

 

Right now I'm taking 30mg Mirtazapine in the evenings (around 8pm).

I'm also taking Tumeric (500 mg), B6 (100mg), Magnesium (350mg )  and a probiotic (1 capsule ) in the morning and night (other than B6, that is only in the morning). I've been on these supplements coming up to 2 weeks and have noticed no adverse effects (symptoms still the same, possibly marginally better, than before I started them). 

 

Akathisia - it was extreme at 45mg (couldn't sit still, felt like I wanted to jump out of my skin). Improved at 30mg, now its just a feeling like my insides are running with electricity... like my insides are buzzing (although now I've read more, I realise this may be anxiety and withdrawl induced effects). From what I can tell, there is no real pattern, it's with me mostly constantly, but if I'm able to go for walks or keep occupied I notice it less. 

 

My sleep, date I say it, it's not too bad at the moment. I get about 7 out 8 hours. Although I do wake up earlier than normal, with my brain ruminating before I even open my eyes. 

 

Pill shaving... OK, thank you. Sorry I didn't mean to question your advice, I really value it. I was just checking (I'm doubting my abilities to make the liquid properly). On my box of Mirtazapine it says in big black bold writing... do not crush or chew. Is this the same as in the US and UK? Just wondering if I have the same tablets (they've got a pink plastic like coating on them)... they don't look like they'd dissolve well that's all. 

I feel nervous doing this when the time comes (there is no way I'd tell my physchiatrist... he's adament that I just do the drop to 22.5). 

 

I know in my last post I asked this question (may have been missed), but have any members used the Dutch company Cinderella Therapeutics that make up tapering packs? You need a script, and while my physchiatrist won't do this, my integrative GP will (he recognises WD although doesn't specialise in it). 

 

I'm not going to be tapering any time soon... still stabilising, but am doing my homework now and getting prepared for when I do. 

 

Thank you

[Altostrata]

Yes, you could order the tapering strips, that might be a good way for you to taper. It may be expensive, though, if your insurance doesn't cover it.

 

Does the mirtazapine help you sleep?

 

I agree with Rhi, it's probable you're suffering from paroxetine withdrawal. A very small dose, such as 0.5mg, of fluoxetine, another SSRI, might help. It comes in a prescription liquid.

[cathnz]

34 minutes ago, Altostrata said:

Yes, you could order the tapering strips, that might be a good way for you to taper. It may be expensive, though, if your insurance doesn't cover it.

 

Does the mirtazapine help you sleep?

 

I agree with Rhi, it's probable you're suffering from paroxetine withdrawal. A very small dose, such as 0.5mg, of fluoxetine, another SSRI, might help. It comes in a prescription liquid.

 

Thanks @Altostrata, I'll have a look into the fluoxetine. I'm not sure how I'll go... highly unlikely my physchiatrist will prescribe (but hey, I can try). Also, I live in NZ and we don't have liquids 😞

 

The strips... I'd need to pay for. Our insurance system here in NZ works differently. 

 

Maybe I'll stay saving for the strips now and by the time I'm ready to taper I'll have enough money 😂

[Altostrata]

See

 

You can get advice about the NZ formulary from other New Zealanders.

[cathnz]

Oh my goodness, I'm having a really really really bad day today (well few days actually) and am utterly overwhelmed with feelings that I can't go on like this. My body is locked in a constant state of fight/flight. I have been practising a lot of acceptance, but sometimes I feel like I'm going to lose control and hurt myself 🙁.  In the past when I have experienced this level of distress (while on meds) I have switched medications and come right over time. But given the catastrophic switch off meds 3 months ago (15mg paroxetine to 15mg mirtazapine... then 30mg... then 45mg... then back to 30mg) I'm never ever ever going down that track again. I feel like I'm stuck. I don't want to be on Mirtazapine (I've never felt this bad on any antidepressant in the past) but I don't want to come off it because a) I could be even worse off it and b) I'm not anywhere stable enough to reduce. 

Just to clarify, will I still be experiencing withdrawl from the paroxetine even though another medication was put back in its place? That's where I'm getting confused. I'm so sorry for being naieve, I'm new to this. I appreciate this support so much. 

P. S I have an appointment with my physchiatrist in a couple of days and I know he's going to tell me that I'm doing damage to myself not being treated (and having levels of adrenaline and cortisol this high constantly). I'm adament that I'm not changing a thing (I will reduce later but not till I'm stable). But holy holy crap, this is no way to live. I'm so scared I'm going to lose my mind completely and flip out. Everytime I see a knife on the bench I'm scared I'm going to use it on myself even though that's not what I want to do. I feel like I have zero self control. 

How can I be sure that the Mirtazapine isn't exacerbating things too? Some calm quiet words of reassurance needed please. 

[cathnz]

On 10/20/2019 at 8:12 AM, Altostrata said:

I agree with Rhi, it's probable you're suffering from paroxetine withdrawal. A very small dose, such as 0.5mg, of fluoxetine, another SSRI, might help. It comes in a prescription liquid.

@Altostrata  @Rhiannon 

I didn't register earlier when you said about possibly adding fluoxetine. I don't think this can be an option because I tried fluoxetine several years ago and it was awful for me.

 

I feel so lousy I just don't know what to do. It's been 4 months since my paroxetine pooped out (and 3 months since I was switched directly from paroxetine to Mirtazapine). The Mirtazapine hasn't done anything to help. And from what I've read on other threads on here, 3 months is too long to reinstate the paroxetine isn't it (and given that it pooped out on me would it even do anything anyway)? Plus I don't think my physchiatrist would prescribe for me. 

Is the best thing to do for me to just keep trying to stabilise on the 30mg of Mirtazapine? It's not doing anything to help whatsoever and I want off, but my poor body has been through so much change (my last change was only 3 weeks ago dropping from 45mg to 30mg of mirtazapine). Sit tight? Is that the best thing I can do? 

I can't imagine ever being stable enough to reduce Mirtazapine. I feel like my life is well and truly screwed up. 😔

[Altostrata]

What dosage fluoxetine did you take some years ago?

 

You have the opportunity to substitute a different SSRI for paroxetine reinstatement; if not fluoxetine, perhaps citalopram. Paroxetine is a very difficult drug to taper. Psychiatrists love to prescribe antidepressants, getting a prescription for another probably won't be difficult -- as long as you don't get into a discussion about withdrawal and tapering, they don't know anything about that.

 

Please answer this question:

On 10/19/2019 at 12:12 PM, Altostrata said:

Does the mirtazapine help you sleep?

 

No one can predict if you'll stabilize on 30mg mirtazapine. If it hasn't helped so far, it probably won't help.

 

On 10/19/2019 at 11:20 AM, Altostrata said:

Please change your .docx file to a text file or pdf or link to a Google doc so we don't have to download anything.

 

or follow these instructions Please put your drug and withdrawal history in your signature You may need to use a computer to do this.

[cathnz]

2 hours ago, Altostrata said:

What dosage fluoxetine did you take some years ago?

 

You have the opportunity to substitute a different SSRI for paroxetine reinstatement; if not fluoxetine, perhaps citalopram. Paroxetine is a very difficult drug to taper. Psychiatrists love to prescribe antidepressants, getting a prescription for another probably won't be difficult -- as long as you don't get into a discussion about withdrawal and tapering, they don't know anything about that.

 

Please answer this question:

 

No one can predict if you'll stabilize on 30mg mirtazapine. If it hasn't helped so far, it probably won't help.

 

 

or follow these instructions Please put your drug and withdrawal history in your signature You may need to use a computer to do this.

Hi @Altostrata,

 

Yes I think the Mirtazapine is helping with sleep at least. I still get hit with a few panic attacks as I'm drifting off to sleep, and I'm waking about an hour earlier than I used to (with ruminating thoughts), but I'm still getting about 7 hours on average so I'll take that as a win. It also helps a little with my appetite (I'd lost 20kg on the last year, 10 initially due to cutting sugar and gluten a year ago, then another 10 when my paroxetine pooped out due to high anxiety). So I'm at least eating more now and am fueling my body. 

 

So the Mirtazapine isn't touching the daytime anxiety, ruminating and panic, but I'm thankful at least In eating and getting some sleep. For now. I know nothing is forever (I need to remind myself that that goes for the bad too). 

 

So when I say the Mirtazapine is not working, maybe I should rethink that, given sleep is important. Its just working as well as the paroxetine or lexapro did in the past. 

 

So if you think the Mirtazapine 30mg isn't working at a well enough level, what do I do???? I'm not stable so can't imagine shaking myself up into possible withdrawls by reducing yet. Eeeek. I'm stuck! I can't breathe thinking about it! 

 

When I took fluoxetine many years ago I believe it was 5mg for about 5 weeks. It was an awful experience. 

 

Would reinstating a small dose of Lexapro be an option (even though it pooped out on me 7 years ago)? I had very little side effects with the Lexapro (and no issue coming off), although I know our bodies change. I believe I'm in perimenopause now so changing hormones won't be helping matters I'm sure. 

 

I will adjust my signature, I just haven't had access to a pc I'm sorry. I copy and paste it further up in my  introduction thread too. 

 

Thanks for your help. Feeling so so so overwhelmed. 

[cathnz]

Hi there, 

 

Can someone help please? I'm still stuck in the same situation as above (still on 30mg of Mirtazapine and not doing well - other than being able to sleep at night, thank goodness). Not sure if the Mirtazapine is making my anxiety worse, or just not working. Do I start to taper off even with a very rocky foundation? What do I do 😭😭😭

[Gem92]

Hello, I am also on Mirtazapine. I was in a Lexapro, Ativan and Zyprexa withdrawal. You are not alone.