cathnz: tapering off Remeron / mirtazapine

[Morfs]

4 hours ago, cathnz said:

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 😭😭😭

Hi Cath,

My situation is very different from yours but earlier this year I had severe anxiety/depression and was prescribed Citalopram, then Mirtazapine. The Mirtazapine helped me sleep as at the time I was only sleeping 1-2 hours per night at best. Once I went up to 30mg though, I didn't like how it made me feel at all so I decided it wasn't for me. At that point I was very unwell and consulted a private psychiatrist. I was then prescribed Sertraline. I tapered off the Mirtazapine myself rapidly and switched to Sertraline, quickly updosing to 100mg/day. The Psychiatrist wanted me at 150mg/day but I couldn't tolerate the side effects. For me, the SSRI was the lesser of 2 evils compared with Mirtazapine. I've now got the Sertraline down to 7.5mg/day and having some issues tapering beyond that, but that is another story.

I am also in NZ (Wellington). I have used a compounding pharmacy in Auckland (compund labs) to get 2.5mg Sertraline capsules made up. It's not cheap, but that's what I am doing at the moment. I did also import some tapering strips from Holland, but the taper was too fast so I had to stop it.

 

I am not suggesting you go on Sertraline, just relaying my own experience. I am not a moderator here and am quite new to the trials of AD withdrawal myself so I would listen to the advice from the folks here at SA above these suggestions. I have discovered that no one knows how these various drugs will react in my body, including me. It is an unpleasant reality, but no choice but to deal with it best we can.

Regards, Morfs 

[cathnz]

@Morfs thank you for your reply. It's so tough isn't it. I'm not doing at all well, I'm feeling so depressed and anxious. Too scared to stay on the Mirtazapine and too scared to come off it. My foundation is too rocky to be coming off anything, but I'm so miserable. I really don't know what to do. I desperately need to feel better I have been barely functioning since July.

Which compounding pharmacy have you been using? Do they break the doses into points of mg? 

[Morfs]

5 hours ago, cathnz said:

@Morfs thank you for your reply. It's so tough isn't it. I'm not doing at all well, I'm feeling so depressed and anxious. Too scared to stay on the Mirtazapine and too scared to come off it. My foundation is too rocky to be coming off anything, but I'm so miserable. I really don't know what to do. I desperately need to feel better I have been barely functioning since July.

Which compounding pharmacy have you been using? Do they break the doses into points of mg? 

The compounding pharmacy is https://compoundlabs.co.nz/ They will make up capsules to any strength that you want (I have Sertraline 2.5mg at the moment). It is a good service but not hassle free and quite expensive. it is approx $100 for 100 capsules of any strength. You also need a prescription from a GP specifiying the strength and amount and you need to post the original to them.

Hope this helps. Where are you in NZ?

[cathnz]

16 hours ago, Morfs said:

The compounding pharmacy is https://compoundlabs.co.nz/ They will make up capsules to any strength that you want (I have Sertraline 2.5mg at the moment). It is a good service but not hassle free and quite expensive. it is approx $100 for 100 capsules of any strength. You also need a prescription from a GP specifiying the strength and amount and you need to post the original to them.

Hope this helps. Where are you in NZ?

Thank you @Morfs. I'm in Hamilton.

I don't think my physchiatrist (or GP) will buy into me slow tapering, but luckily I have an integrative Dr who can write scripts so I will get him to do it for me. 

I am very stuck and think I need to do something that everyone here will strongly warn me not to do... change my meds. I can't go on like I am. Its becoming dangerous. But I don't know how to do a switch when a taper would effectively take me a year or more 😢 I know everyone will say don't do it, but I can't continue as I am 😭😭😭 But that leaves me with not knowing how to do a switch safely 😩

[Altostrata]

On 10/22/2019 at 12:28 PM, cathnz said:

....
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. 

....

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. 

....

 

Is the pattern of these panic attacks after you take mirtazapine different from your usual symptom pattern? What time by the clock do they occur? Please keep daily notes of times of day you take your drugs, their dosages, and your symptoms throughout the day. You can post 24 hours of notes at a time in this topic, with a simple list format with time of day on the left and notation (symptom or drug and dosage) on the right.

 

It appears that mirtazapine may be causing an adverse reaction. This may carry into the day. Please post your symptom pattern notes so we can get the mirtazapine dosage settled before making any other drug changes.

 

What was your adverse reaction to 5mg fluoxetine?

 

Yes, you can substitute escilatopram rather than citalopram or fluoxetine. As escilatopram is stronger than the other SSRIs, I might try 0.5mg to start. But let's get the mirtazapine settled first.

 

[cathnz]

8 minutes ago, Altostrata said:

 

Is the pattern of these panic attacks after you take mirtazapine different from your usual symptom pattern? What time by the clock do they occur? Please keep daily notes of times of day you take your drugs, their dosages, and your symptoms throughout the day. You can post 24 hours of notes at a time in this topic, with a simple list format with time of day on the left and notation (symptom or drug and dosage) on the right.

 

It appears that mirtazapine may be causing an adverse reaction. This may carry into the day. Please post your symptom pattern notes so we can get the mirtazapine dosage settled before making any other drug changes.

 

What was your adverse reaction to 5mg fluoxetine?

 

Yes, you can substitute escilatopram rather than citalopram or fluoxetine. As escilatopram is stronger than the other SSRIs, I might try 0.5mg to start. But let's get the mirtazapine settled first.

 

Thank you @Altostrata.

Since I made that post about the panic attacks as I'm going to sleep, they have abated thankfully (I do still have occasional panic attacks but they are at random times of day, and are usually following a time when I've been dealing with my triggers, so seem to be quite linked to my thought processes). 

My level of anxiety is pretty high constantly (feel like I'm in fright or fight most of the time). But I'm also incredibly tearful, hopeless and not wanting to go on with life. I cannot function and have stopped caring for my family. 

I'll try to keep a diary. I'm pretty consistent... I take my magnesium with dinner every night, then 30mg Mirtazapine between 8.30 and 9pm. I'm usually asleep by 10 at the latest (and mostly sleep until 5 or 6 unless I get woken up). I know that's a pretty good amount of sleep, but I'm always so so so tired. And I can't stop crying. My family are very concerned for my wellbeing and safety. This isn't new since the Mirtazapine... it begun while I was still on the 15mg of paroxetine and the switch to Mirtazapine was done to try and help. They were close to needing to hospitalise me. So 5 months on and I'm still in the same boat. 

[cathnz]

P. S I am trying to add signature (at the moment it's a doc) but I can't fit the relevant info on only 12 lines 😔

[Altostrata]

You can make it a link to Google Docs.

 

Paroxetine poop-out can have the same symptoms as withdrawal. Reinstatement of a very low dose of an SSRI, such as 0.5mg escitalopram may help.

 

Why did you go off escitalopram before?

[cathnz]

On 11/17/2019 at 8:53 AM, Altostrata said:

You can make it a link to Google Docs.

 

Paroxetine poop-out can have the same symptoms as withdrawal. Reinstatement of a very low dose of an SSRI, such as 0.5mg escitalopram may help.

 

Why did you go off escitalopram before?

On 11/17/2019 at 8:53 AM, Altostrata said:

You can make it a link to Google Docs.

 

Paroxetine poop-out can have the same symptoms as withdrawal. Reinstatement of a very low dose of an SSRI, such as 0.5mg escitalopram may help.

 

Why did you go off escitalopram before?

@Altostrata thank you.

I came off the escitalopram before because that pooped out on me too (although I didn't suffer this badly). 

 

If I was to reinstate an ssri, do I stay at my Mirtazapine 30mg? 

I'm not sure I'll be able to get 0.5mg of escitalopram (no liquid available here) so I will look into ways of doing this. Perhaps a compounding pharmacy (but I'll need to convince a Dr to write a script!!) 

[Sassenach]

Hi Cath

 

How are you doing and what are your current symptoms?

 

Sass

[cathnz]

4 hours ago, Sassenach said:

Hi Cath

 

How are you doing and what are your current symptoms?

 

Sass

Hi @Sassenach thank you so much for your message, I really appreciate it. I am feeling stuck in no man's land.

My anxiety is high and mood really really really low. Having feelings of not being able to go on.

That said, I did feel slightly better yesterday, only to wake up at square one today. 

I feel overwhelmed because even when my mind feels somewhat calm, and I'm engaged and busy with things, my body is still "buzzing" (it's like an electrical crawling feeling in my chest and torso, and sometimes legs). I don't know if it's the Mirtazapine causing it (in which case do I need to get off? ), if its my system still in shock from the paroxetine pooping out (and then being withdrawn suddenly with the switch over), or if I'm feeding my anxiety by worrying about it all (and am stuck in a loop). I'm terrified that it's akathisia and it won't stop while I'm on the Mirtazapine (but what if its is not the mirt at all). 

Question... if my body is buzzing etc because of the paroxetine withdrawl, will this calm down eventually over time if I DO NOTHING (@alto suggested I could try to a reinstatement of low dose ssri, but haven't been able to convince my pdoc of this, so can time alone heal??? ). 

But what if its the Mirtazapine causing it... I want to just get the heck off it incase it is a side effect from the Mirtazapine, and I want to get off NOW, but I know I can't just jump off quickly. 

My nervous system feels so over sensitised and shot to peices. What do I do!?!? 

(There is no pattern to my symptoms that I can see... I have them most days although some days worse than others, and its any time of day. Sometimes worse in morning, sometimes worse at night) 

[Boris]

You describe similar symptoms to what I had coming off Paroxetine, especially the akathesia/constant anxiety.

 

I can't really offer advice as your situation is different with poop out. Just that the extreme symptoms eventually went from the Paroxetine withdrawal and my nervous system isn't as sensitive now.

 

I was also prescribed Mitrazipine when I finally got off Paroxetine. It's still sat in the cupboard.

[cathnz]

26 minutes ago, Boris said:

You describe similar symptoms to what I had coming off Paroxetine, especially the akathesia/constant anxiety.

 

I can't really offer advice as your situation is different with poop out. Just that the extreme symptoms eventually went from the Paroxetine withdrawal and my nervous system isn't as sensitive now.

 

I was also prescribed Mitrazipine when I finally got off Paroxetine. It's still sat in the cupboard.

Thanks @Boris

I just can't work out if it's paroxetine withdrawl (because I went straight on to Mirtazapine, I thought that would have helped me NOT have withdrawls. Plus I started having the symptoms when it stopped working, so, before I withdrew). Or if its the Mirtazapine. 

@Altostrata@Sassenach I'm beside myself not knowing what to do. My physchiatrist has only offered the options of switching, augmenting with a low dose antiphyschotic (!), or giving me propranolol. I don't want to do any of those. But I need to stay alive and not feel this awful. I've been getting through by just trying to eat cleanly, take magnesium, gentle exercise, yoga, meditation but I'm only just keeping my head above water. I'm scared this will never ever end. 

[Altostrata]

You can have withdrawal symptoms from the first drug even if you're taking another drug.

 

Please fix your signature. Downloading an MS Word doc is a lot of trouble for me.

 

Still need these notes:

On 11/16/2019 at 10:40 AM, Altostrata said:

Please keep daily notes of times of day you take your drugs, their dosages, and your symptoms throughout the day. You can post 24 hours of notes at a time in this topic, with a simple list format with time of day on the left and notation (symptom or drug and dosage) on the right.

 

[cathnz]

@Altostrata @Sassenach @brassmonkey @ChessieCat... anyone... please help... I'm panicking. I've just messed up my dose and not sure what to do now. I normally take 30mg of mirtazapine at night. This morning I absent mindedly took a mirtazapine instead of my magnesium. I realised my mistake instantly and ran to the toilet to induce vomiting. I did vomit in the next 10 - 20 minutes, but was unable to see a whole tablet in there (I had a protein shake for breakfast so it was pretty much liquid). I feel like I vomited a decent amount, but seeing as I couldn't see the tablet, I'm panicking. Could have it dissolved that quickly? Now I don't know whether to have my tablet tonight or not. Because I'll either be double dosing, or no dosing. Panicking about the problems this may cause my already unstable body. Please help!!! 

[Sassenach]

Hi Cath

 

Don't panic, we have all done it.

 

Do NOT take a dose tonight.

 

Resume tomorrow.

 

You may feel a small bump in symptoms in a few days but it will settle down again.

Sorry to be brief but late here.

 

Sassenach

[cathnz]

1 hour ago, Sassenach said:

Hi Cath

 

Don't panic, we have all done it.

 

Do NOT take a dose tonight.

 

Resume tomorrow.

 

You may feel a small bump in symptoms in a few days but it will settle down again.

Sorry to be brief but late here.

 

Sassenach

Thank you @Sassenach. I had come to the conclusion that I probably DID vomit it up given my swiftness and the amount I vomited, BUT as per your advice I WON'T take one tonight to err on the side of caution. Thank you 😊

[Altostrata]

cath, did you feel any effect from that pill?

 

If not, you probably did vomit it up and you can take mirtazapine tonight as usual.

[cathnz]

19 hours ago, Altostrata said:

cath, did you feel any effect from that pill?

 

If not, you probably did vomit it up and you can take mirtazapine tonight as usual.

@Altostrata I'm sorry, I was too late seeing this and had already gone to bed (without taking the tablet 😕). Because I didn't see your message I'd gone with Sassenachs earlier and NOT taken it. I thought I'd take tonight's dose slightly earlier seeing as I might have missed yesterday's (depending on whether or not I vomited it up). 

[Altostrata]

How do you feel over the last 24 hours?

[cathnz]

1 hour ago, Altostrata said:

How do you feel over the last 24 hours?

@Altostrata thank you for checking in. I've been much the same as usual the last 24 hours (still crappy, but not any worse from what I can tell. I have been at an overnight school camp, so am pretty exhausted... so hard its to tell exactly). But not significantly worse anyway.

 

I'm sorry I haven't put up my daily diary of symptoms for you to check. I've been trying so hard to NOT focus on all the sensations and trying just to 'float though' without giving them too much attention because I get SO overwhelmed when I focus on them. But I know you need them to help me.

 

I'm also sorry I haven't changed my signature yet. I can't for the life of me for it on 12 lines, I have tried so many times 😔

[Sassenach]

Hi Kath

 

How are you doing now?

 

I have completed your drug signature but please check the bottom three lines and the dates for 30mgs  and 45 mgs seem to overrun.

If you felt better on 30mgs why did you increase back to 45mgs?

 

Sass

[cathnz]

On 12/28/2019 at 7:14 AM, Sassenach said:

Hi Kath

 

How are you doing now?

 

I have completed your drug signature but please check the bottom three lines and the dates for 30mgs  and 45 mgs seem to overrun.

If you felt better on 30mgs why did you increase back to 45mgs?

 

Sass

@Sassenach thank you so much.

 

Re the 45mg...That was a typo on my behalf. Since that reduction back to 30mg on the 4th October, that's what I've stayed at. I've made no further changes. 

 

I'm still not great. Theres no real pattern that I can see either. I'm trying to keep busy and engage in life so I don't dwell on how I'm feeling (dwelling on how I'm feeling makes it SO much worse) . Not really sure what to do. Still on the Mirtazapine 30mg and still feeling crap (but at least sleeping and eating OK) . Too scared to make any other changes so feel stuck on this 30mg. Certainly don't feel anywhere near stable enough to reduce. 😢

[Sassenach]

13 hours ago, cathnz said:

Theres no real pattern that I can see either

There is no pattern in W/D and we all react differently.

 

13 hours ago, cathnz said:

(but at least sleeping and eating OK)

Very important for speed of recovery.

It is only three months since you stopped the rollercoaster ride.

Took me seven months for enough stability to taper.

You are doing the right things, stay patient.

 

Sass

[cathnz]

On 1/6/2020 at 12:58 AM, Sassenach said:

There is no pattern in W/D and we all react differently.

 

Very important for speed of recovery.

It is only three months since you stopped the rollercoaster ride.

Took me seven months for enough stability to taper.

You are doing the right things, stay patient.

 

Sass

 @Sassenach

Being patient is getting harder by the day. I'm unraveling by the minute. I lost complete control this morning, rocked in the corner and scratched my legs up in desperation. I'm losing my mind. I think about ending everything constantly. I don't feel safe with myself. It's not fair that my son is witnessing this. My husband is trying to help but its not enough. I feel so scared of what I'll do (esp given the self harm) that I wanted to call the crisis team to keep safe. But I can't because I know they'll want to change meds or augment because living like this is not ok. Wanting to end your life everyday is not ok. But I'm scared to contact them even when I feel unsafe because I know any change around meds will be the worst possible thing. 

I'm so scared. My thoughts are racing. 

I'm not even sure if this is withdrawl. I felt like this the very first time I became unwell 16 odd years ago. That's when they started me on Aropax and everything calmed down. 

I'm scared 😭

[cathnz]

I meant that it was like this before I ever started on meds back in 2004. Then when I took the meds it got better. 

[Sassenach]

Hi Cath

 

So sorry to hear you are having such a hard time.

Have you harmed yourself before?

17 hours ago, cathnz said:

Wanting to end your life everyday is not ok.

Have you contemplated suicide and how to do it?

Unfortunately the time difference means communication is not great.

If you or your husband believe you are a danger to yourself, you should call the crisis team.

I do not say this lightly but your safety at this moment is what matters.

Please keep me advised.

 

Sass

[cathnz]

4 hours ago, Sassenach said:

Hi Cath

 

So sorry to hear you are having such a hard time.

Have you harmed yourself before?

Have you contemplated suicide and how to do it?

Unfortunately the time difference means communication is not great.

If you or your husband believe you are a danger to yourself, you should call the crisis team.

I do not say this lightly but your safety at this moment is what matters.

Please keep me advised.

 

Sass

@Sassenach

My self harm yesterday was just scratching up my legs with my nails. Have never done that before, that was a first. 

I think about not wanting to carry on life feeling like this often. It's a dark cloud that's hung over me and consumed my mind for months on and off. I haven't thought of methods. Just that I need to stop feeling this way and I can't go on any longer. Still this bad 6 months on, I see no way out any more. I have zero hope. This is how I felt the first time I ever got sick. It was this bad. But the meds saved me (I know that isn't the general opinion of this site). They stopped my mind racing and me wanting to die. But this time, they're not saving me. Nothing is. 

Feeling like this is hell, but now I have the fear of God in me to reach out for help because from all accounts what I've read on here it could get potentially so much worse if I reach out and they change meds. At least I'm sleeping mostly. The days are just hell. Seeing the nightmares people have had on here make me far too scared to reach out and have them address meds. I can't live like this though. 

[brassmonkey]

Hi Cathnz-- I was just reading your posts over on "Are We There Yet" talking about poopout.  You got some very good responses from some other members, all good advise.  Reading through your signature and from what you describe it seems to me that your body is screaming out for stability.  That would involve remaining on the same dose of everything at the same time every day until things settle down, which they will.  Because of all the changes it is going to take a while, many months, for that to happen.  While it is going on there will be some pretty big swings in symptoms, but you've made it through them so far so you can keep getting through them. There is a lot of good information on self soothing and self care on the site that will help get you through it.

 

I would be very careful about reading other peoples journals if the "horror stories" trigger you.  You have to remember that each individual is going to experience a different journey getting off of these drugs, and what happens to someone else won't necessarily happen to you. Yes we have some people who are having a really hard time of it, but far and away the most people don't.  Believing that things will work out for the best will go a long ways toward improving your situation. Accepting what is happening is very important too. We've found ourselves in a very uncomfortable situation through no fault of our own and now have to make the best of it until it sorts itself out. Yes, it can be really miserable at times but "suffering through it" is a conscience decision on our part.  It's all in the attitude.

 

The entire process isn't going to be suffering.  It takes a long time to get through, but once a person is stable things start to get better. The large swings settle down and a taper is possible.  As the taper progresses the symptoms start to decrease in intensity until they are just "background noise".  Once off the drug healing can continue unhindered and things keep improving.  It sounds like a long time when you read about it, and can seem like it's taking forever, but in reality it goes pretty quickly, and once over the memories do fade.

 

For right now work on self soothing, learning triggers and how to handle the symptoms as you wait out the stabilization period.

[cathnz]

25 minutes ago, brassmonkey said:

Hi Cathnz-- I was just reading your posts over on "Are We There Yet" talking about poopout.  You got some very good responses from some other members, all good advise.  Reading through your signature and from what you describe it seems to me that your body is screaming out for stability.  That would involve remaining on the same dose of everything at the same time every day until things settle down, which they will.  Because of all the changes it is going to take a while, many months, for that to happen.  While it is going on there will be some pretty big swings in symptoms, but you've made it through them so far so you can keep getting through them. There is a lot of good information on self soothing and self care on the site that will help get you through it.

 

I would be very careful about reading other peoples journals if the "horror stories" trigger you.  You have to remember that each individual is going to experience a different journey getting off of these drugs, and what happens to someone else won't necessarily happen to you. Yes we have some people who are having a really hard time of it, but far and away the most people don't.  Believing that things will work out for the best will go a long ways toward improving your situation. Accepting what is happening is very important too. We've found ourselves in a very uncomfortable situation through no fault of our own and now have to make the best of it until it sorts itself out. Yes, it can be really miserable at times but "suffering through it" is a conscience decision on our part.  It's all in the attitude.

 

The entire process isn't going to be suffering.  It takes a long time to get through, but once a person is stable things start to get better. The large swings settle down and a taper is possible.  As the taper progresses the symptoms start to decrease in intensity until they are just "background noise".  Once off the drug healing can continue unhindered and things keep improving.  It sounds like a long time when you read about it, and can seem like it's taking forever, but in reality it goes pretty quickly, and once over the memories do fade.

 

For right now work on self soothing, learning triggers and how to handle the symptoms as you wait out the stabilization period.

 

Thank you so much @brassmonkey. I really really appreciate your reply ❤️

I have no doubt that my system is still in disarray from the med switch. But I still can't help wondering if the Mirtazapine isn't disagreeing with me also. I'm trying to figure out if it's just withdrawl, or side effects from the Mirtazapine. There has been no let up in the 6 months since I started it. Some days I'm able to 'distract' myself better than others (using Claire Weekes methods and engaging with life), but the constant flight/fight has been there all the time and feeling flooded with adrenaline and chest crawling. At what point do I know if its withdrawl or the Mirtazapine not agreeing with me? If I stay on a med that doesn't agree with me won't that make it harder for my cns to heal?? If it is v the Mirtazapine, how do I go about changing (because I don't want to disrupt things further). Do I do a straight switch or a cross taper (in which case it would obviously need to be quicker than a long show taper as recommended). 

I can't tell you how much I appreciate your response! It was kind, caring and hopeful. It get the same kind reassurance from your message that I do from listening to Claire Weekes. I would appreciate it so much if you could help me out with some sound advice about the Mirtazapine. I feel so utterly confused about the way forward. If I were just dealing with poopout or WD the answer would be clear to me... let time heal. But seeing as there's a new med in the mix (and when things went from bad to worse), it confuses matters. Please help! 

[brassmonkey]

We are big fans of Claire Weekes around here.  You may see references to a technique we call AAF. It's based on her ideas and we have good success with it.

 

I think the things that you are feeling are a combination of the two, WD from your past experiences and side effects from the new drug.  It can be very hard to tell them apart, and unless they are debilitating it doesn't really matter where the symptoms are coming from. We just have to handle them as best as we can.  If you were having a bad reaction to the Mirtazapine you'd know it. There are two basic types of bad reactions: an Adverse Reaction and an Allergic Reaction.  An Allergic reaction can vary from a mild rash to anaphylactic shock.  You haven't reported a rash and you would have been hospitalized for the shock, so that rules that out. An Adverse reaction usually hits very hard and very fast causing very debilitating symptoms with in a few hours to a few days. The symptoms are unrelenting and severe enough that a person can't really function (i.e. get out of bed, shower, dress, eat, that sort of thing).

 

The symptoms that you describe are quite familiar to me, having gone through them my self.  My last round was my 18 month wave a year or so a go.  The constant anxiety is hard to cope with, but the Weekes methods and AAF help keep it under control. I don't want to diminish what you are feeling, but it sounds like pretty normal symptoms given your situation. Six months sounds like it is a long time to be going through this, and it is, but unfortunately it can frequently take longer than that to stabilize.  Keep using the techniques that are working for you and read around the site, we have a lot more "helpful hints" that will make things more bearable. Try not to obsess over the day to day fluctuations in symptoms, they are going to be all over the place and we have to bear with them as best as possible.  Over the long run, month over month you should be seeing a small bit of improvement, and that is what counts.  As we move forward you will gain stability and once that s established we can come up with a tapering plan to get you off of the medication in the most painless way possible.  Right now I'm thinking a 10% Brassmonkey Slide, but that's down the road a bit.

[cathnz]

3 hours ago, brassmonkey said:

We are big fans of Claire Weekes around here.  You may see references to a technique we call AAF. It's based on her ideas and we have good success with it.

 

I think the things that you are feeling are a combination of the two, WD from your past experiences and side effects from the new drug.  It can be very hard to tell them apart, and unless they are debilitating it doesn't really matter where the symptoms are coming from. We just have to handle them as best as we can.  If you were having a bad reaction to the Mirtazapine you'd know it. There are two basic types of bad reactions: an Adverse Reaction and an Allergic Reaction.  An Allergic reaction can vary from a mild rash to anaphylactic shock.  You haven't reported a rash and you would have been hospitalized for the shock, so that rules that out. An Adverse reaction usually hits very hard and very fast causing very debilitating symptoms with in a few hours to a few days. The symptoms are unrelenting and severe enough that a person can't really function (i.e. get out of bed, shower, dress, eat, that sort of thing).

 

The symptoms that you describe are quite familiar to me, having gone through them my self.  My last round was my 18 month wave a year or so a go.  The constant anxiety is hard to cope with, but the Weekes methods and AAF help keep it under control. I don't want to diminish what you are feeling, but it sounds like pretty normal symptoms given your situation. Six months sounds like it is a long time to be going through this, and it is, but unfortunately it can frequently take longer than that to stabilize.  Keep using the techniques that are working for you and read around the site, we have a lot more "helpful hints" that will make things more bearable. Try not to obsess over the day to day fluctuations in symptoms, they are going to be all over the place and we have to bear with them as best as possible.  Over the long run, month over month you should be seeing a small bit of improvement, and that is what counts.  As we move forward you will gain stability and once that s established we can come up with a tapering plan to get you off of the medication in the most painless way possible.  Right now I'm thinking a 10% Brassmonkey Slide, but that's down the road a bit.

 

@brassmonkeyThank you for your kind words 🙏

[cathnz]

On 1/23/2020 at 9:47 AM, brassmonkey said:

We are big fans of Claire Weekes around here.  You may see references to a technique we call AAF. It's based on her ideas and we have good success with it.

 

I think the things that you are feeling are a combination of the two, WD from your past experiences and side effects from the new drug.  It can be very hard to tell them apart, and unless they are debilitating it doesn't really matter where the symptoms are coming from. We just have to handle them as best as we can.  If you were having a bad reaction to the Mirtazapine you'd know it. There are two basic types of bad reactions: an Adverse Reaction and an Allergic Reaction.  An Allergic reaction can vary from a mild rash to anaphylactic shock.  You haven't reported a rash and you would have been hospitalized for the shock, so that rules that out. An Adverse reaction usually hits very hard and very fast causing very debilitating symptoms with in a few hours to a few days. The symptoms are unrelenting and severe enough that a person can't really function (i.e. get out of bed, shower, dress, eat, that sort of thing).

 

The symptoms that you describe are quite familiar to me, having gone through them my self.  My last round was my 18 month wave a year or so a go.  The constant anxiety is hard to cope with, but the Weekes methods and AAF help keep it under control. I don't want to diminish what you are feeling, but it sounds like pretty normal symptoms given your situation. Six months sounds like it is a long time to be going through this, and it is, but unfortunately it can frequently take longer than that to stabilize.  Keep using the techniques that are working for you and read around the site, we have a lot more "helpful hints" that will make things more bearable. Try not to obsess over the day to day fluctuations in symptoms, they are going to be all over the place and we have to bear with them as best as possible.  Over the long run, month over month you should be seeing a small bit of improvement, and that is what counts.  As we move forward you will gain stability and once that s established we can come up with a tapering plan to get you off of the medication in the most painless way possible.  Right now I'm thinking a 10% Brassmonkey Slide, but that's down the road a bit.

@brassmonkey I'm feeling overwhelmed by the constant electrical buzzing in my body (which I think is akathisia) . It's been there constantly since the med switch 7 months ago. Some days I can distract myself, other days I can't. I feel really really toxic. I feel like it's the Mirtazapine, but after my experience coming off paroxetine, I feel like I'm now stuck on mirtazapine even though its making me sick. I feel far too emotionally unstable to come off, but I feel so toxic on the Mirtazapine. I don't see a way out of this hell. I want to climb out of my skin. I can't believe that this will ever get better, and hate knowing b that I've day I will have to go through this coming off Mirtazapine.

I know this may be withdrawl still, but it really feels like Mirtazapine. There has been no change in this feeling for 7 months. Emotionally there have been some windows and waves but the feeling of electricity inside me (mild akathisia?) has been constant. 

I'm at my wits end 😭

[brassmonkey]

Hi Cath-- I'm sorry to hear that you are experiencing such discomfort every day. It does sound like a bad reaction to the Mirtazapine.  Your signature indicated that reducing from 45mgai to 30mgai did help the situation.  I'm thinking that continued reductions will also help. If you are having a bad reaction to the drug then reducing the amount you take will help reduce the problems.  Because you are having symptoms right now I would suggest the gentlest taper so as to not rock the boat.  I would try a 10% Brassmonkey Slide. That would be 2.5% a week for four weeks and an additional 2 week hold.  This will give a good reduction fairly quickly, but will avoid adding in many new WD symptoms. Then as you go lower what you are feeling now should decrease.

[cathnz]

5 hours ago, brassmonkey said:

Hi Cath-- I'm sorry to hear that you are experiencing such discomfort every day. It does sound like a bad reaction to the Mirtazapine.  Your signature indicated that reducing from 45mgai to 30mgai did help the situation.  I'm thinking that continued reductions will also help. If you are having a bad reaction to the drug then reducing the amount you take will help reduce the problems.  Because you are having symptoms right now I would suggest the gentlest taper so as to not rock the boat.  I would try a 10% Brassmonkey Slide. That would be 2.5% a week for four weeks and an additional 2 week hold.  This will give a good reduction fairly quickly, but will avoid adding in many new WD symptoms. Then as you go lower what you are feeling now should decrease.

 

Thank you @brassmonkey.

I'm feeling so so overwhelmed with this all. Can I please ask you some questions, because I'm really confused with how on earth I'm going to be able to do this. 

 

*These buzzing sensations were present for me even at 15mg when they first started me on the Mirtazapine. At that time I just thought it was WD from the Paroxetine or my anxiety around the med switch (despite having been on Antidepressants for nearly 17 years, I have always been extremely med phobic, so I always panic around med changes). Given that I had these symptoms at 15mg (and now I'm on 30mg) and I was still in a really dark place mentally on 15mg (hence them putting it up), how will I cope mentally going even lower?? And using the slide that will take me over 6 months won't it? So at least 6 months (because I'll need to be lower than the 15mg to be rid of these side effects 😭). I don't know how mentally I'll cope. I have so many major life stressors at the moment, I feel like I'm so fragile to anything. I'm scared to reduce that low while I'm so mentally unstable. But I don't have an option do I 😭😭😭

 

*Forgive me for being 'dumb', but I can't work out how I'm going to do your slide taper. Liquid forms aren't available in NZ, and I don't trust myself to make the liquid. It seems really really complicated, and I can't work out how I'll get my quantities exact enough. I can't get my head around it at all. Even the fact that Mirtazapine has a pink plasticy type coating... does that get factored onto the equation?? It all seems so complicated and I feel like I'll completely mess it up because I don't understand it at all 😭 I'm scared I'll do worse damage. I wish it was something like Effexor that I could doubt the beads, that seems so much more simple. I looked at getting a compounding pharmacy to do them for me, but the smallest capsules they do is 1mg, so that won't allow for the smaller amounts. And they don't do liquids over here. For 90 days supply of capsules it will cost me nearly $500!

 

*Another variable in all this has just dawned on me. I've had these sensations ongoing, sometimes more manageable than others. But they got really bad over the weekend. I couldn't understand why. When I went into work today the penny dropped. New carpet had been put into my classroom last week, and the chemical smell from the glue was affecting me! I didn't put 2 and 2 together until today. I got very sick 17 years ago when I worked in a printing factory, because of the chemicals. Infact, that's when my first breakdown happened. But I don't have an option. I HAVE to work in that space, there is nowhere else available. And I have to keep working because I can't afford not to. I am flipping out about how sick this could make me. 

 

I feel so overwhelmed @brassmonkey. While I feel physically awful on the Mirtazapine, I'm scared of reducing because mentally I'm not great. My mum has dementia and I'm not coping with the stress of that whatsoever. While I hate how I feel on the Mirtazapine, I'm at least incredibly grateful that I am at least sleeping and eating. If I stop sleeping I'm afraid I'll lose my mind completely. People keep telling me how horrendous Mirtazapine is to come off because you get insomnia. I feel stuck between a rock and a hard place. Mirtazapine is making me sick, but it's holding me together in an ugly kind of way through an incredibly stressful time. I've thought about whether I should try and change to another med, but that's just Russian roulette isn't it. It could make me so much worse. And I'm running out of options anyway. I've been on Lexapro (pooped out), paroxetine (pooped out), fluoxetine (disastrous for me). I had a genetic test done and it said zoloft wouldn't be good for me (along with many others). It said paroxetine would be OK (although it pooped out at 15mg), Effexor and nortriptyline... but then again, it said Mirtazapine would be ok too 😭 . And even if I were to change, how the hell do I do that safely. The straight switch from 15mg paroxetine to 15mg mirtazapine was a disaster. 

 

There are so many variables that I'm flipping myself out thinking "I HAVE to make the right choice or things could go from bad to worse". I literally feel like I'm losing my mind trying to figure out what's the right thing to do. 

 

I'm so sorry for all the questions and for being overwhelmed. I'm doing this solo. Noone in my life gets it. Right now I am just filled with so much despair that I am stuck on something making me so sick, but 'needing it'. I'm trying not to despair. I'm trying to accept, slow, and float. But it feels all consuming having to make this decision around what to do. And even understand how to do it (I. E getting the taper method correct). 

 

I'm sorry 😭

 

 

[brassmonkey]

Hi Cath-- I'm sorry to hear that the upgrades your classroom are causing problems.  Do you have windows you can open to air the place out?  The smell should dissipate in a couple of weeks, which will help.

 

There is so much involved in dealing with these drugs, it's quite easy to get over whelmed with it all.  Stressing about doing the "right thing" is pretty common.  To make it worse we can't really tell what the right thing is, all we can do is go by past experience and try to relate it to each person. But all the mods are here to help you make sense of it all and guide as best as we can. So you are not alone, we truly understand.

 

It's good to know that there was a dose where the problem became apparent.  That gives a target to work with.  The standard 10% Brassmonkey Slide has a half life of 9 months. Which means that if you start today at 30mgai in 9 months you will be at 15mgai and in 18 months you will be at 7.5mgai. It does take a long time, but it is so much better to go slow and have a smooth taper than to go fast and have a very bumpy ride. By taking our time your body will have time to adjust and heal as you decrease so the symptoms really will start to resolve and fade. Shocking the body with large abrupt changes is what causes many of the problems people face when tapering. By taking it slow and listening to your body by the time you get back to 15mgai things should be quite different than the first time.

 

The easiest way to do the Slide is to crush up your current pills and make up your own capsules with specific doses.  This will require a milligram scale and some empty gel caps.  You can get both on line for a quite reasonable price. We will determine the average weight of your pills and then set up some calculations to determine the weight of each new dose.  Then it is a matter of crushing the pills and weighing out the proper amount for each week.  It's pretty easy once you've done it a few times.

 

All the mods here are well versed in how to do it so there will always be someone on call.