DD44: please help, currently on mirtazapine and gabapentin

[DD44]

Been having trouble keeping up with daily logs of activities. 

 

Although Iv been getting more rest I’m feeling extremely depressed 

 

when i I begin to get closer to a normalized schedule I start to think of all the things in my life I need to fix to have a happier future 

 

I’m in a job that isn’t using my degree at all and have no idea what to do with my life career wise

i have over 60k in student debt and feel tremendously worried on how to address it 

 

I have almost no friends - and feel it’s hopeless sometimes as a 33 year old 

sorry I’m venting today but really wish I could find someone to help me unfold these issues one at a time. Feels like my life is passing me by and I want to do what I can to not find myself in 20 years broke and alone

i feel If I keep behaving how I have I’ll end up no better than I am

[elbee]

Hi DD44,

 

On 10/29/2019 at 9:59 AM, DD44 said:

Been having trouble keeping up with daily logs of activities.

 

Focusing on the little things to take care of myself has been my one of my biggest challenges in this healing / recovery process. The little things can seem so inconsequential when compared to the big questions you touched on in your last post. Yes, those other things matter and can feel overwhelming, and finding resources of "trusted others" who can help you navigate turbulent waters is really important . . . at least it has been for me (therapists at times, peer support groups,  meditation communities, this website, etc.). But the part I've struggled with most are the little things that when added up equal self-care. It's been an incremental process for me. One of the earliest things I started doing was to make sure I had a banana to eat every morning. Most of my adult life I only ate one meal a day . . . dinner. Breakfast and lunch was always coffee and cigarettes. Having a banana on hand to to eat every morning (even, if at first, I didn't always eat it) was a foundational way for me to start building trust with myself around self care. I've come a long way since then . . . I regularly eat three meals a day now, but that's how it started for me. 

 

In my opinion, you are going to need to find small, incremental ways to build trust with yourself around self-care . . . the little commitments you make to yourself that can so easily be broken but are so important to keep. Logging your experience daily (or regularly) on this website may be a way you do that . . . or not, you may find other ways to build internal trust. But most of my life I looked for silver bullets to make things better, and the psych meds were a part of that. Incremental self-care isn't sexy and I've had a lot of resistance to it, but it has been central in my path to healing.

[DD44]

@Shep @Altostrata or anyone else who wants to chime in

 

im doing significantly better. I’m considering discussing use of a Compounding pharmacy with my psych next week and to ask to reduce from 7.5 to 7, this is just a little over a 5% drop. Would hold there for no less than a month. I did some thinking about it and am wondering if I see how that goes would it be okay to stick with dry tapering. Maybe switch to liquid when it gets very low. I ask ideas about this because I would like the option to travel this coming year and traveling with a liquid seems cumbersome. Any input from anyone is appreciated. Also, I know we have somewhat gone over “stable” which I still struggle with (since I am basically a one symptom subject) My mood is really good. I’m working on knowing triggers and how to manage my emotions. anyhow I’m not trying to rush.. just want as much input as I can get 

[Shep]

@DD44 I moved your last post for the symptoms forum to here in your intro thread, since you're asking questions about your own taper.

 

I'm glad you're doing better. Compounding can be a good way to go for someone who's traveling. 

 

Getting custom dosages at compounding pharmacies (US, UK, Canada, and elsewhere)

 

For information on using a scale for dry tapering and for liquid, please see:

 

Using a digital scale to measure doses

 

A scale that many members recommend is this one:

 

Gemini 20 Scale

 

This thread is for doing a liquid taper:

 

How to make a liquid from tablets or capsules

 

This post in that thread contains a video.

[elbee]

On 11/4/2019 at 12:10 AM, DD44 said:

im doing significantly better.

 

Hey DD44, it's good to hear you seem to have stablized a bit and that you've been feeling better 👍😊

 

On 11/4/2019 at 12:10 AM, DD44 said:

I’m working on knowing triggers and how to manage my emotions. anyhow I’m not trying to rush.

 

For me too, sometimes being able to simply recognize a trigger can soften it a bit and make the feelings that arise from it more manageable. And yes, it is very much a practice . . . well done on trying to to rush things 

[DD44]

Any words of wisdom anyone can give me that aren’t just the typical see this link about initiating my new taper would be helpful. Everybody sees a big change in me it’s pretty drastic over the last couple of weeks, that’s why I’m very nervous about the taper but I just don’t want to be dependent on this medication. Hard to decide between 2-5% to see how it effects me. Iv felt so good the last 2-3 weeks that it’s nerve racking. I had a fairly superwoman attitude PRE psych drugs- and suddenly that pesky reemerged, when I sat back and tried to allow things to go the way they would go. Stopped obsessing, did my self care as much as I could. Focused on what I can do with my life rather than what I can’t... I know I need to go slow. But I’m just so scared to make myself suffer anymore. I was in hell from April till just a couple weeks ago.. anyhow ... I need advice and encouragement 

[elbee]

I learned to follow the guideline, "When in doubt, hold." Even if I just waited a week to make a drop, something in me appreciated knowing I was trying to take a gentle approach and generally, it worked out well that way. You're doing great. Stay the course.

[DD44]

@elbee I feel like I’m always going to have a certain level of fear or concern about withdrawal ...or “doubt” as you say.. 

[elbee]

1 hour ago, DD44 said:

I feel like I’m always going to have a certain level of fear or concern about withdrawal ...or “doubt” as you say.

 
Yes of course . . . it's a matter of degree. If I waited until I was completely sure about everything, I would never move from where I'm standing. To clarify my suggestion about "when in doubt, don't" -- when I'm feeling "intense" doubt about something, if possible, I try to slow down or pause. For me, it's about balancing gentleness and consistency in the process.

[DD44]

NEED SOME SERIOUS ADVICE HELP

 

i have been doing very well . I initiated a 6% reduction in dose two nights ago,  with the use of a compounding pharmacy. I even asked and was told I was being given the same brand of medication. I’m now on my second night of not getting the rest I need. It feels like a total absence. Things don’t feel right. Do I need an adjustment period? Do I need to go back to pill form and trim bits off myself? Things can get very bad if I don’t get on a regular pattern soon. I’m getting worried. I only went from 7.5 to 7. And the only known difference was I went from pills to capsules. Contemplating asking my doctor to call in a round of pills. Please help. 

[Shep]

It's best to transition over to a compounded formula at the same dose. It's impossible to know if you're reacting to the dose reduction or to the compounded formula, which could also have a slight variation in dose. 

 

It takes 4 days for your nervous system to register a change and it can take a week or longer to adjust to the change. You can either wait it out for a few days to a week or, if the symptoms are severe, go back to your previous method and see if you can stabilize to where you were 2 days ago.

 

Please let us know what you decide and how you're doing. 

 

Please also update your signature to reflect your changes since October. A direct link is here:

 

Account Setting - Create or Update Your Signature

[DD44]

@Shep @Altostrata @elbee

i would really like some words of encouragement. I thought I was doing all the right things - stabilized, waited. Had my prescription compounded (cost a lot more) and I only did a 6% drop. Going forward I’d like to reference my ability to get rest as “berries” that’s what I call it with my therapist and it helps me not feel triggered. Getting “berries” is really my single primary issue- everything else comes after that if at all. It helps me to not think of the word and try not to think of it at all (I never worried about how much berries id get before it became this thing in my life) So basically I tried the new compound the last two nights and my berries were extremely disrupted. This makes me really nervous and worried how am I suppose to do this. My doctor is calling in my original dose and I’m going back up until I feel clear and confident about how to proceed. This feels discouraging but I’m trying not to ruminate. Any advise on how I can reinitiate this process better next time I try would be sincerely appreciated. 

[Altostrata]

8 hours ago, Shep said:

It's best to transition over to a compounded formula at the same dose.

 

Hello, DD. If I read your post correctly, you switched to the compounded formula and made a dosage reduction at the same time. Is it a compounded liquid?

 

Please go back to 7.5mg and hold there for a bit. Please let us know how you're doing. I'm sure you'll find all your berries again.

[DD44]

@Altostrata

yes I switched to compounded capsules (have been on pills) and made a 6% reduction. I guess Iv overlooked that I wasn’t suppose to make a reduction until I adjusted to the new formula. I am going back to my regular dose tonight and will keep everyone posted 

[elbee]

Hi @DD44 . As Shep and Alto suggested, it makes sense to me too not to make too many changes at once. I get how the distress you're experiencing can feel really scary, especially after you've "been doing very well" for a period. And if you've been doing well as you say, then yes that's probably an indication that you've been the right things. Know that when distress arises, it never nullifies all the "right things" you've been doing for yourself . . . even when dips / waves happen. I hope separating the steps of switching to capsules and making a drop make the process less uncomfortable for you.

[DD44]

@Shep @Altostrata @elbee

 

hi guys sorry to bug you again. I’ll be talking to my psych next week. I just went to make sure I’m crystal clear on what would give the best case outcome. I should ask him to call in my same dosage (7.5) in the capsules. Is there anything else I should know, need to do, or should consider to increase my chances of successfully switching over. Thanks for the help -Dana 

[Altostrata]

Save your other capsules for a reduction in a month or two.

[DD44]

Yes @Altostrata I planned on that. Just got a littler nervous since this wasn’t successful this time although I realize now I need to keep everything like a science experiment (everything constant only one change )

[elbee]

@DD44 it sounds to me like you are clear on your next best steps (I agree with Alto, it makes sense to keep the other capsules at the lower does for later use). 

 

11 hours ago, DD44 said:

wasn’t successful

 

In my opinion, you navigated this really successfully . . . you got into a tough spot, reached out for some trusted help, listened to the help and now seem to feel much better now about your plan moving forward. Well done 😊

 

11 hours ago, DD44 said:

like a science experiment (everything constant only one change )

 

I think this is a great way to look at the taper . . . like an experiment that involves you getting to know yourself (your body, your feelings, your needs) more intimately, and in my experience you are absolutely right that it's best to "limit the variables" that you change (to the degree you can) in this experiment. This way, you can better learn the "language" of how your body is trying to communicate with you. Again, well done! 👍😉

[DD44]

Hey guys 

I don’t want to sound like I’m jumping the gun 

but I’m asking in light of the fact that things seemed to go very bad very quickly when I tried this switch earlier this month.

what will I do if I’m not successful switching to the compound capsule at the same dose? Would I reach out to the pharmacy? Do I give it time? I really want to make this happen and I’m feeling a tiny bit anxious on what I would do in that scenario. I ask because I want to try again around the first of the year, and want to know my next steps if I have any issues. This is important to me because I now have enough money to move to a healthier environment- but I want the switch to be done and successful before I move to a new environment / surroundings. Thanks in advance for hearing me 

[Shep]

If you use a compounded version and you have problems, than you switch back to your old method. Switching over to the same dose and being as consistent as you can is the best advice we can give for those going the compounded route. 

 

Were you having any problems making your own doses? If not, you may want to stick with that if going over to a compounded version is causing so much distress. Most people on the forum make their own doses via liquid or using a scale and are successful. 

[DD44]

@Shep

in the past when i tried to reduce my dose I never really made a new dose. I’m simply would try to scratch a little off my pill at a time (I was doing this with 15mg pills which are larger and softer than the 7.5s I currently have) My pills are very small are hard so  not sure how it would go. I worry and wonder if I had to grind up the entire pill and take it in a powder form if it would metabolize faster. Right now I take my dose about 2 hours before bed and then I’m very tired two hours later. Sorry I just am trying to figure out how to make this process as simple as I can and without pain for myself. 

[Shep]

21 hours ago, DD44 said:

in the past when i tried to reduce my dose I never really made a new dose. I’m simply would try to scratch a little off my pill at a time

 

Are you using a scale to get an accurate dose? 

 

If not, please see: 

 

Using a digital scale to measure doses

 

21 hours ago, DD44 said:

I worry and wonder if I had to grind up the entire pill and take it in a powder form if it would metabolize faster.

 

The only time we don't recommend crushing up a pill is if it's sustained release. For regular release, it's okay to crush the pill. 

 

This thread as more information specific to Remeron, including making your own liquid: 

 

Tips for tapering off Remeron (mirtazapine)

 

On 4/10/2012 at 8:07 PM, Altostrata said:

While water solubility of mirtazapine is "slight" according to http://www.drugbank.ca/drugs/DB00370
you may wish to make a suspension of it yourself with water or a pharmaceutical liquid such as Ora-Plus. See How to make a liquid from tablets or capsules Refrigerate the DIY suspension for up to 5 days, then discard.

 

If you decide to make your own doses as opposed to using a compounding pharmacy, after you read over these links, please post any questions about making a liquid or using a scale. 

 

 

[DD44]

@Shep @Altostrata @elbee checking in 

I see my doctor today. We discussed getting a compound made of 7.5 to begin again early January. He made a good point though that the pharmacy may not be willing to compound a dose that already exists. I will call and ask them. But I’m the event that they cannot do it, what might I do? Ask for 7.45 to be made ? Just let me know and thank you so much for you continued help.

 

Dana 

[Shep]

See what the closest dose is you can get to 7.5 mg. If they will make 7.49 mg, that's 99.87% of what you're currently taking, just in case there is some variation between what you're currently taking and the compounded form. 

 

Also, check to see if the brand they're going to use is the same brand you're already using, since variations can be due to a change in brand. 

[Altostrata]

If you're talking about mirtazapine, it does come in 7.5mg tablets. If you feel you need to let your nervous system settle down, you could just get a prescription for ordinary 7.5mg tablets and stabilize on that for a month.

 

After you feel stable, I would get 5mg capsules compounded plus compounded liquid, so you could take 7.25mg for your first reduction. Your doctor can write the prescription for "one capsule plus liquid for total dose of 7.25mg per night."

 

(Or, you could make your own liquid from capsule contents -- you have extra capsules, correct? That would make your doctor's prescription simply for the compounded 5mg capsules.)

 

You will be tapering the liquid portion of your dose. You can continue to take the compounded 5mg capsules until you're down to 5mg total daily dose, then you can ask your doctor to prescribe 2.5mg compounded capsules plus compounded liquid (or continue to make your own).

 

The compounded liquid will last you for several months (look for expiration on the label and discuss with pharmacist).

 

When you get down to 2.5mg, you'll take all your daily dose in the liquid form and continue to taper that.

[DD44]

@Altostrata Iv been stable (or as stable as I think I’m going to get) for some time) about 3 months. Except for those 2 nights when I tried the compounded capsule. I didn’t respond well- enough so that o switched right back to 7.5 after 2 days 
 

I’m going to have to read that like 5 times to get it.

 

im trying to avoid liquid if possible. I worry about my math skills and ability to get it right every single night for what could be 6 months to a year. Also would just like to avoid the cumbersome-ness of liquid- if possible. 
 

I will find out from pharmacy if they can make 7.49 on Monday .... 

 

also getting a compounded capsule plus a liquid could be even more expensive - I’m already committed to paying 45$ a month just for the compounded capsule. It’s a consideration I don’t make a ton of money. 

[Altostrata]

You could get 7.49mg, but you might as well build in a decrease as long as you're paying for a compounded order. 7.275mg is a 3% decrease.

[DD44]

@Altostrata I don’t care so much about the money if I can make a successful transfer 

 

I didn’t do well with just a 6% decrease ...

 

but I hear you 

[Altostrata]

How about 7.40mg? That's a 1.33% reduction.

[DD44]

I’m willing to try whatever 

 

it’s 45$ every time I fill it 

 

my sole goal is to transition over successfully so I just feel that then I’m on a path to where I want, no matter how slow 

[elbee]

On 12/20/2019 at 11:23 PM, DD44 said:

the pharmacy may not be willing to compound a dose that already exists

 

Hey @DD44. Perhaps the first step might be to check with the compounding pharmacy and see if they in fact will not fill the 7.5 mg dose of Remeron? The current conversation seems based on the assumption they will not.

[DD44]

Spoke to pharmacist 

they cannot compound 7.5 because it’s commercially available 

 

they can do 7.4 (cannot really guarantee 7.49 because less than a .01 they said is negligible?)

 

They said doing a half compounded  capsule with a liquid along with it would be quite expensive (100 a month) really not prepared to commit to that price over the long haul. 
 

so that’s what I’m working with 

[elbee]

Hey @DD44, well done on checking that out and getting the information you need. Yup, that's a bummer on the pharmacy's restriction. I personally think Alto's suggestion makes sense:

 

On 12/22/2019 at 1:46 PM, Altostrata said:

How about 7.40mg? That's a 1.33% reduction.

 

Ideally you would switch over and not change the current dose, but as that doesn't seem to be viable, this route seems to be the best alternative option. The advised base reduction on this website is 10%, and you're looking at moving forward with 1/10th of 10% (1.3%). How does that sound / feel to you?

[DD44]

@elbee sounds like the only viable option

 

really hope it works out so I can feel I’m on the path 

[Altostrata]

Quite often, ordering a larger number of capsules doesn't cost much more than 30 compounded capsules. The cost is in the equipment set-up.

 

Another option is to order 90 2.5mg capsules, with the prescription written to take 2.5mg three times a day. You could get 180 2.5mg capsules made, for 2 months' prescription.

 

You'd start out taking 3 capsules for your 7.5mg dose. When you're ready to reduce, you could make a liquid from one of the 2.5mg capsules and add to 2 2.5mg capsules (5mg).

 

Or, you could order 2 months of 60 5mg capsules and 60 2.5mg capsules, with instructions to take 5mg at night and 2.5mg in the morning. Initially, you'd be paying a higher up-front cost but you'd have at least 2 months of capsules to work with. There are many ways the prescription can be written.