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KarateKat

KarateKat Mirtazapine Fast Taper & Reinstatement advice

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KarateKat

I was prescribed 15mg Mirtazapine in May 2019 for sleep and anxiety following a diagnosis of PVFS (now ME/CFS) in Jan 19. Developed tinnitus 4 weeks later and advised to come off by MD. Both the MD and pharmacist advised that what I now know as a FT would be ok as I was only taking the drug for almost 3 months. In fact, my MD said that Mirtazapine would be ok to just stop. Dropped from 15mg to 0 in about 4 weeks and unsurprisingly got the whole raft of symptoms. The worst was my inability to sleep and brain tremors that would come on as I was just falling asleep and if I did fall asleep would wake me at every sleep cycle. I went for some nights with no sleep and became suicidal. 

Reinstated after 16 days, under the advice of my MD  at 3.75mg for 2 days, with little improvement, then up to 7.5mg, where I have been for two months. 

 

I have been a heavy meditator since the start of June as part of an ME/CFS recovery program, called ANS Rewire (highly recommended), which includes brain training. I am taking a supplement regime as part of this protocol, I also take melatonin (2mg).

 

Two months on from reinstatement pretty much all withdrawal symptoms have disappeared apart from minor tingling and skin crawling sensations (this could be withdrawal, the drug side affects, or my illness) and the sleep disturbance, and I am seeking advice on whether to up the dose to 11.75mg as suggested by MD.

It has  improved a great deal and I am getting a number of hours a night. Initially the brain tremor would be very intense, making my whole body tingle/tremor and my tinnitus gets very loud, stopping me from falling asleep and waking me on each sleep cycle (perhaps on REM part as I can always remember dreams and never could prior). After a bit, it became much milder and less frequent, still stopping me falling asleep and waking me, but feeling more like an odd sensation. More recently it appears to have worsened and when I wake my heart is pounding. I think I wake on each sleep cycle and after about 4.30 am, its constant as a fall asleep and will happen multiple times until waking. 

 

Oddly, I have noticed that on days where my meditation feels particularly deep, the night is much worse and this worries me, because it makes me feel as though there is something wrong with my brain. I also wonder whether having ME/CFS (a dysfunction of the ANS), means that things are harder. 

Anyway, I am thinking of upping the dose to 11.75mg and am seeking advice. 

Also, I wondered if anyone else has experienced that meditation makes symptoms worse? I do go very deep and believe that I have high brain neuroplasticity. 

 

 

 

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KarateKat

Hi again, having read a bit more on this wonderful site, I think perhaps that i’m experiencing ‘waves’ when my sleep is poorer and that the meditation link is a coincidence. Have given the meditation a rest for a few days and am now experiencing very poor nights again. Would this be linked to cortisol spikes?

Would still like advice on the dose increase. 

Many thanks. 

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Altostrata

Welcome, Karate.

 

Your nervous system did experience an upset when you went off mirtazapine too fast. It could take more than a couple of months for it to stabilize on reinstatement of 7.5mg August 3. (Please organize the notes in your signature chronologically.)

 

Your meditation might be so effective in calming your nervous system that is it causing a paradoxical reaction in combination with melatonin and mirtazapine. If you are taking 2mg melatonin, I might reduce it to 1mg melatonin.

 

It is also possible that your nervous system has settled down some and 7.5mg mirtazapine is now too much for it, causing a paradoxical reaction later in the night. I'd reduce the melatonin first, see if that helps.

 

You're doing everything right -- thanks very much for the tags and signature and good symptom pattern notes. Please continue to let us know how you're doing.

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KarateKat

Many thanks Altostrata. I have corrected my signature.

I will follow your advice and reduce the melatonin. I am also taking 440mg of high quality magnesium at bedtime. Do you think this would be worth changing to the morning?

 

So, at this stage, you would not recommend increasing the Mirtazapine?

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KarateKat

Hi, I took the 1mg melatonin instead of the slow acting 2mg. I don’t think there was any noticeable difference except that I spent more time awake. Still experiencing the episodes of arousal  each sleep cycle. Didn’t get to sleep after 4.0am. I carried out deep relaxation techniques, and whenever I felt on the point of sleep, I was jolted into arousal (pounding heart and anxious feeling in the chest). I am able to control this with 5 deep relaxing breaths.

I started to experience this as soon as I started the fast taper. Initially it was infrequently, but by the end I couldn’t sleep at all. The sensation was much worse ( brain tremor s/zaps and electricity in my body) On reinstatement things slowly improved, with some really good nights. 

While the experience is not as awful as during the taper, the frequency seems to be getting worse. 

 

I do get other symptoms , which also seem to be worse, particularly in the evening. I didn’t mention them before as it’s hard to determine if they are related to the ME/CFS or this withdrawal/reinstatement. I get flu-like symptoms,  deep muscle aches, pains deep in my ears, tingling and pins and needles etc..my instinct is that is is withdrawal related as it feels more like it did during withdrawal. 

 

As part of ANS Rewire program I mentioned earlier, I had already implemented the recommended wellbeing measures (sleep hygiene, no alcohol, caffeine, sugar, gluten, following a whole food anti-inflammatory diet) some months prior, and was starting to recover. 

 

The reinstatement seemed to be working very well for about six weeks, but my experience now seems to be like the withdrawal. This is why my MD has suggested upping the dose. Advice is appreciated.

1. If, as you suggest, I am having a paradoxical reaction, what is the best course of action? 

2. If I up the dose and it has no/negative effect, canI just drop back down to 7.5? This is what the MD has suggested, 

3. Should I try no magnesium at bedtime 

 I have held off the meditation fo a week now and haven’t seen any noticeable improvement so am thinking about restarting as this is a key strategy in my ME/CFS recovery program. 

Thanks in advance.

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Altostrata
1 minute ago, KarateKat said:

I do get other symptoms , which also seem to be worse, particularly in the evening. I didn’t mention them before as it’s hard to determine if they are related to the ME/CFS or this withdrawal/reinstatement. I get flu-like symptoms,  deep muscle aches, pains deep in my ears, tingling and pins and needles etc..my instinct is that is is withdrawal related as it feels more like it did during withdrawal. 

 

Do these happen at the same time each evening? How long do they last?

 

What times of day do you take each of your drugs, with their dosages?

 

My guess is 7.5mg mirtazapine is a little too high in combination with your meditation. I'd go back to 2mg melatonin and try a reduction of mirtazapine to 7.25mg, see what happens.

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KarateKat

Many thanks for you prompt reply, very much appreciated.

It's hard to pinpoint about the other symptoms. They are there constantly in varying degrees and start to get worse early evening. I generally feel better in the mornings. 

 

Amlodipine 5mg - 8am

Ubiquinol CoQ10  100mg - 8am

Omega 3  3000g - 8am

Vitamin C - 1000mg - 8am (sometimes throughout the day if high sore throat/glands, on advice from my Integrative DR)

B Complex - 8am (this has a variety of levels)

D-Ribose 5mg - 8am & 4pm

Magnesium - 440mg - 8.45 pm

Melatonin - 2mg (slow release)

Mirtazapine 7.5g - 9.30pm

 

For the reduction, I will need to get some micro-scales and shave a little off. 

I can try without the magnesium tonight. 

 

 

 

 

 

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KarateKat

Sorry, forgot the zinc, 25 mg 8am. 

This also has Manganese 2mg and B6 10mg, which actually takes my total B6 to 20mg (from the B complex)

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KarateKat

Hi AltoStrata, I've ordered the scales and will reduce to 7.25 as suggested. 

I'm wondering what the recommended course of action is after that? How long would one typically wait before other adjustments? 

If I feel worse should I go back to 7.5mg, can you advise how long I would wait to see?

 

I recall that the night time reactions started before withdrawel, at about the same time as the tinnitus (albeit in a much milder form). Possibly my CNS was already sensitised because of the illness. I now that people with ME/CFS are very sensitive to medication. I think that this was a much to high dose from the start. 

Many thanks of course. 

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KarateKat

Hi, still waiting for the scales, should be here on Tuesday. Symptoms getting worse, particularly sleep. I'm now getting the arousal/flight or flight sensations when just relaxing as well as falling asleep and when asleep. Not more than a 2/3 broken hours a night. Getting a bit desperate. 

I would super grateful if someone is able to answer my previous questions please?. 

On ‎11‎/‎9‎/‎2019 at 12:33 PM, KarateKat said:

Hi AltoStrata, I've ordered the scales and will reduce to 7.25 as suggested. 

I'm wondering what the recommended course of action is after that? How long would one typically wait before other adjustments? 

If I feel worse should I go back to 7.5mg, can you advise how long I would wait to see?

 

I'm a newbie at this. Am I correct in understanding that if, as in my case I reinstate and things improve, but then deteriorate after a couple of months, then it means that my dose is too high? Not to low as the DR suggests and that increasing is risky.

 

 

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