Faure: mirtazapine withdrawal

[Faure]

I started 15mg of mirtazepine in october 2018 as I had become severely depressed due to a very difficult living situation. I had not eaten properly for three months, had been having trouble sleeping for most of that period and by the time these were prescribed I had been barely sleeping, getting out of bed or eating for two weeks. I refused anti depressants from my GP as he’s always given me SSRIs which have nasty side effects of reducing my appetite and increasing anxiety even further and I was too weak to endure awful side effects.

 

As I was so desperate my mother paid for me to see a private psychiatrist who prescribed mirtazepine. Once I received the prescription I spent about four days googling about it (during this time my living situation improved and I hoped I might not need them afterall) however I finally took the plunge after a very desperate day. I can say I didn't look back. Within 30 minutes I prepared and ate a small meal and the next day I was on three full meals a day plus snacks. I'd dropped about from over 60kg to about 52kg during the prior three months. My mood didn't take long to lift, in fact the suicidal thoughts I'd been having went within a few days. After two weeks I did a phased return to work which was successful although (unfortunately) I’ve had a lot of practice at going back to to work after these episodes so have learned how to pace myself. I can only work about 20 hours a week atm as I just don’t have the energy for more, probably because of the Mirtazepine.

 

After 7 months on 15mg I started to taper down to 7.5mg using the skip a day every 2 weeks approach. This worked and by August 2019 I was on 7.5.  I continued this method until the end of September when I started to get highs. Always a warning sign for me. Fortunately I was by then seeing my psychotherapist who had helped me for the previous 2 years and knows me well. I could see this method wasn’t working and with her encouragement decided to do the 10% taper I’d read about here. I started at 6mg at the start of October. Although this was not before I had about 5 days at 15mg and a few at 7.5 while I stabilised.  

 

Mid October I experienced a day with more anxiety than usual (usually there was not any) followed by a very tired day (took the day off work) and then I was ok. I thought this was withdrawal although it also coincided with overdoing it. Things settled again till last week when I had a week off work (I work in schools, it was half term break). I overworked as I’d found a new approach I wanted to use after the break. So instead of taking a break and having a rest I became obsessed with this new approach, learning as much as I could about it.  I was aware I mustn’t over do it but I didn’t  succeed in stopping myself. Obsession is one of my warning signs (I was aware but not enough to stop myself). On Sunday morning at 5.30 I felt anxious and had a couple of mg Mirtazepine which helped.

 

I had to rest the whole day Friday, took it easy Saturday and went out Sunday. Yesterday (Monday) I was exhausted. I went to work but had to cancel clients at short notice as I knew if I tried to push through I would throw up (that happens if I get anxious / over do things) and collapse. Yesterday morning I took an extra 3mg to see if it would help with the fatigue; it didn’t.

 

Yesterday evening I took 3mg as I’d had 3 earlier (adds up to the 6 I’m on) and went to bed very early. It was very difficult to relax / sleep and at 10pm or so I took another 3mg.  At some point I slept and woke at 5.30 am feeling anxious. It’s subsided a bit. 

 

I don’t know if this is a blip because I overworked and am exhausted or if it’s because of the reduced dose, but I’ve been in that for coming up to 5 weeks now without any major incidents. 

 

So I’m looking for reassurance / advice. I am very scared (isn’t everyone!) of getting ill again. I was ill 3 times between 2016-18 and really can’t handle another episode. Should I stick on 6mg, should I go back to 7.5 or 15? Does it sound like I’m just exhausted and need to rest....the psychiatrist who prescribed them is useless regarding withdrawing. (But they were a life saver at the time.) Around Easter she suggested 1 week @ 7.5 then stop (I tried it, disaster, went straight back to 15). She also admitted at a recent appointment she didn’t know what to suggest. I am seeing my psychotherapist later today who has advocated slow & steady all along and is on board with the 10% approach.

[Altostrata]

Welcome, Faure.

 

I'm a bit confused about where you are with mirtazapine. Could you list the drug changes in the last month?

 

What is your tapering method?

 

Is fatigue your main adverse symptom? How are you sleeping?

[Faure]

Thank you for responding Altostrata. Initially it was fatigue which in hindsight was caused by overdoing it during my week off. However there is some new information which is that on 1 Nov I started taking a different brand (Noumed) as that’s what the chemist provided, but I realised after 3 - 4 days it wasn’t agreeing with me. So the fatigue, which I usually deal with by resting for a day or 2 and am then fine, was compounded by the change of brand which has destabilised me.

 

2 October-31 October 6mg Aurobindo brand all was well

1 - 3 November 6mg Noumed brand. Tired 1-3 November. Trouble getting to sleep (usual when I’ve overdone things). But did stay asleep.

4 November v tired and a bit anxious 3mg Noumed in the morning, 3mg at 6pm and further 3mg at 10pm as I was having trouble sleeping. This 3mg made me worse, I felt worse shortly after taking it. Suspected the new brand was causing a problem.

5 November woke up anxious at 530, had trouble eating (one of my symptoms when I’m anxious). 7pm 6mg Noumed. 45 mins later anxiety hit.  V bad sleep. Decided that the next night I’d go back to the original brand. 

6 November 4.30 am couldn’t take anymore anxiety so took 9mg Aurobindo. Worked like a dream. Felt much better very soon and had a good day. Back on Aurobindo now. 

7 November better day. 5pm 7mg 

8 November better day again. 6pm 6.5mg  

9 November woke anxious at 5.30 2.7mg, 6.30 still not great 3mg & felt better by 8am. Mid morning I was upset because seemed to be getting worse again - slightly anxious, easily upset and (foolishly) thought I needed to get mirt levels back up so took 7.5mg at noon. Huge mistake as early evening  I got extremely distraught for no reason. I think it was too much mirt. Very difficult to sleep but did sleep.

10 Nov (today) woke about 6am. Going to wait till at least 1pm for next dose (24 hours since last dose), and ideally try to get to the evening. Thinking I should try to stabilise on 7.5 mg or maybe 6...really hoping you can give me some advice today if at all possible.

 

I think I need to be patient and accept there will be bad times. The thing is I’ve been so stable for the last year it’s really hard to accept this episode and just wait. 

 

Until the end of September (possibly a bit before, I only started records in October) I was on 7.5mg & tapering by missing 1 day every two weeks. But since about mid to late September when I started getting highs I decided to do the 10% method. I decided to start on 6mg daily as I reckoned I was on about that with the missing day’s method. I think I was missing 3 days a week by the time I decided to stop that approach. But I haven’t made any more cuts yet as I was waiting to completely stabilise on the 6mg. I got odd mornings when I’d just need a couple of mg to help with slight anxiety, only a few times. 

 

I think that that if I hadn’t had the change of brand all would now be well ☹️

 

[Faure]

Had 2 days on 6mg and tonight couldn’t sleep at all despite being exhausted. I took 6mg at 6.15pm, 2 at 11, 2 more at 12am and then 4 at 1am = 14mg. Same mistake as Saturday. A friend has given me a serious talking to and said I must stick at 6 and not keep changing the dose and must accept lack of sleep & slight suicidal feelings. Going up doesn’t help, I must do better & stick at 6. Please help and encourage me. 

[Altostrata]

Are you still taking Aurobindo brand?

 

People do report difficulties with generic brand switches. You may have to report this to your doctor and pharmacist to make yours a "do not substitute" prescription to be filled with Aurobindo brand only, if it is available.

 

If 9mg Aurobindo worked, why didn't you keep taking that for a while? Why do you think taking 7.5mg would not be an improvement?

 

Skipping doses is a high-risk way to taper. Your estimate of your average daily dosage might have been off and 7.5mg each day for a while might have been fine.

 

Your friend is correct, taking doses inconsistently can lead to inconsistent symptom patterns. We aim to keep the nervous system stable with very controlled, gradual changes. It is possible you can settle at 6mg, but it can take some weeks.

[Faure]

Thank you. I have gone up to 10mg following a conversation with the gp. Stabilising was a priority as I was unable to work the way I was.  I’m feeling much better after a few days on 10 and hoping to get back to work sometime next week. I can’t believe I have been so badly derailed by the change in brand. I am back on Aurobindo now and my prescription states this. I also told the chemist in no uncertain terms I would not accept anything else and his attitude changed from ‘we just get what we get’ to putting the existing supply aside for me and saying he would shop around. 

[Faure]

@Altostrata I had been doing very well on 10mg daily. Anxiety gone, sleeping well.

 

Wednesday did a morning’s work, tired & rested till bed

Thursday  ditto but less tired

Friday worked longer, tired but not exhausted. Rested from 3.30. Began to get anxious in the evening about a new work thing. Slept badly.

Saturday, felt a bit anxious, tired. I went out briefly in the morning then rested. Anxiety lurking. 10mg @7.40pm. Bed around 8.40. Anxious. Took an extra 2.5mg 9pm.

 

Can’t sleep tonight, been feeling I need to go to a higher dose for most of today. Thinking 15mg. Have you any advice? Unfortunately tomorrow is Sunday so I can’t call the gp till Monday.

[Altostrata]

If I were you, I'd stay with 10mg for several weeks. You've been skipping around in dosages, which is destabilizing and may have sensitized you to stress.

 

Generally, once one has experienced an adverse drug reaction, it can take some time for the nervous system to settle down. You may feel some bumps along the way. See The Windows and Waves Pattern of Stabilization

 

If you want to go drug-free, you'll have to learn how to manage stress and anxiety that might disturb your sleep. See

 

Non-drug techniques to cope with emotional symptoms

 

Easing your way into meditation for a stressed-out nervous system

 

Music for self-care: calms hyperalertness, anxiety, aids relaxation and sleep

 

Ways to cope with daily anxiety

 

Tips to help sleep -- so many of us have that awful withdrawal insomnia

 

Path to Better Sleep FREE online for everyone from the US Veterans Administration

 

Music for self-care: Calms hyperalertness, anxiety, aids relaxation and sleep

 

What is the sleep cycle?

 

Melatonin for sleep: Many people find it helpful

 

TV or computer use in evening can disrupt sleep: Bright light signals the brain that it's daytime

 

[Faure]

Thank you Altostrata. I’m staying on 10mg. Gradually starting to feel steadier but I’m very tired. Don’t know if it’s 10mg making me tired or just the stress / difficulty of the past few weeks. Hoping it’s the latter. 

[Faure]

I’m still very tired. I tried to get back to most of my work last week but had to cancel some because of fatigue. I teach piano to young children which uses a lot of energy. 

 

I’ve decided to cancel a couple of afternoons till after Christmas and try to do the rest for two more weeks till the holiday. My schedule is now:

 

Tuesday 2 hours, Wednesday & Thursday 3.5 hours and Friday 6 hours although I’m not sure about Friday. The last two times I’ve done it I’ve been exhausted. I might reduce the Friday hours.

 

When I was on 15mg (until April this year) I managed all work, the gym, social activities plus enough rest). I also managed all work as I lowered the dose till the recent problem. I don’t know if the current fatigue is because I’m still recovering from recent turmoil or the 10mg is making me this tired. I’m seeing the GP on Friday. 

 

I’d be grateful for anyone’s advice. I’m intending to do another week on 10mg. I don’t think I’m stable enough to lower by 10% to get back to my plan to get off the drug (I was tired on 7,5 but coping and on 6 my energy was starting to return). I’m wondering if I should just increase the dose to 15 mg (if my body will accept it), stay on it a year or so and have another go at getting off then.....I’m self employed and it is quite important I earn money!

[Faure]

I am wondering whether a drop to 9 might increase my energy slightly. Thinking back to when this blip started, the first week when I was on 8/9mg I wasn’t so tired....but then the following week I caused big destabilisation by changing doses all the time...

[Winner51]

Hello Faure. I tapered mirtazapine from Aug of 2018 to Aug of 2019 and I followed a taper of 15% every 2 weeks.  This method is faster than recommended and I did have some issues.  If my symptoms were worse than usual I would hold at the current dosage until the symptoms calmed. For me, I listened to my body and I tried to keep with a consistent schedule of tapering unless I was experiencing more severe symptoms.  In my experience tapering and being without the drug, you are going to experience withdrawls and unfortunately that’s part of it. I accept the symptoms as part of the journey and for me consistency helped.  It helped me physically, mentally and  emotionally. If you formulate a plan and stick with it and deviate when needed, this should help you work towards your goal.  

[Faure]

@Altostrata & @Winner51 thank you for your comments and for the links. I refer to the windows and waves one a lot. Does this sound like a relapse or a wave? 

 

I was feeling ok for a couple of weeks on 10mg although tired.  Exactly three weeks after starting 10mg I felt totally exhausted (Wednesday last week). Yesterday I had real trouble eating (one of my warning signs I’m not ok), last night I had very broken sleep and felt pretty sick, vomiting at 4 & 5 am. Depression returning. 

 

I am worried it’s a relapse. When I spoke to the psychiatrist about going back to 10mg she said if I was going to do that I should get back to 15 about a week after as that is the therapeutic dose. 

 

I get very ill very quickly when it happens and I am tempted to follow the psychiatrist’s advice and get back to 15. And forget about withdrawing for 18 months or so. 

 

I find it it hard to accept her advice because in the same conversation she said I should also just be able to stop the meds altogether as 6mg doesn’t do anything. Well I tried following her advice twice earlier this year, both times I destabilised within days so I didn’t follow it again. The GP was more helpful saying I should go to 10 to stabilise. But I don’t seem to be improving on 10, just limping along. I don’t think I’m well enough to consider reducing. 

[Winner51]

Faure, I’m going to let Altostrata handle this question as she has much more experience with this issue than I. I can only speak from my experience and I’ve never gone up in dosage. When tapering, I either cut or held and when I have severe withdrawls I consider it a wave.  I’ve wanted so badly to be free of this drug and to ingest more of it is something I’ve never considered and I don’t think I would under any circumstances. But, as so often is said on this website everyone is different and Altostrata may make a recommendation of upping your dose. When I’ve experienced nausea it does seem to subside fairly quickly and I’ve noticed carbs (not healthy carbs such as veges but heavy, processed carbs like bread and pasta and sometimes potatoes) seem to really trigger it and they seem to make me feel completely exhausted sometimes.  Have you noticed particular foods causing your nausea and tiredness? Another thing I noticed about my taper and could be the case with you, when I would cut, the symptoms from cutting wouldn’t show until the second week after the cut. Apparently it took my body a while to notice the change. Perhaps you are having delayed withdrawls to the cut and this is simply a wave. 

[Faure]

Following my post on Sunday I upped to 15mg and felt pretty good for a couple of days but the third day my body felt like it had been punched. It was very physical and felt the same as earlier occasions when I’ve had too much Mirtazepine. I couldn’t eat much at all that day. I got an emergency gp appointment where it was agreed I’d go to 12.5mg. Emotionally I improved during the day. 

 

First day on 12,5 (yesterday) was not bad at all, I managed to eat little and often and didn’t feel anxious or depressed.  This morning at 2am I was unfortunately woken by a neighbour and anxiety set in fairly shortly after. I can’t help wondering what sort of day I’d be having if I hadn’t been woken. Both times when I’ve been woken in the night recently have been followed by a bad day. 

 

Anyway I know its early days and I ought to stick to 12.5 for a while. I feel like I can manage that despite the earlier anxiety and despite the fact I can’t face food. I am managing Complan (meal in a drink) and have had a small amount of soup. It always goes to my stomach when I’m anxious and I have starved so many times it’s hard not to worry, but I am at least managing something today and the anxiety had subsided.  Any helpful comments would be most welcome. 

[Hamster]

Hi Faure,

 

I know the urge to do change the dose frequently and find the right dose very well. I've been through this.

Unluckily, it never worked. With hindsight it only made things worse for me.

So after a lot of "playing around" with my dose I finally had to accept my WD symptoms and I try to keep them bearable them by doing a slow taper.

For me, even the 10% drops in mirtazapine were challenging (from day 3-4 after a drop: nausea, week 2-3 bad morning lows, ...). Nothing I could do about it. Every time I tried to add a dose or make a larger drop made things only worse. 

 

So now I'm finally doing a Brassmonkey-type-taper and hopefully I will be strong enough to stick to this for the coming months, maybe years.

So my advice for you: If you want to get rid of mirtazapine, stick to whatever dose you feel comfortable with (10 mg? 12.5 mg?) for a couple of weeks or even more and try to ride through the waves that may come. After this you can think about your taper. And do whatever you can do with your psychotherapist in the meantime.

 

Hamster

 

 

[Faure]

Just updating my thread. So I’ve been on 15mg Mirtazepine since December 2019. It took a full 12 months for my mood to stabilise. I was able to work from April 2020. I still suffer a lot from fatigue, but can do more than I could a year ago. Still not as much as I could before and would like to. I have been so patient in hoping energy levels are going to improve, and they have, but not enough. I am at the point where I’ve decided to start the 10% taper recommended here and am talking to my GP about it next week. Hoping for his support.  I’ve printed the Royal College of Psychiatrists leaflet about this and also the paper by Horowitz & Taylor.  
 

The forum is full of people having terrible trouble having not known about the 10% taper (and I’m so sorry for everyone suffering so badly), I’d really like to hear from people for whom the 10% taper is going well / whether they’ve encountered many problems. 

[Faure]

@Altostrata or @Shepor @brassmonkey I’m looking for some advice as to whether I should start my 10% taper or not. For the last 2 mornings I’ve woken at 5am with the cortisol spike but an eye mask and deep breathing has relieved it somewhat. Yesterday I identified I needed to step back (even more) on a work project, which I can do, but I don’t know why it happened again today.  It may be hormonal but I don’t usually get this problem every month. I’ve been more tired than usual the last couple of weeks.  It feels like any progress I was making on 15mg mirtazepine has stalled completely. I’m only able to work for 15 hours a week as I just get too tired for more. 
 

I’ve felt emotionally stable since November 2020. There are no stressful events in my life which is stable and I have one very supportive friend to lean on plus my mother. I have developed a meditation habit and have done a 40 minute body scan nearly every day since March 2020; this has really strengthened my mind and ability to notice how I’m feeling, accept it and make me feel calmer. 
 

Staying on 15mg doesn’t seem to be an option anymore as things appear to be worsening. I had wanted to be physically stronger before starting a taper. But I’m apparently getting weaker.  With all the episodes of the last few years I’d hoped for 2-3 years of good stability before trying to come off again. But it seems I need to come off it sooner, or go up in dose which I feel fairly sure would give me more energy almost immediately (I accidentally took a double dose a couple of weeks ago and felt very hyper the next day) but isn’t what I really want in the long term. Long term I want to lead a healthy life medication free. 
 

When I spoke to the GP yesterday he suggested first of all skipping doses to come off, then when I said no, he suggested reducing by 1/3 every 3 weeks. I said the only thing I’d be happy with is the 10% taper which he agreed to support while saying it would be very slow (I know that!). Unfortunately he told me he is leaving the practice next month.  He has ordered blood tests to see if here’s any other reason for the tiredness. He seems to have some problem with me cutting / weighing pills. I’ll ask why when I speak to him next week. 
 

So, even though I don’t feel ready to start the taper I have to 1) decide whether to, and 2) if I decide to do it, fully commit to seeing it through. My main concern is remaining well enough to work - I’ve had 4 long term absences from work in the last 4.5 years and really want to avoid more. Any advice would be gratefully received. Thank you. 
 

 

[Faure]

I’ve remembered that on 14 May I took an accidental double dose and am wondering if how I’m feeling now is a consequence

[brassmonkey]

A single one time double dose shouldn't cause any long term problems, It may cause a little instability and uptick in symptoms for a few weeks but should then settle out.

 

I don't see a problem with your starting a taper. But getting a new doctor that is willing to help may take some work. 

 

Because you are looking to minimize WD symptoms and are wanting to try for 10% reductions, I would suggest trying a 10% Brassmonkey Slide. You would reduce 2.5% a week for four weeks and then hold for an additional two weeks. This provides a 10% reduction every six weeks and will keep WD symptoms to a minimum.

[Gridley]

@Faure

 

You asked via PM whether it would be all right to cut your 15mg Mirtazapine pill into slivers to reduce by 10%, since it seemed excessive to make powder from a whole 15mg pill to reduce by only 1.5mg.

 

It is better to make powder from your tablets than to cut slivers.  There is no way to tell the standards that the manufacturer of your brand uses to make sure the active ingredient is evenly distributed throughout the pill.  If you cut into slivers, there may be more or less active ingredient in your sliver than in slivers from other parts of the tablet, putting you at risk of taking inconsistent doses.  If you grind into powder and stir thoroughly with a toothpick (or a powder measuring spoon, available on Amazon), that will ensure that the active ingredient is evenly distributed throughout the powder and thus in each dose.  

 

Either with tweezers or a powder measuring spoon, you can add or subtract powder from the scale to get the correct weight for your dose.  Then, using the tweezers or measuring spoon, transfer the powder to a size 0 gelatin capsule to make your dose.   Keep the rest of the powder in another gelatin capsule for future doses.  Pour the powder into the capsule with a bent 3" Post-it or, as I did, with LabExact 3" weighing paper, also available on Amazon.

Edited June 8, 2021 by Gridley

[Faure]

@Gridley, thank you so much for your comprehensive reply about how to reduce the tablet by 10%.  I already have scales, will go look for the other items. Thanks again ☺️

[Faure]

@brassmonkey, sorry I didn’t reply sooner I only just noticed your reply. Thank you. The effects of the one accidental up dose were rather unpleasant last week - I was very down and even more tired than usual.  This week I’m feeling better but my arms / legs feel drained.
 

I’m a bit reluctant to do the brass monkey slide as that will take even longer.  But given I’ve tried 3 times to come off this medication and had a very difficult few years maybe it would be the sensible thing to do. I want to get off and stay off now so need the most stability possible. The other thing is as I reduce dose I will get even more tired till I’m under 7mg or so as mirtazepine is even more sedating at 7.5mg....I’d really like to be under 7mg by Christmas, I feel I can put up with excessive tiredness till then...is it worth trying the 10% drop and seeing how I get on or do you think with previous failed withdrawal I should go straight for the brass monkey slide?  I’m starting Monday, after I’ve seen the GP.

[brassmonkey]

One of the biggest lessons we have learned here at SA is that "slower is faster". Yes, the Brassmonkey Slide will take longer than a standard 10% a month taper. However, the 10% a month taper is just a recommended starting point and is not workable for everyone. Many of our members have to make adjustments to it and end up at a smaller reduction percentage, which adds more time to their taper. If people try to go faster than the 10% a month there is a buildup of unresolved symptoms that manifests in a crash that can take many months to stabilize and then they have to do a slower taper to minimize the risk of triggering a bad reaction.

 

Not to mention that with the 10% a month taper a person is hit with a large symptom load right off the bat where as with the Brassmonkey Slide those symptoms are milder, due to the smaller reductions, and are spread out over several weeks. Some members report having almost no symptoms at all from each reduction. The smaller symptom load makes it much easier to get on with your life while tapering.

 

Having made three attempts in the past to get off I think taking it slow and easy would be the best route. Your body is probably sensitized to making changes so taking it slow and easy would be best. I wouldn't risk anything too harsh and would go straight to the Brassmonkey Slide.

 

For general planning purposes the half life of a Brassmonkey Slide is nine (9) months. So if you start Monday, in nine months you will be at half of your current dose. In 18 months you will be at one quarter of your current dose.

 

Constant fatigue is a real problem while tapering. There is no real way around it, it is just something we end up having to live with and work around as best as possible. Personally, I found ignoring it and just getting on with things worked pretty well. I frequently got a "second wind" and just kept going as normal. But there were also times that I really needed a day off and a good nap. It's all about listening to your body and doing what needs to be done whether it's take a day off or push through.

[Faure]

Thanks so much @brassmonkeyfor explaining why this is a good idea.  It is my priority to stay well, functioning and working, of course, isn’t it everyone’s!  The schedule is all printed off from your website.  Just waiting for my Amazon delivery. 
 

One other question please. Is it ok to prepare 7 days of tablets in one go?

[brassmonkey]

Making a weeks worth of capsules would be no problem. During my taper I frequently made two or three weeks worth at a time. Once while traveling I made up 60 in advance, it was a long trip.

[Gridley]

On 6/8/2021 at 12:50 PM, Faure said:

 

I’m a bit reluctant to do the brass monkey slide as that will take even longer.

I did the Brassmonkey slide for my entire taper off 20mg Lexapro and would heartily recommend it.  The fact that you have had difficulties with your previous attempts to taper is a strong argument to take it as gently as you can this time around.  It takes a bit longer, but the time really does pass.

Edited June 9, 2021 by Gridley

[Faure]

@Gridley, did you dispense with the two week holds? The Brassmonkey slide takes around 5.5 years but yours took just under 4....

[Faure]

My pill grinder etc have arrived. I’ve done a practise run on just one pill. I’ll do more in one go when I start.  Hoping there are no silly questions here: the pill ground to a very fine white powder with a few bits of yellow that didn’t grind; these are the same colour as the outer layer of the pill...what should I do with the yellow bits? 

[Gridley]

3 hours ago, Faure said:

My pill grinder etc have arrived. I’ve done a practise run on just one pill. I’ll do more in one go when I start.  Hoping there are no silly questions here: the pill ground to a very fine white powder with a few bits of yellow that didn’t grind; these are the same colour as the outer layer of the pill...what should I do with the yellow bits? 

Brassmonkey's taper took 5.5 years and mine took four because he was tapering from 40mg (Paxil) and I was tapering from 20mg (Lexapro).  I didn't dispense with the 2-week holds.  They're a very important part of the process.

 

Don't worry about the little pieces of yellow outer layer that didn't grind.  Just weigh the powder (with the yellow pieces included).  It won't make any significant difference in the amount of active ingredient you get, since there's so much more binder and pill cover in each pill compared to amount of active ingredient.  If you weigh what you get from the pill grinder, you'll get the right dose.

 

Before you pour the powder into your gelatin capsule, give the powder a good stir with a toothpick to evenly distribute the active ingredient in the powder.

 

 

[Faure]

Ok Gridley, thanks. I think I’m very clear on everything now. Thank you for your help and I’ll pop back in in a while to update my progress. ☺️

[Faure]

Dear @Gridleyand @brassmonkeyjust to let you know week 1 is complete and I’m so grateful to you for your help and especially encouraging me to do the BMslide.  Withdrawal effects have mostly been mild, with 3 days with none! Only 1 slightly difficult night (night 4) when I woke from 1.30-6am not feeling quite right and when I did sleep having very weird dreams which are normal for mirtazepine.  Fortunately I always enjoy mine! 
 

When I search for “how to get off anti depressants” this website doesn’t come up. Are the mods aware / making any changes to SEO keywords? It’s such a shame that people only discover this site when they have WD because this information about tapering really would be so useful to so many people before they try to stop…

[Altostrata]

Most likely, you are not seeing this site in top results because you are in Europe and we are based in the US.

[Faure]

I’m just about to start week 4 of the brass monkey slide. So far I have sailed through with 12 days with 0 WD affects and 8 days of mild ones.  The last couple of nights have been pretty difficult to get to sleep and today I feel mildly anxious. I have a feeling the WD effects have been backing up and are going to start being felt and it doesn’t feel like a good idea to do the 4th cut this week. I have been very keen to do the other cuts and definitely felt ready. This week I think it’s not a good idea. I remember when I was trying to come off before (by skipping days🙁) that WD effects showed up late. So it feels like I should hold this week - I absolutely don’t want to become incapacitated as I’ve had months at a time off work in the last 4 years.  I have read Alto saying all the time listen to your body - so I think this is what I need to do this week. Does this sound ok @brassmonkey / @Gridley?

[wantrelief]

Hi Faure,

 

5 hours ago, Faure said:

So it feels like I should hold this week - I absolutely don’t want to become incapacitated as I’ve had months at a time off work in the last 4 years.  I have read Alto saying all the time listen to your body - so I think this is what I need to do this week. Does this sound ok

I am not BM or Gridley but I think you should listen to what your body is telling you.  I am also tapering using the BM method and have had to adjust my tapering schedule many times because I could tell my body/brain wasn't ready for that next cut or there was something stressful going on in my life.  It is really hard and disappointing to prolong things but I think it can lead to trouble if we just plow ahead not heading the signs that we aren't ready for that next cut.

 

I am wishing you the best of luck with your taper!  

[Gridley]

6 hours ago, Faure said:

I have a feeling the WD effects have been backing up and are going to start being felt and it doesn’t feel like a good idea to do the 4th cut this week. 

@wantrelief is exactly correct.  You should hold where you are until your body tells you you're ready to continue the taper.  Like wantrelief, I did the Brassmonkey slide (off Lexapro) and needed to hold several times throughout the taper.  The 4 week taper/2 week hold is a only a guideline.  We always say, don't listen to a schedule, listen to your body.

 

Once you feel you're ready to taper again, you can do the 4th 2.5% taper, then hold for the standard two weeks.  Then you can try the standard 4 week/2 week schedule again.  If it works, you can continue using this speed.  It may be you need to taper less than 2.5% every week (maybe 1.25%) or you may need to hold longer, like now.  It will be a continuing process of tweaking as necessary.

 

You are wise to bring this to our attention and not to try to hold a schedule.