Gilla999: hello

[Gilla999]

Just thought I'd post a quick intro post. I've been taking Mirtazapine since July after a bout of insomnia (not my first) which was so severe this time that my mental health deteriorated very badly and after a suicide attempt I was eventually hospitalised. Thankfully the Mirtazapine was the thing that eventually helped turn the corner with the sleep. After only a short time I knew I wouldn't want to be on it long term and started a quick taper pretty quickly. I figured as I had only been on it for about 3 weeks I would be fine to do a quick taper - more fool me! Gave myself horrific withdrawal and accepted I would need to do the slow taper. I've been tapering since then and am now down to 7.5mg, doing a 10% drop every 3 weeks. So far on that method I have managed to avoid bad withdrawal - a couple of icky days here and there but something that could equally pass as PMT or coming down with a cold, and nothing that seems to follow any set pattern. A world away from the horrific WD of a too-quick taper!

 

It feels as though I've been tapering for forever, but I realise I still have a long way to go and am already extremely nervous about what happens in the Spring when I get down to the low numbers. My primary concern is avoiding rebound insomnia as I know from experience that when I get it, it often kicks off a cycle that can lead me to an extremely dark place, both physically and mentally. On the flip side I am desperate to be off of it because of the weight gain - from being a size 8 all my life to the size almost-16 I am now, my body doesn't feel like my own.

 

Though I'm in a pretty good place right now I'm always interested to hear/read about others experiences and tips with tapering as the one thing I have learnt is that everyone is different!!

 

Sending good vibes from me to all of those who have struggled with the tapering and withdrawal - it still staggers me that doctors really have little clue about how difficult it really is.

 

Gill xxxx

[Gridley]

Welcome to SA, Gilla999.  I'm glad you're doing better.

 

We recommend tapering 10% of current dose every four weeks.  You might want to consider extending from every three weeks to every four weeks.

 

Why taper by 10% of my dosage?

 

This link is specifically about tapering Mirtazapine.

 

Tips for tapering off Remeron (mirtazapine)

 

As you get down to lower doses, you might want go more slowly to minimize withdrawal possibilities.  One option is to institute a two-week hold after your 3-week (or, as I recommended, 4-week) taper.  Another possibility to consider is the Brassmonkey slide taper, which consists of four weekly 2 1/2% drops followed by a 2-week hold, as opposed to a larger drop every four weeks. 

The Brassmonkey Slide Method of Micro-tapering

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Please research all supplements first and only add in one at a time and at a low dose in case you do experience problems.

 

This is your Introduction topic where you can ask questions and connect with other members.  We're glad you found your way here.,

[Gilla999]

Hi all - I had a quick question regarding alcohol and Mirtazapine. I've been on it since June and have been tapering pretty much straight away using the 10% method - anything quicker gives me WD.

 

I haven't had a single alcoholic drink the entire time - since May actually - initially from being so ill and then because I knew from posts I'd read that they didn't mix well. However realistically it's going to be another year before I'm fully off it- I'm down to 5.7mg now - and I would like to think I could have a couple of drinks if I wanted to. Ive never been a regular drinker but am a social drinker and i really miss being able to have 2 or 3 glasses of wine with friends. I'm interested to hear about others experiences - is it an absolute no-no to mix the two at all?

 

Thanks in advance!

[Gilla999]

For some reason I didn't get a notification about this reply, but I just wanted to say thanks for taking the time to reply - much appreciated. I've planned to do as you suggested and go more slowly with reductions when I get down to the very low numbers in a couple of months' time. Not only because of the Mirtazapine itself but because I seem to find my dreaded episodic insomnia always happens during the midsummer months, it never presents in Winter with the dark days so I'm planning to eke it out until next winter.  Thanks again for the suggestions, much appreciated

[manymoretodays]

22 hours ago, Gilla999 said:

Hi all - I had a quick question regarding alcohol and Mirtazapine. I've been on it since June and have been tapering pretty much straight away using the 10% method - anything quicker gives me WD.

 

I haven't had a single alcoholic drink the entire time - since May actually - initially from being so ill and then because I knew from posts I'd read that they didn't mix well. However realistically it's going to be another year before I'm fully off it- I'm down to 5.7mg now - and I would like to think I could have a couple of drinks if I wanted to. Ive never been a regular drinker but am a social drinker and i really miss being able to have 2 or 3 glasses of wine with friends. I'm interested to hear about others experiences - is it an absolute no-no to mix the two at all?

 

Thanks in advance!

 

Hi Gilla @Gilla999 and welcome aboard,

I moved your post from the Relationship forum back to here, your introduction. You'll see it above your previous post now.  And then I quoted it here, as well.

We do have this topic in the Symptoms and Self care forum:  Alcohol and beer

As this was a topic started, more specific to you, and your situation,  the best place for a post and ? like that, would be right here, your Intro topic.

 

With mirtazapine specifically, alcohol may result in more side effects of dizziness and confusion.  Not a great combination. 

Drug Interaction Report 

I don't think I would,  indulge, if I were you, given that you report being in a good place and all right now, with your tapering and WD.  I mean why mess up a good thing.  Taking chances and all.

 

Please put your withdrawal history in your signature  to help the moderators.

 

I noticed your post over in symptoms and self care as well.  You can find that again here.  It looks like you may be recovering from some other AD's and WD too.  I had no idea, that's why signatures can be helpful.

You may get responses from that, or not......but that was the correct way to post on a topic in other forums that you found interesting, or perhaps wanted to discuss with others more.

 

Best,

L, P, H, and G,

mmt

Edited January 1, 2020 by manymoretodays
checking my link, finishing my response

[hezzer78]

@Gilla999 Fellow mirtazapine user here. I'm in the middle of a taper as well.  What were your WD symptoms when you did the quick taper the first time? For unavoidable reasons, I had to do a big drop from 15mg -> 7.5mg.  I've been at 7.5mg for 4 days now and the worst thing I've encountered so far is insomnia.  I'm taking some ativan and benadryl to get through that rough patch, but will start to decrease those drugs as well soon. I get about 4 -5 hours of sleep a night - which is not horrible and I can definitely still function, but it's just an anxiety building situation to constantly have to take meds like that.

 

With regards to alcohol - I've been on Mirtazapine for over a year (like 14 months?) and I've drank alcohol pretty much weekly. That being said, I was taking my mirtazapine dose in the afternoon (around 3pm) because taking it later made it difficult for me to get out of bed in the morning.  So I would take my mirt at 3pm, and have a glass of wine or drink in the evening - around 8 or 9.  I can't say I noticed any horrible effects if I kept it to one or two drinks. Anymore than that and I felt horrible - everyone is different though, so just try and see what works with your body.  However, if you're in a good spot now, maybe don't risk it? Only you know what's best and what you're willing to chance.  I'm a mom to a 1 year old AND a high school teacher, so there was NO way I was going to go without wine. 😉

 

That being said, 2020 is going to be my year of my "I'm not drinking right now" experiment. I've decided to cut alcohol out for as long as I can.. just for bettering my health.

 

 

 

 

[Gilla999]

Hey @hezzer78 thanks for the reply! To answer your question - I was prescribed it purely for extreme / severe episode of insomnia that really had a very bad impact on my mental health (I probably slept about 2 hours in 10 days... I was delusional etc... really not good). Mirtazapine was the only thing that turned the corner for me and helped me sleep - I've tried all kinds of sleeping pills (prescription and non) and although I'm super sensitive to medication I seem to be able to take enough sleeping pills to tranquilise a horse and still not sleep! So I'm forever grateful to the Mirtazapine for being the thing to rescue me at that point as I honestly believe without it I wouldn't be sitting here now. But because I never want to be taking a pill long term for my sleep and I also found the initial side effects very strong I wanted to come off it pretty much as soon as it had got me over the initial hurdle. Thinking that as I had only been taking it for a 3 or 4 weeks and wouldn't have WD, I did a very quick "taper" from 30mg to 5mg in the space of about 3 weeks. My psychiatrist knew and approved and at that point I was very ill informed so thought it would be ok. I was initially fine except a bit short tempered until I literally felt the WD hit me like a brick one afternoon around the 3 week mark. Hard to really describe - the worst anxiety you can imagine, racing heartbeat, terrible insomnia (no sleep at all) and a really strange buzzing / tense sensation in my head, like all my nerve endings were on edge. A really horrible sensation I've never experienced before, even when I previously suffered with WD from SSRIs. I knew I needed to reinstate straight away and after about a week of doing so I was fine again and accepted I would have to do the long, slow taper like a lot of people do, despite having only been on it for a few weeks. That WD experience was bad enough to make me never want to risk pushing it again, as tempting as it often gets when you feel it is dragging.

 

As for your drop - is it absolutely unavoidable? If so try to just remember that it will pass eventually. I'm sure you've probably read about lower doses of Mirt being more sedating than higher, so once the WD is over your sleep should be fine on 7.5mg And if you do / can reinstate at a dose somewhere in between then do so if you can. The biggest thing I have learnt is that everyone is different in how they react. My brother in law was on Mirtazapine for months and tapered as per the doctor's instructions (way quicker than 10% every 4 weeks) and he was absolutely fine. 

 

Thanks about the alcohol - it's good to know that it isn't necessarily a total no-no. (I lol'd btw - teachers do need their class of wine!) But as you and @manymoretodays both said, perhaps it isn't worth the risk - especially as after 8 months without one I likely won't feel great anyway. It's just a shame to feel like aspects of your life are on hold (that + the weight thing *sob*).

[hezzer78]

@gilla999 Thanks for the info - Once I stabilize at 7.5mg, I do plan on tapering much slower - 10% every few weeks. Hopefully it will make the insomnia less.  The initial drop from 15 to 7.5 is because my husband and I are thinking of trying for another baby in 2020. Mirtazapine is 'not recommended' for pregnancy, so I really do need to get off it as soon as I can. I figure if I can take a big jump from 15 to 7.5, then smaller drops, I can just quit CT on whatever mg's I'm taking when I get pregnant. It's not ideal, but it's the best situation I think. I'm 40, so waiting a few years to get slowly off mirtazapine isn't an option.

 

I was RX'd it for extreme postpartum anxiety and insomnia - and I'm not sure I will take it again for my 2nd post partum. Time will tell, but I'm hoping I can be in a better head space. 

 

I seem to be really sensitive to changes in medications, so I'm hoping I can start to decrease the benadryl + ativan combo soon as my sleep will hopefully start to get back on track the next week or so.

[Gilla999]

@hezzer78 that makes sense - I'd imagine it's more important to do smaller drops on the lower doses. I'm obviously not a doctor, but is there anything you could switch to instead of the Mirtazapine that wouldn't be such a problem, that might help instead of needing to potentially go CT? I'm guessing not as I think (?) they don't recommend any ADs for pregnancy. From one 40 year old to another I understand the "can't wait" thing 😊😊. I guess just try to keep in mind that all WD will eventually pass. The original post here https://www.survivingantidepressants.org/topic/1160-how-psychiatric-drugs-remodel-your-brain/?do=findComment&comment=465726 I found really helpful in trying to rationalise what is happening during WD. Everyone is different but I find it helps to understand the science of what's going on - that your brain chemistry needs to learn to rebalance itself.

 

Wishing you lots of luck, both with the drop and trying for a baby! Keep me posted on how your taper goes

 

[Gilla999]

Getting Lexapro WD and wondering whether I should reinstate or stick with the dose I'm on and ride it out!

 

I'm on both Escitalopram (Lexapro) and Mirtazapine (Remeron). I've been tapering the Mirt at 10% every 3 weeks since the summer and have successfully had very little WD this way. I decided to start tapering the Escitalopram too (just want all this rat poison out of my body!) and went from the 7.5mg I have been on since last summer to 6,25mg without suffering any WD. Stayed at that for 4 weeks and then dropped from 6.25mg to 5mg  and 7 days in I was hit by the dreaded WD.

 

It feels exactly the same as the WD I used to get tapering from Sertraline/Zoloft in previous years when I was on that (and interestingly feels quite different to the Mirt WD I experienced when I initially tried to taper too fast). The SSRI WD symptoms for me are basically brain zaps, extreme emotional state, not being able to get to sleep for hours (keep zapping awake), feeling extreme tiredness. 

 

So last night was night/day two of horrible WD and my question is - and I know there is never a golden answer but am interested to get feedback - should I stick with the 5mg that I've now been taking for 9 days, or should I reinstate at 6.25mg? Either way I have an appointment with a doctor to try and get the liquid version of it to do smaller drops in future to avoid this happening again, but am wondering what the best thing to do with my dose today is - have I been on the lower dose for a length of time (9 days) that I should just stick with it? 

 

The liquid version of Mirt has literally been a life saver - I don't know what I would have done if I only had Mirt pills.

[planifolia]

Hi Gilla, welcome to SA.

 

There is no clear awnser but there are options you can take.

 

if you think that you can tolerate the brain zaps and other symptoms, you can choose to stay on the dose and wait it out. With time the symptoms will subside. Given that its been only 9days, it would usually take longer than this for them to subside

 

if not, you can updose. To what dose is hard to say. You can updose back to 6.25mg and wait for symptoms to ease, then make a smaller cut than you did next time. Or you can do a partial updose, such as to 5.5mg. Sometimes a partial updose is enough to relieve symptoms. 
 

this is my take on your situation. Hopefully a moderator will contribute to your thread soon. 
 

take care

 

[Gilla999]

Thanks @planifolia I appreciate the reply - I know it's always a hard one and I am cautious myself about giving advice on these things as everyone's experience is so different. I think I'd find it impossible to go back to 5.5mg simply because the pills are so small that it's even difficult to cut them into quarters (to get 6.25mg) let alone anything more accurate. I'm trying to recall from my previous experience how long this WD is likely to last before my brain chemistry kicks in and restabilises itself... if it's longer than a few days then I'd probably go with reinstating.

 

I see you've been on a slow taper of Lexapro - how have you been finding that?

[Shep]

On 1/30/2020 at 4:14 AM, Gilla999 said:

I decided to start tapering the Escitalopram too (just want all this rat poison out of my body!) and went from the 7.5mg I have been on since last summer to 6,25mg without suffering any WD. Stayed at that for 4 weeks and then dropped from 6.25mg to 5mg  and 7 days in I was hit by the dreaded WD.

 

Gilla, please note I merged your second intro thread with your first. Please continuing posting in this one intro thread so all of your information is in one place.

 

You're getting withdrawal symptoms because you're tapering too fast.

 

Going from 7.5 mg to 6.25 mg is a 16.67% reduction. And then going from 6.25 mg to 5 mg is a 20% reduction. 

 

I would updose back to 6.25 mg and hold.

 

Please note: escitalopram is an EXTREMELY potent drug, much more potent than the other SSRIs. Please see: 

 

Why taper by 10% of my dosage?

 

Tips for tapering off Lexapro (escitalopram)

 

 

[Gilla999]

Thanks@Shep - I can't seem to get posting locations right! 

I reinstated at 6.25mg the day after writing this post and have remained there since - WD subsided after a couple of days. This morning I got a prescription from the doctor for liquid Escitalopram so I can now do the taper much more slowly. Thanks for sharing the info on Escitalopram - I had no idea about its strength. 

 

Again not sure if this is the correct place to post this, but as a side note I am completely baffled as to why we have to go to such lengths to find ways off this medication that don't harm us. You'd have thought the drug companies would have cottoned on how difficult it is for people to come off, and come up with easier ways (tablets etc) that meant we could safely taper. The doctor looked at me like I was crazy today when I spoke about last week's WD and needing to taper more slowly. He also gave me the same "look" when I explained how Mirtazapine had been the only thing to help with my extreme sleep issue last year and I believed  this was because of the noradrenaline aspect of it. He replied "it just affects your serotonin, the same as other SSRIs" I'm pretty sure this info is outright wrong 🤨. I find it totally crazy that people in charge of dispensing medications that have such a big impact in many ways are so ill-informed about them. *rant over*

[Shep]

1 hour ago, Gilla999 said:

You'd have thought the drug companies would have cottoned on how difficult it is for people to come off, and come up with easier ways (tablets etc) that meant we could safely taper

 

Unfortunately, drug companies are no different than other large corporations - they want us to continue buying their products. So it's simply not in their best interest to help us come off these drugs. Dr. Peter Gøtzsche is a whistleblower who's been documenting pharma crime for a long time. Here's one of his articles:

 

Deadly Medicines and Organised Crime: How Big Pharma Has Corrupted Health Care

 

As far as "easier ways (tablets etc) that meant we could safely taper," there has been a movement to get tapering strips. 

 

Tapering strips for psychiatric drugs being produced in Netherlands

 

But so far, this isn't mainstream. You can always use a compounding pharmacy, though. 

 

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

 

2 hours ago, Gilla999 said:

The doctor looked at me like I was crazy today when I spoke about last week's WD and needing to taper more slowly. He also gave me the same "look" when I explained how Mirtazapine had been the only thing to help with my extreme sleep issue last year and I believed  this was because of the noradrenaline aspect of it. He replied "it just affects your serotonin, the same as other SSRIs" I'm pretty sure this info is outright wrong 🤨. I find it totally crazy that people in charge of dispensing medications that have such a big impact in many ways are so ill-informed about them. *rant over*

 

Yep, I agree with you 100%. 

 

You may find these links helpful:

 

How do you talk to a doctor about tapering and withdrawal?

 

Withdrawal dialogues & encouragement

 

There's more coming out in the media about the danger of withdrawal (see the In the Media section), but for the most part, we simply need doctors to write the prescription and then the taper is done according to symptoms. As long as you view your symptoms as your teachers and guides, you'll be able to get through your taper and recover, regardless of the ignorance of these doctors. And that's the goal. You're going to be okay. 

 

[Gilla999]

Thank you @Shep - love this. I have to say I felt very much like the more informed one while sitting in the clinic today and thought to myself "what would they say/think on SA if they could hear this doctor now!". I'm just so glad that I am now educated enough to be able to manage it without causing myself harm (mostly - still learning some parts eg the Escitalopram escapade last week!). Thank you for all you do 😀

[Santino]

HI Gilla

I did successfully taper MIrtazapine as you can see from my success story and my introduction topic in SA. I used to drink a lot before this whole thing started but during the taper i almost completely stopped it. You are in a good spot and my advice is to stay away from drinking for some time. If i drunk 1-2 glasses during withdrawal i would just feel sleepy and it was not fun anymore, and the next 3-4 days i would be really sedated and depressive. Improvements would come after 3-4 days. IN that case i decided to skip alcohol during the taper and currently i am free of meds but i am also free from alcohol. My advice is to refrain. If it happens for you to sit with people who drink an nonalcoholic beer is perfect to accompany the people drinking.

All the best my friend and keep tight. You will succeed.

Santino

[Gilla999]

Thank you @Santino for the kind words and good advice! I've still not had a drink and intend to keep it that way. It's a big change in lifestyle but the longer it goes on for the more normal it becomes. As you rightly say, I don't want to risk setting myself back. As I haven't had a drink for 9 months now I imagine I wouldn't feel great on it anyway, so what's the point?

 

Thanks again for your kind words!

[Malbec37]

Hi @Gilla999I've been reading your thread and can see that you're also on the journey to taper mirtazapine, as am I, so wanted you to know you're not alone in this...there are thousands of us out there and it is a really tough experience but I am finding encouragement from seeing people such as @Santinowho have managed to succeed....it's really inspiring

 

I will follow your thread

 

Keep going slowly and gradually and you will get there

 

Malbec37

[Gilla999]

Thank you @Malbec37 it definitely helps to know you're not alone! Aside from when I tried to taper too quickly initially, I've thankfully not had any real issues in my Mirt taper at 10%. Of course I still have a way to go (currently on 4.35mg) and I'm aware there could be bumps in the road when I either get really low or come off altogether - still not sure when I will take that plunge. I'm also very aware how tempting it is to try and rush it - the weight gain (I've always been a size 8 - now a size 14-16) is so depressing - but I just don't think it's worth it and it only ends up setting you back in the long run.  Are you still on Mirt and at what dose? Would be interested to hear about your experience 😊

[Malbec37]

@Gilla999Very happy that you've had no real issues at 10% reductions ...it does give me hope although I can see that I've been on mert a lot longer (nearly 6 years) so that could be a factor for me....I am currently on 13mg having reduced from 30mg over 6 months....from 30 to 15 was fairly easy but dropping from 15 to 11mg was awful and I've been in WD ever since...I have now updosed to 13mg after advice on here and have been on this for 4 weeks now and WD constantly including insomnia and tinnitus being the worst. But I'm coping somehow and sticking on 13mg for as long as it takes to get consistent and stable in WD symptoms (hopefully none!) and then will begin to taper maybe at 10% but possibly at 5% to begin with as I'm super sensitive to withdrawal and have been on the stuff for many years and then 10 years on citalopram before that so my CNS has become very accustomed to the meds

 

I am doing everything I can to help myself insulting quitting alcohol and caffeine, lots of yoga, running, nature, epsom baths constantly etc....slowly but surely I think I'm steadying out but it's so up and down

[Gilla999]

@Malbec37 I'm sorry to hear you've had such a rough time. I really do believe that a 10% taper (or less) is the only way to go. I tried 15% Mirt taper once as an experiment but got WD - not terrible, but enough that I didn't want to do it again. We all have our own reasons why we want off these medications sooner rather than later, but my own personal experience is that trying to rush it only makes it take longer, as you end up having to reinstate and stabilise. As for now, it may take a little time but you WILL restabilise once your brain chemistry kicks in. Insomnia is the worst thing in the whole world though, so I have a lot of sympathy for you. Things like Yoga and nature have huge healing qualities. Eating nourishing, healthy home cooked food is another! Take good care of yourself and you WILL restabilise soon enough. Sending you lots of good vibes 🌈

[Malbec37]

@Gilla999thanks so much for the lovely message of support. It helps enormously to get this kind of advice and reassurance that the WD will pass and stability will come again....such a tough few weeks but I'm feeling pretty resilient.

 

Yes yoga, nature and quality food are a big part of my healing plan! I am taking the best possible care of myself that I can....

 

Wishing you a good weekend

[Andie]

19 hours ago, Gilla999 said:

@Andie that's a great idea - and yes that's the one I have  - I'm not sure where to buy the empty bottles from (I'm in the UK, not sure we have compounding pharmacies here) but I'm sure they can't be hard to find - I shall have a Google

 

 

Im curious if this will work, let me know if you try it ! 

[Gilla999]

On 2/16/2020 at 3:29 AM, Andie said:

 

 

Im curious if this will work, let me know if you try it ! 

 

Started doing this today - it's a bit fiddly as you can't hold the bottle upside down and measure out the dose by looking at it as I have no stopper for the bottle/syringe. You have to pull the 0.5 plunger all the way up whilst it's inside the bottle and then hold it up outside of the bottle so you can see what level you're plunging it down to (if that makes sense!). But I was able to accurately measure out .31ml doing this, which I calculated to be the 6.25mg dose I'm on (1ml = 20mg). I'm planning to switch to liquid at the same dose as the pills for a while just to see how my body reacts to it first.

 

In some ways it's actually easier this way, as when you're doing it measuring out drops you have to stand in front of a mirror to see how many drops are actually released - this also means you end up doing it closer to the front of your mouth rather than plunging at the back with a syringe and this liquid Escitalopram tastes AWFUL (I thought the Mirt liquid was bad - that tastes like strawberries and cream compared to this!!)

 

Thank you for your suggestion - I'll let you know how it goes, fingers crossed I don't get any WD from switching to the liquid and I've done it all correctly!

[Gilla999]

So just when I thought I was nearing the end of this battle...two nights ago I had a trigger for an extremely stressful and upsetting situation and unsurprisingly I only slept for about an hour that night. As very often happens for me, that meant the next night (last night) I didn't sleep either. I don't know if this is the case for anyone else, but a night of insomnia for me very often creates some kind of change to my brainwave patterns that means it's impossible for me to sleep the next day... and so on and so on and this is when I spiral. 

 

I am down in my taper to 2.7mg of Mirt. Last night I ended up taking 4.95mg which seemed to help me get off at about 3am after hours of hot sweats, racing heartbeat and shaking. Obviously I feel terrible today from a combo of the disrupted sleep (I got about 4 hours) and increased dose. 

 

Does anyone have any thoughts or advice on what dose I should stick with this eve? I know chopping and changing is not good. I need to find a balance between stabilizing myself and not spiralling, and not having the whole last year of slow taper be for nothing. It's crazy how two days ago I was 100% fine and yet this insomnia beast I have can just turn everything around with a snap of the fingers.

[Shep]

23 hours ago, Gilla999 said:

So just when I thought I was nearing the end of this battle...two nights ago I had a trigger for an extremely stressful and upsetting situation and unsurprisingly I only slept for about an hour that night.

 

If this situation is not something that can be resolved quickly, you may want to stop tapering and go into a long hold. We don't recommend tapering while dealing with external stressors, especially those that affect sleep. Please do as much self-care as you can to get through this. 

 

23 hours ago, Gilla999 said:

I am down in my taper to 2.7mg of Mirt. Last night I ended up taking 4.95mg which seemed to help me get off at about 3am after hours of hot sweats, racing heartbeat and shaking. Obviously I feel terrible today from a combo of the disrupted sleep (I got about 4 hours) and increased dose. 

 

When were you last at a dose of 4.95 mg? If it's been a month or longer, that's likely too high a dose to return to.  I wouldn't updose to anything higher than you've been on recently. You risk kindling (destabilizing) your nervous system. 

 

When you stabilize and wish to re-start your taper, I would taper off the Escitalopram first, leaving the mirtazapine to help with sleep. Please see:

 

Taking multiple psych drugs? Which drug to taper first?

 

Are you currently taking any supplements? If so, please list them.  We don't recommend a lot of supplements, as many members report their nervous systems are simply too fragile to handle them. However, magnesium and fish oil tend to be calming to the nervous system and many people report they do help. Please only add in one supplement at a time and at a small dose. For more, please see:

 

 King of supplements: Omega-3 fatty acids (fish oil)

 

Magnesium, nature's calcium channel blocker

[Gilla999]

Thank you for your reply @Shep . Yes, 4.95mg was the dose I was on back in January.... however I need the dose to be strong enough to deal with this sudden episode of insomnia, so it's a difficult balance to find. As you say, ideally it should not be this high and I'd like to try and get somewhere in between that and the 2.7mg that I had tapered to.  Just to reiterate, the insomnia and anxiety this time was triggered by something completely unrelated to the medication, it wasn't anything to do with withdrawal. 

 

Whatever dose I go back up to I will do as you suggest and do a longer than usual hold to allow my body to settle back down.

 

The advice to taper off Escitalorpam sounds wise. I have also realised over the last few days that for me personally, SSRIs really aren't what I need. My issue is and has always been periodic / episodic acute / severe insomnia and the resulting anxiety... and the resulting insomnia! Something triggers it and I get locked in an impossible cycle.  However once the cycle IS broken, i don't suffer from anxiety or insomnia at all and often for a long time - a year or more. So I have reached the thought that SSRIs aren't great for me despite being thrown them by the doctors because (a) they take weeks to start to work on the anxiety, with horrible start up side effects and (b) then i'm stuck on a medication long term because it takes ages to come off, that I really don't need long term - I just need to get over the initial episode that happens.

 

Yesterday I took a small dose of Diazepam (2.5mg) at about 5pm to deal with the anxiety and this left me much more able to sleep (by taking the Mirt at night). I believe that without the Diazepam I still wouldn't have slept, because I am in a constant state of panic (brought on by lack of sleep). I think going forwards this short term use of Diazepam along with the Mirt might be the best strategy for my episodes.

 

I just wish there was an alternative to Mirt that worked just as well on the histamine (ie. sending you to sleep) but didn't make me put on so much weight! What an elixir that would be.............

[Gilla999]

Update - last night was even worse and I ended up needing to take 7.5mg Mirt, to sleep finally got off around 2am and up at 7am. I know I need to stick with one dose - messing around with them is the worst thing. And that dose is probably 7.5mg, it's just soul destroying when you have worked so hard at a slow taper and then have 6 months of work wiped out in the space of three days.

[Shep]

On 5/15/2020 at 9:28 AM, Gilla999 said:

Yesterday I took a small dose of Diazepam (2.5mg) at about 5pm to deal with the anxiety and this left me much more able to sleep (by taking the Mirt at night). I believe that without the Diazepam I still wouldn't have slept, because I am in a constant state of panic (brought on by lack of sleep). I think going forwards this short term use of Diazepam along with the Mirt might be the best strategy for my episodes.

 

Just a caution regarding using periodic benzos - you can become dependent on benzos in as little as 2 - 4 weeks, even with periodic use. Valium can be especially problematic because of its long half-life (up to 200 hours, which is 8 days). 

 

So I wouldn't take more than 2 or 3 per month. If that is enough to keep you from going into an insomnia spiral, you may be okay using it. 

 

On 5/15/2020 at 9:28 AM, Gilla999 said:

I just wish there was an alternative to Mirt that worked just as well on the histamine (ie. sending you to sleep) but didn't make me put on so much weight! What an elixir that would be.............

 

As you're able to, please focus on exercise (a 30 minute gentle walk each day, if that's all you can manage), a healthy and clean diet, plenty of water to stay hydrated, avoiding caffeine and alcohol, and having purpose in life. These are what make up the best elixir for insomnia (and everything else in life!). If there are other issues, such as hormonal issues, grief issues, work or relationship stressors, etc., then these should be an area of focus. Anything we take to knock us out is simply keeping us from solving the root problem. Simply starting the process of working on these types of life problems can be very beneficial as it provides a since of control in our lives. 

 

On 5/15/2020 at 9:28 AM, Gilla999 said:

The advice to taper off Escitalorpam sounds wise.

 

I think you'll find you're a lot less likely to go into an insomnia spiral when the stimulating drug is removed. 

 

Please let us know how you're doing. 

[Gilla999]

Hi @Shep - wanted to give an update of where things stand and ask for your opinion. Sorry it's a bit long - a lot has been going on! On the advice of my Psych I had actually ended up increasing my Escitalopram dose in mid May and worked my way up from 6.3 to 9mg. I know this is directly against what you suggested - it's just so hard to know the right thing to do - everyone tells you different things and when my Psych told me it was best in order to "treat my baseline anxiety", it's hard not to go with that. 

 

But a few things have become clear -

1. He is right that I have a baseline of anxiety, because I can feel when the Escitalopram kicked in my mood improve, I felt more sociable - almost a bit hyper

2. But I don't feel this is really the issue and, crucially, it doesn't prevent an insomnia spiral which is really the crux of all my problems

3. Since May I've had continued / worsening problems with insomnia which is really unusual for me. Always (over the last 15 years) I'd have a spiral that would last X amount of time but once it had passed, I would sleep fine. Now I'm having a few days of ok sleep, then it happens again etc - and a lot of waking at 1am and not getting back to sleep, again which is unusual for me (normally I can't get to sleep in the first place.)

 

I am now starting to think that, as you originally suggested, the Escitalopram in this instance could be aggrivating the insomnia and I'm thinking of tapering down. I have also had to increase my Mirtazapine dose way back up (now to 17mg) in order to cope with the horrific spirals that have happened (although am not feeling it has the same effect on sleep as it used to).

 

I've come to realise that the root of the problem for me is that when I have an insomnia crash, it switches on the "fight or flight" part of my brain. I get the most horrific anxiety/panic attack that is permanent - it doesn't ebb and flow like a normal panic attack, it's in full on mode continuously. Someone else might sleep for 5 hours and feel tired but fine, the next day but for me it triggers a huge 'episode' which gets so bad that I literally spend the whole day vomiting, sweating, sobbing uncontrollably, I can't eat at all etc. It really is quite severe. My body basically goes into "fight a lion" mode and it physically cannot switch off - it's not a case of saying "just relax". Obviously you are then never going to sleep in that state (because you're not designed to, you're fighting a lion!) and then the problem spirals. After much research I believe that the Mirtazapine has worked so well for me when these spirals happen because as well as being a sedative it also works on noradrenaline and cortisol, both of which are specifically connected to the fight or flight part of the brain. SSRIs - all of them I've ever tried - do not work when I'm in this state. But the Mirtazapine desensitises me and switches off that part of my brain which has got stuck in "on" mode.

 

It's not reasonable to expect never to have insomnia again - everyone has to deal with it at times - but it's how I prevent this "fight or flight" part of my brain getting switched on that is really what I need to understand. I have tried talking to my Psych but I've never really been that impressed and felt like I've had more education through the research I've done and through this site. 

 

I am wondering whether I might benefit from coming off Escitalopram and eventually moving to an SNRI, which works in a similar way to Mirt and affects noradrenaline - it affects the fight or flight part of the brain. From everything I've read it seems that SNRIs (eg Venlafaxine) are less associated with insomnia than SSRIs. The ultimate goal obviously would not to be on the Mirt at all, but that will take a long time to taper.

 

I have no experience at all with SNRIs and I know starting up any new drug is always accompanied by months of side effects to get used to. And realistically it will take me quite some time to 10% taper from the Escitalopram and switch to an SNRI anyway. But I'm feeling like this makes more sense to at least try, than staying on the Escitalopram which doesn't help my panic attack and actually potentially worsens the trigger for them?!

[ChessieCat]

 

8 minutes ago, Gilla999 said:

 

I am wondering whether I might benefit from coming off Escitalopram and eventually moving to an SNRI

 

 

SA is a site for helping people to lower or get off their drug.  You might find a different site or Facebook group more suitable.  If you feel you need continued drug treatment, your needs may be better met on forums such as depressionforums.org  or patientslikeme.com

 

On 6/16/2011 at 4:45 AM, Altostrata said:

 

Drug shopping or recommending drugs
This is a site for going off drugs. It is not a site for finding out what drug to take next

 

 

  

[Gilla999]

1 minute ago, ChessieCat said:

 

 

SA is a site for helping people to lower or get off their drug.  You might find a different site or Facebook group more suitable.  If you feel you need continued drug treatment, your needs may be better met on forums such as depressionforums.org  or patientslikeme.com

 

 

  

 

Ok - apologies - I thought it was a general site for discussing antidepressants. Apologies ❤️

[Altostrata]

15 hours ago, Gilla999 said:

But a few things have become clear -

1. He is right that I have a baseline of anxiety, because I can feel when the Escitalopram kicked in my mood improve, I felt more sociable - almost a bit hyper

2. But I don't feel this is really the issue and, crucially, it doesn't prevent an insomnia spiral which is really the crux of all my problems

3. Since May I've had continued / worsening problems with insomnia which is really unusual for me. Always (over the last 15 years) I'd have a spiral that would last X amount of time but once it had passed, I would sleep fine. Now I'm having a few days of ok sleep, then it happens again etc - and a lot of waking at 1am and not getting back to sleep, again which is unusual for me (normally I can't get to sleep in the first place.)

 

1. If your anxiety is withdrawal from lowering one of your drugs, taking more of it will assuage withdrawal.

2. If escilatopram is making you hyper and keeping you from sleeping, it's too stimulating. It may be causing your anxiety as well.

3. You may either have insomnia from making drug changes or as an adverse effect of Lexapro.

 

15 hours ago, Gilla999 said:

I've come to realise that the root of the problem for me is that when I have an insomnia crash, it switches on the "fight or flight" part of my brain. I get the most horrific anxiety/panic attack that is permanent - it doesn't ebb and flow like a normal panic attack, it's in full on mode continuously. Someone else might sleep for 5 hours and feel tired but fine, the next day but for me it triggers a huge 'episode' which gets so bad that I literally spend the whole day vomiting, sweating, sobbing uncontrollably, I can't eat at all etc. It really is quite severe.

 

This sounds like psychiatric drug withdrawal. See if those episodes match up with a drug change. Have you ever accidentally skipped a dose? Taken your drugs off-schedule? Taken a benzo for a few days in a row, then stopped?

 

By the way, if mirtazapine, also an antidepressant, works for you, why are you messing around with SSRIs that are "always accompanied by months of side effects to get used to"? You don't have to take 2 antidepressants. What symptoms are you trying to crush?

 

If you are convinced you have a psychiatric disorder and need drugs, we can't help with that.

[Gilla999]

Thank you @Altostrata. I think you're right that the Escitalopram is too stimulating and I'll begin the slow 10% taper - I hope that 10% goes ok as I know from education here that Escitalopram is a strong drug. I'm going to stick with the Mirt for now as again, I understand from here that it's best to taper one drug at a time. I also agree that the insomnia this time could well be being caused by either of the medications (I guess most likely the Escitalopram) as I'm also experiencing other side effects from it too (like constantly needing to pee in the evening). What is clear is that at best Escitalopram is not helping me in any way. 

 

I still had insomnia last night and ended up needing to take a high dose of Mirt and 4mg of valium to get some sleep - I hate relying on the valium, I am all too aware of the risks and the last thing I need is another thing to taper off. I'm also annoyed at myself for messing around with my Mirt dose - it has not helped me and I'm planning to stick with 22.5mg for now until I can stabilise. Interestingly the Mirtazapine does not seem to work for me in terms of sleep the amazing way it did for the first year. My Psych tells me there is no evidence to support that being true, but.....

 

Thanks again for all the education I've received here. 

[Altostrata]

10 hours ago, Gilla999 said:

I still had insomnia last night and ended up needing to take a high dose of Mirt and 4mg of valium to get some sleep - I hate relying on the valium, I am all too aware of the risks and the last thing I need is another thing to taper off.

 

This is exactly the sort of messing around that you need to stop. You've changed the mirtazapine dose AGAIN and added Valium at the same time. When we say change only one drug at a time, what we mean is change only one drug out of all the drugs you're taking. Do not add, subtract, reduce, increase, or drop more than one drug at a time.

 

When you make any drug change, it will take at least 4 days to fully register in your system. In the case of Valium, it will take several weeks for that one dose to fully wear off. This confounds your symptom pattern. Since you increased mirtazapine and Valium at the same time, you won't know which is doing what afterward. (It makes no sense at all to increase both mirtazapine and Valium.)

 

How often do you take Valium or other benzodiazepine? Your rushes of anxiety and insomnia can be caused by irregular benzo dosing alone.

 

When was the last time you change escilatopram? Please update your signature with your drug change in the last 2 months.