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Gilla999

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I know and agree @Altostrata. The trouble is that while I logically understand these things the sheer desperation I feel when I'm either battling insomnia or in the midst of an all-day panic attack because of the insomnia (I spend most of those days alternating between sobbing and vomiting/retching - it really is very severe) I'm desperate for anything to just take the pain away. I've updated my signature but honestly I'm a bit embarrassed by all the fluctuations. Looking back at the last couple of weeks in particular my Mirt doses have been all over the place and it's no wonder I'm suffering with such erratic insomnia. As I said, when it happens I'm just so desperate in that moment that I think upping it will help (and sometimes it does on that night - psychologically or otherwise - but then looking at things it seems to cause more instability a few days down the line).

 

I plan to stick to 22.5mg Mirt now as looking back over what I've taken over the last week or so that seems to be about right and just try to restabilise myself for a few weeks. I'm so annoyed at myself - I feel so stupid and should know better than this behaviour! When you have multiple things going on there is no way of telling side effects of one thing over another and I'm an idiot for messing with the Mirt dose so much.

 

As for the valium - I have taken it 3 times in the last month - twice at 2mg and once at 4mg. I try my best only to take it when desperate as am fully aware of the risks - but really it is the only thing that takes away the excruciating pain and distress of my panic attacks following insomnia, which are very severe.

  • 2010 - 2017: 25mg Sertraline, with numerous failed attempts to come off
  • Feb - May 2017: drug free woooooh 😁
  • May 2017 - Oct 2018: 50mg Sertraline, insomnia episode
  • Oct 2018 - May 2019: 25mg Sertraline
  • May 2019:  Severe insomnia episode, hallucinating, suicide attempt, hospitalised
  • June 2019: Mirtazapine 15mg and switched from Sertraline 25mg to Escitalopram 7.5mg
  • July 2019-May 2020: Successfully tapering the Mirt at 10 every 3 weeks ever since without any major WD. Through taper had successfully reached 2.9mg of Mirtazapine and 5.8mg Escitalopram
  • May 2020: Relapse of insomnia and subsequent extreme anxiety caused by entering perimenopause
  • May-Dec 2020: Increased Mirtazapine back to 15mg, switched from Escitalopram back to Sertraline 50mg
  • Jan 2021 - Dec 2022: slow tapered down Mirtazapine to 3mg and switch over to Trazodone 37.5mg
  • Dec 29 2022: Hormonal fluctuation as part of perimenopause causing severe insomnia and anxiety, started using Diazepam between 2-4mg a day. Increased Trazodone to 75mg, however this caused even more anxiety and palpitations
  • Jan 14 2022: Reduced Trazodone back to 37.5mg and instead increased Mirtazapine to 10.5mg
  • Jan 23 2022: Experiencing bad side effects from increase of Mirtazapine, reduced back slightly to 9.3mg. Stabilised on 2mg Valium once an evening.
  • March 2022: Stabilised on 2mg Valium, 37.5mg Trazodone, 50mg Sertraline. Mirt taper continues and currently at 7.2mg

 

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  • Administrator

Yes, Gilla, we often have other new members who desperately make frequent drug changes, that's how we know it's a mistake!

 

Be sure to take the same amount of drug at the same time each day to find your baseline symptom pattern.

 

What is your current drug schedule, with times and dosages?

 

It may take some time for your nervous system to settle down. You will need to stay calm when you can't sleep. Please read

 

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

 

White noise devices for sleep

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Current drug schedule (as of the last two days) is:

Escitalopram 8mg (dropped from 9mg, this is the beginning of my 10% taper) at 9am

Mirtazapine 22.5mg at 10pm ish

 

I'm hoping that I haven't made a mistake in dropping the Escitalopram because of all the recent chopping and changing but I did really feel this time around that the increase in dose (as instructed to do by my Psych) was at the very least contributing to the the insomnia - I was having other side effects from it too, so there was definitely something going on with it.

 

The last two nights I've slept ok - I know there may still be bumps to come however. Thanks for all the information shared - I will have a good read.

 

I think part of what's happened since May is that I've had a dip (the insomnia has been caused by a range of things - hormones, a traumatic event, potentially Escitalopram side effects), I've up-dosed on the Mirt to deal with it it which has worked, but then I've 10% tapered back down after anything between 2 to 5 days thinking "I'm fine now" and it's thrown everything out of whack again. Even my Psych told me it was fine to up-dose from 22.5mg from 15mg for one week only and then go back down 🙄. If I have to up-dose next time, I will make sure I stick with it for a good period of time.

 

 

 

  • 2010 - 2017: 25mg Sertraline, with numerous failed attempts to come off
  • Feb - May 2017: drug free woooooh 😁
  • May 2017 - Oct 2018: 50mg Sertraline, insomnia episode
  • Oct 2018 - May 2019: 25mg Sertraline
  • May 2019:  Severe insomnia episode, hallucinating, suicide attempt, hospitalised
  • June 2019: Mirtazapine 15mg and switched from Sertraline 25mg to Escitalopram 7.5mg
  • July 2019-May 2020: Successfully tapering the Mirt at 10 every 3 weeks ever since without any major WD. Through taper had successfully reached 2.9mg of Mirtazapine and 5.8mg Escitalopram
  • May 2020: Relapse of insomnia and subsequent extreme anxiety caused by entering perimenopause
  • May-Dec 2020: Increased Mirtazapine back to 15mg, switched from Escitalopram back to Sertraline 50mg
  • Jan 2021 - Dec 2022: slow tapered down Mirtazapine to 3mg and switch over to Trazodone 37.5mg
  • Dec 29 2022: Hormonal fluctuation as part of perimenopause causing severe insomnia and anxiety, started using Diazepam between 2-4mg a day. Increased Trazodone to 75mg, however this caused even more anxiety and palpitations
  • Jan 14 2022: Reduced Trazodone back to 37.5mg and instead increased Mirtazapine to 10.5mg
  • Jan 23 2022: Experiencing bad side effects from increase of Mirtazapine, reduced back slightly to 9.3mg. Stabilised on 2mg Valium once an evening.
  • March 2022: Stabilised on 2mg Valium, 37.5mg Trazodone, 50mg Sertraline. Mirt taper continues and currently at 7.2mg

 

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@Altostrata I wondered if I could ask your advice/opinion. As you know I had been planning to stabilise on the Mirt at 22.5mg to try and get my insomnia and the ensuing panic attacks on an even keel again. I had reduced the Escitalopram from 9mg to 8mg and straight away the insomnia side effects went away. I've been sleeping fine in the last 7 days but in the last two days I've had really bad side effects from the increase in Mirt that I'd made in at attempt to rid myself of insomnia. At around the same time each day (late afternoon) I get a "rush" - breathless, sweating, rushing, shaky, a bit of nausea. It feels like I've taken bad speed or drunk 220 black coffees. It's definitely not withdrawal as I know that feeling well and I don't have any of the panic thoughts / feelings or any of the awful sensations in my head. This is definitely more of a hyper/manic feeling which I guess is from whacking my Mirt dose up so much like the idiot I was. I really want to stabilise and not make any more changes but this is really awful. Below is the full list of what I've taken over the last 3 weeks. In your opinion should I still continue to hold at 22.5mg and try to ride this out, or would I be ok to lower the dose as I've not been on it for long, and if so what to? Also feeling slightly anxious about giving myself Serotonin Syndrome as I've never actually taken this kind of dose of Mirt while I've also been on more than 5mg of Escitalopram (though my Pscyh is aware and didn't flag any concern so I'm sure that's just my worrisome thoughts).

 

Really don't want to have to deal with this but definitely do NOT want to give myself rebound withdrawal!  All advice welcomed xx

 

previous - 15th Jul - 7.5mg

16th-20th Jul - 15mg

29th Jul - now: 22.5mg

Edited by Altostrata
removed code
  • 2010 - 2017: 25mg Sertraline, with numerous failed attempts to come off
  • Feb - May 2017: drug free woooooh 😁
  • May 2017 - Oct 2018: 50mg Sertraline, insomnia episode
  • Oct 2018 - May 2019: 25mg Sertraline
  • May 2019:  Severe insomnia episode, hallucinating, suicide attempt, hospitalised
  • June 2019: Mirtazapine 15mg and switched from Sertraline 25mg to Escitalopram 7.5mg
  • July 2019-May 2020: Successfully tapering the Mirt at 10 every 3 weeks ever since without any major WD. Through taper had successfully reached 2.9mg of Mirtazapine and 5.8mg Escitalopram
  • May 2020: Relapse of insomnia and subsequent extreme anxiety caused by entering perimenopause
  • May-Dec 2020: Increased Mirtazapine back to 15mg, switched from Escitalopram back to Sertraline 50mg
  • Jan 2021 - Dec 2022: slow tapered down Mirtazapine to 3mg and switch over to Trazodone 37.5mg
  • Dec 29 2022: Hormonal fluctuation as part of perimenopause causing severe insomnia and anxiety, started using Diazepam between 2-4mg a day. Increased Trazodone to 75mg, however this caused even more anxiety and palpitations
  • Jan 14 2022: Reduced Trazodone back to 37.5mg and instead increased Mirtazapine to 10.5mg
  • Jan 23 2022: Experiencing bad side effects from increase of Mirtazapine, reduced back slightly to 9.3mg. Stabilised on 2mg Valium once an evening.
  • March 2022: Stabilised on 2mg Valium, 37.5mg Trazodone, 50mg Sertraline. Mirt taper continues and currently at 7.2mg

 

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  • Administrator
On 8/2/2020 at 11:53 PM, Gilla999 said:

I did really feel this time around that the increase in dose (as instructed to do by my Psych) was at the very least contributing to the the insomnia - I was having other side effects from it too, so there was definitely something going on with it.

 

The last two nights I've slept ok - I know there may still be bumps to come however.

 

This is reasonable -- the proof that the escitalopram dosage was too high is that the activation reduced when you reduced the dosage.

 

2 hours ago, Gilla999 said:

At around the same time each day (late afternoon) I get a "rush" - breathless, sweating, rushing, shaky, a bit of nausea. It feels like I've taken bad speed or drunk 220 black coffees.

 

Doesn't sound like mirtazapine. What times of day do you take your drugs, with their dosages?

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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I take the Escitalopram first thing at about 8am and the Mirt at 10pm. I know that Mirt is less sedating at higher doses so I suspect I'm now dealing with the activating aspect of the noradrenaline and feeling less sedation. I'm so annoyed at myself for panicking and raising it as high as I did as now I'm in a tricky place feeling pretty crap and it's whether to push on through or drop lower and risk WD, which I want to absolutely avoid. 

  • 2010 - 2017: 25mg Sertraline, with numerous failed attempts to come off
  • Feb - May 2017: drug free woooooh 😁
  • May 2017 - Oct 2018: 50mg Sertraline, insomnia episode
  • Oct 2018 - May 2019: 25mg Sertraline
  • May 2019:  Severe insomnia episode, hallucinating, suicide attempt, hospitalised
  • June 2019: Mirtazapine 15mg and switched from Sertraline 25mg to Escitalopram 7.5mg
  • July 2019-May 2020: Successfully tapering the Mirt at 10 every 3 weeks ever since without any major WD. Through taper had successfully reached 2.9mg of Mirtazapine and 5.8mg Escitalopram
  • May 2020: Relapse of insomnia and subsequent extreme anxiety caused by entering perimenopause
  • May-Dec 2020: Increased Mirtazapine back to 15mg, switched from Escitalopram back to Sertraline 50mg
  • Jan 2021 - Dec 2022: slow tapered down Mirtazapine to 3mg and switch over to Trazodone 37.5mg
  • Dec 29 2022: Hormonal fluctuation as part of perimenopause causing severe insomnia and anxiety, started using Diazepam between 2-4mg a day. Increased Trazodone to 75mg, however this caused even more anxiety and palpitations
  • Jan 14 2022: Reduced Trazodone back to 37.5mg and instead increased Mirtazapine to 10.5mg
  • Jan 23 2022: Experiencing bad side effects from increase of Mirtazapine, reduced back slightly to 9.3mg. Stabilised on 2mg Valium once an evening.
  • March 2022: Stabilised on 2mg Valium, 37.5mg Trazodone, 50mg Sertraline. Mirt taper continues and currently at 7.2mg

 

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  • Administrator

Did you take escitalopram at night? Have you recently changed your drug schedule?

 

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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On 8/9/2020 at 11:41 PM, Altostrata said:

Did you take escitalopram at night? Have you recently changed your drug schedule?

 

No changes to timings and no I've always taken the Escitalopram in the morning. It was definitely side effects from the increase in Mirt... I dropped back down from 22.5mg to 18.75mg and the sensations stopped. I think it makes sense that I'd be feeling something after going from 5mg to 22.5mg of Mirt in four weeks. Although the histamine aspect makes it sedating, it's also a powerful noradrenaline and serotonin stimulant so I'm not really surprised. I'm feeling so much better and stable now. I'm not planning on making any changes to my Mirtazapine for quite a while, but I am planning to switch from the Escitalopram to Sertraline, which I used to take at a low dose for years and did much much better on, for various reasons. Can I ask you - in terms of switching from one SSRI to another, do you advise doing it as slowly as the you would if you were slow tapering off an SSRI ie. 10% a month? I'e been trying to work out a switch plan but the difficulty is that while Escitalopram comes in liquid form I don't think (???) Sertraline does, so the lowest dose of that I could start with would be 12.5mg and overall I'm keen not to increase total drugs than I'm on now (or decrease, for a matter of fact, I just want to be stable for a little while!). 

  • 2010 - 2017: 25mg Sertraline, with numerous failed attempts to come off
  • Feb - May 2017: drug free woooooh 😁
  • May 2017 - Oct 2018: 50mg Sertraline, insomnia episode
  • Oct 2018 - May 2019: 25mg Sertraline
  • May 2019:  Severe insomnia episode, hallucinating, suicide attempt, hospitalised
  • June 2019: Mirtazapine 15mg and switched from Sertraline 25mg to Escitalopram 7.5mg
  • July 2019-May 2020: Successfully tapering the Mirt at 10 every 3 weeks ever since without any major WD. Through taper had successfully reached 2.9mg of Mirtazapine and 5.8mg Escitalopram
  • May 2020: Relapse of insomnia and subsequent extreme anxiety caused by entering perimenopause
  • May-Dec 2020: Increased Mirtazapine back to 15mg, switched from Escitalopram back to Sertraline 50mg
  • Jan 2021 - Dec 2022: slow tapered down Mirtazapine to 3mg and switch over to Trazodone 37.5mg
  • Dec 29 2022: Hormonal fluctuation as part of perimenopause causing severe insomnia and anxiety, started using Diazepam between 2-4mg a day. Increased Trazodone to 75mg, however this caused even more anxiety and palpitations
  • Jan 14 2022: Reduced Trazodone back to 37.5mg and instead increased Mirtazapine to 10.5mg
  • Jan 23 2022: Experiencing bad side effects from increase of Mirtazapine, reduced back slightly to 9.3mg. Stabilised on 2mg Valium once an evening.
  • March 2022: Stabilised on 2mg Valium, 37.5mg Trazodone, 50mg Sertraline. Mirt taper continues and currently at 7.2mg

 

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  • Administrator
14 hours ago, Gilla999 said:

I am planning to switch from the Escitalopram to Sertraline

 

A drug switch may be destabilizing. Very gradually reducing escitalopram makes more sense, it may be adding to sleep difficulties. I would not change mirtazapine while decreasing escitalopram.

 

We don't treat "depression" here, so I cannot tell you what will "work" in that regard. We help people go off drugs.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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  • 6 months later...

Hi all, I thought I would post a little update and ask for some advice over tapering.

 

Over the last 6 months I have had persistent insomnia every couple of weeks for a few nights in a row (where I get about 2 hours sleep each night) which has been very difficult to deal with and has unfortunately resulted in me increasing my Mirtazapine dose to 30mg on the advise of my Psych out of desperation trying to break the loop. I finally got a diagnosis that I have a hormonal imbalance which if not the whole cause is at least a chunk of it. However it has not solved the problem entirely and I have come to the conclusion (though I can't find any proof of this) that Mirtazapine may now actually be exacerbating the problem for me - I won't go into the reasons why.

 

I am desperate to get off this medication but I can't seem to go long enough without having another episode of insomnia and whilst I'm not increasing anymore, I am struggling to taper when that happens and feeling fearful about tapers and destabilsing in general. So far I've only managed to do one 5% drop in 2 months and am now on 28.5mg.

 

Even though I know drops are supposed to be easier at a higher dose, I'm struggling (possibly just psychologically) with what feels like a large drop in numbers, yet I am simultaneously  desperate to get off this medication as quickly as I can (without withdrawal), for various health reasons. I thought I remembered reading somewhere here that it was possible to do a 5% drop every two weeks, and I wondered if one of the Admins could share any insight into that and the best approach? I'm also considering the Brass Monkey Slide method

  • 2010 - 2017: 25mg Sertraline, with numerous failed attempts to come off
  • Feb - May 2017: drug free woooooh 😁
  • May 2017 - Oct 2018: 50mg Sertraline, insomnia episode
  • Oct 2018 - May 2019: 25mg Sertraline
  • May 2019:  Severe insomnia episode, hallucinating, suicide attempt, hospitalised
  • June 2019: Mirtazapine 15mg and switched from Sertraline 25mg to Escitalopram 7.5mg
  • July 2019-May 2020: Successfully tapering the Mirt at 10 every 3 weeks ever since without any major WD. Through taper had successfully reached 2.9mg of Mirtazapine and 5.8mg Escitalopram
  • May 2020: Relapse of insomnia and subsequent extreme anxiety caused by entering perimenopause
  • May-Dec 2020: Increased Mirtazapine back to 15mg, switched from Escitalopram back to Sertraline 50mg
  • Jan 2021 - Dec 2022: slow tapered down Mirtazapine to 3mg and switch over to Trazodone 37.5mg
  • Dec 29 2022: Hormonal fluctuation as part of perimenopause causing severe insomnia and anxiety, started using Diazepam between 2-4mg a day. Increased Trazodone to 75mg, however this caused even more anxiety and palpitations
  • Jan 14 2022: Reduced Trazodone back to 37.5mg and instead increased Mirtazapine to 10.5mg
  • Jan 23 2022: Experiencing bad side effects from increase of Mirtazapine, reduced back slightly to 9.3mg. Stabilised on 2mg Valium once an evening.
  • March 2022: Stabilised on 2mg Valium, 37.5mg Trazodone, 50mg Sertraline. Mirt taper continues and currently at 7.2mg

 

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Sorry I pressed send too soon! I meant to say I'm also considering the Brass Monkey slide method and wondered if the Admins had any suggestion or opinion on which is best between that or the 5% every two weeks (I think I recall you need to take an extra hold week if you do the 5% every 2 weeks vs 10% every 4 weeks?) Is the overall timeline of the slide method vs the 5% every two weeks the same? Thanks so much  - I've also updated my signature 🙂

  • 2010 - 2017: 25mg Sertraline, with numerous failed attempts to come off
  • Feb - May 2017: drug free woooooh 😁
  • May 2017 - Oct 2018: 50mg Sertraline, insomnia episode
  • Oct 2018 - May 2019: 25mg Sertraline
  • May 2019:  Severe insomnia episode, hallucinating, suicide attempt, hospitalised
  • June 2019: Mirtazapine 15mg and switched from Sertraline 25mg to Escitalopram 7.5mg
  • July 2019-May 2020: Successfully tapering the Mirt at 10 every 3 weeks ever since without any major WD. Through taper had successfully reached 2.9mg of Mirtazapine and 5.8mg Escitalopram
  • May 2020: Relapse of insomnia and subsequent extreme anxiety caused by entering perimenopause
  • May-Dec 2020: Increased Mirtazapine back to 15mg, switched from Escitalopram back to Sertraline 50mg
  • Jan 2021 - Dec 2022: slow tapered down Mirtazapine to 3mg and switch over to Trazodone 37.5mg
  • Dec 29 2022: Hormonal fluctuation as part of perimenopause causing severe insomnia and anxiety, started using Diazepam between 2-4mg a day. Increased Trazodone to 75mg, however this caused even more anxiety and palpitations
  • Jan 14 2022: Reduced Trazodone back to 37.5mg and instead increased Mirtazapine to 10.5mg
  • Jan 23 2022: Experiencing bad side effects from increase of Mirtazapine, reduced back slightly to 9.3mg. Stabilised on 2mg Valium once an evening.
  • March 2022: Stabilised on 2mg Valium, 37.5mg Trazodone, 50mg Sertraline. Mirt taper continues and currently at 7.2mg

 

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  • Moderator Emeritus

@Gilla999When did you switch from Escitalopram to Sertraline? (the date is not in your signature). How did you crossover? 

 

Why are you decreasing the drug you're taking to sleep (mirtazapine) and not the sertraline? 

 

 

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Hi Shep, thanks for your reply. I switched from the Escitalopram to the Sertraline in August over the space of a couple of months and had no problems or side effects with this.

 

I'm decreasing the Mirtazapine because of various reasons related to my health. I've been on Sertraline for many years for my anxiety condition without it having any negative impact on my sleep so I know I am fine with it. 

 

I am just trying to work out the best taper schedule for the Mirtazapine as an alternative to the 10% every 4 weeks - even though I had no issues doing this last year, because I'm on such a high dose of it now the 10% drops feel psychologically a bit high in terms of "number", even though I know logically it's the same %. So I'm thinking of either the brass monkey slide or the 5% every 2 weeks, but couldn't remember how many weeks I'm supposed to hold for when doing the 5% method.

 

Hope this helps!

  • 2010 - 2017: 25mg Sertraline, with numerous failed attempts to come off
  • Feb - May 2017: drug free woooooh 😁
  • May 2017 - Oct 2018: 50mg Sertraline, insomnia episode
  • Oct 2018 - May 2019: 25mg Sertraline
  • May 2019:  Severe insomnia episode, hallucinating, suicide attempt, hospitalised
  • June 2019: Mirtazapine 15mg and switched from Sertraline 25mg to Escitalopram 7.5mg
  • July 2019-May 2020: Successfully tapering the Mirt at 10 every 3 weeks ever since without any major WD. Through taper had successfully reached 2.9mg of Mirtazapine and 5.8mg Escitalopram
  • May 2020: Relapse of insomnia and subsequent extreme anxiety caused by entering perimenopause
  • May-Dec 2020: Increased Mirtazapine back to 15mg, switched from Escitalopram back to Sertraline 50mg
  • Jan 2021 - Dec 2022: slow tapered down Mirtazapine to 3mg and switch over to Trazodone 37.5mg
  • Dec 29 2022: Hormonal fluctuation as part of perimenopause causing severe insomnia and anxiety, started using Diazepam between 2-4mg a day. Increased Trazodone to 75mg, however this caused even more anxiety and palpitations
  • Jan 14 2022: Reduced Trazodone back to 37.5mg and instead increased Mirtazapine to 10.5mg
  • Jan 23 2022: Experiencing bad side effects from increase of Mirtazapine, reduced back slightly to 9.3mg. Stabilised on 2mg Valium once an evening.
  • March 2022: Stabilised on 2mg Valium, 37.5mg Trazodone, 50mg Sertraline. Mirt taper continues and currently at 7.2mg

 

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  • Moderator Emeritus
On 3/2/2021 at 7:14 AM, Gilla999 said:

So I'm thinking of either the brass monkey slide or the 5% every 2 weeks, but couldn't remember how many weeks I'm supposed to hold for when doing the 5% method.

 

 

 

Instead of seeking out a specific length of time to hold, you may want to let your symptoms guide you. Come to a place, as Brassmonkey calls it, of Withdrawal Normal. 

 

WD Normal (Withdrawal Normal)

 

 

On 3/2/2021 at 7:14 AM, Gilla999 said:

I switched from the Escitalopram to the Sertraline in August over the space of a couple of months and had no problems or side effects with this.

 

Thanks for the additional information. I've updated your signature to reflect this. 

 

 

 

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Thanks for your help on the signature Shep.

 

Thanks for sharing the post, it's an interesting read - my WD always kicks in at two weeks (usually to the day!) so I guess holding for two weeks after the second 5% drop should be a good place to start from and see how I go. Thanks for your help 🙂

 

  • 2010 - 2017: 25mg Sertraline, with numerous failed attempts to come off
  • Feb - May 2017: drug free woooooh 😁
  • May 2017 - Oct 2018: 50mg Sertraline, insomnia episode
  • Oct 2018 - May 2019: 25mg Sertraline
  • May 2019:  Severe insomnia episode, hallucinating, suicide attempt, hospitalised
  • June 2019: Mirtazapine 15mg and switched from Sertraline 25mg to Escitalopram 7.5mg
  • July 2019-May 2020: Successfully tapering the Mirt at 10 every 3 weeks ever since without any major WD. Through taper had successfully reached 2.9mg of Mirtazapine and 5.8mg Escitalopram
  • May 2020: Relapse of insomnia and subsequent extreme anxiety caused by entering perimenopause
  • May-Dec 2020: Increased Mirtazapine back to 15mg, switched from Escitalopram back to Sertraline 50mg
  • Jan 2021 - Dec 2022: slow tapered down Mirtazapine to 3mg and switch over to Trazodone 37.5mg
  • Dec 29 2022: Hormonal fluctuation as part of perimenopause causing severe insomnia and anxiety, started using Diazepam between 2-4mg a day. Increased Trazodone to 75mg, however this caused even more anxiety and palpitations
  • Jan 14 2022: Reduced Trazodone back to 37.5mg and instead increased Mirtazapine to 10.5mg
  • Jan 23 2022: Experiencing bad side effects from increase of Mirtazapine, reduced back slightly to 9.3mg. Stabilised on 2mg Valium once an evening.
  • March 2022: Stabilised on 2mg Valium, 37.5mg Trazodone, 50mg Sertraline. Mirt taper continues and currently at 7.2mg

 

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  • 2 months later...

Hi Admins - I'm hoping someone can help advise. All of 2019 and the first part of 2020 I was tapering the Mirt at 10% every 3 weeks successfully with no withdrawal. Due to a few different things (hormonal issues being the main one) I ended up needing to increase my Mirt back right up to 30mg at the end of last year. I've started the slow taper again but appear to have fallen at the first hurdle?! I did a micro taper from 30mg to 27mg over 4 weeks and then held for 2 weeks, as advised. All absolutely fine. After the two week hold I went back to doing just one 10% drop - from 27mg to 24.3 mg on 6th May. Just over a week later (last weekend) I was hit by withdrawal, and it's really thrown me! This is day 3-4 of it. It's not the all-encompassing gut-wrenching withdrawal that I had years ago when I tried doing huge drops (being none the wiser) but it is definitely withdrawal - the exhausted feeling, sad emotions and last night couldn't get to sleep without assistance because of the withdrawal sensation in my head, which hasn't happened in long time. I'm really confused as to why I would experience withdrawal after only a 10% drop when I did absolutely fine doing 10% drops every 3 weeks (not even every 4!) for a long time previously - and that was when I was on much lower doses to now! 

 

The ONLY thing I can think is that on Thursday last week I did something I've never once done before: I forgot to take my Mirt dose one night! When I realised in the morning I obviously couldn't then make it up. Is it possible that the combination of a 10% taper and that one missed dose could have given me withdrawal? Should I re-updose and if to what would be the guidance?

 

So perplexed by why I would be experiencing it! 

  • 2010 - 2017: 25mg Sertraline, with numerous failed attempts to come off
  • Feb - May 2017: drug free woooooh 😁
  • May 2017 - Oct 2018: 50mg Sertraline, insomnia episode
  • Oct 2018 - May 2019: 25mg Sertraline
  • May 2019:  Severe insomnia episode, hallucinating, suicide attempt, hospitalised
  • June 2019: Mirtazapine 15mg and switched from Sertraline 25mg to Escitalopram 7.5mg
  • July 2019-May 2020: Successfully tapering the Mirt at 10 every 3 weeks ever since without any major WD. Through taper had successfully reached 2.9mg of Mirtazapine and 5.8mg Escitalopram
  • May 2020: Relapse of insomnia and subsequent extreme anxiety caused by entering perimenopause
  • May-Dec 2020: Increased Mirtazapine back to 15mg, switched from Escitalopram back to Sertraline 50mg
  • Jan 2021 - Dec 2022: slow tapered down Mirtazapine to 3mg and switch over to Trazodone 37.5mg
  • Dec 29 2022: Hormonal fluctuation as part of perimenopause causing severe insomnia and anxiety, started using Diazepam between 2-4mg a day. Increased Trazodone to 75mg, however this caused even more anxiety and palpitations
  • Jan 14 2022: Reduced Trazodone back to 37.5mg and instead increased Mirtazapine to 10.5mg
  • Jan 23 2022: Experiencing bad side effects from increase of Mirtazapine, reduced back slightly to 9.3mg. Stabilised on 2mg Valium once an evening.
  • March 2022: Stabilised on 2mg Valium, 37.5mg Trazodone, 50mg Sertraline. Mirt taper continues and currently at 7.2mg

 

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  • 1 year later...

New user, Diazepam 2mg a day, very frightened and need some advice/support

 

Hi all, looking for a bit of support and reassurance. I've been going through Perimenopause hell for the last 3 years which have required medicating me with various ADs, namely Sertraline 50mg and I've been slow tapering from Mirtazapine over to Trazodone. All of that was prescribed related to severe insomnia when no one realised I was going through early menopause.

 

I have been surviving ok for the last 3 years with ups and downs, but have had a really good 3-4 months and thought the worst was behind me. Then in mid December it all fell apart, related to my hormones. I had gotten down to 2mg of Mirtazapine and 37.5mg Trazodone but after everything turned upside down, the only thing working for me was Diazepam. I had already been taking this for 3 years on a very sparingly "as needed" basis - eg. one night every 3 months or something if i had particularly bad sleep. But during this recent crisis it was the only thing that worked for my sleep and also the severe anxiety. 

 

I now believe I have developed a dependacy on it due to the timeframe and the amount used, and I am absolutely heartbroken at this after working so hard to come off my ADs and knowing full well the horror stories of tapering benzos. I have taken if for 9 out of 17 days (sporadically) and it seems to now be the case that I can't sleep without taking 2mg, though because I am also still suffering from night sweats I've clearly got hormonal issues still going on too so it's hard to know for sure.

 

I am seeing my Psychiatrist this week to discuss, but I would really value some advice from the real world. Should I now just continue to take it every day and when things are settled, think about beginning a slow taper using liquid and if so - what is the recommendation from this forum? (My Psych will no doubt tell me to go too fast). I don't care how slowly I have to go, I am just absolutley terrified of the withdrawal (I am generally sensitive to coming off any antidepressants and have only ever been able to taper my ADs at 10% a month without having withdrawal, though doing it this way I have experienced no problems at all). Is it possible to avoid withdrawal with Diazepam if I go slowly enough?

 

Any words of reassurance would be greatly appreciated as I'm feeling super scared and upset at the situation I find myself in.

Edited by Shep
added title after merging from another topic
  • 2010 - 2017: 25mg Sertraline, with numerous failed attempts to come off
  • Feb - May 2017: drug free woooooh 😁
  • May 2017 - Oct 2018: 50mg Sertraline, insomnia episode
  • Oct 2018 - May 2019: 25mg Sertraline
  • May 2019:  Severe insomnia episode, hallucinating, suicide attempt, hospitalised
  • June 2019: Mirtazapine 15mg and switched from Sertraline 25mg to Escitalopram 7.5mg
  • July 2019-May 2020: Successfully tapering the Mirt at 10 every 3 weeks ever since without any major WD. Through taper had successfully reached 2.9mg of Mirtazapine and 5.8mg Escitalopram
  • May 2020: Relapse of insomnia and subsequent extreme anxiety caused by entering perimenopause
  • May-Dec 2020: Increased Mirtazapine back to 15mg, switched from Escitalopram back to Sertraline 50mg
  • Jan 2021 - Dec 2022: slow tapered down Mirtazapine to 3mg and switch over to Trazodone 37.5mg
  • Dec 29 2022: Hormonal fluctuation as part of perimenopause causing severe insomnia and anxiety, started using Diazepam between 2-4mg a day. Increased Trazodone to 75mg, however this caused even more anxiety and palpitations
  • Jan 14 2022: Reduced Trazodone back to 37.5mg and instead increased Mirtazapine to 10.5mg
  • Jan 23 2022: Experiencing bad side effects from increase of Mirtazapine, reduced back slightly to 9.3mg. Stabilised on 2mg Valium once an evening.
  • March 2022: Stabilised on 2mg Valium, 37.5mg Trazodone, 50mg Sertraline. Mirt taper continues and currently at 7.2mg

 

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  • Moderator Emeritus

@Gilla999 Please note I moved your last post from the benzo forum to your intro so all your information is in one place.

 

Please continue posting here in your intro thread. 

 

6 hours ago, Gilla999 said:

I have taken if for 9 out of 17 days (sporadically) and it seems to now be the case that I can't sleep without taking 2mg, though because I am also still suffering from night sweats I've clearly got hormonal issues still going on too so it's hard to know for sure.

 

You can become dependent on it in 2 - 4 weeks, especially with diazepam's long half-life of up to 200 hours (8 days). 

 

But whether you're physically dependent on it or not is hard to say. It may be that it's helping with sleep due to hormonal issues and / or covering up withdrawal from your other drugs, so when you don't take it, you feel those symptoms. 

 

6 hours ago, Gilla999 said:

Should I now just continue to take it every day and when things are settled, think about beginning a slow taper using liquid and if so - what is the recommendation from this forum?

 

That may be best at this point. I wouldn't be any more scared of the withdrawal from a benzo than from an AD - the symptoms are virtually the same. The problems come when any of these drugs are tapered too fast. You'll want to taper diazepam at no more than 10% a month, the same as any other psychiatric drug. 

 

And 2 mg is a VERY low dose. If you're afraid you're already dependent on it and it's getting you sleep, I would continue taking it while tapering off the other drugs. Again, diazepam is no more difficult to come off than any other psychiatric drug. 

 

Do be careful of paradoxical reactions, though. That can happen when you bring in yet another sedating drug - the more you dampen down the brain with sedating drugs (or supplements), the more the brain fights to stay alert. This creates paradoxical reactions.

 

What time(s) of the day do you take each of your drugs? 

 

 

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@ShepI can't thank you enough from the bottom of my heart for this reply. I think the sheer amount of (justifiable) horror stories I've heard about benzo withdrawal have made me SO fearful of them that it's making the anxiety even worse. Withdrawal from any AD is horrific but I know that, following the advice I took from this forum, at 10% a month I can manage with no side effects (and even if I have to do it more slowly with valium that doesn't matter to me, as long as experiencing withdrawal can be very much minimised is all that matters). 

 

I originally only started taking it at sleep time when I struggledat the start in mid December, but as the anxiety has trebled across the last 4 or 5 days I have ad hoc taken it during the day also (so perhaps on some days taling 4mg in total). What I really think I need is to now stabilise everything, as going up and down with thr valium + increasing Mirtazapine a lot + significantly reducing Trazodone all at once I know from experience can only do more damage than good. If you have any suggestions of a best approach to stabilise the valium I would love to hear it - I will of course speak to my doctor too, I'm just not totally trusting in their judgements when it comes to ADs etc.

 

I wasn't aware of the paradoxical issue at all - I will definitely look into it. 

 

Thanks so much for your advice Shep, it is very appreciated 

  • 2010 - 2017: 25mg Sertraline, with numerous failed attempts to come off
  • Feb - May 2017: drug free woooooh 😁
  • May 2017 - Oct 2018: 50mg Sertraline, insomnia episode
  • Oct 2018 - May 2019: 25mg Sertraline
  • May 2019:  Severe insomnia episode, hallucinating, suicide attempt, hospitalised
  • June 2019: Mirtazapine 15mg and switched from Sertraline 25mg to Escitalopram 7.5mg
  • July 2019-May 2020: Successfully tapering the Mirt at 10 every 3 weeks ever since without any major WD. Through taper had successfully reached 2.9mg of Mirtazapine and 5.8mg Escitalopram
  • May 2020: Relapse of insomnia and subsequent extreme anxiety caused by entering perimenopause
  • May-Dec 2020: Increased Mirtazapine back to 15mg, switched from Escitalopram back to Sertraline 50mg
  • Jan 2021 - Dec 2022: slow tapered down Mirtazapine to 3mg and switch over to Trazodone 37.5mg
  • Dec 29 2022: Hormonal fluctuation as part of perimenopause causing severe insomnia and anxiety, started using Diazepam between 2-4mg a day. Increased Trazodone to 75mg, however this caused even more anxiety and palpitations
  • Jan 14 2022: Reduced Trazodone back to 37.5mg and instead increased Mirtazapine to 10.5mg
  • Jan 23 2022: Experiencing bad side effects from increase of Mirtazapine, reduced back slightly to 9.3mg. Stabilised on 2mg Valium once an evening.
  • March 2022: Stabilised on 2mg Valium, 37.5mg Trazodone, 50mg Sertraline. Mirt taper continues and currently at 7.2mg

 

Link to comment

Just to add - the reason I made the Trazodone / Mirtazapine switch was because I found as soon as I got past 50mg of Traz it had an extreme stimulating affect on me and intense palpitations. Where as I know from past experience that Mirt is an extremely calming drug for me and weight gain aside I have done very well on it.

  • 2010 - 2017: 25mg Sertraline, with numerous failed attempts to come off
  • Feb - May 2017: drug free woooooh 😁
  • May 2017 - Oct 2018: 50mg Sertraline, insomnia episode
  • Oct 2018 - May 2019: 25mg Sertraline
  • May 2019:  Severe insomnia episode, hallucinating, suicide attempt, hospitalised
  • June 2019: Mirtazapine 15mg and switched from Sertraline 25mg to Escitalopram 7.5mg
  • July 2019-May 2020: Successfully tapering the Mirt at 10 every 3 weeks ever since without any major WD. Through taper had successfully reached 2.9mg of Mirtazapine and 5.8mg Escitalopram
  • May 2020: Relapse of insomnia and subsequent extreme anxiety caused by entering perimenopause
  • May-Dec 2020: Increased Mirtazapine back to 15mg, switched from Escitalopram back to Sertraline 50mg
  • Jan 2021 - Dec 2022: slow tapered down Mirtazapine to 3mg and switch over to Trazodone 37.5mg
  • Dec 29 2022: Hormonal fluctuation as part of perimenopause causing severe insomnia and anxiety, started using Diazepam between 2-4mg a day. Increased Trazodone to 75mg, however this caused even more anxiety and palpitations
  • Jan 14 2022: Reduced Trazodone back to 37.5mg and instead increased Mirtazapine to 10.5mg
  • Jan 23 2022: Experiencing bad side effects from increase of Mirtazapine, reduced back slightly to 9.3mg. Stabilised on 2mg Valium once an evening.
  • March 2022: Stabilised on 2mg Valium, 37.5mg Trazodone, 50mg Sertraline. Mirt taper continues and currently at 7.2mg

 

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  • Moderator Emeritus
On 1/16/2023 at 10:19 AM, Gilla999 said:

I originally only started taking it at sleep time when I struggledat the start in mid December, but as the anxiety has trebled across the last 4 or 5 days I have ad hoc taken it during the day also (so perhaps on some days taling 4mg in total). What I really think I need is to now stabilise everything, as going up and down with thr valium + increasing Mirtazapine a lot + significantly reducing Trazodone all at once I know from experience can only do more damage than good. If you have any suggestions of a best approach to stabilise the valium I would love to hear it - I will of course speak to my doctor too, I'm just not totally trusting in their judgements when it comes to ADs etc.

 

Please be VERY consistent with your drugs. These types of ups and downs and all arounds can really destabilize your nervous system and make things worse. 

 

Are you getting the side effect of Trazodone's active metabolite, mCPP? Please see the first post in this thread which explains it: 

 

Tips for tapering off trazodone (Desyrel)

 

What time(s) of the day are you taking each of your drugs? What time(s) of the day are your symptoms worse? 

 

 

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Thanks very much for this @Shep. I have now stabilised with my medication, except for the diazepam. I'm on .70ml Mirtazapine (oral solution) and 37.5mg of Trazodone. I want to keep those as they are for now until I feel well stabilised.

 

Two days ago I was experiencing withdrawal hell from the sudden drop in my Trazodone, but that was short and sharp (I had only increased it for 7 days) and I am feeling a bit better now (although still obviously fragile). The main thing is I need to decide now is what to do about my Diazepam. I spoke to my GP and he was absolutley useless! My symptoms arrive like clockwork from 4pm onwards, and most of the time I have needed the Diazepam then at night to sleep. I know now what has been causing the problem - I am having quite a severe allergic reaction to my HRT which is causing the anxiety, palpitations, insomnia and a bunch of other allergic reaction type stuff at the same time each day, but as with ADs I need to reduce my HRT very slowly or I get rebound side effects.

 

Here is the full picture of my valium use since 12th December:

12th: 4mg

13th: -

14th: -

15th: 4mg

16th: -

17th:

18th: -

19th: -

20th: -

21st: 8mg

22nd: -

23rd: -

24th: -

25th: -

26th: -

27th: -

28th: -

29th - 4mg

30th - 4mg

31st: -

1st Jan: -

2nd: -

3rd: 6mg

4th: -

5th: 6mg

6th: - 

7th: -

8th: -

9th: 6mg

10th: -

11th: 4mg

12th: -

13th: 4mg

14th: 2mg

15th: 2mg

16th: 4mg

17th: 4mg

 

Do you think it's time I tapered from it Shep? I believe that I have a good chance that if I can reduce my HRT today I should be able to minimize the allergic reaction that happens in the late afternoon enoguh to not need the valium, but it's whether I've now been taking it for too long that I'll cause a problem if I stop it anyway. If I cannot minimize the allergic reaction enough then I estimate that in general I would need to take 2mg in the afternoon and potentially another 2mg at bed time.

 

Any thoughts would be much appreciated!

 

  • 2010 - 2017: 25mg Sertraline, with numerous failed attempts to come off
  • Feb - May 2017: drug free woooooh 😁
  • May 2017 - Oct 2018: 50mg Sertraline, insomnia episode
  • Oct 2018 - May 2019: 25mg Sertraline
  • May 2019:  Severe insomnia episode, hallucinating, suicide attempt, hospitalised
  • June 2019: Mirtazapine 15mg and switched from Sertraline 25mg to Escitalopram 7.5mg
  • July 2019-May 2020: Successfully tapering the Mirt at 10 every 3 weeks ever since without any major WD. Through taper had successfully reached 2.9mg of Mirtazapine and 5.8mg Escitalopram
  • May 2020: Relapse of insomnia and subsequent extreme anxiety caused by entering perimenopause
  • May-Dec 2020: Increased Mirtazapine back to 15mg, switched from Escitalopram back to Sertraline 50mg
  • Jan 2021 - Dec 2022: slow tapered down Mirtazapine to 3mg and switch over to Trazodone 37.5mg
  • Dec 29 2022: Hormonal fluctuation as part of perimenopause causing severe insomnia and anxiety, started using Diazepam between 2-4mg a day. Increased Trazodone to 75mg, however this caused even more anxiety and palpitations
  • Jan 14 2022: Reduced Trazodone back to 37.5mg and instead increased Mirtazapine to 10.5mg
  • Jan 23 2022: Experiencing bad side effects from increase of Mirtazapine, reduced back slightly to 9.3mg. Stabilised on 2mg Valium once an evening.
  • March 2022: Stabilised on 2mg Valium, 37.5mg Trazodone, 50mg Sertraline. Mirt taper continues and currently at 7.2mg

 

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  • Moderator Emeritus
14 hours ago, Gilla999 said:

My symptoms arrive like clockwork from 4pm onwards, and most of the time I have needed the Diazepam then at night to sleep. I know now what has been causing the problem - I am having quite a severe allergic reaction to my HRT which is causing the anxiety, palpitations, insomnia and a bunch of other allergic reaction type stuff at the same time each day, but as with ADs I need to reduce my HRT very slowly or I get rebound side effects.

 

 

14 hours ago, Gilla999 said:

Do you think it's time I tapered from it Shep? I believe that I have a good chance that if I can reduce my HRT today I should be able to minimize the allergic reaction that happens in the late afternoon enoguh to not need the valium, but it's whether I've now been taking it for too long that I'll cause a problem if I stop it anyway. If I cannot minimize the allergic reaction enough then I estimate that in general I would need to take 2mg in the afternoon and potentially another 2mg at bed time.

 

Any thoughts would be much appreciated!

 

You may find this half-life calculator helpful:

 

Drug Half-Life Calculator

 

Diazepam has a half-life of up to 200 hours, so you can plug that into the calculator and see how much you'd still have in your system hours or even days later. At 400 hours, which is 16 days, you'd still have 25% of the previous dose in your system. So you may be dependent on it at this point. But please don't panic. If it's getting you sleep as you deal with the HRT, than so be it. You'll taper it later. Just be very consistent with your doses. Part of your symptoms may be due to inconsistent dosing. 

 

What time(s) of the day do you take each of your drugs? Please list the time o'clock, the drug name, and the dose. Also include your HRT and any supplements. 

 

 

 

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On 1/18/2023 at 10:34 PM, Shep said:

 

 

Diazepam has a half-life of up to 200 hours, so you can plug that into the calculator and see how much you'd still have in your system hours or even days later. At 400 hours, which is 16 days, you'd still have 25% of the previous dose in your system. So you may be dependent on it at this point. But please don't panic. If it's getting you sleep as you deal with the HRT, than so be it. You'll taper it later. Just be very consistent with your doses. Part of your symptoms may be due to inconsistent dosing. 

 

What time(s) of the day do you take each of your drugs? Please list the time o'clock, the drug name, and the dose. Also include your HRT and any supplements. 

 

Hi @Shep

 

Thank you for this, it's very helpful and your words are very reassuring. Here are the full details of what I've stabilised on:

 

Trazodone: 37.5mg 10:30pm

Mirtazapine: .70ml 10:30pm

Diazepam: 2mg 10pm

Sertraline: 50mg 8am (been on this since 2010)

HRT Lenzetto: 3 sprays 8am

 

I'm on both Trazodone AND Mirtazapine as I had been slow tapering from Mirt to Trazodone for a while, however after this hormone induced mess of the last 6 weeks I've needed to increase the Mirtazapine back up. I haven't reacted well to the Trazodone in general so tapering off that as well as the Diazepam would be my two priorities. I'm speaking to a Psychiatrist on 4th Feb who will hopefully prescribe me the liquid version of Diazepam to enable me to get started with that at 10% a month. Is that what you do Shep, in terms of priorities? I want to do everything in the safest way possible...

  • 2010 - 2017: 25mg Sertraline, with numerous failed attempts to come off
  • Feb - May 2017: drug free woooooh 😁
  • May 2017 - Oct 2018: 50mg Sertraline, insomnia episode
  • Oct 2018 - May 2019: 25mg Sertraline
  • May 2019:  Severe insomnia episode, hallucinating, suicide attempt, hospitalised
  • June 2019: Mirtazapine 15mg and switched from Sertraline 25mg to Escitalopram 7.5mg
  • July 2019-May 2020: Successfully tapering the Mirt at 10 every 3 weeks ever since without any major WD. Through taper had successfully reached 2.9mg of Mirtazapine and 5.8mg Escitalopram
  • May 2020: Relapse of insomnia and subsequent extreme anxiety caused by entering perimenopause
  • May-Dec 2020: Increased Mirtazapine back to 15mg, switched from Escitalopram back to Sertraline 50mg
  • Jan 2021 - Dec 2022: slow tapered down Mirtazapine to 3mg and switch over to Trazodone 37.5mg
  • Dec 29 2022: Hormonal fluctuation as part of perimenopause causing severe insomnia and anxiety, started using Diazepam between 2-4mg a day. Increased Trazodone to 75mg, however this caused even more anxiety and palpitations
  • Jan 14 2022: Reduced Trazodone back to 37.5mg and instead increased Mirtazapine to 10.5mg
  • Jan 23 2022: Experiencing bad side effects from increase of Mirtazapine, reduced back slightly to 9.3mg. Stabilised on 2mg Valium once an evening.
  • March 2022: Stabilised on 2mg Valium, 37.5mg Trazodone, 50mg Sertraline. Mirt taper continues and currently at 7.2mg

 

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  • Moderator Emeritus
On 1/18/2023 at 3:00 AM, Gilla999 said:

My symptoms arrive like clockwork from 4pm onwards, and most of the time I have needed the Diazepam then at night to sleep. I know now what has been causing the problem - I am having quite a severe allergic reaction to my HRT which is causing the anxiety, palpitations, insomnia and a bunch of other allergic reaction type stuff at the same time each day, but as with ADs I need to reduce my HRT very slowly or I get rebound side effects.

 

Can you write more about when the symptoms started at 4PM onwards? 

 

Quote

 

Jan 2021 - Dec 2022: slow tapered down Mirtazaine to 3mg and switched to Trazodone 50mg

Dec 2022: Hormonal swing causing repeat of severe insomnia and anxiety, using Dizaepam to survive 4mg a day - now dependent. Increase Mirtazapine back to 12mg and reduced Trazodone to 25mg after finding Trazodone was causing severe palpitations

 

 

You have this in your signature. What were your drug changes in October and November 2022 in the lead up to having more symptoms in December? 

 

Just trying to pinpoint any other variables besides hormonal issues that may be causing problems. 

 

Are you currently making changes to the HRT? If so, please add that information to your signature. 

 

 

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Hi @Shep. The slow taper from Mirtazapine to Trazodone was done over a number of months (years in the case of the Mirt reductions) at no more than 10% every four weeks. There were no drug changes in Oct or Nov 2022 except for my normal 10% Mirt taper. No changes to HRT.

 

The cause of the initial problems was because I have a condition called Chronic Spontaneous Urticaria. I used the word "allergy" earlier, but this isn't quite accurate - it's an autoimmune condition that is flared by either my HRT or by Estrogen fluctuations in general, which are natural as part of perimenopause (and I have had a really horrendous menopause experience). So the initial cause had nothing to do with my antidepressant use, but unfortunately in trying to "fix" the issue (primarily the insomnia and the palpitations that the histamine surges cause) I seriously messed with my other drugs and made the problem 1,000 times worse. I first of all tried increasing the Trazodone for about 7 days, which caused me even worse anxiety / stimulation / palpitations the next day, and so then I used valium to counteract that... and now I find myself in the place I am in! 

 

I am over the "eye of the storm" now in the sense that both my original CSU flare has died down and my anxiety/insomnia symptoms have mostly abated. I'm still psychologically trying to process the fact I'm now dependent on valium as well as 3 antidepressants - which is not the place I want to be in my life, especially when I had been doing so well at getting low on my ADs only a month ago - but I can only try to think calmly and make a plan for the future. 

 

My primary concern is getting off both the 2mg valium and 37.5mg Trazodone, though I know I should only attempt one at a time. I'm getting the liquid valium today and will start with a 10% taper. I did have one question for you - I read on this site about the potential interaction between Diazepam and ADs which affect certain liver enzymes and I see that Sertraline also uses CYP2C19. Do you think this will have any impact on how I approach my valium taper? 

 

  • 2010 - 2017: 25mg Sertraline, with numerous failed attempts to come off
  • Feb - May 2017: drug free woooooh 😁
  • May 2017 - Oct 2018: 50mg Sertraline, insomnia episode
  • Oct 2018 - May 2019: 25mg Sertraline
  • May 2019:  Severe insomnia episode, hallucinating, suicide attempt, hospitalised
  • June 2019: Mirtazapine 15mg and switched from Sertraline 25mg to Escitalopram 7.5mg
  • July 2019-May 2020: Successfully tapering the Mirt at 10 every 3 weeks ever since without any major WD. Through taper had successfully reached 2.9mg of Mirtazapine and 5.8mg Escitalopram
  • May 2020: Relapse of insomnia and subsequent extreme anxiety caused by entering perimenopause
  • May-Dec 2020: Increased Mirtazapine back to 15mg, switched from Escitalopram back to Sertraline 50mg
  • Jan 2021 - Dec 2022: slow tapered down Mirtazapine to 3mg and switch over to Trazodone 37.5mg
  • Dec 29 2022: Hormonal fluctuation as part of perimenopause causing severe insomnia and anxiety, started using Diazepam between 2-4mg a day. Increased Trazodone to 75mg, however this caused even more anxiety and palpitations
  • Jan 14 2022: Reduced Trazodone back to 37.5mg and instead increased Mirtazapine to 10.5mg
  • Jan 23 2022: Experiencing bad side effects from increase of Mirtazapine, reduced back slightly to 9.3mg. Stabilised on 2mg Valium once an evening.
  • March 2022: Stabilised on 2mg Valium, 37.5mg Trazodone, 50mg Sertraline. Mirt taper continues and currently at 7.2mg

 

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  • Moderator Emeritus
2 hours ago, Gilla999 said:

My primary concern is getting off both the 2mg valium and 37.5mg Trazodone, though I know I should only attempt one at a time. I'm getting the liquid valium today and will start with a 10% taper. I did have one question for you - I read on this site about the potential interaction between Diazepam and ADs which affect certain liver enzymes and I see that Sertraline also uses CYP2C19. Do you think this will have any impact on how I approach my valium taper? 

 

All of your drugs have interactions - Drug interaction report - sertraline, diazepam, and trazadone

 

The interaction between diazepam and trazadone is actually worse than with diazepam and sertraline. And of course, trazadone has a major interaction with sertraline. Spacing out your drugs can help with us (we recommend taking offending drugs at least 2 hours apart). 

 

Yes, diazepam is metabolized in part by CYP2C19 (along with the CYP3A4 enzyme). The CYP3A4 enzyme is also involved in all three of your drugs. But I keep coming back to what you wrote here: 

 

2 hours ago, Gilla999 said:

I am over the "eye of the storm" now in the sense that both my original CSU flare has died down and my anxiety/insomnia symptoms have mostly abated

 

You may want to hold for awhile, Gilla. If you've been struggling a lot over the past couple of months and are now able to sleep all night and function during the day, you may want to stabilize for a few weeks and set up a solid baseline before continuing to taper.

 

I wouldn't be so afraid of the diazepam that you'll risk destabilizing yourself in a scramble to get off it. 

 

 

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This is very true @Shep - I have made that mistake in the past with ADs more than once. I think I have some unscientifically-based fear that the longer I stay on the valium, the harder it will be to come off it - but I guess if I'm dependent now, I'm dependent and will need to taper... end of story.

 

Interesting on the Trazodone/Diazepam interaction, I wasn't aware of that. I was also not aware that Trazodone has an interaction with Sertraline - I have never taken an AD that wasn't prescribed by my Psychiatrist and he's been happy for me to slow taper from Mirt onto Trazodone, whilst still being on Sertraline. I can't help but wonder if that was part of the reason I experienced such a horrific reaction when I initially tried increasing my Trazodone dose in December, because it was really quite severe and matches the symptoms. Even when I took valium to try to calm it down and mentally felt perfectly fine, the palpitations/high blood pressure/sweating etc were still like nothing I've ever known.

 

Thank you for sharing all of this information with me Shep, it really has been so valuable.

  • 2010 - 2017: 25mg Sertraline, with numerous failed attempts to come off
  • Feb - May 2017: drug free woooooh 😁
  • May 2017 - Oct 2018: 50mg Sertraline, insomnia episode
  • Oct 2018 - May 2019: 25mg Sertraline
  • May 2019:  Severe insomnia episode, hallucinating, suicide attempt, hospitalised
  • June 2019: Mirtazapine 15mg and switched from Sertraline 25mg to Escitalopram 7.5mg
  • July 2019-May 2020: Successfully tapering the Mirt at 10 every 3 weeks ever since without any major WD. Through taper had successfully reached 2.9mg of Mirtazapine and 5.8mg Escitalopram
  • May 2020: Relapse of insomnia and subsequent extreme anxiety caused by entering perimenopause
  • May-Dec 2020: Increased Mirtazapine back to 15mg, switched from Escitalopram back to Sertraline 50mg
  • Jan 2021 - Dec 2022: slow tapered down Mirtazapine to 3mg and switch over to Trazodone 37.5mg
  • Dec 29 2022: Hormonal fluctuation as part of perimenopause causing severe insomnia and anxiety, started using Diazepam between 2-4mg a day. Increased Trazodone to 75mg, however this caused even more anxiety and palpitations
  • Jan 14 2022: Reduced Trazodone back to 37.5mg and instead increased Mirtazapine to 10.5mg
  • Jan 23 2022: Experiencing bad side effects from increase of Mirtazapine, reduced back slightly to 9.3mg. Stabilised on 2mg Valium once an evening.
  • March 2022: Stabilised on 2mg Valium, 37.5mg Trazodone, 50mg Sertraline. Mirt taper continues and currently at 7.2mg

 

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@ShepI do have one further question, if that's ok. As you can see when this storm hit, I increased my Mirtazapine from 3mg to 10.5mg (I use the liquid version) in a bid to (a) help me sleep, (b) prevent Diazepam dependence (didnt work!) and (c) I know that generally I tolerate it well and it has worked for me in the past.

 

However I have found it to be extremely stimulating the next day this time around - more so than I remember, but actually when I checked back over my notes today from last time, I did have the issue before, from the noradrenaline aspect of it. It is kicking in during the day once the histamine aspect wears off.

 

I was on the increased dose of 10.5mg for 9 days and dropped down slightly to 9.3mg on Monday of this week. It definitely improved the stimulation / wired head / jittery feelings the next day, but not totally and they're very uncomfortable.

 

My question is - if I were to try to drop it back further to 7.5mg (which they say is the optimum dose for sedation vs stimulation) do you think it would be a bad idea and risk withdrawal, after 13 days now on a higher dose? Would I be better off just riding out the start up side effects? On the plus side I am not feeling anxiety, but the tension headache/palpitations/wired feeling it gives is really unpleasant - there is no sense of 'calm'. I'm really trying hard to do the right / sensible thing, it's just very hard to know where the line is with these drugs!

  • 2010 - 2017: 25mg Sertraline, with numerous failed attempts to come off
  • Feb - May 2017: drug free woooooh 😁
  • May 2017 - Oct 2018: 50mg Sertraline, insomnia episode
  • Oct 2018 - May 2019: 25mg Sertraline
  • May 2019:  Severe insomnia episode, hallucinating, suicide attempt, hospitalised
  • June 2019: Mirtazapine 15mg and switched from Sertraline 25mg to Escitalopram 7.5mg
  • July 2019-May 2020: Successfully tapering the Mirt at 10 every 3 weeks ever since without any major WD. Through taper had successfully reached 2.9mg of Mirtazapine and 5.8mg Escitalopram
  • May 2020: Relapse of insomnia and subsequent extreme anxiety caused by entering perimenopause
  • May-Dec 2020: Increased Mirtazapine back to 15mg, switched from Escitalopram back to Sertraline 50mg
  • Jan 2021 - Dec 2022: slow tapered down Mirtazapine to 3mg and switch over to Trazodone 37.5mg
  • Dec 29 2022: Hormonal fluctuation as part of perimenopause causing severe insomnia and anxiety, started using Diazepam between 2-4mg a day. Increased Trazodone to 75mg, however this caused even more anxiety and palpitations
  • Jan 14 2022: Reduced Trazodone back to 37.5mg and instead increased Mirtazapine to 10.5mg
  • Jan 23 2022: Experiencing bad side effects from increase of Mirtazapine, reduced back slightly to 9.3mg. Stabilised on 2mg Valium once an evening.
  • March 2022: Stabilised on 2mg Valium, 37.5mg Trazodone, 50mg Sertraline. Mirt taper continues and currently at 7.2mg

 

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  • Moderator Emeritus

 

18 hours ago, Gilla999 said:

I was on the increased dose of 10.5mg for 9 days and dropped down slightly to 9.3mg on Monday of this week. It definitely improved the stimulation / wired head / jittery feelings the next day, but not totally and they're very uncomfortable.

 

My question is - if I were to try to drop it back further to 7.5mg (which they say is the optimum dose for sedation vs stimulation) do you think it would be a bad idea and risk withdrawal, after 13 days now on a higher dose? Would I be better off just riding out the start up side effects? On the plus side I am not feeling anxiety, but the tension headache/palpitations/wired feeling it gives is really unpleasant - there is no sense of 'calm'. I'm really trying hard to do the right / sensible thing, it's just very hard to know where the line is with these drugs!

 

 

Please stop moving your dose around. You risk kindling by continuing to do this (see - Hypersensitivity and Kindling).

 

While lower doses of mirtazapine are known to be more sedating, making abrupt changes can make the withdrawal symptoms worse. 

 

I would stay at the 9.3 mg dose for awhile longer and see how you do. That's already a larger percentage reduction than we recommend (10.5 down to 9.3 is about an 11% reduction). And going from 10.5 mg all the way down to 7.5 mg is way above what we recommend in one month's time - that's about a 29% reduction in the dose, far more than the 10% per month we recommend. 

 

Please update your signature with your recent changes. 

 

 Account Settings – Create or Edit a signature

 

 

 

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Thanks @Shep.I had reduced it from .70ml to .62ml which was 10% so I think it's ok, but I agree I won't make any further changes until four weeks has passed, and I'll just have to ride out the horrible stimulating start up side effects. I'll update my signature now.

  • 2010 - 2017: 25mg Sertraline, with numerous failed attempts to come off
  • Feb - May 2017: drug free woooooh 😁
  • May 2017 - Oct 2018: 50mg Sertraline, insomnia episode
  • Oct 2018 - May 2019: 25mg Sertraline
  • May 2019:  Severe insomnia episode, hallucinating, suicide attempt, hospitalised
  • June 2019: Mirtazapine 15mg and switched from Sertraline 25mg to Escitalopram 7.5mg
  • July 2019-May 2020: Successfully tapering the Mirt at 10 every 3 weeks ever since without any major WD. Through taper had successfully reached 2.9mg of Mirtazapine and 5.8mg Escitalopram
  • May 2020: Relapse of insomnia and subsequent extreme anxiety caused by entering perimenopause
  • May-Dec 2020: Increased Mirtazapine back to 15mg, switched from Escitalopram back to Sertraline 50mg
  • Jan 2021 - Dec 2022: slow tapered down Mirtazapine to 3mg and switch over to Trazodone 37.5mg
  • Dec 29 2022: Hormonal fluctuation as part of perimenopause causing severe insomnia and anxiety, started using Diazepam between 2-4mg a day. Increased Trazodone to 75mg, however this caused even more anxiety and palpitations
  • Jan 14 2022: Reduced Trazodone back to 37.5mg and instead increased Mirtazapine to 10.5mg
  • Jan 23 2022: Experiencing bad side effects from increase of Mirtazapine, reduced back slightly to 9.3mg. Stabilised on 2mg Valium once an evening.
  • March 2022: Stabilised on 2mg Valium, 37.5mg Trazodone, 50mg Sertraline. Mirt taper continues and currently at 7.2mg

 

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  • 2 weeks later...

Hi again @Shep - I was wondering if I can ask for your feedback? I am still suffering with these palpitations and a racing heart like clockwork from 3pm ish onwards. Sometimes i have it in the early morning too, but most of the time I am fine until afternoon. I don't mentally have any anxiety, it's just the heart symptoms and this stimulated / wired feeling, which is also causing hypnic jerks and preventing sleep. Do you have any thoughts as to what it might be? I can only think that it is either "start up" noradrenaline side effects of increasing the Mirt, or something connected to the valium. Is there any connection with valium causing adrenaline type of side effects the next day? It doesn't seem to correlate to any change in dose of valium though. I'm super perplexed and frustrated by it as it's really the only thing now preventing me from feeling back to my old self!

 

I should add that whenever I increase or decrease an SSRI (even by 10%) I do get palpitations. But I don't recall getting it to this extent previously from Mirt, nor it stopping me from sleeping.

  • 2010 - 2017: 25mg Sertraline, with numerous failed attempts to come off
  • Feb - May 2017: drug free woooooh 😁
  • May 2017 - Oct 2018: 50mg Sertraline, insomnia episode
  • Oct 2018 - May 2019: 25mg Sertraline
  • May 2019:  Severe insomnia episode, hallucinating, suicide attempt, hospitalised
  • June 2019: Mirtazapine 15mg and switched from Sertraline 25mg to Escitalopram 7.5mg
  • July 2019-May 2020: Successfully tapering the Mirt at 10 every 3 weeks ever since without any major WD. Through taper had successfully reached 2.9mg of Mirtazapine and 5.8mg Escitalopram
  • May 2020: Relapse of insomnia and subsequent extreme anxiety caused by entering perimenopause
  • May-Dec 2020: Increased Mirtazapine back to 15mg, switched from Escitalopram back to Sertraline 50mg
  • Jan 2021 - Dec 2022: slow tapered down Mirtazapine to 3mg and switch over to Trazodone 37.5mg
  • Dec 29 2022: Hormonal fluctuation as part of perimenopause causing severe insomnia and anxiety, started using Diazepam between 2-4mg a day. Increased Trazodone to 75mg, however this caused even more anxiety and palpitations
  • Jan 14 2022: Reduced Trazodone back to 37.5mg and instead increased Mirtazapine to 10.5mg
  • Jan 23 2022: Experiencing bad side effects from increase of Mirtazapine, reduced back slightly to 9.3mg. Stabilised on 2mg Valium once an evening.
  • March 2022: Stabilised on 2mg Valium, 37.5mg Trazodone, 50mg Sertraline. Mirt taper continues and currently at 7.2mg

 

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  • Moderator Emeritus

@Gilla999I can't tell what's going on from what you've posted so far, but I imagine it's partly the many changes over the past few weeks, as well as possibly some drug interactions.

 

For more targeted advice, please start a daily drug and symptoms journal. Include:

 

  • the time of day you take each drug and supplement and the dose.
  • how you feel before and after you take each drug.
  • how many hours you sleep each night

 

Over the course of the next few days, we can see your symptoms within the context of when you take each of your drugs. 

 

Here is more information and an example of a daily journal: 

 

 

On 9/27/2016 at 2:49 PM, Altostrata said:

In the course of discussion in your Introductions forum topic, you may be asked to keep notes on paper of your daily symptom pattern, including when you take your drugs, their dosages, and any symptoms. We ask this because there may be something we can do to reduce the symptoms.

 

What we need to see for every single day over several days is what symptoms you get before and after you take your drugs. If you're not taking any drugs and have withdrawal symptoms, we still need to see your symptom pattern throughout the day:

 

The time of day, dosage, and severity of symptoms are essential information. Include

 

- Time and dosage for all drugs taken throughout the day, psychiatric and non-psychiatric.

- Following each dose, note any symptoms. If you are having a reaction to the drug, it may take hours for a symptom to show up -- that's why we ask you to keep notes all day long.

- If you're not taking any drugs, your symptoms throughout the day.

- Your sleep pattern. Since so many drugs disturb sleep, if you find you're waking in the middle of the night, it could be from a drug you took earlier in the evening. If you're not taking any drugs, there may be ways you can improve your sleep.

And so forth. A diary, in chronological order, looking something like this:
 

Example:


DATE:

 

6 a.m. Woke with anxiety
8 a.m. Took 2.5mg Lexapro
10 a.m. Stomach is upset
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Feel a bit better
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Feeling dizzy
10:30 p.m. Fell asleep
2:30 a.m. Woke, took 3mg Ambien (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke but got back to sleep

 

 

 

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  • 3 months later...
  • Administrator

Hello, @Gilla999, how are you doing?

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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