hezzer78: Mirtazapine/Remeron WD and Tapering

[hezzer78]

Hello!

 

I was Rx'd mirtazapine postpartum for postpartum anxiety and insomnia, as well as ativan 0.5mg - 1 mg (i only took the ativan for about 2 weeks though). At one point before these meds, I was up for 72 hours straight - not a single minute of sleep. It was horrible, but the meds were a godsend. I've been on it a little over a year now (about 14 months). I was originally rx'd 7.5 mg and upped the dosage to 15 mg in Feb 2019. Since my reasons for being rx'd it are now gone (my son is well over a year old and my postpartum hormones have leveled off), I want to try my life without it. Before the birth of my son, I was never on any AD's or antianxiety meds. 

 

I saw a doc on monday and he said to just start by taking half a pill and do that for a few weeks or a month and then we would reassess how I feel and proceed the rest of my taper from there.  Last night was the first night on the low dose and sleep was hard - I ended up taking 1 mg of ativan (which I have for the occasional anxiety inducing situation) and 50 mg of benadryl. I didn't get great sleep - maybe about 3-4 hours, but without those meds I would have gotten none. I'm reading some places not to take benadryl with mirtazapine - but I'm not sure I understand why.  Can anyone explain why that's a poor decision? Is it ok to do every once in a while - as long as I don't do it every night? I can handle a night of absolutely no sleep if I know I can get some sleep the next night. I've tried melatonin but it doesn't seem to work for me - I was taking 3 mg, but maybe I need a *lower* dose of it? Valerian root gives me nightmares so I avoid it. 

 

After reading some on the board, I think I'm going to taper by 10% from 7.5mg -> 0mg.  I've bought my solution and pill crusher - but I've already started this taper from 15mg -> 7.5mg so I think I'm just gonna see it through the next few weeks - even if it's really horrible. 

 

Anyways - other than the crappy sleep, I don't really have any other noticeable effects from the drop yet. I know they may take a few days to show up.

 

Thanks!

[Gridley]

Welcome to SA, hezzer78.

 

As you've read. we recommend tapering by no more than 10% of your current dose every four weeks.  This is to minimize withdrawal symptoms from going off the drug.  Doctors unfortunately know nothing about antidepressant withdrawal (they don't believe it exists) and invariably advise their patients to taper too quickly.

 

Why taper by 10% of my dosage?

 

What is withdrawal syndrome.

 

Though the reasons you were taking the drug have passed, the necessity for a slow taper remains.  When we take psychiatric medications, the CNS (central nervous system) responds by making changes over the months and years we take the drug(s). When the medication is discontinued, the CNS has to undo all the changes it made. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur.  

 

Your drop from 15mg to 7.5 was a 50% drop and could cause problems later, as withdrawal symptoms are often delayed and it takes a bit over a week for a dose change to be fully felt.  Since it's been only 3 days I'd recommend going back up to 15mg and holding there for a month to stabilize before beginning your 10% taper.  You might be able to "get away with" that large a drop, but we take a cautious harm reduction approach here, and you could be looking at a good bit more than a few horrible weeks.  

 

3mg of Melatonin is a high dose, which can have a paradoxical effect (keep you awake). I would start out at 0.25mg and work up from there.

 

Please be careful with the Ativan.  Dependency (addiction) can begin within 2-4 weeks of regular use and even intermittent usage can cause dependency.

 

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)  

 

Add in one at a time and at a low dose in case you do experience problems.

 

Here's what the drug interactions between Mirtazapine and Benadryl are.  We urge caution in the use of antihistamines with antidepressants.

Interactions between your drugs

Moderate

 

Using diphenhydrAMINE together with mirtazapine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

[hezzer78]

Thanks Gridley. I appreciate your advice.

 

The melatonin I have is 1.5mg gummies, so I think I will go to the store and buy smaller doses. Is there a recommended brand people have success with?

 

One thing I didn't mention is that my husband and I are thinking of trying for another baby in 2020. Since mirtazapine is "not recommended" for pregnancy, I'd like to be in a position where I can stop it if I get pregnant.  That's the main reason why I made such a big initial jump to 7.5mg.  I figure I can taper from 10% from 7.5mg until I get pregnant, then I'll just be forced to quit at whatever dose I'm currently at. (I'm 40, so waiting a few years to get off mirtazapine before we get pregnant isn't an option). 

 

Last night was the 2nd night at 7.5mg. I took only 0.5mg ativan, but at 1AM when I couldn't sleep, I caved and took 50mg benadryl. I got about 4 hours of sleep. I feel fine today - a slight headache and head "heaviness" (if that makes sense).  

 

I plan on using magnesium + sleepy time tea as well to help my evening wind down time. 

 

[Gridley]

@hezzer78

 

I understand your situation regarding pregnancy. Please keep up updated on how you're doing.

 

Here's another link, this one specifically about tapering Mirtazapine, including information about how to obtain the small, nonstandard doses you'll need for your 10% taper.

 

Tips for tapering off Remeron (mirtazapine)

 

Many members who choose to taper by cutting tablets use the AWS Gemini-20 scale, available on Amazon.

 

The GEMINI-20 Scale

 

Using a digital scale to measure doses

 

I use Natrol 1mg extended release Melatonin and cut it in half to get 0.5mg.  When I awaken in the middle of the night, I take another 0.5mg.  Experiment and see what works best for you.

Magnesium glycinate is a good form of magnesium, with fewer laxative problems associated with it.  As I said earlier, start low and work up.  

I sympathize about the sleep.  It's perhaps the most common withdrawal symptom.

Edited January 1, 2020 by Gridley

[hezzer78]

Last night was the third night on the lower dose. This was what I did..

 

7pm - took 7.5 mg remeron

8:30pm - shut off all TVs/Computer/Phone - spent the evening reading, coloring and journaling.

9:30pm - took 0.5mg melatonin and drank some sleepy time tea. Took a warm bath with epsom salts

10:15pm - feeling pretty sleepy so I got in bed to read for a bit.

12:30AM - got up and went to the couch a few times to read when I couldn't sleep in bed. Took 50mg benadryl since it looked like I wasn't going to sleep.

1:30AM - Still not asleep - took 1mg Ativan and went to the couch, fell asleep on the couch

6AM - woke up when my husband got up to take a shower.

 

So all in all - got a little over 4 hours. Same as the past two nights. It sucks, but I can  most definitely function. No other symptoms yet besides the lack of sleep.

 

I'm thinking I may try one more night at this dosage and then tomorrow drop to 0.5 mg Ativan and 25mg Benadryl and just see if that helps. I know I can't do this ativan+benadryl combo forever.

 

Anyone who tapered quickly at first (15mg -> 7.5 mg) how long did it take the initial sleep issues to disappear? My doc told me if I still have sleep problems when he sees me in 2 weeks he can rx Trazodone for me - he said I can take it as needed, but I'm hesitant to throw another pill in the mix.

 

Also - anyone have luck with CBD oil? I'm mildly interested in going this route but have no idea who to talk to. My GP?

[Gridley]

1 hour ago, hezzer78 said:

rx Trazodone

We wouldn't advise throwing another drug into the mix, especially trazodone.  Altostrata, founder of this site, wrote the following about trazodone:

"Trazodone (trazodone hydrochloride) is a nasty drug often added to antidepressants and other "activating" drugs to aid sleep.
It's nasty because it has an evil active metabolite, meta-Chlorophenylpiperazine (mCPP), and a huge number of interactions with other drugs that can make you feel very sick."  

 

Trazodone has a major drug interaction with mirtazapine.

 

Interactions between your drugs

Major

Using traZODone together with mirtazapine can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should seek immediate medical attention if you experience these symptoms while taking the medications. 

 

We recommend using non-drug methods to deal with withdrawal symptoms, including insomnia.

 

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

 

Relaxation exercises, guided meditations, calming videos, sleep hypnosis

 

Trick and tips to fall asleep faster

http://articles.mercola.com/sites/articles/archive/2017/02/16/tips-tricks-fall-asleep-faster.aspx?utm_source=dnl&utm_medium=email&utm_content=art1&utm_campaign=20170216Z1&et_cid=DM133787&et_rid=1889748952

 

This link contains helpful information, including insomnia and also non-drug coping skills.  

 

 Important topics about symptoms, including sleep problems

 

 

[hezzer78]

@gridley Thanks - I figured it wouldn't be a good idea to keep heaping pills at the problem. I will muscle through without it.  

[hezzer78]

4th night on 7.5 mg.  Here's how it ended up..

 

8:45 - turned off tv/computer/phone. Took 0.5mg melatonin 

9:15 - made some sleepy time tea and took a hot bath.

9:45 - laid on the couch and read for a bit, but I was pretty tired

10 - went to bed and tried to sleep

11:30 - After a few times getting up and going to the couch, I took 37.5mg benadryl (i'm trying to cut this down)

12:30 - Still no luck sleeping, took 1mg Ativan

Sometime between 12:30 and 1:30 I fell asleep and woke up at 5:30.

 

I feel ok today. I'm not sure the benadryl is really helping anymore - it may actually be stimulating me - so I may just ditch that tonight and see how I do on just the ativan.  I really don't want to be on the 1mg Ativan more than a week. I'd like to start tapering that down next week. 

 

I got some yoga and dance practice in yesterday (i'm a belly dancer), and this morning I got an awesome workout in at Crossfit, so I'm feeling pretty good. Gonna cut out caffeine after noon and all alcohol, and watch sugar intake. I know from experience all these things really help.

 

[hezzer78]

5th night on 7.5mg. Probably the worst night yet.

 

I ended up taking 1mg ativan and 37.5 mg of benadryl and I'm not sure either thing helped all that much. I only got about 2-3 hours of sleep. BUT! I *THINK* I fell asleep on my own (no drugs) for about 20 mins at the start of the night. I'm pretty hopeful if that's the case.  I' think I'm going to move the lamp from my son's room into the living room so i can read with a softer light when I get up and can't sleep. The lamp that's in there now is really bright and not doing me any favors.  I go back to work on Monday so I hope this sleep thing is situated out before then.

 

Anyone who dropped 50%, how long did it take for the sleep to sort back out? (I realize the insomnia will come and go - I guess I'm just talking aboutthe initial time). Remeron is supposed to be MORE sedating at lower mg's, so I'm hoping that means my sleep will get way better soon.

 

 

[Gridley]

21 hours ago, hezzer78 said:

8:45 - turned off tv/computer/phone

 

You might consider turning off the computer earlier.  That might help with sleep.

 

Please update your signature to reflect the drop to 7.5 and the date.

 

Account Settings – Create or Edit a signature.

 

[savinggrace]

Hello Hezzer,

 

I can't help but respond here.  If you look at my signature, I have been a toxic cocktail of pysch drugs for a very long time.  Now at the age of 65, I can barely taper because I am dealing with the severe health ramifications of taking these drugs, exactly as prescribed and never up-dosing but always tapering, even if at a snail's pace.

 

Remeron is indeed more sedating at lower doses; at least for me I went from 7.5 to half of that without tapering and slept better. However, I believe I was taking klonopin and ambien at the time which is why I got away with that 50% cut.  That better sleep didn't last long though.  Meanwhile, I have been on valium and trileptal as well.  Still am.

 

I don't know how that ativan was prescribed, but you will exacerbate your problem a hundred-fold if you continue to take it.  I WISH someone had told me this 20 years ago.  The ativan will stop working very soon unless you updose.  It will also eventually cause side effects and be more troublesome to come off of than the remeron.

 

Trazodone is just another old-school tri-cyclic for sleep.  I took it once at a fairly high dose, 20 years ago, and it did NOTHING for my sleep and made me feel terrible in general.   Marie is trying to get off of remeron AFTER  a long struggle to get off trazodone so you are just substituting one problem for another.

 

I don't know the exact answer for you (no one does)   and I sympathize enormously.  I went nearly a week without sleeping 20 years ago.  I was still working, raising kids etc. and decided to trust my doctor.  I should have quit my job and done what I needed to do before I let these poisons ruin my life...and they have.

 

My goal is not to scare you.  It is to tell you the truth because your doctor isn't going to.   It would be helpful to know how quickly you tapered from 15mg. to 7.5 of the remeron.  Remeron is considered to be a pretty difficult drug to taper.  If you tapered 50% too fast, that is likely what has caused your extreme withdrawal.  I would turn to the experts here.  Depending on your taper length, it might not be too late to re-instate some remeron and forget about the other two drugs.  I hope you are hearing me.  The ativan will ruin your life.

 

I wish you well.  I really do.  I wish someone had written this to me 20 years ago.

Grace

[hezzer78]

@savinggrace Thanks for your input. I dropped from 15mg to 7.5mg on Monday. I realize it's a fast initial taper, but with the prospects of maybe getting pregnant this year, I had to do it. It sucks, but ah well.

 

When I was about 8 weeks postpartum with my first baby and suffering horrible postpartum anxiety/insomnia, I was rx'd ativan. I took it for almost a month while we got the remeron sorted and got off it quite easily, so I was hoping for the same experience again. It has helped me sleep in the past, which is why I'm taking it again. I always try to sleep on my own before taking it - I give myself a good 2 hours of trying to sleep (getting up every 20 mins to go to the couch to read for 10-15 mins) before I resort to the ativan. I'm really hoping my brain figures this initial insomnia period out soon. (I know the insomnia could come back, but I'm hoping the lower dosage sedating effect starts to work)

 

I do plan on tapering much slower from 7.5mg - until I get pregnant, which would mean I just stop at whatever mg's I'm at at that point.

 

@Gridley Thanks for the advice. I will try to cut my technology usage back some. I think this whole yucky process just is gonna take some time and as much as I want to, I don't have any control over how long it takes my brain to figure things out. All I can do is feed my body well, move daily, and do my best to relax in the evenings.

 

 

[RenewedLife]

@hezzer78 I haven’t been on the site in a while, but check it occasionally just to catch up on things. I really need to get on my profile and update it. BUT, I did notice that you mentioned trying to get pregnant this year and that’s your motivation to get off mirtazapine. Just to help ease your mind, I actually took 7.5 of mirt for the entire length of my pregnancy. My mental health absolutely depended on stabilization and no changes. This is by no means a way to encourage you to continue taking it if your wish is to eliminate it. I just want to make sure that you know going slow and taking your time is better than rushing off of it. My son was born happy and healthy and has not had any problems and he is 10 months old. 
 

I say this because you need to make sure to do it the right way. Make sure that you aren’t making drastic changes to anything and take the steps needed. 

[savinggrace]

Wow, that's a big drop.

 

I sympathize about the pregnancy thing.  Back in the 80's I was on post-partum AD and wanted to get pregnant again.  Had to basically C/T my AD.  I had a terrible pregnancy.  THEN, I got (unknowingly) pregnant with my 3rd baby while on an anti-depressant.  I was 12 weeks pregnant when I found out (with a 6 month old...yikes).  My doctors decided I was already past the most critical time (as far as harming the baby) and I was at such high-risk because of my previous C/T with my 2nd pregnancy, they advised I just stay on the AD.  My psych and OBGYN and I were all nervous if this would affect my baby, but interestingly, other than being too sedated at birth and taking longer to wake up in general and nurse properly, he is the happiest of all 3 of my kids and suffered no ill consequences.

 

That said, I would never have chosen to get pregnant while on the medication.  I don't know what the school of thought is now, but I am guessing most everyone would agree you should get off the meds before you get pregnant.

 

You have to be in acute W/D from the 50% cut.  For me that would be like a C/T.  If you are not willing to stabilize by up-dosing the remeron, you are going to have to tough this out or delay your pregnancy plans and taper at a reasonable rate.  I am sorry this is so hard.  Believe me, it can be done.  I did it with my second pregnancy but I didn't have any other drugs to deal with (ativan, trazodone).  I was on amitriptyline at the time.

 

I wish you well.

 

[Gridley]

1 hour ago, hezzer78 said:

do my best to relax in the evenings.

 

And try to get your bedroom as dark and light-proof as possible.  Cool temperatures are also conducive to sleep.

[hezzer78]

@RenewedLife @savinggrace  Thank you for your comments. I've been thinking about reintroduction, but not sure how to do that - Would I reintroduce at 11.25? (3/4 of a pill?) Honestly, I don't feel like my symptoms are that bad - the only one I have is this pesky insomnia. Does it suck? Yes. Am I beyond tired? Oh god yes. BUT - I'm functioning quite well. I hang out with friends, clean the house, make dinner, go grocery shopping, do yoga, belly dance, workout, and take care of  and play with my son. So I'm not really suffering in my day to day life besides the exhaustion pulling at me.  Now, if this gets worse and I end up going days without any sleep at all (or if other symptoms appear) I will reevaluate and make that choice. But right now it's VERY sucky - but manageable.  I've got all my fingers crossed that this passes in the next week or so. 

 

@savinggrace Also - I'm 40 - so waiting a few years to get off the meds isn't an option for another baby.

 

What's the window for reinstatement if that's what I decide to do?  Is 2 weeks recommended? 

 

 

[Gridley]

1 hour ago, hezzer78 said:

 

What's the window for reinstatement if that's what I decide to do?  Is 2 weeks recommended? 

 

 

Updosing (going to a higher dose from an existing dose) and reinstatement (reintroducing the drug from zero) works most predictably within 3 months after the dose change. You are well within that range.   It is best to updose.as soon after WD symptoms appear, however.  It's a tough call whether to updose in your case or not, given you're making it fairly okay.

 

If you decide you want to do it, please don't do it without letting us know so we can suggest a dose.  Updosing too much can overwhelm and destabilize your system further and you don't want that.

[savinggrace]

Hezzer,

I would listen to the mods here. Gridley will likely give you an idea of what to updose to. I have no idea but my gut says to go a least halfway back. 
 

Did you know 1 mg. Ativan is equivalent to 20 mg. Valium?  
 

The Benadryl is contra-indicated because it is an anti-histamine and anti-cholinergic of which remeron has both properties. I imagine the Benadryl is doing little for sedation at this point. Benadryl actually stimulated me. Maybe cutting that out quickly would help along with whatever up dose is recommended. 
 

I understand about.the age thing. I never had that worry as I started young. I was very impatient when I wanted to get pregnant and I C/T the Amitriptyline after 3 years on it; and my whole pregnancy was terrible. I now know I was in withdraws most of that time. 
 

I am sure Gridley or another mod will be back soon. I am thinking it has only been 6 days so maybe you haven’t been too sensitized and will manage an up dose just fine. Then you can do a more reasonable taper. 
 

Grace

[hezzer78]

@Gridley Thanks so much for your advice. I think I'm gonna ride this out a few more days at least. If things turn worse or don't seem to be getting better after 2 weeks, I'll probably try to updose. 

 

@savinggrace I suspected that about benadryl and will try to go without it tonight - although I've taken it occasionally the past year I've been on mirtazapine and it's always knocked me out. I've never taken it more than one or two nights in a row though until now. 

[hezzer78]

Night 6 on 7.5mg

 

8:30 - shut off all electronics, journaled, colored and read.

9:00 - took a warm bath with epsom salt& lavender. Took 0.5mg melatonin ( I’m also taking 175mg of magnesium daily)

9:30 - went to bed and read for a bit, used an eye mask when lights out at 945.

10:15 - got up and went to the couch, read

10;45 - back in bedroom

11:15 - back on couch, tried to listen to a sleep story

11:30 - 1mg of ativan

11:45 - back in bed

12:30 - back on the couch

1:30 - back in bed, 50mg of benadryl - fell asleep

5:30 - woke up

 

At this point, i don’t know if the drugs only work together - or they don’t work at all and my body just routinely craps out at 1:30.  I’m going to email my doc tomorrow and ask about the possibility of updosing- he seemed pretty young and hip and knowledgeable so I think he would agree to whatever makes me comfortable. At any rate, I didn’t want to be on the Ativan more than 2 weeks, so Tonight I’m gonna try 0.75mg of Ativan and 50mg of benadryl.

 

i go back to work tomorrow - which sucks - but It’s also good. I’m a high school teacher and my work exhausts me. I’m hoping the presence of a routine will help me get the sleep I need. 4 hrs isn’t horrible - but I would like more of course.

 

@Gridley If I DID iodide, would going back to 11.25 (half the difference) be a good plan?

 

 

 

[Gridley]

1 hour ago, hezzer78 said:

 

@Gridley If I DID iodide, would going back to 11.25 (half the difference) be a good plan?

In the month or so that you've been at 7.5, your system has become somewhat accustomed to that dose.  We recommend small updoses to avoid overwhelming your system.  I'd recommend updosing no more than 2mg (for a total of 9.5mg).

[hezzer78]

37 minutes ago, Gridley said:

In the month or so that you've been at 7.5, your system has become somewhat accustomed to that dose.  We recommend small updoses to avoid overwhelming your system.  I'd recommend updosing no more than 2mg (for a total of 9.5mg).

@Gridley Ive only been on 7.5mg for a week. I’m going to give it one more week - so when I do the updose, I will have been on 7.5 for 2 weeks.

[Gridley]

50 minutes ago, hezzer78 said:

have been on 7.5 for 2 weeks

 

 

A week is about the outside limit for updosing to the full previous dose.  Two weeks might work, I just can't say.  The general rule is to updose as soon after the reduction as possible, but I know you have several factors in play.  I know you want to wait a week to see if the updose is necessary and that you hope it won't be.  I know your plan is to drop to zero once you get pregnant, which argues for being on as low a dose as possible when you begin your taper.  

 

11.25mg might be all right at two weeks out.  I just tend to be very conservative when it comes to updosing.

Edited January 5, 2020 by Gridley

[hezzer78]

Night 7 on 7.5mg

 

I took my dose at 7pm and about 45 mins later, started to feel really drowsy so I knew the sedative effects of 7.5 were kicking in.  I was actually able to fall asleep at 9:30 without Ativan OR benadryl! I'm super stoked about that - maybe that means my brain is starting to level out a bit. I didn't take any melatonin.

 

7pm - took 7.5mg mirt

8:30pm - TV/phone/computer off - journaled and read

9:00pm - warm bath

9:30pm - bed to read and fell asleep

12AM, 1:30AM, 4AM - I did wake up 3 times throughout the night (once cuz my husband was snoring), but that's not really unusual for me. 

5:30AM - Up for the day

 

I think I'm going to stay at this dose for a little while before I drop some more. I may try drops of 15 or 20% moving forward and see how I handle it. 

[Gridley]

4 minutes ago, hezzer78 said:

15 or 20% moving forward and see how I handle it. 

I would counsel against it.  You just dropped 50% and the effects of future drops can be cumulative.  Everything can be okay then you get hit with symptoms.  Have you decided not to updose?

 

I know you want off because of the pregnancy, but you don't want to put yourself at risk of protracted withdrawal which can last a long time.  It's at the lower doses that you need to go slower, not faster. 

 

 

[hezzer78]

@Gridley Sorry - I wasn't clear. I mean to stay here at 7.5mg for a while - probably at least 2 months (maybe 3) before tapering again. I know the symptoms can come weeks later. Tapering at 15 to 20% would be slower than 50% - that's why I suggested that amount. But I will worry about that in a few months I suppose. 

[hezzer78]

It's been over a week on 7.5mg. My sleep has normalized and I feel pretty good. I even managed to get to Crossfit this morning so for now, I'm doing well.

 

I'm going to update after my doctor appointment on Tuesday - or if symptoms/issues come back up. 

[savinggrace]

Good for you for toughing it out, Hezzer.  I hope things continue to be stable for you.

Grace

[hezzer78]

@savinggrace Thanks! Things are going pretty well so far.

 

I did have a question about using a liquid vs. using a scale to taper lower. (If I need to ask this somewhere else, let me know).

 

I have a friend who used to be a pharmacy technician and she told me that whereever the pills are scored, the dosage is split evenly. So my 15mg pill is split down the middle - which means that each half is 7.5mg. But those halves are not scored - so that 7.5mg could not be distributed evenly throughout that half.  So if I use a mg scale, and shave off 10% of my pill, I MAY not be shaving off 10% of my dose.  Does this sound right/correct??

 

That being said - is it more accurate to make a suspension of an entire pill or shave off 10% of the pill? 

[Gridley]

34 minutes ago, hezzer78 said:

 

That being said - is it more accurate to make a suspension of an entire pill or shave off 10% of the pill? 

Both methods are fine and accurate.  It depends on which you prefer.  

 

If the pill is not scored, and you decide to stay with using the tablet, you need to use a scale so that you are sure you're getting half.  Remember that when you're using a scale you're weighing the pill weight, which will be more than 15mg, since it's made mostly of binders and fillers.  You should weigh ten pills to get an average weight and use that weight.  Then cut ithe pill in half in half and add or subtract to get half of the pill weight. 

 

The active ingredient of 7.5mg is evenly distributed throughout the pill.

[Malbec37]

@hezzer78 firstly amazing that you’ve managed to level out after reducing from 15 to 7.5 well done! I’m not sure how you’ve done that as I’m having major WD going from 15 to 11 and now updosing to 13...I’m doing ok but just shows how different we all are 

 

I’m following your thread closely as I also have to consider what to do at lower amounts 

 

My doctor in UK has said that I could switch to liquid for lower doses so I may go down that route but it’s a long time away 

[hezzer78]

I had a follow up with my doc today. I told him about my week of crappy sleep and how I really didn't want to repeat that now that I'm back at work (I started my taper over the winter holiday, so I wasn't working). Wrangling 150 high schoolers daily doesn't sound like fun on 2 hours of sleep for a week. I suggested a super slow taper with making the drops over the weekends. He asked me how I was going to cut the pill that small and I said I was going to file down the pills with a nail file. He kind of laughed and essentially said - ok. Do what you gotta do. He said if it makes ME feel better to approach the treatment like that, go ahead and do that. I'm doing really well on 7.5mg right now (besides being really tired a lot of the time) so I think I'll do a cut next weekend. I'm going to try around 15% and see how I feel.

 

I'm hoping I'm one of the lucky ones that may get through this without significant issues. 

[brassmonkey]

Hi Hezzer-- I glad to hear that your doctor is on board with the way you want to taper, that can make things a whole lot easier. 

 

If wrangling the high schoolers on just a couple of hours sleep is tough, trying to do it in acute ADWD will be a nightmare.  I strongly recommend that you do not do a 15% drop next time.  The chances of getting away with it are extremely slim and the results will make lack of sleep seem like a walk in the park.  I would stick to the schedule that you have been having success with, or even better switch over to a Brassmonkey Slide Method taper.  We have been having tremendous success with it as a method for continuing a good speed on the taper yet experiencing reduced symptoms. If you need to keep your head as clear as possible it really is the way to go.

[savinggrace]

I agree with Brass Monkey, Hezzer. Please consider a smaller cut. 10% or less. Many people feel “out of the woods” in early days, only to get slammed a week, a month or more later. I was a teacher. I know what you are dealing with every day. I understand your sense of urgency very well. If you are slowed down by an acute withdrawal attack, and then have to up-dose, you will likely make negative progress. Slow but steady wins the race. Your brain needs time to adjust. None of us want to see this go bad for you. 
 

Grace

[hezzer78]

Hey everyone - 

 

Thought I'd give an update here.

 

After 3.5 weeks on 7.5mg, I've decided to do another cut this weekend. I went down to 6.5mg - which is a drop of 13% and took my first dose of it this evening. I used a milligram scale and a razor blade to cut my 15mg pill into two pieces that had 6.5 mg each. I've been feeling pretty good the past 3.5 weeks - besides being really exhausted, but I'm guessing that's the mirtazapine. I may stay at this dosage until we get back from Spain in March, but I will see how I feel.

 

Question about pills and travel - do I continue to take my mirt at 7pm MY time? Spain is 6 hours ahead of us - so I'd be taking it at like 1AM. We will only be there a week so IDK if switching to taking it 6 hours "earlier" than normal will be weird for my system or not? I've traveled loads of times, but I've never been on a daily medication so IDK how that works..

 

Thanks!

 

 

[Altostrata]

You have to take the dose at the same time according to your body clock.

 

It might be a good idea for you to hold for a month at least, to make sure you don't get withdrawal symptoms again.