Malbec37: tapering off mirtazapine / Remeron and hit major WD

[Gridley]

5 hours ago, Malbec37 said:

could this have destabilised me so much that I am now feeling worse than ever?

It's possible.  We can't know for sure, of course, but our systems are so sensitive.  I'm sorry you're feeling so bad.  It could also be the herb you took or, a combination of causes.

[Ripley]

Hi Malbec, how are you doing? Have things settled down for you?

Best wishes, Ripley

[Malbec37]

@Ripleythanks for checking in. Thankfully my CNS seems to have stabilised. I think it was definitely the combo of brand switch and herbal tincture that destabilised me...was really awful experience, WD symptoms are really hideous 

 

But feeling much better now and on holiday for a week in Devon and Cornwall 😀

 

When I’m back I’ll start the gradual switch across to the prescribed liquid and hold it doesn’t trigger more WD and that I can get stable before next reduction 

 

How are you? 

[Ripley]

Hey that's great Malbec! I'm really pleased for you. I'm glad you're back on track. 

 

I'll post an update on my thread shortly. Enjoy your hols!

[sunnysideup69]

Am glad you've settled @Malbec37.

[Malbec37]

Hi all

 

Hope all are well and here is my update:

 

I am currently doing well and have stabilised a lot since my recent problems of bad WD waves that made me feel so terribly sick...but they have currently stopped and I've been in a pretty solid window for 10 days or so now and I went on holiday to the SW of UK camping and staying with an old friend and felt pretty good throughout. I tried to avoid all naughty things like sugar, gluten and alcohol but couldn't entirely without telling people what I was going through which I didn't feel like doing...so I indulged a little and it didn't affect me too bad although on the night I had sugar I didn't sleep well which is no surprise given what I know about sugar. But anyway main thing is I had a great time on my hols which has been good for my soul, and now I'm home in Bristol and I have my house to myself as my lodger has left and I'm feeling stable and in a good place

 

So now I am going to try and switch from 15mg pill to 15mg prescribed liquid in the gradual way recommended by @Gridley by doing 7 days of each gradual transition across

 

In many ways I'm concerned now about tipping myself back into WD again by doing this switch but also I have been holding on 15mg for 5 months now and I do want to get across to the liquid so I can do my first reduction down...I'm not rushing and I'm stable but I do need to keep going otherwise I'll never be free of this stuff

 

So I need a little help with the switch across as detailed below please:

 

I am going to start my gradual switch from pill 15mg to prescribed mert liquid 15mg. I am planning to do 1/4 liquid 3/4 pill for a week, 1/2 pill and 1/2 liquid for a week, 1/4 pill and 3/4 liquid for a week and then all liquid thereafter...this is to try and limit any WD from changing form of medication and brand

 

My question is because the 15mg pills are all weighing slightly different amounts between 15mg and 15.5mg (due to fillers and binders) what amount of pill should I be cutting and measuring to get an accurate 3/4 of 15mg Active Ingredient Mert for the first stage of transition?

 

My thinking is to measure weight of 7 pills (for one week) and then add them up and divide by 7 so giving an average weight and then X this by 0.75 to get an amount for 3/4 and then take that together with the correct amount of liquid for 1/4...is this correct?

 

I guess I'm a little confused how to get a precise 3/4 of pill given that they weigh slightly different amounts

 

Any useful and constructive advice would be welcome

 

Thanks all

[Gridley]

32 minutes ago, Malbec37 said:

 

I guess I'm a little confused how to get a precise 3/4 of pill given that they weigh slightly different amounts

 

 

32 minutes ago, Malbec37 said:

the 15mg pills are all weighing slightly different amounts between 15mg and 15.5mg (due to fillers and binders

It's not possible that a dosage of 15mg active ingredient (15mgai) weighs 15mg pill weight (15mgpw).  There's generally a ratio of at least 10:1 or more pill weight to active ingredient due to the fillers and binders.  For example my 20mgai brand of Lexapro weighs 200mgpw.  My 2mgai Ativan tablet weighs 30mgpw.

 

If you're taking 15mg pill weight, you're taking much less than 15mg active ingredient.

 

What dosage (active ingredient) tablet are you using and how much does it weigh?

 

 

 

 

Edited July 27, 2020 by Gridley

[Malbec37]

37 minutes ago, Gridley said:

It's not possible that a dosage of 15mg active ingredient (15mgai) weighs 15mg pill weight (15mgpw).  There's generally a ratio of at least 10:1 or more pill weight to active ingredient due to the fillers and binders.  For example my 20mgai brand of Lexapro weighs 200mgpw.  My 2mgai Ativan tablet weighs 30mgpw.

 

If you're taking 15mg pill weight, you're taking much less than 15mg active ingredient.

 

What dosage (active ingredient) tablet are you using and how much does it weigh?

 

Hi @Gridley thanks for the response! With mertazapine it does weigh almost the same strangely 

 

So I'm taking 15mg AI dosage mertazapine and it weights usually 15.4 or 15.5mg but occasionally only 15!? I'm 100% certain of it, no doubt at all

 

So the fillers and binders can only be .4 or .5 of a mg at the very most 

 

So I think maybe the best way forward is to find 7 tablets that weigh the most typical amount of 15.4 and then take 0.75 or 3/4 so that would be 11.55mg plus the 3.75mg of liquid 

 

What do you think?

[Gridley]

10 minutes ago, Malbec37 said:

So I think maybe the best way forward is to find 7 tablets that weigh the most typical amount of 15.4 and then take 0.75 or 3/4 so that would be 11.55mg plus the 3.75mg of liquid 

 

That sounds like a good plan.

[Malbec37]

2 minutes ago, Gridley said:

That sounds like a good plan.

 

Cool cheers

 

There is another chap on a different mert forum who said that he straight switched across without gradual transition and had no problems at all...it's very tempting but also just because that worked for him doesn't mean it would for me and I don't want to go into some nightmare WD again because of that  

[Gridley]

3 hours ago, Malbec37 said:

just because that worked for him doesn't mean it would for me

Exactly.  Everyone's different.  We definitely recommend the gradual switchover to make the transition less disruptive to your system.  People often react differently to liquid as opposed to tablet due to absorption rate and other factors.

[sunnysideup69]

Hey @Malbec37, thought I'd just drop by and say hello! I think you were on holiday recently? Hope it was enjoyable. How are you doing these days?

[Malbec37]

On 8/1/2020 at 11:36 AM, sunnysideup69 said:

Hey @Malbec37, thought I'd just drop by and say hello! I think you were on holiday recently? Hope it was enjoyable. How are you doing these days?

 

Hi Sunny lovely to hear from you! Yes I went to North Devon coast camping solo for 3 days, totally beautiful, and then I went to Cornwall to stay with old friends...I have written a detailed run down in my previous big post above that you can read.

 

I had a great time all in all and was pretty stable...now I am back and in the thick of things...work quite full on and also started teaching yoga again. I'm mostly in a stable window which I'm enjoying but I do want to get across from 15mg pill to liquid and that is a transition which can cause more WD waves but there is NO way of avoiding them (if they happen) so I'm going to start my gradual shift with part pill part liquid tonight...I've got all the measurements precise and ready to go and I'm starting in a very solid place today. Fingers crossed that I can get onto the liquid and then stabilise there for a while before making my first reduction.

 

Malbec 

[Ripley]

Good luck with starting your crossover tonight, Malbec. R

[sunnysideup69]

You're four days in I see @Malbec37, how's it going?

[Malbec37]

Thanks @Ripley and @sunnysideup69

 

So I'm approaching night 3 of taking 3/4 pill and 1/4 liquid...so far so good! No WD, bit of stronger tinnitus this morning but mood is solid, sleep not too bad. I've been quite nervous about it all and expecting the worst but the measurements are precise and I think I managed to reach a pretty solid and stable place before starting and this really helps. I will either do 5 or 7 days then go to 50/50.

 

I have started teaching yoga again recently which has helped me as yoga really lifts my spirits and it's also  a good balance to my other job as a support worker.

 

Also my lodger has left and I've decided to live alone for the foreseeable future....I cannot handle going through WD and having someone else living in my house. I just need a lot of space so willing to sacrifice things financially to be able to live alone for a while.

[sunnysideup69]

@Malbec37, that sounds like a good plan....having some privacy and space at home. Good stuff! Got my fingers crossed that your switchover is nice and smooth.

[Malbec37]

Hi all

 

Here is a little update:

 

I have one week ago begun switching from pill to prescribed Mertazapine liquid at 15mg. I started doing 3/4 pill and 1/4 liquid for 4 days, my WD symptoms increased a little but I decided to go to 50/50 pill and liquid (7.5mg each)...I am struggling a bit more today (day 2 of 50/50) with nausea, more tinnitus, lower mood, an uptick in WD symptoms basically 

 

I was really steady and stable when I started 

 

Is this normal and to be expected? I don't feel too bad and think my system is just trying to adapt...I guess there is some fear in me that I'll be one of the unlucky ones who's bodies will not tolerate the liquid and have to cross back onto the pill

 

Any insights or reassurance would be welcome

 

Thanks all

 

Malbec

[Gridley]

21 minutes ago, Malbec37 said:

4 days

 

You might want to extend the 4 days to a week to allow your system to become more accustomed to the new formulation.  

 

There are bound to be some bumps in the transition.  I wouldn't think about being one of the unlucky ones.  That's catastrohopizing.

Edited August 10, 2020 by Gridley

[Malbec37]

@Gridley yes very wise it is catastrophising! Hard not to sometimes but not helpful I agree 

 

I was going to do a week on 3/4 1/4 but felt like my body needed more liquid for some reason so upped after 4 days 

 

I’ll hold for at least a week at 50/50

 

Gracias amigo 👍

[sunnysideup69]

Good luck, you're doing great  

[Malbec37]

Hi everyone 

 

Here is a little update...I have been trying to move across onto the liquid mirt here in the UK but I have failed...I got to 50/50 for 5 nights but I became increasingly unwell, insomnia, awful nausea....I just started becoming so unwell and had to work and function and just couldn't cope with it...I had no idea if I'd stabilise and when so I decided to cut my losses and go back on the tabs....it's disheartening and I'm quite sad really but brand switches really affect me badly. If I didn't have to work to pay my bills etc and could just spend the days walking in nature and growing on my allotment then maybe I could have settled in time but I can't and I cannot cope with my intense job as a mental health support worker when I feel that unwell...I know feeling unwell comes with the territory in WD but I just couldn't do this 

 

Then today my big brother who is a psychiatrist contacted me to tell me that he thought it was a bad idea what I am doing and that I should reconsider for the sake of my health. He thinks that my history of severe recurrent depression puts me at great risk of further episodes that could put my life at risk and he urges me not to continue...this has really shaken me up and combined with my ongoing WD has made me feel pretty bad

 

So I will now try and stabilise again on 15mg and consider what I will do next...I really badly want to live a medication free life but there is a part of me that does worry that he is right

 

I need sleep and time off for a while 

 

Thanks for listening 

[Ripley]

Hi Malbec

 

I'm sorry to hear that your changeover to liquid hasn't worked out. It sounds like you've made the right decision to stop given your work commitments etc....One of the hardest things about WD symptoms is not knowing how long they will last and it's very hard to struggle on indefinitely, especially when you're trying to hold down a job. At least now you know you will settle down again soon and feel better.

 

Try not to see it as a failure but more as a tactical retreat. I'm sure I've read in the Mirt tapering section that people still taper from the pills. It might be more faff than the liquid but still possible! You can shave tiny amounts off using the Gemini scale and I think some people grind them up and make their own suspensions. 

 

I'm sorry your brother isn't supportive of your wish to be drug-free. I'm sure he has your best interests at heart. If you do decide to continue tapering, you will have the full understanding and support of this community.

 

For now, it sounds like you need to recover from this latest destabilisation and hold for a while to feel better and stronger again. Then you'll be in a better place to decide what to do next.

 

Best wishes

Ripley

[Gridley]

14 hours ago, Malbec37 said:

brand switches really affect me badly

I'm sorry the liquid didn't work out.  Sometimes it doesn't.  As Ripley said, it's not the end of the world to taper from tablets.  I've tapered Lexapro using tablets (which I grind into powder) and the Gemini scale for the past 3 1/2 years and haven't had a problem with this method, including at the very low doses where I am now (0.1mg).

 

Right now you need to recover from the switch and stabilize.  That might be a several months.  Don't lose heart--you can still be drug-free.

[Malbec37]

@Gridley @Ripley thanks for your kind input.

 

Yes you're right it's not the end of the world that I wasn't able to stabilise on the liquid. I seem to be highly sensitive to changes of brand so I am happy to be stabilising again so I can get on with my life for a while. I have processed what my brother has said and I know deep inside me that I want to get off this medication for good and I will achieve this. I do have other options including making my own liquid with the same brand I take and also using an ora dispensable tablet which is easier to measure...and then yes I can always cut and measure if required. I will investigate these in time and try again

 

Onwards and upwards day by day 

[Ripley]

Definitely! Onwards and downwards 😉

[sunnysideup69]

Hey @Malbec37,

Don't stress. Just let yourself settle. Remember, different types of tapering suit different people and I personally know two people who couldn't get on with liquid forms of their drug.

Ugh, it's just the way that someone will make a destabilising comment when you're in the thick of it.

I'm sure he cares about you, and meant well, but remember he's a psychiatrist and has trained with that ideology ie that we all have incurable brain diseases... perhaps you could gently point him in the direction of Kelly Brogan, Joanna Moncrieff, David Healy, Peter Breggin....all psychs who are not pro medication.

Making a powder is still an option. 

I'm nervous too, about living without meds. It would be unnatural not to be, after being medicated and told a particular story for such a long time. That's why we come off so slowly, though. It's a tiny, gradual change.

Of course, we also have to address our underlying patterns/ diet etc. As you already do. Therapy is also really helpful for stress management.

I don't know about you, but for me, it was the anxiety that lead to a diagnosis of 'depression' in the first place. As Kelly Brogan says, they are really symptoms of something in our lives being amiss. For me, it's always been helpful to therapeutically work on managing anxiety.

 

Thinking of you. You've got this. Have a rest and settle back on the tabs 😊

 

[juneight]

Hi everybody. Some of you may know me form the forum. I want myself to include your conversations about tapering Rem. Is there a group or platform here apart from Introduction to talk about that?

[ChessieCat]

4 minutes ago, juneight said:

Hi everybody. Some of you may know me form the forum. I want myself to include your conversations about tapering Rem. Is there a group or platform here apart from Introduction to talk about that?

 

tips-for-tapering-off-mirtazapine-remeron

 

It's okay to ask general questions in the above topic, but please make sure that you post questions specific to your own taper in your own Introduction topic so that your history is all in one place.

 

Edited August 19, 2020 by ChessieCat

[sunnysideup69]

Hey @Malbec37, how are you resettling on the tablet version of Mirtazipine? Sending good wishes. I'm just down the road from you today, visiting my parents in Chippenham. 😊

[Malbec37]

3 hours ago, sunnysideup69 said:

Hey @Malbec37, how are you resettling on the tablet version of Mirtazipine? Sending good wishes. I'm just down the road from you today, visiting my parents in Chippenham. 😊

 

Hey @sunnysideup69 thanks for the message! Funny to think of you just down the road in Chippenham with your folks...I hope they are doing ok and you too - you've all been through so much so thank goodness you have each other for support...family is so important if we are fortunate to have some of it.

 

I'm ok, sort of...I'm about 10 days in to returning back to the 15mg tablet mirtazapine and it's been pretty horrendous at times I have to say - I think I'm just destabilised by trying to get on the liquid (and failing - I know not to be hard on myself for that) and now back on the tablets and my CNS is confused and trying to catch up I guess....so it's hard, Thursday I had a terrible day of intense anxiety, fatigue, panic and nausea and had to work and teach yoga and was a thoroughly exhausting and upsetting day and I just felt so done with the whole god awful process and all the suffering we are having to go through to try and rid ourselves of these drugs - I took Friday off and had a restful day and then today I feel sort of ok but still pretty rubbish although I did have some dried ginger tea, quite strong, for the nausea and it seemed to help with that symptom 

 

So I'm struggling on and hoping I'll stabilise soon but I'm aware that it could take a few weeks but what can I do other than keep going and trying to be kind myself...it's very tough but I know you know all about it as do all the other souls on this website. Once I'm stable then I'll consider trying a new strategy to taper but not sure what yet

 

I'm starting to realise that the taper process could take me an awful long time and I think I'm starting to accept that....there is no quicker way to do it, it can only happen at the pace that my body requires, this has taken some acceptance but all I want is to be able to taper slowly and not suffer too badly as my fear is tapering slow AND awful WD the whole way through...I just pray that I can avoid this as I am already pretty done in by the whole experience and it's a lonely place but thank goodness for this site and also the FB groups which I find hugely helpful 

 

Wishing you a happy weekend with your folks 

 

Malbec xx

[sunnysideup69]

Thanks @Malbec37,

Over all, it was a good weekend. But in WD, normal family annoyances just feel a bit amplified, I guess. Started to feel like a wave was coming, which didn't help, but I survived and they were really glad to see me and I, them.

 

You'll restabilise, just try not to put a time frame on it. Sounds like you did amazingly with working when feeling so crappy. I know that's tough and can feel very isolating. 

Onwards and upwards, as they say....we will get there, even though it may be at snail's pace.

[Malbec37]

Hi everyone, hope all are well and here is my update:

 

So I am now very stable after the recent problems of trying to switch onto the prescribed liquid here in UK and failing to settle and having to go back onto the 15mg tablets. I fully accept it didn't work and will now be going down the route of making my own suspension from the 15mg tablets that I use...the advantage is that I get to stay on the same BRAND throughout that I am used to and brand really matters to me...the 2 recent periods of horrible wavey destabilisation have come from brand changes and then trying to restabilise. I am in the process of trying different methods of making the liquid and I am making progress..it will essentially be 15ml liquid to 15mg mirt. I am planning to switch across at the same amount 15mg in October and then give myself up to 4 weeks to get used to the new form of medication before doing my first 10% in November.

 

I spoke to my GP recently who agreed that this was the only realistic way left to me to taper (although I can cut and measure but don't trust this enough)...the GP also said why don't you just wait until spring 2021 to start tapering again as there is lots of difficult things happening in the world and winter is coming etc...I told him that I do not want to drag out an already very long process any longer so cannot wait (as much as 6+ months of stability is attractive)...so I will be continuing and feel that I am learning a lot at each stage. I am hoping that the liquid taper will work but it does seem tried and tested and I'm being very meticulous in planning it so I feel confident in the process. 

 

I want to make some progress now but equally will not rush anything and will hold as long as is necessary at different stages.

 

I am also starting to think about a low histamine diet and implementing it as mirtazapine is an anti-histamine and as you get lower you need to be careful about having too much histamine in the system...this frustrates me a lot as if it wasn't hard enough to get off this stuff!!

 

Everything else in my life is pretty ok...work is stable enough and I'm still teaching yoga and mostly enjoying it 

 

That's it for now 

 

Malbec

[Ripley]

Hi Malbec

 

I was wondering how you were getting along and I'm so pleased to see that you're stable again! That's great! It sounds like you have a good plan for moving forward with making your own liquid. I would also feel the same and not want to wait a further 6 months to begin. With a gentle taper, you could have reduced by a good few milligrams in that time!

 

Perhaps when you're ready to start you could try a 2.5% weekly drop as in the Brass Monkey slide taper. Personally, I feel a 10% drop in one go could be too much for me as my system still feels sensitized. And my own anxieties feed into my sleep issues so even if it's only psychological I'm keeping my drops small. But you will be the best judge.

 

I don't have much to add to the histamine discussion as I don't follow a particular diet and haven't seen the need to. I eat healthily and am strictly no alcohol or caffeine and am avoiding supplements and herbal things or anything unusual for a while! But small amounts of chocolate and sugars in general, dairy etc...seem to be fine. 

 

I'm glad you're back on track now Malbec and good luck with the next steps!

 

Ripley

[Malbec37]

6 hours ago, Ripley said:

I would also feel the same and not want to wait a further 6 months to begin. With a gentle taper, you could have reduced by a good few milligrams in that time!

 

Hi @Ripley thanks for the response and yes I agree with you why wait any longer...I could be down a very mg by next spring and making nice progress

 

Also thanks for the reminder about the Brass Monkey Sliding Scale...I will research this and see if it appeals to me 

 

Do you make your own liquid? I'm planning on using a mixture of warm water and possibly a drop of alcohol to dissolve the tablet then maple syrup as the suspension agent 

 

6 hours ago, Ripley said:

I don't have much to add to the histamine discussion as I don't follow a particular diet and haven't seen the need to.

 

Yes I agree it's not definite that I will be affected by this histamine thing...but it's good to know and I will keep an eye out on what happens when I decrease and if I get stronger WD then I can always cut a few of these things out no problem

 

6 hours ago, Ripley said:

I'm glad you're back on track now Malbec and good luck with the next steps!

 

Thanks! Yes so glad to be feeling stable once again and getting ready for my cross over in a few weeks

 

Malbec 

[Gridley]

8 hours ago, Malbec37 said:

I am planning to switch across at the same amount 15mg in October

Malbec,

 

I'm glad to hear you're doing so well.

 

Are you planning a gradual crossover from the tablets to the homemade liquid?