enaz: mirtazapine withdrawal, insomnia

[enaz]

I was on mirtazipine for 13 weeks which included a fast taper of 3.5 weeks from 30mg to 7.5mg then off. Never had insomnia in my life before this drug. Insomnia started when on 30mg and has just got worse and worse. Now 7 weeks off and can only get 2 hours sleep some nights. I am a very elderly woman

Will it end. Psychiatrist says this is impossible. GP insisting i,must get some sleep so has prescribed zopiclone7.5mg gives me 3.5 hrs sleep.  Terrible anxiety and panic attacks. 

It is ruining my life and my husband’s. At my age, will this ever end. Has anyone experienced insomnia and how long does it go on. I think anx would lessen if I could sleep naturally as I always did before Mirtazipine 

Edited January 23, 2020 by manymoretodays
moved from another members topic

[enaz]

I was on Mirtazipine for just 13 weeks. Insomnia started when on 30mg. Did a quick taper and now off 7 weeks. In all,

I have had insomnia for 3 months now.  No sleep and terrible anxiety. I am old.but I had a very happy life til I started MIRT for anxiety after a very upsetting event. Never had insomnia in my life

Can anyone say that it will end. h

Hss anyone had insomnia and how long did it last

Edited January 22, 2020 by manymoretodays
moved to introductions from S and S topic

[enaz]

I am very very frightened. Iam very elderly. I was on Mirtazipine for 13 weeks (2 on 15mg then 7 on 30mg then 10 days on 15mg Then tapering to 7.5mg and off.) Docs were telling me to go faster.

 

Insomnia started while on 30mgs which is why I wanted to stop.  but insomnia got worse and worse. sleeping 0 hours or 2 hours at night.

 

Is my life over after such a short time on this drug.  definitely do not want to reinstate because as I said I had the insomnia when on 30 and 15 and lower

[Gridley]

Welcome to SA, enaz. @enaz  I'm sorry you're going through this.  No, your life is not over and yes, it will end but we can't predict when.  Virtually everyone on this site, myself included, has has insomnia to greater or lesser degrees. Unfortunately, 13 weeks on the drug is definitely enough to put you at risk of withdrawal  symptoms, and insomnia is definitely one of the most common of these.  

 

Doctors know nothing about safe tapering or withdrawal (they don't even  believe it exists).  

 

What is withdrawal syndrome.

 

Glenmullen’s withdrawal symptom list.

 

When we take 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.  

 

Video:  Healing From Antidepressants - Patterns of Recovery

 

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 are some tips about insomnia.

 

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

 

Tricks 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=188974895

 

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

 

 Important topics about symptoms, including sleep problems

 

Some members have found Melatonin helpful with insomnia.   

 

 Melatonin for sleep 

 

It's best to start at a very low dosage, such as .25mg, and gradually increase if needed to the lowest effective dose.  

 

I recently cut from 0.5mg to 0.25mg and my sleep is better.  Here is a link where you can buy .3mg, which some studies have show to be an ideal dose.

 

 on Amazon 

 

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

Edited August 17, 2020 by manymoretodays
added an @ notification for member, removed excess white space

[manymoretodays]

Welcome aboard enaz,

I've added an @enaz so you can find your way back here.  I consolidated some of your posts that had been started.

 

 

Gridley's given you some great stuff to look at.

And this won't go on forever.

 

Best,

L, P, H, and G,

mmt

[enaz]

Mirtazipine withdrawal 10 months
i quit Mirtazipine after 11 weeks of use at 15mg and 30mg. The insomnia had actually started after I had been taking it for 9 weeks. I did a taper of 3.5 weeks. The insomnia continued and the anxiety started. In May I thought things we improving. I was sleeping a bit better and did not need to use a sleep aid.  I was getting 5 or 6 hours sleep on most nights. The anxiety was also reduced. Since late June things have become much worse with many sleepless nights. I took my last Mirtazipine pill in November. I am worried that because I am old,  I am never going to get over this.

 

Many months ago, Altostrada offered to guide me but I didn’t pursue that for various reasons. Could I now ask for some help

 

thankyou enaz

 

Edited August 14, 2020 by ChessieCat
added topic title

[ChessieCat]

Q:  Have you been taking any other types of drugs or supplements since you stopped the mirtazapine?

 

So that we can see your drug history at a glance, please create your drug signature.  We need to see details of ALL drugs for the last 2 years and for anything older just a summary.  Thank you.

 

Instructions:  Withdrawal History Signature

Account Settings – Create or Edit a signature

 

 

 

[DataGuy]

On 1/22/2020 at 7:24 PM, Gridley said:

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

 

Tricks 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=188974895

 

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

 

 Important topics about symptoms, including sleep problems

 

Some members have found Melatonin helpful with insomnia.   

 

 Melatonin for sleep 

 

It's best to start at a very low dosage, such as .25mg, and gradually increase if needed to the lowest effective dose.  

 

I recently cut from 0.5mg to 0.25mg and my sleep is better.  Here is a link where you can buy .3mg, which some studies have show to be an ideal dose.

 

 

Hello @enaz,

 

Gridley has provided some excellent resources here. It can take a long time to recover from rapid withdrawal of these drugs. Very likely the reason you began to have insomnia on a higher dose was due to a specific property of Remeron, where at low doses it primarily acts on histamine, but as the dose increases, the effect on norepinephrine (noradrenaline) becomes more dominant, thus making the drug very sedating at low doses but stimulating at higher doses. 

 

I think you should be encouraged that you had begun to recover. There is no reason you can't get back to the place where you were previously, sleeping 5 to 6 hours per night, and then improve from there. Often recovery happens unevenly, with gains followed by setbacks. It can be useful to create a symptom and activity journal, where you record significant events during your day which may have an effect on symptoms. This way you can get at what may be worsening symptoms. You will likely find something that helps you in the tips for sleeping provided by @Gridley. I would suggest looking through there first. 

 

Both heart rate and body temperature variability have been associated with improved sleep (greater variability = better sleep), so exercise can be very useful - in addition to  promoting health - as can saunas. These should be done at least a few hours before bed. Light exercise before bed is fine, but higher intensity exercise should be done earlier in the day. A warm bath a few hours before bed can help with sleep as well, as your body temperature will drop afterwards and this will help encourage drowsiness. 

 

@ChessieCat's questions are also important to answer. It is best to stay away from most supplements and drugs, as these can prevent your brain from returning to its pre-drug state. Some magnesium and fish oil are normally safe for most people and can help improve symptoms. 

Edited August 14, 2020 by DataGuy

[enaz]

Thank you Data Boy  I am fearful that as I am 77 years old I will,not recover but your words are encouraging. May I ask your views on using zopiclone 3.25 a couple of times a week. Also I have taken .25 xanax once a day lately because the anxiety is hard to bear. For nearly 4 months when I appeared to be improving I took nothing but at the moment I am overwhelmed with the insomnia and anxiety. it is wonderfully kind of you to respond to my post

Enaz

[DataGuy]

50 minutes ago, enaz said:

Thank you Data Boy  I am fearful that as I am 77 years old I will,not recover but your words are encouraging. May I ask your views on using zopiclone 3.25 a couple of times a week. Also I have taken .25 xanax once a day lately because the anxiety is hard to bear. For nearly 4 months when I appeared to be improving I took nothing but at the moment I am overwhelmed with the insomnia and anxiety. it is wonderfully kind of you to respond to my post

Enaz

 

Hi @enaz,

 

I'm sorry you are still suffering, but I would highly recommend avoiding both zopiclone and xanax. Xanax is a benzodiazepine and can cause pretty substantial physical dependence (it actually causes the most extreme physical dependence of any drug I know). How long have you been taking this? It may be necessary to taper it slowly. Xanax and drugs like zopiclone (which is a benzodiazepine-like drug, colloquially know as a Z-drug), suppress the nervous system and can help with sleep and anxiety in the short term, but in the long term typically make both worse, as the body tends to react to them by adjusting in the opposite direction (in this case downregulating GABA receptors). It's best to avoid taking these drugs for a more than a couple weeks. You are on relatively low doses, but may still need to taper them, as cold-turkeying can worsen the insomnia as well as other withdrawal symptoms. It may have been that you had a brief down period and when you started taking Xanax and Zopiclone, this prolonged the spell of insomnia. Xanax has a duration of action of around 6 hours, so you may be suffering some interdose withdrawal if you are taking it daily. 

 

@Frogie has been tapering Xanax and may have some tips for you. Here is her thread. Typically we taper Xanax in the same way we taper antidepressants, by reducing 10% once every couple weeks or once per month. 

 

I hope you will take our advice and perhaps avoid further drug-induced problems with your recovery. If you could fill out your drug history by clicking on this link, this will allow moderators and mentors to help you more quickly by seeing what medications you have taken when. Instructions on how to fill out the drug history can be found here. If you have been taking either of these medications daily, please do not stop taking them. It is much preferable and easier on your nervous system to taper. This link explains why it is best to taper drugs by 10%.

 

I'd also like to congratulate you on finding this website. Not too many your age would have the skills and resourcefulness to find and use a site like this. I hope we can help. 

 

Edited August 14, 2020 by DataGuy

[enaz]

Thank you so very much. I have tried desperately and in vain to find some support since my symptoms were triggered by Mirtazipine. I’m overwhelmed by your speedy responses. I have to go out now but I hope I can write again very very soon with more details about my situation and more questions. I will be so grateful to stay in touch. with you.

 

enaz

[Altostrata]

3 hours ago, enaz said:

Also I have taken .25 xanax once a day lately because the anxiety is hard to bear.

 

Hello, @enaz. How often have you been taking Xanax, for how long? @Frogie will help you with this.

 

Have you taken any antibiotics, alcohol, made any drug changes in the last few months?

[enaz]

Thank you for your response. I have already sent a reply by email but I will summarise

Taking Xanax or Clonazapam in small dose once a day on and off since July 2019.I miss some days and hardly took any in March,Apri, May 2020.

Have been doing social drinking

Have been taking small dose Zopiclone on and off for 9 months. Again, hardly any when symptoms were improving fromMarch to June this year.

No other meds but I have tried loads of OTC stuff for sleep. Doesn’t work

Thanks again enaz

[Frogie]

2 hours ago, enaz said:

Thank you for your response. I have already sent a reply by email but I will summarise

Taking Xanax or Clonazapam in small dose once a day on and off since July 2019.I miss some days and hardly took any in March,Apri, May 2020.

Have been doing social drinking

Have been taking small dose Zopiclone on and off for 9 months. Again, hardly any when symptoms were improving fromMarch to June this year.

No other meds but I have tried loads of OTC stuff for sleep. Doesn’t work

Thanks again enaz

If you sent me a message, I never received it?
 

How much Clonazapam, Zopiclone and Xanax do you take each day? And at what times? How long have you been taking it? 

 

 If you can answer these questions, we can set up a taper for you. I will be happy to help you.

Edited August 14, 2020 by Frogie

[enaz]

 

Thank you so much for your response and offer of help

 

I have been taking Clonazapam and Xanax for more than a year but in an on and off very erratic way. This is partly due to the advice of different doctors and then my giving up on doctors. Mainly the idea has been that I take a benzo on a prn basis. I have tried very hard to take as little as possible

 

 I have taken Zopiclone for 10 months - again, off and on at an average rate of 10 per month

 

Xanax July 2019 -September 2019 - .25 (occasionally.50) per day at varying times

Clonazapam September 2019 - February  2019 .5 per day in the morning and sometimes .5 in the evening

March - June  2020 only a very few pills

June - .25 clonazapam (very occasionally.50) per day on most days but at varying times

July - now xanax .25 (very occasionally.50) per on most days at varying times

 

I know!! It’s a mess. The only good thing is that I take a low dose. I haven’t been under medical supervision recently because the GP and 3 psychiatrists I consulted after Mirtazipine made me ill were very, very, unhelpful and wanted to put me on different ADs or various other drugs.  

Just for the record I had a 5 week course of Xanax in 2017after steroid injections made me ill. The Xanax worked well and I just quit without a problem after 5 weeks.

 

Im not sure how to taper off .24 mg of benzo per day. A pill cutter?

 

Enaz

 

 

[ChessieCat]

Please keep you drug signature simple so we can see drugs, dates and doses at a glance, ie we don't need explanations/descriptions.  If you wish to keep the current drug signature copy and paste it into a post because altering it.  Please include ALL drugs.  We need details for anything during the last 2 years.  Anything old can be a summary.  Thank you.

 

Instructions:  Withdrawal History Signature
Account Settings – Create or Edit a signature

[enaz]

Hi ChessieCat

I have edited my signature. I hope it is clear now

[Frogie]

Have you been taking the Xanax .25 mg consistently for over a month? If you have, unfortunately your body has probably become dependent on it.

 

My best suggestion would be to weight the tablets and then you can do a 10% taper a month to taper off of it.

 

Do you have a scale? If not, you can purchase them on Amazon fairly inexpensive.

 

Can you tag me so I can answer you? @Frogie . Then I know you answered me😊

 

Take care,

 Frogie xx

[Shep]

On 8/14/2020 at 4:10 PM, enaz said:

Taking Xanax or Clonazapam in small dose once a day on and off since July 2019.I miss some days and hardly took any in March,Apri, May 2020.

Have been doing social drinking

Have been taking small dose Zopiclone on and off for 9 months. Again, hardly any when symptoms were improving fromMarch to June this year.

No other meds but I have tried loads of OTC stuff for sleep. Doesn’t work

 

Hi, Enaz.

 

We recommend avoiding alcohol during your taper (and well afterwards). Please note that alcohol works on the same receptors as benzos do. Dr. David Healy, who is well versed in withdrawal, refers to benzos as "alcohol in a pill." 

 

As Dataguy mentioned, some of your symptoms are likely due to interdose withdrawal (withdrawal in between doses). You may also be getting rebound anxiety from the off-and-on dosing. Your nervous system is seeking stability, so the more you can do to take the same dose at the same time(s) of the day each day, the more stability you'll give your nervous system. 

 

Using OTC remedies can add to paradoxical reactions. The more you dampen down your nervous system, the more your nervous system fights to stay awake. This creates the paradoxical reaction. The simpler you can keep your taper by not adding in more sedating drugs or supplements, the better. 

 

As Frogie mentioned, due to the length of time you've been on benzos, you're likely dependent. 

 

The best advice is to find the lowest benzo dose that gives you some sleep each night, with the benzo spaced out so that you don't go into withdrawal in between doses.

 

If you want us to help you set up a schedule, please start a drug and symptoms journal. Please see the below for instructions and an example of what is needed. Also include:

 

• any supplements you are taking
• any OTC meds you are taking
• any alcohol you drink

 

After a few days of keeping a journal, we can help you set up a benzo schedule. Since it's almost impossible to taper off benzos with periodic use, setting up a consistent schedule will set yourself up for success.  

 

 

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

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

 

Edited August 16, 2020 by Shep
added bolding

[enaz]

Thank you very much. I t is amazing that you are taking so much trouble to help me. I really appreciate it. I will definitely follow your advice because I am clearly doing it all wrong. Last night I hardly slept and all day today my anxiety has been awful.

 

I will start the diary immediately .

 

The small dose of benzo I have been taking erratically dose not  calm my anxiety or help me sleep. I have been frightened to take a larger dose or more frequent dose. Do you think I should start taking .25mg xanax in the morning and .25 in the evening. (I will have to go to a psychiatrist soon for a prescription as I don’t have too many tablets left.) immediately or just carry on with one .25mg dose until I have completed a few days of the diary.

 

Again, thankyou enaz

 

[enaz]

Diary

Sunday 16 August

to bed at midnight but could not sleep  

read 

2.30 took 3.25 mg zopiclone 

slept for maybe 1.5 hours

6.am very tired, mild anxiety

8.00 am light breakfast

9.30 am walk

11.30 am brief visit to daughter

12.30 pm exhausted tried to sleep but could not

1.30 did some chores

2.30 took .25 xanax

tried to sleep again. May have slept 20 minutes

3.00 to friends for meal

very, very, anxious 

6.45 came home very anxious and frightened

don’t know whether to take .25 xanax or not. PLEASE ADVISE 

 

 

[enaz]

Dear Frogie

thanks so much for your help. I don’t know how to tag you. I will buy a scale as you advise.  

[enaz]

I forgot to mention that I take vitamin C and 200mg magnesium every day. I will definitely drink no alcohol or take any OTC meds

Many thanks

[Frogie]

9 minutes ago, enaz said:

Dear Frogie

thanks so much for your help. I don’t know how to tag you. I will buy a scale as you advise.  

Sounds good.

 

To tag someone, you just use the @ symbol then type in the name (don’t use spaces). So it would look like @enaz.

[enaz]

@Frogie

[Frogie]

21 minutes ago, enaz said:

Diary

Sunday 16 August

to bed at midnight but could not sleep  

read 

2.30 took 3.25 mg zopiclone 

slept for maybe 1.5 hours

6.am very tired, mild anxiety

8.00 am light breakfast

9.30 am walk

11.30 am brief visit to daughter

12.30 pm exhausted tried to sleep but could not

1.30 did some chores

2.30 took .25 xanax

tried to sleep again. May have slept 20 minutes

3.00 to friends for meal

very, very, anxious 

6.45 came home very anxious and frightened

don’t know whether to take .25 xanax or not. PLEASE ADVISE 

 

 

If you take Xanax twice a day then you need to take it twice a day. You need to take it at the same time every day. 

Just now, enaz said:

@Frogie

It worked. Thank you.

[enaz]

Dear Frogie I’m not sure where to put the @Frogie.  In the reply box or where and why is it important to tag you rather than just put a reply in the reply box. So sorry, I’m not very technically strong 

[Frogie]

38 minutes ago, enaz said:

Dear Frogie I’m not sure where to put the @Frogie.  In the reply box or where and why is it important to tag you rather than just put a reply in the reply box. So sorry, I’m not very technically strong 

It’s ok. Just put the @Frogieat the top of the page that you are typing on.

 

It would look something like this:

 

@enaz

 

Hello...

[enaz]

Dear Shep

Im sorry to inundate you with questions.You say I should take enough benzo to be calmer and get some sleep.  I presume you would advise using only one drug so should I stick  to the Xanax and would a dose in the evening help with sleep, or is it necessary to take it immediately before bed. I presume I should stop taking any zopiclone.

 

Hopefully I will be able to establish a positive regime and taper and then I won’t have to bother you so much.

 

Im so grateful to have found a group of people who care so much

 

enaz

[Shep]

4 minutes ago, enaz said:

I presume I should stop taking any zopiclone.

 

Enaz, you have in your signature that you've been taking an average of 12 Zopiclone pills per month going back to November 2019. 

 

It's possible you're dependent on the z-drug, but it's also possible the Xanax may help with z-drug withdrawals, so it's very hard to give advice just yet. Do you know the days you've taken the zopiclone in the past 2 weeks? If so, please list the days. 

 

1 hour ago, enaz said:

Do you think I should start taking .25mg xanax in the morning and .25 in the evening. (I will have to go to a psychiatrist soon for a prescription as I don’t have too many tablets left.) immediately or just carry on with one .25mg dose until I have completed a few days of the diary.

 

Since you've been taking just one a day, I would stick to that. Let's see how you're doing over the coming days as you work to get a more consistent schedule.

 

1 hour ago, enaz said:

I forgot to mention that I take vitamin C and 200mg magnesium every day. I will definitely drink no alcohol or take any OTC meds

 

Please include these supplements in your daily notes. 

 

Some additional questions: 

 

• Which helps you more for sleep - zopiclone or Xanax? 
• Are you taking any other drugs besides psychiatric drugs? If so, please include them in your daily drug and symptoms journal. 

[enaz]

I have taken Zopiclone on August 2,5,9,12,15.  I often take a slightly smaller dose than 3.25 mg. I have taken it typically after waking up in the middle of the night. It does not give me many hours of sleep and on the last 2 occasions it didn’t seem to work at all. I have never tried to take a xanax for sleep. I have always taken xanax for anxiety and much earlier than bed time.

 

Thanks for all the attention enaz

[Altostrata]

@enaz, what does this mean "Prozac bridge Dec 2019 - Jan 2019" in your signature?

 

When did you start Prozac and when did you go off? Was it a bridge off mirtazapine? Please correct your signature.

 

Why were you taking clonazepam in September 2019? How did you feel after you went off Prozac?

[enaz]

CLONAZAPAM  prescribed by psychiatrist at same time as Mirtazapine (while Mirtazipine “kicked in” )to treat my anxiety.. Initially “.5mg up to 3 times a day prescribed for 2 weeks. I never took more than 2x .5mg and usually only one. After the initial 2 weeks I was prescribed.5mg as needed or prn. After 9 weeks on Mirtazipine I had a very bad reaction to it. I couldn’t sleep at all etc. The psychiatrist wanted me to go straight on to Sertraline , which I refused. I won’t go into the difficult weeks I had with the psychiatrist after that,  I tapered off Mirt over 3.5 weeks. My insomnia and anxiety were the same or worse.

 

Eventually my GP suggested I take PROZAC for a while to mitigate the withdrawal from Mirt. I took Prozac 10mg daily for 5 weeks. I felt no different after I stopped taking it. The insomnia and anxiety continues.

 

 

[enaz]

Thank you Altostrada for all your help. I have edited my signature as you have asked. I have also changed my Xanax and a Clonazapam use to prn rather than pd because as I have explained I have been taking these meds on and off and very erratically. Many days I have taken none and for 4 months from March to June 2020 I took hardly any. I have not had any medical support since i,parted company with the psychiatrist last November.

enaz

[enaz]

Do I put my daily diary entry into this reply box or is there another place for it

[Hanna72]

Hi @enaz

29 minutes ago, enaz said:

Do I put my daily diary entry into this reply box

Yes you put it in the reply box.

Take care.