enaz: mirtazapine withdrawal, insomnia

[Shep]

14 hours ago, enaz said:

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.

 

Some information for insomnia:

 

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

 

You may also find guided meditations helpful, such as this one:

 

Guided Meditation Deep sleep | anxiety and insomnia relief | relaxation before bedtime video (21 minutes)

 

It's important to find non-drug ways of relaxing and learning to let go of your thoughts prior to trying to sleep. Having a cool, dark place to sleep is also helpful. Dark shades over the windows or wearing a sleep mask can keep early morning light out. 

 

A few more questions: 

• Are you taking any other drugs besides psychiatric drugs? If so, please list them. We need to see if there may be any drug interactions. 
• How is your diet? Do you consume any caffeine or sugar? How often were you having alcohol?  
• On the days when you didn't take Zopiclone, did you take Xanax? 

 

Edited August 17, 2020 by ChessieCat
Made questions heading a bit more noticeable

[ChessieCat]

1 hour ago, Shep said:

A few more questions: 

• Are you taking any other drugs besides psychiatric drugs? If so, please list them. We need to see if there may be any drug interactions. 
• How is your diet? Do you consume any caffeine or sugar? How often were you having alcohol?  
• On the days when you didn't take Zopiclone, did you take Xanax? 

 

Just drawing your attention to the questions which Shep asked, just in case you overlooked them. ☺️

[enaz]

 

Dear Shep

I have read your inspiring story this morning. In answer to your questions

 

Sometimes I have taken Zopiclone and Xanax on the same day and sometimes not.

 

August 2     3.25 Zopiclone.   NO Xanax

August 5      3.25Zopiclone   .5 Xanax

august 9      3 25. Zopiclone     No Xanax

August 12    3.25 Zopiclone   NO Xanax

August 15  3.25. Zopiclone  .25 Xanax

 

My diet is very good - very, very little red meat, mainly chicken and fish, vegetables, fruit. I have recently cut out all caffeine. I was having a little alcohol (mainly red wine) most evenings but on your advice I have very recently cut it out.

I do have some sugar in desserts etc but I will cut down. I suppose I should cut out honey too

 

I am not on any other medication. I am taking magnesium, vitamin C and I have just bought fish oil.

 

Thank you

[Shep]

Thanks for this information, Enaz. It's quite possible that the alcohol has been causing a lot of the sleep problems, in addition to possibly being dependent on the z-drug and / or benzo. You can google "alcohol and sleep disturbances" and find many articles linking the two.  

 

I belonged to a benzodiazepine withdrawal site where a couple of people were tapering off alcohol slowly. So you might want to consider tapering alcohol instead of going cold turkey. This will help with any withdrawal symptoms. You don't have to be an out-right alcoholic or heavy drinker to become dependent. This is especially true as we get older and metabolize alcohol differently than when we were younger. 

 

It's really hard to say if you're dependent on the z-drug and / or benzo, so if you think you are, you'll want to take a daily dose and once you're more stable after stopping alcohol, do a taper off the drug. However, if you're able to find non-drug ways of coping, you may want to try those first. Breathing exercises, gentle stretches, learning mindfulness to tune out negative thoughts, and distractions such as the "change the channel" technique can all be very effective. 

 

Please post your thoughts on this. The fact that you're eating a clean diet, avoiding caffeine and cutting back on sugar, and at the age of 77, aren't on any other drugs will all work to your favor. 

[enaz]

 

Thank you Shep. There is just one thing you have said that I don’t quite understand.  - you say that if I can find non drug ways of coping I may want to try these first (along with tapering alcahol) - do you mean I could consider doing this rather than staying on a daily dose of benzo and then tapering off. My thought is that I will certainly try the non drug approach but I think I need the small dose of benzo for a while. I do want very much to taper off the benzo though. I have ordered scales to measure.I am hoping to receive a tapering schedule from you.

 

Thank you sincerely

enaz

[Shep]

If you wish to stay on the benzo and taper off, that's fine. 

 

But please bring the non-drug coping skills in, too. You can do both. We encourage that here. As you taper, bring in as many non-drug coping skills to aid you along the way. 

 

Non-drug techniques to cope with emotional symptoms

 

Tons to choose from! With anxiety and insomnia, the mindfulness type of coping skills work the best. You may also find drawing or coloring, working a jigsaw puzzle in the evenings, and listening to soft, relaxing music to all be helpful in the hours before you try to sleep. Anything you can do to calm the nervous system is helpful. 

[enaz]

I will certainly do these things. Also, I will pick up my knitting which I haven’t done for a while. It is calming.

 

Thanks again

[enaz]

 

 

 

My DIARY

 

Monday 17 August

slept 10.45 -2.40 then woke 

slept 2.40 - 3.05 woke

slept 3.05 - 5.05 woke

dozed off and on til 7.20Responding to questionfrom SA

8.20 breakfast

8.40 getting anxious about my problem with insomnia and anxiety after so long. Will it end

Feel v pleased to be getting so much support from SA

Doing

10.00  took 100mg magnesium, vitamin C

anxious

10 20 took .25 xajax

went shopping

11.30 a little less anxious 

12.00 home, daughter visits for lunch

3pm feel less anxious but very tired even though I slept better last night

took 100g magnesium and omega fish oil

3.45 had a 30 minut nap

4.45 headache 

6.45 walk in park

7.45 home preparing dinner

mild headache

relatively mild anxiety 

8.30- 9.45 watched TV

9.45 had bath

chatted with husband

10.45 to bed 

difficulty falling asleep

12.00 probably fell asleep

1 a.m woke. No more sleep

2.am went downstairs to read

rest of the night trying to sleep 

and getting in and out of bed

6.40 a.m writing this diary

 

 

 

 

 

[enaz]

Dear Shep have you received my diary for 17 August. it actually goes up til this morning 18 August. I hope I’m putting it in the right place

 

enaz

[Shep]

6 hours ago, enaz said:

10 20 took .25 xajax

went shopping

 

6 hours ago, enaz said:

1 a.m woke. No more sleep

 

Enaz, this looks like interdose withdrawal (going into withdrawal in between doses). You took Xanax at 10:20 AM and then about 13 hours later, you were wide awake.

 

However, the day before, you reported:

 

  

On 8/16/2020 at 2:20 PM, enaz said:

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

 

So you were getting anxiety not long after taking the Xanax. This could have been caused by interdose withdrawal from the zopiclone taken at 2:30 AM the previous morning. Or do you think you may have been anxious being around people? That's not uncommon during withdrawal. Even close friends and family members can be overwhelming to someone who's not feeling well. 

 

Please continue with the daily journal so we can see if there's a definite pattern with your symptoms. Please take your drug(s) at the same time of the day and at the same dose. I'm not sure if you're going to take both Xanax and Zopiclone, so once you make this decision, we can work to set up the best schedule to deal with any interdose problems due to the drugs' short half lives. 

 

Zopiclone's half-life is 5 - 6 hours and the half-life for Xanax is 6 - 12 hours. 

 

Also, please take your supplements at the same time(s) of the day and the same dose. We really need consistency to see if there are any patterns with your symptoms. 

 

 

[enaz]

Thank you Shep

i response to your points 

Anxiety (and insomnia and awaking with fear)  have been consistent since my adverse reaction to Mirtazipine in November. i never had insomnia in my life before Mirtazipine. When I haven’t slept the anxiety is worse the next day.  I find it hard to believe that these symptoms could go on so long after taking Mirt for such a short time. Have you seen this in anyone else.

 

I would like to hope my symptoms are  due, at least in part, to interdose. withdrawal  because then maybe I could fix it. I will really try to take all pills at the same time each day. Unfortunately I did take the .25 xanax at 9 a.m rather than 10.30 a.m this morning because I felt so awful having been up all night. 

 

I don’t think being with people causes my anxiety.

 

With respect to whether I should take Zopiclone and Xanax - I don’t know and really want your advice. on what and how much to take.. My main problem at the moment is insomnia and 3.25 mg of zopiclone has helped me sometimes but not every time. On the rare occasions when I have taken xanax in the evening or at night, I don’t think it has helped much with sleep.

 

Ifeel very bad about bombarding you with my problems It must be quite early in the morning for you. 

Thankyou enaz

 

[Shep]

22 hours ago, enaz said:

Anxiety (and insomnia and awaking with fear)  have been consistent since my adverse reaction to Mirtazipine in November. i never had insomnia in my life before Mirtazipine.

 

It looks like you may be hyper-sensitive to medications - did you have a reaction to the 2017 steroid that caused you to need Xanax? 

 

If you know you were hyper-sensitive to medications prior to psychiatric drug withdrawal, that means you have to be extra careful with your nervous system. That doesn't mean you won't heal, it just means you may have an adverse drug reaction mixed in with withdrawal symptoms. 

 

22 hours ago, enaz said:

With respect to whether I should take Zopiclone and Xanax - I don’t know and really want your advice. on what and how much to take.. My main problem at the moment is insomnia and 3.25 mg of zopiclone has helped me sometimes but not every time. On the rare occasions when I have taken xanax in the evening or at night, I don’t think it has helped much with sleep.

 

Sleep is a number one priority. So if you're able to handle the daytime anxiety without Xanax, than you could focus on using the Zopiclone only. Please note due to Zopiclone's short half-life of 5 - 6 hours, you may need to split the dose and take it several times throughout the day to avoid interdose withdrawal. However, it may not work when the dose is split, so you may need to take it only once a day and handle the interdose symptoms with non-drug coping skills or a bit of magnesium to help. Unfortunately, there really are no great answers, so things like limiting stress, finding distractions, eating clean foods and staying hydrated will help you navigate through some tough insomnia patches. 

 

Another option may be a bit of melatonin taking in the evening. Please see:

 

Melatonin for sleep

 

Please keep posting your daily notes and let us know your thoughts on whether to continue with the Zopiclone and Xanax. 

[enaz]

You are exactly right Shep. Thankyou. I had a very bad reaction to steroids and xanax eliminated the pain and anxiety in 5 weeks. I didn’t have insomnia on that occasion.

 

Can you take Zopiclone during the day and it makes you sleep at night ??. I thought it was only for night and also it is always prescribed with a warning not to take every night or it becomes ineffective or you get rebound insomnia.

 

I will send diary later as have togo out today

[enaz]

Diary 18 August 

Awake most of night

exhausted 

anxious all day

7.45 went for walk

9.O0 a.m took .25 Xanax

10.00 magnesium and fish oil

11.00a.mwent out with husband

12.30 light lunch

3pm magnesium and vit C

emailing

tidying

5.45( pm went for  walk

7pm prepared  and ate supper

8pm talk  to friend on phone

10.30 to bed, couldn’t sleep

slept some between 12 and 3

[Altostrata]

enaz, in the last 2 weeks, how often have you taken Xanax? Why are you taking it in the morning?

[enaz]

I have taken  2.50 xanax on 10 mornings to deal withbad anxiety. I do try not to take it every day but I don’t know whether that is the right thing to do. I don’t think I can do without it at the moment. But I am wondering whether I should  try to take .125mg in the morning and .125 mg later in the day or even at bedtime. That might help me sleep a little better. 

 

enaz

[enaz]

Diary 

19 August

6.a.m slept

7.30 a.m awake, got up

8.30 breakfast

10.00 1/2 xanax, magnesium, fish oil

11.00 with husband to collect grandchild

12.30 lunch

1.30 cooking

3pm magnesium, vitamin C

5.30 took grandchild home

7.15 dinner

8.30 very tired, bath and bed

9pm reading in bed

10.00 pm slept

11.30pm woke but got back to sleep 

4.30 am woke

6.30 may have gone back to sleep

7.30 am got up

 

 

[enaz]

Dear Shep

I know xanax is considered the worst benzo. Du you think I should try to switch to a different one, like Clonazapam which I have used. I think I could get more prescribed. As you know, I am trying to take as little benzo as possible. Do you think the benzo slows down the healing from Mirtazipine withdrawal

Thanks

enaz

[Shep]

On 8/19/2020 at 9:33 AM, enaz said:

Can you take Zopiclone during the day and it makes you sleep at night ??. I thought it was only for night and also it is always prescribed with a warning not to take every night or it becomes ineffective or you get rebound insomnia.

 

Some people experience such severe interdose withdrawal, that taking a small amount during the day is helpful. Keep in mind that you'd be splitting out the 3.25 mg dose, so it likely won't make you very sleepy. That being said, it's best to not drive if you're unsure how it will effect you. 

 

5 hours ago, enaz said:

But I am wondering whether I should  try to take .125mg in the morning and .125 mg later in the day or even at bedtime. That might help me sleep a little better. 

 

If you do this, please move the dose 1 hour a day. This is gentlest on the nervous system as opposed to making abrupt changes. 

 

5 hours ago, enaz said:

I know xanax is considered the worst benzo.

 

There is no good or bad benzo. It's not the benzo, but how dependent you are on the benzo. These withdrawal forums are full of people withdrawing from all kinds of benzos. 

 

Please don't catastrophize over your particular drugs. With a slow and careful taper, you'll be fine. 

 

5 hours ago, enaz said:

Du you think I should try to switch to a different one, like Clonazapam which I have used.

 

Clonazepam has a longer half life, which is a plus and you were recently on it within the past month, so that could be an option. 

 

Which one worked better for you? Why did you switch? 

 

5 hours ago, enaz said:

Do you think the benzo slows down the healing from Mirtazipine withdrawal

 

 

Your body needs to recover from nervous system dysregulation from the many changes. The more you can do to dose consistently, the more your nervous system will calm down. This post may be helpful:

 

How psychiatric drugs remodel your brain

 

5 hours ago, enaz said:

10.00 1/2 xanax, magnesium, fish oil

 

Please place the dose in your daily notes. Did you reduce your dose and only take half of what you normally take? 

[enaz]

No, sorry. same dose of .25 mg but 
i have .50mg pills so my dose of .25 is half a tablet

 

Thank you for the advice I am doing breathing exercises. I will think about changing to Clonazapam if I can get a prescription. I’m not sure what you mean by moving the dose 1 hour a day. What do you think about my taking 2 doses of .125mg a day

 

thanks so: much I will do the recommended reading 

[Frogie]

4 hours ago, enaz said:

. I’m not sure what you mean by moving the dose 1 hour a day.

What Shep is trying to explain is if you take your Xanax at 10:00, then the next day take it at 11:00, the next day 12:00, until you get it to the time you want to take it.

 

I hope that makes sense 😊

[enaz]

Diary 20 August

 

7.30 got up and had breakfast

8.30 cleaning 

10.00.25 xanax, magnesium and fish oil

11.00 coffee at daughters house

11.30 took granddaughter out 

 1.pm lunch

2.pm  cooking

3pm took magnesium and vitamin C

4pm to friends house

7.30 dinner

9.30 reading in bed

10.30 tried to sleep

11.30 woke, tried to gat back to sleep with breathing exercise

3am took 3.5 zopiclone 

slept very superficially on and off til 5a.m

 

 

 

[enaz]

Dear Shep, , you said earlier that sleep is really important and that is my major problem. I can manage the daytime anxiety with the small dose of xanax I’m taking but it is very difficult if I’ve had hardly any sleep. I took a zopiclone 3.5 mg at  3a.m this morning. I just had to get some sleep.It has never given me more than a couple of hours sleep and. last night probably even less but it is better than nothing. I don’t think xanax taken before bed would help me sleep any better. 3.50 Zopiclone may not be a large enough dose for me though at my age 3.5 is the recommended dose. I really don’t want to become dependent on it but I have to sleep sometimes.

 

It seems that on average 2 nights a week I get enough (broken) sleep naturally but the other nights are bad and there is no medication I have that makes me sleep very long.

 

I am really trying to practice sleep hygiene, do breathing exercises etc. 
i am also keeping busy. Following your advice  I’m tapering off the wine. That’s no problem as I have never drunk much anyway

 

If you agree I think I will switch to taking a Clonazapam. I would like to try taking two doses of .125 mg per day, morning and evening.

 

Thankyou for your help

 

 

[Shep]

On 8/20/2020 at 4:20 AM, enaz said:

Du you think I should try to switch to a different one, like Clonazapam which I have used.

 

19 hours ago, Shep said:

Clonazepam has a longer half life, which is a plus and you were recently on it within the past month, so that could be an option. 

 

Which one worked better for you? Why did you switch? 

 

Please post the answer to these questions. Why did you switch from clonazepam to Xanax? 

[enaz]

9 minutes ago, Shep said:

When I got very anxious I thought I would take xanax instead of clonazapam because it works faster and because back in 2017 after the steroids Xanax really helped me. But the small dose of xanax .i have taken lately doesn’t help all that much and as you say Clonazapam has a longer half life which is good. My day time anxiety is getting fairly manageable if I get some sleep

Thank you very much Shep

9 minutes ago, Shep said:

 

Please post the answer to these questions. Why did you switch from clonazepam to Xanax? 

 

[enaz]

Dear Shep my real fear is that at my age my sleep will never return to the really good pattern I had. Many old people don’t sleep well. Before the psychiatric meds I always slept well - I was lucky. Do you know of anyone at my age who has returned fully to their former healthy state

 

Thanks

[Shep]

Enaz, please answer:

 

Why did you switch from clonazepam to Xanax? 

 

I can't answer any more questions until this question is answered. 

[enaz]

I changed from Clonazapam to Xanax because at the small dose I am taking it didntb give much relief from anxiety and  I thought that Xanax is supposed to act faster.. In fact neither gives me much relief but I am managing on .250 per day and unless you advise it I don’t think I should have more .?? 

I now think that as Clonazapam has a longer half life it may be better and maybe I should change back. Sorry, I know I’m confused.

 

Thank you

 

 

 

 

 

 

, 

[Shep]

Thanks for this information, enaz. 

 

What do you think about taking .25 mg Xanax in the morning and .125 mg Clonazepam in the evening and stopping the Zopiclone completely? You should space out the Clonazepam at least two hours from your alcohol taper, as benzos don't mix well with alcohol. 

 

Please post your thoughts on this. It's likely going to be a bit rocky for awhile, as neither of these benzos has been particularly effective due to your nervous system being so destablized from the mirtazapine and then the Prozac bridge. The goal is to eliminate interdose withdrawal and get on a regular dosing schedule to help your nervous system stabilize as much as possible. 

 

On 8/21/2020 at 5:51 AM, enaz said:

Do you know of anyone at my age who has returned fully to their former healthy state

 

Here are a couple of benzo success stories from ladies in their 70s from the Benzo Buddies website. 

 

Driving in the Left Lane- pianogirl's Story of Healing and Hope for all of You!

 

My Journey

 

No reason to think you won't heal from all of this. Just takes time and loads of self care.

[enaz]

Thanks Shep for the encouragement. I will certainly try your suggestion of xanax in the morning and clonazapam in the evening. The last couple of days when I have slept so little (last night practically none) the dose of benzo I am taking is just not enough to help me sleep or to help control the anxiety in the day. I am reluctant to up the dose for fear of dependence but I don’t know how long I can go on like this. 

I will now read the success stories you have sent me.

 

best wishes enaz

[enaz]

Dear Shep I have read the stories of successful withdrawal from benzo that you sent and they are positive in that these ladies have recovered but they have also scared me. I’m suffering withdrawal from mirtazipine and taking benzo to help with the symptoms. Will I then have to suffer a horrendous withdrawal from the benzo Im taking

[enaz]

Dear Shep

sorry to be inundating you with so many questions again. I am happy to try your suggestion but I’m wondering why you suggest taking both xanax and clonazepam. 

Also 
i am aware that the Ashton manual suggests switching to Valium. What do you think of that idea

 

Thank you

PS having read the success stories I realise the importance of keeping benzo stories the minimum.

I will also try very hard to stay off the Zopiclone. Do you think it is even worse than clonazapam and xanax

Its wonderful to be able to ask these questions. The doctors and psychiatrists I have seen are so ill informed about the consequences of their prescribing.

[Shep]

4 minutes ago, enaz said:

I am happy to try your suggestion but I’m wondering why you suggest taking both xanax and clonazepam. 

Also 
i am aware that the Ashton manual suggests switching to Valium. What do you think of that idea

 

Valium would be another option. The reason we're discussing clonazepam is because you had asked about going back on it. And Klonopin has a longer half life than Xanax and because you were recently on it, it's safe to reinstate (benzos reinstatements work best within a month of coming off). 

 

Have you ever been on Valium before? If so, when was it and what was your experience? 

 

16 minutes ago, enaz said:

I will also try very hard to stay off the Zopiclone. Do you think it is even worse than clonazapam and xanax

 

This is tricky. Zopiclone's short half-life can be problematic. From what you've written, none of these drugs is helping with sleep. You really are between a rock and a hard place. If Zopiclone helps with sleep, you would want to stay on it. But you aren't getting much sleep from it and it looks like some of the insomnia may be from interdose withdrawal from the morning Xanax. Please correct me if any of this is incorrect. You are the expert on how these drugs are effecting you. 

 

Please note that moving around from one benzo to another does cause you to go into withdrawal from the previous benzo. It can also make you more susceptible to kindling. Here's more on kindling - Kindling.

 

So it's best to set up a game plan for the long run so you're not unnecessarily switching benzos and traumatizing your nervous system even further. This is one reason to go back to Klonopin, as opposed to switching to Valium, if the main reason is the longer half-life. You're still within that one-month time period when it's safe to return to Klonopin. 

 

Does this answer your questions? If not, please post more questions. 

[enaz]

Yes, thankyou so much It does answer most of my questions. No, I’ve never been on valium.I just noticed that it is often used to help taper off another benzo, 

 

This is the last question I promise. Why do you suggest 1 dose xanax and 1 dose clonazapam each day rather than two doses of clonazapam 

[Shep]

14 minutes ago, enaz said:

Why do you suggest 1 dose xanax and 1 dose clonazapam each day rather than two doses of clonazapam 

 

We usually recommend crossing over much more slowly, but since your Zopiclone use was sporadic, I'm hoping the clonazepam covers any dependency you may have to it. 

 

And you don't want to suddenly stop the Xanax because you'll go into Xanax withdrawal. Since you were recently on Clonazepam, you can reinstate a small amount of that to help with dropping the Zopiclone. And since clonazepam has a longer half-life, it will stay in your system longer to help with interdose withdrawal. Let's see how you do with the clonazepam in the evening before deciding about replacing the morning Xanax. If the morning Xanax is more helpful for daytime anxiety, you may want to leave it until you've stabilized from all of these changes. 

 

Again, no easy answers here because your nervous system is already destabilized, so the drugs don't have the effect that they would otherwise. So you'll need to do a lot of self-care in the form of guided meditations, breathing exercises, gentle yoga or stretching, a daily walk, and you mentioned knitting, which is excellent during withdrawal. Anything that calms the nervous system is helpful. 

[enaz]

Thanks Shep, that’s very clear. I have my plan and will follow it clearly. I am walking, knitting and will be swimming this week. i’m trying to meditate but it’s hard, I will take the vitamins regularly and am tapering off my glass of wine.

 

i guess I don’t have to do a daily diary now because the routine is the same every day. I hope I won’t be bothering you with too many questions but will report on my progress in a few days.

thanks and best wishes enaz