enaz: mirtazapine withdrawal, insomnia

[Shep]

3 hours ago, enaz said:

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.

 

Please keep a daily diary on paper or on a Word doc. That way if you do run into problems, you can post for us to review with you. And no worries on the questions. You haven't asked anything so far that wasn't a valid question. This is a learning experience for everyone who comes here. 

[enaz]

Dear Shep

I will keep up a daily diary. Thanks for all the support. I hope I will heal gradually and will inform you of progress or setbacks. You are doing wonderful work

enaz

[enaz]

Dear Shep

I have 2 questions - 

1. Often I can get to sleep but I always wake up several times in the night, sometimes I can get back to sleep but often, around 3a.m. I can’t get back to sleep. Would  it be o.k. to take my evening benzo then rather than earlier in the evening so Hopefully I can get a bit more sleep

2. Although I feel I need the benzos to function I am worried that they will prevent my recovery from the mirtazipine withdrawal. 

I have been sticking to the plan you advised so I am taking .375 benzo per day. I believe that is a low dose but I am scared of dependence 

Thank you for all your help

enaz

[Shep]

On 8/29/2020 at 4:11 AM, enaz said:

1. Often I can get to sleep but I always wake up several times in the night, sometimes I can get back to sleep but often, around 3a.m. I can’t get back to sleep. Would  it be o.k. to take my evening benzo then rather than earlier in the evening so Hopefully I can get a bit more sleep

 

This sounds like a good idea, especially since you're waking around the same time each night. 

 

Hopefully the timing won't vary significantly and the additional sleep will make your daytime symptoms more manageable. 

 

On 8/29/2020 at 4:11 AM, enaz said:

2. Although I feel I need the benzos to function I am worried that they will prevent my recovery from the mirtazipine withdrawal. 

 

You're dealing with polypharmacy and in order to stay as well as possible, if the benzo is helping you sleep, then it will only help your recovery. Since you're also dealing with benzo dependency, taking the benzo regularly will help with the withdrawal from that drug. 

 

On 8/29/2020 at 4:11 AM, enaz said:

I have been sticking to the plan you advised so I am taking .375 benzo per day. I believe that is a low dose but I am scared of dependence 

 

You're likely already dependent, but there's nothing to fear because you have the information you need to set up a slow and careful taper. 

[enaz]

Thank you Shep for your thoughtful response.

Although my sleep is very erratic and I suffer anxiety every day, I really would like to taper off the benzodiazapines slowly as I am so worried about being on them so long. As time goes on I think the worry is cancelling any benefit I get from them. 

 

I would be most grateful if you would create a tapering schedule for me. I am going to ask the doctor for a prescription of the smallest dose of clonazapam .125mg, and the smallest dose of xanax .250mg. I will be able to cut these to get smaller doses.

 

The pills I have at the moment are .5mg for both these meds so I am already cutting the clonazapam in quarters and it’s not accurate and it is impossible to cut them further.

 

Thankyou enaz

[Shep]

6 hours ago, enaz said:

Although my sleep is very erratic and I suffer anxiety every day, I really would like to taper off the benzodiazapines slowly as I am so worried about being on them so long. As time goes on I think the worry is cancelling any benefit I get from them. 

 

 

I hear you, but going off these drugs too quickly can really damage your nervous system. To quote an analogy that's used a lot on the benzo forums: Tapering slowly and carefully is like taking the steps. Going too quickly is like jumping out the window. 

 

Being on a drug that causes this level of dependency will harm you a lot less than coming off too quickly. 

 

6 hours ago, enaz said:

I would be most grateful if you would create a tapering schedule for me. I am going to ask the doctor for a prescription of the smallest dose of clonazapam .125mg, and the smallest dose of xanax .250mg. I will be able to cut these to get smaller doses.

 

The pills I have at the moment are .5mg for both these meds so I am already cutting the clonazapam in quarters and it’s not accurate and it is impossible to cut them further.

 

Please ask your doctor for liquid formulas for both of these drugs, if they're available where you live. I believe clonazepam comes in the brand Rosemont in the UK, but also ask if Xanax is available in liquid prescription. 

 

If not, you can make a liquid solution using the tablets, but let's first aim for the prescription liquid. 

 

[enaz]

Thank you Shep, I am so sorry but I have become so frightened, particularly of the xanax. Do you think,I could drop the Xanax  and take  .125mg Clonazapam morning and night so .250 per day. 

I appreciate your patience. I know I keep changing my mind. This last year has nearly driven me mad. 

Please forgive me and if possible reply soon because I am frightened to take Xanax tonight

I will try to get a liquid formulation from the doctor 

thanks so much and apologies 

enaz

[enaz]

Dear Shep, maybe even one dose per day of .125 clonazapam would be enough as I was on .250 for quite a while. .125 clonazapam is apparently equal to 2.5mg of diazepam which is often the dose per day given for anxiety in the UK.

I am truly sorry for being so deranged

enaz

[enaz]

Dear Shep in an earlier post, you , or maybe it was one of the other mentors, suggested that I find “the lowest dose of benzo” that would help me with sleep and during the day. I think I would like to try .125 clonazapam twice daily. Or do you think this is too low a dose and will damage my CNS

thank you for your enormous patience

enaz

[enaz]

Dear Shep

by now you will be really fed up hearing from me - I’m so sorry. Looking back over earlier posts I notice that one of the mentors emphasised that Xanax results in the worst withdrawal of all benzos. Over the last 2 months I have taken about 11 mgs Xanax in total and prior to that I didn’t have any since February. If I taper I will be taking a lot more. However I will take your advice if you think I should continue to take it. But surely I can take a very small dose to start the taper.

 

An important point is - how interchangeable are these benzos. Am I depend on benzos or am I dependent specifically on xanax and specifically on clonazapam, so that ?I have to taper each one individually 

I can’t apologise enough for the torrent of questions

enaz

 

[enaz]

Dear Shep

Im sorry for writing to you like a crazy person. I was reading people’s accounts of tapering off benzos slowly and carefully and still suffering terribly. I have suffered 10 months from Mirtazipine and I now dread a long drawn out suffering from benzos in addition. But I am sticking to the plan I agreed with you and hoping that when you can you will a answer my questions of yesterday.

I have another question. I was taking benzos from August 2019 til January 2020. I then stopped. I didn’t taper off the benzos. I was feeling much better from February to June and thought I was healing from the Mirtazipine. I then started to feel bad again and started taking benzos again. So I have been taking benzos again for two months. I don’t know whether to consider myself a two month consistent user or whether to count my use from August last year, in which case I have been using benzos for over a year. The recommendations seem to be that if you have been using for 2 months, a long taper may not be necessary. I don’t know if my gap of 5 months in benzo use will have saved me from dependence, or not. 
I can see that the whole community that knows about benzos recommends a slow taper but to continue taking them for several:more months after having taken them on this occasion for only 2 months seems hard. Maybe my going on for several months then coming off and then going on has just made dependence more likely.

I do appreciate your patience Shep 

[ChessieCat]

20 hours ago, Shep said:

 

Being on a drug that causes this level of dependency will harm you a lot less than coming off too quickly. 

 

 

[Shep]

 

On 8/29/2020 at 4:11 AM, enaz said:

I have been sticking to the plan you advised so I am taking .375 benzo per day. I believe that is a low dose but I am scared of dependence 

 

20 hours ago, enaz said:

Dear Shep in an earlier post, you , or maybe it was one of the other mentors, suggested that I find “the lowest dose of benzo” that would help me with sleep and during the day. I think I would like to try .125 clonazapam twice daily.

 

Please pick a dose and a consistent time(s) of the day to take a benzo and stick to it. You are currently in a safe timeframe to go back to Klonopin, but I still would do so gradually because you've been on Xanax long enough to become dependent on it. You could swap out 25% of the Xanax with Klonopin for a few days and see how you do. If you switch to liquid clonazepam, you'll have an easier time of tapering. 

 

 

19 hours ago, enaz said:

Looking back over earlier posts I notice that one of the mentors emphasised that Xanax results in the worst withdrawal of all benzos.

 

I don't know what context this was in, but I don't know of any benzo that causes "worst" withdrawal. There are members here and on other forums dealing with problems coming off Ativan, Klonopin, Valium, Librium, etc. It's not about the drug but about the damage to the nervous system due to abrupt changes, including previous drug withdrawals. 

 

4 hours ago, enaz said:

I don’t know whether to consider myself a two month consistent user or whether to count my use from August last year, in which case I have been using benzos for over a year. The recommendations seem to be that if you have been using for 2 months, a long taper may not be necessary. I don’t know if my gap of 5 months in benzo use will have saved me from dependence, or not. 

 

Two months is more than enough time to become dependent. It only takes 2 - 4 weeks of even periodic use for many people to become dependent on these drugs. Also, I don't see a gap of 5 months in benzo use in your signature. You were on clonazepam from September 2019 - January 2020 at .50 mg and then January 2020 - July 2020 at .25 mg. And you were also on Xanax a lot of that time and are still on it, along with adding in a z-drug along the way. This speaks to dependency, along with trying to help withdrawal symptoms from mirtazapine. 

 

I'm sorry you're in this situation, but all I can do is offer up the advice to stop making changes, work with the non-drug coping skills, rest as much as you can, and try to stabilize before rushing into more changes.  

 

We discussed kindling earlier in your thread, but it's important enough to emphasis. Please see - Kindling.

 

This part of the article is important:

 

Quote

In an attempt to put the kindling phenomenon in layman’s terms, it is as if the nervous system has a “memory” of the withdrawal(s) and/or damage from a substance like benzodiazepines. Even when someone with a history of withdrawal(s) and/or damage seemingly recovers from the initial withdrawal(s) and/or damage, this “memory” of prior withdrawal(s) and/or damage still remains “imprinted” within the nervous system and subsequent withdrawals and/or damage are worse because the nervous system “recalls” that it has been sensitized/damaged in prior withdrawal(s).

 

I've given you the best advice I can offer. Continuing to make changes in doses, types of benzos, and rushing into a quick taper will lead to kindling, which is nervous system destabilization. Because these drugs cause confusion and lots of difficulty in being able to form a taper game plan, I would take the advice offered here. We simply don't know of any quick fixes to this. 

[enaz]

Thank you Shep

you are so right. I will take your advice. No:more nonsense just get panicked when I read things about how badly people suffer even doing a slow taper.im seeing the doctor tomorrow to get the liquid formulation

Thank you very much enaz

[Shep]

I'm very glad to read this, enaz. Set yourself up for success and don't read too much into the online stories. We simply don't know enough about people's struggles to weigh our own against theirs. A lot of people are dealing with the collateral damage of job losses, relationship problems, other medical issues, etc. All of this factors into the equations of healing. Lots of variables in these equations. 

 

The best way to taper liquid concentrated formulas is to add additional water. Once you get your prescription and are ready, please post the ratio (it will be listed on the package in mg / mL). And then we can go through how to set up your crossover and eventual taper. 

[enaz]

Thankyou so much Shep for your words of wisdom

I saw a primary care doc today (I have had enough of psychiatrists). She said she had no problem prescribing the liquid formulation but had to consult a psychiatrist colleague first !!!

 She said she would send the prescription as soon as she can

best wishes Enaz

[Shep]

19 hours ago, enaz said:

I saw a primary care doc today (I have had enough of psychiatrists). She said she had no problem prescribing the liquid formulation but had to consult a psychiatrist colleague first !!!

 

I hear you on the "enough" aspect of psychiatry. Hopefully you'll be able to get what you need without a problem. 

 

Please let us know how you're doing. 

[enaz]

Thanks Shep

[enaz]

Dear  Shep

 

Im afraid It’s me back with more difficult questions. I am in despair.

After much trouble with the GP I have been able to get a prescription for the  liquid formulation of clonazapam. It will be with the pharmacy tomorrow. It comes from the company you mentioned. I will send you the ratio on the package.

Please would you be so kind as to give me your suggested taper. 

 

I feel so awful, I have lost hope. I am getting no relief for my anxiety or insomnia at all from my  current dose of benzo.  Two nights this week I didn’t sleep at all.

 

Is it possible that the benzo is  contributing to the problem. Rather than feeling more anxious as time pssses after taking my dose, which is what I would expect as the effect of the drug wears off - I actually feel less anxious. I take a dose in the morning, I am anxious for several hours but then the anxiety eases in the evening. Then I take my second dose and it seems to do nothing to help me sleep. I don’t understand.

 

It is hard for me to keep taking this dangerous medication when it appears not to help at all and even makes me wonder if it is making my symptoms worse. Maybe it is because I am taking a relatively small dose. But Clonazapam is stated to be 20 times stronger than Diazepam so it’s not such a small dose. Or maybe I have reached tolerance. I am wondering if it has ever done much good, I kept taking it because I hoped /believed it would help.

 

I do understand that abruptly stopping could cause much bigger problems so I won’t do that

 

Mirtazipine is supposed to be a sedating AD but while I was on it my insomnia started. I’ve heard of people having a paradoxical reaction to certain drugs. Could this be my situation.

[Shep]

20 hours ago, enaz said:

Is it possible that the benzo is  contributing to the problem. Rather than feeling more anxious as time pssses after taking my dose, which is what I would expect as the effect of the drug wears off - I actually feel less anxious. I take a dose in the morning, I am anxious for several hours but then the anxiety eases in the evening. Then I take my second dose and it seems to do nothing to help me sleep. I don’t understand.

 

Unfortunately, you're in a state of nervous system dysregulation. Please post your daily drug and symptoms journal if you wish to have more feedback. I suspect that you're feeling better in the evening because that's when cortisol naturally decreases. Many of us feel better in the evening than in the mornings. For more, please see:

 

Early-morning waking - managing the morning cortisol spike

 

The more you can plan your daily activities around this, the better. Try to float through your symptoms. Fighting them is just too exhausting. 

 

20 hours ago, enaz said:

It is hard for me to keep taking this dangerous medication when it appears not to help at all and even makes me wonder if it is making my symptoms worse. Maybe it is because I am taking a relatively small dose. But Clonazapam is stated to be 20 times stronger than Diazepam so it’s not such a small dose. Or maybe I have reached tolerance. I am wondering if it has ever done much good, I kept taking it because I hoped /believed it would help.

 

I do understand that abruptly stopping could cause much bigger problems so I won’t do that

 

Your analysis is correct. We continue taking benzos to stave off withdrawal, even though the drug isn't helping.  Between a rock and a hard place, as the saying goes. But in the long run, the slow taper is best.

 

20 hours ago, enaz said:

Mirtazipine is supposed to be a sedating AD but while I was on it my insomnia started. I’ve heard of people having a paradoxical reaction to certain drugs. Could this be my situation.

 

It could be, especially if you're taking the benzo and / or z-drug too close to the mirtazapine. 

 

20 hours ago, enaz said:

After much trouble with the GP I have been able to get a prescription for the  liquid formulation of clonazapam. It will be with the pharmacy tomorrow. It comes from the company you mentioned. I will send you the ratio on the package.

Please would you be so kind as to give me your suggested taper. 

 

In addition to the ratio, please also post what drugs and doses you are currently taking for all of your drugs (I believe you're still on Xanax and zopiclone). Also, please post the times you take them. The goal will be to replace part of the Xanax with the clonazepam because I'm not sure you want to increase your benzo load. I welcome your thoughts on this. 

 

[enaz]

Dear Shep thank you. What you say makes such good sense. Thank goodness for your good guidance

 

I thought I had told you I had to I start to replace the xanax with Clonazapam because I had hardly any left and the doctor told me she could not/would not prescribe more and that it is not available in liquid form anyway. So I gradually replaced the Xanax with the Clonazapam as you suggested how to do it (the other way roundwhen I reintroduced the Xanax)

 

So since I used the last Xanax (5 days ago) I have been taking .125 mg  clonazapam at 8.30 a.m and 1.25mg   at 8.30 p.m. I hope that’s ok

 

I have taken .375 zopiclone only once in two weeks.

 

I hope to get the liquid Clonazapam  later today if the pharmacy has received the order

 

Thank you Enaz

[Shep]

4 hours ago, enaz said:

I thought I had told you I had to I start to replace the xanax with Clonazapam because I had hardly any left and the doctor told me she could not/would not prescribe more and that it is not available in liquid form anyway. So I gradually replaced the Xanax with the Clonazapam as you suggested how to do it (the other way roundwhen I reintroduced the Xanax)

 

Thanks for this information, enaz. Please add a line to your signature with your current drugs. Right now it looks like you're off everything because you have August 2020 as your latest date. Perhaps add a line with "currently taking" and then add in your drugs and doses. 

 

Account Settings - Create or Edit Your Signature

 

 

[enaz]

Dear Shep thank you. What you say makes such good sense. 

 

I thought I had told you I had to I start to replace the xanax with Clonazapam because I had hardly any left and the doctor told me she could not/would not prescribe more and that it is not available in liquid form anyway

 

For the last 6 days I have been taking .125 mg  clonazapam at 8.30 a.m and 1.25mg   at 8.30 p.m because I was completely out of Xanax. 

 

I have taken .375 zopiclone only once in two weeks.

 

 

[enaz]

Dear Shep

 

I have the liquid Clonazepam and the ratio is .5mg to 5 ml

 

Thanks for your help

 

enaz

 

[Shep]

14 hours ago, enaz said:

For the last 6 days I have been taking .125 mg  clonazapam at 8.30 a.m and 1.25mg   at 8.30 p.m because I was completely out of Xanax. 

 

I have taken .375 zopiclone only once in two weeks.

 

First, I want to verify your clonazepam dose. You have .125 mg and 1.25 mg in the part I highlighted in red. Is that second number a typo? Do you mean two doses of .125 mg (which is in your signature)? I'm going by the .125 mg dose, not the 1.25 mg dose, but please correct me if I'm mistaken. 

 

15 hours ago, enaz said:

I have the liquid Clonazepam and the ratio is .5mg to 5 ml

 

This ratio means you have 0.1 mg in every 1 mL of medication. You can add water to this to make it easier to make small reductions for tapering. We'll go over this step by step. 

 

I would transfer over gradually from tablet to liquid. So you could take one dose in liquid and one in tablet for a few days to see how you do. 

 

One option would be to take 2.5 mL (.25 mg) of medication and add it to 22.5 mL water, for a total of 25 mL liquid. The ratio is now .01 mg in every 1 mL of liquid. 

 

To take a dose of .125 mg clonazepam, you would take 12.5 mL of liquid. 

 

Take one dose as 12.5 mL (.125 mg) in liquid and the other dose of .125 mg in tablet for a few days before switching over to both doses in liquid. 

 

Please do NOT make any reductions yet. You've had so many changes recently, it's best to hold for a few weeks and stabilize as much as possible before beginning your taper. 

 

Please post if you have any questions. 

[enaz]

Dear Shep thank you. What you say makes such good sense. 

 

I thought I had told you I had to I start to replace the xanax with Clonazapam because I had hardly any left and the doctor told me she could not/would not prescribe more and that it is not available in liquid form anyway

 

For the last 6 days I have been taking .125 mg  clonazapam at 8.30 a.m and 1.25mg   at 8.30 p.m because I was completely out of Xanax. 

 

I have taken .375 zopiclone only once in two weeks.

 

 

[enaz]

Thank you for your last post Shep. It is so kind of you to continue to advise me. There is no one else I can turn to for advice.

 

 Unfortunately on the instructions on the bottle of Clonazapam it says that once opened it can be used for only one month and then it has to be discarded. so I will clearly have to ask for a prescription for at least another bottle if I am to very gradually exchange pills for liquid and then do a slow taper. Getting the prescription and medication is difficult and expensive. 

 

It would help me arrange things if you could give me an idea of roughly how long the whole process will take. Please could you tell me how many weeks I should stay on my current dose and by how much I should aim to decrease every week when I start to taper.  I have read on SA about tapering 10% a week or every two weeks. If someone is on a higher dose their 10% reduction could be equal to my total dose. Does the 10% rate apply if you are on a low dose to start with. 

 

Also it is difficult for me to know if I am stable on a particular dose of Clonazapam because I’m continuing to suffer the symptoms from the mirtazipine. Only if my symptoms changed or got worse could I say it was due to reducing the Clonazapam.

 

I feel I am being a real pest but I do appreciate your help

 

Enaz

[Shep]

12 minutes ago, enaz said:

Unfortunately on the instructions on the bottle of Clonazapam it says that once opened it can be used for only one month and then it has to be discarded. so I will clearly have to ask for a prescription for at least another bottle if I am to very gradually exchange pills for liquid and then do a slow taper. Getting the prescription and medication is difficult and expensive. 

 

Sorry, enaz. This is one of the main problems with doctors. I can't remember if we've posted this before, but this is a list of recommended doctors. Please check out the ones for the UK and see if any of them could help with prescriptions:

 

Recommended doctors, therapists, and clinics

 

15 minutes ago, enaz said:

It would help me arrange things if you could give me an idea of roughly how long the whole process will take. Please could you tell me how many weeks I should stay on my current dose and by how much I should aim to decrease every week when I start to taper.  I have read on SA about tapering 10% a week or every two weeks. If someone is on a higher dose their 10% reduction could be equal to my total dose. Does the 10% rate apply if you are on a low dose to start with. 

 

No, you didn't read about 10% a week or every two weeks on this site. There are some sites like Benzo Buddies that recommend "a taper of 5-10% every 10-14 days", but we don't recommend going that fast (10% every 14 days would be 20% a month! - way too fast). 

 

On SA, we only recommend 10% or less a month.

 

I wish I had a crystal ball and could tell you a timeframe of when you should start your taper. But your symptoms are going to be your teachers and guides. You may want to continue using the pills and not open the liquid until closer to when you're going to taper. That way, you'll save the liquid for when you'll need it for the reductions. 

 

Yes, the 10% rate does apply even if you start on a low dose. However, you won't have as long a taper because you're already on less of the drug. 

 

I hear you on the difficulty of obtaining monthly liquid prescriptions. Is your doctor more open to prescribing pills for more than a month at a time? The other option is taper the pill using a scale or making your own liquid using tablets. 

 

Please don't rush this. In 13 months at 10% reductions, you would be down from .25 mg to about .0635 mg, which is a good stopping dose for some people. Others wish to go lower. Again, it will depend on your symptoms. Please also factor in holds. Don't go faster than your nervous system can handle. As you wisely noted, you're still dealing with withdrawal from other drugs. 

 

Here is a link for some calculators and spreadsheets that may be helpful:

 

How to calculate dosages and dilutions? Spreadsheets and calculators

 

 

[enaz]

Dear Shep thank you. What you say makes such good sense. 

 

I thought I had told you I had to I start to replace the xanax with Clonazapam because I had hardly any left and the doctor told me she could not/would not prescribe more and that it is not available in liquid form anyway

 

For the last 6 days I have been taking .125 mg  clonazapam at 8.30 a.m and 1.25mg   at 8.30 p.m because I was completely out of Xanax. 

 

I have taken .375 zopiclone only once in two weeks.

 

 

[enaz]

thanks for your latest response Shep. I will hold for a while and see how I feel. I will then start to taper. I think I can get some pills for the start of the taper, keeping the liquid for later as you suggest.

 

Thank you so much

[Shep]

You're welcome, enaz. Let us know how you're doing before you start your taper and if you have any questions. 

[enaz]

Dear Shep, it’s Enaz here. I don’t know where on the site to find our correspondence.I have to write to you. I do want to start my taper of Clonazapam but I am in a terrible state.My insomnia from my adverse reaction to Mirtazipine remains very bad and the day time anxiety is terrible. I have no hope of it ending especially given my advanced age. I have read that for some people  the protracted withdrawal never ends. Is there any hope, 10 months after I took the last Mirtazipine pill.

Thanks for reading this

Enax

[Shep]

Enaz, I moved your last post off my success story and here in your own topic. 

 

19 hours ago, enaz said:

I do want to start my taper of Clonazapam but I am in a terrible state.My insomnia from my adverse reaction to Mirtazipine remains very bad and the day time anxiety is terrible.

 

When are you taking the clonazepam? Please list the time(s) of day and the doses. 

 

Are you taking any other drugs? 

 

You've had a number of drug changes and if you're still struggling with severe insomnia, I would not remove the benzo now. Removing the benzo will make the insomnia worse. If your daytime insomnia is from interdose withdrawal, you may be able to space out the clonazepam throughout the day so you're more comfortable. 

[enaz]

1 hour ago, Shep said:

Enaz, I moved your last post off my success story and here in your own topic. 

 

 

When are you taking the clonazepam? Please list the time(s) of day and the doses. 

 

Are you taking any other drugs? 

 

You've had a number of drug changes and if you're still struggling with severe insomnia, I would not remove the benzo now. Removing the benzo will make the insomnia worse. If your daytime insomnia is from interdose withdrawal, you may be able to space out the clonazepam throughout the day so you're more comfortable. 

 

[enaz]

than you Shep