nipsu: Mirtazapine withdrawal

[nipsu]

Hello,

I would like to ask what i should do with my mirtazapine tapering. I started mirtazapine about 10 months ago with dose of 7.5 mg for sleep. I have tried multiple times to quit it cold turkey and i haven't succeed with this kind of method. My doctor prescibed me Trintellix (Vortioxetine) for depression 10 mg/daily which i ate for 13 days and i didn't see any benefit from it during that short period of time. When i started Trintellix i just stopped mirtazapine cold turkey and i slept ok and anxiety was manageable but at day 6 on trintellix + mirtazapine cold turkey withdrawal i experienced serious increase in anxiety so i ate 7.5 mg mirtazapine and day after that i ate 3.75 mg mirtazapine. My anxiety reduced after this and i was again 5 days without mirtazapine and again terrible anxiety came back, tinnitus and i wake up at 3 am anxious and unable to go back to sleep. I don't know what i should do. It would be really nice if you can recommend good aproach for withdrawing from mirtazapine. I don't really want to eat anymore AD:s because i haven't noticed any benefit from them for depression. Mirtazapine has helpt with sleep alot. 

 

I think that i should continue mirtazapine withdrawal and quit Trintellix at day 14 because i dont want to be addicted to psych drugs anymore. Two years ago i ate bupropion for 7 months but i had quit it because it started to cause itchy rash around my body. After quitting bupropion i experinced worst depression ever in my life and it also probably destroyed my sleep + memory.

[Gridley]

Welcome to SA, nipsu.

 

 I need to understand your drug history correctly. Please correct any errors and answer the questions so we can better assist you.

 

March, 2019  7.5mg  mirtazapine

Several attempts to cold turkey (Question: did you go back to taking the 7.5mg Mirtazapine after each CT attempt?  Please supply approximate dates of each attempt.)

Trintillex 10mg for 13 days, CT Mirtazapine (Question: approximate date?)

Went back to 7.5mg Mirtazapine for one day, 3.75 Mirtazapine (Question: for how many days and what date?)

5 days no Mirtazapine (Question: approximate date?  Is this now?)

 

Very important questions:  Are you taking Mirtazapine now and at what dosage?  If you are not taking it now, when was the last time you took it and at what dosage?  

 

Once you've corrected this drug history and answered my questions, I'll be able to make a recommendation about the Mirtazapine.  

 

In he future, it is very important that you take a consistent dose of drugs and not keep changing doses and starting and stopping.  Your central nervous system needs stability.  When you go off psychiatric drugs, it is important to do it slowly and with a plan, which we can help you with.

The rule of 3KIS: Keep it simple. Keep it slow. Keep it stable.

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

 

[nipsu]

March, 2019  7.5mg  mirtazapine

Several attempts to cold turkey

Question: did you go back to taking the 7.5mg Mirtazapine after each CT attempt?  Please supply approximate dates of each attempt

 

Yes i went back to 7.5 mg after each CT attempt and it took about 3-4 days to feel better after going back. I have tried CT mirtazapine 11/2019 and 12/2019. And these attempts have lasted 4-5 days each until i gave up.

 

Trintillex 10mg for 13 days Mirtazapine (Question: approximate date?)

 

I started Mirtazapine on February 2019 with dose of 7.5 mg. Trintellix 10 mg i started 09.01.2020 and quitted it 22.01.2020. 

 

Went back to 7.5mg Mirtazapine for one day, 3.75 Mirtazapine (Question: for how many days and what date?) 

 

14.01.2020 i ate 7.5 mg of mirtazapine and next night 3.75 mg. I also took 3.75 mg of mirtazapine 21.01.2020. So i have taken mirtazapine just three times during my quitting process which started 10.01.2020.

 

5 days no Mirtazapine (Question: approximate date?  Is this now?)

 

I was actually without mirtazapine between 16.01.2020 - 21.01.2020 but the no mirtazapine streak ended because i had to take 3.75 mg to make withdrawal symptoms little bit more manageable.

 

Very important questions:  Are you taking Mirtazapine now and at what dosage?  If you are not taking it now, when was the last time you took it and at what dosage? 

 

Last time i took it at the evening of 21.01. and dose was 3.75 mg. 

 

[Gridley]

5 hours ago, nipsu said:

Last time i took it at the evening of 21.01. and dose was 3.75 mg. 

 

I would reinstate with 0.5 mirtazapine and take that at the same time every day. It is very important to be consistent with your dose and take it every day.  Skipping doses is is hard on your central nervous system and makes withdrawal worse.

 

It takes a little more than a week for the reinstatement to reach full state in your blood.  You should start feeling some small relief after a few days.  If after ten days you feel no relief, we can talk about a small increase.  Please do not increase or change your dose without contacting us.

 

Keep daily notes on paper about you're feeling so you can see how the reinstatement is working.

 

Please keep us updated.

[nipsu]

Do you mean that i should reinstate with 7.5 mg mirtazapine or 3.75 mg?

[Gridley]

55 minutes ago, nipsu said:

Do you mean that i should reinstate with 7.5 mg mirtazapine or 3.75 mg?

No.  Reinstate with 0.5mg (1/2mg).  3.75 could be too much and could overwhelm your system.

 

This link shows you how to make small doses.

 

Tips for tapering off Remeron (mirtazapine)

[nipsu]

Today has been really bad day. I have been nauseous and i slept 4,5 hours last night + terrible anxiety, lack of energy, strong tinnitus, pressure in frontal lobe of brain and feeling like brain dead. I think its because of mirtazapine. I took trintellix just for 13 days and i dont belive that my body got used to it.. i hope so.. But i wont reinstate it back because it made me feel emotioneless + it made me lazy (loss of daily routine and i am single parent of 4 year old). I will try to take just 0.5 mg of mirtazapine if it helps.

[nipsu]

I updated my signature to get better understanding about my previous medication history.

[Gridley]

6 hours ago, nipsu said:

I will try to take just 0.5 mg of mirtazapine if it helps.

Please keep us updated.  Remember, it will take a little more than a week to reach full state in your blood.

 

Thanks for updating your signature.

 

If the current dose of melatonin is helping, that's fine.  Lower doses often work better.  I was taking 0.5mg and cut it in half to 0.25 and slept better.

[nipsu]

The first picture shows how my mirtazapine levels have altered during my withdrawal process (approximation with 30h half life). At the end of chart you can see how reinstating 0.5 mg of mirtazapine affects my body mirtazapine levels.

 

The second picture shows what happens to vortioxetine levels in your body after you quit it CT and you have just achieved steady blood plasma of it (demo from my situation). The chart shows that it takes about 17 days of cold turkey (Day 30 in second chart) vortioxetine to leave your system almost completely (99%). 

 

If you are intrested about making your own medicine half life chart. I recommend to download Half Life calculator from google app store.

[nipsu]

Update:

 

Saturday 25.1.

i woke at 5:30 am so i got 6 hours of sleep. I felt very anxious during day and i noticed that my tinnitus had become worse and i also felt alot of nausea. At the evening i took 0.5 mg of mirtazapine and 0.95 mg melatonin. I went to sleep 23:30 and had some difficulties falling asleep.

 

Sunday 26.1.

I woke up 7.00 am so i got 7,5 hours of sleep. I felt quite good during day and had only little anxiety during morning and evening. Before i went to sleep i took 0.5 mg mirtazapin and 0.95 mg melatonin. I couldnt fall asleep during night and had very strong tinnitus.

 

Monday 27.1.

 

I had terrible night because i didnt get any sleep at all. So today i have been very anxied and almost panicking. I feel hopeless and fearful about future and myself. I am afraid that this feeling doesnt go away and i am afraid about next night also. I feel exhausted but at the same time too "wired" to sleep.

 

What i should do now? I have taken 0.5 mg mirtazapine last two nights. Should i updose mirtazapine or stay on current dose? It looks like i get severe withdrawal symptoms after 4 days without 3.75 mg of mirtazapine.

 

 

 

 

 

[Nm190]

I feel for you nipsu, I am in similar place after CTing mirt. Its a long and tough road, I cannot offer you advice other that the sleep issues will continue if you stop mirt completely right now.

[nipsu]

1 hour ago, Nm190 said:

I feel for you nipsu, I am in similar place after CTing mirt. Its a long and tough road, I cannot offer you advice other that the sleep issues will continue if you stop mirt completely right now.

 

Do you still suffer from insomnia after Ct:ing mirtazapine in november? Have you noticed any improvement during withdrawal process? 

[Nm190]

Yes I still have insomnia, I was able to get rid of it temporary with benzos, but it returned after I stopped using magnesium before bed.  I had to retrain myself to learn to fall asleep again and I don't stay asleep like I used to. I wake up easy. I have hope that one day I will be able to sleep again normally soon.

 

Yes I have seen slow improvements and most of my symptoms are gone. I just have bad anxiety from time to time that seems to be improving and the insomnia. I got brain fog and headaches and muscle twitches after the few uses of the benzo but its not mirt related.

[Nm190]

One thing I forgot to mention, the biggest notice for me about feeling better was when the bad hits of anxiety would turn into other emotions. If i was hungry, I just felt anxiety. If I was tired I just felt anxiety etc. Eventually those moments turned into normal feelings and I was able to yawn and stretch again and feel more normal.

[nipsu]

I took last night 3.75 mg mirtazapine because i couldnt get sleep and had terrible panic attack. That dose made me calmer but didnt help me to fall sleep. I know that you shouldn't updose like that but i was losing my sanity. I will go to work today eventhought i have had 2 terrible nights in a row because i have experience that insomnia will go worse if you stop working and seeing other people.

[nipsu]

Today was quite good day eventhought i slept poorly. I didn't dissociate and tried to process my anxiety in good way and not to overthink about everything. I will probably eat this evening 3.75 mg mirtazapine and see if it is enough to stabilize my withdrawal symptoms.  If it works I can then keep that dose for sometime (4-5 weeks) and go off it using 5-10% taper technique which is taught here in SA.  I would be very happy if i can manage my withdrawal symptoms with just 3.75 mg because it would be still 50 % drop from start.

[nipsu]

Update:

Today and yesterday have been quite good days. I didnt have anxiety and i slept last night 6-7 hours.

 

I will probably reinstate to 2.7 mg mirtazapine. This 2.7 mg dose comes from my calculations which are calculated by using mirtazapine half life of 30 hours and how much mirtazapine i had in my system today. I had to memorize my past 30 days doses and filled them in half life app which gives me quite good approximation from current mirtazapine levels.

 

Half life is estimation because it can be from 20-40 hours but typically its 27-30 hours for male. Mirtazapine reaches stable plasma concertration levels in two weeks. 

 

[nipsu]

Now i have reinstated mirtazapine 2.7 mg for a week. My withdrawal symptoms are pretty mild compared to ct:ing mirtazapine.  So the reinstating has worked so far. My total sleep time has reduced to 6 hours but sleep continuity is now better. I have less brainfog than i had when i took 7.5 mg mirtazapine. My eyes arent anymore so dry and red. I also have lost weight 5 kg during last 4 weeks. I am now more positive and i dont ruminate bad thoughts as much. I see brighter future ahead. I will stay on this dose for few more weeks and then slowly reduce it to 0 mg. Lets see what happens then.

[nipsu]

I am doing quite well when i reinstated with 2.7 mg of mirtazapine. But i wake up at 4 am eventhought i try to sleep till 7 am. Before i wake at 4 am i see vivid dream and it makes me to wake up. I also feel that my breathing is very shallow when waking up. I dont feel anxied when i wake up 4 am but i feel very tired and i feel i need to sleep more so i go back to bed and try to sleep but my sleep feels very shallow after waking up. I try to go sleep 23 pm everyday and wake up 7 am. Do you have any ideas to make my sleep quality better? I eat quite healthy and i dont drink coffee after 2 pm. I have also started exercising. I use nicotine during day maybe it affects my sleep? I would like to hear how you have get rid off early morning awakenings without medications. 

[nipsu]

Update:

 

Reinstating to 2.7 mg mirtazapine is working very well. I feel more stable, my sleep is better and i eat healthy and exercise more. Tinnitus is also less noticeable and anxiety has also reduced. I have taken this dose now for 2 weeks and i will take it at least 2 more weeks before tapering it 10 % / 4 weeks. I took Trintellix only for 12 days so i don't believe it was enought time to cause depency for nervous system and thats why i dont feel withdrawal symptoms from it?

[Gridley]

1 hour ago, nipsu said:

l take it at least 2 more weeks

You might want to hold a little longer before tapering.  Sounds like you're doing very well.

[nipsu]

I was taking 2.55 mg for last 4 weeks. I had many good days during these 4 weeks. Some days were awful but not horrible. Last week i started to sleep better and now i only wake up once a night and i can fall asleep quite quick after waking up during night. I sleep 7-8 hours every night. Last week i started taking 100 mikrograms of vitamin D every morning maybe this have made my sleep better? I live close to north pole so i dont get any vitamin D during winter and most likely i have defiency of it. 

 

I lowered my mirtazapine dose yesterday from 2.55 mg to 2.25 mg. 

 

When i started mirtazapine withdrawal from 7.5 mg, i thought this dose is so low that it shouldn't cause any withdrawal symptoms if i CT it. But i was wrong, my brain was became depend to its strong antihistaminic effect. When i started mirtazapine last year with dose of 7.5 mg it made me feel like i was walking zombie and it made me stupor for whole day. It took about one week to get used to these strong anticholienergetic side effects. If your doc ever offer mirtazapine just refuse to take it. It has terrible anticholienergetic side-effects which make you fall asleep but it affects your capability to think clear and function properly + long term side effects which are unknown.

[Shebon]

Hi Nipsu:

 

I see you are squeaky getting down on your dose of mirt now.  A big congrats to you!!  Glad to hear your sleep is improving as that is a huge sign for your healing as you go down in dose.  You might be spot on for a deficiency in Vit D.  It does play a big role in sleep patterns.  

 

I will go down to 2.11 mg. later this week.  I will stay on that until mid-July and then down to 1/2 (1.87 mg.)  of my original years--long dose of 3.75 mg.  I will stay at 1.87 mg. for a few months to stabilize and continue with my method that seems to be working for me.

 

I so want to be off and done with this drug.  It makes one bear hungry for carbs and causes the infamous weight increase.  But slow and easy is my preferred way to go -- I've tried too many other tapers and failed.  

 

Best regards,

Shebon