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Ripley: Mirtazapine withdrawal and reinstatement problems

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Ripley

Hi

I feel I am writing this too late as I have made many errors in my withdrawal from Mirtazapine and subsequent reinstatement but I only found this website and information recently. Perhaps you can still help me.

 

In October, I tapered off from just under 1.5mg Mirt where i had been for several months following a slow taper from 7.5mg (18 months total time).  The doctor told me this dose was too low to have therapeutic value but if I wanted to taper i should miss alternate nights, then 2 nights etc...and I should be off in a month.

 

I did this but had insomnia on the missed nights but it seemed to settle. My sleep deteriorated though. In early December and exhausted, I was hosting a party and needed to sleep so I took a 1.5mg dose of Mirt for 2 nights only and slept. 6 days later, I had shocking vertigo and sickness and could barely move. Luckily, this passed in a few hours but it alarmed me and I vowed to stay away from Mirt. 

 

My sleep was deteriorating again and exactly 2 weeks later it went completely. Christmas was awful. I didn't really know what the problem was tbh but I didn't want to take any Mirt so I used Phenergan to sleep. After about a week, the Phenergan stopped working and without it I could not sleep at all so I reinstated Mirtazapine. The low dose worked and then didn't work so a week later I increased it to 7.5mg. I know now this was too large an increase but I was desperate.

 

I saw a big improvement but it was still erratic so a week later I tried 10.5mg for 2 nights. This didn't make much difference so I went back to 7.5mg. By now, I had found this website and learned about waves and windows etc.. That next week, things improved but I had a couple of bad nights around day 4, which I thought was the dose change causing problems. Then the next few nights improved again, but last night and the night before I had about an hour and am feeling dreadful.

 

I suppose my questions now would be: does this seem like windows/waves? Or could I have 'kindled'? I dont know much about this or when it would happen but what would I do if it is? I presume I stay at 7.5mg now? I presume it's too late and unwise to reduce this dose? 

 

This is a truly awful experience and I'm hoping to stabilise and taper slowly again. Any thoughts or advice would be greatly appreciated. I know I have probably done everything I'm not meant to do and I'm really paying for it. I wish I had never taken this drug and don't think I should have been prescribed it in the first place but that's another story.

 

 

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Ripley

In case it's helpful:

I reinstated at 1.5mg on 6th Jan 2020

I updosed to 7.5mg on 13th Jan

Took 10.5mg on 18th & 19th Jan and 9mg on 20th.

Since then 7.5mg. 

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Gridley

Welcome to SA, Ripley.  I'm sorry you're having this experience.  Please don't blame yourself for any mistakes you've made.  The majority of members who come here have made errors before discovering SA, myself included.  You will straighten out and heal, but it will take some time.  Other than insomnia, what are your current symptoms?

 

You are suffering from withdrawal from the time you went off the mirtazapine and the alternate day tapering (an awful idea much beloved by doctors), likely exacerbated by too high an updose.   It's also possible you could have kindled, which is destabilization caused by going on and off a drug.  In any case, what you need now is stability, so I would stay on the 7.5mg dose and make no further changes.

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

It's likely going to take you several months to stabilize.  Once that has happened, you will be ready to taper off the mirt.  We recommend tapering by no more than 10%of your current dose every four weeks.

 

Why taper by 10% of my dosage?

 

So that you have a better idea of what you're experiencing, here is some information on withdrawal and healing.

 

What is withdrawal syndrome.

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF)

 

The Windows and Waves Pattern of Stabilization

 

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 to help sleep.

 

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

 

Relaxation exercises, guided meditations, calming videos, sleep hypnosis

 

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.  

 

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

 
 

 

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Ripley

Hi Gridley

Many thanks for your response. It's as I thought really. Although I'm upset and alarmed to think it could take 'several months to stabilize'. Am I in for a rocky ride even though it was such a low dose I was alternating? 

 

Apart from insomnia, I'm suffering from anxiety which spikes after a bad night and general nausea but, again, I think this is lack of sleep as I feel much better after a good night. 

 

Can I take Propranalol for the anxiety ( a beta-blocker) or is this a bad idea?

 

Thank you.

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Gridley
2 hours ago, Ripley said:

Can I take Propranalol for the anxiety ( a beta-blocker) or is this a bad idea?

 

Here is a link.  Members have had varied experiences.

Beta Blockers: Propranolol, Metopropol, Atenolol etc ...

If you do use it, it will need to be tapered to stop.  This link gives some parameters.

 

Tips for tapering off propranolol - Surviving Antidepressants

 

2 hours ago, Ripley said:

. Am I in for a rocky ride even though it was such a low dose I was alternating? 

 

It's impossible to predict how rocky a ride it will be.  The low doses can be potent.  Let's assume it won't be too rocky a ride.  This is not a pollyanna approach.  Worry causes stress which can ramp up withdrawal symptoms.  

 

2 hours ago, Ripley said:

Although I'm upset and alarmed to think it could take 'several months to stabilize'.

 

Again, let's assume the best and wait and see how you do.

 

For sleep, keep the Melatonin in mind.  I started out cutting a 1mg tablet in half with a pill cutter, giving me 0.5mg and it helped somewhat.  When I reduced my dose to 0.25mg my sleep improved considerably.  Don't go too high in dose; it can go paradoxical on you (keep you awake).

 

Here are some links for dealing with anxiety. The last link about the restorative yoga pose has helped me with anxiety.

 

 

 

Edited by Gridley

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Ripley

Thank you for your considerate response Gridley. You make some excellent points and I'll be taking your advice. 

 

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juneight

Hi Ripley, i am sorry for your struggle. While being so close to see finish line, it was a pity to involve this process again. How could you describe your anx.? How was your first taper journey? Did you go weekly or monthly?

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Ripley

Hi juneight

You asked about my previous taper. Tbh it was very straightforward and without withdrawal symptoms. I requested the liquid and just gradually and slowly took less and less out of the syringe and the process lasted about 6 to 8 months to get from 7.5mg to 1.5mg. I didn't do any measuring or timing as I didn't know about SA and the doctor hadn't told me anything about tapering.

 

I got stuck at 1.5mg as I couldn't go any lower on my syringe without insomnia (it was 0.1ml) so I spoke to the doctor and ended up in the situation I described above. I've seen on this website advice on how to dilute the Mirt liquid to 1mg/1ml, which I will do next time to taper this final 1.5mg and would suggest this to others. 

 

I have kicked myself for having reinstated so high but thankfully things have improved a lot recently. Some nights I can get 8 hours sleep, which is amazing considering it went completely! After a poor night I also feel much less anxious and not really nauseous anymore. My appetite has returned and I often feel quite normal again. Ultimately I'm just grateful and relieved things are moving in the right direction.  I have a woolly headed feeling and sometimes aching in the temples but hopefully this will pass too. Otherwise I'm fine.

 

When I'm properly settled I'll begin tapering again. More cautiously this time but I'm optimistic I'll get there in the end. 

 

Ripley

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juneight

hi ripley again, has there been times in which you had crippling anx. that as if it will never pass?

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Ripley

Hi. When I couldn't get any sleep I was incredibly anxious and I did worry it might never improve, but thankfully it did. I hope yours does soon too.

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Ripley

Hi SA again

 

I wonder if you can help me again please? Things seemed to be settling down and for the last week I was getting about 5 hours sleep a night, which I thought was pretty good. Then these last 2 nights I have managed no sleep at all. I was thinking its probably a wave but I'm concerned because I only got zero sleep BEFORE I reinstated the Mirt and since reinstating a bad night has always been followed  by a much better night. So I had a few questions which you might be able to answer.

 

1. I wondered if it was related to when I updosed to 10.5mg (2 nights and 9mg 1 night) before coming back to 7.5mg? Although this was now 4 weeks ago (and only 3 nights) so wouldn't it have caused problems sooner?

 

2. I got very stressed on 18th (first night of zero sleep) and had compulsive thinking and regrets all day about Mirt. I had read about a link between increased dementia risk and tetracyclic antidepressants and was reading lots of stories on SA and getting very upset. My brain was aching by the evening and I wondered if I could have induced a bad wave through stress? I was MUCH more relaxed yesterday (19th) but still got zero sleep.

 

3. By yesterday evening, I had a migraine which lasted all night. This happened about 45 mins BEFORE bedtime and taking the Mirt. Could this be anything? (Maybe just sleep deprivation.)

 

4. Also, I didn't take any painkillers as I didn't want an interaction. Is it best to avoid painkillers (ibuprofin/aspirin) or are they ok? 

 

5. Could my Mirt. have 'pooped out'? I hope this is unlikely. 

 

Perhaps you won't really know the answer but you'll know more than me I figured! Could this just be a bad wave? It just feels more dramatic than earlier ones and things seemed to have really improved lately? This is putting a huge strain on my family. My husband has had to take time off work again today as we have a small child. He can't keep doing that and we don't have other support. And I dont really know what's happening to me. 

 

I appreciate your time.

Ripley

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Ripley

Just to add, my 'normal' bad night since reinstating has been between 1 and 3hrs sleep, so not complete zero. And normally a good few hours better the next day. Is it normal for a wave to be much worse? Thanks x

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Ripley

I also feel quite 'wired' and awake despite being tired. I had started feeling more tired after a bad night too, which I think is more normal.

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Ripley

https://www.biovea.net/uk/product/detail/21501/melatonin-liquid-orange-1mg-2oz-59ml

 

Does this melatonin look good to you? It's the lowest dose I can find in the UK (the link you sent me Gridley wasn't available in the UK unfort) and it looks like you can use say 1/3 of a dropper to get 0.3mg. 

 

Unfort, my anxiety has returned and tears as you can imagine. I'm very worried about tonight.

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Hamster

Hi Ripley,

 

sorry to hear you suffering so much.

When it comes to painkillers I did not experience any major side effects from taking them (Ibuprofene in my case).

As 7.5 mg obviously do not help with sleep I'd even think about reducing it a bit. Mirt is known to be "activating" at high doses. No idea why but maybe 7.5 mg is a high dose for you already in your current state. 

As whatever kind of antihistamine seems not to help you any more (Phenergan and Mirt do have antihistaminic properties and they should help with sleep as a side effect) Melatonin may be worth a try. Never tried it on my own so far.

 

Why did you start Mirtazapin in the first place? 7.5 mg is rather low, so I wonder whether it was prescribed for insomnia or for whatever psychological issue.

 

The only other advice I can offer: My impression is that your stress level plus the WD symptoms are simply too much for the time being.

"Fighting" against WD symptoms is not only impossible in most cases, it may make things worse and you will end up totally exhausted (you obviously are ...). Lack of sleep, a small child and a husband who has to go back to work is though. Add WD and you risk to collapse.

 

So I'd try to read a bit less about WD (it helps to know that you are not alone, but some stories may be scary) and start doing whatever may make you feel a bit better or distract you from your anxiety at least. Go out for a walk with your kid. And try to find a therapist if you do not have one already. 

 

I keep my fingers crossed that you can get some sleep tonight!

 

Regards,


Hamster

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Ripley

Hi Hamster

Thank you for your kind reply. I just wanted to do a quick update to say that I had a good night's sleep last night. Phew!

 

I think I'll assume it was a bad wave, probably exacerbated by my acting like a stress head. I've learned my lesson (another!) and will look after myself better in future.

 

I see you seem to be doing well tapering off Mirt. Hope that's going well for you.

 

I was initially prescribed 15mg but, as a reluctant pill taker and finding it very sedating, I broke them in half from the start.

 

Right, I'm off for now....good wishes to all. 

 

Ripley

 

 

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Ripley

Hi, back again. Had another zero hours last night and feeling ill.

 

I would like to ask a moderator's opinion on whether my high updose could be causing this? Would it not have been more apparent earlier? Perhaps this is just  wave?

 

But if I'd be better reducing my dose, what would you suggest? I'm aware this could cause more destabilisation, so I'd be grateful for your opinion on whether this is what I should do.

 

I hope you can answer me. 

Thanks

R

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Ripley

Just a further thought, I am now in week 6 following my updose to 7.5mg. If it were too high, would i not already know this somehow? Or would now be the time it would be showing - as mirtazapine can take 4-6 weeks to take full effect? 

 

I would be grateful for your thoughts. Shall I continue holding and assume it's a wave or should I try to reduce it? 

 

Many thanks for your time. I sincerely wish I wasn't bothering you again.

Ripley 

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Gridley
58 minutes ago, Ripley said:

 

Just a further thought, I am now in week 6 following my updose to 7.5mg. If it were too high, would i not already know this somehow? Or would now be the time it would be showing - as mirtazapine can take 4-6 weeks to take full effect? 

 

 

Yes, you would've known within a little more than a week.  Did symptoms worsen around that time?  If so, have they improved since that time?  Are you better than at 1.5?  Is it ups and downs?

 

 

 

 

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Ripley

Hi Gridley

 

Thank you for your reply. After about a week on the updose there was quite an improvement. My sleep became deeper rather than extremely light as it had been. And then it was ups and downs as you say.

 

Recently, I had felt the bad nights were less bad - say 3 hours instead of 1 and good nights becoming a bit more frequent. Prior to this recent bad spell, I had been averaging maybe 5 or even 6 hours. (With an 8hrs happening as often as a 3hrs.)

 

So would you say this is looking like a wave? And I should hold at 7.5mg? It seems quite extreme - does it sound normal?

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Ripley

I was averaging 5 hours now I look again. It's only the zero hour nights that instill panic and stressing about coping. I dont have much left in the tank for these. So just want to check I'm not missing something obvious.

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Gridley
25 minutes ago, Ripley said:

 

So would you say this is looking like a wave? And I should hold at 7.5mg?

Yes, it's looking like a wave.  I would hold at 7.5mg.  

 

Yes, the sleepless nights are difficult but not uncommon.  Averaging 5 hours a night isn't bad.

26 minutes ago, Ripley said:

It seems quite extreme - does it sound normal?

 

What seems quite extreme?

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Ripley

Thanks for your reply.

 

It feels extreme that I've had 3 zero nights out of 4, when I haven't had zero nights since before I updosed. 

 

 

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Gridley
1 minute ago, Ripley said:

 

It feels extreme that I've had 3 zero nights out of 4, when I haven't had zero nights since before I updosed. 

 

I'm sorry.  I know that's distressing.  It still looks like a wave to me.  I would say to give yourself some time to stabilize and we can then talk about a slow taper down.

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Ripley

Thank you Gridley.

 

I'm actually pleased you think it's a wave as that seems better than other options right now! Just hope it doesn't last too long.

 

Ripley x

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Hamster

Hi Ripley,

 

sorry to hear that the bad nights are back ... 

When do you take your mirt dose? In the evening I guess? Do you feel a sedating effect afterwards? Any difference between "good" and "bad" nights afterwards?

 

Mirt tends to knock me out completely. I do not have problems to fall asleep afterwards. During bad waves (with and without Mirt) I sometimes wake up after a few hours and cannot get back to sleep. But I was never hit as bad with insomnia as you are.

 

Have you tried CBT-I (sleep hygiene and some kind of sleep management) yet? It helped me a bit during depression and St. Johns Wort WD.

 

I hope your next window will start soon! 

 

Hamster

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Shebon

Hi Ripley:

 

I can relate completely!  I cut to half of my dose (1.87 mg.) of mirt in August 2017, and was fine for about 30 days....I then updosed back to 3.75 mg. and I experienced the zero sleep nights, usually alternated zero nites too.  

 

I have been stable or at least more so, since that time in 2017.  Then, in Aug. 2019, I started having zero sleep nites and they alternated again, and I had been back to the normal dose of 3.75 (1/4 of 15 mg) for a long, long time.  I thought what the????  I had to get up around 2 or 3 a.m. and take an additional 1/8 of 15 mg. (1.87 mg) and that would help me get to sleep.  So, the teeny bit can be lifesaving.  You may have gone up too high on your dose and it will take a while to settle down.  

 

Right now, I am trying to follow a modified CITA schedule.... I started halving one dose of 3.75 mg. one nite a week....right now I am halving (2) nites of the week with the normal dose of 3.75 mg. the other days.  I hold each dose halve for 30 days or so.  I will be going to 1.87 mg. dose (3) nites per week in the next 2-3 weeks.  It is much gentler than any other way I have tried and I have tried crushing  the tablet and switched to liquid Soltab last year and that bombed too.  This is a less than 10 percent decrease every month and I am currently at 3.25 mg.

 

I hope you can stabilize again....maybe the teeny dose of 1.87 mg might help you over the hump as it did me in August last year.

 

Best regards and hope to stay in touch,

Shebon😃

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Ripley

Hi Hamster and Shebon

 

Thanks for your messages and input. Had a good night last night but I know i need to give things a while now to hopefully settle down. And then the tapering, it's such a long game isn't it!

 

Best wishes

Ripley x

 

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Ripley

Hi

 

I'd be grateful for your thoughts on my next step please. I've been stable now for 5 weeks (big relief). It took 8 weeks of ups and downs from from mid-Jan to mid-March to stabilise. And now I'm thinking about when I would begin my taper. I was wondering if holding for a further 3 weeks and starting in early May would be long enough in your opinion? I'm keen to start reducing but I'd like to avoid big mistakes if possible!

 

I was also thinking of diluting my Mirtazapine liquid to get 5mg per 1ml as I think this would be easier to reduce than 15mg per 1ml which it is now from the bottle. I assume I would mix 1ml of liquid with 2ml water? Does this sound right to you? Do you think this would keep in the fridge overnight to use again? 

 

I also realise this will be my 3rd attempt to come off Mirtazapine and not my second. Previously, I had taken it for 4 or 5 months then halved the dose for a week then stopped. I thought I had no problems but 3 or 4 months later the all-night, relentless insomnia kicked in! I tried other sleeping meds but luckily reinstated the Mirtazapine (at my full 7.5mg dose) which sorted the problem. I now know I was lucky for this to work as it was about 6 months after stopping. And I now know it was delayed withdrawal! I hadn't connected the two at all until recently with info. from this site. Anyway, now I've found SA I'm aiming for this to be my final time. 

 

I hope everyone is doing ok.

 

Best wishes and thank you,

Ripley

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Ripley

Hello

 

I've now been stable almost 6 weeks and I wondered if it would be ok to start a slow taper in another couple of weeks? I've been holding at 7.5mg since 13th Jan and keen to start reducing but scared to upset the apple cart.

 

In the mornings I struggle to get up and often feel sleepy during the day so it feels like the Mirtazapine is now taking full effect in my system. I've also put on the weight I lost in WD and prob a little more now. Anyway, I'm keen to reduce but dont want to start too soon. I'd be very grateful for your opinion.

 

Sending good wishes to everyone at this time.

 

Ripley

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brassmonkey

It sounds like a good plan to me. 

 

Yes adding two parts water will give the dilution you are aiming for.  The new liquid should keep in the refrigerator  for several days with no problems.

 

I would suggest that when you start your taper that you do a Brassmonkey Slide.  It has proven to reduce the severity of symptoms associated with each reduction and still allow a fairly fast taper.

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Ripley

Thank you so much for your reply Brassmonkey. It has given me the confidence to go ahead in a couple of weeks and answered my diluting question. I will do the Brassmonkey Slide. All the best, Ripley

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Ripley
On 4/18/2020 at 8:30 PM, brassmonkey said:

It sounds like a good plan to me. 

 

Yes adding two parts water will give the dilution you are aiming for.  The new liquid should keep in the refrigerator  for several days with no problems.

 

I would suggest that when you start your taper that you do a Brassmonkey Slide.  It has proven to reduce the severity of symptoms associated with each reduction and still allow a fairly fast taper.

Hi @brassmonkey

 

Something terrible has happened since I last wrote to you and I'd be grateful if you could help me at all please.

 

I seem to have triggered almost total insomnia after having 100% normal sleep for nearly 6 weeks. This happened 5 nights ago. It was the night I last emailed you actually. I normally don't go on my phone in the evenings as I know it can keep me awake. (It's not the blue light as I have this turned off. It must be brain activation too late. I also don't read before bed as this has kept me awake in the past also. TV is fine.) Anyway, I sent a few quick emails about an hour before bed and sure enough it kept me awake all night. I know this probably makes me sound neurotic but it's true. And I was stupid to do this.

 

Anyway, the problem is that every night since then I have been unable to sleep! I think I sleep lightly for about 45 mins early on and then I wake and cannot sleep again. I get overheated in the night and sweating and then cold and shivering, which I'm guessing may be my anxiety about it. If I'm lucky I may get another hour or 2 of very light, broken dozing.

 

I should say that I have not altered my dose of mirtazapine, i take it at the same time, have not had alcohol or coffee or even a painkiller. Nothing has changed chemically but something clearly has changed. In the past, a night of 'induced' insomnia from something like this wouldn't affect the following nights.

 

It feels like I've flipped a switch somehow but I'm not sure why as I've not changed anything? Could it be permanent?? This feels as bad as before I reinstated! My early waves were much more up and down than this. I'd have a couple of terrible nights but then a good one or 2 and so on. This has been 5 awful ones in a row with no let up. If this is a wave, I would have thought it would be a less severe one after 6 weeks of 'normal'.

 

I guess I'm asking if you've come across a worse wave after such a good stretch? Have you seen it triggered in this way?

 

I would have expected a better night by now going on past my experience. This feels different and I'm scared. My life has turned upside down in less than a week. I have to keep lying down and I feel nauseous and like crying all the time. Sometimes I feel physically cold with dread. I'm not myself, which is also upsetting my husband.

 

What could have gone wrong in my brain? The mirtazapine felt so sedating before and now its like I've taken nothing. Could it be poop out? 

 

I know you have a wealth of experience so maybe you know what's likely to have happened? Is there anything I can do?

 

Sorry it's such a long message. Thank you for reading.

 

Ripley

 

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brassmonkey

Hi Ripley-- I sorry to hear that you're having such trouble all of a sudden. Mirtazapine is known to cause insomnia problems. They come in wave out of the blue with no obvious triggers. They are miserable to go through but they do end and things go back to "normal".  We have a lot of members going through them and they try every trick in the book, good sleep hygiene and a lot of AAF seem to work the best on minimizing the distress and discomfort while your body works things out.  It's nothing you've done it's just one of those phases that Stabilizing/WD goes through.

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Ripley
14 hours ago, brassmonkey said:

Hi Ripley-- I sorry to hear that you're having such trouble all of a sudden. Mirtazapine is known to cause insomnia problems. They come in wave out of the blue with no obvious triggers. They are miserable to go through but they do end and things go back to "normal".  We have a lot of members going through them and they try every trick in the book, good sleep hygiene and a lot of AAF seem to work the best on minimizing the distress and discomfort while your body works things out.  It's nothing you've done it's just one of those phases that Stabilizing/WD goes through

 

Thank you again for your reply Brassmonkey. It's appreciated. AAF has been helping as you say. It feels better to try to accept the wave than blame myself and try to explain it. And the only thing we can control is the sleep hygiene. 

 

Best,

Ripley

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