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Oriyah: Remeron withdrawal insomnia hell


Oriyah4

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Hello -- I'm so glad to have found this site. I really need help. 

 

I was prescribed 7.5 mg Remeron about a year ago (I think February 2020) due to health anxiety. Before being prescribed this drug, I had never had any sleep issues whatsoever. The Remeron was great for my anxiety for awhile (I think I was on it about 7 months), but then I began to notice that, when taking handwritten notes in interviews with clients (I'm an attorney), I was frequently skipping over letters (e.g. would write "cient" instead of "client" and then immediately notice and go back and add in the letter) -- this was something I'd never noticed happening before. I also didn't like the feeling I had when waking up in the morning -- for the first few minutes, I felt like I was still asleep, but I also 100% knew that I was awake. It was very disconcerting -- felt like I was losing my mind -- and I knew I wanted to get off the medication.

 

My psychiatrist said, "no problem, you're at a super low dose, just quit." I did that and immediately could not sleep a wink and had no appetite at all. I suffered through that for a few weeks, but it was simply intolerable by that time and not getting better. I found a Remeron FB group that suggested reinstating.

 

So, I reinstated at about 2.5 mg in, I guess, September 2020? and that helped reduce the initial intolerable withdrawal symptoms a lot. But then I started having awful GI symptoms. I went to a gastroenterologist after weeks of that and was told I needed a colonoscopy. The results of the colonoscopy were normal, and my symptoms finally subsided. As that was going on, I was slowly reducing my dose via a liquid preparation my pharmacy prepares for me. I stayed at 2.5 for September, then 2 for October, then 1.05 for November, then down by .15 mg per week for December (.9 first week, .75 second week, .6 third week, .45 fourth week, .3 fifth week) so that I was at .15 mg (1 mg of liquid) at the start of January 2021.

 

I also started on buspirone (5 mg 3 times a day) to help deal with my anxiety in November, a drug which seems to be more benign than many other alternatives.

 

I stayed at .15 on the Remeron (an amount so small that I could barely taste it!) until 3 days ago, when it felt absolutely ridiculous to continue, so I stopped. To be honest, my sleep kept getting worse and worse throughout November and December -- I would wake up several times a night -- but each time I'd be able to fall back asleep pretty easily, so it was tolerable. Then, the day I completely stopped taking the .15 mg, I couldn't sleep more than an hour. I was tired and fell asleep at the regular time, then woke up with a racing heart an hour later. The rest of the night I got no sleep at all. The next day, I decided to take the .15 mg again, which maybe helped a little, but I also took 2 benadryl, so it might have been that that was helping -- at any rate, I slept for 3 hours that night.

 

Yesterday, I took the .15 mg again and also took .5 mg of melatonin. I got 3.5 hours of sleep, woke up at 2 am, took another .25 mg of melatonin, and slept fitfully the rest of the night (waking up on the hour but eventually falling back asleep again, such that I may have gotten another segmented 2.5 hours of sleep).

 

With my health anxiety, I'm really worried that I've permanently ruined my ability to sleep normally, or, in particularly dark moments, I start worrying that some other cognitive degeneration is happening (I'm only 39!), because it doesn't seem possible that such a small amount of Remeron could be having such extreme effects. My psychiatrist (a different one now than the one who originally prescribed Remeron) said he's been practicing for 45 years and never seen anyone have trouble coming off of Remeron. He's trying to prescribe me a benzo to help me sleep and I really don't want to go there.

 

Any advice??? I don't know if I should go back to a higher dose of Remeron again, and if so, what dose, or if I should stay off and rely on Melatonin to get whatever sleep I can until sleep gets back to normal (if ever???) I would be so appreciative of any advice.

Edited by manymoretodays
name to title, spacing of block text done
  • 7.5 mg Remeron about a year ago (I think February 2020) 
  • Stopped CT in August 2020, I think?
  • Reinstated at about 2.5 mg in September 2020 (liquid taper)
  • Started Buspirone (5 mg 3x day) in November 2020
  • Tapered to 2 mg for October, then dropped to 1.05 for November, and then down by .15 mg once/week for December (.9 first week, .75 second week, .6 third week, .45 fourth week, .3 fifth week) so that I was at .15 mg (1 mg of liquid) at the start of January 2021
  • Stopped in second week of January 2021 and am seeking support -- experiencing extreme insomnia
  • Supplements: 200 mg magnesium, .5 mg melatonin, 2000 mg Vitamin D, Omega 3 (kelp-based)
Link to post
  • manymoretodays changed the title to Oriyah: Remeron withdrawal insomnia hell

Titled:  Moderators, please, I need help

 

Still waiting for my introduction post to be approved. I cannot sleep more than 2 hours a night, and it’s been this way for 2 weeks. Melatonin isn’t even really working anymore. Please, please send advice. I can’t tolerate this and know I need to reinstate. But reinstating at .3 mg did nothing at all. Please, someone, please send advice to let me know what mg to reinstate at. I’m desperate. Thank you.

Edited by manymoretodays
title added, merged to topic
  • 7.5 mg Remeron about a year ago (I think February 2020) 
  • Stopped CT in August 2020, I think?
  • Reinstated at about 2.5 mg in September 2020 (liquid taper)
  • Started Buspirone (5 mg 3x day) in November 2020
  • Tapered to 2 mg for October, then dropped to 1.05 for November, and then down by .15 mg once/week for December (.9 first week, .75 second week, .6 third week, .45 fourth week, .3 fifth week) so that I was at .15 mg (1 mg of liquid) at the start of January 2021
  • Stopped in second week of January 2021 and am seeking support -- experiencing extreme insomnia
  • Supplements: 200 mg magnesium, .5 mg melatonin, 2000 mg Vitamin D, Omega 3 (kelp-based)
Link to post
  • Moderator
manymoretodays

Hi Oriyah4 and welcome.

Apologies on the delay getting you started.  And thank you, thank you for getting your signature nicely done!

 

So just the last 2 weeks with the overwhelming insomnia?

Has this gotten worse since you started the Buspirone?

Buspirone Side Effects: Common, severe, long term- Drugs.com

and Drugs.com, is an excellent site to not only check out any medications/drugs before taking them, but also to do interactions checks on as well

And then, was the anxiety your biggest symptom, since coming off the Remeron/mirtazapine?

 

Buspirone is also a drug that we would recommend a taper on.

Tips for tapering off buspirone(Buspar)

 

And okay, more on WD(withdrawal) symptoms:

 

Dr Joseph Glenmullen's withdrawal symptom checklist

 

We advocate for a more harm reduction approach to tapering:

Why taper by 10% of my dosage?

And then sometimes, at the lower doses, when tapering, one needs to go even slower or lessen the percentage drops.

 

Do you remember at which dose of Remeron you were doing okay with?  And then, this may have been prior to your addition of Buspar.

 

*Tips for tapering off mirtazapine(Remeron)

And then, are you still taking the Remeron now?  I'm a bit confused as to your dosage, as well.  What concentration do you have of Remeron?  And are you taking 1 mg or 0.15 mg. 

What does the label on the bottle say?

Usually there are so many mg's(milligrams) per mL's(millileters).

The millileters are the volume, sometimes abbreviated to ml, mL, or cc

 

 

Would you do an interactions check, on Buspar and Remeron there, and then either link us to it, or copy and post right here, in a reply box.  Drugs.com interactions checker

 

And then when do you take your drugs, the time(s) daily?

 

So I am guessing that you are experiencing a lot of WD(withdrawal) now. 

What is withdrawal syndrome?

Brain remodeling

 

And then we often find a non-linear recovery from WD too.

The Windows are 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.  The CNS likes stability. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur. And sleep is really important during withdrawal.  Insomnia is no small deal. 

 

And I'm sure you know that, about the insomnia.......it can make things all feel really tough.

 

You may have a bit of a drug interaction going on too, although with your lower dose of Remeron now, hopefully less likely.........but possible.

Best to space interacting drugs apart by at least 2 hours too.  That's something you can more immediately do, while we get to know you, and your case a bit better.

 

And okay, finally.......what you want to know more about.
About reinstating and stabilizing to reduce withdrawal symptoms

and this does apply to updosing too

 

I'm going to stop here, and get you approved now, give you chance to digest more information too.  We can also get into some more non-drug coping too, if you have not found much on your own yet.

 

This is your introduction/journal page where you have now introduced yourself to the community, you can ask questions here regarding your tapering, give updates, and just keep a record of your journey.

 

Welcome again.  And apologies........ as w e would really like to get to everyone started, within 24 hours, but sometimes it is just not possible.  Forgive.

 

Love, peace, healing, and growth,

manymoretodays(mmt)

Edited by manymoretodays
futher formatiing, tapering mirtazapine link added

Started with psycho meds/psychiatric care circa 1988.  In retrospect, and on contemplation, situational overwhelm.

Rounding up to 30 years of medications(30 medication trials, poly-pharmacy maximum was 3 at one time).

5/28/2015-off Adderal salts 2.5mg. (I had been on that since hospital 10/2014)

12/2015---just holding, holding, holding, with trileptal/oxcarb at 75 mg. 1/2 tab at hs.  My last psycho med ever!  Tapered @ 10% every 4 weeks, sometimes 2 weeks to

2016 Dec 16 medication free!!

Longer signature post here, with current supplements.

Herb and alcohol free since 5/15/2016. 

None of my posts are intended as medical advice.  Please discuss any decisions about your medical care with a knowledgeable medical provider. manymoretodays

 

Link to post

Thank you so much for your response, MMT. Sorry to be so desperate. I'm very much at my wit's end and am incredibly grateful to hear from you. Recovering from these drugs is such a lonely road to go down. It's so easy to feel like you're losing your mind.

 

I've had issues with waking in the night for awhile now. I don't remember how long. Probably ever since I reinstated at 2.5 mg. I would usually just fall right back to sleep when I woke up, though. It's just been in the last 2-3 weeks (when I was as .3, then .15, then zero mg) that I started waking up in the middle of the night unable to go back to sleep at all.

 

I don't believe that the insomnia has gotten worse since starting the Buspirone. The Buspirone has helped control (though not completely) waves of anxiety. My hope is that I can get completely off of Remeron and then tackle getting off Buspirone. I've seen a couple of references online, here and elsewhere, of folks having trouble with Buspirone taper, but it doesn't seem to be anywhere near to the extent that they have trouble with Remeron.

 

The only interaction between the two drugs on drugs.com is regarding the risk for serotonin syndrome. I have been trying to be careful not to take the two within a couple hours of each other. I usually take Buspirone at 7 am, 3 pm, and 10 or 11 pm, and had been taking the Remeron at about 8 pm. I haven't taken any Remeron for about a week now (except one night when I tried taking .3 mg of Remeron but it didn't help).

 

I was basically still "OK" (could tolerate symptoms) until I got down to about .3 mg (my liquid is 7.5 mg medicine/5 mg liquid, so I'm figuring that there is .15 mg medicine in .1 mg liquid). At .3 mg, my spouse and my psychiatrist were telling me just to get off of it, it couldn't possibly be causing the symptoms I thought it was. I'm wondering if tonight I shouldn't try reinstating at .6 mg (.4 mg of liquid) or maybe .9 mg (.6 mg of liquid).

  • 7.5 mg Remeron about a year ago (I think February 2020) 
  • Stopped CT in August 2020, I think?
  • Reinstated at about 2.5 mg in September 2020 (liquid taper)
  • Started Buspirone (5 mg 3x day) in November 2020
  • Tapered to 2 mg for October, then dropped to 1.05 for November, and then down by .15 mg once/week for December (.9 first week, .75 second week, .6 third week, .45 fourth week, .3 fifth week) so that I was at .15 mg (1 mg of liquid) at the start of January 2021
  • Stopped in second week of January 2021 and am seeking support -- experiencing extreme insomnia
  • Supplements: 200 mg magnesium, .5 mg melatonin, 2000 mg Vitamin D, Omega 3 (kelp-based)
Link to post
  • Moderator
manymoretodays

Hi Oriyah,

I can get back to you later today.  Happy Monday. B)

Started with psycho meds/psychiatric care circa 1988.  In retrospect, and on contemplation, situational overwhelm.

Rounding up to 30 years of medications(30 medication trials, poly-pharmacy maximum was 3 at one time).

5/28/2015-off Adderal salts 2.5mg. (I had been on that since hospital 10/2014)

12/2015---just holding, holding, holding, with trileptal/oxcarb at 75 mg. 1/2 tab at hs.  My last psycho med ever!  Tapered @ 10% every 4 weeks, sometimes 2 weeks to

2016 Dec 16 medication free!!

Longer signature post here, with current supplements.

Herb and alcohol free since 5/15/2016. 

None of my posts are intended as medical advice.  Please discuss any decisions about your medical care with a knowledgeable medical provider. manymoretodays

 

Link to post

Thanks, MMT! Quick update: I took .4 mg (=.6 mg of actual remeron) last night to see how it would go. Sweet relief: I could sleep again. I woke up at least 5 or 6 times, but fell back asleep fairly quickly. So now my question is: should I take a little more so that I start my taper from a place where I sleep soundly through the night and don’t wake up? Or should I just hold here at .6 mg for awhile? And at what point will I know I’m ready for a decrease?

  • 7.5 mg Remeron about a year ago (I think February 2020) 
  • Stopped CT in August 2020, I think?
  • Reinstated at about 2.5 mg in September 2020 (liquid taper)
  • Started Buspirone (5 mg 3x day) in November 2020
  • Tapered to 2 mg for October, then dropped to 1.05 for November, and then down by .15 mg once/week for December (.9 first week, .75 second week, .6 third week, .45 fourth week, .3 fifth week) so that I was at .15 mg (1 mg of liquid) at the start of January 2021
  • Stopped in second week of January 2021 and am seeking support -- experiencing extreme insomnia
  • Supplements: 200 mg magnesium, .5 mg melatonin, 2000 mg Vitamin D, Omega 3 (kelp-based)
Link to post
  • Moderator
manymoretodays
On 1/17/2021 at 1:43 PM, Oriyah4 said:

The only interaction between the two drugs on drugs.com is regarding the risk for serotonin syndrome. I have been trying to be careful not to take the two within a couple hours of each other. I usually take Buspirone at 7 am, 3 pm, and 10 or 11 pm, and had been taking the Remeron at about 8 pm. I haven't taken any Remeron for about a week now (except one night when I tried taking .3 mg of Remeron but it didn't help).

 

I was basically still "OK" (could tolerate symptoms) until I got down to about .3 mg (my liquid is 7.5 mg medicine/5 mg liquid, so I'm figuring that there is .15 mg medicine in .1 mg liquid). At .3 mg, my spouse and my psychiatrist were telling me just to get off of it, it couldn't possibly be causing the symptoms I thought it was. I'm wondering if tonight I shouldn't try reinstating at .6 mg (.4 mg of liquid) or maybe .9 mg (.6 mg of liquid).

 

Hi Oriyah4,

Well, later today......B) Barely, if I don't sign off soon, it will be tomorrow.

And okay, yah, but on the serotonin syndrome, it comes in all different degrees, you know like milder, moderate, or heavy duty.  But......your mirtazapine dose is so low too. 

But if things went awry after your Buspar addition, then......well.......likely that it may not have helped at all.  I guess that was all I wanted you to take stock of.

 

And I did the math too, on your concentration of 7.5 mg per 5 mL, and came up with the same numbers, or .15 mg per .1 ml

 

And okay then, you had been off the Remeron for about a week.

6 hours ago, Oriyah4 said:

hanks, MMT! Quick update: I took .4 mg (=.6 mg of actual remeron) last night to see how it would go. Sweet relief: I could sleep again. I woke up at least 5 or 6 times, but fell back asleep fairly quickly. So now my question is: should I take a little more so that I start my taper from a place where I sleep soundly through the night and don’t wake up? Or should I just hold here at .6 mg for awhile? And at what point will I know I’m ready for a decrease?

 

I'd say to stick with the .6 mg now.  Go with the same dose for a week.  It's usually 4-7 days for most drugs to see more clearly if a reinstatement, or updose sometimes, is going to be effective.  So I'd suggest you stick with the .6 mg.  You might not get perfect sleep, but I'm sure at this point any improvement will be grand.

 

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

I'd suggest you scour this topic, for any non-drug coping....... that could really help too

 

And oh yes, a good HOLD, and a chance for your nervous system to stabilize a bit, and then after several months, you can begin a taper.  And even then, you can do a gradual taper, 10% or less, from each previous dose.  You could further dilute your liquid to do so.  And you don't even have to discuss it with your doctor or others, until perhaps comfortable doing so.  Maybe after the fact.

 

Please do update.  And ask if anything else comes up as far as questions.  We have so much information here, and I'm happy to point you towards it, and even help you learn how to search for it too.

 

Best, L, P, H, and G,

mmt

Edited by manymoretodays

Started with psycho meds/psychiatric care circa 1988.  In retrospect, and on contemplation, situational overwhelm.

Rounding up to 30 years of medications(30 medication trials, poly-pharmacy maximum was 3 at one time).

5/28/2015-off Adderal salts 2.5mg. (I had been on that since hospital 10/2014)

12/2015---just holding, holding, holding, with trileptal/oxcarb at 75 mg. 1/2 tab at hs.  My last psycho med ever!  Tapered @ 10% every 4 weeks, sometimes 2 weeks to

2016 Dec 16 medication free!!

Longer signature post here, with current supplements.

Herb and alcohol free since 5/15/2016. 

None of my posts are intended as medical advice.  Please discuss any decisions about your medical care with a knowledgeable medical provider. manymoretodays

 

Link to post

Mmt, tonight I took the .6 mg and my sleep was as bad as it was before I reinstated. It seems like yesterday was a fluke (or maybe I was just so exhausted that i managed to overcome insomnia for one night). I’m planning to try .9 mg tomorrow. Is there any problem with trying that?

  • 7.5 mg Remeron about a year ago (I think February 2020) 
  • Stopped CT in August 2020, I think?
  • Reinstated at about 2.5 mg in September 2020 (liquid taper)
  • Started Buspirone (5 mg 3x day) in November 2020
  • Tapered to 2 mg for October, then dropped to 1.05 for November, and then down by .15 mg once/week for December (.9 first week, .75 second week, .6 third week, .45 fourth week, .3 fifth week) so that I was at .15 mg (1 mg of liquid) at the start of January 2021
  • Stopped in second week of January 2021 and am seeking support -- experiencing extreme insomnia
  • Supplements: 200 mg magnesium, .5 mg melatonin, 2000 mg Vitamin D, Omega 3 (kelp-based)
Link to post

Ok, I decided to stick with .6 mg for awhile for stability’s sake and have been on .6 mg for 5 nights now (after my too-fast taper to zero). And am also using melatonin. I take 1 one mg melatonin, fall asleep for 2 hours, wake up and take another 1 mg melatonin, fall asleep for 2 hours, take another melatonin, and from that point (usually around 2 am) I am tossing and turning the rest of the night, maybe getting a bit of sleep here and there but mostly awake. Now that it’s been 5 days without great improvement, should I increase my dose some, or just hold tight at .6 mg a little longer??? I wonder if I shouldn’t have just stuck it out at zero, since it seems like I’m going to suffer regardless. And at least at zero I didn’t have another year of tapering ahead of me. Maybe I could still do that if I do it now, before my body gets too used to the .6 mg again. Please help...

  • 7.5 mg Remeron about a year ago (I think February 2020) 
  • Stopped CT in August 2020, I think?
  • Reinstated at about 2.5 mg in September 2020 (liquid taper)
  • Started Buspirone (5 mg 3x day) in November 2020
  • Tapered to 2 mg for October, then dropped to 1.05 for November, and then down by .15 mg once/week for December (.9 first week, .75 second week, .6 third week, .45 fourth week, .3 fifth week) so that I was at .15 mg (1 mg of liquid) at the start of January 2021
  • Stopped in second week of January 2021 and am seeking support -- experiencing extreme insomnia
  • Supplements: 200 mg magnesium, .5 mg melatonin, 2000 mg Vitamin D, Omega 3 (kelp-based)
Link to post

Hi Oriyah:

 

Yes, it is tricky to get re-stabilized when doing an updose.  I had to do it 2017 from 1.87 mg. to 3.75 mg. and it took about 35 days for me to stabilize with some 0 sleep nites thrown in.  So hang in there -- I think better nites are ahead.  

 

Also, Omega 3s might be a little stimulating to the CNS so you might want to consider "on hold" for right now.  Are you taking Vit D in the a.m.s?

 

Best regards,

Shebon

Started 3.75 mg. remeron 4/2013.  Had tapered off benzo 4/2011.  1/2020 began 5th or 6th taper off Remeron.  Am doing a modified CITA taper--started 6 nites at 3.75 mg. then one nite at 1.87 mg. (half dose).  Currently (6/4/20), 5 nites at 1.87 and 2 nites at 3.75.  I stay on each phase for one month - it will take me around 7 mths to be at 1.87 mg nitely (1/2 of normal dose of 3.75 mg.)  4/10/20 -  2.67 mg. Remeron/day; 5/10/20 - 2.39 mg.;  6/10/20 - 2.11 mg.; 7/11 1.87 mg.  My first BIG benchmark!  1/25/2021 -- going back up to 1.87 mg. as cutting 1/8s into 1/16s became problematic and I have had withdrawal symptoms the past 4 months or so that I thought was due to other stuff going on.   NOT -- all withdrawals (insomnia, headachy, flushes, flu-ishness).  I will be happy at a 50% reduction until I re-stabilize again, and start afresh with a compounding pharmacy and take it very slow.

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HardTimes

Oriyah4,

I SO share your pain! I so wish I could just figure it out for you (and for me!), as the stress of "too much? not enough? up? down?" is really hard. The worst part is that, at least according to me, you have to wait to see the effects apparently. Our instincts are immediate: If I do X and feel bad, X made us feel bad. But maybe doing X actually helps us four days later, or a week later? So really trying to keep track of symptoms over time and noting other things (like diet, exercise, supplements etc.) is important so you CAN ultimately make smart decisions. There are different suggestions here for journaling or symptom tracking. Me, I scrapped my more complex forms and just have a notebook like this:

 

Night before: Slept 9:30-2:30, read, some dozing from 4-6. (5h +2dozing)

8am - out of bed, took dose of 0.xx, +magnesium with breakfast

10am - still unmotivated, depressed, tired.

12pm - some improvement - going for walk

1pm - big lunch, mood improved, mild headache. 

 

etc. 

 

That way I can see, for example, that I almost always improve as the day goes on, and I can look back and see if, for example, taking the dose in the morning or evening makes a difference. 

 

But I totally share your pain! I'm still in the same problem: after a great deal of agonizing, I've decided my reinstatement is a failure, so I'm going down/off. A couple of days after going down, certain symptoms seemed to have gone away (HURRAH!). So of course I rejoice and think I've made the right decision. But then, all day yesterday and last night were again pretty awful. So maybe I didn't?? ARG! But it looks like you've found a knowledgable moderator, which can be reassuring. The idea of making longer decisions to allow some stability seems to be very common advice - decide after a week, not every day. 

 

Finally: Insomnia is such a common symptom here, but you really haven't had it for too long yet (not at all to belittle your suffering!). My point is that it might actually turn out to be fairly short lived now you've tried to nip it in the bud so quickly. I have high hopes your symptoms will resolve! Hang in there!

15+ years Citalopram 10mg (sometimes 20?)

2019 Citalopram 5mg. No problem reduction.

2020 Citalopram 5mg to zero. (Feb)

2020 (Feb - mid Oct): Very rare use of 0.125 or .25mg Xanax for really bad symptoms

2020 (Feb - Nov): Occasional use of "Nytol" sleep aid (an antihistamine). 

2020 Failed reinstatement: Escitalopram by accident (not Citalopram).  

 -- using a scale, started July 27 0.5mg, doubled every week or so to reach 5mg by Aug 30. Too fast - terrible depression, quit.

2020 (Oct-current): Supplements:

 -- Morning: Magnesium 300mg, Omega 3(483 EPA, 360 DHA +Vit E) Night: Liquid Valerian/Passiflore/Escholtzia - French organic herbal sleep aid, 1.9mg LD Melatonin 

2020 Current - new Citalopram reinstatement. (Accidentally started with Escitalopram before realizing and switching to Citalopram Oct. 30)

 -- using pipette method: Oct 30, 0.25mg; Nov. 4th, 0.375; Dec. 1st 0.5mg, Dec. 21st 0.75mg Jan 19: Decide reinstatement fail: Jan 21 0.625mg, Jan 28: 0.5mg Feb 8 0mg

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