Marija: Help needed with reinstating mirtazapine after severe WD

[Altostrata]

We can't tell from your experiment whether it was the lorazepam or updose in mirtazapine that enabled you to sleep. As Gridley said, you have to change only one thing at a time to see what works.

 

Why do you put honey in your liquid mixture?

[Marija]

1 hour ago, Altostrata said:

Why do you put honey in your liquid mixture?

 @Altostrata, I add honey to the mixture because my partner who's a lab scientist advised that it suspends the dispersed powder better than water alone due to being thicker and thus ensures a more accurate dose each time. 

[Altostrata]

You'll need to give it all a gentle but thorough stir. An uneven mixture might have caused you to get irregular dosages.

 

Can your partner get pharmacy liquid that's made for suspensions? One brand is Ora-Plus.

[Marija]

@AltostrataI've been giving it a stir every time. But I will look into get ora-plus.

[Hopefull]

On 3/4/2021 at 11:26 PM, Marija said:

Thanks so much for you reply @Ripley, I really appreciate it. I shall stick to 0.5mg for a bit longer than and see how I sleep tonight. I find the zero hour nights way WAY worse than any other symptoms I've experienced such as severe anxiety, paranoia, nausea etc. I feel that when I get at least 5 hours of sleep (even if it's broken), I can cope with all of those symptoms a lot better but once I get two nights in a row of zero sleep, it all goes downhill and I become very unwell in every sense. If I have a zero hour night again tonight, would you increase the mirtazapine a little or try to ride it out? I can definitely handle a night or two of zero sleep but once it's three, four etc nights in a row, I simply cannot cope. There's so much dread I feel in relation to sleep. My life quite literally stops completely once I've had two nights of zero sleep. Do you have any advice on coping strategies? I often worry that I'll become very physically ill due to such lack of sleep and run my immune system to the ground... I do understand that excessive worry is not helpful but so far my experience with mirtazapine WD and particularly the insomnia, has scared the life out of me!

 

All the best,

Marija

 

Hi Marija,

It can take couple of months to stabilise. You need to be patient. 

Don't chop and change the dose. 

Stick with your current dose and ride out the storm. Kind regards, Hopefull.

[Marija]

Hello again...

 

I hope you're doing well. Unfortunately, I'm very desperate for help and advice again please. I have no idea what is happening to me. Long story short, I have been doing extremely well on 0.75mg if mirtazapine for weeks so I reduced it to 0.725mg. I know it sounds utterly stupid but the night a reduced it, there was a fly ins the bedroom keeping me awake that I was trying to get rid of - it got me quite worked up and o ended up having an increased heart rate and complete insomnia. Strangely, since I started tapering mirtazapine, I the smallest of things can throw me off and causes my CNS to get all fired up. Not sure is this is at all normal..? Anyway, I thought that no sleep that night was a bit a fluke due to the fly (silly, I know!) and I thought I'd stick to 0.725 especially considering I shouldn't notice any effects of such a slight reduction on the first night. The next day, I had a very very stressful day due to university related stuff for my master's degree - got quite worked up again - and had another night of zero sleep. This has my rocketed my anxiety and I had my third night of ZERO sleep experiencing extreme anxiety and adrenaline surges. It was as if my body is too scared to fall asleep - as soon as I start drifting, extreme anxiety jolted my out of sleep. I decided to up mirtazapine to 0.85mg to get some sleep as I was close to a complete crisis, however, it did not help at all and I have just had my fourth night of ZERO sleep. I had severe heart palpitations, anxiety, adrenaline surges, became severely distressed and suicidal during the night due to extreme exhaustion and anxiety, very nauseous too. I have no idea what to do now. I'm considering taking lorazepam and my regular dose of 0.75mg of mirtazapine that I was doing well on for weeks. Lorazepam is known to calm my adrenaline surges down and I always end up breaking the cycle of severe insomnia and I then tend to be okay and can carry on with my taper. So far I have only taken one dose of lorazepam every 2-3 weeks or so so it's not a regular occurrence. I'm beyond terrified of creating another dependency problem with lorazepam so I don't know what to do. My partner is telling me I'll be fine as I only take it so rarely and we know it breaks very bad cycles of insomnia like this. If I don't sleep tonight, I'll end up in A&E as it'd be my 5th night of ZERO sleep. I have no idea what to do. Please help. I know I'm not getting it perfectly every time but I am truly trying my best. This is the hardest thing I've ever had to do. 

@Altostrata @Hopefull @Ripley @Gridley do any of you have any advice please? I'd be SO so grateful. I need to make sure I sleep tonight. My anxiety and all other symptoms are getting so much worse with every night of no sleep. Every night it harder and harder. 

 

thank you

[Altostrata]

Why not try 0.75mg of mirtazapine? 

 

Is it possible you're worrying so much about the mirtazapine dose, you're keeping yourself awake? Please see methods to strengthen your sleep:

 

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

 

Path to Better Sleep FREE online for everyone from the US Veterans Administration

 

Music for self-care: Calms hyperalertness, anxiety, aids relaxation and sleep

 

White noise devices for sleep

 

Melatonin for sleep: Many people find it helpful

 

TV or computer use in evening can disrupt sleep: Bright light signals the brain that it's daytime

[Iman]

@Marija

 

Hi there Marija

How're doing? Are feeling better? Any success with your sleep?

[Marija]

Hi @Iman and apologies about a delay in replying.

 

I haven't been doing that well to be honest. I'm still currently on 0.75mg mirtazapine, however, I'm crashing really badly every 2-3 weeks with severe insomnia and anxiety, and become completely unable to function. In those situations I rely on lorazepam, however, I've realised I can no longer do it as I'm playing with fire even if I am taking it only once every 2-3 weeks.

 

I have decided that tonight is going to be the frst night that I will up my mirtazapine significantly - close to the dose I was taking for a couple of years which was approx. 3.25mg. So I'll perhaps try 2mg or 2.5mg tonight and see if I can stabilise on it. The reason for that decision is that I never managed to stabilise on 0.75mg even though I've been on this dose for about 3 months now. My sleep is still very disturbed - on good nights I sleep for about 4-5 hours and then just "snooze" or rest there half awake and half asleep. On bad nights, I get ZERO sleep. These bad nights often involve some sort of emotional trigger and I'm currently trying to learn how to deal with my emotions better by engaging in therapy, meditating and adopting a generally more positive attitude towards everything. Anyway, my appetite had never come back either on 0.75mg... I've lost ALL enjoyment that I used to get from food and 80% of the time I'm forcing myself to eat. Strangely, dinner is the only meal of the day, I vaguely enjoy... The mild nausea is still haunting me as well. I've also become very withdrawn from my friends - the thought of going over to my friend's place for a girly sleepover is terrifying because I'm worried about starting another cycle of COMPLETE insomnia by not sleeping in my own bed etc. There's not much more to my life except managing withdrawal, ensuring my mood is stable and that there are no triggers of any kind that may cause stress and subsequent insomnia. I'm mostly a worried, paranoid and exhausted mess with very noticeable OCD patterns as well. As I said, I'm working on myself in other ways too by taking up talking therapy sessions etc. However, my gut feeling is telling me that I need a much higher dose of mirtazapine to properly stabilise and THEN start tapering by very very small amounts. I'm of course keen to hear everyone's thoughts on this and I will take them into consideration.

 

I'm not entirely sure what the right thing to do is as I quit mirtazapine 3.25mg cold turkey for about 10 days, then reinstated at 0.5mg, then upped to 0.75mg and stayed there for 3 months ish without managing to achieve stability in terms of lack of appetite, frequent mild nausea, emotional disregulation and sensitivity to the smallest of stress-inducing triggers. I know you could argue that I need to learn to deal with these things without relying on medication and that's what I am trying to do but at the same time I'm not sure if it's the mirtazapine causing such sensitivity and disregulation that so frequently ends up giving me nights with absolutely no sleep until I crash so badly that I have no choice but to take lorazepam or I'd just jump out of the window instead... Or... If it's just me. Meaning that I'd have this sensitivity and be just as disregulated even if I had never been mirtazapine. No way of telling I suppose...

I feel like increasing mirtazapine, closer to the dose I used to take, is now my only option in terms of any real stabilisation before I start the taper. I'm not sure that being strong and waiting it out is an option as much as I'd like it to be as I will either end up dead or on a psychiatric ward one day if I continue the way I have been. 

 

Don't get me wrong, I get plenty of good days but the crisis point that I seem to reach every 2-3 weeks and having to take lorazepam to come out of it because no amount of meditation and other coping strategies (you name them) will work just has to stop... And the only way I can see to make it stop is up my mirtazapine which will hopefully lead to some real stabilisation and then I start the taper from there... Could anyone offer their opinion on this please?

 

I hope you're all well.

 

Marija

 

 

[Iman]

@Marija

 

You seem to be on the right track. I believe the source of ur problem is the CT from 3.25 mg which was done too soon. I have this inkling that your updose can significantly alleviate ur symptoms, however it's with moderators to come up with the final recipe. I understand how it feels like when u say insomnia with zero sleep hits u bad. I, too, experience such nasty waves of insomnia and sleep-deprived nights every 3 weeks or so. But once ur tapering gets on a regualr track of 10 percent-cut, your system will eventually stablize on this regularity and ur wave symptoms will be much more bearable. Hang in there, we are all on the same boat and will sooner or later get to our desired destination. Resilience is the key.

[Marija]

Hello again...

 

I thought I'd do an update. 

 

Things have been reasonable I suppose. Since my final updose to 2.5mg (which I do not intend to change anymore until I stabilise completely) my WD symptoms have eased - less anxiety, less nausea, sleep improved but only for about 3 weeks which seemed to be the case previously as well. And then... I crashed. Today is the fifth day of me running on about 2 hours of broken sleep a night. Strangely, I'm dealing with it a lot better than previously which I reckon is likely to do with my updose which eased anxiety, paranoia, intrusive thoughts and OCD type symptoms.

At night, I keep feeling like it's mirtazapine that's keeping me awake particularly because I tend to get a couple of hours of broken sleep in the early hours after the sedation from mirtazapine has worn off slightly. Throughout the night, I'm just lying in bed barely able to move from sedation and drowsiness but totally incapable of falling asleep. Could I be right about this? If so, is it worth trying to gradually start taking mirtazapine earlier in the evening to see if I manage to get more sleep during the night that way? 

It can't explain it but it just feels like my body doesn't want this drug anymore. It's also strange how every time I updosed (including this time) I got 2-3 weeks of okay sleep and then crashed. I wonder why that is? I realise that coming off of it cold turkey is not an option as that's going to trigger a wide range of other WD symptoms. I'm just not quite sure what to do about the relentless insomnia. There's only so long I can cope on 2 hours of broken sleep a night... Just to make it clear, I have no intentions of changing the dose this time unless advised to do otherwise here. The insomnia is, however, making me really really ill.

 

Any thoughts would be greatly appreciated.

 

Marija

[Shep]

On 4/19/2021 at 3:00 AM, Marija said:

Long story short, I have been doing extremely well on 0.75mg if mirtazapine for weeks so I reduced it to 0.725mg.

 

On 4/19/2021 at 5:51 PM, Altostrata said:

Why not try 0.75mg of mirtazapine? 

 

1 hour ago, Marija said:

Since my final updose to 2.5mg

 

Marija, you went from .725 mg to 2.5 mg, which is a very high updose. As Alto mentioned, you may have benefited from going back up to .75 mg. 

 

From what you wrote in your latest post, it looks like that increase created a paradoxical reaction. The more you dampen down your nervous system with sedatives,  the more your nervous system fights to stay alert, which is the paradoxical reaction. This is especially true for someone with a hyper-sensitive nervous system. 

 

When did you increase to 2.5 mg? It's possible you may benefit from decreasing, but it will be helpful to know the dates. 

 

Please update your signature to reflect these changes. A direct link to your signature is here:

 

Account - Setting - Create or Update Your Signature

 

Also, please include the dates you've used lorazepam and the dose. I know you're trying to limit use of this drug, but even periodic use can cause problems, especially paradoxical reactions. The more you can let us know, the better we can advise you going forward. 

 

 

[Marija]

Hi @Shep, thanks so much for your reply. 

 

I updosed to 2.5mg on 9th May. The reason for that was because in the end I crashed on 0.75mg really badly and had multiple nights of ZERO sleep which resulted in me feeling suicidal and having to take lorazepam. Other WD symptoms such as nausea, total lack of appetite and anxiety were still somewhat present on 0.75mg too. I didn't want to keep toying with my dose anymore and adjust it every two weeks so I thought if updosed closer to a dose that I was originally taking which was around 3.25mg, it'd be more likely to help with insomnia and other WD symptoms. After I updosed to 2.5mg my other WD symptoms such as nausea and anxiety subsided and I slept okay for about two weeks until 5 nights ago when the relentless insomnia started again which again, leaves me clueless about what I should do next. So far since the reinstatement, on all doses I've run into relentless insomnia after some time which results in a significant crisis. Out of all doses I've tried so far, 2.5mg seems to have worked the best for general WD symptoms but as I said, about two weeks after updose, the relentless insomnia started again - it's currently day 5 of me running on 2 hours of very light broken sleep and it's making me want to jump off a bridge. I understand what you're saying about the paradoxical reaction, however, I ran into the same relentless insomnia after a few weeks on 0.5mg and then after several weeks on 0.75mg too. Now the same thing is happening on 2.5mg the only difference being my other WD symptoms are much milder. Granted, my sleep stayed okay the longest on 0.75mg, however, in the end I still got relentless insomnia. I'm really not sure what to do. 

 

I have updated my signature. I can't remember when it took the occasional lorazepam but I will try and find out and update that too. 

 

 

[Marija]

I have now fully updated my signature including lorazepam. I only took lorazepam when I was in crisis after multiple days of absolutely no sleep. I have no intentions to take lorazepam ever again as I know how addictive this drug is.

[Marija]

As you can probably see from my signature, so far, I've had a pattern of sudden onset of absolutely relentless insomnia on all doses I have tried following reinstatement. Each time following an updose I slept reasonably well for some time until BAM sudden insomnia. As I said the longest time o had okay sleep was on 0.75mg but even then the insomnia started after several weeks. And I do mean, complete relentless insomnia. On 0.75mg I still had other WD symptoms even when I slept okay. On 2.5mg other WD symptoms are practically non existent, except again, the sudden onset of total insomnia about 2 weeks after updosing. I'm desperate and I have no idea what's going on and why this happens no matter what dose I've taken so far - 0.5, 0.75 or 2.5.

[Altostrata]

6 hours ago, Marija said:

After I updosed to 2.5mg my other WD symptoms such as nausea and anxiety subsided and I slept okay for about two weeks

 

You increased from 0.75mg to 2.5mg about 3 weeks before your sleep broke up again. Over that time, the increase ramped up to full strength over about the first 4-8 days. 

 

As Shep said, you probably got a paradoxical reaction after the increase ramped up, because the effect was too strong, particularly when you add lorazepam. This might have happened after you updosed to 0.75mg earlier, too. It may have happened every time you changed your dosage. This is why we urge people to make very small changes.

 

Suggest you decrease to 2mg, hold on that for 2 weeks, and see what happens. Avoid taking lorazepam.

[Marija]

1 hour ago, Altostrata said:

 

You increased from 0.75mg to 2.5mg about 3 weeks before your sleep broke up again. Over that time, the increase ramped up to full strength over about the first 4-8 days. 

 

As Shep said, you probably got a paradoxical reaction after the increase ramped up, because the effect was too strong, particularly when you add lorazepam. This might have happened after you updosed to 0.75mg earlier, too. It may have happened every time you changed your dosage. This is why we urge people to make very small changes.

 

Suggest you decrease to 2mg, hold on that for 2 weeks, and see what happens. Avoid taking lorazepam.

Dear @Shep @Altostrata, thank you for your wisdom. That's exactly what I'm going to do. I've just taken 2mg as it's 9.30pm here in the UK. I'll stick to it for two weeks as advised. I've already promised myself to never take lorazepam again as I don't want to play with fire. Just to make it clear as well, the last time I took lorazepam was about 3 weeks ago when I updosed to 2.5mg. I haven't taken any since. 

[Marija]

Happy to report that I got a little bit more sleep last night after reducing from 2.5mg to 2mg. I managed to get about 4 hours of broken sleep instead of about 2 hours. I still had a strange 'blocking' sensation throughout the night, feeling quite sedated, drowsy but not being able to actually sleep. The majority of my sleep happened in the earlier hours of the morning after the sedation from mirtazapine wore off a little. It seems like I certainly didn't do myself any favours by jumping up to 2.5mg and indeed caused a paradoxical reaction. This makes it very tempting to reduce even further tonight with the hope to get more sleep but I shall hold at 2mg for two weeks as advised by @Altostrata unless you suggest to reduce again..? I imagine the answer is likely going to be to carry on holding. 

 

Thank you again for your support. I'm very grateful for this community.

 

[Shep]

26 minutes ago, Marija said:

This makes it very tempting to reduce even further tonight with the hope to get more sleep but I shall hold at 2mg for two weeks as advised by @Altostrata unless you suggest to reduce again..? I imagine the answer is likely going to be to carry on holding. 

 

Please let us know how you're doing over the coming days. We can advise you along the way. 

[Marija]

I will do - thank you! 

[Marija]

Just thought I'd do a quick update.

 

So I spent half of my night violently throwing up last night because I got food poisoning. The other half of the night I spent feeling sedated from mirtazapine and desperately wanting to sleep but not being able to until the early hours of the morning again. I managed to get maybe 4 hours of sleep so it's still an improvement compared to when I was on 2.5mg!! And I'm so grateful for that improvement.

 

I keep getting this 'blocking' sensation when it comes to sleep - I feel drowsy and sedated but unable to fall asleep until the early hours which seems to coincide with mirtazapine "wearing off". That seems to be totally in line with the paradoxical reaction that you suggested I created by jumping up too high! Completely my fault but it's so hard not to make mistakes during this process when I'm desperate...

 

I know you suggested to hold 2mg for two weeks which I am going to do but I'm wondering if I could start taking mirtazapine a bit earlier in the evening gradually (e.g. at 8.30pm instead of 9.30pm etc) to see if that helps me to fall asleep earlier. Would that be reasonable or should I not change anything at all for now? @Altostrata 

@Shep

 

Thank you ever so much as always

 

Marija

[Marija]

Another update. Slept for about 8 hours last night. I feel like a brand new person today! Not sure if it was a fluke due to me being totally exhausted after food poisoning etc or if it's the lower dose of mirtazapine allowing me to sleep finally. I suppose time will tell. 

[Iman]

@Marija

this is absolutely brilliant. So happy for you. Whatever the cause of this pleasant event, it's a fair indication of ur brain's outstanding ability to adjust things to ur favor. I hope u realize how important this 8-hour sleep is as it proves ur brain is well CAPABLE of bringing things back to normal no matter how hard it sounds. I trust better days for u are yet to come. Sweetness is the result of patience and resilience. 👏👏👏👍👍👍

[Marija]

57 minutes ago, Iman said:

@Marija

this is absolutely brilliant. So happy for you. Whatever the cause of this pleasant event, it's a fair indication of ur brain's outstanding ability to adjust things to ur favor. I hope u realize how important this 8-hour sleep is as it proves ur brain is well CAPABLE of bringing things back to normal no matter how hard it sounds. I trust better days for u are yet to come. Sweetness is the result of patience and resilience. 👏👏👏👍👍👍

Thank you so much for your kind words. Messages like this really put a smile on my face and encourage me to carry on fighting. I'm not going to lie, this experience has been very humbling... Whenever I thought I was doing better, I got knocked down again and had to pick myself up over and over again. I do truly believe though that once I come out at the other end, I will be a stronger, more resilient and wiser person. So I shall keep going... I am and will be forever grateful for the support I have received from everyone.

 

It's a beautiful sunny day here and I have just come back from a short walk ☀️☀️☀️ Today is better day. Whatever the future brings, I'll try to remember that good days do exist and they will always eventually come. 

[Altostrata]

On 5/29/2021 at 1:11 PM, Marija said:

I know you suggested to hold 2mg for two weeks which I am going to do but I'm wondering if I could start taking mirtazapine a bit earlier in the evening gradually (e.g. at 8.30pm instead of 9.30pm etc) to see if that helps me to fall asleep earlier.

 

This is a good solution, since you've done such an excellent job observing the mirtazapine effects. It does sound like 2mg is still a bit too high for you.

 

I would move taking it earlier by an hour each day and see if the effect moves, too. That would verify 2mg is too high -- and you might get more sleep. When you feel better, you might be able to fine-tune the dosage.

[Marija]

On 5/31/2021 at 1:42 AM, Altostrata said:

 

This is a good solution, since you've done such an excellent job observing the mirtazapine effects. It does sound like 2mg is still a bit too high for you.

 

I would move taking it earlier by an hour each day and see if the effect moves, too. That would verify 2mg is too high -- and you might get more sleep. When you feel better, you might be able to fine-tune the dosage.

Thank you - I shall do that if needed! 

 

Also, very happy to report that I got about 7 hours of sleep last night and about 5-6 hours the night before after taking mirt at 8.30pm - an hour earlier than I normally do. I'm not so sure anymore if 2mg is too high. It could be that reducing it from 2.5mg to 2mg has actually done the job as I didn't notice the sleep "blocking" effect the past two nights and managed to fall asleep quickly! I shall keep observing the effects and checking in with you accordingly. I wonder if this glorious amount of sleep is going to last. I'll keep making the most of it... 

 

Sending love to everyone 

[Marija]

I thought I'd do a little update...

 

After numerous nights of great sleep since reducing mirtazapine from 2.5mg to 2mg on 27th May, it has recently started to deteriorate again.

I wonder if that's because the dose is still a little too high... The deterioration happened around 2 weeks after I started to take 2mg which was the case when I updosed to 2.5mg as well. The pattern is also similar to before - I feel like I get this "blocking" sensation when it comes to sleep though not AS bad as it was on 2.5mg. I toss and turn in a drowsy, sleepy state for hours, falling asleep for very short periods of time, and then most of my sleep happens in the early hours of the morning. For this reason, I will start taking mirtazapine earlier by an hour each day as previously considered to see if it allows me to fall asleep earlier. I haven't done this already as after a couple of nights of taking 2mg I started sleeping A LOT better so I didn't want to change anything.

If I see improvement, I'll assume that my dose is probably still a little too high but before changing anything, I'll check in with the wise minds here, to see by how much I should decrease. 

 

Best wishes and lots of love to everyone.

[Marija]

Another update... So on the day of my last post I moved my mirtazapine time from 8.30pm to 7.30pm and then last night to 6.30pm. However, my sleep is still going downhill. I managed maybe two hours of very light, broken sleep last night... 

 

Dear @Altostrata, do yo feel like I should carry on taking mirt earlier/holding? Or should I try another reduction? I'm very puzzled about what's happening as I slept okay for a while on 2.5mg and then it went downhill after approx two weeks. Then, as you know, I lowered the dose to 2mg, slept amazingly for approx a week and a half and then my sleep started to go downhill again. Do you think the dose still too high causing a paradoxical reaction? There was no difference in my sleep after taking it earlier though which I hoped would make a difference based on my observations... Should I keep going for a bit longer? Perhaps I should be more patient. I shall not change anything until I hear from you.

 

Many many thanks

 

 

[Shep]

2 hours ago, Marija said:

I'm very puzzled about what's happening as I slept okay for a while on 2.5mg and then it went downhill after approx two weeks. Then, as you know, I lowered the dose to 2mg, slept amazingly for approx a week and a half and then my sleep started to go downhill again.

 

Has anything changed in the way of external stressors that may be at play, such as work or family stressors? No need to list specifics, but if you look back over the past week or so, check to see if anything might have triggered insomnia.

 

Any changes in diet? Does the timing of poor sleep line up with PMS symptoms? 

 

Also, are you taking any supplements? If so, please list them and the time you take them. Just checking to see if when you take the mirtazapine may be too close to taking anything else sedating, such as magnesium, which could amplify a paradoxical reaction. 

[Marija]

6 minutes ago, Shep said:

 

Has anything changed in the way of external stressors that may be at play, such as work or family stressors? No need to list specifics, but if you look back over the past week or so, check to see if anything might have triggered insomnia.

 

Any changes in diet? Does the timing of poor sleep line up with PMS symptoms? 

 

Also, are you taking any supplements? If so, please list them and the time you take them. Just checking to see if when you take the mirtazapine may be too close to taking anything else sedating, such as magnesium, which could amplify a paradoxical reaction. 

Hello @Shep. No, nothing has changed. There are no additional stressors or issues. I do not take any supplements currently except DIM (Diindolylmethane) in the evening at different times between 7-10 pm which I have been taking for a few years without it causing any issues. No changes in diet either. I don't think the timing of sleep deterioration aligns with any PMS symptoms. It's hard to tell...

 

[Shep]

8 minutes ago, Marija said:

I do not take any supplements currently except DIM (Diindolylmethane) in the evening at different times between 7-10 pm which I have been taking for a few years without it causing any issues.

 

Click on the tab labeled "Interactions" on this webpage: 

 

WebMD - Diindolylmethane interactions

 

You'll see "minor interactions" for drugs which interact with Diindolylmethane due to Cytochrome P450 1A2 (CYP1A2) substrates. 

 

Go to this table for CYP450:

 

CYP450 Table

 

Mirtazapine is listed as a 1A2 substrate. A substrate competes for that same enzyme. The peak plasma of mirtazapine is about 2 hours, so it's possible that you're taking this supplement too close to when you take the mirtazapine, now that you've moved the drug. Also, you're varying when you take the diindolylmethane, which could be causing problems. 

 

You may want to separate the mirtazapine and the diindolylmethane by at least two hours and take them both consistently at these times. No varying doses, including when you take supplements. Your nervous system is craving stability. 

 

Since your nervous system is now destabilized from withdrawal, it may be hyper-reacting to an interaction that it didn't react to earlier. That's very common in withdrawal. 

 

[Marija]

5 minutes ago, Shep said:

 

Click on the tab labeled "Interactions" on this webpage: 

 

WebMD - Diindolylmethane interactions

 

You'll see "minor interactions" for drugs which interact with Diindolylmethane due to Cytochrome P450 1A2 (CYP1A2) substrates. 

 

Go to this table for CYP450:

 

CYP450 Table

 

Mirtazapine is listed as a 1A2 substrate. A substrate competes for that same enzyme. The peak plasma of mirtazapine is about 2 hours, so it's possible that you're taking this supplement too close to when you take the mirtazapine, now that you've moved the drug. Also, you're varying when you take the diindolylmethane, which could be causing problems. 

 

You may want to separate the mirtazapine and the diindolylmethane by at least two hours and take them both consistently at these times. No varying doses, including when you take supplements. Your nervous system is craving stability. 

 

Since your nervous system is now destabilized from withdrawal, it may be hyper-reacting to an interaction that it didn't react to earlier. That's very common in withdrawal. 

 

Thank you so much for this information @Shep. I shall try doing what you suggested. I'll start taking DIM in the morning at the same time every day and mirtazapine in the evening and see if this results in any improvement. 

 

I'm just puzzled about why the sleep deterioration occured around the same time both after I updosed to 2.5mg and then reduced to 2mg. Initially, I was convinced that it must have been the paradoxical reaction due to my updose being too high as you suggested. Could it be that 2mg is still too high for me and that's why my sleep deteriorated again? Would you advise I stick to 2mg or try a small reduction again? I have no other WD symptoms except insomnia.

[Shep]

21 minutes ago, Marija said:

Would you advise I stick to 2mg or try a small reduction again? I have no other WD symptoms except insomnia.

 

Please separate the drug and the supplement before making any dose changes. Give your nervous system time to adjust to consistent dosing. 

[Marija]

8 minutes ago, Shep said:

 

Please separate the drug and the supplement before making any dose changes. Give your nervous system time to adjust to consistent dosing. 

Okay, I shall do that. Thank you very much for your replies @Shep.

[Altostrata]

On 6/9/2021 at 11:07 AM, Marija said:

The deterioration happened around 2 weeks after I started to take 2mg which was the case when I updosed to 2.5mg as well.

 

This indicates the change in symptom pattern is due to mirtazapine as, due to mirtazapine's long half-life, it takes about 2 weeks for a change in mirtazapine dosing to fully register in your body.

[Marija]

10 hours ago, Altostrata said:

 

This indicates the change in symptom pattern is due to mirtazapine as, due to mirtazapine's long half-life, it takes about 2 weeks for a change in mirtazapine dosing to fully register in your body.

@Altostrata would you suggest I hold at 2mg then until my sleep becomes a bit more stable or attempt a small reduction again?