Robineye: Mirtazapine and Lexapro issues and possible withdrawal

[Robineye]

Hi, 

I am 67 year old male and have been on antidepressants since the mid 1990s (for low mood and anxiety):

- Prozac 15mg until November 2016.

- I wasn’t sleeping well so GP changed me to Mirtazapine 15mg (Nov 16) which worked for sleep but gradually increased anxiety to distressing and unacceptable levels (also low mood). I tried one slow taper in 2018 but sleep was immediately an issue.

- GP recently changed me (I was very unsure about it) to Lexapro 10mg (straight swop, no tapers).

- The swop has caused more anxiety and as the Lexapro is starting to work I can feel the debilitating effects it has on my sleep (as I know SSRIs can).

My preferred future would be to be drug free (I’ve wanted this for a long time) but I’m unsure where to go now. I feel caught between two very disagreeable and scary drug options. It might be good not to get caught on Lexapro for a long time which I know would make withdrawal potentially even more difficult...? 
My GP said I could take 5mg of the Lexapro if 10mg was too much. I’m thinking of doing that immediately?
Any insight or support would be very much appreciated.

 

Edited February 23, 2021 by Gridley

[Gridley]

Welcome o SA, Robineye.  We need a little more information before we can address your situation.

 

To give members the best information, we ask them to summarize their medication history in a signature -- drugs, doses, dates, and discontinuations & reinstatements, in the last 12-24 months particularly.  Be sure to include the date when you started the Lexapro.

 

A person is at risk of withdrawal symptoms after 3 weeks to a month on an antidepressant.  After this point a slow taper (we recommend no more than 10% of current dose every four weeks).

 

Why taper by 10% of my dosage?

 

What is withdrawal syndrome.

 

Depending on how long you've been on the Lexapro, a 50% op from 10mg to 5 might be too much.  

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

 

 

Account Settings – Create or Edit a signature.

 

 

[Heath]

@Robineye welcome to SA! The anxiety and feelings you are having now are most likely from the process of changing meds. Withdrawals of one and start up side effects of the other . Especially if dr didn’t get the correct equivalent dose  correct. This has caused nervous system to become unstable. Get you signature done with dates and meds and dosages and moderators can help you decide with to hold on 10 or reduce. Gridley is right 10 to 5 mg will be too much depending on factors like how long you’ve been on 10 mg. And depending on how bad the side effects are at present. This drugs will cause worse start up side effects especially if dosage is too high which is very common with drs. Hang in there !

[Robineye]

Hi Heath,

Thanks for the reply. I have just done my signature as best I can. Had a really bad day with worsening anxiety yesterday (after broken sleep) so ended contacting GP who gave me some Valium to get through the day. Have only taken 5mg of the Lexapro this morning (and half a 2mg Valium) as I’m so scared of the way it attacks my sleep and then that makes me feel so bad all day (darker than any low mood). I hope to speak to a counsellor tomorrow about all this. Best wishes.

[Altostrata]

Welcome, @Robineye

 

Yes, you may take 5mg Lexapro rather than 10mg. 10mg Lexapro is roughly equivalent to 20mg or 30mg Prozac.

 

When did you go down to 9mg mirtazapine? Why did you not simply increase mirtazapine a bit when you got withdrawal insomnia?

 

How long has it been since you took mirtazapine?

[Robineye]

Thanks Altostrata, It was probably mid 2018 when I tried the mirtazapine taper. I didn’t really think about stabilising on the lower dose. I’m new to all this and so afraid of not sleeping.
Stopped mirtazapine about 9 days ago (very small overlap with Lexapro but felt dizzy the next day) and took the lower dose of 5mg Lexapro yesterday. Feel dreadful again today; poor sleep, strong anxiety which Valium isn’t helping much. Trying to speak to GP but just want to go back to sleeping on mirtazapine even though I’ve come to hate it. I feel totally trapped with only unacceptable choices... Mirtazapine gives me no life but sleep. SSRIs mess my sleep up and again no life.

 

[Robineye]

Hi,  After the very difficult time in February (when I first posted) in trying to switch from Mirtazapine to Lexapro I am now stabilised once again on 15mg Mirtazapine. My mood is still low and I have anxiety levels like I’ve never experienced before. My interpretation of my current condition is a slow worsening reaction to the Mirtazapine but I’ve never been in this place before so It’s difficult to interpret. My GP recently referred me to a consultant psychiatrist who in response (my interpretation) to my low mood and obvious distress from the anxiety has offered Quetiapine 25mg to run concurrently with the Mirtazapine. I have never had any kind of mental health diagnosis other than anxiety (GAD?) and mild to moderate depression. My continuing goal is to be drug free but I’m facing another difficult decision:

1. Do I start the Quetiapine 25mg and hope for some immediate psychological relief with a view to using it to get off Mirtazapine (this year?) This doesn’t appear to be a great choice as the Quetiapine can also produce withdrawal symptoms...

2. Just stay with the Mirtazapine but start a slow taper when I’m ready and stabilise when withdrawal symptoms start as per your guidelines?
I would appreciate any input at this time as I have little support from the medical profession here in the UK and even less for any taper program.

With thanks one again.

[Ariel]

Hello @Robineye

I was just reading your recent topic in the media forum and thought I'd stop by your thread to say hi. 

I see that you haven't posted here since over a year ago. In your last post you were soliciting input pertaining a possible tapering decision. 

Did you receive the guidance you were looking for? 

How are things today? 

Do you have the tapering support you need? 

Well wishes,

A.

[Robineye]

Hi Ariel,

It is very kind of you to be in touch and to ask how I’m doing, thank you.

I’m still on a very slow taper (after taking advice from this site) so 2.5% every two weeks and going longer between changes if I feel unstable. This process has given me a sense of control over my withdrawal that I’ve never had before. Combined with a relative stability around my worst withdrawal symptoms and a sleep pattern that often gives me enough energy to cope and to keep my head above water. I no longer fear a lack of sleep and the torture that this causes (fingers crossed). I think a bit of a breakthrough came when I read the Brassmonkey method and accepted I would be in this for the long haul.  I’m also starting to believe a little that maybe my neuro-system may recover, with patience and self-care.
I have sort support through a Jungian therapist (useful be not revelatory), I also joined a men’s spirituality group and was able to share many of my issues. These have not been ongoing though for various reasons. I have an interest in contemplative prayer so practice that most days (see Richard Rohr). I try to exercise daily. I try to share with family and friends but it’s difficult and my main issue currently is anxiety and the triggers that set it off and leave me very tortured and upset. The triggers come from interactions with family and friends, and are very distressing, hence I often avoid people. I also get very upset when people try to fix me…

 I did have anger issues as soon as I started mirtazapine and I’m hoping that this ever-present anxiety has some drug-based component which may or may not eventually subside with lower dosing (my hope anyway). The mirtazapine has little AD effect now so I also think I’m fairly depressed most of the time (feelings of dread on waking, no motivation for anything, a sense of despair close by). I generally feel mildly at the end of my patience with people and the world all the time (and I was never like this before). I still don’t know how to get help with feeling like this, nothing seems to affect it. (No professional medical help here I’m afraid).
I do feel positive about the withdrawal though, even though I know nothing is predictable. My big hope has been to attain a drug-free life (with fair sleep and no WD symptoms) and to at least know who I am again (even if that is in itself is still difficult). 
That’s probably enough for now…

Thanks again and very best wishes to you on your journey….