Mimi65: Can I just stop duloxetine now?

[Gigi68]

Hi Mimi, I have found that it sometimes takes quite awhile to get a response from a moderator. Based on my experience, it sounds like WD. Did you have any of those problems before tapering? If so, I would say they’re side effects. Otherwise WD. I have had lots of problems with side effects from starting mirt. For example, I have had constant tinnitus so I don’t consider that WD. On the other hand, a recent problem I’ve had while tapering is burning ears. Since I didn’t have that before tapering, I consider that WD. What dose are you at now?

[Mimi65]

Thanks for responding Gigi, I am still holding at a dose of 4.3, it will be 2 weeks tomorrow at that dose.  Things have shown some improvement, sleep is still broken up.  Muscle pain, brain fog and daytime fatigue were the big side effects for me and why I wanted to get off mirtazapine.  Tinnitus I have had since chemotherapy but it has been louder in withdrawal.  I have been considering making smaller cuts going forward.  Usually when I cut things start up on day 3 or 4 after the cut and intensify until day 8 and then start to get better however this cut is just starting to ease up a little but so I’m thinking perhaps holding for another week at 4.3.  I tapered off in June according to my doc who said drop a quarter every two weeks, things went very smoothly during the taper but 4 days after I stopped it things went out of control, especially the insomnia.  By 3 weeks off things were improving ex pet I couldn’t sleep more than 2 hours a night so wound u going back on to the 7.5 dose for a month and then started a slower taper.  Thanks again for responding, nice to know I’m not alone in this.

[Mimi65]

Today is day 3 of 4.0 dose, hoping the smaller cut will have milder effects.

[Gigi68]

I hope so too! You might want to update your signature. If possible list the dates of your cuts and the amount you were then on. It will be easier for people to see your history with mirt. 

[Mimi65]

@Altostrata

i take mirtazapine about 930 at night, fall asleep about 10 and am always up by 4, waking at 4 has only been while on mirtazapine.  About 9 am I start to feel cruddy, tinnitus, nausea, headache and light anxiety.  Things settle down about 2 in the afternoon and remain stable and calm until the following morning.  Any ideas on why this is occurring, is it part of the withdrawal or it the mirtazapine causing it?  Any ideas or advice is always appreciated.  

[Altostrata]

8 hours ago, Mimi65 said:

@Altostrata

i take mirtazapine about 930 at night, fall asleep about 10 and am always up by 4, waking at 4 has only been while on mirtazapine. 

 

Are you taking any other drugs or supplements in the evening?

 

Waking at 4 a.m. sounds like you're very sensitive to the normal early-morning cortisol peak. This is brought on by morning light. Installing blackout shades and curtains in your bedroom and using a sleep mask can help.

 

8 hours ago, Mimi65 said:

About 9 am I start to feel cruddy, tinnitus, nausea, headache and light anxiety.  Things settle down about 2 in the afternoon and remain stable and calm until the following morning.

 

What do you do regularly between the time you get up and 9 a.m.? Do you drink any caffeine?

[Mimi65]

@Altostrata

The only other thing I take in the evening is a medical marijuana gummy, which is 10cbd and 5 THC.  I have been using it for a few years now due to the pain from residual nerve damage from the chemo I had.

I have black out shades and curtains, I can try a sleep mask but when I wake up there is no light in my room at all.

In the morning I have a cup of tea with breakfast but I use decaffeinated tea bags.  I usually eat a bowl of Cheerios and half a banana for breakfast.

[Altostrata]

Suggest you wear the mask as well.

When did you start to have this symptom pattern beginning at 9 a.m.?

 

It could be fallout from the dosage reduction you made only a week ago, that would fit with mirtazapine washout. It should fade as you accommodate to the lower dosage.

[Mimi65]

@Altostrata

Wore a sleep mask last night, slept til 425 this morning, not sure if it helped but surely didn’t hurt so I will continue wearing it.  Thanks for that tip.

I have had the symptoms every morning since I started tapering mirtazapine,    
always seems to stay the same, rolls in between 8 and 9 in the morning and usually dissipates middle of the afternoon.  I have never really liked the way I felt on mirtazapine, but it was the only thing that helped me sleep when the insomnia started.  I am hopeful that the insomnia will have resolved and I will be able to get off mirtazapine and stay off.  The last time I tried to get off mirtazapine, per doc, I cut a quarter off every 2 weeks, didn’t really have much in the way of withdrawal until I got off completely, while most things have improved by 3 weeks off the insomnia came back and kept getting worse until I was back to sleeping only 2 hours a night so went back on the mirtazapine for the sleep.  I am trying to stay patient with this taper but the daytime fatigue is horrible.  Thanks for your help and advice, it is very much appreciated.

[Altostrata]

On 10/25/2021 at 5:22 AM, Mimi65 said:

About 9 am I start to feel cruddy, tinnitus, nausea, headache and light anxiety.  Things settle down about 2 in the afternoon and remain stable and calm until the following morning.

 

You may wish to vary what you have for breakfast, see if the symptoms you get around 9 a.m. might be a food sensitivity. You can try swapping out your breakfast items one at a time. I would start with skipping the banana.

 

Otherwise, it looks like a drug hangover or reaction to a metabolite. But please try varying breakfast first.

[Mimi65]

@Altostrata

i will experiment with breakfast items and see how things go.  

 

[Mimi65]

@Altostrata

i have been trying different things for breakfast as well as skipping it and things have remained the same.  I take dose at 930, asleep by 10, several awakenings during the night and up around 430.  Things start up between 8 and 9 and pretty much dissipate by mid afternoon.  Also this past week I have been having a lot of hip and low back pain, especially when lying down, causing many of the night awakenings.  
I have also been scheduled for surgery on nov 23rd, doc would like me off mirtazapine by surgery but I have told him I will be unable to do that, could get to lower dose but not off by then.  He saw some type of arrhythmia in pre op physical which he thinks is the mirtazapine.  I just reduced my dose last night to 3.2, I’m trying to move a little faster due to this finding but the most I will be able to do is another small cut in maybe 2 weeks and then hold until after surgery.

do you have any ideas or suggestions, they’d be most appreciated.

[Altostrata]

8 hours ago, Mimi65 said:

I just reduced my dose last night to 3.2, I’m trying to move a little faster due to this finding but the most I will be able to do is another small cut in maybe 2 weeks and then hold until after surgery.

 

The symptoms you get in the early part of the day may be mirtazapine hangover. How do you feel, having just reduced the dose?

[Mimi65]

@Altostrata

I feel about the same, but usually don’t feel a cut until day 3 or 4.  Still the same tinnitus, headache, nausea and anxiety for several hours each day at about the same timeframe.  The hip and back pain is something new and only bothers me while lying down during the night, disturbs my sleep.

[Altostrata]

Did you have any unusual reactions to mirtazapine when you started it?

 

I've never seen this before with mirtazapine, but it has an active metabolite, normirtazapine, about which I can find little. It's possible it emerges 12 hours after you take mirtazapine, you react to it for a while, then it's metabolized and your reaction dies down.

 

If it's the metabolite, I'm not sure what you can do about it. As you decrease mirtazapine, this reaction in the morning should decrease as well.

 

If the gummy helps, you might take a little tiny bit of gummy when you get up.

[Mimi65]

@Altostrata

my doc was cross tapering me off cymbalta and onto mirtazapine so I’m not sure what was cymbalta going away and start up of mirtazapine.  I do know that the only thing I felt mirtazapine did was help me sleep which was also getting worse a couple months in.  I have never felt well or like myself on mirtazapine, I am usually outgoing, easygoing and happy but on mirtazapine I felt the opposite.  I am seeing more of myself return with each drop in dose, has also been noticed by friends and family that I am more myself lately.  I don’t know what else to tell you.  I guess I will continue the taper and have my surgery later this month and hope for the best.

I don’t take the gummy during the day because it does make me a little high for a few hours.  
thanks for all your help, it is so appreciated.

[Altostrata]

15 hours ago, Mimi65 said:

I don’t take the gummy during the day because it does make me a little high for a few hours.

 

This is why I suggest taking a little fraction of the gummy. Since you're doing better as you carefully taper, a tiny bit of gummy might make the first part of your day more comfortable.

[Mimi65]

Day 6 after cut, still at 3.2 dose, sleep has deteriorated to 2 hours a night, but that seems to happen about one week after the cut.  Going to try to hold at this dose and see if sleep improves.  Insomnia is the very worst symptom for me.

[Gigi68]

Hi Mimi, I saw your question on Marie’s page but thought it would be better to answer on your page. Like you, I have a lot of sleep issues, sometimes I can’t go to sleep, more frequently I wake up super early and can’t go back to sleep. Unlike you, when I get up in the morning I am usually ok, maybe a little anxiety. When I was first started tapering I would wake up feeling horrible. I called it mental anguish because I just couldn’t  find the right words to describe it. That has improved and really doesn’t happen now. I get some slight nausea but only for a few days shortly after a drop. I use ginger tablets and ginger lozenges for that and they help. 
 

I usually try to get some good exercise in the morning, either a hike or a bike ride. If I can do that, it seems to set me up for a better day. Maybe I’m bleeding off some adrenaline or cortisol. Who knows? I guess exercise can cause problems for some people though.

 

My level of anxiety/mental anguish overall has really improved as I’ve gotten lower which I am very pleased about so I guess it was a side effect for me. Just hope it doesn’t come back!
 

Take care,

Gigi

 

[savinggrace]

Hi Mimi,

I started to hijack Marie's thread again so I relocated to your thread.

 

On first look, what jumps out at me is that you tapered duloxetine very very fast, and that your brain/body had not adjusted to that and you added in mirtazapine.

I understand.  I have made those mistakes before.  I am considered that you started mirt from a place of acute withdrawal and then added something else into the mix.

 

IF IT WERE ME, (because we are all so different and have different reasons for why we make our choices) I would stop tapering the mirtazapine or maybe even updose a little (as this mirtazapine taper is pretty fast as well, as indicated by your symptoms; maybe ask the mods)  I know you don't feel stable, but if you are getting worse with each cut, I would suggest that you do a very long hold until you brain adjusts to the mirt.  I scanned your thread quickly and it does look like the mods agree that the duloxetine taper was much too fast.  If holding is not a possiblity for some reason, I don't know what to say, but I do think it is likely that you never stabilized at all from the duloxetine taper.  Duloxetine is a strong drug.  30 mg. to zero in a month is very very fast.

 

Hoping to give you food for thought and perhaps consider slowing down for now.

 

Grace

[Mimi65]

Grace,

Thanks for coming to my thread.  I was having a bad reaction to cymbalta, which I was only on for six weeks, so my doctor cross tapered me off of cymbalta and onto mirtazapine.  I have never felt well or myself on mirtazapine and was only put on it for insomnia, after a few months on it my doc suggested trying to get off due to some of the side affects I was getting.  At his suggestion I dropped 25 percent at a time for a hold of 10 days at each drop.  I had no withdrawal from it at all during the taper but after 3 weeks I could not sleep at all again, getting 2 hours sleep a night so went back on it for about 6 weeks.  Doc suggested trying again so this time I was going slower and smaller than the first time.  I will have to do a longer soon as I am scheduled for surgery on nov 23.  Thanks for your suggestions though, all help is greatly appreciated 

[marie123]

Hi Mimi65. I wanted to stop by and post on your thread. I understand you are getting surgery at the end of the month and the doctor is asking you to taper off. I saw that you wanted to get as low as possible before the surgery Just tell the doctor you are doing the best you can as it's difficult to taper. You mentioned the doc said your chloresterol is high and is affecting your heart. I'm pretty sure my chloresterol is high and I do get a pounding heart here and there. It sure is from mirtazapine. I know I'm doing the best I can by tapering slow. Just think of it as getting healthier and healthier as we taper. I'm sure you are stressed out now too since surgery is coming up. Symptoms flare for me during stressful times. I can't say this enough, please slow down your taper. Take good care of youself. Be well. Marie.

[Mimi65]

Thanks, Marie, for stopping by.  I do understand the need to go slow and am trying the best I can.  I have been trying to let my body and sleep guide me more than the calendar but I will try to be more attentive to time.  The surgery doesn’t have me stressed out as much as my doc, who is by no means and alarmist, raising concerns about a heart arrthymia evident on my ekg which he feels is caused by the mirtazapine.  He even phoned me at home last night, which never happens, to see how I was feeling and how the taper was going.  I also have an aortic aneurysm, discovered a few years ago doing all the testing before my chemotherapy started.  I promise to do the best I can and am planning to hold for a bit after surgery and possibly into the new year.

thanks for your concern, much appreciated, come visit me here anytime.

[marie123]

Hello Mimi65. I hope your surgery went well and you are home and had a nice Thanksgiving. Rest up and heal. Be well. Marie.

[Gigi68]

Hi Mimi, how are you doing since your surgery? I’ve been thinking about you. 

[Mimi65]

@Gigi68, @marie123

thanks for asking about me, so thoughtful and kind.  I’m doing okay following surgery, follow up in a few more weeks and pt for a few weeks.  How are you both doing?  Marie, I think I saw something about a fall, glad you didn’t get hurt.  I am still working on this mirtazapine taper, I’m going to try to do to 1.8 tonight and I will let you know how things go, fingers crossed.  Trying to get ready for the holidays, shopping, wrapping, decorating, baking so going to try the 1.8 and hope for the best then a bit of a hold to get through the holidays, family will be coming to my house so want to be stable for all of that.  Again, nice to hear from you both, hope you’re both doing well and tapers aren’t too bad.

[Mimi65]

@marie123, @Gigi68

Hello ladies, just checking in to see how my fellow mirtazapine taperers are doing.  It’s been a while and I’m hoping that’s a good things and you’re both too busy with the holidays to come on here.  If you find a minute just drop a quick post to let me know how things are going.  Take care.

[Gigi68]

Hi Mimi, thanks for asking about us. I dropped to 3.3mg 5 days ago and am having a very good day today. Yesterday wasn’t so good but I try to not let it get in the way of whatever I have planned. Wish there was some way to predict which days are going to be good. I can’t ever tell. I did sleep well last night and that always seems to help. 
 

I am in southern Arizona where it never feels like Christmas. People decorate their saguaros and other cacti with lights and ornaments but it’s just not the same. I sure do enjoy the warm winters though. I have been busy painting watercolor Christmas cards to send to friends and family. Watercolor is a new hobby for me since I began taking/tapering mirt. For awhile, it was about the only thing I could do. Fortunately I am feeling much better and able to do most things I did before- just usually need a nap in the afternoon. 
 

How are you doing? It looks like you’ve made some biggish (is that a word?) drops and not held long. Are you feeling ok? Hope you enjoy the holidays!
 

Gigi

 

[marie123]

Hello Mimi65. I'm back from my long trip but unfortunately tested positive for covid. I have medium cold symptoms. I hope you are doing well with your taper.

Happy Holidays. Marie.

[LiaJ]

On 12/16/2021 at 9:02 AM, Mimi65 said:

@marie123, @Gigi68

Hello ladies, just checking in to see how my fellow mirtazapine taperers are doing.  It’s been a while and I’m hoping that’s a good things and you’re both too busy with the holidays to come on here.  If you find a minute just drop a quick post to let me know how things are going.  Take care.

Hey there,

 

I'm also tapering Mirtazapine and I think we're at the same dose! I'm at 1.5 mgs as well. 

How is yours going? I've found that my WD symptoms are very mild now. I'm also tapering very slowly, like 5% every eight weeks. 

Hope you've had a lovely holiday.

 

Lia

[Mimi65]

@LiaJ

nice to meet you.  I’m a little opposite of you, my withdrawal seems to be more difficult at the lower doses.  I have been on 1.5 for about 2 weeks now and the worst for me is the insomnia, I’ve only been sleeping about 3 hours a night for the past 4 or 5 nights.  I’m don’t feel like I ever fully stabilize during the taper just go from feeling really bad back to regular bad from being on mirtazapine, I usually decrease my dose when things go back to normal bad for a couple of days.  Insomnia was why I went on mirtazapine, like you I stopped sleeping entirely when I had some serious health issues December 2020, but it really only helped sleep for the first few weeks and the side effects were really bothering me which is why I decided to get off.  I really want to be off this drug but I have tried so many things for the insomnia and mirtazapine was the only one i could get some sleep on, at least in the beginning.  What are cuts like for you, when do they start, when do they start to improve and what symptoms do you get.  Nice to compare notes with someone at the same stage of taper.  

[Mimi65]

@marie123

i almost missed your post.  I’m glad you had a nice trip but sorry you got covid.  I hope it’s only a mild case and you feel better soon.  I am struggling with this lasypt cut to 1.5, made that cut two weeks ago and it’s really been a tough one with sleep being the worst.  Not much sleep at all the past few nights, not sure if I should try to keep holding at this dose or proceed with another small cut.  I have already cut two weeks worth of a 1.2 dose but could put them aside and prepare another week of 1.5 to see if that helps at all.  Any input?

[marie123]

Hello Mimi. I say this in the most thoughtful and caring way: you are cutting too fast. On 11/7 you cut to 2.9 and at 12/11 you cut to 1.5. That's about 50%. If I did that I would be in a very bad state. It will get worse if you cut now. Please hold and let any withdrawal catch up. I know you want off, I do too. Going too fast winds up taking longer. Ask me how I know. Marie.

[Mimi65]

@marie123

Thanks for your input, I know it comes from a caring place and from experience.  I have cut another week of 1.5 and see if things settle down.  Thanks again, so much, for your advice, much appreciated.

[ChessieCat]

From Post #1 of Why taper by 10% of my dosage?

 

On 8/6/2011 at 6:43 AM, Altostrata said:

 

You can't know how your nervous system will respond to a decrease in medication until you try it. If you go too fast, won't know if you're in the unlucky half until it's too late. It's a lot easier to taper slowly than to put your nervous system back together again after it's injured.

 

 

[Mimi65]

I have noticed with my last dose reduction of mirtazapine I am starting to have a lot of body aches and pains, particularly back and hip.  I also getting what feels like internal vibrations or tremors down my back and across my hips, sometimes under my ribcage, not painful, just annoying.  They usually happen in the early hours of the morning, like 4 am.  The aches and pains seem to be constant but the tremor feelings usually go away by afternoon, only to return again the next morning. Anyone else experience this or something similar.