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SenatorBirch: Possible Remeron withdrawal


SenatorBirch

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Hi.  New user here, on behalf of my (adult) son. His story is complicated!  But I guess most here are. 

 

He took Remeron for about 5 years. (he has a form of Sleep Disordered Breathing - like sleep apnea - and Remeron helped with the related insomnia).

 

Remeron suddenly - like, overnight - stopped working in December 2020, possibly because of a vertigo-inducing inner ear infection. Not only did Remeron no longer sedate him, it actually seemed to have a paradoxical effect. It was like a dose of adrenalin, but worse. (Would REALLY love to know what happened there, but primarily our interest now is in tapering off Remeron). 

 

So we've been cutting the Remeron, but I now fear that the terrible time he's having is because he's tapering way too fast. He went from an average of 30mg nightly (he'd take from 15-45 as needed), down to currently a quarter of a 7.5mg tablet (approx 2mg), all within three months.

 

If all he were doing was giving up Remeron, I would be fairly certain it's withdrawal. 

However, the fact that the drug stopped working and began producing horrible side effects (dysphoria and a gross physical feeling) complicates it, as does his breathing disorder, which wakes him every night with severe feelings of respiratory distress.  By the way, he also takes Effexor. 

 

But I still think some, maybe most, of what we're dealing with is withdrawal - for example, flu-like feelings, sweating, tingly skin, very dry mouth, even a slight gag reflex lately. 

 

Edited by Karma
name to title, Effexor to tags, name update

2002 - Feb 2021: Effexor, 187.5Mg (may have varied, but at 187.5Mg for long time)
Feb 2021 - Present: Effexor 225mg
2014 - Dec 2020: Remeron 15-45mg (varied nightly)
Dec 2020 - Present: Remeron 3.75mg (necessary rapid taper from 15Mg > 3.75Mg during Dec-Apr 2021)

 

SenatorBirch's Intro

 

(FYI ... this is not for me - it's for my son, who needs my help to even use the forum at this point.)

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  • manymoretodays changed the title to Rcashin: Possible Remeron withdrawal
  • Moderator

Hello and welcome to SA.  We are a peer owned and run forum of people who have been or are getting off of psychiatric drugs.  I'm so sorry you are having these issues with your son.  The flu like symptoms, being sweaty, and tingly, are definitely symptoms of psychiatric drug withdrawal.  What you are describing is a fast taper, and is probably causing these issues. 

 

First of all, can you please give us specific information about his drug history?  Please read the link below for instructions.  This will allow us to give you the best guidance.  

 

How to List Drug History in Signature

 

This helps you understand what withdrawal syndrome is: 

 

What is Withdrawal Syndrome?

 

Here is some information about how these drugs actually work.  

 

How Psychiatric Drugs Remodel Your Brain

 

This explains withdrawal syndrome. 

 

What is Withdrawal Syndrome?

 

These drugs need to be tapered very slowly.  Please read the following that explains this. 

 

 Why Taper by 10% of my Dosage  

 

When we recover, there are times of feeling OK mixed in with times of feeling bad.  This is called waves and windows.  

 

Windows and Waves Pattern of Stabilization

 

Here are some techniques to cope with symptoms: 

 

Non Drug Ways to Cope with Withdrawal Symptoms

 

Here is a link about Remeron tapering: 

 

Tapering Remeron

 

We don't recommend many supplements, but 3 that we do recommend are magnesium, omega-3, and melatonin. Here are the links for info about those. 

Magnesium

Omega 3 Fish Oil

Melatonin

 

 

I've given you quite a bit of information here.  Please read through it, and mull it over, and we will take it from there. In the meantime,  take heart.  We in this forum have been through this, and we understand first hand the pain and discomfort he is going through.  Please know that the brain is amazing in it's healing abilities.  It takes time, but healing can and will happen. 

 

Once we get more information from you, we can determine a good course of action and we will get back to you. 

 

 

 

I'm currently taking a break, and will not be moderating at this time. 

 

Do not private message me. Please do not tag me unless it's an urgent question about tapering or reinstating.

 

***Please note this is not medical advice.  Discuss any decisions about your medical care with a doctor who understands psych meds and how to withdraw from them, if you can find one.

 

Lexapro   Started Apr 15 '02 - 10 mg;  Apr 2 '20  0.18 mg; Jul 16  0.17 mg, Aug 23  0.16 mg, Oct 7  0.15 mg, Nov 8 - 0.14, Jan 16 '21 - 0.13, Feb 7 - 0.12, Feb 22 - 0.11, Mar 26 - 0.10, May 21 - 0.09, June 15 - 0.08 Aug 16 - 0.07, Oct 6 - 0.06, Nov 21 0.05, Dec. 17 0.04, Jan 14 '22 0.03, Feb 19 0.02, Apr 18 0.01, May 15 0.005,  Jul 8, 0.00.  Psych Drug Free as of July 8, 2022!!  Woohoo!!!

other meds: Levothyroxine 75 mg

magnesium in small amounts at 4 AM, 3 PM, before bed

suppl AM: fish oil, flax oil, vit C, vit E, multivitamin, zinc

suppl noon: calcium

suppl supper: calcium

suppl 8 PM: magnesium 350 mg, GABA 750 mg, Estroven, melatonin 2 mg

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Thanks so much for your response.  I'll have a go through these links and then fix up my profile. 

2002 - Feb 2021: Effexor, 187.5Mg (may have varied, but at 187.5Mg for long time)
Feb 2021 - Present: Effexor 225mg
2014 - Dec 2020: Remeron 15-45mg (varied nightly)
Dec 2020 - Present: Remeron 3.75mg (necessary rapid taper from 15Mg > 3.75Mg during Dec-Apr 2021)

 

SenatorBirch's Intro

 

(FYI ... this is not for me - it's for my son, who needs my help to even use the forum at this point.)

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  • Karma changed the title to SenatorBirch: Possible Remeron withdrawal
  • Moderator
On 3/5/2021 at 8:04 PM, SenatorBirch said:

Hi.  New user here, on behalf of my (adult) son. His story is complicated!  But I guess most here are. 

 

He took Remeron for about 5 years. (he has a form of Sleep Disordered Breathing - like sleep apnea - and Remeron helped with the related insomnia).

 

Remeron suddenly - like, overnight - stopped working in December 2020, possibly because of a vertigo-inducing inner ear infection. Not only did Remeron no longer sedate him, it actually seemed to have a paradoxical effect. It was like a dose of adrenalin, but worse. (Would REALLY love to know what happened there, but primarily our interest now is in tapering off Remeron). 

 

So we've been cutting the Remeron, but I now fear that the terrible time he's having is because he's tapering way too fast. He went from an average of 30mg nightly (he'd take from 15-45 as needed), down to currently a quarter of a 7.5mg tablet (approx 2mg), all within three months.

 

If all he were doing was giving up Remeron, I would be fairly certain it's withdrawal. 

However, the fact that the drug stopped working and began producing horrible side effects (dysphoria and a gross physical feeling) complicates it, as does his breathing disorder, which wakes him every night with severe feelings of respiratory distress.  By the way, he also takes Effexor. 

 

But I still think some, maybe most, of what we're dealing with is withdrawal - for example, flu-like feelings, sweating, tingly skin, very dry mouth, even a slight gag reflex lately. 

 

 

Sorry your son experienced that, @SenatorBirch. Sounds quite awful. 

 

This paper may give at least a partial explanation of what happened: https://proceedings.med.ucla.edu/wp-content/uploads/2016/11/Dose-Dependent-Sedating-and-Stimulating-Effects-of-Mirtazapine.pdf

 

At lower doses, Mirtazapine preferentially blocks the histamine receptor, resulting in a powerful sedative effect. But at higher doses, the antihistamine effect is offset by increased noradrenergic and adrenergic effects (so it makes sense you noticed that at higher doses the drug seemed to be more like a shot of adrenaline). So it is possible that using the higher doses caused the paradoxical effect.

 

I just have a couple questions: 

1) How much was your son sleeping when he first started taking mirtazapine? Was he very sedated throughout the day? 

2) Can you describe the dysphoric and 'gross' physical feeling? Did he feel like he needed to move or pace? Was he restless? Toe-tapping? Fidgety? Did he have feelings of impending doom?

3) Was the above feeling relieved by lowering the dose?

 

It does sound like he is suffering from withdrawal. Normal features of Mirtazapine withdrawal are generally the opposite of its most prominent effects: nausea, insomnia, anxiety (tingly skin aka parasthesia, and a gag reflex can be a feature of anxiety). And yes that is much faster than we recommend tapering. However, if he is having an adverse reaction to the Mirtazapine, updosing might not be a very good option. 

Edited by DataGuy

Remeron - 2004-2005 (bad withdrawal)

Clonazepam - 2005-2018 (jumped around March)

Olanzapine - 2014- late 2017

Domperidone - 2008-2018

Many drugs in between including Lexapro, other benzos and z-drugs.

Still suffering post-withdrawal from Clonazepam (Klonopin), Olanzapine and Domperidone. 

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  • 1 year later...

Hi.  Been here a year but only now posting.  The drug issue is my son's, not mine, but he needs my help. (I'll call him Mike)

 

(A complicating factor is that Mike has untreated Upper Airway Resistance Syndrome - sort of like Sleep Apnea)

 

Mike had to take Remeron in order to be able to use the CPAP mask for the above-noted condition.  He would take one 15mg pill, but sometimes, an extra one, or even two, if needed.  Worked very well as a sleep aid.

 

In December 2020, he developed vestibular neuritis (the thing where you get really dizzy).  The assumption is that this is caused by a virus in the middle(?) ear.

 

Within a day of that, the Remeron totally blew up on him.  MIKE figured it out (no doctor did, even after multiple visits to regular and psychiatric emergency departments, and calls to mental health help lines).  The drug caused him to go just crazy!  Angry, sad, anxious, feelings of total dread and doom; just waves of it.  I have NEVER seen a human being suffer like that.  He came off MOST of the Remeron within a few weeks, and the extreme symptoms subsided.  However, since that time, they continue to return in periodic waves (I call them relapses).  These waves are not nearly as bad as the original December episode, but they are still bad enough that he would rather be dead (I mean that literally).

 

We believe it's the Remeron, even at a smaller dose.  Recently, Mike THINKS he took a full 15mg Remeron by mistake, and he had an unusually severe relapse, that seemed reminiscent of the original December event, though STILL not quite as severe as that.  Although we're not 100% certain he took the extra Remeron, we're thinking he did, and that would be further evidence that it is in fact the Remeron that is causing him problems.

 

We think (hope) that we can get rid of these episodes by weaning off Remeron totally.  (We are of course worried that he won't in fact change, and also that it will make sleep nearly impossible, but we can't see a choice here).

 

So ... that's where we are.  Looking to start a taper soon.  I have the stuff: a scale, capsules, etc,  I've perused some posts, and the BrassMonkey method, so that's probably what we'll try.

 

Would love to hear if anyone else experienced this phenomenon with Remeron of any other med.

 

I'm also wondering how far you taper down before you just cut to zero - but I also just saw and scanned through the topic on the End-Game, so I guess whatever advice I'll find, will be found in there.
 

 

 

2002 - Feb 2021: Effexor, 187.5Mg (may have varied, but at 187.5Mg for long time)
Feb 2021 - Present: Effexor 225mg
2014 - Dec 2020: Remeron 15-45mg (varied nightly)
Dec 2020 - Present: Remeron 3.75mg (necessary rapid taper from 15Mg > 3.75Mg during Dec-Apr 2021)

 

SenatorBirch's Intro

 

(FYI ... this is not for me - it's for my son, who needs my help to even use the forum at this point.)

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  • ChessieCat changed the title to Intro - Remeron / mirtazapine taper
  • Moderator Emeritus

Merged 2 intro topics.

Please DO NOT TAG me - thank you

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions. 

  MISSION ACCOMPLISHED:    (6 year taper)      0mg Pristiq      on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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  • Moderator Emeritus

It is very difficult for SA to work through a 3rd party.  Please have your son make an account so that the staff can work directly with him.

 

Working directly with the person taking the drugs can be beneficial for them.  We have found that members who get involved directly with their drug issues can feel more empowered because they feel that they have more control over what is happening to them.  And when they achieve small goals along the way it is very encouraging because they have achieved it by themselves.  And it can give them more strength and determination to get through the more difficult challenges that they face during their journey.

 

They can also get support from other members who understand what they are going through instead of feeling isolated.

Please DO NOT TAG me - thank you

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions. 

  MISSION ACCOMPLISHED:    (6 year taper)      0mg Pristiq      on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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Hello ChessieCat.

 

Thank you so much for your response.  Thanks also for merging the two (redundant) posts I made.  I thought I had posted last year, but couldn't find the original post for some reason.

 

I completely understand your position on the 3rd party issue.  Unfortunately my son is simply not capable of doing this himself right now.  (He's had an account here for some time; in fact that's who made me aware of the forum.)  His sleep is so bad, and is so compounded by this drug issue, that he can't handle any forum interaction.  He can't handle it emotionally, nor does he have the concentration to do it.  He can't work (never has, at 33+ years of age, despite being quite frankly, a brilliant young man); can't attend school, socialize, travel, read ... he pretty much can't do anything.

 

To put it bluntly, if I don't do this, it won't get done.  There's obviously a wealth of information and experience on this forum, and I'll do my best to tap into that.  I understand if you or others don't feel comfortable working through a 3rd party.  To be fair to you and other members, perhaps I should add to my profile, the fact that I am acting on someone else's behalf.

 

Ideally, yes, he should be the one doing this.  But he won't.  If that means he can't get help, then it seems to me to be a case of throwing the baby out with the bath water.

 

Put another way, I see three choices: (1) my son engages with the forum; (2) I engage on his behalf; (3) neither of us engage.  #1 is not possible; #2 is obviously better than #3.

 

Thanks again, and I understand your concern.  I know it comes from the right place - you want to help the members on here.  But in this case I think it will have quite the opposite effect.

 

 

2002 - Feb 2021: Effexor, 187.5Mg (may have varied, but at 187.5Mg for long time)
Feb 2021 - Present: Effexor 225mg
2014 - Dec 2020: Remeron 15-45mg (varied nightly)
Dec 2020 - Present: Remeron 3.75mg (necessary rapid taper from 15Mg > 3.75Mg during Dec-Apr 2021)

 

SenatorBirch's Intro

 

(FYI ... this is not for me - it's for my son, who needs my help to even use the forum at this point.)

Link to comment
  • Moderator Emeritus

Thank you for explaining the situation.  As you can understand it will be harder for the staff to work through you, but we can try our best to help.  Once your son is able to post for himself then it would be better for everyone concerned if he does this himself.  As I stated previously, it can be helpful for the person concerned to have more input and control of their situation.

 

Did you son create an Introduction topic or did he just join the site?  If he made an Introduction topic, please  advise us of your son's member name so that we can combine the information.  Thank you.

 

Please DO NOT TAG me - thank you

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions. 

  MISSION ACCOMPLISHED:    (6 year taper)      0mg Pristiq      on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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Thank YOU for your understanding! 

Tomorrow I will get his forum name and intro post (though I suspect he did not do one). And of course I will encourage him to get on board as soon as it's possible. 

 

2002 - Feb 2021: Effexor, 187.5Mg (may have varied, but at 187.5Mg for long time)
Feb 2021 - Present: Effexor 225mg
2014 - Dec 2020: Remeron 15-45mg (varied nightly)
Dec 2020 - Present: Remeron 3.75mg (necessary rapid taper from 15Mg > 3.75Mg during Dec-Apr 2021)

 

SenatorBirch's Intro

 

(FYI ... this is not for me - it's for my son, who needs my help to even use the forum at this point.)

Link to comment

Hi @SenatorBirch

 

When I was reading your son's story, something struck me as very similar to my own experience with Remeron/Mirtazapine and I wonder if this might also be what happened to Mike back in December 2020. 

 

You mention that your son used to take between 15mg and 45mg as needed. This may well have 'kindled' his CNS resulting in the episode of vertigo and subsequent paradoxical reactions to Remeron.

 

I had been advised to take my dose on alternate nights to taper off the drug and I later realised that this going up and down in dose led to kindling, which is where everything gets a whole lot worse and your CNS is sensitised. A while after the various dose changes, I suffered an episode of dreadful vertigo where the room was spinning for several hours as I lay on my pillow. At the time, we thought this could be a vestibular infection also. I now believe it was caused by the dose changes of Mirtazapine and everything got a whole lot worse for me afterwards too. 

 

When your son reduced the dose it seemed to relieve his symptoms, which would make sense if he was now hypersensitive to the drug. Although, it seems he was left with withdrawal symptoms from the speed of the reduction. 

 

In any future taper, I think Mike will have to make extremely small reductions and hold for good periods of time. I personally came a cropper with the brass monkey style of tapering as I now know the wd symptoms from Mirtazapine take approx. 1-3 weeks to manifest with my system so a few weekly reductions led to a terrible crash. It's all on my thread if you fancy a depressing read!

 

I'm now reducing by only 0.15mg at a time and holding for several weeks and I certainly feel it. If I were Mike, I'd only reduce by 0.1mg to start with and hold for 6 weeks and chart any wd symptoms and when they resolve. Hopefully after that he'll find he's able to reduce every month and perhaps by larger amounts. The good thing is he's on a relatively low dose to taper off. 

 

If he is suffering now, it may be advisable for him to hold longer. How long has he been holding at this dose and has he seen improvements during that time? Is he still taking Effexor? I don't know anything about that drug but I wonder if this is too much for his sensitive system? Perhaps that is the drug to reduce first as it looks a high dose and the Remeron may help him sleep while he reduces Effexor? This is something a moderator would need to advise you on as I really don't know. 

 

I hope this is helpful to you and I wish your son all the best.

▪︎2000 - Seroxat (25mg?) 6 months C/T

▪︎2015 - 7.5mg Zopiclone 1 month C/T

▪︎ 2016 - 2018 - Diazapam and Phenergan occasionally for sleep

▪︎2017 June to Oct - Mirtazapine 7.5mg C/T

▪︎2018 April - 2019 Oct Mirtazapine 7.5mg tapered to 1.5mg.

▪︎2019 October - Mirtazapine 1.5mg (Skipped alternate doses on doctor's advice then stopped - Insomnia.) Phenergan

▪︎2020 Jan 6th - Mirtazapine 1.5mg

▪︎2020 Jan 13th - Mirtazapine 7.5mg

▪︎2020 - Feb - May, holding 7.5mg

▪︎2020 1st June, 7.35mg. 27 June, 7.2mg. 7 July, 7.05mg. 18 July, 6.9mg. 28 July, 6.75mg. 27 Aug, 6.6mg. 7 Sep, 6.45mg. 17 Sep, 6.6mg. Crash/Hold

▪︎2022 - 4 Feb, 6.45mg. 24 Mar, 6.3mg. 13 May, 6.15mg. 13 July, 6mg. 10 Aug, 5.85mg.

Link to comment

Hello again @SenatorBirch

 

A difference in our situations is that I had come off the drug and your son was still on it when the vertigo episodes happened. But the process of dose changing, vertigo episode and subsequent problems strikes me as similar. He then came down in dose drastically while I unfortunatley went up. 

▪︎2000 - Seroxat (25mg?) 6 months C/T

▪︎2015 - 7.5mg Zopiclone 1 month C/T

▪︎ 2016 - 2018 - Diazapam and Phenergan occasionally for sleep

▪︎2017 June to Oct - Mirtazapine 7.5mg C/T

▪︎2018 April - 2019 Oct Mirtazapine 7.5mg tapered to 1.5mg.

▪︎2019 October - Mirtazapine 1.5mg (Skipped alternate doses on doctor's advice then stopped - Insomnia.) Phenergan

▪︎2020 Jan 6th - Mirtazapine 1.5mg

▪︎2020 Jan 13th - Mirtazapine 7.5mg

▪︎2020 - Feb - May, holding 7.5mg

▪︎2020 1st June, 7.35mg. 27 June, 7.2mg. 7 July, 7.05mg. 18 July, 6.9mg. 28 July, 6.75mg. 27 Aug, 6.6mg. 7 Sep, 6.45mg. 17 Sep, 6.6mg. Crash/Hold

▪︎2022 - 4 Feb, 6.45mg. 24 Mar, 6.3mg. 13 May, 6.15mg. 13 July, 6mg. 10 Aug, 5.85mg.

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  • Administrator

 

On 4/13/2022 at 10:37 PM, SenatorBirch said:

He can't work (never has, at 33+ years of age, despite being quite frankly, a brilliant young man); can't attend school, socialize, travel, read ... he pretty much can't do anything.

 

Does he have any other medical conditions besides the Sleep Disordered Breathing? Does he take any other drugs besides Remeron? If so, please list them.

 

Drug free May 22, 2015 after 30 years of neuroleptics, benzos, z-drugs, so-called "anti"-depressants, and amphetamines 

 

My Success Story:  Shep's Success: "Leaving Plato's Cave"

 

And what is good, Phaedrus, and what is not good — need we ask anyone to tell us these things? ~ Zen and the Art of Motorcycle Maintenance


I am not a medical professional and this is not medical advice, but simply information based on my own experience, as well as other members who have survived these drugs.

 

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  • Administrator
On 4/13/2022 at 8:25 PM, SenatorBirch said:

In December 2020, he developed vestibular neuritis (the thing where you get really dizzy).  The assumption is that this is caused by a virus in the middle(?) ear.

 

One more question - was your son prescribed any medications to treat this condition? If so, please list them.

Drug free May 22, 2015 after 30 years of neuroleptics, benzos, z-drugs, so-called "anti"-depressants, and amphetamines 

 

My Success Story:  Shep's Success: "Leaving Plato's Cave"

 

And what is good, Phaedrus, and what is not good — need we ask anyone to tell us these things? ~ Zen and the Art of Motorcycle Maintenance


I am not a medical professional and this is not medical advice, but simply information based on my own experience, as well as other members who have survived these drugs.

 

Link to comment

Hi Shep. 

No, my son does not have any other medical conditions beyond UARS. He WAS of course diagnosed with anxiety and depression, long before we discovered the UARS, but most of that is quite likely a natural side effect of a life of SDB (Sleep Disordered Breathing), a point on which even his current psychiatrist tends to agree. 

 

As for other meds besides Remeron, he has been on Effexor for many years (see profile). 

 

He was prescribed a drug for the vestibular neuritis, but he only took it once or twice because at the time we believed this bizarre episode was the result of a drug interaction.  Same thing for a proton pump inhibitor type of drug that he started at around the same time, for nighttime Reflux (a result of UARS). 

He discontinued both of those meds almost immediate after this horrendous episode began.  We had observed in the past that antibiotics seemed to interfere with his antidepressant, so we were immediately suspicious of the new drugs. 

During the peak of this episode, he was prescribed various drugs for sleep, because he was going days at a time without sleep. But most of those he took only once or twice, very reluctantly, and then gave up, because of his (justified) fear of drugs. 

 

2002 - Feb 2021: Effexor, 187.5Mg (may have varied, but at 187.5Mg for long time)
Feb 2021 - Present: Effexor 225mg
2014 - Dec 2020: Remeron 15-45mg (varied nightly)
Dec 2020 - Present: Remeron 3.75mg (necessary rapid taper from 15Mg > 3.75Mg during Dec-Apr 2021)

 

SenatorBirch's Intro

 

(FYI ... this is not for me - it's for my son, who needs my help to even use the forum at this point.)

Link to comment
On 4/14/2022 at 6:19 AM, Ripley said:

Hi @SenatorBirch

 

When I was reading your son's story, something struck me as very similar to my own experience with Remeron/Mirtazapine and I wonder if this might also be what happened to Mike back in December 2020. 

 

You mention that your son used to take between 15mg and 45mg as needed. This may well have 'kindled' his CNS resulting in the episode of vertigo and subsequent paradoxical reactions to Remeron.

 

I had been advised to take my dose on alternate nights to taper off the drug and I later realised that this going up and down in dose led to kindling, which is where everything gets a whole lot worse and your CNS is sensitised. A while after the various dose changes, I suffered an episode of dreadful vertigo where the room was spinning for several hours as I lay on my pillow. At the time, we thought this could be a vestibular infection also. I now believe it was caused by the dose changes of Mirtazapine and everything got a whole lot worse for me afterwards too. 

 

When your son reduced the dose it seemed to relieve his symptoms, which would make sense if he was now hypersensitive to the drug. Although, it seems he was left with withdrawal symptoms from the speed of the reduction. 

 

In any future taper, I think Mike will have to make extremely small reductions and hold for good periods of time. I personally came a cropper with the brass monkey style of tapering as I now know the wd symptoms from Mirtazapine take approx. 1-3 weeks to manifest with my system so a few weekly reductions led to a terrible crash. It's all on my thread if you fancy a depressing read!

 

I'm now reducing by only 0.15mg at a time and holding for several weeks and I certainly feel it. If I were Mike, I'd only reduce by 0.1mg to start with and hold for 6 weeks and chart any wd symptoms and when they resolve. Hopefully after that he'll find he's able to reduce every month and perhaps by larger amounts. The good thing is he's on a relatively low dose to taper off. 

 

If he is suffering now, it may be advisable for him to hold longer. How long has he been holding at this dose and has he seen improvements during that time? Is he still taking Effexor? I don't know anything about that drug but I wonder if this is too much for his sensitive system? Perhaps that is the drug to reduce first as it looks a high dose and the Remeron may help him sleep while he reduces Effexor? This is something a moderator would need to advise you on as I really don't know. 

 

I hope this is helpful to you and I wish your son all the best.

 

@RipleyThis is an interesting possibility I have never heard of (kindling). 

 

(It's amazing that I can even have a conversation with someone about these possibilities.  Talking to the doctors here is like talking to a turnip - or a field of them.  No one seems in the least bit concerned or interested, while my son is suffering to the point of literally wanting to die.  But I digress...)

 

To answer your question, he has not tapered in more than a year.  This is why I'm not sure that his symptoms are withdrawal.  I tend to think it's simply how he reacts to the drug now.  Why it comes in waves, I don't know.

 

I think he'll start to taper any day.  I just have to grind and make some pills.  (smallest pill available here is 15mg, which he cuts in quarters (3.75mg)

 

I wanted to read your thread on your experience, but I can't find it.  (not used to navigating forums these days :))

Is it possible for you to post a direct link?

 

Thanks.  I'll be posting here for sure as to his progress.

 

 

 

2002 - Feb 2021: Effexor, 187.5Mg (may have varied, but at 187.5Mg for long time)
Feb 2021 - Present: Effexor 225mg
2014 - Dec 2020: Remeron 15-45mg (varied nightly)
Dec 2020 - Present: Remeron 3.75mg (necessary rapid taper from 15Mg > 3.75Mg during Dec-Apr 2021)

 

SenatorBirch's Intro

 

(FYI ... this is not for me - it's for my son, who needs my help to even use the forum at this point.)

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@SenatorBirch

 

You mention that you doubt your son is still suffering from withdrawal as he hasn't tapered for over year and it's now therfore his reaction to the drug. Unfortunately, withdrawal can last a very long time, many months even years. And the pattern of recovery is not linear - people have recognised a 'windows and waves' pattern like you have. 'Windows' are periods of feeling better and 'waves' feel like relapses and can be very discouraging but overall the trajectory should be gradual improvement. Do you think your son is slowly improving through this pattern of 'windows and waves'? 

 

I'm sorry if you know this already, I just thought it worth mentioning in case you didn't. My point being that it may not be reducing the drug that's a priority but allowing Mike's system time to further stabilise and settle down. I have recently held my dose for 16 months to feel better and I really needed that time. I may even need to hold longer I'm not sure because tapering when you're not ready can make things worse. I obviously wouldn't want that to happen for Mike.

 

Perhaps if there is no improvement you might start to taper, perhaps a moderator can advise on that. I also wondered if reducing Effexor might be something to do first? 

 

You also noticed that antibiotics made things worse and others on this site have found that too. Avoiding other drugs is advisable if you can. Even vitamin supplements can be aggravating for a delicate CNS and this site only recommends magnesium or fish oil. You can find links on all these topics - just put a keyword into the search box. A plain diet with plenty of fruit and veg and water is best and no alcohol or caffeine. 

 

I'll try to post a link to my thread but I do everything on my phone and not a laptop so I'll see if I can. I do understand the nightmare of this though. 

 

 

▪︎2000 - Seroxat (25mg?) 6 months C/T

▪︎2015 - 7.5mg Zopiclone 1 month C/T

▪︎ 2016 - 2018 - Diazapam and Phenergan occasionally for sleep

▪︎2017 June to Oct - Mirtazapine 7.5mg C/T

▪︎2018 April - 2019 Oct Mirtazapine 7.5mg tapered to 1.5mg.

▪︎2019 October - Mirtazapine 1.5mg (Skipped alternate doses on doctor's advice then stopped - Insomnia.) Phenergan

▪︎2020 Jan 6th - Mirtazapine 1.5mg

▪︎2020 Jan 13th - Mirtazapine 7.5mg

▪︎2020 - Feb - May, holding 7.5mg

▪︎2020 1st June, 7.35mg. 27 June, 7.2mg. 7 July, 7.05mg. 18 July, 6.9mg. 28 July, 6.75mg. 27 Aug, 6.6mg. 7 Sep, 6.45mg. 17 Sep, 6.6mg. Crash/Hold

▪︎2022 - 4 Feb, 6.45mg. 24 Mar, 6.3mg. 13 May, 6.15mg. 13 July, 6mg. 10 Aug, 5.85mg.

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I hadn't quite finished @SenatorBirch when my last post posted! I wanted to also say that healing does happen with time! Hopefully your son will have experienced some windows where things are better? Our systems like consistency so if you can avoid anything other than slow, gentle change in future.

▪︎2000 - Seroxat (25mg?) 6 months C/T

▪︎2015 - 7.5mg Zopiclone 1 month C/T

▪︎ 2016 - 2018 - Diazapam and Phenergan occasionally for sleep

▪︎2017 June to Oct - Mirtazapine 7.5mg C/T

▪︎2018 April - 2019 Oct Mirtazapine 7.5mg tapered to 1.5mg.

▪︎2019 October - Mirtazapine 1.5mg (Skipped alternate doses on doctor's advice then stopped - Insomnia.) Phenergan

▪︎2020 Jan 6th - Mirtazapine 1.5mg

▪︎2020 Jan 13th - Mirtazapine 7.5mg

▪︎2020 - Feb - May, holding 7.5mg

▪︎2020 1st June, 7.35mg. 27 June, 7.2mg. 7 July, 7.05mg. 18 July, 6.9mg. 28 July, 6.75mg. 27 Aug, 6.6mg. 7 Sep, 6.45mg. 17 Sep, 6.6mg. Crash/Hold

▪︎2022 - 4 Feb, 6.45mg. 24 Mar, 6.3mg. 13 May, 6.15mg. 13 July, 6mg. 10 Aug, 5.85mg.

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@Ripley  Thanks SO much for the encouraging message!  That's one of the challenges of this stuff - it's not just "how will I get through", but "WILL I get through it?"  Without some reason for hope, it is pretty nasty.  I guess you know that better than I do.

 

As for your previous message:

 

It's really hard to know if my son's symptoms result from withdrawal, or from the actual presence of the drug (the actual opposite).    We DO know the presence of the drug caused extreme symptoms all of a sudden.  And when he weaned from 15-45mg/night down to 3.75mg/night, those extreme symptoms greatly subsided.  |So it does definitely seem like MORE DRUG : WORSE SYMPTOMS - LESS DRUG : LESS SYMPTOMS.

 

Another clue is that when he recently (we think) took an extra 15mg by accident - he got REALLY bad.  Not as bad as the initial event, but worse than most of the relapses since then.  So again - more drug, more symptoms.

 

I understand you when you say that withdrawal can take a LONG time, and come in waves resembling my son's experience.  But we can't rule out the possibility that the drug's presence - whatever the trigger was - could show a similar pattern.  Given that we've seen more evidence of the drug's presence causing problems, rather than its absence - that's where I'm putting my money.

 

I (and my son) feel somewhat comfortable in going ahead with this, with a slow and careful taper.  With some moderator input, ideally,

 

We'd also both like to see him off the Effexor, but at a much higher dose, it would substantially delay dealing with the Remeron, and again - we have a lot of reasons to believe that the Remeron, not the Effexor, is causing the problem.

 

Thanks so much for your input and comments.  It helps us to think through and sort out this tangly mess, and keeps us on our toes to not miss something.  Like I said before - I only wish a doctor had the interest, concern, and insight into this as you do!

 

 

 

 

2002 - Feb 2021: Effexor, 187.5Mg (may have varied, but at 187.5Mg for long time)
Feb 2021 - Present: Effexor 225mg
2014 - Dec 2020: Remeron 15-45mg (varied nightly)
Dec 2020 - Present: Remeron 3.75mg (necessary rapid taper from 15Mg > 3.75Mg during Dec-Apr 2021)

 

SenatorBirch's Intro

 

(FYI ... this is not for me - it's for my son, who needs my help to even use the forum at this point.)

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Posted (edited)
On 4/14/2022 at 4:49 AM, Ripley said:

If he is suffering now, it may be advisable for him to hold longer. How long has he been holding at this dose and has he seen improvements during that time? Is he still taking Effexor? I don't know anything about that drug but I wonder if this is too much for his sensitive system? Perhaps that is the drug to reduce first as it looks a high dose and the Remeron may help him sleep while he reduces Effexor? This is something a moderator would need to advise you on as I really don't know. 

 

Ripley, this is a great point. 

 

@SenatorBirchPlease update your signature to reflect the drugs your son is currently taking. The way it's written, it looks like he's only on Remeron and the Effexor was a previous antidepressant. 

 

There is a MAJOR drug interaction between these two drugs. 

 

Drug interaction - Remeron and Effexor

 

This combination of Effexor and Remeron is also called California Rocket Fuel. You and your son need to read this thread very carefully:

 

 

About going off mirtazapine plus venlafaxine (Effexor) aka "California rocket fuel"

 

On 4/15/2022 at 9:56 AM, SenatorBirch said:

Hi Shep. 

No, my son does not have any other medical conditions beyond UARS. He WAS of course diagnosed with anxiety and depression, long before we discovered the UARS, but most of that is quite likely a natural side effect of a life of SDB (Sleep Disordered Breathing), a point on which even his current psychiatrist tends to agree. 

 

Sleep problems are a common side effect of drugs like Effexor. If he started Effexor in 2002 when he was 13, he may have developed a sleep disorder due to this drug or it may have made it worse. Young people under the age of 24 tend to have more problems with these drugs.  Either way, he never should have been prescribed Remeron at the same time he was taking Effexor. He may want to find a new doctor. 

 

What time(s) of day does he take his drugs? It may help with the potential drug interaction to space them out, if he's not already doing so. 

Edited by Shep
fixed typo

Drug free May 22, 2015 after 30 years of neuroleptics, benzos, z-drugs, so-called "anti"-depressants, and amphetamines 

 

My Success Story:  Shep's Success: "Leaving Plato's Cave"

 

And what is good, Phaedrus, and what is not good — need we ask anyone to tell us these things? ~ Zen and the Art of Motorcycle Maintenance


I am not a medical professional and this is not medical advice, but simply information based on my own experience, as well as other members who have survived these drugs.

 

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Thanks @Shep (Interesting avatar.  There was a polar bear sighting here in my home province recently.  Very unusual)

 

  • I think the drug history is clearer now in my profile.
  • I had read about the "California Rocket Fuel" thing before - probably somewhere on this forum.  All the more reason to get off one, if not both of those.
  • I hear you on the sleep problem thing.  But in my son's case, the sleep has been pretty much a lifelong thing, and it is very clearly a respiratory issue.  (though his Dr and respiratory tech are telling his he's "cured"; that's a complicated issue and is a case where we REALLY need a new Dr.  Unfortunately, sleep medicine is probably in much worse shape than psych medicine, so we're fighting an uphill battle there)  
  • Though my son's current state could be attributed, we believe (as I pointed out in my response to Riply) that it's in fact the drug's presence that's causing the turmoil.

 

 

2002 - Feb 2021: Effexor, 187.5Mg (may have varied, but at 187.5Mg for long time)
Feb 2021 - Present: Effexor 225mg
2014 - Dec 2020: Remeron 15-45mg (varied nightly)
Dec 2020 - Present: Remeron 3.75mg (necessary rapid taper from 15Mg > 3.75Mg during Dec-Apr 2021)

 

SenatorBirch's Intro

 

(FYI ... this is not for me - it's for my son, who needs my help to even use the forum at this point.)

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Very good points, @Ripley

 

@SenatorBirch your son may have suffered instability because of irregular mirtazapine dosing, as Ripley mentioned, or drug-drug interactions, or both. He needs to research adverse effects of any drug before he takes it, and check for potential interactions by using  this Interactions Checker or similar. Doctors and pharmacists are supposed to be alert to drug interactions but they're not.

 

What makes you and he think his current symptom pattern is withdrawal rather than, say, emergence of adverse reactions to his other drugs?

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Posted (edited)

@Altostrata ... thanks for your comments.

 

No, actually we think his current symptom pattern is NOT withdrawal.  We believe it is an effect of the presence of Remeron.  SOMETHING happened one day in Dec 2020 (the very day after he experienced a nasty bout of vestibular neuritis).  He nearly went insane for about three weeks.  After some self-observation and trial and error, he determined that Remeron itself was doing this.

 

The evidence is this:

  1. In Dec 2020 when he'd take a Remeron, the symptoms would explode.  When he avoided the Remeron, the symptoms subsided.
  2. He weaned from a varying dose of 15-45mg a night, to 3.75mg, where he has stayed for about a year.  Since then, he has not experienced the terror he did in Dec 2020.  He DOES have periodic waves that are similar to that episode, but not nearly as intense (still HORRIBLE though).
  3. Recently we think he took a full 15mg pill by accident (in addition to his regular 3.75), and his symptoms got really bad.

So the plan is to slowly taper Remeron from 3.75mg to 0 .

 

After that, we'll probably look at getting of Effexor as well, but that's another issue.  One of the problems here is that his respiratory-related sleep problem in itself is quite debilitating, and everything we do has to consider that as well.  As for drug interactions, I absolutely agree - he won't be adding anything without checking - and in fact, he is now very reluctant to take ANY drug, even for a few days.  If he has any depression or anxiety resulting from the sleep issue, I think he'd rather take a non-drug approach, or, to be honest, just suffer through it.  It seems the cure is often much worse than the disease.

 

(Why this happened suddenly, out of the blue, will probably always be a mystery.  A virus likely caused the vestibular neuritis (the doctor's opinion, and a common occurrence), so perhaps the virus also caused a change in how his body reacted to Remeron.  Or maybe the Remeron spontaneously "pooped out", as can happen, and THAT caused the dizziness.  Or as @Ripley suggested, the irregular Remeron dosing caused it.  The reason I think the first sequence is more likely, is that Remeron did not simply poop out.  It did not simply stop working - it actually had severe adverse effects.  Also, he thinks he's having other weird symptoms since Dec 2020 - some numbness in his face, strange tasting sputum, a bunch of things - that might be some sort of post-viral syndrome.  But we are more focused on the cure now rather than the cause.)

 

 

 

Edited by SenatorBirch
minor changes

2002 - Feb 2021: Effexor, 187.5Mg (may have varied, but at 187.5Mg for long time)
Feb 2021 - Present: Effexor 225mg
2014 - Dec 2020: Remeron 15-45mg (varied nightly)
Dec 2020 - Present: Remeron 3.75mg (necessary rapid taper from 15Mg > 3.75Mg during Dec-Apr 2021)

 

SenatorBirch's Intro

 

(FYI ... this is not for me - it's for my son, who needs my help to even use the forum at this point.)

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12 hours ago, SenatorBirch said:

After that, we'll probably look at getting of Effexor as well, but that's another issue.

 

Thanks for updating your signature, but I believe in your previous version, he was at 1875.5. If that's correct, when did he go up to 225 mg? 

 

Both antidepressant use and withdrawal disrupt sleep architecture, so I don't see this drug as "another issue," but part of the overall equation. See:

 

What is the sleep cycle?

 

What age was your son when he was diagnosed as having a sleep disorder? 

Drug free May 22, 2015 after 30 years of neuroleptics, benzos, z-drugs, so-called "anti"-depressants, and amphetamines 

 

My Success Story:  Shep's Success: "Leaving Plato's Cave"

 

And what is good, Phaedrus, and what is not good — need we ask anyone to tell us these things? ~ Zen and the Art of Motorcycle Maintenance


I am not a medical professional and this is not medical advice, but simply information based on my own experience, as well as other members who have survived these drugs.

 

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17 hours ago, SenatorBirch said:

The evidence is this:

  1. In Dec 2020 when he'd take a Remeron, the symptoms would explode.  When he avoided the Remeron, the symptoms subsided.
  2. He weaned from a varying dose of 15-45mg a night, to 3.75mg, where he has stayed for about a year.  Since then, he has not experienced the terror he did in Dec 2020.  He DOES have periodic waves that are similar to that episode, but not nearly as intense (still HORRIBLE though).
  3. Recently we think he took a full 15mg pill by accident (in addition to his regular 3.75), and his symptoms got really bad.

 

HIs irregular dosing gradually made him vulnerable to a reaction called kindling when he takes a full dose of the drug again.

 

What effects does he feel from 3.75mg mirtazapine? It's important he take all his drugs at the same dosages and times each day, on a regular drug schedule.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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@Shep

  • I added/corrected the date details regarding Effexor.  He was in such bad shape that around Feb 2021 his Dr bumped it to try to deal with the depression)
  • When I say Effexor is "another issue", what I mean is that I don't think we can deal with tapering two drugs at once, and since Remeron seems to have firmly established itself as the culprit, we'll deal with Remeron first, and Effexor will have to wait.
  • He was diagnosed with UARS around 2014, so he was around 25-ish.  He had always had pretty serious sleep issues (even before any drugs or anxiety/depression diagnosis, which happened when he was around 13 or so)

 

@Altostrata

  • Re "kindling" ... yes, it certainly looks like a strong possibility.  (First I've heard of that phenomenon was from Ripley a few days ago.)
  • So you believe it's feasible that even though he was probably varying his Remeron dose for years, the kindling might have just "decided" to happen when it did?
  • Do you think the vestibular neuritis could have played a role?  Perhaps a virus caused both the VN AND the kindling?  (I know you can't say for sure - but just wondering what you think)
  • He takes Remeron shortly before going to sleep (he takes it for sleep, not anxiety/depression), and takes Effexor shortly after he wakes.
  • The 3.75Mg Remeron (mirtazapine) does seem to have a sedating effect.
  • It seems that maybe with the new, lower dose, he is less insulated from the horrible sleep he gets every night.  When he wakes he seems more intensely aware of his breathing problems.

 

So the bottom line for us is this ... we think he should begin a slow taper from 3.75Mg to 0Mg mirtazapine. 

Any thoughts on that?

 

(I've done a schedule based on the BrassMonkey Sliding Scale.  There remains the question of when to jump to zero.  I've read up on the "end game", and it appears this is something we might have to play by ear.)

 

Thanks so much.

 

2002 - Feb 2021: Effexor, 187.5Mg (may have varied, but at 187.5Mg for long time)
Feb 2021 - Present: Effexor 225mg
2014 - Dec 2020: Remeron 15-45mg (varied nightly)
Dec 2020 - Present: Remeron 3.75mg (necessary rapid taper from 15Mg > 3.75Mg during Dec-Apr 2021)

 

SenatorBirch's Intro

 

(FYI ... this is not for me - it's for my son, who needs my help to even use the forum at this point.)

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9 hours ago, SenatorBirch said:

I added/corrected the date details regarding Effexor.  He was in such bad shape that around Feb 2021 his Dr bumped it to try to deal with the depression)

 

Just so we're on the same page, please see:

 

Again, chemical imbalance is a myth. Stop the lies, please.

 

9 hours ago, SenatorBirch said:

So the bottom line for us is this ... we think he should begin a slow taper from 3.75Mg to 0Mg mirtazapine. 

Any thoughts on that?

 

(I've done a schedule based on the BrassMonkey Sliding Scale.  There remains the question of when to jump to zero.  I've read up on the "end game", and it appears this is something we might have to play by ear.)

 

How much is your son sleeping now? Is he able to manage any upticks in withdrawal symptoms that come from tapering? If so, then you may want to do a micro-taper of say 2 or 3% to test the waters.

 

I wouldn't worry about when to jump to zero at this point. Yes, it's very much a play by ear.

 

How is your son's diet? Is he able to get a walk in the sun during the day?

Drug free May 22, 2015 after 30 years of neuroleptics, benzos, z-drugs, so-called "anti"-depressants, and amphetamines 

 

My Success Story:  Shep's Success: "Leaving Plato's Cave"

 

And what is good, Phaedrus, and what is not good — need we ask anyone to tell us these things? ~ Zen and the Art of Motorcycle Maintenance


I am not a medical professional and this is not medical advice, but simply information based on my own experience, as well as other members who have survived these drugs.

 

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@Shep, my son's sleep is (always has been) complicated because of the UARS condition I described.  He "sleeps" probably 10 hours a night, though it's not good sleep, and it's hard to say exactly how long it even is.  He has non-24 hour sleep-wake disorder, probably as a result of the UARS.  His bedtime and waketime advance by roughly a couple of hours every day.  So he will go to bed Monday at 8pm, Tue at 10pm, Wed at midnight, etc.

 

Regarding upticks in withdrawal symptoms ... we are really questioning whether ANY of the extreme symptoms he had originally (Dec 2020), or the waves since then, are withdrawal.  We're thinking it's more likely an oversensitivity (potentially the "kindling" effect that I just learned about on here).

 

You mention 2-3% ... that's what we had in mind.  Using the BrassMonkey method, I arrived at 2.5% as the initial taper (based on 10%/month, but done via 4 weekly reductions).  That's partly to guard against withdrawal, but also to make sure his sleep doesn't suffer.  If we see a problem with sleep, we'd probably go back up 2.5% to the previous dose.

 

Diet is good - we generally eat healthy - except that he does eat too much sweets (cookies etc) particularly when he is going to bed.  This started when he started taking Remeron.  It apparently creates a craving for carbs (we were warned), but it seems even worse than that - my son finds that WITHOUT indulging the carb craving at night, it's harder to get to sleep.

 

We try to walk as much as we can (usually an hour on a nearby trail).  But AGAIN it's never simple for my son.  Because of the Non24 disorder, we walk much more at night than in the day (and find it difficult to maintain it past a couple of weeks at most).  This is something I am trying to improve upon.  Like much of this, any changes, improvements etc are greatly hampered by his sleep disordered breathing, AND ...

 

AND ... because this has all caught up with him and ground him down over the past year.  His depression is through the roof.  He wishes he had the courage to take his own life.

 

Sorry to burden you with all this.  But talking (typing) it out I think is helping me bring some of this into clearer focus.

 

One thing we are kind of changing our minds on is this:  my son would, as I said, get periodic waves of horrible despair etc.  It starts immediately upon awakening.  He has "this feeling" (that's what we call it).  It's a horrible physical/mental thing (it sounds like akathesia without the physical movement aspect - just the intense dread, doom, fear etc).  He would be terrible for most of the day (I often wouldn't be able to leave his bedroom for 6-8 hours a day).  But now he is having terrible days even when he does not wake with "that feeling".  It is beginning to look like he is now "just" suffering from severe depression.

 

This of course leads us to the difficult question: it this is now "just" depression, but at an unbearable level - should he consider taking another anti-depressant?  Even with all the horror stories, including his own, is it ever possible that the depression is so severe (near suicide-level) that an anti-depressant becomes a necessary risk?  (Obviously with all due caution regarding drug interactions etc)

 

 

2002 - Feb 2021: Effexor, 187.5Mg (may have varied, but at 187.5Mg for long time)
Feb 2021 - Present: Effexor 225mg
2014 - Dec 2020: Remeron 15-45mg (varied nightly)
Dec 2020 - Present: Remeron 3.75mg (necessary rapid taper from 15Mg > 3.75Mg during Dec-Apr 2021)

 

SenatorBirch's Intro

 

(FYI ... this is not for me - it's for my son, who needs my help to even use the forum at this point.)

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16 hours ago, SenatorBirch said:

One thing we are kind of changing our minds on is this:  my son would, as I said, get periodic waves of horrible despair etc.  It starts immediately upon awakening.  He has "this feeling" (that's what we call it).  It's a horrible physical/mental thing (it sounds like akathesia without the physical movement aspect - just the intense dread, doom, fear etc).  He would be terrible for most of the day (I often wouldn't be able to leave his bedroom for 6-8 hours a day).  But now he is having terrible days even when he does not wake with "that feeling".  It is beginning to look like he is now "just" suffering from severe depression.

 

Some of this may be cortisol in the early morning.

 

Early-morning waking - managing the morning cortisol spike

 

And some of it is likely situational despair. And also, battle fatigue from suffering from this for so long. I would get away from psych terms like "depression" and encourage your son to name his pain so he can deal with it. If he hasn't already, he may want to join a support forum for other people dealing with UARS.

 

Has he seen a holistic practitioner to see if there may be some natural ways of handling his sleep disorder? I would be very careful of supplements until he's off drugs and healed from withdrawal, but it might be worth exploring natural healing, if he hasn't already done so. At the least, it may give him some hope.

 

16 hours ago, SenatorBirch said:

This of course leads us to the difficult question: it this is now "just" depression, but at an unbearable level - should he consider taking another anti-depressant?  Even with all the horror stories, including his own, is it ever possible that the depression is so severe (near suicide-level) that an anti-depressant becomes a necessary risk?  (Obviously with all due caution regarding drug interactions etc)

 

Again, this link is IMPORTANT:

 

Again, chemical imbalance is a myth. Stop the lies, please.

 

More resources:

 

Anatomy of an Epidemic by Robert Whitaker. It comes highly recommended on this site. Whitaker is a medical journalist and historian. 

 

Here is the book trailer video: 

 

Robert Whitaker, author Anatomy of an Epidemic video (11.5 minutes)

 

And on his website, Mad in America, you'll find the scientific research linked:

 

Mad in America - Anatomy of an Epidemic

 

Long-term Evidence We Can’t Overlook Anymore: Anti-Depressant Outcomes

 

If the root cause of your son's pain is UARS, is drugging him with a neurotoxin known for destroying sleep architecture and causing suicidal ideation going to solve his problems?

 

If your son is suicidal, here are some resources:

 

For those who are feeling desperate or suicidal

 

If your son feels he needs continuing drug "treatment," he needs to work with his doctor.

 

Drug free May 22, 2015 after 30 years of neuroleptics, benzos, z-drugs, so-called "anti"-depressants, and amphetamines 

 

My Success Story:  Shep's Success: "Leaving Plato's Cave"

 

And what is good, Phaedrus, and what is not good — need we ask anyone to tell us these things? ~ Zen and the Art of Motorcycle Maintenance


I am not a medical professional and this is not medical advice, but simply information based on my own experience, as well as other members who have survived these drugs.

 

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Thanks again @Shep

Interesting point about the cortisol spike.  We have long suspected something like excess adrenaline, norepinephrine, whatever.   And whatever it is, it's weird, and inconsistent.

We used to think the "depression" that followed this was a continuation of it, just dissipating over the day.  But now we think that it's more a reaction to it - "depression", or like you said, situational despair.  I don't know that we'll ever know, which sucks because if we really understood the dynamics of the whole thing, we might be in a better position to deal with it.  And in my son's case, the sleep complicates it all!

 

As for the sleep, unfortunately it's an anatomical thing, likely a narrow airway.  The only solution will have to be a CPAP-like machine (currently not working), or surgery, or other physical devices like jaw advancement devices, tongue stabilizing devices etc.

 

And finally - I'm not surprised at your reaction to my musing about an antidepressant.  I know - that's quite the antithesis of why we're here on this forum in the first place.  I appreciate your honesty.  Ultimately it will be my son's decision one way or the other.  Neither one of us trust these drugs, to be honest.

 

2002 - Feb 2021: Effexor, 187.5Mg (may have varied, but at 187.5Mg for long time)
Feb 2021 - Present: Effexor 225mg
2014 - Dec 2020: Remeron 15-45mg (varied nightly)
Dec 2020 - Present: Remeron 3.75mg (necessary rapid taper from 15Mg > 3.75Mg during Dec-Apr 2021)

 

SenatorBirch's Intro

 

(FYI ... this is not for me - it's for my son, who needs my help to even use the forum at this point.)

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  • Mentor
On 4/14/2022 at 1:25 AM, SenatorBirch said:

Recently, Mike THINKS he took a full 15mg Remeron by mistake,

Hello, I’m so sorry to read of your son’s suffering. You are being well supported here by many experienced and wise mods.  
 

About a year ago I accidentally took a double dose of mirtazepine (remeron). The next day I felt absolutely fantastic, the best I had in a couple of years (I was very high).  About 3 weeks later I had a huge crash and felt probably the worst I’d felt in those couple of years. It affected me for several days. Fortunately I was on holiday from work otherwise I’d have had to have time off. This gave me the wake up call I needed to get off this drug. I have been very successfully doing the brass monkey slide.

 

You might want to read either Sedated or The Truth about Psychiatric Drugs. There is now evidence to show anti depressants are no better than a placebo and long term use of them results in worse outcomes for people.  I have read Sedated but I think the other one would probably be more helpful for you although I haven’t read it. Drug companies only need to show 2 successful trials to get their medication approved, even if they had 100 others that failed. They also don’t conduct any research into the effects of long term use, the dependency they create or how to get off them safely. If they had to do this I doubt any would be approved - they couldn’t be.
 

From what I have seen on here adding more psychiatric drugs to an already upset nervous system leads to people feeling even worse. Reading through threads on here provides plenty of evidence for that. E.g Alan1234.  Unfortunately the only thing that makes things better seems to be time, and lots of it. Sadly people are suffering enormously in the meantime. 

Mirtazepine 15mg Nov 2018 -April 2019

April - Sept 2019 Mirtazepine 7.5

October 2019 - about 4 Nov 6mg Mirtazepine 

4-13 Nov anxiety & sleep problems caused by change of brand & jumping around with doses

13 Nov 2019 to 7 Dec 2019 10mg Mirtazepine 

8-10 Dec 2019 15mg Mirtazepine 

11 Dec 2019 to 14 Dec 12.5mg Mirtazepine 

15 December 2019 to 13 June 2021 15mg Mirtazepine 

14 June 2021 started brass monkey Slide.  
2021: 23 August 12.3mg, 28 October 11.1mg, 6 Dec 10mg

2022: 12 Feb 8.5, 27 Feb 8.1, 22 March 7.7, 5 May 6.9, 25 July 5.7, 12 Sept 5mg (yayyyy)

 

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Hello again, I was just browsing content I posted in and came across this. Her son was in a bad way with drugs, the psychiatrist insisted he needed more, he refused and a few months later is feeling a lot better. 

Mirtazepine 15mg Nov 2018 -April 2019

April - Sept 2019 Mirtazepine 7.5

October 2019 - about 4 Nov 6mg Mirtazepine 

4-13 Nov anxiety & sleep problems caused by change of brand & jumping around with doses

13 Nov 2019 to 7 Dec 2019 10mg Mirtazepine 

8-10 Dec 2019 15mg Mirtazepine 

11 Dec 2019 to 14 Dec 12.5mg Mirtazepine 

15 December 2019 to 13 June 2021 15mg Mirtazepine 

14 June 2021 started brass monkey Slide.  
2021: 23 August 12.3mg, 28 October 11.1mg, 6 Dec 10mg

2022: 12 Feb 8.5, 27 Feb 8.1, 22 March 7.7, 5 May 6.9, 25 July 5.7, 12 Sept 5mg (yayyyy)

 

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Thanks for that link @Faure

Remarkably similar stories - even the fact that it's a parent posting, and our sons are about the same age (30s).  Some big differences too of course.

 

We just met his psychiatrist yesterday and she suggested an anti-psychotic (Aripiprazole, brand names Abilify and Aristada) for his terrible depression.  I don't think he will take it, even with a gun to his head.  I think he would have possibly considered another "antidepressant" but can't while he's on two others (Remeron and Effexor).

 

I'm kind of relieved.  If he took it and there were any negative repercussions, I would NEVER forgive myself for letting him take it.  But of course it leaves us trying to deal with the depression.  It is horrible.  And we don't know how to "fix" that.  People say time will do it - but in his case I don't see it.  He has a serious sleep problem with an underlying anatomical cause that is not yet being successfully treated.  He literally suffocates every night, multiple times.  And I do mean EVERY single night of his life.  Until that is fixed, we don't see how the depression will lift.  And he doesn't know how much longer he can keep doing this.

 

We are hoping that tapering Remeron may show an improvement, because we believe the Remeron is making him more sensitive to the nighttime suffocation episodes (they are REAL, but he seemed to be not as aware of them until he started on Remeron).  But at the same time we don't know how hard it will be get to sleep without Remeron (that's the main reason he started it).  He's wearing a CPAP (ASV actually - similar), so that's why he needed something to help him sleep.  And he would ditch the CPAP, since it's not working - but he now has a dependency on THAT.  He can't fall asleep without it, even though it is not helping his sleep and in fact is causing greater problems.  Every path out seems to be blocked.  So this is why he is pretty pessimistic about talk therapy, exercise etc, getting him out of this depression.

 

Thanks for listening ...

 

 

 

2002 - Feb 2021: Effexor, 187.5Mg (may have varied, but at 187.5Mg for long time)
Feb 2021 - Present: Effexor 225mg
2014 - Dec 2020: Remeron 15-45mg (varied nightly)
Dec 2020 - Present: Remeron 3.75mg (necessary rapid taper from 15Mg > 3.75Mg during Dec-Apr 2021)

 

SenatorBirch's Intro

 

(FYI ... this is not for me - it's for my son, who needs my help to even use the forum at this point.)

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Hi again folks.

 

My son is ready to start a Remeron taper.  I am thinking he will not have too bad an experience with WD.  My reasoning is this:  A year ago he went from 15Mg tab (sometimes more, per night) down to a quarter tab (3.75Mg) fairly quickly, and did not seem to suffer any noticeable withdrawal.  Yes, he is having some nasty symptoms, but we believe they are from the Remeron in his system, not because of withdrawal. (Long story ... the short version is that on the very day in Dec 2020 when he got a supposed viral infection, taking Remeron suddenly made him crazy, but reducing it got rid of that, mostly.  He recently took a 15Mg pill by accident and symptoms seemed to escalate for a while - again suggesting the problem is the drug's presence, not its absence).

 

Couple of questions:

 

ONE

 

I have a Gemini-20 scale.

One WEIRD thing - the box says "Weighs up to 20g in 0.001g (1mg)"

But when I put a 15Mg pill on the tray, the display shows 0.150 (usually more like 0.155 actually, but let's say 0.150)

So if that label description is correct, then the pill in fact weighs 150Mg. 

I'm confused.  Only thing I can figure is that the pill itself weighs 150Mg but the active ingredient is just a tenth of that (15Mg)?

I suppose it still works the same - if I want to cut by 10%, then I take off 10% of whatever weight is showing - but I don't like not understanding something! (I'm actually a math guy!)

 

TWO

 

I had planned to do the taper where you do 2.5% a week for 4 weeks, then hold for 2 weeks.  However, the amounts are SOOOOO tiny, I don't know if that makes sense.  I don't think the scale is accurate enough to really do that.  2.5% off his current dose of 3.75Mg brings me down to 3.66.  (The scale would show those as 0.038 and 0.037 respectively).  I think the scale's precision is 0.005, so it gets kind of pointless.  

 

I'm thinking I will just have to do the 10% per month.  Obviously keeping an eye on things.  Even that is pretty precise, given the low number we're starting from.  And we can't get 7.5Mg pills here, nor liquid form.

 

Thoughts on those points ?

 

Many thanks as usual.

 

 

Quote

 

scale that goes to a 

2002 - Feb 2021: Effexor, 187.5Mg (may have varied, but at 187.5Mg for long time)
Feb 2021 - Present: Effexor 225mg
2014 - Dec 2020: Remeron 15-45mg (varied nightly)
Dec 2020 - Present: Remeron 3.75mg (necessary rapid taper from 15Mg > 3.75Mg during Dec-Apr 2021)

 

SenatorBirch's Intro

 

(FYI ... this is not for me - it's for my son, who needs my help to even use the forum at this point.)

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The pill weighs 150 ish mg because of fillers. The amount of active ingredient is 15mg. So you take the average of 3 pills, deduct your percentage (10% or 2.5), and that’s your pill weight. Once you’ve done this you grind up the pills and make your doses up. I use a folded piece of paper to get the powder into the capsule. 
 

About the small numbers - I am doing the BrassMonkey slide and was initially deterred because of the small numbers, all the weighing such small amounts, but it has been remarkably successful. Just this week I have gone from 7.3 to 7.1 and 4 days later am noticing a real increase in energy. It’s a really strong drug. If your son doesn’t think he’ll get major WD symptoms you might find he can cope with the 10% but that’s for a mod to advise. I haven’t had issues with accuracy or symptoms from inaccuracy. Just some minor WD symptoms occasionally. 

Mirtazepine 15mg Nov 2018 -April 2019

April - Sept 2019 Mirtazepine 7.5

October 2019 - about 4 Nov 6mg Mirtazepine 

4-13 Nov anxiety & sleep problems caused by change of brand & jumping around with doses

13 Nov 2019 to 7 Dec 2019 10mg Mirtazepine 

8-10 Dec 2019 15mg Mirtazepine 

11 Dec 2019 to 14 Dec 12.5mg Mirtazepine 

15 December 2019 to 13 June 2021 15mg Mirtazepine 

14 June 2021 started brass monkey Slide.  
2021: 23 August 12.3mg, 28 October 11.1mg, 6 Dec 10mg

2022: 12 Feb 8.5, 27 Feb 8.1, 22 March 7.7, 5 May 6.9, 25 July 5.7, 12 Sept 5mg (yayyyy)

 

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12 hours ago, SenatorBirch said:

(Long story ... the short version is that on the very day in Dec 2020 when he got a supposed viral infection, taking Remeron suddenly made him crazy, but reducing it got rid of that, mostly.  He recently took a 15Mg pill by accident and symptoms seemed to escalate for a while - again suggesting the problem is the drug's presence, not its absence).

 

That could be, SB. But it could also be that his system was sensitized by withdrawal and that larger dose was a hyper-reaction due to a nervous system already traumatized (both by withdrawal and by the viral infection). I'm just mentioning this because your son may want to use a micro-taper to start out. I wouldn't assume that everything is a side effect yet. Please pick a conservative approach to start out. He can always speed up later on.

 

On 4/17/2022 at 5:28 PM, Altostrata said:

 

@SenatorBirch your son may have suffered instability because of irregular mirtazapine dosing, as Ripley mentioned, or drug-drug interactions, or both.

 

Just a reminder of what Alto wrote earlier. This can also lead to destabilization, as opposed to a side effect. 

 

And another reminder that he's tapering off a sedating drug (Remeron) while still on a stimulating drug (Effexor). Please see: 

 


Taking multiple psych drugs? Which drug to taper first?

 

 

12 hours ago, SenatorBirch said:

I'm thinking I will just have to do the 10% per month.  Obviously keeping an eye on things.  Even that is pretty precise, given the low number we're starting from.  And we can't get 7.5Mg pills here, nor liquid form.

 

As Faure mentioned, we have a number of members able to do the Brassmonkey Slide with a scale. In fact, Brassmonkey himself used a scale. 

 

However, you can make a liquid form of Remeron if you're not able to get it from the pharmacy. The instructions for making your own liquid is found in the first post in this thread: 

 

Tips for tapering off mirtazapine (Remeron)

 

 

Another option is compounding, if it's within your son's price range. 

 

Getting compound custom dosages at compounding pharmacies (US, UK, Canada, and elsewhere)

 

But please read the "Which drug to taper first?" thread. 

Drug free May 22, 2015 after 30 years of neuroleptics, benzos, z-drugs, so-called "anti"-depressants, and amphetamines 

 

My Success Story:  Shep's Success: "Leaving Plato's Cave"

 

And what is good, Phaedrus, and what is not good — need we ask anyone to tell us these things? ~ Zen and the Art of Motorcycle Maintenance


I am not a medical professional and this is not medical advice, but simply information based on my own experience, as well as other members who have survived these drugs.

 

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