Hank89: PAWS from venlafaxine and what to do?

[Hank89]

Hi everyone,

I’m new in this forum and would like to get some advise about my situation. I found this site in January so it’s just the last couple of months that I’ve been recognizing all about withdrawal, which I believe is a concern for me.

 

In Sep 2018 I was prescribed sertraline for anxiety, that probably started after a half a year with a lot of stress going on in in my life. My anxiety just got worse and I had to add mirtazapine to help with sleep. I quit sertraline after about 4 months and I jumped off at 25 mg after a very short taper from 100 mg. I continued with mirtazapine, can’t remember for what reason.

I switched from sertraline to pregabalin for a few months with little effect. I also think I was in a worse shape after quitting Sertraline.

In Apr 2019 I stopped pregabalin and started venlafaxine (still taking mirtazapine). I had periods both with and without anxiety, but sometimes it got pretty extreme. I was up at 225 mg venlafaxine as most. In June 2019 pregabalin was added as well and I felt quite good for 2-3 months. During the fall the anxiety came back more often and I had a feeling that I didn’t tolerate venlafaxine; I felt speeded, got cold hands, had fast pulse etc. I reduced the dosage in steps to 37.5 mg. I had no bigger issues with the dose reductions from what I can recall. 

 

However, I often had a very high inner tension still so in March 2020 I decided jump off venlafaxine at 37.5 mg. Two weeks later I also jumped off mirtazapine at 15 mg thinking it was a good idea. I felt okay at first, had some brain zaps and I was a bit nauseous but prepared for that to happen. Not long after, my mood dropped a lot together with anxiety and after 6 weeks I couldn’t function anymore. I was depressed and I had never experienced that before. I called my doctor and according to my own wish, I started with mirtazapine again, which I found being least stimulating.

 

To a start, my mood level quickly raised and my anxiety was reduced. Maybe one or two days a week, I was getting back to feel really depressed though. I increased the dosage to 30 mg and later to 45 mg. The number of bad days became less and I felt everything was going to be all right. Unfortunately that wasn’t the case. In late July 2020 I suddenly crashed and was really depressed most of the time. For a short time I increased to 60 mg mirtazapine but it didn’t help much. I had to call my doctor to again. 75 mg venlafaxine was added again and it seemed to lessen my symptoms even though I still had waves of depression. I got quite severe inner tension two weeks after I started, a bit like I had felt on the meds before.

 

After about a month, and a consultation with a psychiatrist, venlafaxine 37.5 mg was switched to fluoxetine 10 mg and mirtazapine was reduced to 45 mg. Windows and waves continued and I didn’t seem to tolerate fluoxetine either, again I got a strong inner tension. I jumped off fluoxetine at 20 mg after 5 weeks and actually felt a bit better but the waves continued.

I decided to try without any further meds. I still was on mirtazapine and also pregabalin but I felt they did nothing good to me. Because of that, I had started to taper pregabalin during the summer and jumped off at 25 mg in October. It’s impossible to know how the pregabalin taper and quitting affected my symptoms but I believe that it didn’t affect me that much, if anything.

In late November 2020 I did a final try with escitalopram 5 mg and was up to 10 mg. Tried for 5 weeks and quit at 5 mg after one week reduction from 10 mg. Like on the other meds, I didn’t feel it was working, felt side effects and got new withdrawal symptoms.   

 

To make things further complicated I reduced the dosage of mirtazapine in Nov to 30 mg and in early Jan to 15 mg. I actually had a decent window in Jan but was hit again with a bad wave similar to what happened in July. At this time, I was familiar to the concept of withdrawal so I went up to 30 mg again and decided to try to stabilize and not do any further medical adjustments for some time. The increased dose lessened my symptoms for a week but I have continued to struggle and was for the first time away from work in Feb and Mar. I’m currently working 25 % of full time.

 

To summarize, since I stopped venlafaxine and mirtazapine a bit more than a year ago I´ve had many symptoms that varies in intensity from a day to day basis. My main issues are emotional; mood swings, depression, anxiety, feelings of unease, anhedonia. Physical symptoms are a faster heartbeat, cold hands and feet, slight headache, some brain fog, and a lower energy level in general.

 

I find many similarities to the wave/window pattern. Already from the start I had distinct clear windows and horrible waves, sometimes switches during the day. In general, there is also a daily pattern feeling better in the evenings. What concerns me is that I don’t really have any clear windows when I feel fine anymore, just days when my symptoms are less strong. I was in a better shape 6 months ago compared to now, so I don’t see any long term improvements either. A couple of weeks ago I took an antibiotic (Xifaxan) to treat SIBO and I don’t know if it’s a coincidence, but the waves have since then been longer and I’m in a two week record long wave at the moment.

 

My questions are:
- Based on my story, do you think I suffer from withdrawal?
- Is it a good idea to start 10 % taper of mirtazapine or should I wait longer? Obviously, it doesn’t do any good and my goal is to get rid of it in a proper way.
- I’ve been holding for 3 months but I don´t feel like I will stabilize, could that be because I mostly suffer from going cold turkey from venlafaxine and never reinstated? 
- Is it worth trying a micro dose venlafaxine to lessen my symptoms? If so, what dosage should I try? The short reinstatement in Aug (75 mg) seemed to lessen my symptoms but also gave me side effects after a while.

 
I’m thankful for any thoughts or advise! 
 

[Altostrata]

Welcome, @Hank89

 

On 4/26/2021 at 7:41 AM, Hank89 said:

To summarize, since I stopped venlafaxine and mirtazapine a bit more than a year ago I´ve had many symptoms that varies in intensity from a day to day basis. My main issues are emotional; mood swings, depression, anxiety, feelings of unease, anhedonia. Physical symptoms are a faster heartbeat, cold hands and feet, slight headache, some brain fog, and a lower energy level in general.

 

You've made so many drug changes, it is difficult to say what's going on. I see a few episodes where your "anxiety" might have been an adverse reaction to the drugs you were taking. So some of your symptoms may be hangover from adverse reactions rather than withdrawal.

 

What are you taking now, at what times of day and dosages? How's your sleep?

[Hank89]

Thanks for your reply. I’ve never felt any immediate adverse reactions after taking one pill or so, but I’ve felt side effects after a while. 

 

Since mid-December I’m just taking mirtazapine. The dosage has been the same for the last 3 months. I’m taking 30 mg in the evening.
I have no sleeping issues. Usually, my symptoms settle down in the evening. 
 

[Altostrata]

What are the symptoms you have in the earlier part of the day, before they settle down? What time o'clock do you take mirtazapine?

[Hank89]

It’s like I have no normal feelings. An inability to feel positive emotions, usually low mood, sometimes very emotional, crying spells, anxiety/inner tension. Sometimes it’s just difficult to explain the feeling. 

The intensity of these feelings varies quite a lot, espacially from day to day. Some days are manageable, and some days are just brutal. The depressive symptoms are the worst. 

 

The physical symptoms are not so severe and easier to handle; a slight headache/pressure in my head, faster heartbeat, brain fog, nausea, cold hands and feet, easily frozen, lower energy level.

 

Anxiety is the only symptom I had before taking any drugs. One positive thing is that the anxiety is better now compared to when I took venlafaxine. I believe there is a connection here to the regulation of cortisol, because I never experience anxiety in the evening.

 

I’m taking mirtazapine usually around 10 pm, before going to bed.

[Hank89]

@Altostrata Do you have any suggestions on my questions below?

Over the last week my symptoms have been less severe.

On 4/26/2021 at 4:41 PM, Hank89 said:

- Is it a good idea to start 10 % taper of mirtazapine or should I wait longer? Obviously, it doesn’t do any good and my goal is to get rid of it in a proper way.
- I’ve been holding for 3 months but I don´t feel like I will stabilize, could that be because I mostly suffer from going cold turkey from venlafaxine and never reinstated? 
- Is it worth trying a micro dose venlafaxine to lessen my symptoms? If so, what dosage should I try? The short reinstatement in Aug (75 mg) seemed to lessen my symptoms but also gave me side effects after a while.

 

[Altostrata]

On 5/1/2021 at 10:14 AM, Hank89 said:

The physical symptoms are not so severe and easier to handle; a slight headache/pressure in my head, faster heartbeat, brain fog, nausea, cold hands and feet, easily frozen, lower energy level.

 

Are these more intense at any particular times of day?

 

9 hours ago, Hank89 said:

Over the last week my symptoms have been less severe.

 

Which symptoms have become less severe?

 

It can take months to stabilize after adverse drug events and big changes. It could be you need to be patient and let your nervous system slowly settle down.

[Hank89]

Some of the symptoms are usually more intense in the morning; faster heartbeat, cold hands and feet, I get easily frozen and anxiety. The other symptoms don’t seem to follow a clear daily pattern.

 

I would say that all symptoms have been less severe the last week. However, since yesterday my mood has dropped again. Not so much of other symptoms yet. This has happened so many times now, without any triggers. I believe the concept of windows and waves is the only thing that can explain what’s happening to me.

 

So do you think I should wait a couple of more months to see if I can stabilize further? I would like to start tapering off mirtazapine but it’s difficult to know if I should start now or if I should wait longer. I hope the drug doesn’t do too much harm in the meantime.

[Altostrata]

Yes, waves and windows are a universal in recovering from drug upsets.

 

If I were you, I'd stop making drug changes and let your nervous system slowly settle down. Please let us know how you're doing.

[Hank89]

3.5 weeks ago I decided to reinstate 0.75 mg venlafaxine to see if that could lessen my withdrawal symptoms. I’m leaning towards that the reinstatement has failed and I think I prefer to quit the reinstatement, rather than trying an updose.

 

I have the extended release capsules with beads. I have used leftovers from an earlier prescription, and I’m unfortunately out of capsules so I have taken half the dose (one bead = 0.375 mg) in the morning and the other half in the evening.

 

Can I quit directly or should I taper, considering the dosage (0.75 mg) and the time I have taken it (3.5 weeks)?

[Hank89]

3.5 weeks ago I decided to reinstate 0.75 mg venlafaxine to see if that could lessen my withdrawal symptoms. I’m leaning towards that the reinstatement has failed and I think I prefer to quit the reinstatement, rather than trying an updose.

 

I have the extended release capsules with beads. I have used leftovers from an earlier prescription, and I’m unfortunately out of capsules so I have taken half the dose (one bead = 0.375 mg) in the morning and the other half in the evening.

 

Can I quit directly or should I taper, considering the dosage (0.75 mg) and the time I have taken it (3.5 weeks)?

[Altostrata]

Hello, @Hank89 Your Introductions topic is the place for those "what should I do?" questions.

 

How have you determined reinstatement has failed?

 

You are taking 2 beads of venlafaxine? How did you determine one bead = 0.375 mg?

[Hank89]

8 hours ago, Altostrata said:

 

How have you determined reinstatement has failed?

 

I’m rating my symptoms everyday, have been doing so for a long time. But it’s still not easy to evaluate the effect from the reinstatement, mostly because I’ve never been stable and the symptoms and their intensity have always been fluctuating more or less.

I can’t see any clear improvents from the RI, I haven’t got significantly worse either. An unusual long wave of low mood brought me to try the reinstatement. About a week into the RI I had a few days with better mood, but not since then. On the other hand, I’ve felt more neuro-fear. A very slight dizziness occasionally is a completely new symptom since RI, but it doesn’t bother me too much.

 

The overall pattern over the last year have been bad days and okay-ish days. Since early July this pattern has changed and I have much less windows. I have no idea why. Since I'm on Mirtazapine and it stopped working more than a year ago I often wonder if I'm dealing with a poop-out, besides venlafaxine withdrawal, and if that stops me from any progress...

 

8 hours ago, Altostrata said:

You are taking 2 beads of venlafaxine? How did you determine one bead = 0.375 mg?

When I still had some capsules I counted the beads in them and there were approx. 100 beads in a 37.5 mg capsule.

 

Can I split the beads in half and continue to take them twice or three times a day in order to be able to lower the dose gradually? This wont be 10 % but more like 0.75 --> 0.56 --> 0.375 --> 0.28 --> 0.19 --> 0 mg

 

Thank's for your help!

 

[Altostrata]

On 9/21/2021 at 3:09 AM, Hank89 said:

100 beads in a 37.5 mg capsule.

 

Are you still getting this same brand of venlafaxine XR?

 

See Tips for tapering off venlafaxine (Effexor)

 

Ordinarily, low mood is not a good marker for withdrawal syndrome, as it is so vague and fluctates greatly in everyone. If you don't feel 2 beads of venlafaxine have not changed your mood, it's because it's not anywhere near a "therapeutic" dose that changes your entire nervous system. You experienced this effect when you were taking 37.5mg-150mg. 

 

When we suggest low-dose reinstatement, it's to reduce withdrawal symptoms. Waves of intense negative emotions may be withdrawal symptoms. Emotional anesthesia (which many people call "depression" or low mood) is a consequence of the dulling effect of the drugs and may fluctuate along with withdrawal symptoms, very gradually dissipating in the same way.

 

Do you have any other withdrawal symptoms? How's your sleep?

[Hank89]

13 hours ago, Altostrata said:

Are you still getting this same brand of venlafaxine XR?

 

The beads I have left are all from the same brand so I know that one bead is approx. 0.375 mg.

 

I have read through everything in the thread about tapering venlafaxine.

I still wonder though if it’s careful enough to quit the reinstatement by splitting the beads and take them twice or three times a day instead of having to make a liquid? In that way I will be able to reduce the dosage in 3-4 steps before stopping. What is your thought about this approach?

 

13 hours ago, Altostrata said:

Ordinarily, low mood is not a good marker for withdrawal syndrome

 

13 hours ago, Altostrata said:

Do you have any other withdrawal symptoms? How's your sleep?

 

I believe it is withdrawal based on the following:

• Low mood is perhaps an understatement. It is very intense negative emotions that are out of proportion. On the better days it is low mood and then there are days when I feel incredibly bad. Usually, I feel more normal in the evenings. I have never felt any dulled emotions on the drugs or after quitting them.
   
• Neurofear comes and goes. Some days I have a strong scary feelings based on nothing. Other days no such feelings.
   
• My other main issue is a daily anxiety that is just there, in the background. No panic attacks. Always settles down in the evening.
   
• Related to above a feel an emotional unpredictability. Meaning that everyday is slightly or a lot different from the day before. ”I can’t trust my emotions”. (I have never felt manic or hypomanic).
   
• Resting heart rate daytime is 85-90 bpm. No matter if I’m anxious or not. Normal hr for me would be 60-65 bpm.
   
• Weakness and exercise intolerance. I have a lower energy level in general and exercise is out of the question, it is making me feel worse. Taking walks is okay though. I used to be very physically active.
   
• I often have Raynauds. Got it when I was on Venlafaxine.
   
• I don’t have so many other symptoms of withdrawal and I have no sleep issues. Occasionally I can have some nausea, dizziness and headache.
   
• I have done many medical check-ups, blood tests and so on and all of them have come back normal.
   
• Good habits, social life, diet, physical activity etc. don't have much of an impact on my mental health, which is strange.
   
• A few weeks of stress related anxiety was my only issue before trying antidepressants.

I which I knew what's going on so I can make the right decisions. I want to be drug free.

My final question is if you think I should start taper Mirtazapine or if I should give it more time? 

I was in a better shape 6 months and 12 months into withdrawal from venlafaxine then I am now at 18 months. That makes me doubt that further waiting will help.

 

[Altostrata]

Two beads of Effexor taken hours apart may not have any effect at all. I wouldn't call that a failed reinstatement.

 

What times o'clock do you take each of your drugs, with their dosages? How do you feel before and after you take your venlafaxine dose? Do these symptoms have any daily pattern? How have they changed in the last month?

 

Why do you think your symptoms are related to Effexor rather than your significant mirtazapine dosage?

[Hank89]

20 hours ago, Altostrata said:

What times o'clock do you take each of your drugs, with their dosages?

 

10 am I take 0.375 mg Venlafaxine
10 pm I take 30 mg Mirtazapine + 0.375 mg Venlafaxine

 

20 hours ago, Altostrata said:

How do you feel before and after you take your venlafaxine dose?

 

I can’t say I feel any difference in symptoms before or after taking the dosage.

 

20 hours ago, Altostrata said:

Do these symptoms have any daily pattern?

 

Yes. Some of the symptoms follow a pattern on most days (not always).
- Low mood is usually bad from waking up and through the day. Often feel better in the evening.
- Anxiety is almost always worst in the morning. Usually have it through the day. Often no anxiety at all in the evening, especially late.
- Heart rate is often highest from morning until lunch. Usually goes down during afternoon and evening. Often normal hr at bedtime.
- Neuro-fear doesn't follow any daily pattern.
- Raynauds disappear in the evening.

 

20 hours ago, Altostrata said:

How have they changed in the last month?

 

I have had more neuro-fear in general. The last two weeks have been unusual in the way that I have often been quite anxious and low also in the evenings.

 

20 hours ago, Altostrata said:

Why do you think your symptoms are related to Effexor rather than your significant mirtazapine dosage?

 

Because I stopped them both abruptly, but only reinstated Mirtazapine back then (because I never tolerated venlafaxine). The idea that Mirtazapine might be the problem is something I have thought of more recently, when I can see a pattern with much less windows over time. There seem to be many people on this site who have been in a difficult poop-out situation with it.
I was hoping that a reinstatement of Venlafaxine would make me feel a little bit better, and after that I would start to taper Mirtazapine.

[Altostrata]

I am dubious 2 beads of Effexor is doing anything, and taking one of the beads at the same time as mirtazapine makes no sense at all.

 

Does mirtazapine help you sleep? What did you increase from 15mg to 30mg in February?

 

18 minutes ago, Hank89 said:

- Anxiety is almost always worst in the morning. Usually have it through the day. Often no anxiety at all in the evening, especially late.

 

- Heart rate is often highest from morning until lunch.

 

Does this occur before or after you take the first bead of Effexor?

 

Do you have a tendency to health anxiety?

[Hank89]

The first two weeks of the reinstatement I had the capsules left and took both beads in the morning. I thought they would turn into immediate release without the capsule. That's why I separated the dose.

 

9 hours ago, Altostrata said:

 

Does mirtazapine help you sleep? What did you increase from 15mg to 30mg in February?

 

I was prescribed 15 mg Mirtazapine initially for sleep issues that was a side effect from Sertraline. I have no sleep issues now, and I don't think I need it for that purpose anymore. The reason I started taking it again was as an antidepressant.

 

The reduction in dosage 5 th of January from 30 mg to 15 mg was probably too big. I felt quite good first but crashed after 3 weeks and decided to updose again. The updose helped initially. From April and forward I have gotten worse without changing the dosage.

 

9 hours ago, Altostrata said:

Does this occur before or after you take the first bead of Effexor?

 

I had the same pattern before I reinstated Venlafaxine. It occurs before I take the bead. 

 

9 hours ago, Altostrata said:

Do you have a tendency to health anxiety?

 

Yes, I have. That was a root cause of my anxiety from the start. But when I tried antidepressants I became overstimulated on all of them, except Mirtazapine. I seldom feel that my thoughts trigger the anxiety anymore, I have worked on that a lot too. I think I have a dysregulated CNS.

[Altostrata]

I cannot see how the 2 beads of Effexor are doing you any good.

 

In 2020, you made many drug changes. You might be experiencing withdrawal syndrome from any of the 5 drugs you went on and off then. It is possible that the symptoms you report are due to this unspecific withdrawal syndrome (and the effects of switching drugs many times) and simply need to dissipate over time.

 

We cannot tell what drug might be reinstated for immediate reversal of your symptoms; that may be impossible under any circumstances. You will need to get your health anxiety in check in order to surf the recovery process, which may include many waves and windows.

 

Sleeping well is a good thing. What effects do you feel from mirtazapine after you take it in the evening?

[Hank89]

23 hours ago, Altostrata said:

I cannot see how the 2 beads of Effexor are doing you any good.

 

 

I agree. Since I’m not ready to go up I dosage I want to quit. I asked before if it’s careful enough to quit by splitting the beads and take them twice or three times a day instead of having to make a liquid? In that way I will be able to reduce the dosage in 3-4 steps before stopping. What is your thought about this approach?

 

23 hours ago, Altostrata said:

What effects do you feel from mirtazapine after you take it in the evening?

 

I don’t feel anything in particular, maybe I get a little bit more tired. (The sedating effect was strong the first year or so after taking it.) 

 

I know it's hard to tell, but is it possible that Mirtazapine is contributing to my symptoms?

 

I'm not sure if it's related to Mirtazapine, but my medical doctor wanted to give me Metoprolol to lower my heart rate. After reading on this site, I refused to take it. Instead, I have tried a low histamine diet for a week and it has been quite successful. My heart rate have been lowered by 5-10 bpm.

 

[Altostrata]

My guess is you can simply drop the Effexor one bead per week.

 

If you think mirtazapine is causing symptoms, please keep daily notes of times o’clock you take your drugs, their dosages, and your symptoms throughout the day. We need to know how you feel before and after taking each drug, and your symptoms in between. Post 24 hours of notes at a time in this topic, in a simple list format with time o’clock on the left and notation (symptom or drug and dosage) on the right. This can show if your symptoms are adverse effects from one of your drugs.

[Hank89]

On 9/26/2021 at 10:07 PM, Altostrata said:

If you think mirtazapine is causing symptoms, please keep daily notes of times o’clock you take your drugs, their dosages, and your symptoms throughout the day.

 

Hello again. I was logging my symptoms during last week and I'm posting 5 days below. During this time I had an average level of most of my issues. None of the days were horrible, or really good. I hope it is enough for an assessment.

 

9/27

06:30 am   Woke up. Slept well. Heavy depressed feeling. Some teeth clenching

08:15 am   Morning alarm, HR 70 bpm in bed. Gets up

08:25 am   Got anxiety, Raynauds, some muscle tension, slightly less depressed

08:30 am   Took 0.375 mg Venlafaxine, 50 mg Losartan, fish oil and Mg

08:30 am   Digital work meeting

09:20 am   Breakfast

09:50 am   Anxiety and Raynauds disappeared. Low mood remained

10:00 am   Coffee

10:30 am   Some anxiety and raynauds again

11:15 am   Loose stools

12:00 am   Resting HR 82 bpm, slightly fatigued

14:00 pm   Lunch

14:30 pm   Rest. Tired but relaxed, felt ok

16:45 pm   1 hour walk, coffee outside. Low energy level

18:25 pm   Low mood, a bit emotional, some anxiety

20:30 pm   Dinner

22:30 pm   Took 30 mg Mirtazapine and Mg

23:00 pm   Bedtime. Fell asleep quickly. Slept during night, but had weird dreams

 

9/28

07:00 am   Woke up. Depressed feeling

09:00 am   HR 70 bpm in bed. Gets up. Feel more depressed, gets a bit worried 

09:45 am   Took 0.375 mg Venlafaxine, 50 mg Losartan, fish oil and Mg

10:00 am   Breakfast

10:30 am   Working from home. Low mood, no anxiety

10:40 am   Coffee

11:15 am   Loose stools 

11:20 am   Errands in town. Low mood, slightly anxious, Raynauds

12:45 pm   Resting HR 80 bpm

14:00 pm   Lunch

15:00 pm   Working from home 

17:00 pm   1 hour walk, coffee outside

20:00 pm   Dinner

21:00 pm   Sauna. Relaxed, better mood in the evening 

23:00 pm   Took 30 mg Mirtazapine and Mg

00:00 pm   Bedtime. Fell asleep quickly. Slept during night, vivid dreams

 

9/29

08:00 am   Woke up. Anxious feeling

09:00 am   HR 72 bpm in bed. Gets up. Slightly anxious, low mood, Raynauds

09:15 am   Took 0.375 mg Venlafaxine, 50 mg Losartan, fish oil and Mg 

09:30 am   Breakfast

09:50 am   Urge to cry. Distracting myself with housekeeping

11:30 am   Working from home

12:00 am   Resting HR 82 bpm. Difficult low mood, anxiety

13:00 pm   Gets emotional. Feeling afraid of the low mood. Lots of raynauds.

14:00 pm   Lunch

14:30 pm   Working from home

16:00 pm   Coffee

16:40 pm   Slightly better. Takes a walk. Ok energy level

19:30 pm   Dinner

20:00 pm   Still low mood, anxious

21:00 pm   Feeling better, watched a movie

22:30 pm   Took 30 mg Mirtazapine and Mg

23:30 pm   Bedtime. Fell asleep quickly. Slept during night

 

9/30

10:00 am   HR 70 bpm in bed. Gets up. Some neuro-fear, low mood

10:30 am   Took 0.375 mg Venlafaxine, 50 mg Losartan, fish oil and Mg 

10:30 am   Breakfast

12:00 am   Resting HR 80 bpm

12:20 pm   Coffee

13:00 pm   Lunch

14:00 pm   At work. Low mood, anxious, Raynauds

17:00 pm   Resting HR 76 bpm

17:30 pm   At home, coffee. Feeling better

19:00 pm   Takes a walk. Slightly nauseous, low mood, ok energy level

21:00 pm   Dinner. Feeling ok

23:00 pm   Took 30 mg Mirtazapine and Mg

00:15 am   Bedtime. Fell asleep quickly. Slept during night

 

10/1

09:00 am   Woke up

09:30 am   HR 68 bpm in bed. Gets up.

09:45 am   Took 0.375 mg Venlafaxine, 50 mg Losartan, fish oil and Mg

10:45 am   Loose stools

11:00 am   At work. Low mood, no other issues

13:00 pm   Resting HR 80 bpm. Low mood, slightly anxious, Raynauds

14:00 pm   Lunch

15:15 pm   2 h car drive. Coffee. Same issues

17:00 pm   Resting HR 68 bpm

17:30 pm   Visiting friends. Slightly low mood and an agitated feeling

18:45 pm   30 min quick walk. Best energy level for weeks 

20:00 pm   Dinner

22:30 pm   Took 30 mg Mirtazapine and Mg

00:00 pm   Bedtime. Fell asleep quickly but a bit restless sleep

[Altostrata]

Why are you taking Losartan at the same time as venlafaxine?

 

Are you taking Losartan for Raynaud's? Please review adverse effects of Losartan.

[Hank89]

Losartan is a blood pressure medicine. I take them at the same time because it's convenient to do so. No one has ever told me that I can't take Losartan and antidepressants at the same time..

 

Almost all of my symptoms are listed as less common side effects of Losartan (nervousness, feeling sad, fast heartbeat) and fatigue is a common side effect.

I started taking Losartan in May 2018. My current issues started later, so I doubt that Losartan is the problem. Maybe I can try to pause it for a while and see if that changes anything. 

[Hank89]

@Altostrata I posted daily notes before to see if you could help me figuring out if Mirtazapine is causing symptoms. You then wanted me to check what kind of adverse affects Losartan can cause, which I posted above. Do you think any of them could be the problem?
Many thanks!

 

Edited May 5, 2022 by ChessieCat
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[Altostrata]

Any of your drugs could be causing problems. Can you separate your Losartan dosing from venlafaxine by moving it an hour later every day, until you're taking Losartan at noon?

 

We will still need to see daily notes as you make this change.

 

It is possible mirtazapine is interacting with Losartan and exaggerating its effects. Please put ALL your drugs in this Interactions Checker and post the report or a link to it in this topic.

[Hank89]

On 10/19/2021 at 5:15 AM, Altostrata said:

Any of your drugs could be causing problems.

 

Is there any way to figure out if I’m dealing with adverse reactions/tolerance or PAWS since the symptoms can be so similar?

If I start to taper mirtazapine for example it would still be ups and downs and I would not be sure if it’s the right thing to do.

 

I stopped the venlafaxine reinstatement seven days ago, by dropping the last bead (0.375 mg). So right now I’m only taking Losartan in the morning and Mirtazapine in the evening.

 

Moderate

losartan  mirtazapine

Applies to: losartan, mirtazapine

Losartan and mirtazapine may have additive effects in lowering your blood pressure. You may experience headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart rate. These side effects are most likely to be seen at the beginning of treatment, following a dose increase, or when treatment is restarted after an interruption. Let your doctor know if you develop these symptoms and they do not go away after a few days or they become troublesome. Avoid driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position. It is important to tell your doctor about all other medications you use, including vitaminsand herbs. Do not stop using any medications without first talking to your doctor.

 

Edited May 5, 2022 by ChessieCat
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[Altostrata]

6 hours ago, Hank89 said:

Is there any way to figure out if I’m dealing with adverse reactions/tolerance or PAWS since the symptoms can be so similar?

 

Yes, the daily notes, as requested twice!!

[Hank89]

Ok, I will come back with more daily notes in a couple of days.

[Hank89]

I am in a horrible situation at the moment and in need of advice.

 

2 weeks ago I finished a cross over from tablets to liquid. I did the following transition:

 

• 75 % pill, 25 % liquid for 5 days
• 50 % pill, 50 % liquid for 5 days
• 25 % pill, 75 % liquid for 5 days
• 100 % liquid

 

In the first 3 steps I shaved the tablet and weighted my daily dose. Then I cut the shaved tablet and put 25-75 % of it in a glass of water, drank that solution, and took the rest as tablet. 

In the final step I put the whole 30 mg tablet in 30 ml water and took my dose (25 ml) using oral syringes.

 

During the transition I didnt notice any worsening of symptoms. 4 days after I finished I experienced some nausea during a couple of hours, for 3 days. After 8 days I crashed big time with intense emotional symptoms. I cannot function and had to move in with my parents. It has been 6 days so far.

 

I have experienced many bad waves during the last 2 years, but this is so bad that I am sure that the cross-over has affected me. Before the cross over I was struggling as well, but I was functioning most days and was able to work 2-4 hours and take care of my family.

 

What is best to do now? Be patient and hope for things to settle down? Go back to the pills? Adjust the dosage? Maybe I should have measured the liquid with an oral syringe already in step one to minimize the risk of differences in dosing. 

 

I should also mention that I havent changed anything else for a long time. I have been on the same dose (25 mg Mirtazapine) since 5th of November when I reduced the dose with 2,5%. I was able to taper and quit my blood pressure medicine in Dec so I am not taking anything else, except from fish oil and Mg.

 

Edited May 5, 2022 by ChessieCat
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[ChessieCat]

Q:  Are the symptoms you are getting like previous withdrawal symptoms?

 

You might not be getting as much of the dose of mirtazapine because the water solubility is "slight:

 

On 4/11/2012 at 10:07 AM, Altostrata said:

Make your own liquid from a tablet

 

To taper, many people make liquids from mirtazapine tablets themselves. While water solubility of mirtazapine is "slight" according to http://www.drugbank.ca/drugs/DB00370 you can make a suspension of it yourself with a tablet and water or a pharmaceutical liquid such as Ora-Plus. See How to make a liquid from tablets or capsules

 

 

It might be better to use a pharmaceutical liquid.  There was some discussion recently about other options.  See from this post and following posts:

 

  

 

 

[Hank89]

Thanks for your reply! Yes, the symptoms are similar to what I am used to, but they are much more intense right now. Deep sadness and being overly emotional is the worst. Anxiety/restless state of mind and neuro-fear is also very strong right now, and I had very little of those during recent weeks before the crash. 

 

I was reading through the related topics before I started the cross over. The pill seems to dissolve well, there can be a few bigger particles at the bottom of the glass though. I stir it up well before drawing my dose. I don’t think it is possible to get a pharmaceutical liquid here in Sweden. The reason I changed to liquid was because the pills have a thin coating which makes it impossible to make a fine powder from the pills without getting chunks in it. It would be possible to continue to shave and weight the pills, but using a suspension seemed to be more accurate and simple when I want to continue taper again in the future. I also wanted to exclude the risk that the distribution of active ingredient might not be even in every part of the pill. I know people say that should not be an issue though..

 

It seems logical that the cross over has changed the dose or uptake somehow. I am worried about if I can be able to stabilize without doing anything, and if changing back to pills again would confuse my brain even more. I also don´t like the idea about up dosing, since I haven’t been well in the first place. I know that mirtazapine is not doing me any good but I have not yet figured out if it’s giving me problems or if my long lasting issues only has to do with the many drug changes I did 2 years ago. I have not dared to taper it much because I have never reached good stability.

 

Do you think it´s likely that I will feel better if I continue to use the suspension and just try to be consistent with the dosing?

[ChessieCat]

7 hours ago, Hank89 said:

Do you think it´s likely that I will feel better if I continue to use the suspension and just try to be consistent with the dosing?

 

I would not updose.  But keep in mind that there is a possibility that you have ended up make a reduction.  Or it could be the body is receiving the dose differently or it could be a combination of both.   Hopefully if you hold for a while things will settle down.

 

I suggest that you try to be consistent with everything you do regarding taking your dose.  For example having your dose before or after food, and possibly even the same type of food, eg so you wouldn't have a piece of toast for breakfast one day but the next day have bacon and eggs.  Doing this will reduce the variables and might make it easier to know how the change to liquid is affecting you without as much guessing.

 

Please continue to let us know how you are doing.

[Altostrata]

How long has it been since you changed to 100% liquid? How has your symptom pattern changed in the last 4 days?

[Hank89]

Sorry for my late reply. It is now 26 days ago I changed to 100% liquid. The very severe situation I was in when I wrote last time improved after a couple of days and I was able to go to work again etc.

 

However, after only 3 days with tolerable symptoms it started to go downhill again and now I am suffering intensely again. Like last time my mood is horribly low, I feel that my life is over and I am overly emotional.

 

I am concerned that the change to liquid has destabalized me further, since the very bad situation has occured again. Last time I was hoping it was a one-time event. 

 

Do you think I can get better and stabilize on the liquid or does this indicate that I don’t tolerate it?