Dee7: Mirtazapine & Sertraline 2019 Story

[Dee7]

No worries @JesusSavemefromWD easily done.

 

Thanks @Altostrata yes my symptoms date from going off mirtazapine, after which I made no progress on sertraline in terms of "recovering" and four months after stopping that, got PSSD and felt worse than ever, so its complicated I guess.

 

My concern is that even if reinstating mirtazapine helps a little bit, the emotional numbing seemed to increase with the onset of PSSD so I feel a bit like it's tied to that. I guess what you're saying at least rules out re-instating Sertraline as an option, as even though it caused it, that would not reverse PSSD (the main symptom it brought).

 

[Dee7]

Sorry if this is an obvious question @Altostrata if I wanted to go ahead with the re-instatement Mirtazapine at 1mg how would I go about that?

 

I've never re-instated and am guessing I couldn't just ask the doctor for standard pills for such a low amount?

[Dee7]

I just found this thanks @Altostrata - I will check to see if Doctors in the UK prescribe it in liquid form 

 

 

[Altostrata]

On 10/22/2021 at 1:02 PM, Dee7 said:

I guess what you're saying at least rules out re-instating Sertraline as an option, as even though it caused it, that would not reverse PSSD (the main symptom it brought).

 

Correct. But very low-dose mirtazapine may not cause emotional numbing.

[Dee7]

Ok thanks, so just to clarify, there's a chance my current emotional numbing may be reduced by the introduction of low-dose mirtazapine?

[Altostrata]

Many people here have post-antidepressant emotional anesthesia. This can be an adverse effect of the drugs or a withdrawal symptom. It very gradually goes away as your nervous system recovers from the drug.

 

We do not attempt to treat emotional anesthesia, we're after reducing other withdrawal symptoms. You've made at least 10 drug changes in less than a year. Please be patient and let your nervous system recover. 

[Dee7]

Just a quick update @Altostrata it looks like it's possible to get Mirtazapine in liquid form from my GP thanks. However obviously it's a very big call for me to make so I will need to think seriously about it. I think it's a tougher call still because I'm aware it may make no difference to my main two symptoms (the emotional and sexual numbing caused by PSSD via Sertraline), so I'm unsure how big a "win" it could be. 

 

If I were to re-instate at 1mg, I wondered in very rough terms a) how long it might take to feel any effect? b) Then, if it was helping, how many months that would mean holding at 1mg per day for before tapering? c) How long that taper off might last (months? years?) and d) how to come off it it makes me feel terrible?

 

Thanks for your help

 

 

[Altostrata]

You have many symptoms that are withdrawal symptoms that may be relieved by reinstatement. If a very low dose helps, you'd probably feel a slight improvement in a few days. It could be enough. You'd stay on the reinstatement until you feel back to normal. You'd taper off by tiny amounts later in a way to minimize withdrawal symptoms. Tips for tapering off mirtazapine (Remeron)

 

The process depends entirely on how you feel, it's going to be tailored to that.

[Dee7]

Thanks @Altostrata one thing I forgot to mention - I checked my medical notes a few days ago since our first conversation and have since corrected the amounts of Mirtazapine I was on in my signature: I had written 50mg originally rather than 15mg.

 

To clarify I was on 15 mg per day for 4 weeks and then 15mg every other day as advised for 2 weeks (in effect 7.5mg per day) before stopping. Obviously the effect was still horrendous.

 

Given this, is 1mg still the right starting point for re-instatement do you think?

[Altostrata]

1 hour ago, Dee7 said:

Given this, is 1mg still the right starting point for re-instatement do you think?

 

Yes. Even 0.50mg if that feels safer to you. Please let us know how you're doing.

[Dee7]

Sorry @Altostrata one other thing - obviously this re-instatement would be after 2.5 years of coming off, and my first piece of advice on here was that that was too long a gap, but I guess you must have seen some positive results with that sort of length previously to suggest it might help?

[Altostrata]

Yes, we have seen this works sometimes.

[Dee7]

Thanks @Altostrata I have the 15mg/1ml liquid 66ml bottle and a 1ml syringe so as far as I can work out if I half the 0.1ml syringe amount that = 0.75mg which seems like a good and simple to achieve starting dose (dropping straight on to the tongue I guess).

[Altostrata]

Yes, if you can measure 0.05mL, that would be 0.75mg. Or, you can pour 10mL (150mg) of the liquid into a clean, tinted jar and add 20mL clean water, which would give you 5mg in 1mL of the diluted liquid (150mg/30mL).

 

You can keep the diluted liquid for several days.

 

This would make it easier to measure doses less than 1mg. Be sure to keep notes of your science experiments.

[JesusSavemefromWD]

3 hours ago, Dee7 said:

Thanks @Altostrata I have the 15mg/1ml liquid 66ml bottle and a 1ml syringe so as far as I can work out if I half the 0.1ml syringe amount that = 0.75mg which seems like a good and simple to achieve starting dose (dropping straight on to the tongue I guess).

If I were u, I wouldn’t do that, it is such a small amount and you risk variation between doses, syringes are not that precise in so low volumes, I know from years of experience working in research. What altostrata gave u as an alternative is much safer. I would also not keep the solution more than 4-5 days , just to be on the safe side. Please let us know how ur doing upon reinstating…. Again I am so sorry for what ur going through, our symptoms are very similar 

[Dee7]

Thanks @JesusSavemefromWD yes I have followed the dilution advice - hope you are doing ok. 

[Dee7]

Thanks @Altostrata for the dilution advice.

 

I have done 3 x days so far @ 0.75mg (the first two nights without dilution method and the third night with, before bed).

 

No noticeable changes good or bad yet (although on the first night I felt more sleepy than usual and felt some brief strange chest / throat pains before falling asleep).

 

Just to clarify, how many days do you think the 30ml jar can be used for before needing to make a new one up?

 

 

[JesusSavemefromWD]

11 minutes ago, Dee7 said:

Thanks @JesusSavemefromWD yes I have followed the dilution advice - hope you are doing ok. 

Hope going back on a low dose works for u. It’s good u had no bad symptoms after starting… I am pretty bad with only minor improvements so I might be going down the reinstating road myself. 
the more diluted a drug is, the less stable, so I wouldn’t keep the diluted solution more than 4 days (refrigerated and protected from light). 
 

[Dee7]

Thanks - didn't realise it had to be refrigerated, will do.

 

I don't have massive expectations as I still had PSSD and lots of emotional numbing from the second drug (Zoloft) which are unlikely to be reversed by this, but it's an interesting experiment to see if any symptoms are helped. 

 

You might have the benefit of only one drug to consider when/if re-instating I guess. 

[JesusSavemefromWD]

39 minutes ago, Dee7 said:

Thanks - didn't realise it had to be refrigerated, will do.

 

I don't have massive expectations as I still had PSSD and lots of emotional numbing from the second drug (Zoloft) which are unlikely to be reversed by this, but it's an interesting experiment to see if any symptoms are helped. 

 

You might have the benefit of only one drug to consider when/if re-instating I guess. 

Yes it has to be refrigerated and wrapped with aluminum foil to protect from light. The one drug being Zoloft is Not really an advantage for me because I had a genetic test and to showed I am an ultra rapid metabolizer of Zoloft and I think that’s what caused my issues …Doctors and pharmaceutical companies believe that if ur a rapid metabolizer is not a bad thing and that a low dose wouldn’t even reach the brain since ur body metabolizes the drug fast. My theory (based on my experience and my neuroscience background) is that a low dose for a rapid metabolizer does reach the brain but causes inter dose withdrawal, kind of what happens to people with Xanax which has a very short half life. That’s why during the day I was feeling ok and then all of a sudden horrible while taking Zoloft. So if I were to go back on an AD it wouldn’t be Zoloft but Prozac …. I ll be taking the risk of introducing another drug but at least I know I am a normal metabolizer of it and due to its long half life I ll be able to reach stable blood levels. I ve read the “adverse reaction” thread here and I remember coming across a couple of people being rapid metabolizers and suffering from these drugs. 
please keep me posted of how things go with ur reinstating. This is needless suffering we are going through …Good luck… 

[Altostrata]

7 hours ago, Dee7 said:

Just to clarify, how many days do you think the 30ml jar can be used for before needing to make a new one up?

 

 

Maybe 5 days. You'd want to keep it in the refrigerator.

[Dee7]

Thanks - both original liquid and mix refrigerated now.

[Dee7]

Hi @Altostrata a quick update - I've done a week of reinstatement now with no real reaction at all good or bad @ 0.75mg per day.

 

It worries me slightly as that dead/numb feeling I have seems to be un-affected whatever I do and if neither time nor re-instatement can shift it, it leaves me at a bit of a loss.

 

I wondered what the next move should be? Perhaps moving up to 1mg for one more week? I'm keen that this should be a time-limited experiment as I don't really want to keep upping indefinitely but let me know thoughts.

 

Thanks a lot 

[Altostrata]

@Dee7, emotional anesthesia is a legacy of having taken antidepressants for 2 years. It very slowly goes away.

 

On 10/23/2021 at 2:34 PM, Altostrata said:

Many people here have post-antidepressant emotional anesthesia. This can be an adverse effect of the drugs or a withdrawal symptom. It very gradually goes away as your nervous system recovers from the drug.

 

We do not attempt to treat emotional anesthesia, we're after reducing other withdrawal symptoms. You've made at least 10 drug changes in less than a year. Please be patient and let your nervous system recover. 

 

Reinstatement probably won't do anything for emotional anesthesia, it's intended to address other withdrawal symptoms.

 

If you're not feeling any effect from 0.75mg, you might go to 1mg for a bit, see what effect that has.

[Dee7]

Ok thanks @Altostrata do you see a roof/limit of where to stop at in terms of upping the reinstatement? And what is the best way to come down from that limit? So if I did one more week @ 1mg for instance (two weeks in all) how carefully would I have to taper from that or not really at all? 

[Altostrata]

It depends on whether you see any benefit from trying a low dose of mirtazapine again. If you end up taking it for more than a month, you'd have to taper by tiny amounts later.

[Dee7]

Ok thanks @Altostrata will try from 1mg tomorrow 

[Dee7]

One area I'm a little confused about @Altostrata re: emotional anesthesia - as the PSSD is the most severe form (both sexual and emotional) then are these elements both going to be absent as long as there is PSSD? Or do you think it is possible that emotional anesthesia could fade (say, over the coming months) even if PSSD doesn't (perhaps for years)? I find the grey area of what is PSSD and what are general withdrawal symptoms quite confusing. Thanks. 

[Altostrata]

PSSD and emotional anesthesia are not the same. You could recover from one and still have the other. But most likely, you'll recover from both.

[Dee7]

Hi @Altostrata - a quick update on my situation:

 

Tomorrow will be the end of my two week minor mirtazapine re-instatement - it has been one week @ 0.75mg and a second @ 1mg. 

 

I have continued to feel worse in terms of my existing symptoms, which is a trajectory I have been on for a while now so I don't think that is necessary due to the reinstatement (more the increasing intensity of PSSD / emotional anesthesia)

 

It alarms me a little that I haven't felt anything new particularly - good or bad - and leads me to think my symptoms and particularly the numbness around my head are deeply entrenched. 

 

I was quite determined that this should be a brief experiment, time-limited to two weeks, rather than an actual "reinstatement".

 

That being the case I was wondering:

 

a) is there a need to taper off if stopping tomorrow and if so how and by what amount?

b) though I'm not keen, is there an argument for extending this at the same or increased rate for a bit longer?

 

Many thanks

 

 

[Altostrata]

Have you felt any changes from taking 1mg? What is your sleep pattern?

[Dee7]

Thanks @Altostrata No changes since going up to 1mg, just a week-on-week growth in intensity of all symptoms that has been going on for a while. It is becoming quite overwhelming - I really don't feel human. So I guess worse, but as I say I think that is more the general trajectory. 

 

My sleep pattern has been the same since all this happened really 2.5 years ago, that is to say I'm so flat/dead/numb I sleep quite easily on the whole because my mind has no thoughts in it (roughly 11pm - 7am but waking up with nightmares regularly). Sleep is definitely not the problem, it's feeling awake / alive.

 

Some of the symptoms that I definitely got from coming off the mirtazapine originally - eg, numb teeth, glazed eyes - I had hoped might be relieved by this tiny reinstatement but really I haven't noticed any difference so far. 

 

 

 

[Altostrata]

You may want to increase mirtazapine by 1mg. Could be the present 1mg isn't enough.

[Dee7]

Thanks @Altostrata could you let me know the amount I can go to without a slow/gradual reduction being required?

 

I don't really want to go up so high / too long that this becomes a three-month project rather than a 3-4 week experiment. 

 

So, if I went up to say, 1.5mg tonight for one more week, I could still stop fairly quickly after that? I'm just keen to know what I'm dealing with time-wise. Thanks. 

[Dee7]

Hi @Altostrata hope you can help - I wanted to get some thoughts / update you on my current reinstatement situation:

 

I am 2.3 weeks into the low dose re-instatement of Mirtazapine (wk 1 - 0.75mg / wk 2 - 1mg  wk 3 (so far) - 2mg).

 

I haven't felt much difference apart from a general increase in intensity of all my pre-existing symptoms (numb head, teeth, glazed eyes, anhedonia, DP, DR, PSSD, etc)

 

Yesterday I felt a tiny bit lighter and got out of bed a little easier I thought, so took fractionally more (2.5mg) last night, but today feel pretty terrible again.

 

I wondered what your advice was at this point? I don't want to keep going up and up as I seem to feel worse and worse, unless a breakthrough in some symptoms might be round the corner? If I taper off at this stage I wondered what the best way was?

 

Thanks a lot

 

(p.s. on the issue of glazed-over eyes, is this something that can right itself? Mine seem to have been stuck like this since coming off Mirtazapine originally)

 

 

 

[Altostrata]

As explained before, it can take a week for mirtazapine to ramp up to full strength. You may have felt a bit better today because the increase to 2mg finally registered.

 

If I were you, I would continue with 2mg. 0.75mg and 1.0mg weren't enough to do anything. You may need even more than 2mg.

 

I understand you are anxious to go off the drug, but this is going to take as long as it takes. The alternative is coping with withdrawal symptoms until they go away, which can be a very long time. An effective reinstatement can at least relieve your suffering so you can get organized to gradually taper off.