Dee7: Mirtazapine & Sertraline 2019 Story

[Dee7]

Hi everyone - I've been reading a lot of the great advice and support here for a while and thought I'd finally tell my own story in the hope there might be some help available. 

 

I was diagnosed with CFS / Fibromyalgia in 2017 and by December 2018 had been recommended antidepressants several times as a way of combatting the symptoms (acute leg pain and anxiety mainly). You probably won't be too surprised to learn that what happened next made things ten times worse.

 

I was prescribed Mirtazapine right at the end of December 2018 but after four weeks thought better of it. I informed my GP who advised me to simply cut my dose in half for two weeks and stop. I felt fine for a few days and met a friend for a glass of wine (again, this was approved by my GP). On the way back I suddenly felt awful, vomited when I got home and had crazy dreams that night. Within 24 hours I couldn't get out of bed, felt like my head had been hit with a baseball bat and had suicidal thoughts for the first time in my life.

 

Feeling totally alien, I hoped the feeling might fade but when it didn't I sought advice from the GP again and was eventually persuaded to take a second drug to "fix" things. This was Sertraline and I was taken up from 0-100mg over three months and back down again the reverse way for the next three months when it had become clear it wasn't helping.

 

Knowing what I do now I cant believe the speed at which this all happened and like many others, before I realised what was happening it was too late. 

 

It's now 19 months since I have taken anything yet I feel worse and worse. The main symptoms are anhedonia, depression, depersonalisation, suicidal ideation and PSSD. I also have numb head, teeth and arms. 

 

My instinct has always been not to take anything again, especially having read that 3 months is the optimum time for reinstatement, but I guess things are pretty bad. If I were to reinstate could there be any benefit at this stage? If so I'm not even sure which of the drugs would be best to re-instate? I felt stunned coming off the first one and then slowly even worse (with PSSD developing) coming off the second. If I decide to simply wait it out and continue to abstain when might I see a turnaround I wonder?

 

Any thoughts much appreciated thanks

 

 

 

 

Edited May 16, 2021 by Gridley

[Gridley]

Welcome to SA, Dee7.  I'm sorry you're feeling so bad.  It will get better.

 

To give members the best information, we ask them to summarize their medication history in a signature -- drugs, doses, dates, and discontinuations & reinstatements.  Alist format is best.  You'll need to use a computer rather than a phone.

 

Account Settings – Create or Edit a signature.

 

You are experiencing antidepressant withdrawal from Mirtazapine and Sertraline caused by tapering too fast per the advice of your GP.  The vast majority of doctors, and this includes psychiatrists, know nothing about safe tapering and don't believe in the existence of extended withdrawal.  Our experience has been the opposite.  We are a site for helping members to safely taper off psychiatric drugs and to deal with withdrawal.

 

I would not recommend the reinstatement of either drug.  You didn't do well with these drugs before, and to reinstate at 19 months is too late and quite risky.  Nor do we recommend the introduction of another drug.  Trying a new drug puts you on what we call the drug merry-go-round, where doctors put their patients on one drug after another, worsening rather than helping the situation.  

 

 It has been our experience on this site that we all do heal, but unfortunately there is no way to tell you when.  Time is the great healer and, to repeat, you will heal.

 

The symptoms you describe are typical of antidepressant withdrawal.  So that you have a better idea of what you're experiencing, here is some information on withdrawal and the healing process.

 

What is withdrawal syndrome.

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

The Windows and Waves Pattern of Stabilization

 

When we take psychiatric medications, the CNS (central nervous system) responds by making changes over the months and years we take the drug(s). When the medication is discontinued, the CNS has to undo all the changes it made. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur.  

 

These explain the healing process really well.

 

Brain Remodelling 

 

Video:  Healing From Antidepressants - Patterns of Recovery

 

As far as general advice to follow while you heal, we recommend eating a healthy diet, avoiding coffee, alcohol and  psychotropic drugs such as marijuana, and getting 30 minutes of gentle exercise per day, such as a walk in nature (strenuous exercise works for some members but is too stimulating for many).  Avoidance of stress insofar as is possible is also a good idea.

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Add in one at a time and at a low dose in case you do experience problems. Get supplements that are single ingredient (not mixed with other types of supplements).

 

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

 

 

 

 

Edited May 16, 2021 by Gridley

[Dee7]

Thanks a lot for the response Gridley I really appreciate it - I may come back with some additional questions at some point but it's good to have signed up for today.

[Dee7]

Hi again - its now 22 months off for me and one of the things I struggle with is the lack of fluctuation. A lot of other people seem to refer to withdrawal as "riding the rollercoaster" and I almost wish I could as there is no sign of any movement at all. I just have constant DP, DR, Anhedonia, PSSD, Brain Fog, Cognitive Dysfunction, Numbness, Apathy - it never lifts and if anything has got more extreme over these last six months. Again I see others discussing reactions - good and bad - to food and supplements whereas I don't notice a thing whatever I take - just a constant flat-lining. Will it ever change? Any advice? Thanks.

[Dee7]

Any thoughts?

[PgadAdam]

@Dee7 not sure really, i've been off for 30 months still not healed. we will have to see in the following years if symptoms begin to fade, wishing you luck on your recovery. it's awful the way we've been treated by the NHS but we can't lose hope, i know just how much anhedonia and apathy stops us from being emotionally invested in friends,family and our hobbies. like you i'm simply surviving untill i feel more human again. i hope you will get back to your normal self one day, sending hugs

[Dee7]

Thank you for your kind words - I completely agree with everything you say - you too. 

[Dee7]

I had been under the impression that Mirtazapine (the first antidepressant I was prescribed) was an SNRI, but was reading something yesterday to suggest it was actually a different type of antidepressant - can anyone clarify? Thanks.

[ChessieCat]

I have just done some searching online.  Wiki says it is an atypical antidepressant.  Mayo Clinic states that it is a tetracyclic antidepressant.

 

And from wiki:

 

Quote

 

Tetracyclic antidepressants are a class of antidepressants that were first introduced in the 1970s. They are named after their tetracyclic chemical structure, containing four rings of atoms, and are closely related to the tricyclic antidepressants, which contain three rings of atoms.

 

 

 

 

For more information about how mirtazapine works please see the following post that I made quoting some information from one of the other moderators:

 

 

[ChessieCat]

It doesn't look like anyone has given you this link.  Post #1 has information about how to get non-standard doses:

 

tips-for-tapering-off-mirtazapine-remeron

 

[Dee7]

Thanks a lot for this but I was on Mirtazapine for four weeks almost 2.5 years ago now, was "tapered" off over 2 weeks by doctors and had a terrible reaction 5 days later.

 

I didn't know about reinstatement then so the opportunity passed and I was given an SSRI instead (Sertraline) which I stopped 6 months later (almost 2 years ago now).

 

I was effectively cold turkey-ed off both on reflection by doctors so missed the opportunity for proper tapering and too late for reinstatement now, so I guess my only option is to wait it out (but that isn't going too well). 

 

 

 

 

[ChessieCat]

My apologies, I'm about to go to bed and didn't check your drug signature.

[Dee7]

Hi - I hope someone can help. I just wanted to double-check on re-instatement again.

 

My symptoms are becoming worse and worse as I hit the two year mark since coming off (Zoloft after six months, and before that Mirtazapine after six weeks).

 

I was pretty much CT'd off both of them and still have the main symptoms of PSSD, Anhedonia, DP, DR, as well as many more with absolutely no improvement (in fact a worsening).

 

I've obviously been advised previously that re-instatement is a no-no this far out but just wondered as my situation gets more desperate and untenable whether it was worth a shot and if so which one to re-instate (coming off Mirtazapine absolutely floored me, then coming off Zoloft gave me PSSD) or even both? (I've seen a couple of cases of re-instatement at high doses helping PSSD, I also read another story yesterday where a reinstatement 'miraculously' removed 90% of withdrawal symptoms).

 

I desperately don't want to, but things are becoming intolerable.

 

Thanks a lot

 

 

[Dee7]

Can anyone help with this? Is it better to tag someone in? Thanks

[JesusSavemefromWD]

4 minutes ago, Dee7 said:

Can anyone help with this? Is it better to tag someone in? Thanks

If u tag moderators u ll probably get a faster response. I am not a moderator but my understanding is that an important question to answer is how u felt while talking the drugs? Did ur symptoms become worst after quitting or were equally bad while u were taking these drugs . 

[Dee7]

Thanks for your reply. In answer to your question, much worse after quitting (but I'm aware it's a long time now). As you suggested, I'll tag some moderators to see if anyone can advise on my options

@Altostrata@ChessieCat @Gridley

[Ktven48]

Hi there, 

 

So sorry you are struggling. I am too at the moment. I’m sure one of the mods will get to you shortly. I agree with @JesusSavemefromWD 

I see you answered! 

[Altostrata]

@Dee7, what is your current symptom pattern, that you attribute to going off the drugs? Are you taking any other drugs? Drink alcohol? Recently taken antibiotics?

[Dee7]

Thanks for getting back to me. My symptom pattern has been very consistent for nearly 2.5 years. 

 

In Feb 2019 after only four weeks on Mirtazapine I wanted to come off (not feeling awful, just not right) and was advised to take one every other day for two weeks and stop which I did. For a few days I felt fine, went out had one glass of wine with a friend when all hell broke loose, within 24 hours I vomited, became suicidal, depressed, numb head, numb teeth no interest in anything.

 

In May 2019 with no improvement I was then put on Sertraline - taken up to 100mg and back down again over six month as it made little difference. I was tapered off too quickly, eventually stopping November 1st 2019. A few months after stopping (March 2020) I developed full-blown PSSD (both sexual and emotional numbness) on top of my original symptoms.

 

I have since waited for almost two years with no improvements: no alcohol (the initial incident put me off apart from anything), and no reinstatement or other drugs or antibiotics (sometimes some fish oil, magnesium and a period on probiotics)

 

Before the drugs I had ME / Fibromyalgia (still do) and was highly anxious, stressed, with chronic pain but not depressed and very motivated. 

 

The symptoms of the drugs have taken me to the opposite end of the spectrum (I describe its as going from a 9 to a 1 or perhaps hyper arousal straight to hypo arousal) the main ones are, and have been for a long time:

 

Anhedonia, DP, DR, Depression, Apathy, PSSD, Numb Head/Teeth as well as Brain Fog, Cognitive Dysfunction, Brain Zaps.

 

I just feel completely numb / dead and don't know how to feel alive again after two years, hence my re-instatement query.

 

Thanks

 

 

 

[Altostrata]

I'm sorry you're going through this, @Dee7

 

Has there been any change in your symptom pattern over the last 6 months? How's your sleep?

[Dee7]

Thank you @Altostrata

 

I feel like the symptoms have got more intense these last six months. My whole head is a bit of a disaster area, tender to touch with sores and scabs but also very numb especially right side. The feeling of being battered by a baseball bat which came overnight back in February 2019 has never gone away, just got worse. This is why re-instatement seems so counter-intuitive to me because how could any drug fix your brain/head when it feels like its pretty much exploded? But of course I may be wrong. 

 

Sleep's ok for me just because I feel so dead - it's easier. It used to be a big issue before the drugs - I could never sleep properly - and was straight out of bed first thing. Now I can't get out of bed for hours, sometimes midday, and often work from bed. It's like everything is the polar opposite from before the drugs (for the worse).

 

I do have these awful nightmares frequently (where I feel either detached from the people in them or I'm under attack) and I wake up from those in a state. I also have better dreams too. Either way it seems to be a nightly experience, it's very rare I don't dream. It's strange with the PSSD - physical arousal can kick in during the night (almost automatically like a switch going on) for a sustained period - there's even the odd erotic dream - but everything is totally numb and whether at night or during waking hours there is zero libido/desire to act on it, so it's kind of pointless. Its like my body is still functioning but the relevant part of my brain isn't connected.

 

In general, it's like my whole life force is gone. 

 

[Altostrata]

Is there an allergic reaction on your scalp? You might change your shampoo or other products you use on your hair. That might reduce one small area of discomfort and worry.

 

What are you doing for exercise? Are you eating fresh fruits and vegetables? They contain nutrients that may help you heal.

 

When was the last time you got a full blood panel checkup, with vitamin B12 and vitamin D levels tested? Thyroid tests?

[Dee7]

Thanks yes I have been exploring shampoos - will do more. 

 

I can't exercise properly due to the Fibromyalgia in my legs but I get out and walk everyday and even go cold-water swimming when I can just to float around / try and feel something, so no real issue there.

 

Yes my diet is all pretty much from raw ingredients so lots of fruit and veg, nothing processed. 

 

I'm pretty sure I had the blood panel checkup recently - I will check again tomorrow on that with the doctor.

 

It feels like I've been doing all the right things but the Anhedonia / DP / DR / PSSD in particular are so unrelenting and its hard to keep motivated to do things when there is never any sense of reward from anything any more, a complete absence of pleasure in life.

 

 

[Altostrata]

Emotional anesthesia appears to be a common after-effect of antidepressants. It slowly goes away, like other withdrawal symptoms.

 

How did you feel when you initiated mirtazapine? What were the symptoms that caused you to stop it?

 

You may wish to get hypo-allergic shampoo, such as hypo-allergenic baby shampoo.

 

[Dee7]

Thanks will look into those.

 

The Mirtazapine never felt quite right from the off and I had a couple of days where I felt a bit flat which wasn't me, but mainly I just decided it was the wrong move to address my existing illness. I thought coming off after only four weeks would be harmless if I followed the doctors advice which was day on / day off over another two weeks then stop. At the end of that, having stopped, I felt fine, no trouble - still very much myself and pleased it was all behind me - then 5 days later complete carnage. So the real damage came after stopping it, as it did with the Sertraline that followed.

 

 

[JesusSavemefromWD]

If u don’t mind me asking, how would u describe ur DP? This is my worst symptom…. 

[Dee7]

I guess i just don't feel anything like myself, don't really recognise myself (even in the mirror), feel alien, like a shell trying to act like my old self. 

[JesusSavemefromWD]

15 hours ago, Dee7 said:

I guess i just don't feel anything like myself, don't really recognise myself (even in the mirror), feel alien, like a shell trying to act like my old self. 

Thanks, that’s how it is for me as well, plus right eye causing distorted vision. There has been a bit of an improvement over the one year since zoloft discontinuation but not to the level that I can function again. Thus, every day I debate between reinstating, or switching to a low dose of Prozac or just keep taking the DP in the hopes of subsiding one day. Have u made up ur mind about reinstating? I wish I had reinstated earlier in this hellish process but I wasn’t expecting I would suffer long term from just few weeks on Zoloft. 

[Overwhelmedlady]

Hi @JesusSavemefromWD I just dropped by to see how you are dealing with your symptoms today.There are a couple of coping resources in the Inner Compass site if you look up depersonalization.I don't know if you will find them useful but may be you could give it a  try. We all wish we could ease symptoms to be able to feel somewhat better .It is quite shocking to learn that there are around 67.000 people online,in different groups going through withdrawal and trying to find peer support. This poisonous overmedication needs to stop and it needs to be challenged by critical psychiatry.

[JesusSavemefromWD]

21 minutes ago, Overwhelmedlady said:

Hi @JesusSavemefromWD I just dropped by to see how you are dealing with your symptoms today.There are a couple of coping resources in the Inner Compass site if you look up depersonalization.I don't know if you will find them useful but may be you could give it a  try. We all wish we could ease symptoms to be able to feel somewhat better .It is quite shocking to learn that there are around 67.000 people online,in different groups going through withdrawal and trying to find peer support. This poisonous overmedication needs to stop and it needs to be challenged by critical psychiatry.

I ve tried every non drug technique out there, I have even bought the manual from a guy who claims he has a way of getting rid of DP. Nothing has worked for me. Zoloft must have caused some serious damage that only time might one day correct. Thank you for thinking of me. Are u feeling any better? Is the water issue taken care of?

[Overwhelmedlady]

Hi @JesusSavemefromWDYes,plumbers worked in the building and solved the problem yesterday.Today I had to solve another minor domestic issue and called another plumber. Solved as well.Saw my friend yesterday for some minutes before she took her plane to LA. The rest of the day was WDnormal as they call it here.  A little better than the previous days. I had to take IBuprofen for a couple of days at night because of flu like symptoms and headache, stress related. Do you have someone at home to cook and do housework? What do you like to cook when you cook? 

[Dee7]

Hi @Altostrata sorry I think the thread went on a bit of a tangent - were you able to draw any conclusions as to what my next move should be following my response re: Mirtazapine? It is just a case of having to wait it out now? The symptoms are very intense.

 

Thanks

[Altostrata]

On 5/16/2021 at 11:37 AM, Dee7 said:

It's now 19 months since I have taken anything yet I feel worse and worse. The main symptoms are anhedonia, depression, depersonalisation, suicidal ideation and PSSD. I also have numb head, teeth and arms. 

 

How's your sleep? How has your symptom pattern changed in the last month? Are you taking any other drugs?

 

Between the time you went off mirtazapine and May 2019, when you started sertraline, how did you feel? Why did you start sertraline?

 

Many people find these to be helpful:

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

You might try a low dose of one at a time to see what it does for you.

[Dee7]

Sleep is generally good, recent average is about 5 hours, wake up around 5am and maybe get another couple after some times. So it's disturbed, but not awful.

 

Symptoms increasingly intense over the last month in these areas: DP, DR, SI, PSSD, Anhedonia, detached, numbness, staring at the wall, total apathy - emotional anaesthesia I guess.

 

No other drugs, alcohol, etc.

 

Between the time of going of Mirtazapine and May 2019 I felt knocked for six, depressed, numb head (like a baseball bat to hit it), can't get out of bed, no libido, miles away from my old self (I was my old self while I'd been on it). 

 

I was persuaded by the doctor that I had simply taken the wrong AD and, because at one stage historically I had been on Sertraline briefly, that that would come in and fix the mess.

 

Cleary this didn't happen as I went up from 0mg - 100mg and back down again over the next six months, with more symptoms (including PSSD) again hitting me after stopping. 

 

 

 

 

 

 

[JesusSavemefromWD]

1 hour ago, Dee7 said:

Hi @Altostrata sorry I think the thread went on a bit of a tangent - were you able to draw any conclusions as to what my next move should be following my response re: Mirtazapine? It is just a case of having to wait it out now? The symptoms are very intense.

 

Thanks

Sorry, I didn’t realize I was replying to overwhelmed while in Dee7 s thread. I hope the moderators can correct this 

[Altostrata]

Thanks for your sensitivity to Dee, @JesusSavemefromWD

 

44 minutes ago, Dee7 said:

Between the time of going of Mirtazapine and May 2019 I felt knocked for six, depressed, numb head (like a baseball bat to hit it), can't get out of bed, no libido, miles away from my old self (I was my old self while I'd been on it). 

 

So your symptoms date from going off mirtazapine?

 

If so, you might try reinstating 1mg mirtazapine. You'd stabilize for some months, then taper by tiny amounts later. 

 

This may help the other symptoms, I don't know how it will affect PSSD, that's from the sertraline and may need to resolve very gradually over time.