Dee7: Mirtazapine & Sertraline 2019 Story

[Dee7]

Ok thanks @Altostrata makes sense

[Dee7]

Hi @Altostratajust to update you I went up to 2.5mg and sustained that for a week but still have felt no movement good or bad so dropped down to 2mg and now 1.5mg. It's roughly a month now of taking it and my initial supply is nearly gone so I guess my options are to phase it out slowly over these next few days or go up again / go harder.

 

Having got nothing from 2.5 I'm a bit reluctant unless there's a general roof/cut off that people tend to go to that I haven't reached?

 

I guess I'm unsure when a minor reinstatement stops being a minor reinstatement and becomes something else.

 

Thanks

[Dee7]

Quick update @Altostrata: I felt a flicker of life again today, a bit like I did on November 19th. Thats two flickers but more than ten days apart. I started the reinstatement on November 3rd and have gone from 0.75mg - 2.5mg, back down to 2 and 1.5mg for the last three days - what do you make of this and the what the next move might be? Thanks.

[Dee7]

Sorry to chase on this @Altostrata I know you are busy, I'm just confused by the situation and concerned about making a wrong move.  I'll try and condense info below:

 

Nov 3rd - Re-instated low dose Mirtazapine 0.75mg

Nov 10th - Moved up to 1mg

Nov 17th - Moved up to 2mg

Nov 19th - Slight flicker of life, moved up to 2.5mg

Nov 24th - No further improvement, moved down to 2.0mg

Nov 27th - Moved down to 1.5mg

Nov 29th - Another flicker of life

Nov 30th  - Moved up to 2.5mg

 

I think what's confused me is that I thought any slight improvement I had would then be maintained the next day and I can't quite understand why the two "flickers" of improvement I had would be ten days apart. 

 

It feels to me that while I'm moving in such small increments at such a low dose I might never get a solid answer, so I have requested more of the liquid form as I'm nearly out and moved the dose back up last night.

 

It seems like I might need to go up to 4-5mg to see if there really is a difference to be made, do you have any thoughts on this?

 

Thanks a lot 

 

 

 

 

 

 

[Altostrata]

On 11/30/2021 at 7:52 AM, Dee7 said:

Quick update @Altostrata: I felt a flicker of life again today, a bit like I did on November 19th. Thats two flickers but more than ten days apart. I started the reinstatement on November 3rd and have gone from 0.75mg - 2.5mg, back down to 2 and 1.5mg for the last three days - what do you make of this and the what the next move might be? Thanks.

 

@Dee7, if I were you, I'd stop changing your dosing. Every time you make a change, your nervous system has to adapt (which takes at least 2 weeks for mirtazapine). Pick one level and stay at it for at least 2 weeks. If you feel you might do well with more, you might increase it by 0.5mg every 2 weeks or so.

 

As explained before, it takes 2 weeks for a change in mirtazapine dose to have full effect. Since you've been going up and down, it's impossible to tell what those "flickers" might mean. Could be that if you stayed at one dose, you'd have more flickers.

[Dee7]

Ok thanks @Altostrata the time gap between raising doses was the bit I was unsure about, so I will stick with two weeks as a minimum rule from now on. 

 

I moved around a bit previously between 0.75mg - 2.5mg because I hadn't really felt any strong effects in a month or so, but will stick to 3mg (which is where I am at as of today) now for two weeks. 

[Dee7]

I'm really struggling with the constant numbness / deadness which has been the case for months and months now. Do people ever recover from not being able to get out of bed, the numb-eyed look, the sudden bouts of fatigue in the day? Does motivation ever replace the apathy? I used to be up and out of bed in five mins. Also my palms used to sweat, now they're bone dry. I just can't find the "on" switch. It's like being a completely different person.

[Altostrata]

Yes, people recover, but it's very gradual and takes months. If you have additional adverse drug events, that adds to recovery time.

 

See

 

The Windows and Waves Pattern of Stabilization

 

Are We There Yet? How Long is Withdrawal Going to Take?

 

"Is it always going to be like this?"

 

[Dee7]

Thanks a lot - I don't think I've had any further adverse events since the first two drugs, I presume my current minor reinstatement of Mirtazapine isn't necessarily an adverse event as nothing out of the ordinary has happened so far, however the emotional anesthesia is very intense as described. I think it could be making that worse and I wouldn't want to delay any potential recovery, but guess I have to give it a go for at least a while. 

[Dee7]

Just an update, four nights now at slightly higher dose of 3mg but no real change in general trajectory. All round symptoms (PSSD, anhedonia, emotional anesthesia, etc) I think may be so overwhelming that it's difficult to see much relieve from this minor-reinstatement alone, but we'll see. 

[HugHK]

1 hour ago, Dee7 said:

Just an update, four nights now at slightly higher dose of 3mg but no real change in general trajectory. All round symptoms (PSSD, anhedonia, emotional anesthesia, etc) I think may be so overwhelming that it's difficult to see much relieve from this minor-reinstatement alone, but we'll see. 

 I didn't come off the same meds as you but after the initial peak of withdrawal, I didn't see any improvements whatsoever for 2 months. Then I had a couple of windows in July-August, then September was worse than August...

 

Finally in October things started to improve and November has been much better. 

 

The point is, it's normal for things to not necessarily look better one month than they had the previous one, and it can even happen that things get worse before they get better. 

 

The windows and waves obviously affects morale a lot, as you must be experiencing, and humans naturally think by induction: 'If I've been feeling bad for months with no improvement, why would I start feeling better next month?' But eventually you will.

 

Good luck, hope things start working out for you soon

[Dee7]

Thank you @HugHK

[Dee7]

Hi @Altostrata a quick update, I've now done 8 days at 3mg (on top of the previous three weeks at slightly lower amounts) but so far all I feel is a slightly increased sense of emotional anesthesia. I also think sleeping has become slightly more difficult (trouble getting off/disturbed).

 

At this stage it's been over a month of minor re-instatement with no significant gains. I feel like tapering back down now and writing it off to experience but I guess it would be worth holding for the full 2 weeks. If I do, and don't feel any better at that stage would it be fair enough to taper back down and end the experiment or do people still keep going up despite feeling bad for sometime? I don't think I can keep going up without some return the way I currently feel. Thanks. 

[Altostrata]

@Dee7 are your symptoms better or worse at any particular times of day? What is your sleep pattern?

[Dee7]

No, I don't really have any variation at all. I just seem to be drifting towards increasing anhedonia, DP, emotional anesthesia, etc 24/7 and I wonder if this re-instatement is intensifying that. 

 

I tend so go to sleep just after 11pm and get a decent amount of sleep but always with disturbances, so quite on/off then waking around 8am. I would say perhaps it's more disturbed since re-instatement. 

 

I really am just starting into space most of the time, barely lifting my head up and that hasn't changed in months.

 

[Altostrata]

@Dee7 this is your symptom pattern prior to reinstatement of mirtazapine:

 

On 10/22/2021 at 11:21 AM, Dee7 said:

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.

.....

 

Your sense that your symptoms are increasing seems to be constant.

 

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

...You've made at least 10 drug changes in less than a year. Please be patient and let your nervous system recover. 

 

I understand you distrust the drugs, but you have a history of drug changes rather than sticking with one thing and seeing if it helps. 

 

You have been taking 3mg for only 8 days. If I were you, I'd continue for the full 2 weeks at least.

[Dee7]

Ok thanks, it just feels the trajectory over, say, the last 12 months has been downwards - I've found it increasingly harder to be social, get out of bed, etc - but that might also be me just getting tired of the whole situation / groundhog day.

 

I understand the need to stick to something. I'm sure its difficult to say, but sometimes it helps me to have a plan and see where I'm going with something. I know this will be based entirely on how I react, that said, is there a range (say 1mg - 5 mg) or time line (say 1-3 months) that people typically stay in with a minor-reinstatement?

[Dee7]

Hi @Altostrata wanted to report back as today marks two weeks @ 3mg on the reinstatement.

 

Nothing much has changed (original symptoms from coming off like numb head, teeth remain). Sleep seems ever so slightly altered - a bit trickier to fall asleep, a bit more disturbed, better dreams, less nightmares - not sure if that could be construed as progress or not. 

 

Otherwise no real lift. I just wondered which direction is best from here. I see some people move quicker to a higher dose but do many retreat back down to zero? I'm happy to look at either as currently I'm struggling.

 

My original dose was 15mg for 4 weeks and then I was told to reduce to 7.5 for 2 weeks. so I guess they may be my benchmarks in how far up I could go?

 

Obviously the situation is a bit complicated by having PSSD from the second drug (Sertraline) which may be overshadowing this.

 

Thanks a lot

 

 

[Altostrata]

What kind of lift are you looking for?

 

How much sleep are you getting now?

[Dee7]

A lift meaning any change in symptoms for the better.

 

I'm getting a pretty good amount of sleep, last couple of nights waking early 5.30 /6 am.

 

 

 

 

[Dee7]

Hi @altostatra I just wanted to clarify something about reinstatement: I am trying to stick with it and move up slightly due to lack of progress (3.5mg currently after 2 + weeks @3mg). If it becomes obvious that I am feeling worse (as discussed, sometimes it's hard to tell as there are no obvious new symptoms) is that a sign to stop the reinstatement, or is there any argument for "pushing through" and, despite maybe feeling awful, going through that to get to a higher dose or longer time on the drug? I read on another thread that any sign of feeling worse should mean end the re-instatement attempt. 

 

Thanks

[Dee7]

Hi @Altostrata hope you're well - I have now been reinstating since Nov 3rd and having stayed around 3mg for a while with no real improvement, have nudged up to 4mg over xmas. Have to say overall I do feel worse than before the reinstatement and am wondering whether to come off or whether to "push on through" to a higher amount having come this far? One thing to add is that having had a bad nightmare the night before (typical since withdrawal) I was able to cry properly on Monday 20th December for the first time in ages, then that night had quite a pleasant dream. This is the only real thing of note to report this month, not sure how related to reinstatement it is?

[Dee7]

Hi @Altostrata I hope someone can help me. I'm in quite urgent need of advice. I have been trying a minor reinstatement of Mirtazapine for two months now. It was getting particularly tough as I went up to 4mg around xmas so I came down a bit and held at 3.5mg.

 

Now I'm not sure which way to head. If I slowly come down/off, it will feel like a failed reinstatement, so I still feel tempted to just up my dose to something like 7.5mg just to see what happens. But I'm so far out now maybe it will never work. I am struggling to get out of bed at all, feel increasingly 'dead' within, plus none of the initial symptoms I got from coming off Mirtazapine (numb teeth, head, etc) have been improved by this so far. Is there an argument for 'pushing through' to a higher level before giving up on this?

 

Thank you

[Altostrata]

@Dee7 what dates did you make drug changes since advised not to make drug changes on December 9 (one month ago)?

 

How have your symptoms changed in the last 2 weeks? Which have improved, which have worsened?

[Dee7]

My situation got quite desperate a few nights ago (7th) and I ended up increasing my dosage to 7.5mg (half the original amount I was prescribed). I originally reinstated on Nov 3rd and had become frustrated that I'd really felt no relief from symptoms in that time. I accept that I did change dosages during that time which may have been a factor. I haven't felt significantly better or worse since.

 

In answer to the question about symptoms I don't seem to have got anything new or of note happen to me at certain times of day, etc like other people. It's just that the main symptoms I've had for ages are more intense: waking up completely blank, unable to get out of bed much before midday, increasingly detached and unable to socialize at all,  emotional anesthesia and numbness - these are what have worsened since reinstatement. I sleep ok most of the time. 

 

I have no intention of going any higher with the reinstatement so I guess now I'm here the thing do now is hold for a while so as not to make any more changes too soon? I remember you said to hold at 3mg before for at least two weeks which I did, now I'm here should I look to do the same before any thoughts of tapering down?

 

Thanks

 

 

 

 

 

 

 

[Dee7]

HI @Altostrata - hope you can help - I did some reading of your notes section on the site about Mirtazapine and was intrigued by the following in terms of my current reinstatement:

 

"Mirtazapine has a high affinity for histamine receptors and is therefore sedating at low doses. This is countered to some extent by its enhancement of noradrenergic neurotransmission at higher doses, making mirtazapine less sedative as its dosage is increased"

 

My main symptoms, as you know over the past couple of years since initially coming off have been flatness, no motivation, apathy, anhedonia, etc. 

 

Since reinstating at a low dose on November 3rd all these have intensified (previously I was getting out of bed by 10.30am, now its after midday) to the point where it's very difficult to function at all. 

 

Is this because I am still at a relatively low dose so I'm bound to be more "sedated"? If I were to go to one of the higher doses of Mirtazapine could it spark some life, could it enhance some "noradrenergic neurotransmission" that might make me feel less dead and more alive? 

 

It's a real struggle to keep going as things are. 

 

Thanks a lot

 

 

 

 

 

 

 

[Dee7]

Hi hope you don't mind me jumping on this thread quickly, I was just interested in what you said about Mirtazapine "In lower doses it is a giant antihistaminic and makes you more drowsy but in higher doses it has more activating properties and is not recommended as a sleep aid but as an AD"

 

Ever since coming off nearly three years ago I have felt flat, depressed, anhedonia, no motivation, numb, can't get out of bed,etc.

 

I reinstated Mirtazapine two months ago at a low dose to try and alleviate symptoms but they are just more intense, could it be that taking a higher dose may spark some life in me and make me feel less dead/numb/flat due to those "activating qualities"? Thanks. 

 

 

[Santino]

48 minutes ago, Dee7 said:

Hi hope you don't mind me jumping on this thread quickly, I was just interested in what you said about Mirtazapine "In lower doses it is a giant antihistaminic and makes you more drowsy but in higher doses it has more activating properties and is not recommended as a sleep aid but as an AD"

 

Ever since coming off nearly three years ago I have felt flat, depressed, anhedonia, no motivation, numb, can't get out of bed,etc.

 

I reinstated Mirtazapine two months ago at a low dose to try and alleviate symptoms but they are just more intense, could it be that taking a higher dose may spark some life in me and make me feel less dead/numb/flat due to those "activating qualities"? Thanks. 

 

 

Hi Dee

From my Experience at the doses between 7.5 up to 3 i was feeling really drowsy. Last year in 2020 due to corona i suffered big time from insomnia so i was forced to have a short love affair with Mirtazapine just for sleeping. I started with 4Mg and i slept well but the next day i was foggy and started to have this brain fog feeling that you mentioned. I got alarmed and i immediately lowered the mirtazapine to 3mg and the next day the foggy feeling was gone. So i continued preserving sleep and tapering slowly for 3-4 months until i reached 0 in May 2021. 

In your case i believe you are taking mirt only to preserve sleep and it has activating properties at doses 15mg and above. If i was you, i was sleeping well i would not go for higher doses just for the AD properties of Mirt. It would be better to stay where you are and slowly lower the doses by 10% every 3-4 weeks while preserving sleep. If you keep notes you will understand whether your intense symptoms are from Mirtazapine or something else. 

From your description i notice you have stopped MIRT quite fast the first time and then you had some time with sertraline so the destability you mention before the reinstatement might as well be related with WD of the first two periods you were on these drugs. 

All the best

Santino

 

[Dee7]

Thanks a lot Santino, but my issue is not with sleep, but with the flatness, depression, numbness that Mirtazapine left me with when I first came off it - no emotions, etc.

 

So I am not so much interested in sleeping - that has been fine since I came off the drug - more, I am interested in feeling alive again in daytime and I wondered if the higher dose might do that?

[Altostrata]

On 10/22/2021 at 11:21 AM, Dee7 said:

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.

....

 

On 11/16/2021 at 2:06 AM, Dee7 said:

....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. 

 

How have your symptoms changed compared to the above?

 

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. 

 

On 11/9/2021 at 2:37 PM, Altostrata said:

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

 

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

....

 

 

Dee, I have tried to tell you that you may be pursuing symptoms that need to resolve with time, and reinstatement won't help. If your primary complaint is still the emotional anesthesia, taking more mirtazapine only brings on more of it.

 

In addition, increasing the dosage appears to have made you more dopey and sluggish, which is what we'd  expect. 

 

It appears 3.5mg mirtazapine did not address the symptoms you want to address, and increasing the dosage to 7.5mg went in the wrong direction.

 

Your impatience has caused you to make a lot of unnecessary drug changes. These changes add to your problems. It does not appear that the symptoms that bother you the most can be reversed by drugs. You need to let them resolve with time.

[Dee7]

Ok @Altostrata thanks, I think that's probably the nub of the problem, the symptoms that trouble be the most probably cant be solved by reinstatement however much I want them to be and that's the issue (and nothing else particularly has been helped by it).

 

If I were to taper down now from where I am is there any advice on how slow to go / what increments?

[Altostrata]

If you jumped from 3.5mg mirtazapine to 7.5mg only 7 days ago, you can go right back to 3.5mg. There may be bumps for a few days.

[Dee7]

Thank you 

[Kiasofia]

Hi Dee,

I moved your posts in gatos thread to your own since they were questions for Santino, not gatos. If you want to continue discussing with Santino, please do it here.

Hope you are able to stabilize soon❤️

[Dee7]

Thank you @Kiasofia appreciate it

[Dee7]

Sorry @Altostrata quick follow up question on this - once back at 3.5mg would you suggest staying there for a while longer to see what happens? If so how long? Or would I taper down slowly from there? I re-instated on Nov 3rd.