wadh3301: Mirtazapine Withdrawal / Introduction

[wadh3301]

Hi there,

 

I'm a 31 year old male, struggling with a prolonged mirtazapine withdrawal.   I was on a dose of 15mg for 5 months from July 20 - November 20 for insomnia (garden variety) and depression which struck around the beginning of the pandemic.  (Prior to that I did try out citalopram which gave me instant sexual problems, so I stopped that after 4-5 pills, returning to normal a week or so later).  Mirt did help me sleep but it came with a *lot* of emotional and physical apathy - so in November I decided I wanted off. 

 

I decided to taper  5 months, hoping that would lessen the possibility of withdrawal side effects (doc told me I could just go straight off - I decided to be more cautious).  I went from 15mg to 7.5mg over 1 month with relatively few problems, and then did a taper down from 7.5mg over 4 months, making bigger drops at the beginning and slowing a lot towards the end as is roughly recommended.

 

Unfortunately it seems that 2.5 months after my last 0.1mg microdose I'm still not quite right.   I've been experiencing a lot of problems with broken sleep, fatigue and depersonalization which started pretty much as soon as I began withdrawing and have mostly persisted in various ways.  I know these are not the return of my original symptoms as I never had insomnia of this type or pattern/severity previously.   Loathe to try to reinstate because I found that for 75% of the time tapering I felt about as bad as I do now anyway.  (Somehow the broken sleep that I always had on a full dose of Mirt ceased to be restorative as I cut the dose  - except for the odd window here and there, notably around 2-3mg mark).

 

My sleep pattern is all over the place - sometimes getting 4 hours, sometimes longer, but always very broken with consistent early awakenings every single day.  I have the feeling of both being exhausted and unable to sleep at the same time (like a 'wired' state where fatigue occurs but sleepiness often doesn't); also I've noticed that my blood sugar and energy levels are different to how they were prior to going on Mirt (no spikes or sleepiness after meal times like I used to have, but a sort of a 'nothing' steady state which doesn't seem to change much).   I know Mirt does affect both these things, so it makes sense. I guess I just thought it would be over by now!  

 

Supplement wise I'm on magnesium and algae oil (veg alternative to fish oil).

 

Basically just looking for some support / moral encouragement.  I'm trying to hang on as best I can but keep getting disheartened by the consistent insomnia, fatigue, apathy, DP symptoms.   Going to try out a low histamine diet in the coming weeks, although I don't seem to have many of the classic symptoms of histamine intolerance so who knows.

 

If someone could look into a crystal ball and give me a date when I'd feel like myself again (even if it was some time quite far in the future), I think I could handle a lot of this better.  A lot of it is the worry that I've damaged my physiology forever...I know probably everyone goes through these thoughts; when progress seems to be so slow it's easy to get stuck on them.  Any words of encouragement, advice,  therefore much appreciated!  I have been feeling terrible for pretty much 7.5 months now - an odd day, afternoon, a few hours, or a couple of weeks here and there aside.  'It sucks' is an understatement, and the majority of days I have to actively drag myself out of rumination.

 

Finally, I know we should count our blessings, and I know some people on these forums are probably struggling with worse so my heart also goes out to everyone out there. 

 

 

Edited July 27, 2021 by manymoretodays

[Onmyway]

Dear Wadh,

welcome to our wonderful little corner of the web. Hope you can find the support that you need here and make your journey at least a bit lighter. Would you mind putting your drug history in your signature so that people can see at a glance and provide advice more easily regarding tapering or what to do. 

 

How to List Drug History in Signature - Introductions and updates - Surviving Antidepressants

 

Your symptoms do sound like classic withdrawal. I had similar wired but sleepless feeling for many months and occasionally they still come back in waves. For me sleep hypnosis tracks on Spotify would occasionally help. 

There are some good forums on sleep issues here: Important topics about symptoms, including sleep problems - Symptoms and self-care - Surviving Antidepressants

 

You seem to have done the right things in tapering (albeit perhaps faster than your body could tolerate) despite your GP's advice and are doing the right things as well with Mg and algae oil. A small reinstatement might help, maybe to your last microdose of 0.1 mg? You can then see if it makes a difference over a week or two. If not, you can then decide to updose slightly or to just stop. It is your decision as you seem to be well informed and it has been 2.5 months already and there is some benefit to keeping things stable. Maybe the other moderators will jump in with better advice here.

 

The thing to remember now is that this does get better and you will feel good again like you do in those hour/week windows you mention. Do your windows have a pattern? Many people feel terrible in the mornings but better in the evenings - a common pattern.  If you identify such a pattern then you can bear the difficult times more easily.

 

Unfortunately, we don't know when and how long it will be or how bumpy your particular road will be. What we do know is that there is an end to this nightmare. If you haven't done that yet, have a look at the Success Stories forum. It sustains many of us through the difficult times. 

 

Are you using any non-drug techniques to manage your emotional symptoms, anxiety and insomnia? Those might help. 

Non-drug techniques to cope with emotional symptoms - Symptoms and self-care - Surviving Antidepressants

 

Have you considered also getting support through some sort of a talking therapy? You only need to self refer yourself through the NHS.  Find an NHS psychological therapies service (IAPT) - NHS (www.nhs.uk) It is a luck of the draw who you will see then but it might help. You could also get a therapist privately, of course. I can provide more resources if you'd like me to. They are not going to take away the withdrawal but some of the skills they teach might be useful both during and after withdrawal. 

 

You seem to be doing the right things also by actively stopping yourself from ruminating. Continue doing that. Distraction is your friend during this time - if you can manage to see other people safely, walk/exercise/watch TV or silly youtube clips... do what you need to do. Your goal is to get through this with the least amount of trauma possible. 

Welcome to our community! This will get better!

Edited July 25, 2021 by Onmyway
added a new link, clarity

[wadh3301]

Thank you for your support and kind words onmyway, they mean a lot.  I'll take a look at the links you've posted through; I've also now updated my signature.

 

I think I'm going to stick with being off the med.  I remember what I felt like at 0.1mg and it was worse than this! (It's hard to keep track).  I'm glad I managed to do a taper of sorts even if quicker than what is recommended here; hopefully that will stand me in some stead.  I have a close friend who jumped off mirt CT with no problems!  So I thought I was being really overly and characteristically cautious... One also tends to think that doctors know what they are talking about, as they generally seem to do with physical health problems.

 

I am not sure about my pattern.  When I have felt better it's usually because I've managed to get a few more hours zzz; by some fluke of sleeping through the alarm or what not.  Occasionally after a good meditation too.  However I have the feeling that these breakthrough patterns may be my brain reverting to what it was like on the mirt rather than anything else (high, wired, bright). I have recently not really had any of them but maybe I also feel consistently slightly less bad as a baseline (?).  Hard to keep track to be honest.

 

Sorry to here that you also struggle with the sleeplessness in waves.  Has that got better over time?

 

 

 

 

[wadh3301]

Hi again onmyway, 

 

Just an update to keep myself on the vaguely sane side of things.

 

I think I've experienced some improvements over the last month although the changes are so slow, that it sometimes feels like I am gaslighting myself.  That said I think I've had a couple of nights where I've perhaps only woke up 2 or 3 times, rather than 5,6,7. 

 

I seem to flip between two states of heavy daytime brain & body fatigue or else feelings of being wired - paradoxically I am probably cognitively higher functioning on days when I've had less sleep due to the 'wired' effect.  On days with more sleep I can feel the wired feeling shifting into fatigue and then eventually depersonalisation, which is the worst..

 

I've also had gastro symptoms - diarrhea upon awakening for a few weeks which now seem to have resolved.  I've gone onto a low histamine diet, possibly what is linked to my modest improvements, but not entirely certain. 

 

I am wondering what is causing this 'wired' state - whether it's linked to histamine intolerance, or whether it's just part of a more 'general' withdrawal.  Certainly unlike anything I've experienced prior to going on ADs.

 

I continue to think my decision not to reinstate was for the best - I don't think I feel *quite* as bad as the worst parts of my 5 month taper, which were even heavier on the depersonalization.  Do wonder though whether I am going to have to have a longer withdrawal due to my relatively quick taper.  I guess these are questions I shouldn't really dwell on!

 

Hope you are well

Paul

[Marija]

Hi @wadh3301, I'm just wondering how you're getting on with your sleep? Are you still on the low histamine diet? Hope you don't mind me asking ☺️

 

[wadh3301]

Hi Marija,

 

Sorry for the slow reply.  I went on a low histamine diet for about a month or so.  I experienced some minor improvements in this time (although more related to brain fog than any improvement in my sleep).  I went on holiday and it didn't prove practical to carry on with the diet during this time - I can't say I feel a massive difference not being on it.  

 

Hard to say - I am planning on reinstating the diet in a couple of weeks' time so will let you know if there is any significant change.

 

My symptoms continue to be a 'wired feeling', depersonalization/braing fog, and disrupted sleep (max 4 hours quality, then usually followed by periods where I feel like I am somehow awake and dreaming, or waking up very frequently).

 

Hope you are keeping as well as can be for you

 

Paul

 

 

[Altostrata]

Welcome, @wadh3301

 

On 7/26/2021 at 2:23 AM, wadh3301 said:

I remember what I felt like at 0.1mg and it was worse than this! (It's hard to keep track).

 

Most likely, what you felt at 0.1mg was withdrawal from your prior reductions.

 

Recovery from antidepressant withdrawal syndrome is very gradual. You've described some slight improvement. This probably will continue if you don't add any drugs, including alcohol, that will upset it. We cannot say how long this will take.; it may be many months.

 

Low-dose reinstatement can take the edge off your current withdrawal syndrome. You might try 0.25mg mirtazapine to start. This topic explains how to make a liquid from tablets Tips for tapering off mirtazapine (Remeron) You may be able to get a prescription liquid from your doctor.

 

Please let us know how you're doing.

[wadh3301]

Hi Altostrata,

 

Thank you for commenting. 

 

My preference is still for staying off the mirtazapine.  I guess my question is, is there any suggestion that I am hindering my healing by not initiating a micro dose at this stage?  

 

I feel like some of my current symptoms were also present as side effects while on the mirt - the pattern of broken sleep which I'm experiencing now was also there on the Mirt (just mitigated by the heavy sedation).  Likewise the changed response to blood sugar.  So I'm not sure how helpful reinstating will be if these are things I'm trying to 'discourage' my CNS from doing.  Don't know if that makes sense?

 

I feel like a reinstatement might also confuse me - I know my symptoms are not helped by anxiety, confusion about what is going on, and relative indecision (normal aspects of my pre-mirt personality).  It may be quite hard for me to determine at what point I have 'stabilised' on 0.25mg and feel good enough to further taper, because my anxiety response gets tied into the WD response.  Something I'm aware and working on, but an aspect to navigate all the same.

 

Thanks,

Paul

 

 

[ChessieCat]

I suggest you read Post #1 of this topic which has information about reinstatement.  It is good idea to read the information that can help you to make an informed decision.

 

about-reinstating-and-stabilizing-to-reduce-withdrawal-symptoms

 

[ReddLedd]

@wadh3301how you doing now? 
im struggling a little at week 10 and looking for some positives anywhere I can!