SueAd: Trying to get off mirtazapine 15mg while pregnant

[SueAd]

Hi, I have been taking mirtazapine 15mg for 6.5 months. I don’t take any other medications and have never been on any medications before. 
I started this in January for postnatal panic  and anxiety. I never had any depression. Just had panic that made me feel like I was dying. I should also note that I have been struggling with insomnia since 2019 which was triggered by a blood donation I made. Prior to this I have never had any problems sleeping ever in my life. The blood donation caused me to have very bad heart  palpitations which interfered with sleep. But I managed it naturally. 
 

fast forward to today. I am 16 weeks pregnant with baby no. 5 and I tried to get off the mirtazapine at 6 weeks by cutting it on half to 7.5mg.  10 days later I become severely depressed, anxious, nauseous, crippled with doom and had severe body aches. I reinstated back to 15mg immediately. Symptoms started to disappear one by one shortly after, but it took me around 6-8 weeks to stabilise. 
Now I’m stable. Sleeping well, feeling well. 
But I have come to realise the trap I have fallen for. How will I ever be able to get off this without further damage? 
I don’t want my baby exposed to this drug any longer and I worry about the baby getting withdrawals. However, I am tight for time. What should I do ? What’s the safest and quickest way possible to get off this poison. Or should I just stay on it until after the baby is born ? 
 

 

 

Edited July 27, 2021 by manymoretodays

[Shep]

Hi, SueAd. Welcome to Surviving Antidepressants.

 

I'm glad you reinstated so quickly back to 15 mg and have now stabilized. It looks like you reduced too fast. Please note we recommend tapering no faster than 10% per month off the prior month's dose. Please see:

 

Why taper by 10% of my dosage?

 

For information specific to mirtazapine, please see:

 

Tips for tapering off mirtazapine (Remeron)

 

Here is some information on withdrawal to get you started: 

 

How psychiatric drugs remodel your brain

 

Healing from antidepressants. Patterns of recovery video (4 minutes)

 

The Windows and Waves Pattern of Stabilization

 

For help with sleep, please see:

 

Tips to help sleep: so many of us have that awful withdrawal insomnia

 

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Please continue to use this thread to document your taper and to ask questions. 

[SueAd]

Hi, I have been told about a different way of tapering. Can you please tell me if it’s also safe ? 
 

mix 15mg orodispersable tablet in 150mL of water and reduce my 1mL each day to wean off in 5 months or reduce by 0.5mL each day to wean off in 10 months ??

 

someone successfully came off this way without any withdrawal and said that since it’s a very gradual drop each day the brain doesn’t notice. 

I don’t know if that’s ok or not.

 

if you have any experience please let me know. 

[Altostrata]

Welcome, @SueAd

 

Many people probably would be able to taper mirtazapine with daily "mini-taper" reductions as you describe. The success of this method depends on whether your personal neurobiology can adapt in 24 hours to these small reductions.

 

If you dissolve 15mg mirtazapine in 150mL of water, you will have 1mg in 10mL, or 0.05mg in 0.5mL. Reducing your dose of 15mg to zero by 0.5mL each day will require 300 reductions.

 

As we recommend a decrease of 10% per month (which at a dosage of 15mg, would be 1.5mg), this reduction schedule would keep you within a 10% reduction bracket for one month. After that, the relative rate of reduction would progressively increase each month.

 

For example, the second month would start with a dosage of 13.5mg; a reduction rate of 0.05mg each day would reduce by another 1.5mg, or 11% over 30 days. The next month starts with 12.15mg: a month of daily 0.05mg reductions to 10.94mg would be 12.34%. And so forth, with the rate of taper getting larger.

 

We have seen these linear tapers get people into trouble, as their nervous systems have to accommodate to ever-increasing gaps in dosage.

 

Another complication is that mirtazapine has a long half-life, so you might be in the 3rd or 4th month of your taper before withdrawal symptoms catch up to you. On the other hand, the long half-life of this particular drug might work in favor of allowing your nervous system to adapt to a fairly gentle downward dosage slope. We cannot predict what your nervous system will tolerate, but

 

However, unfortunately your recent prior withdrawal symptoms increases the likelihood you may run into difficulty with this method, as your nervous system may still be a bruised by the experience.

 

On 7/26/2021 at 8:27 AM, SueAd said:

I tried to get off the mirtazapine at 6 weeks by cutting it on half to 7.5mg.  10 days later I become severely depressed, anxious, nauseous, crippled with doom and had severe body aches. I reinstated back to 15mg immediately. Symptoms started to disappear one by one shortly after, but it took me around 6-8 weeks to stabilise. 

 

You might try your micro taper method for the first month and see how your system responds to it. If you progressively have more difficulty after that -- rebound insomnia is a common sign of mirtazapine withdrawal -- you know that particular micro taper method isn't going to work for you.

 

It's up to you to decide whether you want to try this. Please let us know how you're doing.

 

But before you do anything, to help us out, follow these instructions Please summarize your drug and withdrawal history in your signature You may need to use a computer to do this.

[SueAd]

Hi, I didn’t end up starting a taper and stayed on 15mg for a year now. I had my baby 5 months ago and just this week, Everytime I take the mirtazapine I get a whole body restlessness and difficulty sleeping and heart starts racing. Previously I had no side effects at all from the mirtazapine. Can you tell me what this probably means? Is my dose too high or too low for my body now? Should I start a taper or wait ? I’m scared this is serotonin syndrome or akathisia. Please help. 

[SueAd]

Hi, I didn’t end up starting a taper and stayed on 15mg for a year now. I had my baby 5 months ago and just this week, Everytime I take the mirtazapine I get a whole body restlessness and difficulty sleeping and heart starts racing. I’m always being hit with panic feelings. Previously I had no side effects at all from the mirtazapine. Can you tell me what this probably means? Is my dose too high or too low for my body now? Should I start a taper or wait ? I’m scared this is serotonin syndrome or akathisia. Please help. I don’t take any other medication and have never taken any other medication except 15mg mirtazapine starting in January 2021 for postpartum depression “apparently”. 

[Shep]

SueAd, did anything else change? Are you taking any supplements? Has your diet, stress level, routine, etc changed? Have you had any alcohol or caffeine? Any recent illnesses or dental work? 

[SueAd]

Hi, no nothing has changed except that I had a baby 5 months ago. 

[Shep]

It could be shifts in hormones.

 

You mentioned serotonin syndrome earlier, but I don't think you'd get that at only 15 mg mirtazapine. Serotonin syndrome usually involves a high dose of a serotonin drug or two or more serotonin-increasing drugs used together. 

 

It's possible you may have hit what's called "poopout" (tachyphylaxis), which is when you've reached tolerance. Brassmonkey wrote a good explanation of that here - Tachyphylaxis, Reaching Tolerance  or as It's Lovingly Known "Poop-Out"

 

But at 5 months after having a baby, if it's the shift in hormones, you may want to touch base with your doctor (just be careful of doctors wielding psychiatric drugs as a "cure" for postpartum issues). 

 

[Lauren90]

How are you doing now @SueAd?