Chas13: Mirtazapine discontinuation

[Chas13]

I was put on Mirtazapine 30mg 18 months ago along with duloxetine 60mg. I only was able to realize about two or three months ago that the Mirtazapine was causing me to experience chronic diarrhea, daytime agitation, anxiety and random feelings of dread and doom. It was on the other hand a calming influence when I took it at bedtime. It seemed its affinity for histamine was most prominent at night but by morning the most prominent property was its affinity for noradrenagenic receptors. This put me in a no win circle, I would take it in the evening to relieve me of its daytime effects! I did not initially know this was happening as I was titrating off of clonazapam for the first several months I was taking it, and assumed my symptoms were all from withdrawal. I then thought it might be the duloxetine being too activating, and I asked to switch to Paroxetine 40 mg. After the initial side effect period the Paroxetine had a calming influence and I felt great. But after several weeks the old symptoms of agitation, anxiety and random feelings of dread and doom returned. I then realized it must be the Mirtazapine so I cut back gradually first to 22.5mg for a couple of weeks, then to 15mg for a couple of weeks, and then to 7.5 mg per week. I noticed that at the lowest level the dread, and the agitation was much less. Five days ago I stopped taking the Mirtazapine. It was only then that I noticed withdrawal side effects, namely nausea, diarrhea, agitation, anxiety but no insomnia. I have been taking quetiapine 50mg slow release as needed to deal with the withdrawal. I will post in a few more days. I am determined to stay off of Mirtazapine, and to be only on Paroxetine 10 mg. 

[Shep]

Hi, Chas13. 

 

Welcome to Surviving Antidepressants.

 

It looks like you've had quite a ride with psychiatric drugs. I'm glad you connected your symptoms to withdrawal and found this website. 

 

Here is some information on withdrawal to get you started: 

 

Why taper by 10% of my dosage?

 

Tips for tapering off mirtazapine (Remeron)

 

How psychiatric drugs remodel your brain

 

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

 

The Windows and Waves Pattern of Stabilization

 

I suspect you may benefit from a reinstatement of a tiny amount of the Mirtazapine, especially with such a recent and rapid taper. But before advising anything specific, it will be good to have a timeline of all of your drugs and the changes. 

 

Please read through at least the first post in this thread: 

 

About reinstating and stabilizing to reduce withdrawal symptoms

 

Please add a signature.  Include drugs, doses, dates, and discontinuations & reinstatements in the last 12-24 months. Also include supplements. This will help us give you the most accurate advice we can. 

• Any drugs and supplements prior to 24 months ago can just be listed with start and stop years. 
• Please use actual dates or approximate dates (mid-June, Late October) rather than relative time frames (last week, 3 months ago) 
• Spell out months, e.g. "October" or "Oct."; 9/1/2016 can be interpreted as Jan. 9, 2016 or Sept. 1, 2016. 
• Please leave out symptoms and diagnoses. 
• A list is easier to understand than one or multiple paragraphs. 
• This is a direct link to your signature:  Account Settings – Create or Edit a signature.

More information (and an example of a signature) is here - How to List Drug History in Signature

 

As you provide more information, we can better guide you in setting up your taper. 

 

 

[Chas13]

Thank you Shep for the links and your kind words. I know it is best to taper gradually by decreases of 10 percent but unfortunately the Mirtazapine was causing me to feel horrible waves of dread and doom. In other words I had to come off toute de suite or self-medicate with alcohol. It is now August 14 and day 8 of zero Mirtazapine. I am still experiencing nausea, particularly when I first wake up in the morning, and anxiety. But it is manageable and there are periods of feeling good. I am determined to stick the course no matter how long it takes. I will post again in a few days.

[Chas13]

Well, I should have listened better to the advice to taper slowly. After thirteen days of nausea and anxiety I had to start taking the Mirtazapine again. I am now on 7.5 mg and holding for a while! I made a mistake in my last post I am on 20 mg of Paroxetine.

Edited August 28, 2021 by Chas13
Addition

[Shep]

Are you still taking quetiapine (mentioned in your first post)? Please note we need a complete drug history before we can offer advice. Please add a signature.  Include drugs, doses, dates, and discontinuations & reinstatements in the last 12-24 months. Also include supplements. This will help us give you the most accurate advice we can. 

• Any drugs and supplements prior to 24 months ago can just be listed with start and stop years. 
• Please use actual dates or approximate dates (mid-June, Late October) rather than relative time frames (last week, 3 months ago) 
• Spell out months, e.g. "October" or "Oct."; 9/1/2016 can be interpreted as Jan. 9, 2016 or Sept. 1, 2016. 
• Please leave out symptoms and diagnoses. 
• A list is easier to understand than one or multiple paragraphs. 
• This is a direct link to your signature:  Account Settings – Create or Edit a signature.

More information (and an example of a signature) is here - How to List Drug History in Signature

 

[Chas13]

I had to stop quetiapine 75 mg per day on Aug 22 after taking it for two weeks as it was making me feel worse, nausea on it and nausea coming off it for the following four days. To be honest I was not sure by the end what drug was having what side effect. I needed to simplify the situation, and I am now on Paroxetine 20 mg and Mirtazapine 7.5 mg. I am not taking any supplements. 

[Shep]

Please note there is a major drug interaction between mirtazapine and mirtazapine:

 

Drug Interaction Report

 

Quote

Interactions between your drugs

Major

Paroxetine  mirtazapine

Applies to: Paxil (paroxetine), mirtazapine

Using PARoxetine together with mirtazapine can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should seek immediate medical attention if you experience these symptoms while taking the medications. Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

 

 

Are you still taking clonazapam (mentioned in your first post)? Once you add a signature, we can give you advice. It's unclear when you were on what and for how long. 

 

Please add a signature.  Include drugs, doses, dates, and discontinuations & reinstatements in the last 12-24 months. Also include supplements. This will help us give you the most accurate advice we can. 

• Any drugs and supplements prior to 24 months ago can just be listed with start and stop years. 
• Please use actual dates or approximate dates (mid-June, Late October) rather than relative time frames (last week, 3 months ago) 
• Spell out months, e.g. "October" or "Oct."; 9/1/2016 can be interpreted as Jan. 9, 2016 or Sept. 1, 2016. 
• Please leave out symptoms and diagnoses. 
• A list is easier to understand than one or multiple paragraphs. 
• This is a direct link to your signature:  Account Settings – Create or Edit a signature.

More information (and an example of a signature) is here - How to List Drug History in Signature

 

[Shep]

@Chas13If you're still struggling with your signature, please write your drug history in a post here in your intro thread and I can add it to your signature for you.

 

This is an example of what we need. Please be very specific with your drug history for the first couple of years - list the drug name and dose and the month you started and stopped, if you have that information. Any drugs prior to 24 months ago can just be listed with start and stop years. 

 

Example

2001–2002 paroxetine 
2003  citalopram 
2004  paroxetine
2008  paroxetine slow taper down to 2016 Aug off paroxetine
2016  citalopram May 20mg  Oct slow taper down
2021  citalopram 13 Feb 4.6mg 15 Mar 4.4mg 29 Apr 4.2mg