Jools44: badly managed reinstatement of mirtazapine

[Jools44]

@Malbec37 thanks so much for stopping by with some reassuring words.

life is a bit all over the place for me at the moment. I don’t trust my thoughts or my reactions anymore and I’m always second guessing myself. It’s exhausting! I haven’t really tapered by much so I don’t really understand what’s going on now but I suspect my lady hormones are playing a role which isn’t helping. So hard to know what to do for the best, just feel lost in the wilderness of it all. 
How are you doing these days? Did you opt to go with the liquid mirt in the end or stick with the tablets? I’m still seating making my own liquid up from tablets as I’m not sure the liquid mirt is stable enough for my taper.
I hope you’re doing okay either way and yes nature and good food are essential in this journey.

thanks again for stopping by 🤗

[Malbec37]

Hi @Jools44I totally understand I really do, I'm also totally sick of this journey. It does sound like you know what might be affecting you and it is hard to know what is WD, what is not, what is something else...it's not clear at all, it can be a wilderness as you say. I'm sorry you're experiencing the suicidal thoughts, not pleasant at all, but know they do pass and that better days are coming your way.

 

I've actually had a nightmare 8 weeks and have reinstated about 7 weeks ago back up to 15 from 9mg as it all got too much for me and I had a breakdown and lost my mind for quite some time and had a severe bout of anxiety and depression. It's been very tough indeed but I am starting to get a bit better and I'm back at work. I'm not clear exactly what caused it...probably the WD catching up with me and also I am vulnerable to anxiety and depression...bit of both really. It's been. living hell....No matter I'm back at 15mg and no idea how, if, when I will try again but it doesn't matter currently I just want to live my life a little bit and feel ok!

[Jools44]

@Malbec37 so sorry to hear you’ve had such a rough time but glad to hear you’re doing better now. It’s the not knowing when it’s going to end that causes the most worry I think. If someone could give us a time and a date and say you’ll be better by this time it would be so much easier and we might persevere, but the not knowing is hard.

I think it will take me several years to get off this stuff, if I can do it at all,so I’m in it for the long haul now whether  I like it or not.

 

I hope you get to Enjoy a bit of peace now. It took me a while to get back to anything near normal when I last crashed but day by day it got easier, even if it isn’t linear, but it doesn’t half take it out of you doesn’t it!

 

Take good care and enjoy the sunshine when it comes x

[Jools44]

@Altostrata this new symptom of severe anhedonia has come out of nowhere. I haven't made any major reductions to my dose and apart from the tinnitus which has gone up a notch in the last few weeks, I've no other major symptoms flaring currently. Sleep is still off but getting about 4-5 hours a night. Is it possible this feeling of nothingness (I literally feel no emotions, negative or positive which is a first for me) is a new wave and will likely pass? I realise ADs can have this effect but mirtazepine has never caused me to have blunted emotions. I suspect I'm perimenopausal and I've started having hot flashes but the degree of nothingness I'm experiencing is I think too extreme to just be that.

I realise there's no definitive answer but from your experience could this new symptom be another wave and a sign I'm still healing from the **** show in September? 

TIA

[Altostrata]

13 hours ago, Jools44 said:

this feeling of nothingness (I literally feel no emotions, negative or positive which is a first for me) is a new wave and will likely pass?

 

Emotional anesthesia can be an adverse effect of psychiatric drugs that may persist after going off and it can be a withdrawal symptom. Quite a few members suffer from it. It should very gradually fade once you're off the drugs.

 

See 

 

[Jools44]

@Altostratathanks for your reply. 

If its an adverse reaction then should I taper faster than originally planned? I was going to go super slow and aim for 5% reductions per month so that I can maintain a half decent standard of life. But that will take me 4 or more years, which I'm okay with because I want to succeed and not mess things up this time, but if being exposed to this drug is causing emotional flat lining then the last thing  I want is to stay on it any longer than necessary. 

 

I can cry, that's one emotion that sticks with me and I think perimenopause is compounding things. 

 

 

 

[Jools44]

@Altostrata in addition to the above (sorry for all the questions) I feel very odd in the head most days at the moment, but I often feel "better" in the mid afternoon. This has been a common theme through the last several months. Is there an explanation for this? Is it because the drug is starting to wear off or is that too a simplistic answer? 

[Altostrata]

What was your last reduction, and what were your withdrawal symptoms after that reduction? How long did they last?

[Jools44]

@Altostrata my last reduction was 1st April down to 19.5mg from 20.25mg. In the following weeks I suffered with poor sleep (averaging 3-4 hours a night l) varying degrees of tinnitus/hyperacusis , extremely dry mouth (this has now improved), neuroemotions, and what I describe as "bad head days" which essentially relate to brain fog and cognitive slowness and just generally feeling fairly rotten. All these days are interspersed with better days where the tinnitus is quieter and head is much clearer. On the whole though these symptoms are still very much with me.

In the last 2-3 weeks the emotional numbness set in. Stress has been a factor: I moved to a new country for 3 months and was attending a language course, not  great timing but the world keeps turning and I'm trying to turn with it.

I also find that changing to a new bottle of the mirtazepine causes me issues. I'm going to start storing it in the fridge to see if that helps. 

My periods have become irregular and I've had issues with BV and thrush so I do think perimenopause is a factor (I'm 47). I'm suffering hot flushes but unsure if that PM or this drug, both have the potential to be culprits. 

The emotional numbness is pretty awful the only bright side is there's no anxiety! But I'd rather feel something rather than nothing. Fatigue has also really set it. 

I try and avoid high histamine foods, no alcohol and still no caffeine. 

I guess I my brain may still be trying to find equilibrium but I'm still in favour of a slow 5% drop every 4-6 weeks.

[Altostrata]

It's possible the emotional anesthesia might be from your history of drug changes and a combination of other stresses. From what I've seen, it's unlikely that going off mirtazapine faster and having withdrawal symptoms from that will resolve emotional anesthesia.

[Jools44]

@Altostrata is 4 years a realistic time frame to come off this drug? I've been on it for 10 years and have failed twice to come off. The first time I tried jumping of at 3. 75mg when it suddenly stopped working. I thought it was a small dose so wouldn't be a huge problem but I didn't sleep for 6 weeks and ended up getting quite sick and going back on at a much higher dose. The second was what I thought was a slow taper only to end up suffering incapacitating withdrawals at 7.5mg which is when I updosed dramatically and then reduced by 33% which is when the rot really set in. 

My question is is 4 years too long to taper as its such a debilitating process and I'm still not feeling that great now? Am I just prolonging the agony going so slow? 

 

[Altostrata]

It's not unrealistic to assume it will take as long as it takes! Could be less than 4 years.

 

Dry mouth is an adverse effect of mirtazapine.

 

What times o'clock do you take each of your drugs, with their dosages? Are there times of day you feel better or worse?

[Jools44]

@Altostrata I want to stay as functional as possible for as long as possible (as does everybody going through this) my concern is that I'm already pretty knackered by the process and not able to hold down any kind of demanding job. Another 4 years of this feels not entirely doable but the alternative is a faster taper and guaranteed nasty withdrawals. Rock and a hard place I guess. 

 

I always feel worse in the mornings, more emotional liability, less motivation and then by the evening I'm usually feeling a bit brighter and a bit more "with it". 

 

The tinnitus, hyperacusis and terrible brain fog vary from day to day rather than hour to hour. 

 

I take the mirtazepine every night about 10.30pm. I don't feel any different directly after taking it (at one point I was having adrenaline surges and strange sensations but that seems to have stopped now). I'm still having Windows and waves, but I'm not sure if that's from the fact I've restarted the taper albeit very slowly or if it's still repairs going on from the Autumn debacle. 

 

I am accessing therapy now as I appreciate the importance of mindset in all of this. I err on the negative side, which is easy to do with this process, but having as positive a mindset as possible is clearly integral to getting through it so I need to change bad thought habits. 

 

The dry mouth has settled a bit of late. Maybe that's my system stabilising or maybe it's the slight drop in dose 🤷‍♀️

 

Thanks for your help. 

 

[Mirtazapine20mg]

3 hours ago, Jools44 said:

bit brighter and a bit more "with it". 

Hi Jools, I am surfing Mirt-buddies and mirt-withdrawal-symptoms pretty often and I have read a few of your posts, and I like to read them, because I have been on mirtazapine longer than most mirt-SA-members and so have you. And I have some of the same symptoms as you. I often find it difficult to understand the words used on SA. For example everybody but me seems to know what 'brain fog' is. Your descriptions of other symptoms seems so precise, so maybe it is okay if I ask you. I am certainly experiencing different cognitive difficulties, but when I think of a foggy day and what is going on in my head it is not the same. But the two small words "with it" makes a lot more sense to me. If brain fog is not being "with it" then I also have brain fog. "With it" for me feels like a fatigued numbness is reduced and a little bit of drive returns: I don't just force myself to do things but also feel a desire or necessity to do things. I am also a somewhat more "with it" at night. The "with it" feeling is how I hope I will feel all through the day when all this is over even though the "with it"-feeling is nothing extraordinary - you are just "with it" again. Now I have written "with it" a lot 😅. Last example: You are surfing pictures of your favorite things on the internet - cats for example. Going from not being with it to being "with it" feels sort of when you click on a picture and the full resolution version has downloaded in background and the picture tightens up and becomes clear (how I hate I have to resort to IT metaphors. I like the term "brain fog" a lot more even though I have trouble understanding it). So my to sum up my question: Is brain fog sort of the same as a low resolution consciousness in what appears to be a low resolution reality?

[Jools44]

@Mirtazapine20mg Hi 👋 when I first started tapering mirtazepine (before it all went wrong last autumn) my main withdrawal symptoms were restlessness, anxiety, unable to concentrate and a gradual reduction in the quality of my sleep. All these things should have been a warning that I was tapering too fast, but I failed to put 2 and 2 together unfortunately!

 

The brain fog for me is best described as everything around me is happening too fast and my brain is always a good few seconds behind and is constantly trying to catch up. Basically I feel like a dunce most of the time. I struggle to follow conversations, I am always the last to get a joke and often misinterpret things people are saying simply because my brain can't work fast enough. I don't know if that helps at all? 

 

The best piece of advice I can offer is to taper very cautiously. Don't do what I did and overlook symptoms or notice them and think I could just push on through. As that ended very badly for me. A slow taper is so frustrating but I do so wish I had done it differently. 

 

Having said that we're all different and react differently. I also had some major life stressor at the time which didn't help. 

 

How are you finding your taper so far? 

 

 

[Mirtazapine20mg]

Hi @Jools44 and 👋 and your writing is not the least dunce-like. I can see from your signature that we are somewhere in the same mirtazapine range at the moment (20-ish mg zone) and I am hoping every day that this is worst tapering zone, because I think it is hard at the moment. I miss a clear mind. Most days I feel like a lazy turtle. Slow and without initiative. And INDECISIVE (I so utterly hate that). If I by nature and without mirtazapine was more turtle-like maybe this would not be so hard. One good thing is happening though: The more I taper the more more I hate my current situation and that is a sign of life I think. My sleep is not god. 5 hours this night according to Apple. But that is not the worst: I am pretty sure that my sleep quality sucks, that is when I sleep 5 hours it is 5 hours of low quality sleep. Sometimes I feel like renting a cabin somewhere remote and just CT the hell out of mirtazapine - just be done with it. Have tried GPs half, half, then stop. I got to ha..., so I am not going to rent a cabin. But I am still looking for the magic bullet. If you find it, please let me know. 

 

Another thing I am feeling quit strongly now that I am tapering, is how sedated I have been on the full dose of mirtazapine (30 mg in my case) without really feeling it. That also is a sign of life, but also a cause for both gratitude and anger. Do you also have this "F me, what have been thinking"-feeling? Another thing I am experiencing is that my memories is apparently mirtazapine-state-dependent, that is memories I had on full-dose-mirtazapine is slowly fading and memories from before mirtazapine is becoming clearer. Do you have that? Thank you for writing back :-). 

 

 

[Jools44]

@Mirtazapine20mg  No problem at all, it's good to share experiences in the hope we can learn from one another 🙂 . Although, I'm afraid to say, that in my experience the lower the dose gets the harder it becomes. This is mainly due to receptor occupancy, which even at very low doses of these drugs is extremely high. A paper on citalopram for instance shows receptor occupancy of 60% at just 5mg, and the receptor occupancy drops off remarkably quickly as the dose is lowered. This = more withdrawals. The recommendation is that you actually need to make smaller cuts as you  lower the dose and I would definitely follow that.

 

The main thing is to listen to what your brain and your body are telling you. Withdrawal symptoms are a sign of CNS destabilisation so it's best to wait until they subside before continuing with your taper. Some people leave long holds, others reduce the amount they taper each time. See it more of a marathon than a sprint...and a marathon or unknown duration or distance, just let your brain dictate the journey. Those are my nuggets of wisdom for what they're worth! 😉

 

Are you familiar with Mark Horowitz's work? He's a psychiatrist in training and also someone currently withdrawing from psych drugs (including mirtazepine). Also it's worth checking out Medicating normal page on FB or you tube, loads of really useful stuff on there. Mark talks about how his intellect returned as he lowered the dose and his thinking was clearer so  you're not alone there. It's all a bit of a blur to me now after crashing in the Autumn.

 

The worst side effect for me was loss of concentration and short term memory. I absolutely hate that aspect of this drug and it worries me about the long term effects. I feel very guilty for putting this stuff in me  but i just didn't know any better at the time!!!

[Mirtazapine20mg]

I know Horowitz, and I think he is brilliant. He has given me so much hope. I didn't know that he was tapering mirtazapine though. Now I like him a even more 🙂. You shouldn't feel guilty at all. When we first said yes to this drug we were severely sleep deprived. I am slowly converting guilt to what I would call productive, cool anger: It is evil, it has to stop, and when I have my brain back I am going to do my part in a polite yet unmistakenly manner. I hope. 

 

I also fear that the end game is going to be even harder than it is now, but I am hopeful. On the plus side I think we will get more proficient in handling withdrawal symptoms as the tapering proces drags on. My impression is, reading posts from the members who done careful taper, that the end game is not worse. Maybe my hopeful eyes are seeking out positive information. 

[Jools44]

@Mirtazapine20mg oh I hope you're right and I'm wrong. I was tapering too rapidly and had a lot going on when I crashed so perhaps my experience isn't a fair reflection of getting to the lower doses. Maybe I need to think more positively!

 

Mark is a hero. Thank god for people like him who are willing to share their story as honestly as he has. That can't be easy with all the denial that goes on in psychiatry. 

 

Are you doing a low histamine diet? 

[Altostrata]

On 6/6/2022 at 2:28 AM, Jools44 said:

The dry mouth has settled a bit of late. Maybe that's my system stabilising or maybe it's the slight drop in dose 🤷‍♀️

 

@Jools44 you may be having mirtazapine hangover, which clears up later in the the day. You might consider making another reduction when you feel confident about it.

[Mirtazapine20mg]

God evening Jools, I'm slowly half a..ed converting to a low histamine diet. One of the positive things in my life is that live at harbour, so the meat I eat in the fishing season is pretty much fresh fish caught the same day. Before mirtazapine I was allergic to pollen and fear how that allergy os going to behave when mirtazapine is gone. One of the big problems with mirtazapine and me has been carb cravings. But as I taper they are slowly getting easier to handle (one more positive thing) and I am loosing weight which I also like a lot. I saw in your signature that you are on a low histamine diet. Tell me about good things, so I can get my act together :-). 

[Jools44]

@Mirtazapine20mg I struggle with the low histamine but I concentrate on cutting out the biggies like tomatoes, strawberries and avocado along with alcohol and sea food of course.

 

I'm not entirely sure it makes any difference though, it's so hard to tell with the window and waves effect. 

 

The need to eat on MIRT 😩😩😩😩 since reinstating though I haven't had the weight gain or the appetite drive which is a sign the drug isn't working the same way for me anymore. Unfortunately that means my sleep is badly effected, that was the only thing I really liked about the drug!

[Mirtazapine20mg]

Btw, I see Altostrate in your thread a lot, and I saw her in a YouTube video I think with Horowitz, and that was one of my reasons for becoming a member of SA. They both have a "lets be empirical about this"-attitude I like a lot. 

[Mirtazapine20mg]

Same sleep problem here. And same tomatoes, fermented things anti-histamine-ish diet 😂 and I also miss the regular sleep. I have a lot of morning dread/anxiety, and that is the worst. I hate it. 

[Mirtazapine20mg]

Hey Jools btw, I am feel good the first two-three days after a cut, but then... full force WD. Do you also have this little window?

 

[Jools44]

@Mirtazapine20mg yes Altostrata  et al, all bloody heros!

 

Yes it takes about 4 days for a reduction to show up as withdrawals, I think that's about right for mirtazepine as it has a longish half life. 

 

Weirdly a lot of people report feeling better immediately after a cut but its just the calm before the storm unfortunately!

[Mirtazapine20mg]

Yes, what is that all about? I hope it is window into the post-withdrawal self. I going to bed and as a mirt-buddy my biggest wish for you of course is: Sleep tight.

[Jools44]

@Mirtazapine20mg yes here's hoping 🤞 and you too! 

[Jools44]

@Altostrata @ChessieCat

 

I was wondering if anybody knew how the Mirtazpeine liquid that I am prescribed here in the UK from Rosemout Pharm is manufactured. 

 

Do these company's manufacture mirtazepine themselves or do they simply buy Mirtazepine  tablets from a manufacturer and then convert to the liquid? 

 

If it's the latter do they have one supplier so that the brand of drug they use is consistent or do they "shop around" for the most cost effective? 

 

Almost every time I open a new bottle I suffer withdrawals unless I slowly taper from one bottle to the next. This makes me question the consistency of dosing I'm getting and whether I'd be better making my own liquid from the tablets from the same brand. 

 

I have managed to reduce from 22.5mg to 17.3mg in the last 6 months but I am experiencing problems after gradually improving in that time. My reductions have  been 5% every 4 weeks. 

 

This may just be a wave, but there is a pattern with the new bottle of liquid. 

 

I am awaiting a reply from the company but wondered if anybody else had queried this here and found an answer? 

 

TIA

[Altostrata]

You might contact Rosemont and add the answers to our Tips for Tapering Mirtazapine topic.

 

On 4/10/2012 at 5:07 PM, Altostrata said:

Reduce by titrating a liquid

A liquid is easier to measure in order to taper by small amounts using an oral syringe.  Unfortunately, mirtazapine liquid is not widely available. In the UK, mirtazapine liquid is available from Rosemont Pharmaceuticals in Leeds. Ingredients of the liquid are here: https://www.medicines.org.uk/emc/medicine/31587. Shelf-life after being opened is 6 weeks. Ordering information is here.

 

 

 

[Jools44]

@Faure I would very much like so guidance on weighing meds for withdrawal. I’m currently using the liquid preparation that we can get in the UK but I swear I get destabilised with every new bottle that I open, so I would like to try another method.

 

I’m looking at making a liquid prep too, but quite like the idea of making a fresh dose every day.

 

I’ve never fully recovered from a CT-like cut I made back in the autumn, although I am functional and would like to stay that way!

 

Many thanks

 

jules

[Shep]

2 minutes ago, Jools44 said:

@Faure I would very much like so guidance on weighing meds for withdrawal. I’m currently using the liquid preparation that we can get in the UK but I swear I get destabilised with every new bottle that I open, so I would like to try another method.

 

 

@JulesPlease post questions about weighing meds in your own intro thread or in the Using a Scale thread. Let's please leave this thread for Alex to ask questions. 

[Faure]

Hi, you asked about tapering methods in Alex3’s thread. Here is the advice I received from Gridley when I was starting:

 

“It is better to make powder from your tablets than to cut slivers.  There is no way to tell the standards that the manufacturer of your brand uses to make sure the active ingredient is evenly distributed throughout the pill.  If you cut into slivers, there may be more or less active ingredient in your sliver than in slivers from other parts of the tablet, putting you at risk of taking inconsistent doses.  If you grind into powder and stir thoroughly with a toothpick (or a powder measuring spoon, available on Amazon), that will ensure that the active ingredient is evenly distributed throughout the powder and thus in each dose.  

 

Either with tweezers or a powder measuring spoon, you can add or subtract powder from the scale to get the correct weight for your dose.  Then, using the tweezers or measuring spoon, transfer the powder to a size 0 gelatin capsule to make your dose.   Keep the rest of the powder in another gelatin capsule for future doses.  Pour the powder into the capsule with a bent 3" Post-it or, as I did, with LabExact 3" weighing paper, also available on Amazon.

Edited June 8 by Gridley"

 

You stir the powder with a toothpick and use all the bits, including the yellow outside parts of the pill.”

 

I also always calibrate the scales each time I use them. I make up a weeks supply of tablets in one go so I know they all weigh exactly the same (hopefully - accuracy of scales depending!)

 

I bought this pill grinder and these scales. 
 

Let me know if you’ve any more questions although I’m afraid I can’t help with liquid as I’m not there yet ☺️

[Faure]

BTW, just seen you asking about brands - if you get pills you may well find brands vary from prescription to prescription. I wised up to this issue very quickly and was able to order ahead when they had the brand that works well for me. I’m hoping that with the taper meaning I’m always using less and less each time I’ll be able to get to around 2mg on the current supply (although I think I’ll be lucky to!) when I’ll switch to a liquid I’ll probably make myself.  Again I’ll try to order ahead so I’ve a steady supply of the same brand. 

[Jools44]

@Faure thanks very much for that info, that's exactly what I was looking for. 

 

I think all my issues stemmed from being given different manufacturers brands of mirtazepine, so I too will always get the same brand where possible.

 

I'm currently using a prescription liquid mirt but I'm still convinced there is variability between the batches and I'd much rather have as much control over this as possible. 

 

Thanks again and I hope your taper continues to go well ☺️ 

 

 

[Jools44]

On 8/28/2022 at 8:00 PM, Altostrata said:

You might contact Rosemont and add the answers to our Tips for Tapering Mirtazapine topic.

 

 

 

 

@Altostrata this was the response I got from Rosemont about the source of their mirtazepine. 

 

My question to them was did they always use the same manufacturer for their Mirtazepine liquid prep? I don't think this really answered my question.... 

 

"We buy in Mirtazapine API as a powdered raw material. We only buy from approved suppliers and Manufacturer’s, so this cannot change.

In essence it is always from the same source. I hope this information is helpful." 

 

Stating they always use approved manufacturers and suppliers (which I'd expect them to anyway!) doesn't tell me if it's the same manufacturer for each batch of the liquid. 

 

I don't think this would be helpful to add to SA (although I'd be happy to if you'd like me to). I have sent a follow up email to ask for further clarification on whether it's always the same manufacturer, but whether I'll get a reply this time I don't know.