Tania: 45mg mirtazapine tapering

[Tania]

Hi, I'm not quite sure how to go about this as I'm not super familiar with forums. But I've been on Mirtarzapine 45mg for a couple of years now, I started taking it 5 years ago as a result of a breakdown and have been slowly increasing it. Now I feel a bit more stable in my life and 1 week ago started doing 45mg x 2 nights and 41.25mg approx (I have to cut my tablet so it's never 100% accurate) for 1 night in an alternate fashion. I've noticed I've become more anxious and started experiencing panic feelings...I don't want to give up though. I'm determined to go down to 30mg and stay on it for a while till the next drop. I'm very very afraid though. I'm a single mum with a 5 year old child so I don't want this to affect my relationship with my daughter. Any words of wisdom or support, identification, etc, would be massively appreciated. 

[Tania]

Tapering and 5HTP

 

Quick question, I'm on the max dose of Mirtarzapine, and started tapering recently. Does anyone take things like 5HTP while tapering? And if yes, when would you safely introduce it?

 

[getofflex]

Hello, and welcome to SA.  We are a volunteer-run community of people who have been or are getting off of psychiatric drugs.  I'm glad you found us - you have come to the right place.  

 

First of all, we never recommend varying or skipping doses to taper.  It is important to take the very same dose each and every day, at the same time.  Our nervous systems need the stability of the same amount of the drug each day.  

 

Can you please give us specific information about your drug history for all drugs you are on and have been on, especially for the past 18-24 months?  It would be especially helpful to have the details of your drugs in a concise vertical list (no symptoms), only drug names, specific dates (as best you can say for example early March if you don't recall the day) and dosages of each medication decrease or increase.  Use this format:

 

Drug name: date, dose, date, dose, date, dose…

Drug name: date, dose, date, dose, date, dose…

Etcetera

 

Please read the link below for instructions.  This will allow us to give you the best guidance.  

 

How to List Drug History in Signature

 

Here is some information about how these drugs actually work.   This explains why we get symptoms from going off of these medications, and why it's so important to taper slowly and carefully, and be very cautious about changing our doses: 

 

How Psychiatric Drugs Remodel Your Brain

 

 

This helps you understand what withdrawal syndrome is: 

 

Video on Recovery from Psych Drugs

 

What is Happening in Your Brain

 

Windows and Waves Pattern of Stabilization

 

Before you do any more tapering, I would stick to the 41.25 mg dose each day for a few weeks to few months to allow your nervous system to stabilize.  Then, once the symptoms are minimal to gone, I would do another small reduction. This is especially important to protect your nervous system, since you are the mother of a small child.  If you panic and anxiety is significant, then I would suggest going back up to your original dose, and staying there for a while, until you stabilize, then attempting your taper when you feel better.  

 

Tapering is best done extremely slowly, and we generally taper by 10% of the current dose no more than once every 4 weeks, so that the taper becomes exponentially smaller.

 

 Why Taper by 10% of my Dosage  

 

Tips for Tapering Mirtazapine

 

 

Also, as we are recovering, we suggest keeping things slow, simple, and stable. 

 

Keep it Simple, Slow, and Stable

 

Here is a link with checklists of common WD symptoms: 

 

Dr Joseph Glenmullen Withdrawal Symptom Checklists

 

 

Here are some techniques to cope with symptoms: 

 

Non Drug Ways to Cope with Withdrawal Symptoms

 

 

We don't suggest many supplements, but 2 that many of us find helpful are magnesium and omega-3 fish oil. Here are the links for info about those. It is suggested to add one at a time, and start with a low dose to see how it affects you. 

Magnesium

 

Omega 3 Fish Oil

 

 

I've given you quite a bit of information here.  Please read through it, and mull it over, and we will take it from there. In the meantime, take care of yourself, and take heart.  We in this forum have been through this, and we understand first hand the pain and discomfort you are going through.  Please know that the brain is amazing in it's healing abilities.  It takes time, but healing can and will happen. 

[Tania]

Thank you so much for your thorough response...I will read through all the material you have suggested. I've cried a lot since reading some of this stuff, as I'm so afraid. Here is my list: 

 

2016 Mirtarzapine 30mg
2019 Mirtarzapine 45mg 
11 December 2021  Mitarzapine 41.25mg x 1 day, 45mg x 2 days (in alternate fashion) 

[Tania]

Hi, just a quick one, re: fish oil supplement, is this ok: 660mg EPA & 440mg DHA? 

I'm asking as there is slightly less DHA...

Thank you 

[getofflex]

 

6 hours ago, Tania said:

I've cried a lot since reading some of this stuff, as I'm so afraid

Tania, I'm sorry you are going through this.  Withdrawal from psych drugs is a scary thing.  The symptoms can be bizarre, and they are very uncomfortable and even painful.  I understand, because I've been there too.  Please know that many other people have been and are going through what you are going through now, and have recovered.  I feel much better now, than I did in early WD.  Try reading some of the success stories, it will reassure and comfort you, and give you hope: 

 

Success Stories

 

I don't think there is a precise dosing for the components of fish oil.  What we suggest is to start at a low dose and see how it affects you.  If you feel OK, then go up to a higher dose, etc.  Fish oil is not a drug, so taking a lot will do no harm to most people.  The fish oil I take has 324 EPA and 216 DHA, so I suppose it is normal for the DHA to be lower than the EPA.  I also take a flax seed oil capsule.  

 

I copied your drug history in your signature box, so that it appears with each of your posts for easy reference by the staff.  

 

Edited December 23, 2021 by getofflex

[Tania]

Thank you again. Just one quick question again, why would you not recommend doing the alternate 45mg and 41mg Mirtarzapine? I thought it would balance itself out...is there anything I can read on this? 

[Tania]

Alternate dosing tapering Remeron

 

Hi, I'm new here. I've started tapering from Mirtarzapine (Remeron) 10 days ago, one of the moderators here helpfully suggested taking the same dose instead of alternating, which I totally get, but what happens if I find that 41.25mg is too much of a drop for me? I cannot cut the tablet any smaller than what I'm doing. Is there anything I can read on why it's best not to alternate doses? Thank you.

 

Edited December 23, 2021 by ChessieCat
added Intro topic title before merging with intro topic

[ChessieCat]

Hi Tania,

 

I moved you new Intro topic and merged it with your original Introduction topic.  Each member has only ONE Introduction topic.  Please do not create a new one.  Your own Introduction topic is the best place to ask questions specific to your situation and where you can journal your progress.  This keeps your history in one place and means you do not have to repeat your story.

 

1 hour ago, Tania said:

Is there anything I can read on why it's best not to alternate doses?

 

Please read Post #1 of this topic:  never-skip-doses-to-taper

 

1 hour ago, Tania said:

what happens if I find that 41.25mg is too much of a drop for me?

 

If you find it difficult to measure the dose you need to make a 10% reduction it is better to round up, not down.  That way the reduction will be less than 10% of the current dose, not more.

 

Post #1 of this topic explains how to get non standard doses:

 

tips-for-tapering-off-mirtazapine-remeron

 

[ChessieCat]

And the not skipping doses applies to alternating doses too.  The brain likes consistency, not bouncing the doses up and down.

[Tania]

Ok thank you so MUCH for this...I've read and followed the thread on how to turn mitarzapine into a liquid form but it's not clear what I have to do exactly...do you have an exact formula I can follow? Cos here in UK they don't have the liquid form and the pills are tiny so it's very imprecise when I cut them. Thank you 

[ChessieCat]

How to make a liquid from tablets or capsules

[Altostrata]

Hello, @Tania Please read Tips for Tapering Mirtazapine

[Tania]

Mirtarzapine/Remeron tapering HELP

 

Hi, I keep reading the section on how to turn an SSRI tablet into a liquid form, but can anybody please tell me directly if they turned mitarzapine tablets into a liquid (made with distilled water) and how it was for you? I'm very scared to do this and I don't know who else to ask....thank you. 

 

Edited December 25, 2021 by ChessieCat
added topic title before merging with intro topic

[ChessieCat]

Did you read through the Tips for Tapering Remeron topic?

 

The following post from the above topic has very good information:

 

On 2/10/2021 at 4:30 AM, Nomansland said:

 

Hello everyone,

 

i was asked by the mods to share some informations about making liquid out of the NORMAL mirtazapine/remeron tablet (NOT the SolTabs).

First, mirtazapine is only slighty solutable in water and always immediate release, which means you have to make a suspension out of it (via suspension addon "Ora-Plus" OR stirring it well enough before drawing up your dose, a magnetic stirrer on low speed may make it easier). Like Brassmonkey said its "powder hanging in water like a cloud".

 

I found some german documents that state that the normal mirtazapine/remeron tablets can be made into a suspension ("normally" for patients who are not able to swallow and need a stomach probe). So i will just share these documents with you.

 

NOTE: These documents are in german, if you want to translate them, use this easy google translator for pdfs: https://translate.google.com/?hl=de&sl=auto&tl=de&op=docs

 

 

1: Document from german pharma manufacturer "1 A Pharma" http://www.1a-files.de/pdf/sondenboegen/mirtazapin_122009.pdf

 

-> "The tablet disintegrates in 15 ml of water within 7 minutes. A finely divided suspension forms. Alternatively, grind the tablet in a mortar and disperse in 15 ml of water. The suspension with a syringe pick up and apply. Rinse the probe with 10 ml of water before and after application."

 

 

2: Document from hospital pharmacy of the university of basel: https://www.crit.cloud/uploads/2/7/6/1/27612891/zermoerserbarkeit_tabletten.pdf

 

-> search for "Remeron" and you will find the 30/45 mg normal tablets. There is a sign "Z / S", which means it can be crushed and suspended.

It will say the alternative to this would be to use "SolTabs", so we can be sure the normal tablets are meant in the table.

 

 

3: Document from the central pharmacy of St.-Johannes-Hospital Dortmund http://qz-chemnitz.de/Teilbarkeit/arzneimittelliste_sonde.pdf

 

-> search for "mirtazapin" (without "e" at the end) and you will find the normal, coated mirtazapine tablets. In the table you see a Z which means it can be crushed and an A which means it can be suspended. The X indicates its possible, while the o would mean its not.

 

In the end i want to say that in the german taper forum, nearly everyone uses normal tablets to make a suspension for tapering, not the SolTabs (they dont seem quite common here, but they are available). So i just wanted to share you these informations and say its very possible to make a suspension out of the normal mirtazapine tablets.

 

Greetings

 

Nomansland

 

 

[Tania]

Thank you. A psychologist friend of mine said he's not sure if the body will absorb it once the tablets are crushed...because my 15mg and 45mg tablets have either an A or a M/I 

[getofflex]

6 hours ago, Tania said:

A psychologist friend of mine said he's not sure if the body will absorb it once the tablets are crushed...because my 15mg and 45mg tablets have either an A or a M/I 

The A or the M/I are simply the manufacturer's marks on the tablets, for tablet identification. It's just a trademark.  It in no way affects how the tablet is used or metabolized by your body.  There should be no problem with using your tablets to make a liquid as described in the link above that Altostrata posted on Friday. 

[Altostrata]

Yes, you can use distilled water.

[Faure]

Hi, it's really good that you have found this forum so early in your taper. I got very ill from alternating days when trying to get off mirtazepine a couple of years ago and it took a long while to recover. So I'm very pleased to see that you are not going to alternate doses.

 

I purchased a very nice pill grinder from Amazon and grind a weeks worth of pills in one go, weigh them using a jewellery scale, then put them into pill capsules. It works really well. I have been slowly tapering using the Brassmonkey method which you might like to look into when you're ready to taper again. I have had no loss of stability apart from a couple of days which passed (I didn't do the scheduled drop till it passed).  No missed days of work and I'm actually about to take on a little more. I have been very tired while on mirtazepine which has restricted my ability to work. 

 

If you want more details about what I do I will copy the advice from my thread that I got from Gridley, let me know if you do.

[Tania]

Thank you so much for appeasing my anxiety. I feel so proud and incredibly lucky to be part of this forum. I will go ahead  with the distilled water method then...I'm getting all the kit in the next couple of days. 

 

Faure please yes share the thread. It's good to know what people have done/ are doing. 

 

Since decreasing my dose slightly, some of my anxiety has been triggered but it's manageable so far...

[Faure]

Here's what Gridley said:

 

"You asked via PM whether it would be all right to cut your 15mg Mirtazapine pill into slivers to reduce by 10%, since it seemed excessive to make powder from a whole 15mg pill to reduce by only 1.5mg.

 

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.

 

Good luck with your liquid method, I've not put the effort in to understand it!

[Tania]

Hi Faure, this method appeals to me more actually! Does that mean that if you want to take 42mg of mirtazapine, you weigh 42mg worth of powder and take that? 

[Faure]

NO!! A 15mg mirtazepine tablet actually weighs 152mg. Because of fillers and stuff. So you weigh say 3 tablets to get an average weight, then grind up enough for a week having taken off 10% of whatever the average weight is. I really do recommend the Brassmonkey method as it's very smooth and results in minimal withdrawal effects (at least for me and I've seen it mentioned by others that is very successful). This is vitally important for you as you must stay well for your daughter.

 

Here are some useful links:

 

Scale - must measure to 3 decimal places in grams:

 

https://www.amazon.co.uk/AWS-American-GEMINI-20-Milligram-Stainless/dp/B0012TDNAM

 

Nice pill grinder:

 

https://www.amazon.co.uk/TabTime-Pill-Grinder-Multiple-Medicines/dp/B07MBQWGQ5/ref=mp_s_a_1_2_sspa

 

Brassmonkey tapering method including link to website that does the calculations for you:

 

 

You'd also need capsules which Gridley mentioned in the text I copied before- get the right size!

[Tania]

Hi Faure thank you so much for your reply. I'm really sorry but I don't get it. I actually want to decrease by less than 10%. That's not my issue. My point is, how do I calculate say if I want to take the equivalent of 42mg or 43mg of mirtazapine? That's what I don't understand

[ChessieCat]

4 hours ago, Tania said:

Hi Faure, this method appeals to me more actually! Does that mean that if you want to take 42mg of mirtazapine, you weigh 42mg worth of powder and take that? 

 

There are posts in this topic explaining how to make the calculations.

 

using-a-scale-to-weigh-and-measure-doses

 

Here are the search results to posts made by Brassmonkey which include the term "mgai" (mg active ingredient = dose of the tablet).  Have a look through those and if you do not understand something, I suggest you post in the above topic.

 

https://www.survivingantidepressants.org/search/?&q=mgai&type=forums_topic&quick=1&item=1596&author=brassmonkey&search_and_or=and&sortby=relevancy

 

 

[ChessieCat]

mgai milligrams of active ingredient = dose of drug contained in the tablet

 

mgpw milligrams pill weight =  weight of the physical tablet

[brassmonkey]

1 hour ago, Tania said:

Hi Faure thank you so much for your reply. I'm really sorry but I don't get it. I actually want to decrease by less than 10%. That's not my issue. My point is, how do I calculate say if I want to take the equivalent of 42mg or 43mg of mirtazapine? That's what I don't understand

 

It would be a twostep calculation:

 

First divide the target dose in mgai by the full strength of the tablets in mgai. Using the numbers you mentioned that would be 42/45= 0.93

 

Second step, multiply the weight of an average tablet in mgpw by 0.93. Using the numbers mentioned about that would be 152 X 0.93 = 141.

 

Your new dose would 141mgpw. Roughly a 7% reduction.

[Tania]

Thank you so much. I've just bought the scales and pill grinder that Faure suggested and going to buy size 0 gelatin capsule. And thank you Brassmonkey, your illustration made it super clear for me. I will keep you up to date as to how this is going. Thank you again so much, having this forum is a lifesaver...I can't say this enough.  

[Faure]

Glad the experts have come along and told you about the numbers, they are not my strong point! Take care with the taper and look forward to hearing how you get on😊

[Tania]

The gemini scale and pill crusher arrived. I'm noticing that I've to be very careful with how I'm being...last night I went to be at 3am, I never do that, and woke up 2 hours later in utter panic and in a heightened stateof anxiety. Today has been soul destroying. When I take mitarzapine at night if I don't go to bed straight away, I really suffer the consequences. Today I've felt emotionally and physically hungover. I feel enslaved by this med, and I feel it will take me years to taper from it. 

[Santino]

Hi Tania

I red your topic, introduction and the problems you are facing. If you are interested to know on first account from a fellow Mirtazapine Taperer who successfully did it you can go through my topics of introduction and success story. 

Anyway i will write you a private message. I can help you with a simple video on how i used to make the mixture for me and you can have a look and follow if that is ok with you. 

Anyway you are on a good track. 

All the best

Santino

 

[Bestill]

Hi there!  I just started my taper off Mirtazapine too so if you need a buddy, I’m here!

 

bestill

[Faure]

It's very important to stick to your routine. For me, routine keeps me safe. With all the dose changes you've been experiencing (as you only just got the scales doses will have been inconsistent) it sounds like you've got a bit "high", which makes it next to impossible to stick to a routine.

 

Do stick on whatever dose you're on till you've been steady for a good week or two. Also from my experience the start of the taper is harder as your body has been used to a steady state for years. Mine settled down after a few weeks of the brass monkey slide, but I have only been on mirtazepine for 2-3 years.

 

I agree it will take years, but it's the better safe than sorry route. You really don't want to become destabilised. I am looking at it as an investment in the rest of my life. If I can get off while staying well and stay off, then it's worth doing it this way. Also time does go very quickly. I started in June 2021 from 15mg and next week I'll be at 9mg. This feels like a great achievement, I feel better nearly all the time, can do more and am working more.

 

How are you now?

[Tania]

Hi, I'm very confused. I've now crushed 2 individual pills, and the 1st one weighs 0.391 and the 2nd one weighs 0.463. Do I put different amounts in each capsule? Cos according to the first weight I should take 0.363mg (0.391 x 0.93) but for the second pill, I should take 0.430 (0.463 x 0.93) . I want to do this daily to begin with, not in batches. Thank you for your help. 

[Tania]

Also, quite a bit of powder gets stuck in the grooves of the pill crusher....is that OK? And what's the best way to transfer the powder from the scale into the capsule, I use a piece of folded paper but again it's not great as some of the powder gets stuck on the paper and then get lost on the counter...any tips would be greatly appreciated. 

[ChessieCat]

31 minutes ago, Tania said:

I use a piece of folded paper

 

Some members use baking paper / parchment paper.  These are the search results:

 

https://www.survivingantidepressants.org/search/?q="baking paper"&quick=1

 

One member mentioned that they crush the tablet between the paper:

 

"I crush the tablets between a folded piece of baking paper with a rolling pin"