Alex3: total insomnia after 6 months reinstatement

[Alex3]

In my frustration, I've forgotten another alternative, which makes the Dr's options of staying on them v 50% drops and reinstatement an absolute gas light of the highest order:

 

Oro-dispersible

[Alex3]

Hi all, hope you're well and hope there's scope to converse at some point as I'm heading toward trying to get off these pills.

 

I've had another read of this article: When Tapering Antidepressants, is Going Slow Always the Best Strategy? - Mad in the UK

 

and I can't help but think that a long drawn out taper could prove counter-productive given the food sensitivities I've now got. Foods with high tryptophan/histamine/oxalates cause a lot of aggro/interaction/affect absorption.

 

My situation is as such where, aside from work, I'd be able to focus on getting through withdrawal without being consumed by other things.

[Shep]

15 hours ago, Alex3 said:

and I can't help but think that a long drawn out taper could prove counter-productive given the food sensitivities I've now got. Foods with high tryptophan/histamine/oxalates cause a lot of aggro/interaction/affect absorption.

 

My situation is as such where, aside from work, I'd be able to focus on getting through withdrawal without being consumed by other things.

 

I didn't develop food sensitivities until I came off most of the drugs I was on (fast taper and cold turkey). Although I'm much better with all of my symptoms and out living my life, I still have to be very careful with my diet even 7 years off these drugs. If I deviate from a modified Paleo diet, some of my symptoms return (GI symptoms and insomnia). This doesn't end just because you get off the drugs. 

 

Did you take a look at the research James linked to in his article? It's about something we discuss here on this site - Why taper? SERT transporter occupancy studies show importance of gradual change in plasma concentration

 

Note what Mirtazapain wrote in that thread about mirtazapine in the quote below. A faster taper may be okay at the higher doses, but I wouldn't rush this at the lower doses. Food sensitivities can be controlled in large part by modifying your diet. Other symptoms from a too-fast taper may not be so easily handled. 

 

On 3/29/2022 at 7:04 PM, Mirtazapain said:

mirtazapine occupancy% = 86*dose*2.66/1.94+dose*2.66. 

 

The 2.66 multiplier is because 7.5 mg of mirtazapine is roughly equivalent to 20 mg of Prozac.  Obviously, the drugs aren't equivalent, because at low doses mirtazapine has much more affinity for H1 and it's not an SSRI (it's a serotonin receptor agonist), but the issue of occupancy is similar.  I could not find occupancy curves for mirtazapine, but did find an article that said it can have up to 95% occupancy at 7.5 mg. This is the dose inflection point for this drug.  From 7.5 mg on down the occupancy is hyperbolic.

 

This showed that my 10% tapers (from 22.5 to 7.5 mg) were more or less linear in terms of occupancy rate: 1% occupancy per 10% taper.  My WD symptoms were manageable.  But when I tapered at 10% (from 7.5 mg to 6.75 mg) my WD symptoms were off the charts.  Along with my usual (intensified agitation, irritability, anxiety), I have shaking, nausea, diarrhea, headache - all starting 21 days in.  Yuck.

 

When I found Zk2015's formula I could see that at 7.5 mg mirtazapine shifts from linear to hyperbolic, so 10% taper resulted in a 2.6% decrease in occupancy.  That is 2.5 x higher than what happened when I came down from the higher doses. No wonder I am having such a hard time! 

 

Armed with with this new information, I have plotted a much safter taper schedule for myself that will have me shedding 1% occupancy with every taper.  

 

 

[Alex3]

Wow @Shep

 

"But when I tapered at 10% (from 7.5 mg to 6.75 mg) my WD symptoms were off the charts.  Along with my usual (intensified agitation, irritability, anxiety), I have shaking, nausea, diarrhea, headache - all starting 21 days in.  Yuck."

 

This was exactly my experience!! Tapered with the liquid 15mg / 1.00 ml syringe to 6.75mg / 0.48 ml syringe with no problems (other than that bl**dy 6 week expiration date on the liquid Mirtazapine). I started that drink of beetroot juice at 6.75mg and bam... hyopmania and then the crash

 

Thank you so much. This is the kind of context I need.

[Shep]

You're welcome, Alex. Glad you are going to keep your taper slow. 

[Alex3]

@Shep

 

The reality I'm considering is that I don't think there's an escape from Mirtazapine withdrawals. Mirtazapine itself is also pretty unique it seems, which is another factor to consider

 

Tapering 15mg / 1.00 ml to 7.5 mg / 0.50 ml by 0.01 ml / 0.15 mg every four days was seemingly fine (hence the 90% SERT Occupancy).

 

However, when I dropped beyond the 7.5 mark the drop was still only 0.01 ml / 0.15 mg. If one 0.15mg brings about the withdrawals it did for every tiny drop then I'm going to be in hell for a very, very long time. Many that go cold turkey on Mirtazapine are in hell for 2-6 weeks and then things lift and by the time the months roll by there's significant improvements. It's just being prepared for that initial "bomb" and then immense patience in getting sleep to return. Again, in the early weeks, sleep is non-existent, but then does uplift and whilst a routine of 4-5 hours is horrendous in normal circumstances,  in the context of becoming free, it keeps you functioning so that you can get through the windows and waves.

 

This is the crux of James Moore's article. He followed the 10% taper rule and still finds himself a long way from healing, particularly on the sleep part. He didn't write that article for no reason; he's daring to ask that possibly 10% was ultimately too slow and didn't exclude him from the withdrawals.

[Jools44]

@Alex3 I hope you don't mind me chipping in here.

 

I think when we're lost in the darkness with these drugs with so many uncertainties ahead of us we have a tendancy to look for answers that suite our own narrative. I've certainly done it myself. 

 

Obviously you want to get off this drug ASAP as does everyone on this site, and I think Jame's article is putting out there that there isn't a one size fits all scenario. But he's hypothesising because the truth is we just don't know the answers. 

 

The sad reality is nobody really knows what the best approach is for each individual, as there has been no research in to this. 

 

My feeling is that whatever approach you take you should be prepared for the worst. Whether you opt for a rapid taper or a slow one, you will likely experience withdrawals and they will likely be disabling to a lesser or greater degree, so what position will you be in if they are the latter?

 

Most peoples first experience of withdrawals comes as a massive shock to them as they had no idea that coming off of these drugs could have such a devastating effect on their wellbeing. 

 

We have the benefit now, of knowing the potential fall out of withdrawals, so the questions in my mind are: how do I mitigate or at least minimise the severity of the withdrawals, and secondly if they are severe how will I support myself until I am well again (which can take years for many, not weeks). 

 

The anecdotal and limited academic evidence  strongly suggest a slow taper is the safest route off these drugs. Slow can mean different things to different people and you have to adapt to your previous experiences. Smaller cuts and longer holds is the way I am approaching it, but I have come to the conclusion that at some point things are going to get difficult. Personally I would rather do a slow, somewhat controlled taper that allows my brain and body to re-adapt  to life off of the drugs. That doesn't mean life will return to pre-drug normal, I expect to have some lasting injuries (I already have hyperacusis and tinnitus) but I will at least be free of this drug and a slow taper will likely (although not definitely) reduce the severity of withdrawals. 

 

So my advice is to have a plan. What will you do if it goes really belly up again? Can you support yourself? Have you reconciled yourself to possibly having to take a back seat in your own life for an unknown period of time? Are your loved ones prepared? Are you prepared to forgo psychiatric help because we all know where that road leads. 

 

We've only got so much control really and we can only learn from others experience's.

 

On the flip side, perhaps things won't be so bad this time. You're more attuned to withdrawal symptoms. You'll react faster when you need to and you'll be better prepared.

 

The only way out is through, but there is a drug free life on the side. 

 

[Alex3]

@Jools44

 

Hi Jools, thank for your input, much appreciated

 

I'm honestly just trying to understand the situation as much as possible. In my current circumstances/context, I wouldn't be sacrificing a relationship/marriage, I have no kids, career, mortgage and beyond. I don't even play football atm as a talismanic 11th man, for example. If I was then I'd have a completely different outlook

 

The only potential sacrifice would be my job, but again, in the grand scheme, if it allows me to break free then so be it.

 

Ultimately, my life is now geared towards getting off this stuff.

 

I vividly remember withdrawal. It is the ultimate test, but as you say, I was unprepared and absolutely in shock.

 

If I was to do it again, I'd be fully prepared with information and some kind of idea on time frames, windows and waves and expectations in line with just how difficult this journey will be. Long hours alone, in the night, with no sleep and no company. Just enduring and trying to find distraction

 

Do I think it would be worth it in order to be free of the drugs? I'm filled with dread, but this escape/treasure lies at the back of the cave

[Jools44]

17 minutes ago, Alex3 said:

In my current circumstances/context, I wouldn't be sacrificing a relationship/marriage, I have no kids, career, mortgage and beyond.

Hi @Alex3

 

then I think you’re in about as good a position as anybody can be to come off these drugs. You have no dependants - either financially or emotionally to worry about, you’re withdrawals will affect you alone so you don’t have the burden of other peoples expectations or judgements, you’ve got the time and the space to do this difficult thing in whatever way you choose. My impression is most people withdraw from society/family members in order to deal with withdrawal symptoms.

 

You’ll find plenty of support here when the dark times come which is important and why this site is a life saver.

 

it might be prudent to find a therapist trained in prescription drug withdrawal. It’s hard but they are out there.

 

good luck to you on your journey 🙂

[Alex3]

Thanks @Jools44

 

Yes, it's the blank canvas I personally have that will allow me to take as long as I need to get better. Part of my initial withdrawal hell is that it's a sudden onset; you're shocked as to why? How will this last? Have I done permanent damage? Will I lose my job? This time it will be just getting through each passing day and with each day that passes I'm on the road to recovery and healing. If I had to complete certain tasks (such as a single parent) throughout this time then it's a different conversation. I live in the countryside so each day will be taking it slowly, in my own time and space, getting through, knowing that better days lie ahead once I'm off this drug. Getting from Mirt will be the ultimate motivation. Healing is the new high and all that.

 

With work, this time I'd explain to work that for two weeks I'm going to be in the depths of hell with the only reprieve in the occasional benzo/Zoplicone for some relief. Don't contact myself, but may be contact a family member to confirm I'm still okay. If they agree to something along these lines then it's another element off my mind and it's just a game of patience from there. If I lose my job then so be it - once I'm healed I'll get another Mirt-free.

 

Scouring forums it appears that many people drop off at 6 weeks as the sleep slightly returns and withdrawals subside. I'm under no illusion and not expecting to feel right for a year, maybe longer, but even if I do along drawn-out taper I'm going to have to get through this.

 

The main theme is continuity and stability. Making a decision and sticking to it so I'm in the midst of processing and understanding.

[Jools44]

@Alex3sounds like you’re in really good frame of mind for this👌

[Alex3]

Thanks once more @Jools44

 

Lots to ponder, consider and most of all process.

 

When sudden onset of withdrawals hit, we’ve not even considered (let alone process), what getting off this stuff is to remotely entail. As Alto has said in a podcast and others have written it comes as the most destabilising shock, not just to the CNS, but emotionally.

 

But we are where we are and I notice so many ex-Mirt takers feel inifinitely better by breaking free, no matter the struggle they go through.

 

Atm part of me thinks a very slow, precise taper and another part thinks prepare to get this stuff gone once and for all. 
 

My life is being geared up for a very quiet, slow existence at least for the forseeable. Few direct debits, keeping it simple and slowly breaking free.

[Alex3]

@Jools44

 

Do you know of any specialist Drs that know about withdrawal?
 

How’s your own Mirtazapine journey atm? I noticed you successfully tapered and then reinstated. Is this due to sleep problems?

[ChessieCat]

recommended-doctors-therapists-and-clinics

 

great-britain-uk-members-please-check-in-here

 

[Alex3]

@ChessieCat thanks ChessieCat. I think it’s time to change strategy and tap into a withdrawal specialist than auto-relying on my family GP(s)

 

Does anyone recommend a particular specialist from this lot?
 

http://www.criticalpsychiatry.co.uk/consultations/

[Shep]

15 hours ago, Alex3 said:

With work, this time I'd explain to work that for two weeks I'm going to be in the depths of hell with the only reprieve in the occasional benzo/Zoplicone for some relief.

 

Alex, please tell us more about your benzo / Zoplicone use.

 

We discussed these drugs back in January. You had posted this back then: 

 

On 1/15/2022 at 4:18 AM, Alex3 said:

Lorazepam mid 2021 for 5 days

Temazepam mid 2021 for 2 days

Zoplicone 3.75mg Monday 3.75mg Tuesday

 

From our discussion back then, it sounded like you were only going to be using these drugs on an emergency basis. Is that still the case? Please let us know how often you use them. 

 

[ChessieCat]

34 minutes ago, Alex3 said:

Does anyone recommend a particular specialist from this lot?
 

http://www.criticalpsychiatry.co.uk/consultations/

 

Research papers that I found on SA:

 

stockmann-2019-what-it-was-like-to-stop-an-antidepressant

 

stockmann-2018-ssri-and-snri-withdrawal-symptoms-reported-on-an-internet-forum

 

 

[ChessieCat]

Stockmann has been through his own experience of withdrawal and is familiar with SA.

 

  

On 11/7/2019 at 9:55 AM, bubbles said:

I was aware this was just one person’s experience. However, I came to realize I was far from the only person who had experienced this problem. At a conference I met others who had gone through similar experiences. There, I heard about the Surviving Antidepressants (SA) website,4 which offers peer support for tapering off psychiatric drugs and managing withdrawal symptoms. Many people report finding such resources necessary in the absence of sufficient understanding and support by mental health services;5 this is borne out by SA’s 12,000 registered users and 300,000 hits per month.4

 

 

Edited August 13, 2022 by ChessieCat

[ChessieCat]

I've clicked on the website under his name on the link you gave and found this which confirms it is the same person:

 

https://tomstockmann.com/#deprescribing

[Alex3]

Hi @Shep

 

Yes, I've not come close to touching any benzo/Zoplicone since the issues around January. Not even come close. Just white knuckled the bad nights

 

But when withdrawals hit in full force and for prolonged periods there may a case for a very occasional use of a small dose purely for a tiny fragment of relief.

[Shep]

9 hours ago, Alex3 said:

Hi @Shep

 

Yes, I've not come close to touching any benzo/Zoplicone since the issues around January. Not even come close. Just white knuckled the bad nights

 

But when withdrawals hit in full force and for prolonged periods there may a case for a very occasional use of a small dose purely for a tiny fragment of relief.

 

Thanks, Alex. Please always write down when you use it on a calendar or other place that you keep records. If you find yourself using it more than a couple of times in a month, it may be a sign that you need to slow your taper down or add in a longer hold. Also, having it written down may be helpful if you suspect side effects or rebound symptoms (benzos and z-drugs are notorious for causing this). 

 

I added a note about the benzo/Zoplicone for emergencies to your signature, but feel free to reword it if you like. It's important to include all of your drug information. 

[Jools44]

On 8/13/2022 at 8:01 AM, Alex3 said:

@Jools44

 

Do you know of any specialist Drs that know about withdrawal?
 

How’s your own Mirtazapine journey atm? I noticed you successfully tapered and then reinstated. Is this due to sleep problems?

@Alex3

 

I don't know of any medical doctors but I'm aware of some therapists. I can find there details if that would help you? 

 

I am slowly reducing after being on 22.5mg for 5 months. I crashed due to acute withdrawal symptoms and lots of personal stresses. I'm down to 18mg after about 6 months, so going super slow. I'm mostly recovered from all the drama last autumn but with some with residual tinnitus and hyperacusis that hasn't resolved. It's bearable. I'm alcohol and caffeine free and trying to stick with low histamine where I can. 

 

My life isn't terribly stable so for me it's reducing at a rate that doesn't cause me major issues. I'm anticipating long holds to be honest and no idea when I'll get off of this stuff and I do worry about what life will be without it (if I even get that far), but I've learnt a lot about withdrawal in the past 12 months and am hoping I'm better equipped to deal with it. 

[Alex3]

@Jools44 I wish you the best of luck, really do

 

I'm in a place of despair tbh. I honestly get to the point where I can't be bothered with all this

 

I want my old sleep/life back. I knew from the early times of taking the Clomipramine that this whole thing was BS

[Jools44]

@Alex3 I often feel that way too, but I think that's common for everybody going through this process with no help from the medical field. It's a bloody lonely place to be. However you are not alone, as this website proves and there is a way through it. We can't turn back time unfortunately so just have to plough on.

 

Many people in all walks of life face challenges every day, this is ours. We didn't ask for it and it is a very unwanted "gift" from a profession that has fallen down a rabbit hole of over prescribing, but we can overcome it. It's hard to belive that on the bad days and the lengthy recovery only adds to the fatigue of the process, but there is life after these drugs. 

[Alex3]

Quick question…

 

Who was the psychotherapist that James Moore used to see?

[Alex3]

@ErimusHi Erimus, I seemed to miss your question from all the way back in January…

 

Yes, I now find Mirtazapine’s sedating effects can vary. It sadly no longer has the same effect it did pre-failed taper, but then I was tired throughout the day during that period

[Erimus]

Yeah. Sometimes it blows my head off and heavily sedates me and other times not so much. Complicated by sertraline and the interaction between the two I can imagine. Both sh*tty, evil drugs.

 

Have you read @Faure’s thread? She’s doing amazing with a micro taper after a reinstatement and 18 month hold. Don’t make a rash withdrawal decision and undo all the hard work you’ve put in holding for so long.

[Faure]

On 8/12/2022 at 6:36 PM, Alex3 said:

If I was to do it again, I'd be fully prepared with information and some kind of idea on time frames, windows and waves and expectations in line with just how difficult this journey will be. Long hours alone, in the night, with no sleep and no company. Just enduring and trying to find distraction

Hi @Alex3, Faure here! Don’t go cold turkey - people who have (on here) are in terrible terrible places and all wish they had done a steady slow taper. There is no powering through WD effects. They are awful and destroy lives. If you’re still able to work and go out / exercise then things are very good for you. I know, not as good as before, but in the context of life on ADs things are good. I’m sorry your sleep is not good. I know mirtazepine messes with sleep and dreams. 

 

As @Erimussaid, I am doing the BrassMonkey slide and it is going very well for me. I the first 6-8 months there were times when it took a couple of hours to get to sleep, I’d feel scared / anxious for no reason but WD effects, for me, are always short lived and mild. Sometimes it still takes a little while. Even if WD is more than mild for you, they are still better than cold turkey. Do have a read of my thread and you’ll see how well it’s going for me. I have fortunately not developed any issues with reactions to food. I keep my diet consistent and don’t add sudden changes to diet or lifestyle. I keep everything in my life very stable and steady. It’s boring, but I know it keeps me safe and well in withdrawal.  

 

As for a compounding pharmacy, I wouldn’t bother. I think they are allowed a 10% variation in pill weight which would put you all over the place. I easily make up my pills each week with a grinder and scales (let me know if you want links) and it’s done in 15 minutes. I always get the exact weight on the scales. I think I’m going to have to start making my own liquid when I get down to around 2mg but I have a friend who is a maths whizz to help with that! Plus all of BrassMonkey’s advice in the tapering section. 

 

I also wouldn’t bother with trying to get medical help; there isn’t any. We are on our own and have to help each other through. This website does it wonderfully. 

[Jools44]

@Alex3 sorry Alex, I'm stealing your thunder it would seem!

 

I shall retreat back to my own thread 😁

 

[Alex3]

Hello all, got a face-to-face appointment tomorrow morning. Just looking for pointers please?

 

Want/need to start a slow taper

[ChessieCat]

how-to-talk-to-a-doctor-about-tapering-and-withdrawal-what-to-expect

 

[Alex3]

Hello all, Dr's appointment went well. Was assertive and insisted that I wish to do a micro taper back to 7.5mg and then hold/re-assess.

 

The Dr is enquiring about the liquid availability. Went as well as can be expected. Tense moment when he started to insist on 15mg, 15mg , 15mg, 15mg,  15mg , 15mg, 7.5mg, (week one taper) 15mg, 15mg , 15mg, 15mg,  15mg , 7.5mg, 7.5mg (week two taper) etc. etc.

[ChessieCat]

I'm glad that you know better!  Well done on being prepared and advocating for yourself.

[Faure]

@Alex3, I’m quite excited as I just found these new NICE guidelines. I’m going to have them to hand when I have a “medication review” with my GP next week:

 

https://www.nice.org.uk/guidance/NG215

 

you can download a pdf, link just to the right of Guidance ☺️
 

It endorses what we do here - yayyy! The doctors will have to listen to us now. 

[Alex3]

Hello all, hope you're well

 

Just taken the first liquid dose of Mirtazapine in 15 months.

 

1ml = 15mg - no drop yet to 0.99ml. That will arrive in the coming days.

 

 

[Alex3]

@Faure

 

Pill to liquid switch 15mg = 1ml

 

Hello all, terrible night. Switched back to the liquid and have had tolerable phases of nausea, diarrhoea and a headache.

 

That's not too bad in itself and to be expected as although I don't recall particularly getting this the first time round, I noticed James Moore had it when he switched from pill to liquid.

 

However, what concerns myself the most is that I feel as if my body is sensitised and can't process Mirtazapine unless it's the original pill (and even then there's no guarantees). I feel as if I'm stuck between a rock and a hard place here and honestly just tempted to just accept defeat and stick to the 15mg pills indefinitely.

 

I think there's a liver enzyme test CY45 something? I wonder if that could bring about some insight as to how I'm metabolising the drug

 

I don't think I can face the protracted withdrawal of years of insomnia, even with tapering. I don't have the support network and I'm not sure I have the will.

 

So, yes, considering just switching immediately back to the 15mg pills and just leaving it at that. Every time I try and make some progress forward it's one step ahead and then two back. Not even in withdrawal/tapering yet.

 

Hope everyone is okay.

 

Best wishes, 

Alex