ReddLedd: Mirtazapine Reinstatement help!

[Frogie]

@ReddLedd

 

Like I said, you could try a small updose and see if that might help. You could go up to 2 mg instead of the .5 I originally suggested 

[ReddLedd]

Thanks @Frogie and sorry to be such a pain. This afternoon was a huge reminder of why I wanted to come off this stuff at the start. Mirt def doesn’t agree with me. 
 

I might play it safer and Go with 1.5 maybe, just in case I feel even wonkier tomorrow. 
Unless you think there’d be a benefit going straight to 2mg.  

[Frogie]

@ReddLedd

 

You could try 1.5 mg and see how you feel. Then go up to 2 mg if that doesn’t help.

[ReddLedd]

Hi @Frogie

 

did 1.5 last night and slept quickly. However, woke at 430am completely wired awake. Very restless and full of adrenaline, which is weird as this wasn’t as bad before I did the RI. 
Also seems a bit worse than the last 2 days. Anxiety last night was present for the first time at night in a while. Feeling very strange this morning and feeling some similar symptoms to early withdrawal. Not sure whether this is going to work. What’s your thoughts?  

[Frogie]

@ReddLedd

 

You could try 2 mg. But then wait 7-10 days before updosing anymore as it takes your body approximately that long to register.

[ReddLedd]

@Frogie

 

Would it be safe to hold on 1.5mg considering I’ve already gone up, or would it be better to just go straight to 2mg now and hold? 
it also seems the higher I go the worse I feel, could that be a sign that it might be better to stop? 
 

Please excuse my flip-flopping here, I’m all over the place and a little scared. 

[ReddLedd]

Afternoon update; had anxiety this morning that finally passed. Went to the shops and got some healthy food. Made a salad and as soon as I sat down have had horrible adrenaline rushes (I think that’s what they are), so just trying to get through it as best I can but it’s rough. 
keeping track of my symptoms but so far it’s been harder to manage than previous to RI, I’m praying I level out coz I’m feeling pretty s&@t right now. 
Would it be stupid to stop this now before it gets too hard to manage?
 

[Frogie]

@ReddLedd

 

You’ve only taken a small amount for a couple of days so I think you would be ok to stop and see how you do. 
 

You could have a few bumpy days but it should hopefully even out.

 

Please keep me posted.

[ReddLedd]

Thanks @Frogie  

looking at my diary/notes since the month before I started mirt, tbh I don’t think (even at 30mg) it actually provided me any relief from the anxiety. It blunted it slightly, but also seemed to take my personality with it. 
It helped for sleep, sure, but that was about it. I was only on it for 6 weeks total I know, but I’m just wondering whether the RI risk is worth it if there’s a good chance it won’t help the anxiety subside. 

It’s clear that I may need to address the anxiety somehow, I’m just not sure how to decide which way to go with potentially choosing another med (if necessary). I’m doing everything I can with my lifestyle to keep the wolves at bay, but I may need to accept the fact that I can’t pull myself out of this one without the help of some relief, whatever form that may take. 
 

forgot to say previously, my doc provided a script for Valdoxan (agomelatine) a few weeks ago, but I was wary to get it filled as I can find a lot of info about it aside from a few user posts. 
 

Also, I really appreciate your patience, it’s not been easy with me all over the place, but you’ve been a huge help. 

[ChessieCat]

19Mar2022 RI @ 1mg 

21Mar2022 Ud @ 1.5mg

 

It generally (for drugs with a half life of about 24 hours) takes about 4 days of a dose to get to full level in the blood and a bit longer for it to register in the brain.  However, mirtazapine has a longer half life (20-40 hours) which means that it will take longer to get to the steady state.

[ReddLedd]

2 hours ago, ChessieCat said:

19Mar2022 RI @ 1mg 

21Mar2022 Ud @ 1.5mg

 

It generally (for drugs with a half life of about 24 hours) takes about 4 days of a dose to get to full level in the blood and a bit longer for it to register in the brain.  However, mirtazapine has a longer half life (20-40 hours) which means that it will take longer to get to the steady state.

So it would potentially be a few extra days before I felt any benefits or effects depending on whether I continue or stop?

[Frogie]

@ReddLedd

 

Yes. It takes about 4 days for it to reach a steady level in your bloodstream and a few more days to have your brain recognize it. So we suggest 7-10 days to reach full levels in your system.

 

If you stop, you may feel it longer as your system has to rid the medication.

[ReddLedd]

@Frogie

 

Am I being a little naive, is increased anxiety and restlessness common upon reinstatement? 
Night time is not too bad but the days have been brutal yesterday and today. 

[Frogie]

@ReddLedd

 

Those symptoms are very common in reinstatement.

 

Hopefully they will even out within a few days.

[ReddLedd]

Hi @Frogie

 

held @ 1.5mg last night. Slept fine but instant restless wake at 5 am. 
anxiety and upset stomach/nausea again. Mild temperature disregulation (hot then cold shortly after). pressure headache and dry congested sinus. 

So strange, feels more like withdrawal than stabilising. Not sure how to figure out whether it’s my body rejecting the RI or stabilising. Feeling a bit yuk. 
 

[ReddLedd]

If my issue with the Mirtazapine is related to its antihistamine properties, how would I go about informing myself of another AD that might help me in the short term? 
None of the doctors I’ve seen seem to actually know (as we already know) so how does one go about making the choice on another potential treatment?

My functional doc has also advised that Mirt apparently promotes pro-inflammatory cytokines (which is likely why I’m feeling head pressure again). 

 

If I want to stop, would I have to taper off this dose for a few weeks or months before I could rotate to another AD? I know stability would be paramount before further treatment. 
 

 

[Frogie]

@ReddLedd

No, you wouldn't have to taper off the reinstatement because you only took it a few days.

 

At that point I don't think I would switch to another antidepressant because it could cause more problems than you have now.

[ReddLedd]

Appreciate the feedback @Frogie  

Seems I’m doomed to stay on this stuff or deal with the effects off it. 
Very hard decision to make as I feel terrible on it and off. Will just have to hope for the best and prepare for the worst, but it sounds like maybe it’s safe to just stay on it for now and try to stabilise before I make a decision 

[ReddLedd]

I’m really worried about doing long term damage if I was to stay in the fight or flight mode, so is it safer (regardless of how much I don’t like it) to stay on the Mirtazapine for now, if it’s too risky to try another AD?
Does that sound like the better play to you @Frogie? 

 

it does mean I’ll prob have to hold off on all my supplementation for now, but I need to manage the daily cortisol for a while so my immune system can start to work again. 
 

last question I promise; If I progress with updosing over the next few weeks, how will I ultimately know if this reinstatement is going to be futile, would be at a certain does size or after a certain time of reinstatement?
 

 

 

[Frogie]

@ReddLedd

 

Don't ever be afraid to ask questions. That is what we are here for. Don't apologize at all. It's all new to you.

 

I wouldn't change antidepressants because it can cause problems with your CNS. 

 

I would hold a little while longer and see how you do. You are going to have ups and downs while reinstating because your body is getting used to the medication once again.

 

You will know when you have reached a good level when you are WD Normal. Here is a link that Brassmonkey wrote that really explains what your body is/will go through.

 

 

Please don't hesitate to reach out if you have any other questions.

[ReddLedd]

@FrogieI really appreciate it. 
currently experiencing a weird ‘mini panic episode’ out of nowhere, a bit dizzy and not sure if maybe it’s the mirt actually making it’s way through my blood or something else. 
had some blood drawn today so maybe it promoted some extra circulation..

 

its most certainly all new and I’m only now coming to terms with the fact that I may need some medicated help for a bit to get well again. 
 

So I guess I’ll hold at 1.5 for another week(ish)?

I can tell I’ll prob need to updose a couple of times if this isn’t settling down yet. 

If this gets worse tomorrow it would be safe to assume I’m either having an adverse reaction or my CNS is too sensitive?

[Frogie]

 

 

@ReddLedd

 

I would say the symptoms you are having are from the reinstatement. It takes a good 4 days to get even in the bloodstream and another few days to reach the brain.

 

If you aren't better in 4-5 days, you could try another updose, maybe .5 mg and see if that will even it out. It takes a while on a reinstatement to find the right dose because everyone is different. That is why we always start out low and move up every so slight.

[ReddLedd]

Thanks again @Frogieyou’re amazing. 
A little fragile today and it feels like when I first started on this stuff, it’s incredible how strong such a small amount can be.
I’ll hold on 1.5 until Mon or Tues (unless I get worse) and let you know how I’m doing. 
 

I really hope I can see some small improvement over the next few days. I can tell my nervous system has taken a real hit over the last few weeks.  
Hope you enjoy weekend. 

[Frogie]

@ReddLedd

 

You are very welcome. I'm glad I'm here to help.

 

Hopefully you will feel a little better by the weekend. If not you can upsode a little like I suggested.

 

Just ride the bumpy road for a little while and I'm sure we can get you to the right dosage.

 

I hope you have a wonderful weekend also.

[ReddLedd]

Hi @Frogie

didnt sleep a wink last night. Given how sedating mirt normally is this is concerning. 
Is it a sign that RI may not be working?

[Frogie]

@ReddLedd

 

You could try to updose to 2 mg and see if that might help.

 

It doesn't necessarily mean that isn't working, you just may need a little more.

[ReddLedd]

@Frogie

i hope that’s the case, very shakey and anxious this morning. Haven’t felt this way in a while so it’s a little scary.  
 

[Frogie]

@ReddLedd

 

Let's try a little updose and see if it helps. You are going to have symptoms that feel like wd until your body gets used to the mirtazapine again. Hopefully they will subside soon.

[ReddLedd]

Thanks @Frogie will try 2mg tonight and see how it goes. The reoccurrence of the panic episodes is scary, but will do my best to hang in there.

Are panic attacks typical of RI symptoms or a sign I need to see some sort of doctor? I’m desperate for some sort of stability 🤞

[Frogie]

@ReddLedd

 

No, I don't believe you need a dr. It's all in the healing process and hopefully it won't last long for you.

[ReddLedd]

Thanks @Frogie will keep you posted. 

[Frogie]

@ReddLedd

 

You are very welcome.

[ReddLedd]

@Frogie

Is there still a possibility that mirt itself is the reason I’m having the panic attacks, given that they’ve only been reoccurring since I started the RI?

[Frogie]

@ReddLedd

 

There is that possibility, but I think it is probably due to the reinstatement and your body just needs to get used to it again.

 

Let's see how you are in a couple of days and we can go from there.

[ReddLedd]

49 minutes ago, Frogie said:

@ReddLedd

 

There is that possibility, but I think it is probably due to the reinstatement and your body just needs to get used to it again.

 

Let's see how you are in a couple of days and we can go from there.

@Frogie

so do you think it would be safer to hold at 1.5mg or updose to 2 and hold?

Also, my eyes don’t feel blurry today, but very photosensitive and kind ‘jumpy’, very hard to focus on anything at one time. 

 

[Frogie]

@ReddLedd

 

If you feel the symptoms are a little better, you could hold at 1.5 mg and see how you feel the next couple of days. You may be starting to stabilize.