LiaJ: overwhelmed by deluge of information, mirtazapine tapering, ? updose

[LiaJ]

Hi there,

 

Back after a long hiatus. I attempted to make a liquid suspension last night of a Remeron Soltab and feel today like I skipped an entire dose. Not the greatest feeling!

The tablets are orally disintegrating and are 15 mg tablets. I crushed the tab, mixed it with 7.5 mgs of purified water and 7.5 mgs of Oral suspending fluid for a 1:1 compound. Not sure where I went wrong. I've been weighing tablets on a milligram scale and have failed my last three reductions, which is why I thought to switch to a liquid suspension. 

 

Can someone please explain to me the metric for identifying on a milligram scale how many milligrams I'm actually taking every night? Since I've been making reductions by weight and not by milligrams I think I might be grossly mistaken how many milligrams I'm actually taking every night. I'm not great at math so a little assistance would be awesome, thank you kindly!

[Altostrata]

Hi, Lia. Your math looks correct.

 

When you make this kind of suspension, you have to make sure it's well mixed. With the Ora-Plus liquid, you may have to gently stir it for a while.

 

If you get bubbles in it, you'd need to let them settle out, then gently stir to be sure the drug is distributed throughout the liquid.

 

Could it be you had bubbles in your liquid?

[LiaJ]

Mirtazapine Taper, some questions and support

 

I'm not sure if this is posted in the correct forum, but I am reaching out for some advice/support.

 

I am only taking MIrtazapine at this point, and am finding I must taper much slower than originally anticipated. I have been tapering this drug since it was introduced following a CT off Celexa in November of 2017. I had anticipated being fully off Mirtazapine in August of this year (2019), but am still at 3.5 mgs. Sleep is fairly poor, still. My chief complaint through withdrawal has been intense sleep disturbance, and for that I consider myself lucky. But also not so lucky, because lack of sleep, which we all know, is bloody miserable. 

 

I was hoping to start a dialogue with someone here who has had experience tapering off this particular drug. The SOltab I have been using has been discontinued, up to this point I've been weighing the crushed powder on a milligram scale. But for the discontinuation, I must switch to liquid. I am nervous about this transition, in case my body doesn't like Mirt in a liquid suspension. In some ways I think it will be easier, and dosing much more accurate. I have located a compounding pharmacy in my city, and will be attempting the switch soon. 

Question: should I wait to make another reduction until after my body has adjusted to the route of administration?

 

I have scoured the forums here about supplementation for insomnia and am hesitant to try anything. When I tried supplements a year ago paradoxical reactions abounded. I realize a year has passed and it might be different but still hesitant to try. 

 

Questions: is the insomnia still occurring from the CT off Celexa in 2017 or is this now associated with the taper from Mirtazapine? 

Occasionally I will get 7 hours. Mostly its 5. Many nights I will fall asleep hard and sleep for 4 hours and then be wide awake for the remainder of the night (like last night). Any ideas on how to make sleep more consistent? I have a consistent bedtime. Will this ever get better? 

 

My fear is that I will break down and the bottom will fall out with lack of sleep. I work full time and am in grad school full time and this is totally life interrupting and I'm really pissed about it. 

 

The worst thing is that I can't talk to anyone about it. I just go day in and out pretending that everything is okay but it's not.

 

Edited June 17, 2019 by ChessieCat
added topic title

[LiaJ]

Mirtazapine Taper, some questions and support

 

Hi everyone,

 

I was hoping to have some specific tapering advice about Mirtazapine. I CT off Celexa in 2017 (drug history in signature, it is up to date), and incorporated Mirtazapine in November of 2017 because of horrific insomnia. 

It's been two years, and I am still sleeping poorly. Tapering slowly, and sleeping poorly. Really afraid the bottom is going to drop out. I don't know anymore if I'm sleeping poorly because I'm tapering off of Mirtazapine, or if this is lingering destabilization from the Celexa CT. Or both. Since insomnia is really the only WD symptom I am experiencing (other than tinnitus) I don't really know if I'm going too fast or not fast enough. 

 

And I'm intensely afraid that I've been permanently damaged and wont ever be able to be drug free. 

 

Someone, please talk me off a cliff.

 

Edited June 17, 2019 by ChessieCat
added topic title

[ChessieCat]

9 hours ago, LiaJ said:

 

The SOltab I have been using has been discontinued, up to this point I've been weighing the crushed powder on a milligram scale. But for the discontinuation, I must switch to liquid. I am nervous about this transition, in case my body doesn't like Mirt in a liquid suspension. In some ways I think it will be easier, and dosing much more accurate. I have located a compounding pharmacy in my city, and will be attempting the switch soon. 

 

Question: should I wait to make another reduction until after my body has adjusted to the route of administration?

 

 

If possible it is better to do a cross over when changing form of a drug.  This is gentler on your system.  To do this you would take the following combinations for 3 to 7 days (you can do longer if you have enough of the old drug):  3/4 old + 1/4 new, 1/2 + 1/2, 1/4 old + 3/4 new.

 

9 hours ago, LiaJ said:

I have scoured the forums here about supplementation for insomnia and am hesitant to try anything. When I tried supplements a year ago paradoxical reactions abounded. I realize a year has passed and it might be different but still hesitant to try. 

 

Questions: is the insomnia still occurring from the CT off Celexa in 2017 or is this now associated with the taper from Mirtazapine? 

Occasionally I will get 7 hours. Mostly its 5. Many nights I will fall asleep hard and sleep for 4 hours and then be wide awake for the remainder of the night (like last night). Any ideas on how to make sleep more consistent? I have a consistent bedtime.

 

Insomnia is a common withdrawal / tapering problem.  It's hard to know what is causing it.  It might be one or the other or a combination of both.

 

Sleep problems - that awful withdrawal insomnia

[LiaJ]

Thank you

 

Edited June 17, 2019 by ChessieCat
removed quote

[LiaJ]

Hi everyone,

 

I am currently taking 3.2 mgs of Mirtazapine (liquid formulation), tapered from 7.5. At what point is it advisable to stop taking the drug?

 

Thanks, 

 

[manymoretodays]

Hi LiaJ,

I just moved your most recent post back here to your Introduction, from the Tapering forum.  Makes it easier to keep your most recent ?, in context, of your specific situation.

On 8/31/2019 at 5:33 AM, LiaJ said:

Hi everyone,

 

I am currently taking 3.2 mgs of Mirtazapine (liquid formulation), tapered from 7.5. At what point is it advisable to stop taking the drug?

 

Thanks, 

 

 

Most members jump off, or finish their tapers, somewhere below the 1 mg dose strength.  This is going to depend on how you are doing, or have been doing, with WD symptoms, and coping too.

More about this later, when I get on back here,  or someone else might have a moment to get back to you too before then.

 

How is your taper going at present?   And how have you been tapering, to date?  Meaning: how have you reduced the dose(% wise), and over what period of time?

 

Did you cross over to a new form of mirtazapine?

WD symptoms?  Any improvement with the insomnia?  How are you sleeping now?

And have you continued on the Trintillex, since you started it, back in October of 2017?

 

Best,

Love, peace, healing, and growth,

mmt

 

 

Edited September 1, 2019 by manymoretodays
further ?'s, spelling

[Gridley]

6 hours ago, LiaJ said:

At what point is it advisable to stop taking the drug?

 

 It is best to taper as low as possible before jumping.  If at all possible 0.1mg or smaller.  

[LiaJ]

On 8/31/2019 at 12:01 PM, manymoretodays said:

Hi LiaJ,

I just moved your most recent post back here to your Introduction, from the Tapering forum.  Makes it easier to keep your most recent ?, in context, of your specific situation.

 

Most members jump off, or finish their tapers, somewhere below the 1 mg dose strength.  This is going to depend on how you are doing, or have been doing, with WD symptoms, and coping too.

More about this later, when I get on back here,  or someone else might have a moment to get back to you too before then.

 

How is your taper going at present?   And how have you been tapering, to date?  Meaning: how have you reduced the dose(% wise), and over what period of time?

 

Did you cross over to a new form of mirtazapine?

WD symptoms?  Any improvement with the insomnia?  How are you sleeping now?

And have you continued on the Trintillex, since you started it, back in October of 2017?

 

Best,

Love, peace, healing, and growth,

mmt

 

 

Mmt,

 

Sleep isn’t awesome, and insomnia is my last remaining WD symptom. I am in grad school full time, and working, so I’m sure that doesn’t help. 

July was a beautiful month for sleep. Then it all fell apart again. Most nights I get 6 hours. Quality of that sleep varies widely. Sometimes I wake up feeling okay, and then I’ll have weeks at a time I wake up exhausted. At times I wonder if it will ever get better. Although they are extremely rare, I occasionally get 0-2 hour sleep nights. When I speak with people not in WD from psych meds, they report sleeping difficulties as well. I think they’re more common than we expect. 

 

For the reasons I stated above I am tapering more slowly than I probably need to. I am only taking 3.2 mg of Mirtazapine—no Trintellix. I stopped that in January of 2018. I am making 5% cuts every month or so, depending how I’m feeling. I switched to a liquid formulation in June and that was improved the taper tremendously. I’m due for another cut but I’ve found that I have to wait until after my period to reduce because my insomnia typically worsens around that time. 

 

I wonder if insomnia is a legacy affect. I have no other symptoms, other than my stress response being more sensitive than most. I’m lucky for that—and 1000x better than I was two years ago. 

 

Not taking any supplements other than magnesium. Everything else I tried either made matters worse or I observed no change either way. 

 

Thanks for taking the time to respond

[ChessieCat]

When to end the taper and jump to zero?

[ChessieCat]

Before creating a new topic please search to see if one already exists.  You can use the site search or use google and add survivingantidepressants.org to the search term.  Searching for CBD using either search found the existing topic.

 

I've moved your post to it.

 

cannabis-marijuana-thc-and-cbd-or-hemp-oil

 

[LiaJ]

Hello,

 

I need some advice—not sure if anyone still looks at this thread (post moved from Melatonin topic). I am tapering off Mirtazapine following a CT off Celexa in August of 2017. Sleep is still awful (usually 3-5 hours a night, not restful sleep). I have been hesitant to drop my dose because my sleep has sucked. At this rate I feel like I’ll never taper off. Insomnia is my only severe symptom. 

 

Do I continue to taper? Do I hold? Should I try Melatonin? I usually can fall asleep but wake up and can’t fall back to sleep. Some input on that supplement here is frightening. If anyone has experience tapering off this drug please respond. 

 

Thanks

 

Edited September 25, 2019 by ChessieCat
added moved from info

[ChessieCat]

On 9/2/2019 at 8:15 AM, LiaJ said:

I am only taking 3.2 mg of Mirtazapine

 

Please update your drug signature.  Account Settings – Create or Edit a signature

[LiaJ]

11 minutes ago, ChessieCat said:

 

Please update your drug signature.  Account Settings – Create or Edit a signature

 

11 minutes ago, ChessieCat said:

 

Please update your drug signature.  Account Settings – Create or Edit a signature

The signature is current. I feel like I’m never going to be okay again.

[Altostrata]

Does the mirtazapine help you sleep at all? If your sleep has gotten worse as you've lowered the dosage, I would stop tapering, let your sleep catch up.

 

To improve sleep, please read:

 

Tips to help sleep -- so many of us have that awful withdrawal insomnia

 

Path to Better Sleep FREE online for everyone from the US Veterans Administration

 

Music for self-care: Calms hyperalertness, anxiety, aids relaxation and sleep

 

What is the sleep cycle?

 

Melatonin for sleep: Many people find it helpful

 

TV or computer use in evening can disrupt sleep: Bright light signals the brain that it's daytime

 

White noise devices for sleep

 

Light therapy for sleep problems

Magnesium, nature's calcium channel blocker

 

Have you tried adding omega-3 fish oil? See

 

King of supplements: Omega-3 fatty acids (fish oil)

[LiaJ]

It helps some. I haven’t figured out the wild inconsistencies in sleep quality or lack thereof that is happening. July was a beautiful month for sleep—I felt the best I’ve felt in years. Then August gradually worsened, and September has been the worst month since my early withdrawal days in 2017/2018. My emotional state has deteriorated and my hope for the future is dimming. I feel like a burden to my family and my fiancé. I don’t even know why I continue in grad school because I feel like this is never going to end and I’ll never be okay enough to continue my career. 

 

Ive discontinued all supplementation apart from magnesium, which helps me eliminate. Still drinking coffee because I can’t survive through the day without it, class, research, work, etc. I don’t know anymore if I should continue tapering. If my sleep never improves, should I not reduce the dosage? I feel like I’m going to be on this drug forever. 

[Altostrata]

I would stop tapering for a while.

 

Please review the links I gave you, you might be able to strengthen your sleep. If you're on the computer late at night, that alone can cause poor sleep.

[LiaJ]

21 hours ago, Altostrata said:

I would stop tapering for a while.

 

Please review the links I gave you, you might be able to strengthen your sleep. If you're on the computer late at night, that alone can cause poor sleep.

Okay, will do. Thank you for the advice.

[LiaJ]

I am writing this after another night of no sleep. I CT off Celexa in 2017, and as 2020 is approaching, I feel like healing is not going to happen for me. I am in a dark place and I don't know what to do or where to turn. Everything I read on this site, Dr. Healy's protracted withdrawal list, says that essentially, if you're a women, you're *****. The older we get the worse it will become. For some the "spring" comes back to form but for others, it doesn't. I suppose I'm one of the latter. So now what? What about those of us who are essentially disabled and non-functional, who have had our lives abruptly and irrevocably shaken? Who can't any longer hope to become productive members of society, who cannot earn a living, or continue our PhD, or do the things we used to be able to do? Who are worse, afflicted with an invisible illness, surrounded by family and friends who don't understand, who tell us to "pull ourselves up by our bootstraps" and get along? What if I can't get along? I am feeling like the only way out is an unthinkable option, and I don't frankly have the guts to do it. I wish I did. 

[Altostrata]

@LiaJ what is your sleep pattern? Did you try the suggestions from last September?

 

What drugs are you taking now, at what times of day and dosages?

 

You do realize that caffeine can have a pretty significant bad effect on sleep, correct?

[LiaJ]

1 hour ago, Altostrata said:

@LiaJ what is your sleep pattern? Did you try the suggestions from last September?

 

What drugs are you taking now, at what times of day and dosages?

 

You do realize that caffeine can have a pretty significant bad effect on sleep, correct?

On good days, I fall asleep at 830, 9 pm and sleep until 3 or 4 am. I haven’t slept past 5 am in years, since this all went down. I will have periods of time (usually 3 or 4 weeks) when I sleep like this. Last Friday I slept for 90 minutes. The night after 4 hours. Sunday night I slept fairly soundly. Last night I slept for 3 hours. I try to keep a regular schedule. Epsom baths make it worse. I cannot tolerate fish oil, b vitamins, and I’m afraid to try Melatonin. In early withdrawal it didn’t help. I take magnesium currently. I am taking 3.2 mgs of Mirtazapine at night, and have been at this dose for three months now. 
 

I know instinctively that I should not be drinking coffee. When I stopped drinking coffee in early withdrawal I was a total zombie. I think I use it because it has an antidepressant effect. I’m afraid i won’t be able to drive or work or study if I don’t drink it. I have to work and go to school. I don’t know what to do.

[Altostrata]

That is not a terrible sleep pattern for withdrawal insomnia. You might just consider yourself an early riser for a while and get up at 5 a.m. Once your sleep strengthens, you might be able to sleep on a different schedule. Or you might find you like being an early bird.

 

What drugs are you taking now, at what hours of the day and dosages?

 

Your caffeine intake could be having a significant effect on your sleep pattern. You might taper it down over a few weeks and see if that helps.

 

Please read all the links above, they contain ways you might improve your sleep. Improving your sleep will help you recover from any other post-drug problems. It's up to you to make the small changes that can help you recover.

[LiaJ]

Introduced Progesterone, DIM, and theanine

 

I was doing so well, then my doctor prescribed me hormone replacement therapy, as I am developing symptoms of perimenopause that may or may not be related to W/D. I can't really tell anymore. 

 

I took three 200 mg doses of Progesterone (bioidentical) for three days, and then stopped because it was making me dizzy. Also, prescribed by a functional medicine doctor was DIM (for estrogen metabolism), which I began taking. The past week, my sleep has deteriorated to my early withdrawal days three  years ago. I am unbelievably discouraged by this. Has anyone had a similar experience and does anyone have any advice?

 

Thank you

 

Edited June 17, 2020 by ChessieCat
added topic title

[ChessieCat]

SA's existing topics:

 

older-female-issues-perimenopause-menopause-wd-or-something-else

 

female-hormone-therapy-estrogen-and-progesterone

 

 

 

[Artistic1]

LiaJ - your thread has a lot about sleep disturbances, and that has been my problem throughout, as well. I am not taking the same medication you are, but sleep problems are common with any of these drugs. Your sleep pattern sounds very much like mine. I have a sleep schedule, but never have consistent sleep like I used to before I went on AD's.  I wake up early sometimes and can't go back to sleep, or wake up early and go right back to sleep. Wake up several times a night, or only once or twice. I got so wrapped up with trying to get a good night's sleep that I COULDN"T get a good night's sleep because of my constant thoughts about it.

 

What helped me was learning some facts about sleep (from reputable books) and also by applying my CBT to my sleep. These things helped me to accept my inconsistent sleep patterns and to actually start sleeping better in the past two months:

1. You are probably sleeping more than you realize. Unless you are consistently watching the clock (which is not a good idea in any case), it's hard to know how much we're getting. Our brains will always go to the worst case scenario, especially if we don't feel rested. We'll tell ourselves, "I slept hardly at all last night," when it's really not the truth.

2. You may not need as much sleep as you think. We set ourselves up for frustration when we set requirements like we HAVE to get 8 hours of solid sleep. If you get a good book about how sleep works, you'll find that no one sleeps solidly for 8 hours. There are ups and downs to the sleep patterns. When you realize this, you quit putting pressure on yourself to meet some unrealistic requirement. You said you're getting 5 hours some nights. If you accept that that amount may be adequate for you (ie - you may be tired the next day, but you ARE functioning), it becomes easier to have those nights when you wake early.

3. If you can't sleep, then just rest. Even that is good for the body. When I can't sleep, I deep breathe and try some meditation. Sometimes that doesn't put me to sleep, but it calms my mind about it.

4. There are other CBT skills that can be applied to accepting sleep patterns that are different from your old ones.

 

A book about sleep that helped me feel a whole lot better about my sleep disturbances: "The Sleep Solution" by W. Chris Winter, MD. Available on Amazon. The author puts a lot of humor into this book which I found annoying because it makes it sound like he's making light of a bad situation, but if you can ignore that, I thought the information was really good. There are other books that you might like better, and they're certainly worth a try.

 

About the perimenopause etc.....I am post-menopausal, so not a candidate for hormone replacement therapy, but I did try progesterone by itself, thinking my hormones were part of the picture. It didn't do anything for me, so I stopped them. I wouldn't take HRT unless you absolutely have to (like if your menopause symptoms are unbearable). There are plenty of side effects with HRT, so you probably don't want to add more.

 

Best wishes, and good luck!

[Altostrata]

On 6/17/2020 at 2:12 PM, LiaJ said:

Introduced Progesterone, DIM, and theanine

 

I was doing so well, then my doctor prescribed me hormone replacement therapy, as I am developing symptoms of perimenopause that may or may not be related to W/D. I can't really tell anymore. 

 

I took three 200 mg doses of Progesterone (bioidentical) for three days, and then stopped because it was making me dizzy. Also, prescribed by a functional medicine doctor was DIM (for estrogen metabolism), which I began taking. The past week, my sleep has deteriorated to my early withdrawal days three  years ago. I am unbelievably discouraged by this. Has anyone had a similar experience and does anyone have any advice?

 

Thank you

 

 

Lia, even with "bioidentical" hormones, people who are sensitized by withdrawal may have unusual reactions to "normal" dosages. A tiny amount might work a lot better.

 

How are you doing now? What drugs are you currently taking, at what dosages and times of day?

[LiaJ]

Reaction to iodinated contrast dye?

 

Hi everyone.

 

I am reaching out for advice, hoping someone has had a similar experience and can offer suggestions/support. I had a CT scan on Friday with iodinated contrast media and think I am having a hypersensitive reaction to it. Nothing life threatening, though I am fairly certain I’m experiencing some akathesia. My anxiety at night has been horrible. My heart rate is more pronounced as well. Sleep has been pretty bad, too. I’ve been reading about contrast dye and it isn’t rapidly excreted from the body, which concerns me. I’m having a lot of fear right now, that this will gradually become worse (as it seems to have been the last few nights). Is there anything that can be done to assist with the elimination of iodine in the body? Id love to hear from anyone that has experienced this. 
 

thank you and be well

 

Edited November 3, 2020 by ChessieCat
added topic title

[ChessieCat]

Use a search engine and search for:

 

site:survivingantidepressants.org "contrast dye"

 

This will bring up posts where it is mentioned.

 

I had a CT scan for a bulging disc recently which required a dye and I was okay.  I've got no idea what kind of dye was injected but it probably was iodine contrast dye because that is the most common one.

[LiaJ]

Thank you for your reply. It doesn’t seem to be negatively impacting most people. I am wondering why my sudden downturn seems to be directly related to the CT scan with dye I had Friday. My sleep/anxiety has returned to its early WD state and I don’t know what to do. 
 

I have read that exposure to contrast dye can negatively impact your thyroid functioning, though this is rare in otherwise healthy people with no underlying thyroid condition or genetic predisposition. The iodine in the contrast is extremely slow to be eliminated—about 59 days for most people for iodine levels to return to baseline. 
 

Im just not sure if I should be seen again or ride it out. This feels like a massive setback. 

[ChessieCat]

What was the reason for the CT scan?

 

Have you got the results of it yet?

[LiaJ]

I was having vision disturbances after lifting weights at home. I called my PCP (the doc more or less supporting my taper) who is in another city, and he suggested I go to the ER to be evaluated. My vision was blurry w/strange blinking lights. Everything from the test was normal and fine and they diagnosed me with a migraine, which I’ve never had before. Now I’m of course mad at myself that I potentially complicated my WD for absolutely no reason. I laid in bed all night awake with gut wrenching anxiety and a racing heart. 

[ChessieCat]

I've merged your contrast dye topic with your Introduction topic so it keeps your history in one place.

[LiaJ]

On 6/18/2020 at 10:36 AM, Artistic1 said:

LiaJ - your thread has a lot about sleep disturbances, and that has been my problem throughout, as well. I am not taking the same medication you are, but sleep problems are common with any of these drugs. Your sleep pattern sounds very much like mine. I have a sleep schedule, but never have consistent sleep like I used to before I went on AD's.  I wake up early sometimes and can't go back to sleep, or wake up early and go right back to sleep. Wake up several times a night, or only once or twice. I got so wrapped up with trying to get a good night's sleep that I COULDN"T get a good night's sleep because of my constant thoughts about it.

..........

 

I am just now seeing this message—I very much appreciate your thoughts and reaching out with the support you gave!

 

Hope you are doing well?

 

Edited November 9, 2020 by ChessieCat
removed some of the quote to save space

[Artistic1]

Hi....thank you for replying. It's hard to keep up with all the messages on this site. Yes, I'm doing well...thank you for asking. Hope you are, too.

[LiaJ]

Unsure of what’s happening

 

I’m hoping a moderator will respond with help, or someone who has been through this as well. I had a CT scan with contrast dye a little over a week ago. The following three four days I experienced rapid weight loss, zero appetite, extreme anxiety and what I think may be akathisia, and the symptoms remitted the last few days. I think it was obviously a bad reaction to contrast dye.

Last night I took magnesium like I do every night and the Mirtazapine I am tapering off. Five minutes after I took the magnesium my heart started to race and I’ve been up all night with extreme anxiety, thirst and akathisia, unable to sleep or really just be still. Nothing like this has happened in WD yet and I am really scared. Not sure why this is happening. 

 

Edited November 9, 2020 by ChessieCat
added topic title