Mark840: tapering Cymbalta

[Mark840]

Hi all,

 

I slept about 4.5 hours yesterday, an improvement after a long while.

 

@ChessieCat Does my post above make sense in any way?

[Altostrata]

How are you doing now, @Mark840

[Mark840]

@Altostrata 4.5 hours is the longest sleep recorded when I had this sudden sleep issue on 17 November onward. For the past few days, it is near 4 hours of sleep. However, after waking up, I could resume a light sleep somewhat better, since I seem to have a mini series of abnormal dreams, waking up by the dream then sleeping back again. It's not the same as a long, solid 7 hours sleep, of course.

 

I try to control what I can (sleep hygience, focus on prayers, social support) but I can't do much about work.

 

I got 2 theories:

a) The accumulated and frequent moderate work stress eventually caused a disruption in my sleep. My brain could be sensitive already, due to my failed attempt (by cold turkey) to withdraw previous drugs last year (Cymbalta, Quentiapine; see signature)

b) After 9 months, Mirtazapine has lost the effect to support my sleep and/or failed to "replicate" the previous drugs effect my brain was used (Cymbalta, Quentiapine; see signature)

 

For now, I'll try to tolerate this without doing anything to my 15 mg mirtazapine I'm taking now. Hopefully my sleep improves.

[Altostrata]

When people stabilize, we expect gradual improvement in symptoms such as broken sleep.

[Mark840]

Last Sunday, I suddenly got 5.5 hours of sleep. Yesterday, I got 6 hours. I consider 6 hours as back to normal, my usual hours of sleep. I didn't do anything different to achieve this.

 

I wonder if I can sleep again this long tonight. I hope it's the end of this unknown sleep problem, whether it's due to psychiatric drugs or work problems.

[Altostrata]

On 12/8/2022 at 12:56 PM, Altostrata said:

When people stabilize, we expect gradual improvement in symptoms such as broken sleep.

 

[Mark840]

I would like to update that my sleep has been 4-6.5 hours, an improvement. Been suffering since 17 November. Another symptom I did not mention much is having abnormal dreams frequently. I suppose this problem is linked to my abrupt withdrawal from the previous drugs and that mirtazapine now has lost its effect to aid my sleep.

 

An interesting observation is, after I stopped taking the previous drugs (before being on mirtazapine), I started to lose weight (been gaining despite exercise and high fibre diet) and no longer experience an odd muscle weakness (complicated to describe in detail) that often is triggered by stress for the first time after many years.

[Altostrata]

Good to hear you're doing better, and you're recovering from the adverse effects of the drugs you took.

 

Many people find fish oil and magnesium supplements helpful, see

 

https://survivingantidepressants.org/index.php?/topic/36-king-of-supplements-omega-3-fatty-acids-fish-oil/

 

https://survivingantidepressants.org/topic/15483-magnesium-natures-calcium-channel-blocker/

 

You might try a little bit of one at a time to see how it affects you. Please let us know how you’re doing.

[Mark840]

Hello all,

 

My company is downsizing. Lots of work now with less staff. This has make it hard to sleep well. On average, it's about 4-5 hours, some days no sleep. I sleep about 10:30 p.m. and wake up about 2:00 a.m. Fortunately, I got a new job which I expect it's less demanding. The 2.5 months notice period though is like forever. Been taking fish oil too.

 

Another interesting note is, after a year, I successfully convinced my doctor (public) for the 15 mg mirtazapine tablet. Now I don't need to worry if I cut accurately half of 30 mg tablet. Complicated story. After I stopped the previous drugs abruptly, I'm viewed as a non-compliant patient. After being a little bit stable with mirtazapine, in one visit, I was honest with my experience (work anxiety, etc.). The doctor then said to increase to 30 mg mirtazapine. I wasn't sure how to go about it. If I disagreed, it may reinforce the fact I'm non-compliant. I was also depressed and anxious, so I couldn't think. I just pretended I accepted the 30 mg mirtazapine, but I actually take 15 mg mirtazapine by cutting it.

 

I'm not sure if this is the best way to deal with my situation. I had to report good well-being for 1 year before the doctor said "OK, let's try 15 mg since you've been well for a year." It feels like a job interview where I can't be too honest.

 

Also, I asked if I am ready to go lower in the next visit, how do we go about it? The doctor said I would take the 15 mirtazapine on alternate days. I don't think I'm ready to do so soon, but can this work?

[Altostrata]

9 hours ago, Mark840 said:

Also, I asked if I am ready to go lower in the next visit, how do we go about it? The doctor said I would take the 15 mirtazapine on alternate days. I don't think I'm ready to do so soon, but can this work?

 

This is a terrible idea. NEVER SKIP DOSES TO TAPER 

 

Can you find another doctor? In the meantime, suggest you tell your doctor you're doing well on the 15mg prescription and stop asking them about tapering.

[Mark840]

I'd like add some details after looking at my note. The doctor said I'd need to be well for another 6 months before I could taper. That is which the doctor's advice was I would take the 15 mirtazapine on alternate days for 3 months.

 

When I'm ready and have the financial resources, I'd probably finid a private doctor. For now, I see a public/government doctor which is virtually free but long waiting times and almost everytime I visit therer is a different doctor.

 

I wish to add again the benefits I have now which is consistent weight loss. After consistent weight gain for about 10 yeas, it's finally going down. I lost 8 kg after a year but still overweight. High blood pressure readings are better too. My reguar general physician asked what I did which I suspect it's the change of drugs. Other than that, I don't experience a weird body weakness and tremor that can be trigerred by stress or no reason sometimes. I don't share this with doctors as it appears to be a weird problem that doctors can't explain except to attribute to psychological problems. But I suspect it's the previous drugs side effects.

 

However, if I could go back in time, I'd like to stop myself from going virtually cold turkey on the previous drugs, as the sleep problem and the time to adapt to where I am is not worth it.

[Altostrata]

Great. You can simply reassure the doctor that you are continuing to fill your 15mg prescriptions.

How do you talk to a doctor about tapering and withdrawal?
 

[Mark840]

Hello all,

 

In a new job and less demanding at the moment. Most days of sleep are 4.5 hours, some worse, a few about 5 hours. After wakinig up, easier to relax/sleep lightly again now.

 

The same positive improvements are weight loss (10 kg but still overweight based on BMI) and good blood prerssure (most days within normal readings and no longer borderline/high blood pressure). Perhaps I can ask the doctor if I can do without the high blood pressure medicine.

 

But everyday feels like a dread still since still with little sleep. To describe my experience, the beginning of the day comes with a mild feeling of frustrartion (lack of sleep). Then I got to be careful managing my day-to-day affairis. Hard to look forward to anything like meeting friends, etc. Any issues encountered would worsen my frustration.

[Altostrata]

How has your sleep pattern changed since you started your new job?

 

What times o'clock do you take your drugs, with their dosages?

[Mark840]

Hi Altostrata,

 

Some sleep patterns before new job were:

• average of 4 hours sleep
• After 1st waking up, harder to continue sleeping lightly (consicously awake or resting)
• 8 days of poor/light/no sleep in one of the months

 

Current sleep patterns in the new job are:

• average of 4.5 hours of sleep
• After 1st waking up, can continue to sleep lightly (consicously awake or resting)
• 4 days of poor/light/no sleep in the last 30 days

 

I strictly take 15 mg mirtazapine at 7 p.m. everyday for a long while. I take fish oil supplement too.

 

At this point of time, I'm trying to find out why some days I could sleep a bit longer. Reasons are not so clear. Perhaps I'll look at pillow (memory foam), exercise, melatonin supplement later.

[Altostrata]

You've been at your new job 6 days. How has your sleep pattern changed in the last few days?

 

See sleep tips 

 

What is the sleep cycle?

 

 

Waking with panic or anxiety -- managing the morning cortisol spike

 

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

 

White noise devices for sleep

 

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

 

[Mark840]

Thanks for the sleep articles.

 

Sorry, I didn't mention I started my new job on 5 June. Even though it's less demanding, therer's still some stress due not picking up the tasks fast (due to non-psychiatric heath problems). For now, the stress level is much lower than before.

 

I feel I'm struggling to survive in life for too long. I'm so tired.

[Mark840]

Quote

How has your sleep pattern changed in the last few days?

 

20 Jul

Slept 10:06 pm

Woke up 2:12 am Then resumed light sleep. Weird dream.

 

21 Jul

Slept 11:04 pm

Did not sleep and got off bed at 11:42 pm, probably due to eating lots of my favourite steamed fish (heavy meal) and not enough vegetable (my deduction).

 

22 Jul

Slept 10:19 pm

Woke up 1:11 am; resumed sleep lightly but not effective as I had trouble waking up, felt feverish, sensitive to cold temperature when waking up. Weird dream.

 

23 Jul

Slept at 9:22 am.

Woke up 2:20 am; woke up feelinig anxious and depressed despipte no major work issues. Weird dream.

 

24 Jul

Stressful in the day. Unable to fall asleep at night. Writing this post now.

 

Often it's very hard to note the details once I wake up from the 1st sleep of few hours as I'm still sleepy. I'm restless and tired at the same time. Got to force myself to note down before I forget them easily. There's another complicated health problem which is compounded by this psychiatric withdrawal symptom that I can't disclose without easily being identified since it's a rare disorder.

[Altostrata]

The stress of a new job can cause worry and sleeplessness, but it should wear off.

 

6 hours ago, Mark840 said:

There's another complicated health problem which is compounded by this psychiatric withdrawal symptom that I can't disclose without easily being identified since it's a rare disorder.

 

Could your symptoms be caused by this disorder?

[Mark840]

Before I voluntarily ceased my drugs abruptly, this disorder didn't affect my sleep. After the mess I got myself into, it indirectly affects my sleep. Other symptoms like anxiety, depression are not directly related.

[Altostrata]

Since a new job might cause someone to lose sleep, I can't tell whether that might be what's affecting you.

 

I see you've been on and off a zillion psychiatric drugs in the last 11 years with frequent bouts of poor sleep, might I presume you've been chasing this symptom for all this time? Perhaps you might simply leave your nervous system alone.

 

About 5 hours sleep a night is not bad for withdrawal syndrome.

 

Otherwise, my mind-reading capabilities are very limited, so I cannot tell you what's going on with your sleep or any other health problem you might have. 

[Mark840]

Thanks for trying to understand me. Let me try to address your points short and concise:

 

14 hours ago, Altostrata said:

Since a new job might cause someone to lose sleep, I can't tell whether that might be what's affecting you.

Although work does affect sleep to an extent, before Jul-Sep '21 (in my signature), I didn't have sleep issue. Even when there were major work or personal stresses, sleep was not sigficantly impacted.

 

Quote

I see you've been on and off a zillion psychiatric drugs in the last 11 years with frequent bouts of poor sleep, might I presume you've been chasing this symptom for all this time? Perhaps you might simply leave your nervous system alone.

The sleep issue started Jul-Sep '21 onward. The key drug that disrupted my sleep was the change from Seroquel/quentiapine XR to quentiapine IR. My sleep was affected immediately. Other symptoms I'm not too sure if it's part of the withdrawal syndrone now are waking up feeling anxious for no apparent reason. From Aug-17 Nov '22 onward, I've been on 15 mg mirtazapine alone and no intention of tapering soon.

 

Quote

About 5 hours sleep a night is not bad for withdrawal syndrome.

Perhaps a range is more accurate: 3.5 to 4.5 hours. In the beginning when it started (17 Nov-11 Dec '22), it was 2 hours plus. After about 9 months, I now have 3.5 to 4.5 hours.

 

Hope that clarifies.

[Altostrata]

Well, you've been on and off a zillion psychiatric drugs in the last 11 years and perhaps started experiencing insomnia as an adverse effect or withdrawal symptom from the many drug changes you made July-September 2021. 

 

You were beating up your nervous system for 10 years. Your nervous system is not made of rubber. I have no idea what's causing your poor sleep now. If I were you, I would work on non-drug techniques to strengthen your sleep 

 

 

What is the sleep cycle?

 

Waking with panic or anxiety -- managing the morning cortisol spike

 

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

 

White noise devices for sleep

 

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

 

Light boxes/light therapy for depression and sleep disorders

[Mark840]

My insomnia has disappeared by taking mirtazapine in the morning. I got the idea from: https://www.meded101.com/mirtazapine-for-insomnia-are-you-using-it-correctly/

 

Quote

If the patient is taking mirtazapine doses of 30-45mg/day and is experiencing insomnia, the medication should be taken in the morning to allow for activating noradrenergic effects to decrease by bedtime.

 

 

[Mark840]

My insomnia has disappeared by taking mirtazapine in the morning. I got the idea from: https://www.meded101.com/mirtazapine-for-insomnia-are-you-using-it-correctly/

Quote

If the patient is taking mirtazapine doses of 30-45mg/day and is experiencing insomnia, the medication should be taken in the morning to allow for activating noradrenergic effects to decrease by bedtime.

 

I thank God I found this method after a year of poor sleep.

[Altostrata]

Quote

If the patient is taking mirtazapine doses of 30-45mg/day

 

This advice is for people taking high doses of mirtazapine as an antidepressant, not for people taking low doses of mirtazapine for sleep.

 

Please do not advise other members to change their mirtazapine dosing if they are taking low doses for sleep, you could cause them to have sleep disruption or withdrawal symptoms.

 

Your signature says "Jun '23-present: 3.5 to 4.5 hours hours of sleep". If this has changed, please update your signature.

[Mark840]

My insomnia is gone and mood has been stable for a while. I will explore tapering 15 mg mirtazapine (SolTab) by using the liquid mixture method.