Clematis501: help with Mirtazapine

[Clematis501]

Hi there

 

just wondering if you could advise me.

 

I had taken Mirtazapine 15mg for 3 months.

On gp advice I halved for two days and then stopped completely on 5th feb 22.

Withdrawal symptoms started on the 8th - feeling unwell, tired, reduced appetite and diarrhoea.

I currently have no appetite and have lost weight and diarrhoea and nausea - some anxiety but mostly about withdrawal and not being able to work!

 

I have read lots on this site and see that it’s best to reinstate then taper.

I currently only have 15mg tablets and am awaiting delivery of cutter and scales in a few days time. I could probably cut tabs into rough quarters now but tricky as they are oblong shaped and not sure if 3.75 would be right dose to reinstate with or should be lower.

am going to try to obtain liquid but not sure when this might be possible. Worried about leaving it much longer.

 

any advice greatly received, thank you

 

 

 

 

 

[Clematis501]

Hi again

just to add that I now have oradispersal 15mg so could make liquid solution and try low dose - should I try 1 mg reintroduction ?

thanks so much, this website has so much amazing information.

[getofflex]

Hello, and welcome to SA.  We are a volunteer-run community of people who have been or are getting off of psychiatric drugs.

Thank you for supplying your drug history in your drug signature.  Your GP basically had you cold turkey off mirtazapine, and that is probably why you are having symptoms.  Are you or have you been on any other drugs?  If so, please add this to your drug history.  

 

Here is some information about how these drugs actually work.   This explains why we get symptoms from going off of these medications when we get off them too fast. 

 

How Psychiatric Drugs Remodel Your Brain

 

 

This helps you understand what withdrawal syndrome is: 

 

Video on Recovery from Psych Drugs

 

 

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 believe that you would probably be benefitted by a reinstatement.  The sooner you reinstate after you quit, the better.  When I know more about your medication history, I can give you a suggested reinstatement dose.  Reinstatement is best done very carefully.  This is temporary, and after stabilizing you would then taper gradually off of this.  There is some risk involved.  Here is some information about reinstatement.  

 

About Reinstating and Stabilizing to Reduce Withdrawal Symptoms

 

I've given you quite a bit of information here.  Take your time to go through it.  Please keep in touch, and let us know how you are doing.  

[Clematis501]

Hi getofflex

 

thank you so so much for your reply and all of the information.

This was my first experience of taking an anti depressant  - taken for high anxiety due to a situation that has now passed.

I am not on any other regular meds currently, just occasionally take paracetamol.

 

To deal with nausea I have twice taken an anti sickness - cyclizine 50mg in the last week, which helps, but trying not to use as now very vary about complicating things.

 

I feel I definitely have withdrawal- the physical symptoms are strong. I am using relaxation and mindfulness techniques to help me to manage the anxiety and worry about the situation I am in.

 

I would like to reinstate as soon as possible but as I am indecisive at best of times and prone to catastrophising  and ruminations deciding about which dose to reinstate is really hard.  

 

Thank you  again 
 

 

 

[OldDodgy]

@Clematis501

Hi

i am sorry you were essentially CT recently. I had to reinstate Mirtazipine and found that going back to one third of the jump off dose until comfortable worked for me. In fact I stayed on 3.75 for about three weeks. 
As mirtazipine is an antihistamine AD it’s best to avoid antihistamines in withdrawal and cyclizine is one.  However if it’s helpful then why not try it. I was just told it would slow my taper by the Mirtazipine FB group. 
However after the sleeplessness, nausea and anxiety came under control the next reductions were ok and I was off in a couple of months. Sleep remained an issue. 
I hope you do well and happy to give you moral support. Try a low histamine diet too as it will reduce anxiety. 
yours 

OldDodgy 

[Clematis501]

Thank you so much OldDodgy it helps so much to hear your experiences and not feel so alone with this.

 

I was thinking the same thing about the anti nausea med as I knew there was some sort of antihistamine connection with that and the Mirtazapine.  I will look into the antihistamine diet.

 

so glad to hear your reductions went well, that’s amazing.

 

I had a big insomnia episode before starting the Mirtazapine, the drug did not solve this for me so I turned to the sleep book, guy meadows. This really helped me and I’m using the mindfulness and acceptance techniques now if I feel any anxiety around sleep,  and when I wake in the night, for me they are a lifesaver as otherwise I would be up all night worrying about all of this.

 

yes just got to not worry and make a decision about reinstatement dose and get on with it!!

 

Can I ask whether you reduced your doses by cutting tablets or liquid ?

[OldDodgy]

@Clematis501

 

Hi

If used the 15mg/ml liquid but you need a 1 ml syringe for accurate reduction not the one supplied.  
 

the low histamine diet is pretty crucial imho.  If you find it tricky then the supplement DAO PLUS from Amazon seems to reduce histaminic activity.  
 

You are doing great. Remember your blood fats and your sugar levels are much safer once off mirtazipine BUT please don’t rush it.  

Acceptance is key to sleep loss.  No pillow punching etc, just relax and accept. 
Here is a link…..you click in recourses then Covid resourses and then free audio down loads. Let me know if it helps. My medic friends composed it.   https://www.bscah.com/   

Chin up 

OD

[Clematis501]

Hi

 

Thank you that’s really helpful.

My gp has refused to prescribe liquid so I’m just weighing up the best options. Yes I intend to go slow once I have reinstated that’s great advice.

 

just had a quick look at low histamine diet, seems that mine is pretty low already with a couple of exceptions that I will now cut out.

 

yes acceptance is my mantra with it all !!

[Clematis501]

Hi Getofflex

 

I have just changed my signature to include my dosage halved for two days before I stopped.

just incase that effects you advice about a reinstate dose.

 

many thanks

 

ps my first time on a forum so just let me know if I make any mistakes in my postings.

[OldDodgy]

Hi again @Clematis501

Pity the Gp won’t let you have 45 quids worth of liquid which would see you to the end.  
Although mirtazipine isn’t water soluble providing you create  a 1-1 solution after crushing a 15 in 15 mil of water and withdraw what you need whilst stirring well you will get a pretty near dose. ( There are threads on this in search). 
But anyway mirtazipine has a 20-40 hour elimination so if you use a hobby knife on a 15 you can certainly get to 3.75 fairly accurately and providing you use the same tablet over 4 days it’s going to even out.  Others may disagree with this approach and have other suggestions.  But it worked for me.  As with “acceptance” I didn’t obsess about being 100%. 
I only got the liquid by default as my GP thought it best, however the next thing is worrying about bubbles in you syringes.  -))
If you are going nice n slow I really would not stress. 
I jumped off at 1 mg approx. 

Good luck, I am always happy to be corrected of course. 
yours 

OD 

[Clematis501]

Hi @OldDodgy

 

thank you for so much for your support and reassurance. It really helps.

[getofflex]

17 hours ago, Clematis501 said:

I would like to reinstate as soon as possible but as I am indecisive at best of times and prone to catastrophising  and ruminations deciding about which dose to reinstate is really hard.  

Since you have not been on other psych meds, don't have an extensive history of psych meds, and you recently (2 weeks ago) did a cold turkey, you could try a reinstatement of 7.5 mg. of mirtazapine, which is 1/2 of your original dose.  Remember, the sooner you do a reinstatement after you quit the drug, the better.  Not to pressure you, but just keep that in mind.  Take this every day at the same time of the day for a week, and then we will see where you are.  It takes about a week for a reinstatement to get in your system and register with your brain.  If you feel significantly worse after you reinstate, then stop the reinstatement.  If not, then stay on this for several months, until you stabilize.  Then, you can slowly and gradually taper off of this.  

 

Please let us know what you decide to do.  

Edited February 20, 2022 by getofflex

[OldDodgy]

@Clematis501
 

@getofflex

has given excellent advice in my opinion. Reinstatement of 5-7.5 mg and remaining steady for some months is the key here.  I found a third of the last dose was sufficient. You would be surprised how often this works.  I look forward to you feeling more comfortable. 
(I trust your Vit E dose is not too high, it made me feel pretty grim.)

I am glad you managed to get the dispersing meds as it will be easier. 
All the best 

OD 

  

[Clematis501]

6 hours ago, getofflex said:

Since you have not been on other psych meds, don't have an extensive history of psych meds, and you recently (2 weeks ago) did a cold turkey, you could try a reinstatement of 7.5 mg. of mirtazapine, which is 1/2 of your original dose.  Remember, the sooner you do a reinstatement after you quit the drug, the better.  Not to pressure you, but just keep that in mind.  Take this every day at the same time of the day for a week, and then we will see where you are.  It takes about a week for a reinstatement to get in your system and register with your brain.  If you feel significantly worse after you reinstate, then stop the reinstatement.  If not, then stay on this for several months, until you stabilize.  Then, you can slowly and gradually taper off of this.  

 

Please let us know what you decide to do.  

thank you so much @getofflex

 

last night Before I received your advice I went ahead and took a reinstatement of 2mg, so far this morning I don’t fell any adverse effects, but suspect this isn’t going to be enough to stop withdrawal symptoms 

 

Hopefully it is it still ok to increase to 7.5 tonight - I think it’s a good idea and I’m trying not to overthink.

 

 

 

[Clematis501]

2 hours ago, OldDodgy said:

@Clematis501
 

@getofflex

has given excellent advice in my opinion. Reinstatement of 5-7.5 mg and remaining steady for some months is the key here.  I found a third of the last dose was sufficient. You would be surprised how often this works.  I look forward to you feeling more comfortable. 
(I trust your Vit E dose is not too high, it made me feel pretty grim.)

I am glad you managed to get the dispersing meds as it will be easier. 
All the best 

OD 

  

thank you so much for your support 

 

[Clematis501]

9 hours ago, getofflex said:

Since you have not been on other psych meds, don't have an extensive history of psych meds, and you recently (2 weeks ago) did a cold turkey, you could try a reinstatement of 7.5 mg. of mirtazapine, which is 1/2 of your original dose.  Remember, the sooner you do a reinstatement after you quit the drug, the better.  Not to pressure you, but just keep that in mind.  Take this every day at the same time of the day for a week, and then we will see where you are.  It takes about a week for a reinstatement to get in your system and register with your brain.  If you feel significantly worse after you reinstate, then stop the reinstatement.  If not, then stay on this for several months, until you stabilize.  Then, you can slowly and gradually taper off of this.  

 

Please let us know what you decide to do.  

Hi

 

Another quick question
 

Before my CT I was taking 15mg tablets and I still have approx one months supply.

 

last night I tried 2mg of new orodispersable  different brand.

 

Now I an returning to 7.5 should I go back to old tablets and halve to stabilise and then transition to new orodispersable  ones when I start to taper in the future?

 

many thanks

 

i

 

 

 

[OldDodgy]

I think it’s worth using up your old supply if you are confident in cutting them in half reasonably accurately. 
you will need the dispersible later.
I would follow @getofflex advice as he may have tapered more folk than me. 
I think I was able to reinstate by less because I am still on diazepam of course. 
Try not to overthink it and as getoflex says it takes time to stabilise. 
You will defeat this. Keep in touch. 
OD 

[Clematis501]

Thank you @OldDodgy for your advice again,  I really appreciated it. Yes I will follow @getofflex advice and try the 7.5mg.

 

I had a tough day yesterday with the gut symptoms, anxiety increase etc.

feeling a little better this morning, maybe the 2mg ?

I will monitor the 7.5mg reinstate and let you know how it goes.

Sending my best wishes to you

 

 

 

[Altostrata]

18 hours ago, OldDodgy said:

I found a third of the last dose was sufficient. You would be surprised how often this works.

 

Exactly. At this point, even 2mg might be enough. It seems it made you feel a little better. Mirtazepine will ramp up over a week or so, can you give 2mg a little more time? You should feel progressively better as it reaches steady-state in the coming days. Be sure to take it at the same time each day.

[getofflex]

15 hours ago, Clematis501 said:

Hopefully it is it still ok to increase to 7.5 tonight - I think it’s a good idea and I’m trying not to overthink.

Yes, go ahead and go up to 7.5, and then stay there, unless you feel worse, as previously suggested.  

 

12 hours ago, Clematis501 said:

Now I an returning to 7.5 should I go back to old tablets and halve to stabilise and then transition to new orodispersable  ones when I start to taper in the future?

Yes, I would halve the 15 mg tablets for your 7.5 dose.  Let's take things one step at a time.  I would stay at the 7.5 dose for at leas several months, (3-6) to allow my system to stabilize, if it were me.  

[Clematis501]

18 hours ago, Altostrata said:

 

Exactly. At this point, even 2mg might be enough. It seems it made you feel a little better. Mirtazepine will ramp up over a week or so, can you give 2mg a little more time? You should feel progressively better as it reaches steady-state in the coming days. Be sure to take it at the same time each day.

 

thanks so much much for your reply - I had already taken a 7.5 dose last night before I saw it this morning.

So I am guessing that it is best now to stay with that and take for at least a week if all goes well. So far, so good!

 

can I just say thank you so much for your incredible work, in the midst of my cold turkey this website has been an absolute life saver. 

[Clematis501]

18 hours ago, getofflex said:

Yes, go ahead and go up to 7.5, and then stay there, unless you feel worse, as previously suggested.  

 

Yes, I would halve the 15 mg tablets for your 7.5 dose.  Let's take things one step at a time.  I would stay at the 7.5 dose for at leas several months, (3-6) to allow my system to stabilize, if it were me.  

Thank you again @getofflex

as mentioned, I did take 7.5 last night and have felt a lot better today, so will continue and keep you all posted.

best wishes

 

[getofflex]

I’m glad it’s helping you. I’ve seen too many people cold turkey or fast taper and their condition deteriorates over several months after that. It often takes years to recover from a cold turkey.  I didn’t want to see that happen to you. 

[Clematis501]

19 hours ago, getofflex said:

I’m glad it’s helping you. I’ve seen too many people cold turkey or fast taper and their condition deteriorates over several months after that. It often takes years to recover from a cold turkey.  I didn’t want to see that happen to you. 

thank you so much I really appreciate it.

 

today the withdrawal symptoms (diarrhoea and nausea) a little worse than yesterday but overall not as bad as before I reinstated and no return of severe anxiety and depersonalisation I had last weekend. I will keep going with 7.5 and hopefully it will settle over time.

it’s a worry as I’m off work sick with it, but am very aware that many have been here before and that I  just have to take each day as it comes.

 

thanks so much for replies as I am very aware how many are needing support and that you all have your own lives also.

 

many thanks

 

 

[OldDodgy]

@Clematis501

Glad you seem more positive.  Do take it slow. I wish I had gone slower in retrospect. 
Yours,

 OldDodgy 

[getofflex]

3 hours ago, Clematis501 said:

today the withdrawal symptoms (diarrhoea and nausea) a little worse than yesterday but overall not as bad as before I reinstated and no return of severe anxiety and depersonalisation I had last weekend. I will keep going with 7.5 and hopefully it will settle over time.

I'm glad to hear that the symptoms are still better than before the reinstatement, even if you are a bit worse today.  Recovery from these drugs tends to involve ups and downs.  If these ups and downs are drastic, we call them windows and waves. 

 

Windows and Waves Pattern of Stabilization

 

I think you are wise to stick with the 7.5 mg.  It should settle over time.  I've seen too many people jump around on their drugs and dosages anytime they have a bad day or a worsening symptom, and this tends to make their situation even worse.  

 

[Clematis501]

Thank you @OldDodgy

 

yes I will take it slowly and try to keep positive as much as I can.

 

take care

[OldDodgy]

Bless you @Clematis501

Take your time. 
I have thoroughly messed up my diazepam regime by covering family crisis around Christmas with extra and Kindled myself. I should know better.  
Have been ticked off!! 
Finding stability very difficult. 
chin up 

OD 

[Clematis501]

4 minutes ago, getofflex said:

 

I think you are wise to stick with the 7.5 mg.  It should settle over time.  I've seen too many people jump around on their drugs and dosages anytime they have a bad day or a worsening symptom, and this tends to make their situation even worse.  

 

 

thank you for your reassurance and guidance @getofflex

 

[Clematis501]

7 minutes ago, OldDodgy said:

Bless you @Clematis501

Take your time. 
I have thoroughly messed up my diazepam regime by covering family crisis around Christmas with extra and Kindled myself. I should know better.  
Have been ticked off!! 
Finding stability very difficult. 
chin up 

OD 

I’m so sorry to hear that @OldDodgy

of course we do these things because things are so tough at the time, not always knowing what the consequences will be.

really hoping that things settle for you soon and you get that stability.

best wishes

 

[Altostrata]

Good to hear 7.5mg works for you, @Clematis501

[Clematis501]

Thank you @Altostrata.

 

I know you mentioned the Mirtazapine dose may ramp up over a week or so.

I am hoping WD may reduce a bit more and allow me to return to work and also put me in a better position for future taper.

 

thanks again for all that you do for so many.

 

 

[Clematis501]

Hi 

 

I just wanted to update on how I am getting on - with any advice @Altostrata @getofflex much appreciated.

 

I am still taking 7.5mg mirtazapine nightly at 9pm

 

Positives - GI symptoms, diarrhoea, severe nausea resolved and my appetite has returned.

waves and windows of improvement in anxiety and depersonalisation,

usually feel better in the mornings and evenings

 

Negatives - in the last few days weak and shakiness in the legs, slightly dizziness - most noticeable if I go for a short walk - exercise intolerance. Still have of lack of resilience for long conversations, or anything more than basic daily activities.  Not well enough to return to work or go out and meet people yet

 

Most of the time I accept that I will have to wait this out and deal with what happens whilst using self help techniques to prevent additional worries and fears about it all. 

 

But sometimes wonder if I should be adding a slight increase of mirtazapine to reduce the WD symptoms further at some point ? Sorry if it’s the impossible question to answer !

 

best wishes

C
 

 

 

 

[OldDodgy]

@Clematis501

Hiya

I think that is quite a positive post. And you have settled on a dose for two weeks, so my gut feeling is to stay on that a while. 
(I did partially reinstate mirtazipine after dropping a tad fast but I don’t get the feeling that you need to.)

From here on in it’s important to keep good notes for yourself and those helping.
Really proud of you—- Best wishes

OldDodgy  

[Clematis501]

Thanks so much @OldDodgy

 

I really appreciate your advice to keep notes. I have been avoiding doing this as part of my denial about what is happening - but I think you’re right so will start.

best wishes

C

 

 

[Altostrata]

8 hours ago, Clematis501 said:

Most of the time I accept that I will have to wait this out and deal with what happens whilst using self help techniques to prevent additional worries and fears about it all. 

 

I agree with @OldDodgy, I'd give the 7.5mg some more time.