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Undiagnosed small fiber neuropathy or post-Mirtazapine withdrawal induced neuropathy?


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Since my CT withdrawal 3 years ago, I have been experiencing many of the symptoms listed under autonomic/small fiber neuropathy i.e. damage to the unmyelinated nerve fibers of the autonomic nervous system and somatic neural systems. 


My most consistent symptoms are irregular/delayed gut motility (almost like gastroparesis), leg/feet paresthesia (mostly below the knees), and sinus pressure, and it mostly occurs when I go to sleep/wake up. Lying down seems to always get the gut moving. 


I have searched through this forum, and it appears that neuropathy like symptoms are another withdrawal effect, and I am wondering if it specifically targets the unmyelinated nerves, including the vagus nerve, which results in slower healing.   


I am meeting my gastro next week to check on my GI issues, and an autonomic specialist in Jun, and I am wondering what would rule out actual neuropathy vs withdrawal symptoms?

Chronic IBS since 1990

Former smoker (1992- Jun 2017)

Prescribed mirtazapine for sleep in Aug 2017 after IBS flare-up following Nicotine cessation.

Mirtazapine 7.5mg 8/17 to 5/18

Mirtazapine 3.75mg 5/18 to 1/19

Off Mirtazapine since 2/19.

Vit B, Vit D+K2 and Magnesium Glycinate as needed.

On Ayurvedic herbs for GI issues - Guduchi since Jul 2020, Indukantham since Oct 2020

On Ashwagandha 1g since Nov 2020



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  • 1 month later...

I had the same symptoms that kept worsening with time until I reintroduce a diffrent Antidepressant and restabilized. I felt defeated it was over a year of bedridden misery. I regained some normalcy after reststabilizing on a diffrent AD I don't belive I would have made it without. 


I also somehow had a relapse of lyme during this time so some how it effected my immune system. I researched alot and their are just so many unknown variables. I started the 10% taper recently on my new Antidepressant I guess we can keep in touch if you'd like.

2001-2019 Effexor XR 150mg Cross to Zoloft 100mg.

2003-2004 CT Effexor XR 150

09/18/2020 Zoloft 100mg CT Switch Paxil 20mg /Valium 10mg

2020 Paxil 20mg /Valium 10mg/Gabapentin 900mg.

2021 Paxil 20mg /Valium 6mg /Gabapentin 600mg.


04/14/2022 Paxil 20mg to 15mg 25% reduction/Valium 3mg/Gabapentin 900mg/Fludrocortisone .01mg 

Paxil: Tablet/Liquid Switch 10% Monthly Drops

5/16 Paxil Liquid 7.4ml/ Valium 3mg/ Gabapentin 900mg, 6/1 Paxil Liquid 6.66ml/ Valium 3mg/ Gabapentin 900mg 6/18 "Switch back to tablets" paxil 10mg+1.66ml/Valium 3mg/Gabapentin 900mg

SupplementsFish Oil, Melatonin 1.5mg, Luracidin.

"Slow  Steady Stable" 💚

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