elizze: forced reinstatement to 30mg mirtazapine

[elizze]

Yes I do seem to get a crash day or two after a good one.... I really want to not have to take the valium with me on the plane I am just fighting with myself now, whether to just stop and do the withdrawals or keep holding...

 

When I have a day like this I think f*** it, it doesn't matter, the symptoms are bad whether I taper or hold so why not just stop. Surely 0.5 mg valium is just such a small amount... I have had a rough time all the way down from 5 mg and I only took 5 mg for 10 weeks before tapering. So how bad could it be? (very bad says another voice in my head... )

[Altostrata]

Please be sure to take 0.5mg diazepam at the same time each day. It will take up to a couple of weeks for this to take full effect. 

 

Please stop changing your drug dosing, this may be causing most of your problems. If you're going on a trip, maintain your drug schedule on your home time zone.

[elizze]

7 hours ago, Altostrata said:

Please be sure to take 0.5mg diazepam at the same time each day. It will take up to a couple of weeks for this to take full effect. 

 

Please stop changing your drug dosing, this may be causing most of your problems. If you're going on a trip, maintain your drug schedule on your home time zone.

 

Hi Altostrata, I haven't changed dose I have held at 0.5mg not changed since I updosed 5 or 6 days ago now. I will stick at 0.5mg I just quarter the 2mg tablet instead  of water tapering right now. I have shifted the diazepam 2 hours before the mertazapine. Do the two drugs interact in some way do you think? Is that why it's best to take them apart?

 

I am going to the USA (ET) from the UK it is a 5 hour time difference (5 hours behind). I will be staying for at least 6 weeks, in fact I hope to stay there for good if I possibly can. So I don't think I can stay on UK time zone indefinitely because I need the drugs to get even the small amount of sleep that I currently get... I think best thing to do will be slowly adjust to Eastern Time? I'm just trying to work out how to do that. I leave at 8:25 am and arrive at 13:45 in Chicago which is 18:45 UK time. So if I stick to UK time for dosing to begin with I would be taking D at  approx 15:00 ET and M at 17:00 then I usually try to stay up till bedtime at new time zone but I don't know how that will work out given the drugs and fact I will be on the road initially. If anyone can help me out iwth working out this schedule I would appreciate it as my brain is scrambled....

[elizze]

Now in USA michigan, 2 nights in really struggling. Jet lag has been tough and symptoms very strong. 1st night maybe a couple hours sleep and then awake with severe nausea. Daytime OK just very wired, then last night,  hardly any sleep again followed by night terrors for hours. Need reassurance to stay at the 0.5 because I really just want to tojump. I can't see it would be worse, Updosing to 0.5 does not seem to be working 10 days in now I think. My partner says why don't I change something and thinks I should quit

[Altostrata]

Jet lag is often very difficult. Suggest you move diazepam doses by an hour each day until you are taking them at a convenient time.

 

On 9/10/2022 at 10:00 PM, elizze said:

Do the two drugs interact in some way do you think? Is that why it's best to take them apart?

 

Of course there is, they're both likely to make you sleepy. If you take 2 "brakes" together, they may cause a paradoxical reaction, keeping you awake instead of getting you to sleep.

 

You'll have to maintain your new drug schedule for at least a couple of weeks to tell what your new symptom baseline is. With the jet lag, your symptom pattern is likely to fluctuate.

[elizze]

My sleep stabilized for about 10 days on 0.5mg so then I came down on the valium, used up the last of my last prescription, yesterday was my last dose about 0.25mg. I now have no more valium prescription left and no way to get any more, so that is that.

 

"Following your symptom pattern is the only way you can tell if you're suffering from withdrawal syndrome or an adverse effect of a drug."

 I found this advice on another thread - since I have been in such a bad way ever since the mertazapine CT 7 months ago maybe how I'm feeling now is the side effects of mertazapine?

 

My symptom pattern is now:

one day good, almost no symptoms, just some muscle weakness in my legs and arms and a sinussy feeling headache, good motivation, good appetite

 

followed by

one day bad, stabbing headache, stabbing pains in limbs, severe agitation and bad sleep, no appetite

 

Should I start tapering the mertazapine?

I think it has gone paradoxical on me now or at the very least still giving me bad side effects?

 

 

 

[elizze]

Can someone remind me how to change my signature? I did it before but now just can't seem to work out how to do it! 😕 thank you!

----- never mind I worked it out!!

[Altostrata]

5 hours ago, elizze said:

Should I start tapering the mertazapine?

I think it has gone paradoxical on me now or at the very least still giving me bad side effects?

 

Definitely not. You will need to let the diazepam withdrawal work out. Taper only when your waves are diminished.

[elizze]

Thank you Altostrata. It's just so hard to know what's going on I have been so many months never feeling much better. These 'withdrawals' feel like just another yucky manifestation of how I've been feeling for months. 

 

Now 2 days off the diazepam and in a 2 day wave. No let up on the second day like I had been getting. Heart is thudding constantly, alert all the time, constant anxiety in my body. numb or stabbing brain. 4 hours sleep last night and 4 hours the night before, then awake an unable to sleep again due to alerting. Every thought after 3 am terrifies me, even benign ones. 

 

 I still have  2 x 2mg diazepam that I kept aside I think just for psychological reasons. Now I'm constantly ruminating about them

 

Should I keep them and take a tiny bit PRN every so often to see if it helps with the withdrawal (I don't think it would it never has helped before), or should I split them into 0.25 doses and take 0.25 per day until they are gone, or should I just throw them away??

 

The GOOD NEWS is I managed to get a job here in the US! I have no idea how I managed it through the interviews, but I did. But now comes the worry of how on earth I am going to do it. It is remote, thank goodness, and a good salary, but it's full time and I haven't worked since January and the mertazapine CT. I'm terrified to lose it by not being able to do it due to my situation with these drugs. I just hope it will be a good distraction and my brain won't be so permanently scrambled I can't make it through.

[Altostrata]

You could take 0.10mg per day if you made your diazepam into a liquid, you'd get 20 doses from the 2 tablets. @Frogie @Shep what do you think?

[Shep]

On 10/3/2022 at 10:18 AM, elizze said:

Now 2 days off the diazepam and in a 2 day wave. No let up on the second day like I had been getting. Heart is thudding constantly, alert all the time, constant anxiety in my body. numb or stabbing brain. 4 hours sleep last night and 4 hours the night before, then awake an unable to sleep again due to alerting. Every thought after 3 am terrifies me, even benign ones. 

 

 I still have  2 x 2mg diazepam that I kept aside I think just for psychological reasons. Now I'm constantly ruminating about them

 

Should I keep them and take a tiny bit PRN every so often to see if it helps with the withdrawal (I don't think it would it never has helped before), or should I split them into 0.25 doses and take 0.25 per day until they are gone, or should I just throw them away??

 

Elizze, are you able to get more diazepam? The reason I ask is because diazepam has a half-life of 200 hours (8 days). So if you're having these severe withdrawal symptoms right away while you still have a good amount of the drug left in your system, these symptoms may get much worse. I would reach out to your doctor to get a supply to last for a much slower taper. 

 

Please note the reinstatement timeline for a benzo is much shorter than an antidepressant. It's best to reinstate 2 - 4 weeks after coming off, the sooner, the better. 

 

If you're not able to get another prescription, then what @Altostratawrote in her last post is likely your best option.

 

You may also be able to add in a bit of Valerian root if you're not able to get more diazepam. While it's not ideal, Valerian root is a supplement that works on the same neurotransmitter (GABA) and acts as a very mild benzo. Please note Valerian root will also need to be tapered slowly when you're ready to come off it.  

 

 

[elizze]

Thank you

 

Yesterday a normal day after a 7 hour sleep..felt 90% ... not even much of a headache... BUT then at bedtime could not sleep. Alerting from 9pm and finally after 1am no more sleep at all. Pain throughout body and in head, a burning pain, with extreme mental and physical agitation. 

 

I just keep getting these almost normal days and then really really bad ones. It used to be that I would have a bad morning almost every day and then in the afternoon or evening i would start to feel better, then the next day same again. Now the swings are more extreme and more predictable, and each swing (good or bad) lasts at least a day. 

 

Could I maybe hope that the good days might get more frequent if I can just stay off of this stuff? 

 

Is it possible the diazepam been masking side effects of the mertazapine all this time?

 

If I reinstate, should I reinstate at 0.1mg? 

 

And (sorry for the multiple questions) is Valerian ok to use with the 30mg Mertazapine I am still on? Honestly I'd prefer to try that instead of reinstating the valium.

[Altostrata]

This sounds more like benzo withdrawal, as @Shep suggested. 

 

11 hours ago, elizze said:

If I reinstate, should I reinstate at 0.1mg? 

 

You might even try 0.05mg diazepam. It may not take much. @Shep how long would a homemade suspension last?

[Shep]

10 hours ago, Altostrata said:

@Shep how long would a homemade suspension last?

 

It depends on how the suspension or solution is made. If the pill is dissolved in whole milk, it won't last as long as if the pill is dissolved in Vodka and water, which some people on the benzo forums say can last a couple of weeks. 

 

@elizzeI know it sounds odd, but alcohol is commonly used to dissolve diazepam. It does not need to be refrigerated if you're using water and Vodka, but it does need to be kept in a covered container, since alcohol evaporates. Do not store in plastic, as diazepam can be absorbed into plastic. A dark glass bottle with a lid is best. 

 

If you decide to go with the Vodka method, the ratio is 1 mg of benzo to 2 mL Vodka and then you add water. I would cut your 2 mg pill into quarters because you're going to be taking a very small amount that will need to be disposed off after a couple of weeks of being dissolved. 

 

This would mean you'd take 0.5 mg (one quarter of a 2 mg pill) and place it in 1 mL of Vodka. If you add 19 mL of water, your total liquid is 20 mL. This gives you 0.025 mg per mL solution. 

 

Alto suggested taking 0.05 to 0.1 mg. To take 0.05 mg of this 20 mL solution, you would take 2 mL. To take 0.1 mg, you would take 4 mL. 

 

If you don't wish to use Vodka, you can use whole milk (diazepam is lipid soluble). Some people who can't tolerate milk use Almond or Soy milk as an alternative. This mixture won't last as long, though, and will need to be refrigerated. 

 

Another method would be to simply add the pill to water and make a suspension, as opposed to a solution. It's not as accurate, but in a pinch, may be enough to take the edge off a rapid taper. 

 

You could also divide your pill into 8 pieces, giving you 0.25 mg for each piece. With 2 pills left, this would give you 16 days at 0.25 mg, which could help ease the symptoms.

 

Please do reach out to your doctor to see if you can get a few more pills, if possible. 

 

 

[elizze]

Thank you Shep.

 

I had a pretty good window day (about 4 hours sleep, not too much anxiety, just headache pressure and some tiredness), so that is probably affecting my mood and making me more positive about just staying off of the valium. I've come this far and I just don't want to take it any more. I'm not cold turkeying it or anything, maybe my taper was too fast I don't know. But I made it this far and I don't want to go back. I don't have a doctor here in the US yet. My job starts next month and so I will have to wait for those benefits to kick in. 

I'm going to stay off of the Valium. (I jhave never had much luck dividing the V pills, they always crumble unpredicably if anything less than half. I did a water taper all the way down from 5 mg. I'm not sure if it helped or not. it's been pretty tough the whole way). 

[elizze]

Hello there folks

 

Well it's been an extremely unpleasant 2 months but I think/hope I'm through the worst of the diazapam withdrawal. I've managed to get an apartment and start my job. The last couple weeks have been a lot easier to bear. 

 

I've kept a log since October 1 (when I stopped the diazepam) and I'm going to upload it here to show my progress and in the hopes it might be useful to others. I record my sleep hours (I add up broken sleep, I've only about managed to get unbroken sleep on 2 or 3 nights) and a score for how I have felt each day. I have used melatonin to help me sleep many nights when I wake at 2-3 am and when it works I have gotten sometimes 7, 8 or even 10 hours sleep. But after taking it too many nights consecutively it starts to be ineffective. Currently stopped taking it and I'm still managing to get about 4-5 hours of broken sleep a night. I'm grateful for that; it's been a lot worse. I really wish I could nap, that's just an impossiblity though.

 

I'm at a better place than I was in March after the failed mertazapine taper and a better place than I was at the beginning of October when I finally stopped the diazepam. The awful agitation and nausea have subsided. The head/sinus discomfort is still there but I can go several days without it being too bad. Mainly what I'm struggling with right now is dog-tiredness, and adrenaline surges (albeit much milder) in the early morning. 

 

 

5 days ago I switched to home-made liquid mertazapine, but I've continued taking my full dose - 30mg. 

The first night I woke with high heart rate, but since then I have not experienced that, just the usual crappy broken sleep.

 

I'd like to start tapering the mertazapine. What do you think?

 

Thank you.

Elizze

 

 

 

 

 

 

[Shep]

4 hours ago, elizze said:

5 days ago I switched to home-made liquid mertazapine, but I've continued taking my full dose - 30mg. 

The first night I woke with high heart rate, but since then I have not experienced that, just the usual crappy broken sleep.

 

I'd like to start tapering the mertazapine. What do you think?

 

This post may help you tell if you're at a good point to taper, at a place called "withdrawal normal":

 

Withdrawal Normal

[Altostrata]

If you made a drug change only 5 days ago, I'd give it a little more time to settle in.

[elizze]

Hello...In a bad wave... everything was going well, sleep has gotten better, sometimes sleeping 8 or 9 hours without any melatonin. Still on the 30mg mertazapine and off Valium since October 1. But the nausea came back and also the agitation and I'm feeling very low, just depressed since things seemed to be going better for a while and I was getting ready to taper the mertazapine. What's going on? Is it still waves from the Valium withdrawal or is it the mertazapine at this point? The pattern is back to - worse in the morning and then usually better towards the evening, though not always.  I want to taper the mertazapine but I just never seem to get to a place where it seems doable. I can't risk my job and it's hard enought to work already. Any advice appreciated. Thank you!

Elizze

[Shep]

Did your diet change over the holidays, @elizze? Adding in sweets or high carb foods, caffeine, and especially alcohol can all cause setbacks. 

[elizze]

Thank you Shep I do appreciate your replies! I had a cold (not covid or flu_) from 12/6 to 12/16 but was doing ok with that, sleep was ok. I started a new Mertazapine brand on 12/13 that also didn't seem to be much of a problem. my diet wasn't off (I do low histamine best I can) till the 24th and then the 25th (some sugar, meat and stuff, no alcohol except maybe in the cookies!!!!) but I don't know maybe it was that, as things started to get bad again with the agitation around the 21st. Yesterday I was almost 100 percent again and then today the brain fog is so bad I can hardly think. I have this feeling of complete overwhelmed, my brain/head is numb and feels like it's cramping, and SO thirsty all the time - yesterday I could do my job and everything, felt relaxed no issues with anything; today it's like everything is bad again. I feel like I'm back to the beginning of October again after I stoppied the Diazepam - is it another withdrawal wave from that?? I kind ofo hope so, because if it's the mertazapine no way can I keep this up through years of tapering. And why am I suddenly sleeping 7, 8, 9 hours after months of horrible sleep and yet now during the day I can feel awful ?? I'm beyond depressed . I just keep hoping I can hang on to my job.

[Altostrata]

Hello, @elizze Have you skipped any doses or taken any off-schedule in the last couple of weeks?

 

Could you have gotten some kind of virus bug? Maybe the flu?

[elizze]

No, I had quite a bad cold, but I got tested and it wasn't covid, flu or strep. I haven't skipped any doses. What I usually do now is go to bed around 9, wake up between 11:30 and 1:30, that's when I take my dose, then I go back to sleep for another 3-5 hours, sometimes more. This is the way I've been getting more than 4-5 hours sleep a night.

 

The nausea and painful early morning adrenaline surges that I had been getting for 9 months went away in the middle of November, after a roller coaster 6 weeks off the valium. Then the nausea came back about 10 days ago along with daytime agitation and a feeling of complete inability to concentrate or string 2 thoughts together. Then every so often I get a day when I feel almost totally fine. The headaches are there but feel more like a numb brain cramp or sometimes just sinus pressure. It's 6 am now and I've been awake since 4:30 but I went to sleep at 9, totally exhausted after a horrible day yesterday. I feel nauseous, but at least I can think straight right now.

 

I added in vitamin C when I had a cold and also a B complex after blood tests said I was low. Before that I had just been taking a B12 every day. Should I stop those? I also take magnesium and fish oil but I've been taking those for months 

 

The constant thought in my mind is what if the mertazapine is causing this now? Maybe the diazepam masked its effects? But if I don't feel well enough to taper the mertazapine and it's making me feel this bad, what do I do? Start tapering and risk the insomnia again or just wait and become more and more dependent on it?

[Altostrata]

This sounds more like the waves and windows of benzodiazepine withdrawal. Your rollercoaster off diazepam is not over. Suggest you keep everything constant for a good while more. At least you're getting some sleep.

 

See The Windows and Waves Pattern of Stabilization

 

[elizze]

Thank you Altostrata. I will keep the mertazapine constant at 30mg. Yes, the sleep is much better and also the early morning adrenaline surges much abated. Do you think this suggests a bad interaction between the mertazapine and the valium this whole time??

 

 

 

[Altostrata]

No, it suggests diazepam withdrawal syndrome.

[elizze]

(Sorry to be the annoying kid that always asks Why?) But why? 😀

[Altostrata]

On 12/31/2022 at 3:27 AM, elizze said:

The nausea and painful early morning adrenaline surges that I had been getting for 9 months went away in the middle of November, after a roller coaster 6 weeks off the valium. Then the nausea came back about 10 days ago along with daytime agitation and a feeling of complete inability to concentrate or string 2 thoughts together. Then every so often I get a day when I feel almost totally fine.

 

Because this is a typical withdrawal syndrome pattern when someone has gone off their drug too fast.

[elizze]

Bad wave for a full week with no respite, bad headaches, nausea and anxiety during the day, but OK sleep (6-8 hours per night). Yesterday finally a window, wow what a relief, then last night only 3.5 hours sleep (9pm-10:30pm; 1am took drug; then 1am-3am). It feels like the beginning of the mertazapine withdrawal again, feeling of extreme anxiety and pain in the front of my brain between my eyebrows. Adrenaline surges 3am onwards. Breathing deeply makes me feel like I am going to panic. 

[Altostrata]

What drug are you taking at 1 a.m.? What times o'clock do you take your drugs, with their dosages?

[elizze]

The mertazapine 30mg. That's all I take. I finished with the diazepam about 3 and a half months ago. 

[Shep]

On 1/19/2023 at 7:25 AM, elizze said:

Yesterday finally a window, wow what a relief, then last night only 3.5 hours sleep (9pm-10:30pm; 1am took drug; then 1am-3am)

 

Elizze, do you always take mirtazapine at 1 AM? If not, what time do you usually take it? 

[elizze]

I have no problem falling asleep but I always wake up between 11 and 1 so that's when I take the drug and it puts me back to sleep. I started doing this at the beginning of December.

 

Apart from a bad wave from 11-17 January I'm back to the old routine of one day good, one day horrible. Well actually I did have 2 good days in a row on January 30 and January 31  that hasn't happened since mid December.

 

The good days are pretty much the same, I feel optimistic, can focus, smile, think about the future. The bad days I get "brain cramp", stabbing pain in my head neck and upper arms, sinus pressure and pain, or a combination of the above, and morbid looping thoughts with inability to focus and feeling of anxiety. The nausea went away again a couple weeks ago, and I've been catching around 6-8 hours sleep a night except for a blip a couple of weeks ago when I only got 3.5 - but actually strangely now I come to think of it that's when the nausea went away again.

 

Today is a good day 

 

 

 

 

 

 

[elizze]

I need some advice please. I am still going through the same cycle of one day bad, one day good. I've been 9 months off of valium, but still no difference in the cycles that continue pretty much as before although maybe the bad days are 30% milder and occasionally I get 2 window days in a row but very rarely. I keep hanging on taking the 30mg mertazapine thinking that this will get more bearable and at some point I will feel at a stable place to start tapering. I now take it at 10pm every night and sleep mostly about 7-8 hours. The early morning anxiety surges are mostly gone. However I still have tinnitus (varies), and on the bad days really intense sensations of anxiety and headaches, or numbness, cramping pain in my arms and neck, suicidal thoughts, occasional nausea and so on. Can this really still be attributed to the valium withdrawal? I was on 5mg valium for only 2 and a half months before tapering off it for 6 months. Given these symptoms are so much like clockwork, isn't it likely that this is the mertazapine side effects? If so shouldn't I start to taper the mertazapine slowly, even though I don't feel well at all still? Thanks for your help and advice. 

[Shep]

@elizze The every-other-day pattern is very common, months or even years off a benzo. However, side effects tend to happen each time you take the drug, not every other day you take the drug. So this really sounds like you're still dealing with benzo withdrawal and not mirtazapine side effects causing this particular pattern of symptoms. 

 

That being said, you may be getting side effects from mirtazapine, especially at 30 mg. Many people find that doses as low as 7 mg mirtazapine can be helpful for sleep. Please note the reason for this in the first post in this thread: 

 

Tips for tapering off mirtazapine (Remeron)

 

So it's likely you're dealing with both - benzo withdrawal mixed in with side effects of the mirtazapine. It may be a challenge to figure out when to taper this last drug because you don't want to rock the boat too soon. 

 

Do you feel overly sedated on mirtazapine? Is the 7 - 8 hours of sleep restful? Are you craving carbs and gaining weight on mirtazapine? That's a common problem with this drug. 

 

The goal will be to weigh the benefits of starting to taper the mirtazapine now against holding longer and letting your nervous system recover more from the benzo withdrawal. It hasn't been a full year since you came off valium, so you may want to give yourself a bit more time. However, if you're being slammed with mirtazapine side effects, you may want to test the waters with a micro-taper of say, 3%, and see how you feel. 

 

Also, make sure you're doing gentle stretches every day to help with the cramping, working on non-drug coping skills for emotional symptoms, taking a walk every day in the sun (weather permitting), and eating a nutritional diet with plenty of water throughout the day. 

 

While the every-other-day pattern is aggravating, considering how unpredictable withdrawal is, it may provide you with enough predictability to be able to plan things. So if you can, try to look at that as a positive thing that you can use to your advantage. And make sure you're not over-doing things on the days that are better, which is very easy to do. 

 

[Altostrata]

23 hours ago, elizze said:

I am still going through the same cycle of one day bad, one day good. I've been 9 months off of valium, but still no difference in the cycles that continue pretty much as before although maybe the bad days are 30% milder and occasionally I get 2 window days in a row but very rarely.

 

Classic description of The Windows and Waves Pattern of Stabilization

 

When we say slow and frustrating, we mean slow and frustrating.