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PortugueseSea: metoclopramide, akathisia and mirtazapine


PortugueseSea

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Hello everyone,

 

I guess I might be an outlier here. My journey into the hellscape of psychiatry started with an anti-emetic, metoclopramide, to which I had a terrible reaction which amounted for what I now know to be akathisia. Now I know that drug mimics or is similar to anti-psychotics.

I took the drug at high doses for 20 days in December (10mg x3 day) for a nausea problem and it nearly destroyed my life. After that I took it as needed and only realized it was causing and keeping my akathisia going at the end of February.

 

My restlessness appeared first with the typical akathisia movements only appearing after discontinuation. I was taken off the drug suddenly and my symptoms got worse after discontinuation. March and April I tried winging it without any medicine but the waves were so violent that I eventually caved and tried propranolol, didn't help. Biperiden, an anti-cholinergic, did help but had nasty side effects.

 

Now it's May and here is the conundrum:

 

I started tandospirone to help with anxiety a month ago. I also started on Mirtazapine recently as the propranolol doesn't help. First, 7.5mg in the evening, that was a month ago. I got a 10 day window, the best until now. Then I had a bad crisis and my psychiatrist upped my dose to 15mg. I got a nice 7 day window, then another crisis, that was a week ago.

 

That crisis has passed. Yesterday I had a good day, today I am worse again. It is a rollercoaster. I don't know how I'm holding my job.

I guess I have two questions.

 

1) Should I stay on the drug or not? This is something I have to decide by next Friday, that's my psych appointment day.

2) Given that I have only been on the drug around 1 month, two weeks on 7.5mg and two weeks on 15mg, would I need to taper if I chose to stop? If yes, how fast or slow would be advised?

Any advice would be greatly appreciated.

 

Taking it one day at the time here. Very rough.

 

PortugueseSea

Early December 2021 - Started Metroclopramide (Anti-Emetic) nausea 30mg (10mg 3x day).

Mid December 2021 - Akathisia symptoms start; Metroclopramide gets changed to PRN, taken 5mg, first every other day, then once every 3 days.

Early March 2022 - Akathisia diagnosed; Metroclopramide stopped; started Propranolol 10mg x twice a day to no effect, Biperiden PRN (0.5mg to 1mg).

Early April 2022 - Started Tandospirone 30mg (10mg 3x day), Quetiapine 25mg (only taken once, it skyrocketed symptoms).

Mid April 2022 - Mirtazapine 7.5mg, 10 day window followed. Discontinued Propranolol.

1st of May 2022 - Akathisia symptoms continue, Mirtazapine upped to 15mg. 7 day window followed. Tandospirone cut to 2x 10mg.

20th of May 2022 - Mirtazapine cut back to 11.75mg (3/4 of a 15mg pill).
June 2022 - Mirtazapine updose to 15mg. Tandospirone and Biperiden discontinued. Klonopin started PRN (0.5mg)

Current regimen: Mirtazapine at bedtime for akathisia/sleep/anxiety/depression, 15mg; Magnesium at bedtime for akathisia/sleep/anxiety/depression, Klonopin PRN (0.5mg). Waiting to stabilize.

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  • PortugueseSea changed the title to Metoclopramide, Akathisia and Mirtazapine (Introduction and Advice)
  • ChessieCat changed the title to PortugueseSea: Metoclopramide, Akathisia and Mirtazapine - Introduction and Advice
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Welcome, @PortugueseSea

 

On 5/14/2022 at 8:53 AM, PortugueseSea said:

I started tandospirone to help with anxiety a month ago. I also started on Mirtazapine recently as the propranolol doesn't help. First, 7.5mg in the evening, that was a month ago. I got a 10 day window, the best until now. Then I had a bad crisis and my psychiatrist upped my dose to 15mg. I got a nice 7 day window, then another crisis, that was a week ago.

 

You're taking these drugs for the symptoms resulting from your use of metoclopramide? What did akathisia feel like to you?

 

To help us out, follow these instructions Please put your drug and withdrawal history in your signature You may need to use a computer to do this.

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5 hours ago, Altostrata said:

You're taking these drugs for the symptoms resulting from your use of metoclopramide? What did akathisia feel like to you?

Yes, all my symptoms, including akathisia, anxiety and depression came as a result of my use of metoclopramide. They started within two weeks of me starting the med. At first, I just thought it was all a result of the "stress" of having nausea from an undiagnosed condition.

Akathisia feels well, it depends on how bad it is:

 

A ) If It is really bad it feels like my skull is being crushed from behind or the top, wanting to crawl out of my skin and an unfathomable feeling of despair, my.body.cannot.calm.down. Add to that pacing and fidgeting. I can't function, I just take the Biperiden and it helps. While I wait for it to kick in I just cry. It is a life saver, no matter how much I hate the side effects (making me feel half drunk, slurred speech etc.). Rather than feeling suicidal, I just want to be knocked out.

 

B ) On a "normal" day, it is a sense of discomfort that stops me from focusing on work or daily tasks, I keep crossing and uncrossing my legs and have this feeling of agitation/restlessness at all times. I suffer through my day like that. Can't enjoy anything, anhedonia is pretty bad. This comes with a lot of despair. Suicidal ideation happens at times, mostly morning.

 

Evenings are often 70% free of symptoms.

 

C ) In a window I feel mostly normal, a bit on edge, plenty of anxiety, with a touch of depersonalization. Too bad windows have been partial at best.

 

 

 

Have updated my signature! Thanks!!

Early December 2021 - Started Metroclopramide (Anti-Emetic) nausea 30mg (10mg 3x day).

Mid December 2021 - Akathisia symptoms start; Metroclopramide gets changed to PRN, taken 5mg, first every other day, then once every 3 days.

Early March 2022 - Akathisia diagnosed; Metroclopramide stopped; started Propranolol 10mg x twice a day to no effect, Biperiden PRN (0.5mg to 1mg).

Early April 2022 - Started Tandospirone 30mg (10mg 3x day), Quetiapine 25mg (only taken once, it skyrocketed symptoms).

Mid April 2022 - Mirtazapine 7.5mg, 10 day window followed. Discontinued Propranolol.

1st of May 2022 - Akathisia symptoms continue, Mirtazapine upped to 15mg. 7 day window followed. Tandospirone cut to 2x 10mg.

20th of May 2022 - Mirtazapine cut back to 11.75mg (3/4 of a 15mg pill).
June 2022 - Mirtazapine updose to 15mg. Tandospirone and Biperiden discontinued. Klonopin started PRN (0.5mg)

Current regimen: Mirtazapine at bedtime for akathisia/sleep/anxiety/depression, 15mg; Magnesium at bedtime for akathisia/sleep/anxiety/depression, Klonopin PRN (0.5mg). Waiting to stabilize.

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Why did you just reduce mirtazapine? What effect does it have on you? What effect do you feel from tandospirone? What effect from Biperiden?

 

Please put ALL your drugs in the Drug Interactions Checker https://www.drugs.com/drug_interactions.php

and copy and paste the results or a link to them in this topic.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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On 5/21/2022 at 10:43 PM, Altostrata said:

Why did you just reduce mirtazapine?

The reason was that at higher doses Mirtazapine is more stimulating. As I got better right after upping from 7.5mg to 15mg, when the serum concentration was in between 7.5mg and 15mg,  an intermediate dose could be best to stabilize my CNS. Therefore the 11.75mg, 3/4 of the smallest pill available in Japan.

 

On 5/21/2022 at 10:43 PM, Altostrata said:

What effect does it have on you?

Mirtazapine helps me sleep, which the akathisia symptoms prevented. It also stimulates my appetite and calms my breathing. Akathisia-wise, it does not seem to do much beyond that. I did experience suicidal ideation and restlessness the next day when I first upped to 15mg but, as previously mentioned, that could have been the akathisia. I was hoping it would stabilize my nervous system given it is considered first line therapy. I have not noticed considerable side effects except mild sedation and sugar cravings. 

 

On 5/21/2022 at 10:43 PM, Altostrata said:

What effect do you feel from tandospirone?

Tandospirone has helped control crying spells, I noticed that after starting it they have become less common. These normally happened when akathisia symptoms are at their worst, morning and lunch time. I am thinking about discontinuing this last. Side-effects wise, for the first two weeks I did feel mild sedation for a couple of weeks of starting. 

On 5/21/2022 at 10:43 PM, Altostrata said:

What effect from Biperiden?

Biperiden reduces head pressure and restlessness during an akathisia crisis. Normally, a 0.5mg dose is sufficient. If it is particularly excruciating I take 1mg and cry until the worse has passed.

Side-effect wise it is a myriad. I feel like I am drunk, have slurred speech, hampered thought process, and derealization.

Early December 2021 - Started Metroclopramide (Anti-Emetic) nausea 30mg (10mg 3x day).

Mid December 2021 - Akathisia symptoms start; Metroclopramide gets changed to PRN, taken 5mg, first every other day, then once every 3 days.

Early March 2022 - Akathisia diagnosed; Metroclopramide stopped; started Propranolol 10mg x twice a day to no effect, Biperiden PRN (0.5mg to 1mg).

Early April 2022 - Started Tandospirone 30mg (10mg 3x day), Quetiapine 25mg (only taken once, it skyrocketed symptoms).

Mid April 2022 - Mirtazapine 7.5mg, 10 day window followed. Discontinued Propranolol.

1st of May 2022 - Akathisia symptoms continue, Mirtazapine upped to 15mg. 7 day window followed. Tandospirone cut to 2x 10mg.

20th of May 2022 - Mirtazapine cut back to 11.75mg (3/4 of a 15mg pill).
June 2022 - Mirtazapine updose to 15mg. Tandospirone and Biperiden discontinued. Klonopin started PRN (0.5mg)

Current regimen: Mirtazapine at bedtime for akathisia/sleep/anxiety/depression, 15mg; Magnesium at bedtime for akathisia/sleep/anxiety/depression, Klonopin PRN (0.5mg). Waiting to stabilize.

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DRUG INTERACTIONS:

https://www.drugs.com/interactions-check.php?drug_list=1640-0,384-0
Mirtazapine and Biperiden;

 

Please not that Tandospirone was not included due to now showing up in the search engine; it being generally only used in East Asia might be the reason. 

Early December 2021 - Started Metroclopramide (Anti-Emetic) nausea 30mg (10mg 3x day).

Mid December 2021 - Akathisia symptoms start; Metroclopramide gets changed to PRN, taken 5mg, first every other day, then once every 3 days.

Early March 2022 - Akathisia diagnosed; Metroclopramide stopped; started Propranolol 10mg x twice a day to no effect, Biperiden PRN (0.5mg to 1mg).

Early April 2022 - Started Tandospirone 30mg (10mg 3x day), Quetiapine 25mg (only taken once, it skyrocketed symptoms).

Mid April 2022 - Mirtazapine 7.5mg, 10 day window followed. Discontinued Propranolol.

1st of May 2022 - Akathisia symptoms continue, Mirtazapine upped to 15mg. 7 day window followed. Tandospirone cut to 2x 10mg.

20th of May 2022 - Mirtazapine cut back to 11.75mg (3/4 of a 15mg pill).
June 2022 - Mirtazapine updose to 15mg. Tandospirone and Biperiden discontinued. Klonopin started PRN (0.5mg)

Current regimen: Mirtazapine at bedtime for akathisia/sleep/anxiety/depression, 15mg; Magnesium at bedtime for akathisia/sleep/anxiety/depression, Klonopin PRN (0.5mg). Waiting to stabilize.

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23 minutes ago, PortugueseSea said:

Please not that Tandospirone was not included due to now showing up in the search engine; it being generally only used in East Asia might be the reason. 

 

Here is a page where you can check for individual drug interactions.  Under the heading Interactions there is a list of drugs.  At the top right of the list you can Search for a drug.

 

https://go.drugbank.com/drugs/DB12833

 

According to this from Wikipedia it is closely related to buspirone:

 

"Tandospirone is an anxiolytic and antidepressant drug used in China and Japan, where it is marketed by Dainippon Sumitomo Pharma. It is a member of the azapirone class of drugs and is closely related to other azapirones like buspirone and gepirone."

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Thank you very much!
 

Mirtazapine and Tandospirone:

 

Tandospirone may increase the serotonergic activities of Mirtazapine.

 

Mirtazapine and Biperiden:

 

Tandospirone may increase the central nervous system depressant (CNS depressant) activities of Biperiden.

 

 

Early December 2021 - Started Metroclopramide (Anti-Emetic) nausea 30mg (10mg 3x day).

Mid December 2021 - Akathisia symptoms start; Metroclopramide gets changed to PRN, taken 5mg, first every other day, then once every 3 days.

Early March 2022 - Akathisia diagnosed; Metroclopramide stopped; started Propranolol 10mg x twice a day to no effect, Biperiden PRN (0.5mg to 1mg).

Early April 2022 - Started Tandospirone 30mg (10mg 3x day), Quetiapine 25mg (only taken once, it skyrocketed symptoms).

Mid April 2022 - Mirtazapine 7.5mg, 10 day window followed. Discontinued Propranolol.

1st of May 2022 - Akathisia symptoms continue, Mirtazapine upped to 15mg. 7 day window followed. Tandospirone cut to 2x 10mg.

20th of May 2022 - Mirtazapine cut back to 11.75mg (3/4 of a 15mg pill).
June 2022 - Mirtazapine updose to 15mg. Tandospirone and Biperiden discontinued. Klonopin started PRN (0.5mg)

Current regimen: Mirtazapine at bedtime for akathisia/sleep/anxiety/depression, 15mg; Magnesium at bedtime for akathisia/sleep/anxiety/depression, Klonopin PRN (0.5mg). Waiting to stabilize.

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10 hours ago, PortugueseSea said:

The reason was that at higher doses Mirtazapine is more stimulating.

 

15mg mirtazapine is not a high dose of mirtazapine. How has the reduction to 11.75mg affected your sleep?

 

If your symptoms increased after reducing mirtazapine, I would restore 15mg mirtazapine. It's posslble you are taking the other 2 drugs unnecessarily, and the sleep induced by mirtazapine will enable very slow recovery, as we see from psychiatric drugs. You can taper off mirtazapine later.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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13 hours ago, Altostrata said:

 

15mg mirtazapine is not a high dose of mirtazapine. How has the reduction to 11.75mg affected your sleep?


My sleep as been unaffected or even improved. I really think sleep is crucial, it gives me a break from akathisia and allows my brain to heal.

 

13 hours ago, Altostrata said:

If your symptoms increased after reducing mirtazapine, I would restore 15mg mirtazapine.

Noted, they haven’t though. I had a smaller crisis yesterday but nothing compared to last week or 10 days ago.

 

13 hours ago, Altostrata said:

It's posslble you are taking the other 2 drugs unnecessarily

The Tandospirone definitely. I have often wondered about that.


 

13 hours ago, Altostrata said:
13 hours ago, Altostrata said:

It's posslble you are taking the other 2 drugs unnecessarily, and the sleep induced by mirtazapine will enable very slow recovery, as we see from psychiatric drugs

 

The Biperiden I take as little as possible, only in a full blown crisis. PRN, I figured it’s better than taking an emergency benzodiazepine. It calms my system down.

 

I am definitely willing to consider alternatives though!

 

Could you elaborate on the Mirtazapine sleep helping? I definitely feel well rested. I was just worried that at 15mg it could be contributing to the akathisia as the time I felt best was in the 7.5mg to 15mg transition.

Early December 2021 - Started Metroclopramide (Anti-Emetic) nausea 30mg (10mg 3x day).

Mid December 2021 - Akathisia symptoms start; Metroclopramide gets changed to PRN, taken 5mg, first every other day, then once every 3 days.

Early March 2022 - Akathisia diagnosed; Metroclopramide stopped; started Propranolol 10mg x twice a day to no effect, Biperiden PRN (0.5mg to 1mg).

Early April 2022 - Started Tandospirone 30mg (10mg 3x day), Quetiapine 25mg (only taken once, it skyrocketed symptoms).

Mid April 2022 - Mirtazapine 7.5mg, 10 day window followed. Discontinued Propranolol.

1st of May 2022 - Akathisia symptoms continue, Mirtazapine upped to 15mg. 7 day window followed. Tandospirone cut to 2x 10mg.

20th of May 2022 - Mirtazapine cut back to 11.75mg (3/4 of a 15mg pill).
June 2022 - Mirtazapine updose to 15mg. Tandospirone and Biperiden discontinued. Klonopin started PRN (0.5mg)

Current regimen: Mirtazapine at bedtime for akathisia/sleep/anxiety/depression, 15mg; Magnesium at bedtime for akathisia/sleep/anxiety/depression, Klonopin PRN (0.5mg). Waiting to stabilize.

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Just came from the doctor. The last few days I have been more stable and akathisia symptoms have been mild, if that is even possible.

 

I have decided to stay where I am, 11.25mg Mirtazapine and 10mgx2 a day Tandospirone. My psychiatrist suggested staying on this regimen for at least a year. Thing is, I would like to start tapering way sooner than that.

My doctor mentioned that the compound pharmacies would not allow me to go very very slow so I guess I am stuck making powder for my taper (?). Don't trust myself to handle the liquid.

 

Thank you so much for all the suggestions!

 



 

Early December 2021 - Started Metroclopramide (Anti-Emetic) nausea 30mg (10mg 3x day).

Mid December 2021 - Akathisia symptoms start; Metroclopramide gets changed to PRN, taken 5mg, first every other day, then once every 3 days.

Early March 2022 - Akathisia diagnosed; Metroclopramide stopped; started Propranolol 10mg x twice a day to no effect, Biperiden PRN (0.5mg to 1mg).

Early April 2022 - Started Tandospirone 30mg (10mg 3x day), Quetiapine 25mg (only taken once, it skyrocketed symptoms).

Mid April 2022 - Mirtazapine 7.5mg, 10 day window followed. Discontinued Propranolol.

1st of May 2022 - Akathisia symptoms continue, Mirtazapine upped to 15mg. 7 day window followed. Tandospirone cut to 2x 10mg.

20th of May 2022 - Mirtazapine cut back to 11.75mg (3/4 of a 15mg pill).
June 2022 - Mirtazapine updose to 15mg. Tandospirone and Biperiden discontinued. Klonopin started PRN (0.5mg)

Current regimen: Mirtazapine at bedtime for akathisia/sleep/anxiety/depression, 15mg; Magnesium at bedtime for akathisia/sleep/anxiety/depression, Klonopin PRN (0.5mg). Waiting to stabilize.

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On 5/24/2022 at 3:15 AM, PortugueseSea said:

The Biperiden I take as little as possible, only in a full blown crisis. PRN, I figured it’s better than taking an emergency benzodiazepine. It calms my system down.

 

Do you find biperiden helpful PRN? It's not usually dosed like that.

 

If you find 11.25mg mirtazapine helps you sleep, it if works, it works.

 

On 5/27/2022 at 9:11 AM, PortugueseSea said:

My doctor mentioned that the compound pharmacies would not allow me to go very very slow

 

In other countries, compound pharmacies make up doses according to the doctor's order. So your doctor probably is wrong.

 

As your situation really involves adverse effects from a drug that is not a psychiatric drug -- not withdrawal -- and you are under the care of a psychiatrist, it's outside the purview of this site. Please let us know when you want to taper a psychiatric drug.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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2 hours ago, Altostrata said:

Do you find biperiden helpful PRN? It's not usually dosed like that.


Yes, one hour after taking it it provides some relief of the akathetic movements and mental akathisia, more the former than the latter. Yeah, the dosing is unusual, I was originally on it twice daily but my doctor changed it to PRN. I sometimes wonder if I that was wise...

 

2 hours ago, Altostrata said:

In other countries, compound pharmacies make up doses according to the doctor's order. So your doctor probably is wrong.

Thank you so much for this info, I am confident I can push for those small reductions now!

 

2 hours ago, Altostrata said:

As your situation really involves adverse effects from a drug that is not a psychiatric drug -- not withdrawal -- and you are under the care of a psychiatrist, it's outside the purview of this site. Please let us know when you want to taper a psychiatric drug.

Well, as far as I am aware, being a dopamine antagonist Metroclopramide is psychotropic, no matter what the label says. It can definitely damage the CNS.
https://www.ema.europa.eu/en/news/european-medicines-agency-recommends-changes-use-metoclopramide

As for not being a withdrawal... well, I am not sure. My symptoms escalated after discontinuing a psychotropic drug that can cause withdrawal (refer to the article below for an example), so I do not see any other way to interpret what has been happening to me. My doctor surely thinks my escalation of symptoms was due to the discontinuation of the med.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1002885/pdf/westjmed00106-0072.pdf

I very much want to start tapering the Tandospirone and or the Mirtazapine as soon as I feel stable enough!

Thank you so much for the help and advice!

Early December 2021 - Started Metroclopramide (Anti-Emetic) nausea 30mg (10mg 3x day).

Mid December 2021 - Akathisia symptoms start; Metroclopramide gets changed to PRN, taken 5mg, first every other day, then once every 3 days.

Early March 2022 - Akathisia diagnosed; Metroclopramide stopped; started Propranolol 10mg x twice a day to no effect, Biperiden PRN (0.5mg to 1mg).

Early April 2022 - Started Tandospirone 30mg (10mg 3x day), Quetiapine 25mg (only taken once, it skyrocketed symptoms).

Mid April 2022 - Mirtazapine 7.5mg, 10 day window followed. Discontinued Propranolol.

1st of May 2022 - Akathisia symptoms continue, Mirtazapine upped to 15mg. 7 day window followed. Tandospirone cut to 2x 10mg.

20th of May 2022 - Mirtazapine cut back to 11.75mg (3/4 of a 15mg pill).
June 2022 - Mirtazapine updose to 15mg. Tandospirone and Biperiden discontinued. Klonopin started PRN (0.5mg)

Current regimen: Mirtazapine at bedtime for akathisia/sleep/anxiety/depression, 15mg; Magnesium at bedtime for akathisia/sleep/anxiety/depression, Klonopin PRN (0.5mg). Waiting to stabilize.

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It's possible you do have withdrawal effects from metroclopramide, but we do not address every psychotropic. Akathisia is a known adverse effect of the drug, see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993902/

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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  • 3 weeks later...

Thank you so much for the replies!

 

I have taken your advice to heart and talked with my doctor. We have decided to stop both the Tandospirone and the PRN Biperiden. We have also reinstated the Mirtazapine at 15mg. Very low dose Valproate (Depakote, 100mg) was added because it helps increase GABA levels.

 

I am also to take Clonazepam PRN (0.5mg) if things get desperate. Fortunately they have not and I have started to slowly stabilize. My doctor and I are very happy and she has accepted to taper the Mirtazapine very slowly in the future.

 

Thank you so so much. Will update my signature.

Early December 2021 - Started Metroclopramide (Anti-Emetic) nausea 30mg (10mg 3x day).

Mid December 2021 - Akathisia symptoms start; Metroclopramide gets changed to PRN, taken 5mg, first every other day, then once every 3 days.

Early March 2022 - Akathisia diagnosed; Metroclopramide stopped; started Propranolol 10mg x twice a day to no effect, Biperiden PRN (0.5mg to 1mg).

Early April 2022 - Started Tandospirone 30mg (10mg 3x day), Quetiapine 25mg (only taken once, it skyrocketed symptoms).

Mid April 2022 - Mirtazapine 7.5mg, 10 day window followed. Discontinued Propranolol.

1st of May 2022 - Akathisia symptoms continue, Mirtazapine upped to 15mg. 7 day window followed. Tandospirone cut to 2x 10mg.

20th of May 2022 - Mirtazapine cut back to 11.75mg (3/4 of a 15mg pill).
June 2022 - Mirtazapine updose to 15mg. Tandospirone and Biperiden discontinued. Klonopin started PRN (0.5mg)

Current regimen: Mirtazapine at bedtime for akathisia/sleep/anxiety/depression, 15mg; Magnesium at bedtime for akathisia/sleep/anxiety/depression, Klonopin PRN (0.5mg). Waiting to stabilize.

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This topic contains links to other informative topics:

 

Important topics in the Tapering forum and FAQ

Please DO NOT TAG me - thank you

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions. 

  MISSION ACCOMPLISHED:    (6 year taper)      0mg Pristiq      on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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  • 3 months later...

Thank you so much ChessieCat.

I have started stabilizing recently under the current regimen but the waves are still brutal.

I am currently waiting for the right time to start tapering the mirtazapine, I would rather not take it for too long. I have read Altostrata's article on tapering and have watched for a worsening of symptoms after dosing, haven't noticed anything so I am assuming (?) the Mirtazapine is helping given that I am more stable, or less unstable.

 

Pacing is thankfully gone and agitation has largely turned into discomfort, I am making slow but steady progress. I still have excruciating emotional lability and am very teary all the time. The impairment is still very real but, except during crazy waves, I am largely functional.

Anyhow, I have a practical matter to solve: I am going back to Europe from Japan to stay with my parents so I can get the support I need during this difficult phase of my life. I take Mirtazapine at bedtime and bedtime will be 9 hours later in Europe. Any advice on how to adjust dosing times to account for that? Should I start dosing earlier while in Japan to make the transition smoother?

Thanks everyone, things are still a mess and any advice is invaluable.

Early December 2021 - Started Metroclopramide (Anti-Emetic) nausea 30mg (10mg 3x day).

Mid December 2021 - Akathisia symptoms start; Metroclopramide gets changed to PRN, taken 5mg, first every other day, then once every 3 days.

Early March 2022 - Akathisia diagnosed; Metroclopramide stopped; started Propranolol 10mg x twice a day to no effect, Biperiden PRN (0.5mg to 1mg).

Early April 2022 - Started Tandospirone 30mg (10mg 3x day), Quetiapine 25mg (only taken once, it skyrocketed symptoms).

Mid April 2022 - Mirtazapine 7.5mg, 10 day window followed. Discontinued Propranolol.

1st of May 2022 - Akathisia symptoms continue, Mirtazapine upped to 15mg. 7 day window followed. Tandospirone cut to 2x 10mg.

20th of May 2022 - Mirtazapine cut back to 11.75mg (3/4 of a 15mg pill).
June 2022 - Mirtazapine updose to 15mg. Tandospirone and Biperiden discontinued. Klonopin started PRN (0.5mg)

Current regimen: Mirtazapine at bedtime for akathisia/sleep/anxiety/depression, 15mg; Magnesium at bedtime for akathisia/sleep/anxiety/depression, Klonopin PRN (0.5mg). Waiting to stabilize.

Link to comment

How to adjust to a 9-hour time difference for night dosing (Mirtazapine 15mg)

 

Hello,

I have been on 15mg of mirtazapine for akathisia for months now. I always dose at around 9pm in the evening.
Unfortunately, although I feel a bit better, my symptoms are still too much for me to cope on my own. I am moving back with my parents for the time being.

This means I will be going to bed 9 hours later, that is the time difference between Japan and Portugal, any advice on how to adjust dosing in this particular case?

Thanks everyone!

 

Edited by ChessieCat
added topic title before merging with intro topic

Early December 2021 - Started Metroclopramide (Anti-Emetic) nausea 30mg (10mg 3x day).

Mid December 2021 - Akathisia symptoms start; Metroclopramide gets changed to PRN, taken 5mg, first every other day, then once every 3 days.

Early March 2022 - Akathisia diagnosed; Metroclopramide stopped; started Propranolol 10mg x twice a day to no effect, Biperiden PRN (0.5mg to 1mg).

Early April 2022 - Started Tandospirone 30mg (10mg 3x day), Quetiapine 25mg (only taken once, it skyrocketed symptoms).

Mid April 2022 - Mirtazapine 7.5mg, 10 day window followed. Discontinued Propranolol.

1st of May 2022 - Akathisia symptoms continue, Mirtazapine upped to 15mg. 7 day window followed. Tandospirone cut to 2x 10mg.

20th of May 2022 - Mirtazapine cut back to 11.75mg (3/4 of a 15mg pill).
June 2022 - Mirtazapine updose to 15mg. Tandospirone and Biperiden discontinued. Klonopin started PRN (0.5mg)

Current regimen: Mirtazapine at bedtime for akathisia/sleep/anxiety/depression, 15mg; Magnesium at bedtime for akathisia/sleep/anxiety/depression, Klonopin PRN (0.5mg). Waiting to stabilize.

Link to comment
On 7/31/2015 at 6:42 AM, Altostrata said:

What is the relationship of your thoughts of suicide to your fears about recovery?

 

It's linear. At first I thought there was a direct correlation between the severity of my akathisia and feeling suicidal. 9 months into this mess and now it's clear to me that the suicidality is secondary to fears of having this for life. 

 

An easy thought experiment was, "if I was 100% certain I'd be healed in a year would I feel suicidal?", the answer was a clear no.

 

It became clear:

 

- when the symptoms feel unbearable, or barely bearable, they cause extreme fear, "what if I'm like this forever, I'll have no life, no way out". That's where the thoughts of suicide come from. I feel like every single person who got akathisia from an antiemetic/antipsychotic healed faster than I. So, as time drags on and despite my so very slow improvement, this despair compounds.

I know better than to act on it and many would say 9 months can be considered early, for any psychotropic drug. Still, in the dregs of akathisia it's hard not to dwell on worst case scenarios.

Early December 2021 - Started Metroclopramide (Anti-Emetic) nausea 30mg (10mg 3x day).

Mid December 2021 - Akathisia symptoms start; Metroclopramide gets changed to PRN, taken 5mg, first every other day, then once every 3 days.

Early March 2022 - Akathisia diagnosed; Metroclopramide stopped; started Propranolol 10mg x twice a day to no effect, Biperiden PRN (0.5mg to 1mg).

Early April 2022 - Started Tandospirone 30mg (10mg 3x day), Quetiapine 25mg (only taken once, it skyrocketed symptoms).

Mid April 2022 - Mirtazapine 7.5mg, 10 day window followed. Discontinued Propranolol.

1st of May 2022 - Akathisia symptoms continue, Mirtazapine upped to 15mg. 7 day window followed. Tandospirone cut to 2x 10mg.

20th of May 2022 - Mirtazapine cut back to 11.75mg (3/4 of a 15mg pill).
June 2022 - Mirtazapine updose to 15mg. Tandospirone and Biperiden discontinued. Klonopin started PRN (0.5mg)

Current regimen: Mirtazapine at bedtime for akathisia/sleep/anxiety/depression, 15mg; Magnesium at bedtime for akathisia/sleep/anxiety/depression, Klonopin PRN (0.5mg). Waiting to stabilize.

Link to comment
  • ChessieCat changed the title to PortugueseSea: metoclopramide, akathisia and mirtazapine
  • Administrator
14 hours ago, PortugueseSea said:

the suicidality is secondary to fears of having this for life

 

These beliefs are triggering your anxiety and suicidality. You do not have to hold these beliefs, they push you into emotional pain. There are a range of therapeutic methods that might assist you in changing your beliefs. You might consult a psychotherapist or other counselor.

 

See 

 

 

Non-drug techniques to cope with emotional symptoms

 

Easing your way into meditation for a stressed-out nervous system

 

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

 

Ways to cope with daily anxiety

 

Dealing With Emotional Spirals 

 

Shame, guilt, regret, and self-criticism

 

Health anxiety, hypochondria, and obsession with symptoms

 

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

Link to comment
5 hours ago, Altostrata said:

These beliefs are triggering your anxiety and suicidality. You do not have to hold these beliefs, they push you into emotional pain. There are a range of therapeutic methods that might assist you in changing your beliefs. You might consult a psychotherapist or other counselor.

Thank you so much, will certainly delve into those! I am already connected to a psychotherapist.

I also have an irrational fear that the Mirtazapine might be making me worse, because of things still being so rough this far out. I have read your article on differentiating adverse reactions from withdrawal and truly do not believe that is the case. It might still be worthwhile to share a "normal" week with you guys on my introduction thread just to be sure.

Hanging on! Thank you, bless you.

Early December 2021 - Started Metroclopramide (Anti-Emetic) nausea 30mg (10mg 3x day).

Mid December 2021 - Akathisia symptoms start; Metroclopramide gets changed to PRN, taken 5mg, first every other day, then once every 3 days.

Early March 2022 - Akathisia diagnosed; Metroclopramide stopped; started Propranolol 10mg x twice a day to no effect, Biperiden PRN (0.5mg to 1mg).

Early April 2022 - Started Tandospirone 30mg (10mg 3x day), Quetiapine 25mg (only taken once, it skyrocketed symptoms).

Mid April 2022 - Mirtazapine 7.5mg, 10 day window followed. Discontinued Propranolol.

1st of May 2022 - Akathisia symptoms continue, Mirtazapine upped to 15mg. 7 day window followed. Tandospirone cut to 2x 10mg.

20th of May 2022 - Mirtazapine cut back to 11.75mg (3/4 of a 15mg pill).
June 2022 - Mirtazapine updose to 15mg. Tandospirone and Biperiden discontinued. Klonopin started PRN (0.5mg)

Current regimen: Mirtazapine at bedtime for akathisia/sleep/anxiety/depression, 15mg; Magnesium at bedtime for akathisia/sleep/anxiety/depression, Klonopin PRN (0.5mg). Waiting to stabilize.

Link to comment

Tuesday:

07:00 Wake up; feel okaysh/only slightly off.

07:30 Take son to nursery school , ate a sugary breakfast.

08:00 Restlessness and discomfort start building up; dysphoria builds along with it.

10:00 Feel quite agitated, trouble controlling breathing; leads to fidgeting, tremor, feeling suicidal. Head pressure, starts from the back of the neck

10:30 Eat a healthy lunch.

11:00 Work; Burning sensation on my neck (back) (could that be the Mirtazapine?), tension accumulates around the neck/chest. *Restless fluctuates in intensity during work*

12:30 Tension and restlessness start easing.

13:00 Left work for psych appointment; restlessness keeps easing. Head pressure moves the the sides of the head,

15:00 Autogenic therapy - restlessness keeps easing; the dysphoria starts to give way.

17:00 Limited restlessness; emotional lability, teary and return of dysphoria.

21:00 Take Mirtazapine 15mg

21:30 Go to bed.

 

Slept well, did not wake up during the night.

Early December 2021 - Started Metroclopramide (Anti-Emetic) nausea 30mg (10mg 3x day).

Mid December 2021 - Akathisia symptoms start; Metroclopramide gets changed to PRN, taken 5mg, first every other day, then once every 3 days.

Early March 2022 - Akathisia diagnosed; Metroclopramide stopped; started Propranolol 10mg x twice a day to no effect, Biperiden PRN (0.5mg to 1mg).

Early April 2022 - Started Tandospirone 30mg (10mg 3x day), Quetiapine 25mg (only taken once, it skyrocketed symptoms).

Mid April 2022 - Mirtazapine 7.5mg, 10 day window followed. Discontinued Propranolol.

1st of May 2022 - Akathisia symptoms continue, Mirtazapine upped to 15mg. 7 day window followed. Tandospirone cut to 2x 10mg.

20th of May 2022 - Mirtazapine cut back to 11.75mg (3/4 of a 15mg pill).
June 2022 - Mirtazapine updose to 15mg. Tandospirone and Biperiden discontinued. Klonopin started PRN (0.5mg)

Current regimen: Mirtazapine at bedtime for akathisia/sleep/anxiety/depression, 15mg; Magnesium at bedtime for akathisia/sleep/anxiety/depression, Klonopin PRN (0.5mg). Waiting to stabilize.

Link to comment

Wednesday:

 

07:00 Wake up

07:30 Had a healthy breakfast

08:00 Talked with my mother on the phone about me moving back to Portugal.

08:30 - 10:00 Take son to the doctor, feeling surprisingly okay. Anhedonia.

10:30 Restlessness starts building, head pressure and general discomfort.

11:00 Visit dying priest, received a rosary from him and lots of hope.

11:30 Go for lunch with a friend, restlessness and dysphoria start biting, head pressure.

12:30 - 20:00 Diffuse restlessness continues, it eventually focuses on the neck area. Feel like I'm being pierced with a skewer from the back of the neck. Get fidgety, despair builds.

17:00 Back of the neck starts burning.

17:30 - 22:00 Work

21:00 Restlessness starts to ease. Back of the neck burns.

22:00 Take Mirtazapine 15mg.

23:00 Go to bed.

 

Early December 2021 - Started Metroclopramide (Anti-Emetic) nausea 30mg (10mg 3x day).

Mid December 2021 - Akathisia symptoms start; Metroclopramide gets changed to PRN, taken 5mg, first every other day, then once every 3 days.

Early March 2022 - Akathisia diagnosed; Metroclopramide stopped; started Propranolol 10mg x twice a day to no effect, Biperiden PRN (0.5mg to 1mg).

Early April 2022 - Started Tandospirone 30mg (10mg 3x day), Quetiapine 25mg (only taken once, it skyrocketed symptoms).

Mid April 2022 - Mirtazapine 7.5mg, 10 day window followed. Discontinued Propranolol.

1st of May 2022 - Akathisia symptoms continue, Mirtazapine upped to 15mg. 7 day window followed. Tandospirone cut to 2x 10mg.

20th of May 2022 - Mirtazapine cut back to 11.75mg (3/4 of a 15mg pill).
June 2022 - Mirtazapine updose to 15mg. Tandospirone and Biperiden discontinued. Klonopin started PRN (0.5mg)

Current regimen: Mirtazapine at bedtime for akathisia/sleep/anxiety/depression, 15mg; Magnesium at bedtime for akathisia/sleep/anxiety/depression, Klonopin PRN (0.5mg). Waiting to stabilize.

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  • Administrator

Are you still taking Klonopin? When was the last time you took it?

 

It looks to me like you might have interdose withdrawal from mirtazapine. Suggest you take 12.5mg at night and 2.5mg 12 hours later in the morning.

 

On 9/19/2022 at 4:52 PM, PortugueseSea said:

I also have an irrational fear that the Mirtazapine might be making me worse, because of things still being so rough this far out.

 

If you think about your own way of thinking, you might find irrational fear is a longstanding habit of mind. This is not a withdrawal symptom. 

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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2 hours ago, Altostrata said:

Are you still taking Klonopin? When was the last time you took it?

Last time I took it was on Monday, 0,5mg,  I'm trying not to take it at all. I am only taking it when I'm at my wit's end. From what I've read and learned, I think it would be best either to take it regularly or not to take it at all. I've been using it as a rescue med. I never take it more than 2,3 times a week and three times is very rare. Once or twice is more common.

What is your take on the matter?

 

 

2 hours ago, Altostrata said:

 

It looks to me like you might have interdose withdrawal from mirtazapine. Suggest you take 12.5mg at night and 2.5mg 12 hours later in the morning.


Got it, I'm in the process of back to Europe right now so I can't get it compounded right now. I'm flying out next week.

I'm already looking for a practitioner and compound pharmacy back home so I can implement that. Another very experienced person looked at my symptoms and mentioned the likelihood of interdose withdrawal too.

 

2 hours ago, Altostrata said:

If you think about your own way of thinking, you might find irrational fear is a longstanding habit of mind. This is not a withdrawal symptom. 

 

I agree. I've been looking into it with a therapist. it's definitely become a habit, though it seems to be more recent. It's very unlike me to be honest.

It maybe appeared after doctors failed to diagnose me correctly for 2 months and the absolute disaster of getting prescribed quetiapine and having the most acute akathisia I ever had. I felt the medical profession had completely failed me and that I was on my own. I never felt so alone and vulnerable in my whole life. That led to an irrational fear of meds and and making akathisia worst, making my "fight or flight" response very sensitive. As you can imagine, with akathisia, this only made things worse. It resulted on a series of panic attacks. With the help of my therapist I've been able to identify and am addressing them. Thankfully, things have gotten better in that regard.

 

I've been using the resources you posted. They are very helpful, thank you!

Early December 2021 - Started Metroclopramide (Anti-Emetic) nausea 30mg (10mg 3x day).

Mid December 2021 - Akathisia symptoms start; Metroclopramide gets changed to PRN, taken 5mg, first every other day, then once every 3 days.

Early March 2022 - Akathisia diagnosed; Metroclopramide stopped; started Propranolol 10mg x twice a day to no effect, Biperiden PRN (0.5mg to 1mg).

Early April 2022 - Started Tandospirone 30mg (10mg 3x day), Quetiapine 25mg (only taken once, it skyrocketed symptoms).

Mid April 2022 - Mirtazapine 7.5mg, 10 day window followed. Discontinued Propranolol.

1st of May 2022 - Akathisia symptoms continue, Mirtazapine upped to 15mg. 7 day window followed. Tandospirone cut to 2x 10mg.

20th of May 2022 - Mirtazapine cut back to 11.75mg (3/4 of a 15mg pill).
June 2022 - Mirtazapine updose to 15mg. Tandospirone and Biperiden discontinued. Klonopin started PRN (0.5mg)

Current regimen: Mirtazapine at bedtime for akathisia/sleep/anxiety/depression, 15mg; Magnesium at bedtime for akathisia/sleep/anxiety/depression, Klonopin PRN (0.5mg). Waiting to stabilize.

Link to comment

Thursday:

07:00 Wake up agitated and restless, quite diffuse.
07:30 Take son to the nursery school
8:00 - 12:00 Spent the morning between the internet and walking around, no substantial relief.
13:00 Started settling down; left with anhedonia and emotional lability, very teary.

14:30 - 19:00 Head pressure in the back of the head; burning neck; muscle twitches. Occasional restlessness, more centered around the neck.
21:00 Things settle down
22:00 Take the mirtazapine (with the magnesium, sorry I failed to mention it)

Slept well
 

Early December 2021 - Started Metroclopramide (Anti-Emetic) nausea 30mg (10mg 3x day).

Mid December 2021 - Akathisia symptoms start; Metroclopramide gets changed to PRN, taken 5mg, first every other day, then once every 3 days.

Early March 2022 - Akathisia diagnosed; Metroclopramide stopped; started Propranolol 10mg x twice a day to no effect, Biperiden PRN (0.5mg to 1mg).

Early April 2022 - Started Tandospirone 30mg (10mg 3x day), Quetiapine 25mg (only taken once, it skyrocketed symptoms).

Mid April 2022 - Mirtazapine 7.5mg, 10 day window followed. Discontinued Propranolol.

1st of May 2022 - Akathisia symptoms continue, Mirtazapine upped to 15mg. 7 day window followed. Tandospirone cut to 2x 10mg.

20th of May 2022 - Mirtazapine cut back to 11.75mg (3/4 of a 15mg pill).
June 2022 - Mirtazapine updose to 15mg. Tandospirone and Biperiden discontinued. Klonopin started PRN (0.5mg)

Current regimen: Mirtazapine at bedtime for akathisia/sleep/anxiety/depression, 15mg; Magnesium at bedtime for akathisia/sleep/anxiety/depression, Klonopin PRN (0.5mg). Waiting to stabilize.

Link to comment
10 hours ago, Altostrata said:

Suggest you take 12.5mg at night and 2.5mg 12 hours later in the morning.

If it could be a quarter of a pill, 3.75mg I think I could do it with my pill cutter. Or would that be overdoing it?

Thank you, as always.

Early December 2021 - Started Metroclopramide (Anti-Emetic) nausea 30mg (10mg 3x day).

Mid December 2021 - Akathisia symptoms start; Metroclopramide gets changed to PRN, taken 5mg, first every other day, then once every 3 days.

Early March 2022 - Akathisia diagnosed; Metroclopramide stopped; started Propranolol 10mg x twice a day to no effect, Biperiden PRN (0.5mg to 1mg).

Early April 2022 - Started Tandospirone 30mg (10mg 3x day), Quetiapine 25mg (only taken once, it skyrocketed symptoms).

Mid April 2022 - Mirtazapine 7.5mg, 10 day window followed. Discontinued Propranolol.

1st of May 2022 - Akathisia symptoms continue, Mirtazapine upped to 15mg. 7 day window followed. Tandospirone cut to 2x 10mg.

20th of May 2022 - Mirtazapine cut back to 11.75mg (3/4 of a 15mg pill).
June 2022 - Mirtazapine updose to 15mg. Tandospirone and Biperiden discontinued. Klonopin started PRN (0.5mg)

Current regimen: Mirtazapine at bedtime for akathisia/sleep/anxiety/depression, 15mg; Magnesium at bedtime for akathisia/sleep/anxiety/depression, Klonopin PRN (0.5mg). Waiting to stabilize.

Link to comment
  • Moderator

Hi PortugueseSea,

You are on the right ship now.

Have you seen:

Tips for tapering off mirtazapine(Remeron)

included in ^ are described methods of getting the non-standard doses so often needed

compounding is not the only way

pill cutting can be somewhat inexact over the long haul

and you could do a self made suspension

I only took Remeron briefly myself, but it does look like the lower dose may cause even more sedation or tiredness, so be ready to continue with observations.  And don't freak out......Post when you need to for support, and keep going with those NOTES of yours too.  That's excellent that you are doing those and important for us to see how your symptoms go, both before and after your drug(s) are taken in a 24 hour period.  Definitely add in to those if you do take any clonazepam, or other drugs you've been given.

 

Do also see:

Cross Over: Changing form(eg tablet to liquid) of drug or changing brand of same drug

we wouldn't recommend going straight to all liquid from tablet form, rather a gradual shift......you'll see

 

And then I see you are moving in a weeks time to another time zone.  Sorry that you are finding that you do need some help managing now.......yet on the brighter side.......the grace of having helpful, supportive family.  I expect you will feel off a little bit just adjusting to the different time zone.  Like days of jet lag or something like that.

Generally, when we have members shift the timing of their drug(s) we recommend doing so by just an hour at a time, while not making any other changes.  So you might want to try the split dose first that Alto has advised.   
The rule of 3KI's, simple, slow, stable

And I expect that you will find that moving is stressful too and may intensify some of your symptoms briefly, as stress can often do.

 

Okay, and best.

L, P, H, and G,

mmt

 

Edited by manymoretodays

2022 May- continuing with limited activity on site, just something I need to do right now

Started with psycho meds/psychiatric care circa 1988.  In retrospect, and on contemplation, situational overwhelm.

Rounding up to 30 years of medications(30 medication trials, poly-pharmacy maximum was 3 at one time).

5/28/2015-off Adderal salts 2.5mg. (I had been on that since hospital 10/2014)

12/2015---just holding, holding, holding, with trileptal/oxcarb at 75 mg. 1/2 tab at hs.  My last psycho med ever!  Tapered @ 10% every 4 weeks, sometimes 2 weeks to

2016 Dec 16 medication free!!

Longer signature post here, with current supplements.

Herb and alcohol free since 5/15/2016.  And.....I quit smoking 11/2021.  Can you say Hallelujah?(took me long enough)💜

None of my posts are intended as medical advice.  Please discuss any decisions about your medical care with a knowledgeable medical provider. manymoretodays

 

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  • Administrator
11 hours ago, PortugueseSea said:

If it could be a quarter of a pill, 3.75mg I think I could do it with my pill cutter. Or would that be overdoing it?

Thank you, as always.

 

I suppose you could try this. Move the 3.75mg by an hour earlier each day until you are taking it 12 hours before the evening dose. If it makes you too sleepy during the day, you'll have to make it a smaller morning dose.

 

It appears you metabolize mirtazapine on the faster side of the range.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

Link to comment

@manymoretodays

 

Thank you so much. I am definitely going to look at those resources and get ready to do the compounding myself if necessary. Would rather use a compounding pharmacy but, well, I guess I will find out if that is possible when I am back home.

On 9/24/2022 at 3:14 AM, manymoretodays said:

And don't freak out......Post when you need to for support, and keep going with those NOTES of yours too.


Yeah, restlessness and freak out are almost synonyms; I am working hard to remind myself that this is temporary and that I will get through it. Will update the notes soon!

Thank you so much for keeping an eye on my situation, it means the world to me.

Early December 2021 - Started Metroclopramide (Anti-Emetic) nausea 30mg (10mg 3x day).

Mid December 2021 - Akathisia symptoms start; Metroclopramide gets changed to PRN, taken 5mg, first every other day, then once every 3 days.

Early March 2022 - Akathisia diagnosed; Metroclopramide stopped; started Propranolol 10mg x twice a day to no effect, Biperiden PRN (0.5mg to 1mg).

Early April 2022 - Started Tandospirone 30mg (10mg 3x day), Quetiapine 25mg (only taken once, it skyrocketed symptoms).

Mid April 2022 - Mirtazapine 7.5mg, 10 day window followed. Discontinued Propranolol.

1st of May 2022 - Akathisia symptoms continue, Mirtazapine upped to 15mg. 7 day window followed. Tandospirone cut to 2x 10mg.

20th of May 2022 - Mirtazapine cut back to 11.75mg (3/4 of a 15mg pill).
June 2022 - Mirtazapine updose to 15mg. Tandospirone and Biperiden discontinued. Klonopin started PRN (0.5mg)

Current regimen: Mirtazapine at bedtime for akathisia/sleep/anxiety/depression, 15mg; Magnesium at bedtime for akathisia/sleep/anxiety/depression, Klonopin PRN (0.5mg). Waiting to stabilize.

Link to comment
On 9/24/2022 at 5:44 AM, Altostrata said:

I suppose you could try this. Move the 3.75mg by an hour earlier each day until you are taking it 12 hours before the evening dose. If it makes you too sleepy during the day, you'll have to make it a smaller morning dose.


Got it, will try that and report back. Hopefully, it won't be too difficult to either compound by myself or find a pharmacy to do it in Portugal.

 

On 9/24/2022 at 5:44 AM, Altostrata said:

It appears you metabolize mirtazapine on the faster side of the range.


Yeah, I often wake up okayish and get worse during the morning or lunchtime.

Alto, what is your take on the Klonopin? I am doing my best not to take it all but maybe I am being overzealous. Sometimes I could use a break from the akathisia symptoms, all other symptoms I can deal with very well.

Thank you for the advice, it is invaluable. I am very grateful.

Early December 2021 - Started Metroclopramide (Anti-Emetic) nausea 30mg (10mg 3x day).

Mid December 2021 - Akathisia symptoms start; Metroclopramide gets changed to PRN, taken 5mg, first every other day, then once every 3 days.

Early March 2022 - Akathisia diagnosed; Metroclopramide stopped; started Propranolol 10mg x twice a day to no effect, Biperiden PRN (0.5mg to 1mg).

Early April 2022 - Started Tandospirone 30mg (10mg 3x day), Quetiapine 25mg (only taken once, it skyrocketed symptoms).

Mid April 2022 - Mirtazapine 7.5mg, 10 day window followed. Discontinued Propranolol.

1st of May 2022 - Akathisia symptoms continue, Mirtazapine upped to 15mg. 7 day window followed. Tandospirone cut to 2x 10mg.

20th of May 2022 - Mirtazapine cut back to 11.75mg (3/4 of a 15mg pill).
June 2022 - Mirtazapine updose to 15mg. Tandospirone and Biperiden discontinued. Klonopin started PRN (0.5mg)

Current regimen: Mirtazapine at bedtime for akathisia/sleep/anxiety/depression, 15mg; Magnesium at bedtime for akathisia/sleep/anxiety/depression, Klonopin PRN (0.5mg). Waiting to stabilize.

Link to comment

Friday:
Slept well

07:00 Woke up fairly restless

08:00 Ate light breakfast, milk and cereals.

08:30 Start work, same situation; fidgety.

10:45 - 13:00 Finish work and leave for lunch with family; restless throughout but somehow manage to do it all. Feel fidgety, restless, head pressure starts building.

14:00 - 15:30 Meet with potential client; feel quite restless, some urge to pace; move lower limbs.

15:30 - 17:00 Meet with another potential client, things somewhat calm down; less restless but head feels like it will explode. No pain, just pressure and unbelievable discomfort.

18:30 - 21:00 Meet up with old friend, eat dinner; restless somehow is becoming less intense. Head pressure also eases.

19:00 - 21:00 Play video-games; limited restlessness, less head pressure, less fidgety, still uncomfortable in my own skin though.
22:00 Take Mirtazapine 15mg with Magnesium; go to bed

 

Early December 2021 - Started Metroclopramide (Anti-Emetic) nausea 30mg (10mg 3x day).

Mid December 2021 - Akathisia symptoms start; Metroclopramide gets changed to PRN, taken 5mg, first every other day, then once every 3 days.

Early March 2022 - Akathisia diagnosed; Metroclopramide stopped; started Propranolol 10mg x twice a day to no effect, Biperiden PRN (0.5mg to 1mg).

Early April 2022 - Started Tandospirone 30mg (10mg 3x day), Quetiapine 25mg (only taken once, it skyrocketed symptoms).

Mid April 2022 - Mirtazapine 7.5mg, 10 day window followed. Discontinued Propranolol.

1st of May 2022 - Akathisia symptoms continue, Mirtazapine upped to 15mg. 7 day window followed. Tandospirone cut to 2x 10mg.

20th of May 2022 - Mirtazapine cut back to 11.75mg (3/4 of a 15mg pill).
June 2022 - Mirtazapine updose to 15mg. Tandospirone and Biperiden discontinued. Klonopin started PRN (0.5mg)

Current regimen: Mirtazapine at bedtime for akathisia/sleep/anxiety/depression, 15mg; Magnesium at bedtime for akathisia/sleep/anxiety/depression, Klonopin PRN (0.5mg). Waiting to stabilize.

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Saturday:
Slept well.

07:00 Woke up okayish.

08:00 Eat milk and cereals

08:30 Start work; limited restlessness but head pressure quickly starts building.
08:30 - 18:00 Work, work, work; limited restless, head pressure builds and builds, feel like it's going to explode. Eventually leads to transient suicidal ideation.

20:00 Symptoms ease, head pressure clears 70%. Go home. Still feel slightly restless.
22:00 Take Mirtazapine with magnesium and go to bed.

 

 

Early December 2021 - Started Metroclopramide (Anti-Emetic) nausea 30mg (10mg 3x day).

Mid December 2021 - Akathisia symptoms start; Metroclopramide gets changed to PRN, taken 5mg, first every other day, then once every 3 days.

Early March 2022 - Akathisia diagnosed; Metroclopramide stopped; started Propranolol 10mg x twice a day to no effect, Biperiden PRN (0.5mg to 1mg).

Early April 2022 - Started Tandospirone 30mg (10mg 3x day), Quetiapine 25mg (only taken once, it skyrocketed symptoms).

Mid April 2022 - Mirtazapine 7.5mg, 10 day window followed. Discontinued Propranolol.

1st of May 2022 - Akathisia symptoms continue, Mirtazapine upped to 15mg. 7 day window followed. Tandospirone cut to 2x 10mg.

20th of May 2022 - Mirtazapine cut back to 11.75mg (3/4 of a 15mg pill).
June 2022 - Mirtazapine updose to 15mg. Tandospirone and Biperiden discontinued. Klonopin started PRN (0.5mg)

Current regimen: Mirtazapine at bedtime for akathisia/sleep/anxiety/depression, 15mg; Magnesium at bedtime for akathisia/sleep/anxiety/depression, Klonopin PRN (0.5mg). Waiting to stabilize.

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Slept well.
Sunday:

07:00 wake up restless and uncomfortable; feel like crawling out of my own skin
07:30 Head pressure builds, very distressing

08:00 Eat milk and cereals, quite agitated

10:00 Chest pressure on and off; head pressure continues

11:00 Tinnitus

11:30 Head pressure and chest pressure ease, tinnitus goes away, restlessness eases.

13:00 Restlessness focused on the neck, bout of terror; ate healthy lunch, meat, vegetables and some bread with olive oil.

14:30 Neck burning, fidgety. An ice pack helped a bit.

15:00 Start work.

16:00 Restlessness eases, anhedonia and depressed mood remain.

18:00 Restlessness reaches higher levels, resisted the urge to take the klonopin.

19:00 Ate a burger for dinner.

21:00 Took 3.75mg of Mirtazapine and the magnesium, restlessness eased.

22:00 Took 11.25mg of Mirtazapine. Off to bed.

 

 

Early December 2021 - Started Metroclopramide (Anti-Emetic) nausea 30mg (10mg 3x day).

Mid December 2021 - Akathisia symptoms start; Metroclopramide gets changed to PRN, taken 5mg, first every other day, then once every 3 days.

Early March 2022 - Akathisia diagnosed; Metroclopramide stopped; started Propranolol 10mg x twice a day to no effect, Biperiden PRN (0.5mg to 1mg).

Early April 2022 - Started Tandospirone 30mg (10mg 3x day), Quetiapine 25mg (only taken once, it skyrocketed symptoms).

Mid April 2022 - Mirtazapine 7.5mg, 10 day window followed. Discontinued Propranolol.

1st of May 2022 - Akathisia symptoms continue, Mirtazapine upped to 15mg. 7 day window followed. Tandospirone cut to 2x 10mg.

20th of May 2022 - Mirtazapine cut back to 11.75mg (3/4 of a 15mg pill).
June 2022 - Mirtazapine updose to 15mg. Tandospirone and Biperiden discontinued. Klonopin started PRN (0.5mg)

Current regimen: Mirtazapine at bedtime for akathisia/sleep/anxiety/depression, 15mg; Magnesium at bedtime for akathisia/sleep/anxiety/depression, Klonopin PRN (0.5mg). Waiting to stabilize.

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I hold two beliefs I think are true but would like to ask people's take on it:

1) I believe my current distress, that was originally caused by metoclopramide, to have been compounded by subsequent medication. The worst months for me, by far, were March and April, which coincided with several medication trials including propranolol, tandospirone and valproate. Mirtazapine and Klonopin somehow halted the storm but my CNS is still very unstable. Therefore, it is important I keep to my Mirtazapine dose and use Klonopin as sparingly as possible.

2) Despite not having noticed any negative effects from Klonopin until this point, it could very well lead to kindling and further destabilization if used.

I am pretty unsure about Klonopin use PRN because I've heard both sides of the argument. That it can help stabilization in acute settings, and it has for me at several points, and that it can lead to further destabilization if not used consistently.

Thank you.

 

Early December 2021 - Started Metroclopramide (Anti-Emetic) nausea 30mg (10mg 3x day).

Mid December 2021 - Akathisia symptoms start; Metroclopramide gets changed to PRN, taken 5mg, first every other day, then once every 3 days.

Early March 2022 - Akathisia diagnosed; Metroclopramide stopped; started Propranolol 10mg x twice a day to no effect, Biperiden PRN (0.5mg to 1mg).

Early April 2022 - Started Tandospirone 30mg (10mg 3x day), Quetiapine 25mg (only taken once, it skyrocketed symptoms).

Mid April 2022 - Mirtazapine 7.5mg, 10 day window followed. Discontinued Propranolol.

1st of May 2022 - Akathisia symptoms continue, Mirtazapine upped to 15mg. 7 day window followed. Tandospirone cut to 2x 10mg.

20th of May 2022 - Mirtazapine cut back to 11.75mg (3/4 of a 15mg pill).
June 2022 - Mirtazapine updose to 15mg. Tandospirone and Biperiden discontinued. Klonopin started PRN (0.5mg)

Current regimen: Mirtazapine at bedtime for akathisia/sleep/anxiety/depression, 15mg; Magnesium at bedtime for akathisia/sleep/anxiety/depression, Klonopin PRN (0.5mg). Waiting to stabilize.

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  • Administrator

Yes, going on and off drugs may have upset your nervous system.

 

"Acute settings" means very short-term at the beginning of treatment, when symptoms are most intense. You are not in an acute setting. However, if you take Klonopin every day (and sometimes every other day), you may become physiologically dependent and experience interdose withdrawal symptoms.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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