Puzzled: mirtazapine to Cymbalta?

[Puzzled]

I was originally prescribed Mirtazapine (30mg)for my intense anxiety and insomnia after have COVID in August of 2021.  Have had little to no side effect (weight gain). Unfortunately when I started to feel better I was told by my Dr to cut my 30mg tablet in half for 3-5 days and then stop. Each time my anxiety and insomnia returned so severely my Dr told me to start taking it again. 
 

I have tried a 10% taper from 30mg for 11 days now. Two days ago the insomnia reappeared but not the anxiety. So my Dr now wants to switch me to Cymbalta. I don’t want to take any of these awful meds any longer. Should I go back up to 30mg? Or push through the insomnia at 22.5?

 

Thank-you for this amazing resource!

[getofflex]

Hello, and welcome to SA.  We are a volunteer-run community of people who have been or are getting off of psychiatric drugs.  I'm sorry you are dealing with these issues from mirtazapine.  Your doctor had you basically do a cold turkey off this drug, which was bad practice IMO.  It is good that now you are attempting a much slower taper.  It could be that your system was still destabilized from the previous taper attempts, and not yet ready to start another taper, even a 10% one, and so now you have insomnia.  So, are you now on 27 mg mirtazapine?  (30 mg minus 10% reduction) 

 

I totally don't blame you for not wanting to take these awful drugs any longer.  So many doctors practice just by throwing drugs at people, and switching their drugs around.  This would put you at risk of further destabilizing your nervous system, and making your symptoms even worse.  Not only that, your brain would become dependent on the Cymbalta, and then you would have to taper that if you wanted to get off of it. Cymbalta can be a nasty drug to taper off of.  I would stay away from it , if it were me.  It doesn't make sense that he wants to put you on Cymbalta, as that is an activating drug, and is more likely to worsen the insomnia, rather than help it.  You have other, better options here. 

 

Doctor is Shocked at Severe Cymbalta Withdrawal

 

Can you please give us specific information in your signature about the dates you recently jumped off the Mirtazapine, and then reinstated it over the past year please?  If you don't recall the day, say "early May", or "third week of May", for example.  

 

How to List Drug History in Signature

 

Here is some important information about how these drugs actually work.  This explains why we get symptoms from going off of these medications, and why it's so important to taper slowly and carefully, and be very cautious about changing our doses: 

 

How Psychiatric Drugs Remodel Your Brain

 

 

This helps you understand what withdrawal syndrome is: 

 

Video on Recovery from Psych Drugs

 

Windows and Waves Pattern of Stabilization

 

 

Tapering is best done extremely slowly, and we generally taper by 10% of the current dose no more than once every 4 weeks, so that the reduction becomes exponentially smaller.  However, I would not do any more tapering until you have been on your current dose of mirtazapine for at least several months, and give you system a chance to rest, and stabilize.  

 

 Why Taper by 10% of my Dosage  

 

Tips for Tapering mirtazapine

 

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

 

Stability is really important when we are tapering off psych meds.  Please read the link about stability:

 

Keep It Simple, Slow, and Stable

 

 

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

 

How bad is your insomnia?  On average, how many hours a sleep are you getting each night?  If it is severe, you could do an updose.  Going back on a small dose of your drug, or increasing your dose, which we call reinstatement, is best done very carefully.  If you do updose, the sooner you do it, the better.  I need more precise info about your drug history, as requested above, before I can make a good updosing suggestion.  Here is some information about reinstatement.  

 

About Reinstating and Stabilizing to Reduce Withdrawal Symptoms

 

I've given you quite a bit of information here.  Please let us know what you decide to do about updosing.  

[Puzzled]

Thank-you tremendously for all of this information. I have read through it and decided Cymbalta is definitely not an option for me. I will stabilize again and then attempt a much slower taper with more exact measurements. I can see it will be a long process. 
 

My first two attempts resulted in comeplete lack of sleep. Which by the third day of no sleep destroys my ability to be rational and my anxiety and depression (which I never even had before this medication) begins. 
 

My last attempt to taper in July was going great. Until about the 9th day when I was only about to fall asleep around 2am and then even later each day for the next two day until I found this site and decided I needed to updose and then start again after stabilizing but with a much smaller decrease. 
 

My Dr has also discussed a Prozac “bridge” since I appear to be very sensitive to any reduction in this medication. 
 

How long should I stabilize before I can start tapering again? Is the Prozac bridge a good or bad idea? 
 

Thank-you all so much for volunteering your time to help people through this struggle. 

[getofflex]

I'm happy to help.  So, you are taking 1/2 of a 30 mg tablet twice per day I assume?  Or are you taking the 30 mg tablet once daily?  

 

57 minutes ago, Puzzled said:

My Dr has also discussed a Prozac “bridge” since I appear to be very sensitive to any reduction in this medication.

We generally don't suggest bridging to another drug.  This link will go into the various reasons why bridging is so risky.  Please read it thoroughly. 

 

Bridging with Prozac/fluoxetine

 

Doing an extremely cautious and conservative taper off of your original drug is safer. The gentlest taper is micro tapering.  This links discusses that. 

 

Brassmonkey Slide Method of Micro Tapering

 

Please answer this question: 

2 hours ago, getofflex said:

How bad is your insomnia?  On average, how many hours a sleep are you getting each night?

 

57 minutes ago, Puzzled said:

How long should I stabilize before I can start tapering again?

I would give it at least a couple of months if not longer, but the best thing is to listen to your body.  This link talks about what stability is: 

 

Stability

Edited July 16, 2022 by getofflex

[Puzzled]

I am taking a 30mg tablet every evening before bed. 
 

While on 30mg I do not experience any insomnia. Each attempt of tapering resulted in total insomnia or 0 hrs a sleep at all. My body would not sleep at night or for daytime naps. My anxiety around falling asleep is the issue. I cannot fall asleep. This began in August 2021 when I had COVID. The virus spiked my anxiety which resulted in the insomnia. To resolve this I was prescribed the Mirtazapine. 

 

 

[getofflex]

Thanks for the clarification.  I believe if you hold on this 30 mg dose for at least a few months, or longer, and then do a very gradual taper, you will do better.  When you did the 10% taper previously, you probably did it before your system was ready for it.  The longer of a hold you do, the more likely you will be able to taper in the future without as many issues, like severe insomnia.  Some people in here even do only 5% /month tapers, or less.  

 

Please keep us posted on how you are doing.