Mcat: reinstated Mirt, now coming down again

[brassmonkey]

Looks like you've got it Mcat.

[Mcat]

Lordy, that was gruelling - just did my first official batch to start my first taper dose tonight (nervous about that, too), and it took forever. It was hard not to second guess myself (and every weight), and I couldn't help fretting about the possibility of accidentally messing myself up and lost powder and whether there were more bits of shell in one lot vs another (and whether that would throw me into worse WD), but I guess it can't be a super exact science and we do the best we can and try to get as close to 100% accurate as possible. And assuming I've basically got the calculations and portions right, it will probably be far more stabling dosing from now on because I've been spitting halves with a pill cutter and hard as I've tried to get it exact, I know they're a bit off. Anyway, here goes.

[Mcat]

1st day of taper report: I took my drop dose last night and saw pretty immediate signs of WD, e.g., the internal shaking during the night (not bad; just enough to notice when I stirred to move) I get whenever I'm adjusting to or dropping down off this drug.

 

I went to sleep without any trouble, though it did take me a bit longer to get tired enough to go to bed and slept solid (maybe a bit lighter) for about 4.5/5 hrs, then awake and very hungry at 3.30am. This is my classic pre-med organic and WD insomnia pattern (though WD when I came clean off earlier this year also made it hard to go to sleep sometimes, and sometimes I'd wake up after 1-2 hrs and not be able to get back). This is, I've learned on this site, a cortisol spike, and I believe it's long been my worst enemy; I recently tested my cortisol while I had other bloods done, and it's about 8 points above the normal upper limit - while on a drug that suppresses it. 

 

Anyway, I learned toward the end of my miserable bout of WD insomnia, before I reinstated, that what works best when I wake up hungry in the wee hours is to not stress about it and get up and do something relaxing out of bed (a guided meditation or read) for 1-2 hrs and wait till I start feeling more tired, then have some tea and toast (yes, I know tea has caffeine in it, but it also has l-theanine and it seems to help me sleep rather than hinder) and that usually makes me more sleepy, so then I head back to bed. It doesn't always work, but often, I get another couple of hours that way. So, all up, I got about 6.5 hrs. Not luxurious, but not too shabby, and very acceptable under the circumstances. 

 

So, more or less what I expected. I'll see what happens over the coming days. If I don't show signs of stabilising in 2 weeks, I think I'll switch to the slide to see if that makes the ride smoother. 

[Mcat]

Okay, well, that was interesting. I slept like a baby night 2 post-drop: 8.5 hrs, very like I usually would on my 7.5 starting dose. So, of course, given I'm so new at this, my first thought on waking was, 'great, but does that mean I got it wrong and have taken more than my 10% drop?'.

 

On reflection, I think I should have ground the powder more finely, and I forgot to stir it (though I used a mortar and pestle, which naturally stirs some while grinding), so it's possible I got a bit more active ingredient in that capsule. Anyway, I'll pay more attention to that next time I prep.

 

I guess it's also possible that what I'm feeling is the difference between a 10% drop and the much larger ones I've done previously. When I was on Mirt for 6 months 20 yrs ago, I was on a cocktail of heavy anti-viral drugs, which themselves had massive side effects, including insomnia and anxiety, so when I came off 15mg CT and lost it right after I concluded treatment, I had no way of knowing how much was down to the AD and how much the other drugs (if I'd known how bad WD from Mirt could be, I'd never have gone back on last year), but when the doc pulled me off to try another AD last year and when I tried to come off it again earlier this year, I was doing much bigger drops than 10% and much faster. 

 

Anyway, time will tell. It's still early days. 

[Mcat]

Is fatigue a WD symptom? I don't recall whether I experienced it earlier in the year, but yesterday and today, I feel more tired during the day than usual (I don't think my sleep is compromised enough to do it: so far, so good - another good night last night clocking 7.5 hrs, though it did take me an hour longer than usual to get sleepy). 

 

I feel a bit paranoid that maybe I accidentally put more into the capsules than my intended 10%, but I suppose one could go around the bend second-guessing the tapering prep, so I'll press on and hope I got it right. Anyway, curious know if it's a known WD thing. 

[Faure]

10 hours ago, Mcat said:

Is fatigue a WD symptom?

Yes ☹️ It’s been a terrible symptom for me that I’ve suffered ever since a failed taper a few years ago followed by a full reinstatement. I never recovered from the full reinstatement and have been fatigued for these past 3 years. It is gradually improving as I lower my dose but tapering is very hard work for the body, takes a lot of energy and so we are tired from it. It’s not just me, many people here suffer from fatigue while tapering. Even when I was well on the drug when I first started it I couldn’t do as much as I used to be able to do, it is well known as a sedating drug. 
 

I’ve been reading your posts and am glad to see all is going well with the taper. Taking longer to get to sleep is very common and I suspect as you reach the end of the 4 weeks you’ll be back to getting to sleep normally again, ready to take the next cut. 
 

10 hours ago, Mcat said:

feel a bit paranoid that maybe I accidentally put more into the capsules than my intended 10%

What do you mean by the above??? Hopefully you mean you’re a bit worried you didn’t put exactly 90% of your previous dose into the capsules….measure carefully and trust yourself once it’s done ☺️
 

I’m very interested in hearing how you get on with the 10% drops because I’m considering switching to this as I’m getting almost no WD symptoms and haven’t had for quite some time. It would be a way to speed up my taper while staying within SA guidelines. 

[Mcat]

Thanks, Faure, I figured as much. I get how sedating Mirt is, and that's the reason I went on it because insomnia was my motive for starting an AD last year, and whenever I first went on the drug, I'd be rooted all day for about a week, but I didn't expect daytime tiredness to kick in going down. I guess when I went off earlier in the year, I put any daytime fatigue down to sleeping so poorly as I was many nights only getting 1-4 hrs at that time, but now that I'm reducing slowly AND sleeping very well, I'm noticing feeling more tired during the day.

 

And re the paranoia about dosage - I carefully weighed 0.069, my 10% reduction, on the scales and put that into each capsule, so I'm confident I got that part right, but with my insecurity about calculations etc., and the fact that I seem to be doing so well, I sometimes wonder if I did it right because I expected to have more trouble with sleep, at least for the first couple of weeks.

 

I did belatedly realise that, overwhelmed with getting all the steps right, I probably didn't crush the pills up as finely as I should have or stir the powder, so it might be that I am getting more active ingredient in some caps. I'm prepping some more today and will be more attentive to that. 

 

I had some classic Mirt WD irritability/rage yesterday in the evening, which reassured me that I am, indeed, reducing, but then I got tired very quickly after my dose last night and slept well for about 9 hrs last night, so, again, that might have been a cap with more active ingredient, or it might just be that I'm coping well so far with the drop. 

 

I have to remind myself that I've never gone this slow before and that the whole point of the 10% (or less) protocol is to reduce WD, and that some get none as they taper (until they get to the pointy end when even they seem to have issues), and maybe I'm just experiencing the benefits of that. But it's still early days (only day 4 today, and as we know, days 4-10 are a significant stretch when coming off Mirt), so only time will tell. 

 

I hope you're having a lovely holiday!

[Faure]

Glad it’s all going so well. Maybe as you say you’re expecting it to be worse than it is! You might like to buy a nice pill grinder, I’ve been thrilled with mine! It grinds the powder very finely ☺️
 

The holiday is good thanks although I had some issues with fatigue which meant I lost a couple of days resting ☹️ I seem to be better yesterday and am looking forward to a day trip today. 

[Faure]

@Mcat How are you on day 4 or 5?

[Mcat]

Freaking out today @Faure - last night, I felt knocked out and am still very tired today. I got scared I might have messed up the measuring yesterday, specifically that my scale might not be quite right because I feel like I'm getting more than I should be, especially on some nights. So, I just did a test by calibrating and taring the tray with an empty capsule and then weighing some of my full ones, and they were all over the shop. I'm going for 0.069, and what I got on those reads was anything from 0.063 to 0.072. So, in the vicinity but not spot on, and I'm worried I'm messing myself up with irregular doses. I'm now re-weighing the content in the caps trying to get it right, but that's sending me around the bend as well because I re-weighed one cap, and it was just under 69, so I added a bit more, and it started going down so now I feel gaslit by the scales and wondering if I got a dud one. I don't know what to do now, but I am worried about getting inconsistent dosing as I now understand how important stability is with these meds. I wish the scale was more reliable. Any thoughts? 

[Mcat]

PS: okay, I re-weighed the contents of all my caps, and it did seem like they were all over; mostly around the 69 mark, but a few low 80s (!) and a few low 60s, which is way more than 10%, so who knows what I've taken the last 5 nights. This is disturbing, as I want to be as stable as possible with my dosing.

 

I can't really account for that except to say that either the scale itself may be whack, and the taring business has also been a tad confusing and could be causing issues. Taring itself is straightforward enough - you put the tray on and hit the tare button, and it goes to 0, not weighing the tray, then when you take it off, it shows - 2000-something. When I prepped last time, I assumed the tare setting would hold for the whole session, but at some point, I noticed that when I put the empty tray on, it showed a tiny amount (not its normal weight) instead of a zero reading. I re-did the tare but wonder now if, along the way, between one capsule and another down the line, the tare went a bit off, leading to my patchy weights. This time I put the empty tray on and hit tare each time before adding the powder to be sure.

 

I can't really do any better than this, but I dislike the feeling of insecurity and uncertainty about dose weights, and I'm now thinking maybe I should have gone the compounding route after all. But the financial sustainability of that was a problem. I have seen others say these scales give unstable readings, and I wish they were more accurate, as this kind of thing is anxiety-provoking. 

[Faure]

Sorry to hear things aren’t going super well. How about you calibrate the scales and weigh the weights that came with the scales a few times during the day to check what they weigh? My weights have one slightly heavier than the other so be aware of that. Hopefully you will find they weigh almost the same every time the last number may change by say 0.001/2, but the readings should be pretty consistent. You might also do the same with the weighing tray.  All this will hopefully give you confidence the scales are sound, or if they give wildly different weights your scale may be dud. 
 

I don’t recommend re-weighing the actual tables you make as the capsules are not designed to be weighed and likely weigh differently. Also there is no point removing the powder and re-weighing that because you’ll have lost some putting it in in the first place and then you’ll leave residue in the capsule, so you’ll never get the weight you are expecting.  
 

If you have just made up a new lot of pills and you’re not confident in them, do what I’ve suggested in paragraph 1, then remove all the powder, put it in an egg cup, throw away the capsules (which will have residue) and do it all again. I have been known to do that, most recently with liquid I wasn’t happy with.  If you are not getting fine powder you might want to be sure you give it a good pound up & stir to make sure the active ingredient is evenly distributed.  
 

Make sure you always have the scales in the same place each time you use them, they have been in that room at that temperature for at least an hour and of course you leave it on for a minute before calibrating and using. They are very sensitive so try not to breathe on them while weighing (I used a face mask for a while). Now I tend to hold my breath! 

[Mcat]

Thanks for those suggestions - will try. I did re-weigh and re-use the caps yesterday without thinking through all the points you make here about residue etc. I find the process very stressful and time-consuming and am working to a deadline this week, so I might just live with the residue in the caps I did yesterday rather than re-doing, but will definitely keep that in mind in future. 

 

I had a stressful, busy Easter weekend and last night I woke around 3am very hungry and had some jerks, which I think is a sign that my dose was lower than my 7.5mg starting dose. Took a while, but I managed to get back to sleep, perhaps partly because I'm exhausted from overworking. 

 

I'll do the experiment you suggest re weighing the weights several times and the tray. And yes, I've been using the scales in the same spot and keeping them at room temp, but re leaving them on for a min before using - often they seem to turn themselves off, especially when I first start using them. Any idea what that's about? Is it something that happens perhaps while they are warming up (annoying if so, because it takes longer to get the process going if they keep turning off). 

[Faure]

The scales are set to turn off after a short time, I assume to conserve the battery. I tend to turn them on while getting the other things ready and keep them awake during this time by putting on / taking off the weights / the tray. Any little movement keeps them awake ☺️
 

I tried combining two weeks drops in one last night so dropping 0.2mg instead of 0.1mg. Took about 4 hours to get to sleep 🙄 hopefully won’t take as long tonight. It will be interesting to see how long it takes for things to settle down. If it takes longer than 2-3 nights I’ll probably ditch this idea and stick with the slide but I wanted to see if I could handle a bigger drop. 

[Mcat]

Yes, okay, will try what you do next time. Interesting re your experiment - drops of 0.2 seems so small. I thought the slide was dropping 2.5mg per week; isn’t this dose well under that?

[Faure]

The slide drops 2.5% per week not 2.5mg!!!

[Mcat]

Yes, of course, that's what I meant - I think I've got a bit of the old WD brain fog going on, as I'm not as sharp as usual. Either that, or it's overwork exhaustion or a combo. I also still get momentarily confused when discussing these things between all the different ways of noting the dose. I find it easier just to think in terms of the scale dose for the most part.

 

Slept okay last night - sleep is more broken, and I did wake hungry (cortisol spike) in the wee hours, but so far, I'm managing to go back to sleep without any great drama. Not sleeping for as long, but still getting a very good run. How did you go on your second night of the bigger drop?

[Faure]

Glad you’re going along ok. I still took a while to get to sleep last night, perhaps 3 rather than 4 hours (I didn’t look at the clock!). I’m on holiday from work so it doesn’t matter. I feel much better on waking today than I did yesterday. Hoping after tonight things will settled down, we will see.  If they do I might change drop day to Fridays (from Mondays) so I can get over it on the weekend. 
 

Hope your work life calms down soon ☺️

[Mcat]

I continue to sleep well and feel extra tired during the day, which does worry me. I know it's likely partly from work, but I worry that I may be getting thrown off by those scales and taking more than I mean to. If not, perhaps it's not a big enough drop to affect my sleep much but is enough to get some WD fatigue. Or I might be battling a low-grade lurgy.

 

My anxiety level does seem to be higher, and I'm feeling more prone to agitation, so I think that's a sign my dose has changed. Again, just really hope it's not more than I intend. I'll do the test with the scale today.

[Faure]

It might be because you’ve made a change and any change re meds makes us anxious….I often find I blame everything on my taper and nearly always find out later it has been something else. It will be good when you’ve tested your scales as this will hopefully give you more confidence in them. 

I think feeling irritated is part of WD. I was extremely irritable the first day after my 5% drop. 

 

My sleep was back to normal last night, on the 3rd night after my 5% drop. 

[Mcat]

Oh, good news about signs of stability after your more significant drop! And yes, it's all been very unsettling, and there have been a few other stressors in play, so it could be that more than anything.

 

So, as you suggested, I did the test today using the weights that come with the scale. It was pretty good, mostly accurate and where not only a minuscule difference. I also weighed three whole pills again, which came to 0.464, averaging out to 154 per pill, which is the number I've gotten the most readings on (despite some variation), and I then took them to my trusty chemist (my usual one, not the fancy compounding chemist) who weighed on their scale, and they got 0.463; chemist said not to fret about differences this minor as they were 'within the margin of error'. 

 

I asked if they did this kind of thing for people, and they said they did, but usually at 100 pills a time. I explained that if I decide trying to do it myself is all too much for me and too anxiety-provoking, I would need only 30 or 31 pills a month because I'm on a 10% monthly reduction taper, and he's going to look into it. If it's significantly more affordable than the compounding chemist quote, I might even go that way or at least consider it for once I get to 3mg (and maybe shift to liquid at 1mg). He's going to look into it, so we'll see what he says, and I'll consider the options again then.

 

I think it's mainly the notable increase in daytime fatigue that unnerves me, as that's always been associated with higher doses for me and the adjustment period upon commencement (it typically settles down after about a week or so). So, yeah, don't quite get what's going on there, and that's what spooks me into thinking maybe something's gone very wrong, and I'm getting more than I should. But I've done this batch of capsules twice now as accurately as possible, so there's not much more I can do for now.

 

[Mcat]

@Faure I forgot to say that though the weights that come with the kit were pretty accurate (along the lines of what you described with yours), and my weight of 3 x pills pretty much matched the chemist scale when I experimented with putting a weight off and on many times and did the same with the tray, the weight in both cases went further down the more I did it. Is this normal for these scales, with the first weight being the most accurate, or do you think that indicates an issue with mine?

 

Also, it's now 10 days since I started tapering, and I've slept well every night, apart from the first night, where I got a solid 5, then got up for a while and went for a couple more (so 7ish all up).

 

Do people ever drop again sooner if they feel fairly stable after 2 or 3 weeks (instead of waiting out the full 4)? Insomnia is my biggest WD concern, and I seem to have handled this drop okay on that front, assuming my dosing is reasonably accurate, but if it hasn't been as accurate as I'd like, I think, based on my sleep pattern and daytime fatigue, that I'm likely getting more rather than less than what I want, so wondering if coming down again sooner might be a good idea just this once (and just in case I am getting slightly more than intended).

 

 

 

 

[Faure]

Hello, re the weights, I’m afraid I really can’t say. If you’re not happy with your scales I suggest you buy a second pair and see if you are happier with them. But then you’ll get caught up considering differences between them!

 

As you have only just started your taper I think it would be best to complete at least 2 cycles with a dose change at 4 week intervals.  Please read Alto’s topic about tapering here, the first post is highly relevant and you should pay close attention to all of it.  (I haven’t read further on recently). 
 

Insomnia may be what you are most worried about and it’s good that sleep is fine. But there are myriad other symptoms that could occur and if they occur all at once you could get very ill. 
 

I think you should get more confident with your weighing etc before you even consider make any changes to the schedule. So how about you keep things as they are are for a couple of cycles then we can review. I think a mod should also weigh in before any changes are made, but I don’t think now is the time to ask them. 
 

Be very cautious, because if things go wrong it can take months to recover, including months off work. 

[Mcat]

Yes, that makes sense. Better to be safe than sorry. And I think you're right that buying another set of weights would only do my head in more. I'll press on and see how it goes next time and if I can start to feel more confident with the doses - otherwise, I'll get it sorted at the chemist. 

 

 

 

 

[Faure]

I was just browsing, came across this and thought of you!

 

Quote

Most people tapering on these forums speak highly of the Gemini 20 scale. 

 

Does your scale have a TARE button? Make sure you push that button before you weigh your pill. The TARE button resets the scale to zero. Here is a way to recalibrate your scale to help with accuracy:

 

Place the gram scale on a hard, flat, and level surface with plenty of room to prepare your dose.

 

Press the TARE button to zero it out.

 

Recalibrate the scale. Please see this video for more information, starting at around 3:30 minutes:

 

Smart Weigh GEM20 Digital Jewelry Scale Review

 

Your scale may be a bit different than in this video, so please have a read of the owner's manual for your scale for how to recalibrate.

 

Add the tray to the gram scale. 

 

Wait 5 - 10 seconds to let it settle on the scale.

 

Hit the TARE button again to zero it out.

which Shep posted here

[Mcat]

Thank you! Interesting that it says to Tare before calibrating. I've been doing it the other way around. I'm somewhat reassured that it's reasonably reliable after doing the comparative experiment with the chemist scale, but it does spook me and get inside my head the way the numbers go down if I repeatedly weigh the same thing. I'll check the vid out and try all this next time.

[Mcat]

Quick update: I went well, overall, on that first 10% drop, apart from a spot of panic and uncertainty about the accuracy of the scales, and I did my second drop last night (down to 6.08mg). Slept well last night, which was a nice surprise. WD symptoms to date include muscle weakness, a few jerks (only one really bad night when they stopped me sleeping), anxiety and fatigue and some of that charming Mirt anger/intolerance. Nothing unbearable. 

 

Re scales issues - having viewed the video Faure passed on and coming across comments from others using the same scales, I expect they're about as accurate as they get (though they do seem to trend down, e.g., readings reduce progressively if you re-weigh the same weight multiple times), and given I have to add or reduce powder to get the reading I'm looking for, that's a worry. Anyway, I'll stick to it for now and move to compounded liquid eventually.

 

 

[Mcat]

Hello to anyone still reading my posts/thread. I'm going okay and busy at work, hence the silence, but I've been very grumpy these past few weeks and pretty depressed. To be fair, there are aspects of my life that are reactive-depression inducing, so it's probably partly that, but I suspect it's also partly the taper. I presume other Mirt taperers experience this? I didn't go on this drug because of depression, so it's not a reversion to a pre-med state. My issue pre-med was insomnia, and as that's also the worst Mirt WD symptom, that's my biggest concern. I'm sleeping well so far, which is good, but it's early days, and I don't know how that will go as I get beyond 3.75mg (the lowest proven dose to date that I sleep reasonably well on - wish I'd just stayed that low as I'd have a much faster taper if that had been my starting point). My most notable problem side effects of the Mirt have been significant weight gain (which is causing health problems) and the jerks; the latter is still around but very manageable for the most part - the weight hasn't shifted at all as yet; I hope to see some movement on that soon. Next drop is coming up, so we'll see what that brings. 

[Faure]

Hi @Mcat, thanks for your update. I’m sorry to hear you are feeling depressed and grumpy. I can certainly recognise the grumpy. I’ve been fortunate in that I haven’t experienced depression during my taper. I’m glad to hear sleep is still going well.  Let’s hope the progesterone will take care of insomnia if it starts up again. Good news it’s all going well, keep us posted ☺️

[Faure]

Having seen you comment about depression elsewhere I got to thinking that you should probably tag a mod for advice about this. It might be a withdrawal symptom and if so the taper may need to be slowed….I don’t know enough to offer any advice other than to check with someone that does ☺️

[Mcat]

Thanks @Faure - it is possible the Progesterone could also be playing a part (it can be a side effect), or perhaps a combination of the two. It's also possible that it's reactive depression around life circumstances; quite apart from the Mirt drama, the last couple of years have been pretty hellish, and work has been very intense these past months, and I'm exhausted, so it could be just my resources are low, and the negativity is gaining steam. Or a bit of everything. It's just disconcerting because depression this bad isn't something I've had to deal with for a long time, and it's not fun. I'll try to consult about the Progesterone and get a medical opinion about the chances of that involvement on my dose.

 

[Faure]

Ok, be very wary of medical “professionals” trying to treat your depression with more ADs. I hope you start feeling better soon. I am tagging @Altostrata as I’ve see her weigh in with advice on HRT☺️

[Mcat]

Yeah, SO not falling for that!

[Mcat]

Update: the fierce depression seems to have lifted some, so I'm putting it down to the taper. It kicked in around 10 days after my last drop, which makes sense, given Mirt's WD profile.

 

I did my third drop a couple of days ago; so far, so good. But I'm tired of the head**** of working with less-than-reliable scales. I looked into buying a more expensive one, but the salesperson didn't think even that would be reliable given the small reductions and the fairly small dose I'm on, and I'm not shelling out $1-2000 for one that will be reliable.

 

So, I've spoken to my chemist, who is willing to do a 1mg in 1 ml liquid compound for me for a very reasonable price, and I'm going to get my GP to write a script for that. Planning to transition end of the week or next, depending on how the taper feels. I might move to making liquid myself at some point if I can rally to face the palaver and anxiety of doing it myself - for now, I want to be sure I'm getting the correct dose. 

 

A quick question for mods or anyone with solid knowledge of compounded liquid: I asked if it would expire in 3-4 weeks. He said yes, but then he looked it up and said he could do a preparation that lasted 6 months. This would obviously be preferable, cost-wise, but I've not seen mention of compounded liquid that lasts that long here, so I want to be sure there's not some reason why I should avoid that. 

[Mcat]

PS: we settled on 5mg in 1 ml so that the product lasts longer - I'll adjust down when I get a new script some months down the track. I hope the transition to liquid goes okay. Bit nervous about it, but I don't want to do the half/half thing as I just don't trust these scales, so I'll hope for the best.

[Mcat]

I moved to liquid (long-lasting - compounded by chemist) a couple of weeks back and had no problem with the transition. It's a relief to know I'm getting an accurate dose now. I get a few jerks, especially in the period after a drop, but my CNS seems to be settling as I come down in dose, which is great. Not seeing much difference in weight yet and still have the Mirt gusto appetite, but I might have dropped a bit - I'll weigh next time I'm near a scale. Sleeping well so far. All in all, the taper is going well, at least for now.