Hopeful1987 - Remeron Taper and Insomnia

[hopeful1987]

Hey everyone, I've wrestled with two crippling bouts of insomnia in my life, both within a year a half of each other. Both bouts of insomnia weren't driven by anxiety or depression, but rather came through illness. So, I don't ordinarily have depression or anxiety. The first time I had insomnia it lasted around 3 months and I got through it with temazepam and remeron, which I tapered off of successfully. The second bout of insomnia started December 8th, 2022, again due to illness. I started temazepam again and later remeron. I had some med changes over the course of several days, which is reflected in my signature, but eventually got back on remeron. My sleep eventually stabilized, so I tapered off the temazepam successfully, with the added help of hydroxyzine. I then stopped the hydroxyzine cold turkey and didn't seem to have any issues. The last thing to go was the remeron, which I always took at 10pm and went to bed at 10:30pm. I was on remeron for about 2.5 months, most of that time being on 15mg, which I then reduced to 7.5mg for a week, then 3.75mg for another week. During the remeron taper I also used 5-10mg of THC and 30mg of CBD at night and I only had one night I didn't sleep well. The last day I took the 3.75mg dose of remeron was March 2nd, 2023. So, I hopped off at 3.75mg and it's been two days and I haven't slept at all either night. I'm guessing I should go back on the 3.75mg dose and do a microtaper with a compounding pharmacy?

[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 glad you came to us right away, only 2 days after jumping off the Remeron.  It appears you have tapered off Remeron too fast, and your system has not had a chance to adjust.  Since you only stopped several days ago, I would say yes, you could reinstate to 3.75 mg Remeron.  (Normally we suggest a very tiny reinstatement, but since you have only been off a few days, it should be fine to go back to your 3.75 dose). I would stay on this 3.75 dose for a while, because your nervous system has been destabilized from the many med changes you have had over the past.  If it were me, I would stay on this for at least 6 months, and then if I felt stable, go ahead and do a micro taper.  

 

Thank you for providing us with a clear and concise drug history.  Can you please go ahead and add the dates and dosages of each reduction your did of your Remeron?  Please read the link below for instructions.  This will allow us to give you the best guidance.  

 

How to List Your Drug History in Your 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.

 

 Why Taper by 10% of my Dosage  

 

Tips for Tapering Remeron/Mirtazapine

 

Brassmonkey Slide Method of Microtapering

 

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

 

Please read this link about reinstatement. 

 

About Reinstating and Stabilizing to Reduce Withdrawal Symptoms

 

I've given you quite a bit of information here.  Please read through it, and mull it over, and we will take it from there. In the meantime, take care of yourself, and take heart.  We in this forum have been through this, and we understand first hand the pain and discomfort you are going through.  Please know that the brain is amazing in it's healing abilities.  It takes time, but healing can and will happen. 

Edited March 7, 2023 by getofflex

[hopeful1987]

Update:

 

I reinstated at 3.75mg (pill cut) and slept well. Yesterday, I was able to get a mirtazipine liquid suspension and took 3.75mg at night, but I slept poorly. Maybe 2-3 hrs drifting in and out of sleep. Should I have stuck with the pill for a while before transitioning to the liquid? Should I stick with the liquid in hopes I stabilize soon? So far, my only WD symptom is insomnia, which is of course the reason I started mirtazipine in the first place.

 

Thanks!

[getofflex]

You posted your second post just as I was typing out my reply to your first post.  Yes, if I were you, I would revert back to the pill form, and stick with the 3.75 mg dose.  Be sure you take the very same precise dose each and every day, at the same time of day.  Because you stopped taking it for a few days, it is likely that you will have symptoms for a while, and sleep better on some nights, and poorly on other nights.  If you read my link above on how psych drugs remodel the brain, it will help you understand this.  You have made a lot of drug changes in the past several months, and even with a reinstatement, your system needs a lot of time to settle down and adjust.  Your brain has probably become destabilized, but it will eventually stabilize with proper care.  It will take about a week for a reinstatement to get into your bloodstream and register with your brain, so please be patient.  It can take up to a month or two for a reinstatement to be fully effective.  In the meantime, please work on non drug coping techniques to help with the symptoms.  This link will help you to find ways to help your sleep: 

 

Withdrawal Insomnia

 

It is also very important to avoid alcohol and other mind altering substances.  The THC and CBD oil may cause unpredictable results, and could possibly exacerbate the problem, by further confusing the brain.  Please read 

 

CBD, THC, Marijuana, etc.

 

 

[getofflex]

What day did you reinstate the 3.75 mg Remeron?  Please add this to your signature. 

 

Please let us know how you are doing with your reinstatement of Remeron.  If it makes you significantly worse, please let us know right away. 

Edited March 7, 2023 by getofflex

[hopeful1987]

Thanks for the counsel. I reinstated the Remeron pill (3.75mg) on March 5th. Tried the liquid last night at same dosage and it didn't go well. As far as the THC and CBD, should I drop them cold turkey? I've been on both about a month, with THC at 5-10mg and CBD is a 30mg pill. 

[FireflyFyte]

45 minutes ago, hopeful1987 said:

I reinstated the Remeron pill (3.75mg) on March 5th. Tried the liquid last night at same dosage and it didn't go well.

 

It is recommended to slowly transition from pill to liquid form so since you just reinstated, I would stabilize on the pill for awhile and then slowly cross over to liquid. You can read about it at Cross Over: Changing form (eg tablet to liquid) of drug OR changing brand of same drug. 

[hopeful1987]

Ok, thanks for the help. I'll do the pill tonight. Also, I did a GeneSight test and found I'm a rapid metabolizer. Does this affect tapering or WD symptoms in any way? Another thought: any opinions about using the tapering strips from taperingstrip.com as opposed to liquid forms? 

[getofflex]

I would stay on the pill form of Remeron for a while before transitioning to the liquid.  We want to make only one drug change at a time, and stabilize from that change first before adding another change.  A drug change includes starting or stopping a drug, changing the dosage, changing the form of the drug (pill, liquid),  changing the time of day we take it, or changing the manufacturer.  

 

I will ask the other staff about your question about tapering the CBD and THC. 

Edited March 7, 2023 by getofflex

[getofflex]

2 hours ago, hopeful1987 said:

Does this affect tapering or WD symptoms in any way?

I'm not sure about this.  If anything, you should taper more slowly and carefully if you are a fast metabolizer.  

 

2 hours ago, hopeful1987 said:

Another thought: any opinions about using the tapering strips from taperingstrip.com as opposed to liquid forms? 

Personally, I would just use the liquid.  I imagine the tapering strips would be more expensive.  The liquid is super easy to measure non standard doses, and what if you need to hold for a longer period than how many tapering strips you have?  The liquid allows for great flexibility and ease of dosing.  It's how I tapered off my Lexapro.  The liquid allows you to get down to tiny doses at the end, which is important. 

[hopeful1987]

Any word on needing to taper the THC or CBD? The CBD is a 30mg pill and THC is a 5-10mg gummy. I've been using them for a month. 

[getofflex]

No word yet.  Go ahead and take them tonight as you have been.  

[hopeful1987]

Roger that. And just to clarify, how long should i try to reinstate the 3.75mg pill? In other words, if I dont sleep tonight, how many more attempts do i give it? 

 

Thanks for your help!

[getofflex]

2 hours ago, hopeful1987 said:

how long should i try to reinstate the 3.75mg pill? In other words, if I dont sleep tonight, how many more attempts do i give it? 

Please give it at least a week, unless you feel significantly worse.  That would mean sleepless nights, but also other symptoms, too.  If you feel about the same, or better, stay on the 3.75 mg pill for a minimum of a month or two, longer would be even better.  Let's take this day by day, and see how things go.  I'm very sorry you are dealing with this - I know it's tough when you can't sleep.  Been there, done that, got that t-shirt.  Please hang in there, you are probably in acute WD (withdrawal) now, but this should improve with the reinstatement. What other symptoms are you currently having?  

 

Did you read the link on withdrawal insomnia?  You can use melatonin to help you sleep.  But you only need a very small amount of melatonin - too much can have the opposite effect.  Here is our topic on that: 

 

Melatonin for Sleep

 

 

 

 

Edited March 8, 2023 by getofflex

[hopeful1987]

Thanks for getting back to me. Currently insomnia is my only symptom, but its very debilitating.  Often it means getting zero sleep, or maybe 2-3 hrs. Ive found I either sleep normally (6.5 hrs) or very very poorly. There's no in-between, which I'd love right now! Good news is that I've learned to handle even 2 sleepless nights fairly well. Not easy, but doable. If poor sleep racks up i do find i get digestive issues, reduced appetite, and a little nausea. The difficulty really comes with a 3rd poor night in a row. I have Ambien on hand and I'm very reluctant to use it. But if my sleep gets very crippling, is it going to destroy any progress if i take 10mg one or two nights a week? 

 

I did read up on the sleep post and I ordered the Life Extension melatonin that was recommended. Still waiting for it to arrive.

 

Thanks again!

[hopeful1987]

Reinstated 3.75mg last night and slept normally, normal for me anyway. 

[getofflex]

14 hours ago, hopeful1987 said:

But if my sleep gets very crippling, is it going to destroy any progress if i take 10mg one or two nights a week? 

I'm not sure, I will ask one of the other staff to weigh in on this.  

 

1 hour ago, hopeful1987 said:

Reinstated 3.75mg last night and slept normally, normal for me anyway. 

That's wonderful!  Wait, didn't you say you're reinstated to 3.75 mg Remeron on March 5?  Did you skip March 6, and then restart it again on March 7?  If so, please don't do this.  Stick with the 3.75 mg each and every day, at the same time of day. Taking remeron off and on is likely to further confuse and destabilize your brain, and make your problems even worse. 

 

Here is my approach to my own insomnia. Pay attention to point number 1.  

 

My Insomnia Tips

 

Insomnia has been the worst part of WD for me.  Here is what I do to help.  

 

1) don't get overly anxious about it.  Realize that eventually, your sleep will improve.  Insomnia won't kill you, although it can make you pretty miserable.  Anxiety about sleep just makes the problem worse.  I know, easier said than done. I don't always do this, but I try.  Practice acceptance.

 

2)listen to very soft relaxing music at a very low volume.  

 

3)don't worry about what time it is.  Don't look at the clock.  

 

4) I try to stay active during the first half of the day.  I take a walk (mine is one hour) after breakfast every day.  Then, as the day goes on, gradually slow down.  Several hours before bed, I only do very relaxing things, like read, or just sit and relax.  This helps to set our circadian rhythm.  Try to get outside and get some light exposure during the day, too. 

 

5) Avoid toxic, negative people.  Avoid stress when possible, although I know a lot of stressors are unavoidable.   For me, this can really help me to relax better.  

 

6) I stay away from MSG and aspartame.  These are exitotoxins which overstimulate the nervous system.  They are in a lot of our modern processed foods.  I try to eat more whole and natural, and not as many processed foods.  Also avoid processed meats with sodium nitrate, etc , such as hotdogs, ham, bacon, and sausage.  These can keep you up at night too.

 

7) avoid eating large amounts of sugar and processed carbohydrates.  This causes your blood glucose to spike up, which causes your pancreas to create insulin to control your blood sugar, which then causes your blood sugar to drop too low, and then your to create adrenaline to try to regulate your blood sugar.  Adrenaline keeps you awake because it is an activating hormone.

 

9) too much sodium (salt) can cause your blood pressure and heart rate to rise, and make it hard to sleep.

 

Edited March 8, 2023 by getofflex

[getofflex]

Here is what the founder of this forum, Altostrata, says about getting off CBD and THC.  

 

12 hours ago, Altostrata said:

I suggest 25% a week taper for CBD and THC. Of course, not at the same time.

 

[hopeful1987]

Thanks for the insomnia tips and for getting back to me about the THC and CBD. I honestly just dropped the cbd because it was a single pill, relatively low dose, and i hadn't been taking it long. I will taper the THC though. 

 

I reinstated the remeron pill on March 5th after 2 night's off and no sleep. On the 6th i tried the liquid remeron with no luck. Last night the 7th, i reinstated the pill for the 2nd time and plan to keep doing that for a bit. I'll update my signature. 

[Altostrata]

12 hours ago, hopeful1987 said:

I reinstated the remeron pill on March 5th after 2 night's off and no sleep. On the 6th i tried the liquid remeron with no luck. Last night the 7th, i reinstated the pill for the 2nd time

 

FYI, you'll need to consistently dose mirtazapine for a week or two to get it to full effect.

 

Taking Ambien occasionally will confound your symptom pattern, which is what we need to see to guide tapering and reinstatement decisions.

[hopeful1987]

Last night was my 2nd night on the pill after reinstatement. First night I slept normally, but last night I only got 3-4 hrs. Definitely not the worst for me, so I'm thankful. I feel like there's an initial sleep window (10:30-11:15pm) and if I don't hit it then it's going to be a rougher night. 

 

As you say though, some inconsistency with sleep is normal since my CNS is trying to re-stabilize. Knowing this helps calm my nerves a bit. 

 

I'm working on getting blackout curtains, which I hope will help me sleep a bit more during sunrise. I've noticed on my rougher nights that I've been waking a bit earlier than I normally do.  Also, is it ok to add melatonin while I'm trying to stabilize on the mirtazipine? I bought the 300mcg Life Extension that was recommended. 

 

Thanks for all your help!

 

 

 

Edited March 9, 2023 by hopeful1987

[getofflex]

37 minutes ago, hopeful1987 said:

Also, is it ok to add melatonin while I'm trying to stabilize on the mirtazipine?

Yes, that's fine.

 

Please be patient with the reinstatement.  It is not a quick fix, so you may still have insomnia, and some bad nights.  As we've said, it takes a week or two for it really get into your system.  A reinstatement should help, but you will probably still have sleep issues and symptoms, in other words, it won't cure WD (withdrawal) completely.  Please be sure and remain consistent with your reinstatement.  Keep us posted on how you are doing.  Insomnia is a classic symptom of WD and a destabilized nervous system.  I'm still dealing with it myself many nights.  

Edited March 9, 2023 by getofflex

[hopeful1987]

Thanks again. I'm assuming I shouldn't taper the THC until I'm stable on remeron?

 

Also, I have an in-lab sleep study scheduled this month. Obviously I want my sleep to be relatively stable before doing it. But do you think I should put it off for some time? 

Edited March 9, 2023 by hopeful1987

[hopeful1987]

Another thing. I'm concerned about the accuracy of my pill cuts. Right now im quartering 15mg tablets, but the quarters are rarely equal. Should i buy a scale and get empty pill capsules instead of eyeballing with the cutter?

[littlebird]

9 minutes ago, hopeful1987 said:

Should i buy a scale and get empty pill capsules instead of eyeballing with the cutter?

 

I started feeling a lot more stable day to day when I did, turns out I wasn't as eyeballing as well as I thought! Had the best luck with the Gemini 20 scale.

[hopeful1987]

Thanks. Any recommendations on capsules or will any do? Looking on Amazon of course.

[getofflex]

Please read this topics, that will answer your questions. You can just use regular gelatin capsules.  

 

Tips for Tapering Remeron/Mirtazapine

 

2 hours ago, hopeful1987 said:

I'm assuming I shouldn't taper the THC until I'm stable on remeron?

 

That is what I would do.

[Faure]

You asked by private message how I go about weighing:

 

I make up 7 tablets at a time, so when you start you’ll need to pulverise all 7 and then weigh out 7 identical amounts. Much better this way as it’s all done in about 15 mins (when you get the hang of it) just once a week, rather than daily. I also like to believe doing it all in one go gives the best chance of getting identical weights with the calibration etc. These days I use just over 2 pills a week, so I usually pulverise 3.  Here is how I do it: 

 

Step 1, only necessary the very first time: weigh three whole pills and divide the total weight by 3 to get the average weight per pill.

 

Step 2 calibrate the scales - very important to do this. Make sure they have been on for 60 seconds before calibrating. 

 

Step 3 grind 7 pills, I then put the powder into an egg cup and stir it with a toothpick, including the outer layer of the pills (my outer layer is yellow and the powder is white). 
 

Step 4, open a capsule. Using a teaspoon scoop up some powder and using a toothpick knock it into the measuring tray till you get the right weight. I take off excess powder with the tweezers that come with the scale. 
 

Step 5 tip the powder into a folded small piece of paper and use this to transfer the powder into the capsule. Don’t worry about microscopic bits not making it into the capsule. 
 

Step 6 repeat till 7 pills are complete and store spare powder in a separate capsule for next time.  I then use this powder first in my next session. Be sure to keep pills in the dark. 
 

I bought myself a nice pill grinder as I’ll be doing this a few years.  My equipment:

 

Scale 

Pill crusher

Size 0 capsules

 

Do go to the bother of doing this as you’ll get much more accurate dosing. 
 

You will need to switch to making your own liquid soon as this increases the accuracy and the scales are less accurate at the lower amounts. I switched at 3.2mg. I suggest you start with the grinding & making capsules for a bit and when you are used to that switch to making your own liquid.  My switch was done in one go without any issues (apart from my own mistakes 🙄 which a friend quickly remedied for me). 
 

***Nb while your active ingredient weighs 15mg, the pills themselves weigh about 150mg because of fillers. Fortunately it’s a factor of 10 bigger so even I could manage the difference although I didn’t understand till a friend explained 😂😂.

[hopeful1987]

Thanks for the help Faure. I'm four days back on the pill and have had 2 bad nights (insomnia) and 2 good nights. I take it this is a good sign that my brain is trying to readjust with the pill? Insomnia is a killer and I guess I'm just looking for encouragement that things will stabilize soon, though I know everyone's timeline is different. 

[Faure]

You will have windows (good times) and waves (bad times). It sounds like you’re settling. The important thing is to stay steady with the dose until you reach WD normal; this is when you don’t feel particularly good or bad just generally the same “blah” from day to day. Then stay at WD normal for a few weeks and seek advice from a mod about starting tapering ☺️
 

I’m glad you’re sleeping better. 

[hopeful1987]

7 days back on 3.75mg and ive had good nights and bad nights. No discernable pattern. I would have thought that such early reinstatement would have meant id stabilize faster, though i know its only been a week. Anyway, Im hanging in there, but a little discouraged. Wish i never listened to my doc and hopped off.

[getofflex]

Please remember, it takes about 7 days for the drug to reach steady state in your bloodstream, and register with your brain.  It's not a quick fix.  It can take a month or two for the reinstatement to become fully effective.  It may or may not resolve all your symptoms.  It should decrease your symptoms.  In the meantime, it's important to learn non drug techniques for coping with symptoms.   

 

Non Drug Ways to Cope with Withdrawal Symptoms

 

Hang in there, I know this is discouraging when recovery is so slow and up and down.  Read this link, it is extremely helpful.  

 

Techniques for Managing Withdrawal

 

This link explains why this process is so slow and up and down.  

 

What is Happening in Your Brain? (Explains why recovery takes so long)

[hopeful1987]

Yeah I'm holding onto your words and I appreciate your patience. I can't help but wonder if me being a rapid metabolizer is making things a bit harder and if i should have reinstated at a higher dose (7.5?). But since I have had some good nights this past week (despite 4 bad nights), would you recommend just sitting tight at 3.75?

[getofflex]

1 hour ago, hopeful1987 said:

I can't help but wonder if me being a rapid metabolizer is making things a bit harder and if i should have reinstated at a higher dose (7.5?)

No.  A too high reinstatement puts you at risk of kindling.  You don't want to do that.  

 

Hypersensitivity and Kindling

 

1 hour ago, hopeful1987 said:

would you recommend just sitting tight at 3.75?

Yes.  

 

It would be a good idea to do a daily journal and keep track of your symptoms.  

Edited March 14, 2023 by getofflex

[getofflex]

1 hour ago, hopeful1987 said:

I can't help but wonder if me being a rapid metabolizer is making things a bit harder and if i should have reinstated at a higher dose (7.5?)

No, if you are in fact a fast metabolizer, I would think you need to be even more cautious when it comes to reinstating and tapering. 

Edited March 14, 2023 by getofflex

[FireflyFyte]

2 hours ago, hopeful1987 said:

Yeah I'm holding onto your words and I appreciate your patience. I can't help but wonder if me being a rapid metabolizer is making things a bit harder and if i should have reinstated at a higher dose (7.5?). But since I have had some good nights this past week (despite 4 bad nights), would you recommend just sitting tight at 3.75?

 

When I re-instated Zyprexa, I debated going further up to 5mg from 2.5mg but after a little over a week the 2.5mg took effect and I am glad that I didn't up-dose further. It can be incredibly difficult to be patient while waiting to stabilize but think getoffflex is correct and that it's best to give the 3.75mg more time to settle in your system.