RemTaper: Remeron: 45 --> 30

[RemTaper]

New to the forum and looking forward to your support and advice!

 

I've been taking Mirtazapine for a number of years now, maybe five, and I've gone from a starting dose at 15 to 30 and for the past couple of years I've been at 45. My anxiety on the medication has been pretty well controlled. The major challenge I've encountered, and I still grapple with it, is its sedative effects. If I take it early, it knocks me out, I get good sleep and wake up early in time for work. When I take it late, it knocks me out, I get good sleep, and I'm a zombie in the morning. I also don't feel very comfortable with the notion of taking the drug forever, at 45, or otherwise, if possible.

 

I spoke with my PSY last week and she agreed that with a lack of challenges in my life now and things being great it would be appropriate to reduce to 30. I asked her if she thought I needed to taper but she said, no, and just to let her know of any AEs.

 

Friday (Night):

- 30mg

 

Saturday (Day)

- Woke up ~4AM, fell back to bed a while later

- Terrible gas much of the day, lot of BMs (but not diarrhea)

 

Saturday (Night)

- 30mg

- Gas/BMs continue

- Some trouble "catching my breath"

 

Sunday (Day)

- Woke up ~4AM, fell back to bed a while later

- Stomach feels better

- Some trouble "catching my breath"

 

I'm committed to dropping down to the next level. I know in the past when I've eliminated the drug - or maybe it was when I dropped down levels? I just don't remember - I had a "relapse" with my anxiety and needed to start taking it again. I don't take any other meds for Anxiety/Depression. I have: IBS, (mild) Asthma, Psoriasis and (mild) Allergies.

 

Would love your thoughts on my move from 45 -> 30, so that it's as safe and AE-free as possible.

 

Thanks!

[Jemima]

Welcome to the forum, Rem. You'll find lots of good information and friendly support here. Please browse through our 'Tapering' discussion for general information and specific topics on Remeron.

 

What is an AE?

 

You'll find that we recommend starting a taper at a 10% reduction, not the 33+% you've undertaken. While you may be one of the people who can go off antidepressants with no problems, it really isn't worth the risk. I'm not sure what a PSY is either, but be advised that most doctors are clueless when it comes to getting off antidepressants.

 

Getting the drug out of your system as fast as possible isn't the point, because the drugs make changes in the structure of your brain that remain after the drugs are gone. Withdrawal is your nervous system trying to right itself after having that chemical support removed, so it's best to do it very slowly and let your CNS catch up.

 

I moved your topic to 'Introductions and updates' because it's your first post about yourself. Please continue to use this topic to post about your progress and problems by clicking the "Add Reply" button at the bottom of the page.

[Altostrata]

Welcome, Rem.

 

Yes, those might be withdrawal symptoms. You might be able to get from 45mg to 30mg by making smaller decreases.

 

If the symptoms don't get better in a couple of days or it's clear they're not due to the flu or something else, you might go back to 40mg and see if they clear up. You might need to reinstate the full 45mg.

 

Stabilize, then, like Rhettsgirl, reduce by 1mg at a time to get to 30mg. You'll have to self-monitor to see if you get withdrawal symptoms, which sometimes take several weeks to show up.

[RemTaper]

Thank you both for your thoughts! As you can imagine I don't have the necessary equipment at home to prepare the pills in smaller doses. What I did do though is take 1/2 a 30 and 1/2 a 45, which I thought was less drastic than the reduction to 30 alone. I'm going to speak with my Psychiatrist (PSY - lazy abbreviation) and see what she says about the other dosing methods. I'm definitely open, but would be nice to get her blessing too, if possible.

 

Last night bed time was pretty rough - I went to bed around 10PM, fell asleep right away, but woke up at 12AM (thinking it had to be much, much later), and on and off for the rest of the night. Not fun.

 

[i will add that I have had a cold for a week or so, it's mostly congestion though]

[Altostrata]

That would be 37.5mg.

 

It may take your nervous system a week or so to stabilize again on that dosage.

 

Don't be surprised if your doctor doesn't believe people can be sensitive to small dosage changes.

[dalsaan]

Please also understand that anxiety can be a very common withdrawal symptom and is not necessarily a relapse. Confusing withdrawal symptoms with relapses is a very common mistake that both doctors and patients make

 

I'm on remeron. It's interesting what you say about the sleepy effects. Usually these occur at lower doses rather than higher. Having said that sleep sisturvance has been one of my key issues in withdrawal

 

Wish you the best

 

Dalsaan

[RemTaper]

That would be 37.5mg.

 

It may take your nervous system a week or so to stabilize again on that dosage.

 

Don't be surprised if your doctor doesn't believe people can be sensitive to small dosage changes.

 

From what I've read that makes a lot of sense to me, will definitely keep you posted. Today I had a pretty good breathing wise, although in the afternoon, almost out of nowhere, I had terrible cramps/diarrhea. Hopefully that was a one-time event.

[RemTaper]

Please also understand that anxiety can be a very common withdrawal symptom and is not necessarily a relapse. Confusing withdrawal symptoms with relapses is a very common mistake that both doctors and patients make

 

I'm on remeron. It's interesting what you say about the sleepy effects. Usually these occur at lower doses rather than higher. Having said that sleep sisturvance has been one of my key issues in withdrawal

 

Wish you the best

 

Dalsaan

 

You bring up a great point and I intend to address that with my Doctor. I'm hoping that in the past - and even now - it wasn't so much that I had a relapse of the anxiety as much as I had withdrawal issues. And I'll bet that last time it was a pretty similar process, with big steps down in dosing. I think the drug is amazing, but it's just been so challenging to either have a hard time getting up or choose the alternative, to basically got insanely drowsy, way too early in the evening, and miss out on family/friend time.

[tgirl]

How are you doing now?

[RemTaper]

I just started a taper of 10mg using a 5mg and a 5mg in two. That 7.5 is a 25% reduction.

 

I'm at Day 2, based on this amazing forum, I'm going to do a 5 and 3.75 (3/4 of another 5) to get to 8.75, which is slightly more than 10%. Rather go low and slow than run into an issue. 

 

My goal is to get to no Lexapro. 

 

If my logic is flawed here, please let me know!

[ChessieCat]

Welcome back to SA,

 

SA's recommended taper rate is no more than 10% of the current dose followed by a hold of at least 4 weeks to allow the brain to adapt to not getting as much of the drug.

 

Why taper by 10% of my dosage?

 

Getting of our drug safely has nothing to do with how strong or determined we are as a person.  When we take a psychiatric drug the brain adapts to getting that dose of the drug.  If we take it away too quickly then we can experience withdrawal symptoms.  One common withdrawal symptom is insomnia.  If you experience this, it can make it harder to cope with any other withdrawal symptoms you might get.

Dr Joseph Glenmullen's WD Symptoms Checklist

 

Post #1 of this topic explains how to get non standard doses of your drug so that you can taper following SA's protocol:

 

You will see in Post #1 that Lexapro is a very strong drug, so making your planned reductions could have even worse consequences than if you were tapering a less potent drug.

 

Tips for tapering off escitalopram (Lexapro)

 

If you do start experiencing withdrawal symptoms from you recent reduction it would be a good idea to do an updose.  If you had made a 10% reduction of the 10mg dose, then you would be taking 9mg (10mg x 0.9 = 9mg).  That would be the dose which I would updose to.  Please read Post #1 of this topic, much of which also relates to updosing:

 

About reinstating and stabilizing to reduce withdrawal symptoms

 

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Instructions:  Withdrawal History Signature