MissTrish: Mirtazapine/Remeron Struggle

[MissTrish]

Hello.  I am 58 years old and have been on antidepressants in one form or another since 1986 after the birth of my second child.  In 2005, I was on 50 mg amitriptyline 15 mg Librium, and either Prempro or birth control pills (can't remember what year I made the switch).  With the help of the benzo w/d forum, I tapered successfully off of the Librium but was not able to come off of the amitriptyline, no matter how slowly I went.  I had horrible chills, mental & physical agitation, and insomnia.  So I gave up on that.  By 2008 I was sliding downhill mood-wise - still on the ami and the Prempro.  I became deeply, severely depressed with agitation being a major symptom.  My gynecologist switched my Prempro to Estradiol and things got worse.  My doctor tried me on every mood stabilizer, thinking I was Bipolar ii, but they only made my depression, and often agitation, worse.  Finally at the beginning of 2009 I ended up in intensive daily group outpatient treatment and ditched the ami and estrogen in favor of Cymbalta and Remeron.  I got better.  Lots better.  My life changed in many ways for the better and I had a really good three years.  

 

Then in 2011 the agitation and fatigue/mood drops started.  Upping the Cymbalta made things worse, so I tapered off of it, and tried Wellbutrin for a while.  I did not see much a/d effect on the low dose I was on, and of course the agitation was there.  Adding something to the mix for the agitation increased the depression (gabapentin, or hydroxyzine or benadryl etc.).  So in 2012 I switched to Celexa.  I spent many months trying to make Celexa work - we'd up the dose and I'd feel great for a week or so, then I'd sink into depression and then I began itching and having sinus/headache pain and burning eyes.  

 

So I cut back on that, and in March, when my insurance changed, I switched to Lexapro.  Within the first few weeks, due to the sedating effect, my depression worsened, but as the sedation began to wear off over the weeks and months, I went from feeling pretty good to the same old sinus/headache pain and anxiety.  Two weeks ago, plagued by both that bummed out, surly feeling and agitation, I decided I needed to come off of it.  I had plans to taper very slowly.  However, the chills and angry mood were just awful, and those got a little bit better with each taper, and now only two weeks later I am down to 2.5 mg.  Doing okay as far as w/d symptoms long as I avoid spicy foods.  I had some salsa the other day and got severe chills.  Same thing with some Celestial Seasonings Lemon Ginger tea.  But I can feel some depression creeping in.

 

I have not been able to eat chocolate or handle caffeine for several years now; spicy foods trigger this same nervous system agitation.  I'm tired of it.  I am not sure I will ever actually heal from it, but I do know that being on the SSRIs and even the Celexa were making it worse.  I am not in total principal against A/Ds; they have helped me in the past.  My feeling right now, based on past experience, is that if they're not helping me, then I'm not supposed to be on them.  I'm reluctant to give up the Remeron - I have severe sleep issues and when I do not sleep my depression becomes unbearable.

 

My goal is to work on my depression through CBT and other non-medication methods and that's what I am mostly looking for help with.  I do a lot on my own behalf.  I have lost 28 lbs through Weight Watchers since June, and I am going to the gym regularly.  I am on disability (2005 during benzo taper) for memory issues, but I do make soap and bath/body products and sell them, so I have a creative outlet.  I also have a spiritual program I follow, and great friends and family.  So I am blessed in many ways.

 

Thanks for listening.

[MissTrish]

No longer on estrogen therapy of any kind since 2008.

[Altostrata]

Welcome, MissTrish.

 

People often find whatever beneficial effects antidepressants have wear off over time. Activation is a common side effect. Plus, it sounds like you had an allergic reaction to Celexa.

 

My guess is that your system has been sensitized to antidepressants in general.

 

"Depression" is a common withdrawal symptom. It's good you're looking at other ways to deal with it. See this topic http://survivingantidepressants.org/index.php?/topic/1112-non-drug-techniques-to-cope-with-emotional-symptoms/

[MissTrish]

Thanks

[Jemima]

Welcome to the forum, MissTrish. It would be helpful if you could list your drug history in the signature area of your profile, rather than just what you're currently taking.

 

I also tapered off of Lexapro very quickly.  Please take it really, really carefully and as slowly as you can manage now that you're down to 2.5 mg. That's where I started having the worst problems and many people on this forum have also experienced their greatest challenges at lower doses.

[MissTrish]

I will do that, thanks.  I am staying at 2.5 for the moment but I think the Remeron is oversedating me at this point.  I am thinking of sticking at the Lexapro 2.5 and bumping the Remeron down a bit.  For me, sometimes the side effects of the drug are worse than the withdrawal symptoms.

[Rhiannon]

I will do that, thanks.  I am staying at 2.5 for the moment but I think the Remeron is oversedating me at this point.  I am thinking of sticking at the Lexapro 2.5 and bumping the Remeron down a bit.  For me, sometimes the side effects of the drug are worse than the withdrawal symptoms.

 

Yes, it can be a balancing act between the effects of the drugs and the effects of withdrawal. I worked with that one for a long time.  I've gotten down to low enough doses now that the withdrawal is worse than the drugs though.

 

Anyway, if you can stand to wait a bit before cutting the Remeron, it might be a good idea, or at least if you do, only cut it by a very small amount and then wait. I say that because you have a history of bad times with drug withdrawal in the past (which usually means people are more sensitive to drug withdrawals later) and you tapered really fast off the Lexapro. Usually with fast tapers like that, the full effect of withdrawal doesn't kick in for quite some time. We have many members who came here because they got really sick six or more months out from a CT or too-rapid taper. So I'm concerned you might be pushing your luck. Please be careful.

[MissTrish]

Well.  Because the drug symptoms were so uncomfortable I tapered on Tuesday from 2.5 to 1.25 mg (Lexapro).  Felt pretty good and despite waking up pretty early yesterday I decided to not take one at all.  Thought at that point I might do one day on and one off, which worked so well for me when I was coming off Cymbalta.  However, I woke up at 4 this morning and grew more agitated by the moment.  And nausea, and by the time I gave up on going back to sleep at six, I felt flu-ish and knew it was drug withdrawal.  So I took 2.5 mg Lexapro this morning.

 

I have to vent - I feel pretty frustrated about that.  A number of people I know personally have gone off their SSRIs or their SNRIs with a minimum of difficulty, so I know it's possible.  Right now I feel stuck between withdrawal symptoms and drug side effects.  I hate this; I keep reminding myself I wasn't feeling good at 10 mg either, which is why I started tapering.  I was increasingly surly and bummed out and cold all the time.  But I was sleeping reasonably well.

 

I don't really know what to do at this point.  Since Monday night I am still at 22.5 mg mirtazipine (Remeron).  Don't know whether to go back to 30 or not.  I have been as low as 3.75 on this drug but went back up in October to offset the Lexapro side effects.  I could go back up to 5 mg on Lexapro but I hate to do that if I don't have to.

 

I guess I'm having a bit of a pity party, and feeling a bit scared.  I've been working so hard on my own behalf.  

[mammaP]

Please don't go on the every other day route, some people might have been fine doing that, but you are

obviously sensitive and can't do it that way. In the last 2 weeks you've made a lot of changes and your nervous 

system is suffering. I would suggest going back to the doses that you were most comfortable with, I know comfortable

isn't the best description but you need to stabilise. Stick with it for a few weeks then start to taper again, slowly.

You've tried tapering much too fast for your brain and sadly you only know it's too fast when withdrawal sets in.

It's also not good to try and taper more than one drug at a time, there is no way of knowing which is giving the

worst symptoms. 

 I would updose the lexapro to 2.50 as you have done, and the remeron to 30 as it's only been 4 days on the lower dose.

If you don't feel better in a few days then maybe try a tiny bit more until you are more comfortable. Someone else will be

along soon who may have further advice for you. 

I'm sorry you are starting to feel bad and hope you can feel a little better soon.

[MissTrish]

Thank you, MammaP!  I actually went back up to 5 mg Lexapro and 30 mg Remeron.  Got a good night's sleep; going to try to stay here for a couple of weeks.

[Petunia]

Hi Miss Trish,

I'm sorry you are having a difficult time coming off your medication, but its good you managed to get a good night sleep.

 

Earlier in your thread you mentioned knowing people who had come off their meds without much difficulty.  Some people do manage to take an antidepressant for a while and then do a fast taper or even cold turkey in some cases, without too much trouble.  But a significant minority of people have a very hard time discontinuing these drugs.

 

I don't know why, but it may have something to do with some people being more sensitive to the changes these medications cause and perhaps the length of time taking them, the dose and amount of medication changes over the years is a factor.

 

We generally recommend only tapering one medication at a time, that way you know which one is causing the problem if you get increased symptoms.  We also suggest tapering by no more than 10% at a time.  When you dropped from 5mg to 2.5mg of Lexapro, that was a 50% cut.

 

Have a look at our tips for tapering Lexapro here:

 

http://survivingantidepressants.org/index.php?/topic/406-tips-for-tapering-off-lexapro-escitalopram/

 

When changing dose, it usually takes several weeks for the nervous system to stabilize, so we suggest holding for about 4 weeks until symptoms have reduced before making another cut.  You may need to wait longer than two weeks for your system to settle down again after all your recent dose changes.

 

If I were you, I would stay at the doses you are at for a good while, maybe even a couple of months if you are still feeling unwell.  Once you are feeling stabilized again, with no symptoms, then you could begin a slow, safe taper.

 

I was on various anti-depressants for about 13 years, the last one was Lexapro.  I tapered off it too fast, very much like how you have been trying to do, dropping from 5mg, to 2.5, then 1.25, then alternating days, then I stopped.  I did it over the course of about 2 months.  That was in 2010.  I'm still in protracted withdrawal now, by the time I found this site and learned what what was happening, it was too late for me to reinstate and taper properly.

 

Its good you have found this site and can avoid making the mistake I did.

 

Please keep us updated of your progress.

 

Petu.

[MissTrish]

It has been over 3 weeks since I last posted.  Since then I moved back down on the Lexapro to 2.5, and when the anxiety from the drug started waking me up at night in a sweat, and I just felt I couldn't stand it any longer, I tapered on down and have been completely off for a week.  I realize that it is recommended that we taper more slowly, but (a) I could not get the drug to dissolve in water to calibrate my dose that way, ( I couldn't cut it evenly lower than 1.25 and © the agitation was bad anyway. 

 

So.....

 

I still have the agitation, and now I'm having depression symptoms as well.  I understand this is part of coming off of it, right?  It is a rebound thing?

 

The good thing is that my nose no longer pours constantly and my eyes don't burn.  But I'm having trouble with the agitation/anxiety and I am snappish about little things that aren't important.  I am having all kinds of allergy/cold symptoms, but it's hard to tell whether they are really allergies or are related to anxiety.  Not handling stress well at all.  I woke up at 2:30 last night and, knowing I an 8:00 appointment to keep with a therapist, I took a Benadryl.  Didn't work; I have been awake ever since.  

 

I do not want to go back on this drug; gives me the shivers and tremors just thinking about it.

[Petunia]

I don't want to scare you, but I have been in protracted withdrawal for over 2 years from stopping Lexapro in the way you did.  By the time I found this site, and figured out what was going on, I couldn't reinstate, so I'm advising you to reinstate and continue with a slow, safe taper.  You can get Lexapro as a liquid on prescription, or if you want to make your own, other members can offer support with how to get it to dissolve.

 

If I were you I would go right back on 2.5mg and stay there until you are feeling stable again, then get organized for a proper taper.  From my experience, it can get a lot worse, I would give anything to be able to go back in time with what I have learned here.

 

Petu.

[Altostrata]

MissTrish, it sounds like maybe the switch from Celexa to Lexapro didn't work, or Lexapro was always too activating for you.

 

You might find that reinstating 2.5mg Celexa works better to lessen the withdrawal symptoms. Celexa comes in a liquid, see http://survivingantidepressants.org/index.php?/topic/2023-tips-for-tapering-off-celexa-citalopram/

[MissTrish]

Good info to have - thank you!

[Altostrata]

Lexapro is 2-3 times stronger than Celexa.

[Ellen042]

"Right now I feel stuck between withdrawal symptoms and drug side effects." I can really relate to that.  Sorry that I have no tapering advice- will leave that to the experts.  Just wanted to welcome you, Miss Trish, and let you know that I can relate all too well to the above statement you made.  Probably most of the people here can.  If misery loves company, at least you've found company!  Best wishes to you, and Merry Christmas! (hope it's OK to say that!)  Blessings, Ellen

[MissTrish]

First:  This is a repeat post - I started it a few minutes ago but forgot to put Lexapro in the topic.  Can someone tell me how to delete the previous one?  Darned brain fog!  Thanks!

 

Hello!

I was here in the winter, when I was tapering off of Lexapro.  I seem to be allergic to SSRIs - I was depressed and having sinus/allergy side effects.  And of course, none of them really work for years on end.  So I began tapering in the fall, and I know I went too quickly (over about a month), but the side effects were really unpleasant.  Was totally off by Christmas.

 

Well, about a week after that, suffering from pretty severe anxiety and depression, I went to see my family practice doctor.  I can only get in to see a psychiatrist every 3-4 months, no matter what.  She tried me on Zoloft.  After a few weeks, I was numb, depressed and developed hives.  I went back and she switched me to Wellbutrin.  The activating factor of Wellbutrin (low dose) was so severe it flipped over into fatigue and severe depression.  So I went back on the Lexapro in March and within a week I was getting hives.  So I started a slow taper - not the 10%, quicker than that, but definitely slower than what I did in the fall.  It was tough only because of the side effects.  I was taking gabapentin with it because it helped the itching without depressing me further, but because I am so sensitive to most meds, gaba eventually caused its own side effects (even with the liquid baby dose), so that was out.  By the time I was down to 2.5 mg, I was taking Zyrtec with it and that was helping the itching and the anxiety.  I came off of the 2.5 mg last week, so this was a taper of some 9 weeks.

 

Last week I saw my psychiatrist.  I actually saw a new one since I see a resident who reports to a psychiatrist.  This one is an osteopath and I felt so good because I told her the problems I have had with meds, and when I mentioned fibromyalgia, she said this was why, that I needed to focus on diet, etc. and know that the symptoms of fibro mimic the symptoms of depression.  I left there feeling great!  No new meds; no pressure to try anything new.  This was six days ago.

 

It seems like right after that visit the emotional lability kicked in.  It has only grown worse; I can cope with the occasional crying jag, but just in the last few days I am becoming averse to any social situation and am not sleeping.  Most unpleasant.  I have really had no other withdrawal symptoms - no brain zaps, etc.

 

Here are my issues about re-establishing:

1) I would have to see my family practice doctor for a new prescription and they already think (IMO) I'm a neurotic type.  They'd prefer me to see my psychiatrist because they don't really feel all that comfortable prescribing for a complicated case like me.  However, I can't get in to see a psych until August and they will not prescribe over the phone.  I have 4 or 5 tablets left.

2) The itching and nasal/sinus allergy symptoms I have when taking Lexapro.  Not sure how to deal with them.

3) I think I tried last time, unsuccessfully, to make my own solution instead of cutting them (followed the directions here).  

 

Any thoughts?  I'm concerned that this won't get better, but I don't really know what else to do.

[mammaP]

Hi MissTrish, I've merged the new thread with your original one so we can see your full

story.  It is one thread per person in the introductions forum, this makes it easy to follow 

progress.  

 

You've had  quite a lot of changes over the last few months and your nervous system

has taken quite a battering, there is little wonder that you are feeling so bad!

I think that possibly the 2.5 mg of lexapro could be too high, especially after all those

changes of medication.  I think you need to get a prescription from the doctor, you

should get one if you tell them you are suffering from withdrawal symptoms. 

 

I would reinstate a very low dose of  0.5 mg to start with and see if it helps.  If it doesn't

make you feel worse you could then increase the dose to 1m, When you feel a bit better

you should hold for a few weeks  before cutting and then taper very slowly. 

 

I hope you feel better very soon.

[MissTrish]

Thank you for merging them for me.  Major brain fog day!

 

Well, after I wrote this, but before you replied, I broke down and took 2.5 mg in desperation.  I have to say that right now I feel a whole lot better.  And I called in a refill on my old Lexapro; hope it works.  Sometimes with the med changes from my psych to my family practice doc, the old prescriptions get cancelled.

 

So if I can tolerate the 2.5, would you suggest that for a while before going down?

 

I have some real concerns about this because after successfully tapering from Librium in 2005, I started a similar taper on the amitriptyline I was taking at the time (50 mg).  I did the recommended taper schedule but could never get past 25 mg without severe insomnia and loss of daily functioning.  I only got off of it when I went into outpatient daily therapy and the psychiatrist there moved me straight from that to mirtazapine and cymbalta 5 years ago.  So I am concerned that I am stuck - can't live with or without it.  I am not sure I have faith that I can get off of this but it does help knowing that others have done it.

 

Thanks!

[Altostrata]

I was going to ask how you did with 2.5mg before -- here's the answer:

Well.  Because the drug symptoms were so uncomfortable I tapered on Tuesday from 2.5 to 1.25 mg (Lexapro).  Felt pretty good and despite waking up pretty early yesterday I decided to not take one at all.  Thought at that point I might do one day on and one off, which worked so well for me when I was coming off Cymbalta.  However, I woke up at 4 this morning and grew more agitated by the moment.  And nausea, and by the time I gave up on going back to sleep at six, I felt flu-ish and knew it was drug withdrawal.  So I took 2.5 mg Lexapro this morning.

 

....

 

Did you have a rash or itching when you took 2.5mg before? If so, it's likely you'll have that again.

 

Yes, it seems you are allergic to SSRIs. Zoloft is an SSRI. Going on and off these drugs is probably making you even more sensitive to them.

 

Perhaps you should think in terms of .5mg, as mammaP suggested, or 1.5mg at most.

 

You will need to stabilize for a month or more before going off by very tiny amounts at no more than a 10% decrease per month.

[MissTrish]

Good morning.

Well, against all your good advice, I tried to do it my way - I went back up to 5 mg thinking I could re-establish there, and that it'd be okay at least for a while.

As so many have found, as I've read here, it's not a happy place for me.  So 5 days later, I'm back down to 2.5 mg.

 

How long should I stay here?

 

Next cut to where and stay for how long?

 

I wish I had faith that this would get better.  

Has anyone actually had success after being on A/Ds as long as I have?  (28 years)  I don't understand why this is so hard, especially since I am still on 30 mg mirtazapine.

 

I wish there was a 12 step group I could go to to help me get through this.  I desperately need one.

 

Thank you for your support and your patience with me.

[mammaP]

When you've been off an AD for a while your body becomes sensitised to it and

can react to it as Alto explained.  It does seem that 2.5 is too much and you tried the 5mg

which will have destabilised your nervous system even more.  Lots of us have done what we

thought was best at the time but I can assure you that Alto has done more research than any

doctor or even psychiatrists who prescribe this stuff! I think I would try the 1.5 and hold there

for several weeks to allow your brain and nervous system to stabilise.  

 

You can and will get off this safely if you do it slowly and consistently. Jumping around with doses

will destabilise you and take even longer to taper. Slow and steady wins this race! 

, 

[MissTrish]

How do I get to those lower doses?  I have a prescription of the tablets but I don't think it likely my doctor will give me a liquid version of it.

Can you make a liquid version with Lexapro?  I did a quick look on the site but could not find a link showing how.

Thank you!

[mammaP]

Here is the topic for tapering lexapro 

 

http://survivingantidepressants.org/index.php?/topic/406-tips-for-tapering-off-lexapro-escitalopram/

 

And one for making a liquid from tablets. 

 

http://survivingantidepressants.org/index.php?/topic/2693-how-to-make-a-liquid-from-tablets-or-capsules/

 

Liquid is the best way, you can be much more accurate with measurements.  I understand your reluctance

to ask your  doctor to prescribe the liquid but it's much easier if you can get hold of it. Any doctor can

prescribe it if there is another you can see.  I was scared to ask but I took a deep breath and asked anyway.

He did give me what I wanted but wasn't happy about it! There are a few people here who make their own

and do just fine.

[MissTrish]

Alrighty!  Just got back from the doctor and pharmacy and I have my liquid Lexapro.  Now.... I've been taking about 2 mg in tablet form (shaving a 1/4 tablet a bit).  How does 2 mg translate to 2 ml?  Is that the same thing?

[Altostrata]

What does the label on the bottle say?

[MissTrish]

I got it figured out.  Thanks.

So.... I had been relying on cutting the 10 mg pills in quarters and now this is day 2 of the liquid (2 mg).

I feel like I did when I was taking a higher dosage of the Lexapro - sinus congestion, numbness, etc.  Has anyone else ever noticed a difference in the liquid vs the pills?  I'm guessing I should stay at the 2 mg and not go down any further for a month?

Thank you!

[Altostrata]

Give it at least 4 days. The liquid is absorbed faster, makes sense you've got a similar reaction. It was smart to align the switch to liquid with a decrease in dosage -- though I might have gone to 2.25mg rather than 2.0mg.

[MissTrish]

Day six of switching to liquid Lexapro.  I'm having a lot of the symptoms of intolerance that I had on the pill form at higher doses - not sleeping much, sinus congestion, morning sedation and daily jitters in the afternoon for about 3 hours, easing off around dinnertime.  I'm not sure whether to lower my dosage or stick with this one.  I went down from 2.0 to 1.8 mg yesterday  and today and it did help the jitters, but not the sleeping.  I'm waking really early.

 

Also I have fibromyalgia and it seems it gets worse the lower my dosage.  Might have little to do with that; no idea.  Doesn't really matter, I guess since it just has to be that way.  But the pain is also very distracting.

 

Why would the liquid make a difference?  I love it; it's so much easier to measure dosage!  If it's just something I have to live with and walk through while I taper, I guess it's what I have to do.

[MissTrish]

I could not find the edit button; major brain fog day.  Just wanted to add that the way I am feeling on 1.8 liquid Lexapro is very similar to how I was feeling on 5 mg pill form.  Where is that darned edit button.....???

[Petunia]

A minority of people have a bad reaction when switching to the liquid form, some people just can't tolerated if for some reason.  This is why we sometimes advise not to switch to liquid and drop the dose at the same time, because if there is a reaction, you don't know if it was to the switch or the drop, or the combination of too many changes.

 

Don't keep changing your dose, its just going to cause more destabilization.

 

Please read through the 3KIS rule here:

 

http://survivingantidepressants.org/index.php?/topic/6632-the-rule-of-3kis-keep-it-simple-keep-it-slow-keep-it-stable/

 

If I were you I would go back to 2.0, keep good notes of your daily symptoms and give it more time, hopefully you will be able to stabilize on the liquid.  I hope you start to feel better soon.

[MissTrish]

Thank you!

[MissTrish]

Is it ever okay to stop your w/d for a while and focus on another drug?  Now that I'm down to 1.2 mg Lexapro, I feel that the mirtazipine I take may be really bumming me out and I'm wondering how it would work to stick with the Lexapro where I am for a while and focus on bringing the mirtazipine down at least a bit, from 30 to 15 mg, say.  I notice I'm really depressed in the mornings (hangover, maybe) and in the mid-afternoon I seem to go through a mini-withdrawal session for about an hour and then feel pretty good the rest of the day.  Any experience, thoughts, ideas would be appreciated.

[Petunia]

When you say you go through a withdrawal session in the afternoon for an hour, what do you mean?

 

I don't see anything wrong with holding the Lexapro and bringing the Mirtazapine down now.  Here is our thread for tapering Mirtazapine:

 

http://survivingantidepressants.org/index.php?/topic/5301-tips-for-tapering-off-remeron-mirtazapine/

[MissTrish]

I mean I get chills, shivers, and general anxiety for a while in the afternoons, then it seems to pass after a couple of hours.  In the mornings, I'm depressed, as in a bit too much sedation, perhaps.  The plus side is that so far I am sleeping pretty well.