MissTrish: Mirtazapine/Remeron Struggle

[Petunia]

Its good you are sleeping well now.  Perhaps you could hold for a while and see if your other symptoms settle down before starting the mirtazapine taper.

[MissTrish]

Okay, I don't think reducing the Mirtazipine was the answer to all my problems today.  I reduced because of increasing lethargy and jitteriness.

Ten days later (reduced from 30 to 26.25 - by 1/8 tablet), I have increasing depression, nausea, sinus pain, eye burning, and obsessive thinking.  

So.... I don't know if reducing the mirtazipine has uncovered masked Lexapro w/drawal or if it's the mirtazipine itself.  I've been at 1.2 mg Lexapro for 4 weeks now, from 1.8 to 1.6 to 1.4, each w/about three weeks in between.

I guess tonight I will go back to the 30 mg mirtazipine.

I was doing so well at 1.4 mg Lexapro!  I felt like I could live there for a while.  But at this rate I'll be on these drugs for years!

I don't know what to do.  I'd love some thoughts/suggestions.  Is it better to stay where you're comfortable or keep reducing?

I hate this.  And I hate that I'm whining; I know in the larger scheme of things my misery isn't all that important.  Knowing that doesn't seem to help, though. 

[Altostrata]

Seems like you make changes frequently. You might do better with longer holds.

[MissTrish]

I'm now not convinced the problem is withdrawal.  I went back to my normal dose on Mirtazipine and slept great!  I felt great until about an hour after I'd taken my 1.2 mg dose of Lexapro.  Then the symptoms started, and they're exactly the symptoms that I had when I decided to start tapering in the first place (except I'm not itching).  I think I have just become highly sensitized to the drug itself.  This is not surprising since I can also now no longer tolerate chocolate (or any caffeine), peppers, cinnamon, ginger, cumin, or any even mildly stimulating spice, without a major anxiety reaction.  I have a highly reactive nervous system and this is not new, it's just getting worse.  

 

Soooo - I feel like I'm stuck between that rock and hard place.  Is it better to be miserable with the drug's side effects or the drug's w/drawal effects?

 

Bah!  Humbug..

[Altostrata]

It sounds like you are getting more and more sensitized. If you are getting adverse reactions from Lexapro, it would be wise to continue to reduce it. Perhaps with much smaller reductions, but more frequently?

 

If I were you, I'd wait a week or two before making any further reductions in Lexapro.

[MissTrish]

I think that makes sense.

[mammaP]

Just a thought Miss Trish, the liquid is not slow release so you are getting the whole lot in one hit, whereas the tablets might have been slow release? 

 

I tried effexor liquid and spaced the dose out by taking it 4 times a day so I wasn't getting that big hit. 

1ml per day became 0.25  4 times a day. 

 

Sadly I had an allergic reaction to one of the ingredients but was fine with the multiple dosing for the few days

I was taking it. 

 

Maybe something to think about?  See if any of the others thinks it is a bad idea before trying it though. 

[MissTrish]

You may well be right on the liquid.  Wish me luck; I've had to make a big cut from 1.2 to .6 mg.  Stupid drug is giving me hives, which it did at the higher doses.  All the signs of higher dose toxicity have been creeping in for a while now and I just did not recognize them right away.  I'm of course nervous about the big cut; OTOH, I'm looking forward to the hives and other toxicity symptoms abating.

[Altostrata]

An allergic reaction justifies a sensible reduction. Please let us know how you do.

[MissTrish]

Well I don't do very well.

I went down very quickly from .6 mg to 0, for the reasons stated above.  Saturday was my first day at 0.  Yesterday afternoon physical anxiety kicked in; I couldn't think, focus or sit still.  My nightly mirtazipine helped take the edge off and I actually did sleep.  And I managed fair until mid-afternoon again today when what I've figured out is the mirtazipine wearing off.  Also I went to my zumba class and that seemed to help.  And I read some info on histamine and certainly all the foods & spices listed as histamine inducing are the foods/spices I can't tolerate....

 

Anyway,by mid-afternoon things were bad.  My whole body has begun vibrating and I can't think well or do much of anything except obsess about how agitated I feel, and how I can't do this from now on, etc., etc., and how I don't really see any other option and what's going to happen to met, you know the drill. Chills, shivers, shaking.  Functionality going down to a vibrating mess sitting on the couch trying to figure out how I could possibly live this way, don't think I can, etc.  I broke down and took a Zyrtec and it has taken the edge off, leaving me just basically super bummed out.

 

It's amazing how my life went from doing fairly okay/functional to 'I can't do this' in just two days.  And I don't really understand it.  I was at 1.2 mg for over a month, did really well for a while, then I started going downhill and getting hivey (all symptoms for me of too much SSRI).  This happened, btw, nearly 10 years ago when I tried to taper slowly from amitriptyline.  I tapered successfully from a low dose librium habit that same year but could get nowhere coming off the ami....  Then I ended up in out-patient treatment and got put on the mirtazipine and Cymbalta and eventually the Lexapro.

 

I don't know what to do - I have craft fairs coming up (although not for another month) through December.  I'm looking at an application for another one that I have promised to mail in, and I'm wondering after all the product I've made how I'm going to be able to do any of them.  I miss my life.

 

Anyway, I know I'm on the pity pot; I work hard at staying off of it but I fell in it today.

 

The hell of it is I know there is not an antidepressant out there I can tolerate but my quivering mind keeps wanting to make it happen anyway.  I see how people become addicts.  That emergency bottle of klonopin sure sounded tempting but I stayed away from it.  I know that leads to hell via another route.

[Meimeiquest]

Do you think the hives could have come from rising histamine? It is my understanding that ADs have a pretty potent anti-histamine effect? I am really sorry you are so sick.

[MissTrish]

Hi Meimeiquest,

I don't know - that could be.  I had hives on the full doses of wellbutrin, when I tried that, on zoloft, and lexapro.  It resolved on the Lexapro when I got down to the lower doses, but seems to have been coming back.

Update:  although the zyrtec helped, I woke up at three o'clock with a horrible burning sensation between my shoulder blades, along with of course the anxiety.  I cannot believe this is from anything but drug withdrawal.

I have re-established at 1.5 mg Lexapro as of this morning and will try to deal with the hives w/antihistamines if they come back.  The anxiety has resolved a bit but the burning is still there.

After this, I have some serious doubts about my ability to get off this drug.  

Anyway, life is not all awful - I'm still breathing, the sun is up, I got two more hours of sleep after I took the Lexapro, and I have a huge list of items in my life to be grateful for.  I'm going to try not to hyper-focus on this; unfortunately hyper-focusing seems to be a symptom, lol!

[Altostrata]

If you're getting an allergic reaction, you need to reduce the drug until the reaction stops. I know this is difficult, but you've got to listen to your body.

 

There's a long way between 1.2mg and 0mg, however. Make small cuts, please.

[MissTrish]

Re-establishing at 1.5 did not work; my body did not like that much drug anymore.  The anxiety was bad.  I have stabilized the anxiety at .7 mg.  Instead, I am feeling a tremendous amount of depression.  My appetite is way off (which is not at all like me; I do like food generally).  This is only a concern in that it indicates depression - I'm in no danger of starving.  I'm not sleeping much.  And of course all of this frightens me; depression scares me.  I remember being this way before I went on the a/ds.

 

I am aware that depression is a symptom of w/d.  I am also aware that this might be my new 'normal' and I guess that frightens me more than anything else because I know that I can't tolerate additional antidepressants, should I be so foolish or panicked as to try that route again.  This may be as good as it gets, and I'm still on Remeron.  I have read, btw, the nightmares people face trying to get off that particular drug - tapering Remeron does not seem to be in my near future.  Today I can't even see how I can get off this .7 mg Lexapro.

 

Funny how when I'm depressed like this stories of suicides seem to always come my way, and I hear them and I begin to understand.  And I wonder if that is my future.  I sure hope not; I love life when I'm not depressed, and I have people who love me.  I'd hate to put that burden on them.

[Altostrata]

Going off antidepressants causes big changes in the ways our nervous systems work. What you are calling depression is probably a symptom of that. Stay calm, it probably will pass over time. See http://survivingantidepressants.org/index.php?/topic/82-the-windows-and-waves-pattern-of-recovery/

[MissTrish]

So I have reached a plateau of having a couple of good days in a row.  

I am grateful!

I hope it continues since I inadvertently dropped another .1 ml this morning - just could not get the measurement right in between .6 and .8.  I might have to go to dilution in the near future.

I am also grateful that I am managing to eke out some sleep, but my nights are full of sad dreams and fitful awakenings, and my early mornings are very sad, kind of like in the past when I'd tried sleeping pills.

I am wondering if the .5 mg (1/2 tablet) melatonin is contributing to this.  I know it is good for sleep, and I have felt that it has helped ease me into sleep, although last night I had a really jumpy, difficult transition.  I know melatonin can cause depression in some people.

Of course it could be the Remeron, although it has not ever affected me this way before.  Or it could just be depression/withdrawal.

Just wondering if this is common.  I'd like to fix it if possible but if it's just part of what I have to walk through, then knowing that is helpful.

The days have cooled off enough for me to start getting outside a little bit and absorbing sunlight.  I don't do well with supplemental Vitamin D; it makes me irritable and moodier.

And so it goes - another day; another state of being, haha.  It's never really boring.  Uncomfortable, distressing, and frightening at times but with moments when the clouds part and the sun comes through.

[MissTrish]

Cloudy again. Did not fall asleep at all last night. Felt drugged, sluggish and jumpy all at the same time. Gonna try leaving off the melatonin tonight. Going to be a long day.

[MissTrish]

I have a question. I am surprised to have this much trouble getting off Lexapro. I would understand if I wasn't taking Remeron as well. I would have thought the Remeron would at least cover up or mask the withdrawal symptoms.

[Altostrata]

It doesn't. It's another drug confusing your nervous system.

[MissTrish]

Well that certainly has proved itself true.

As tired as I was from having not slept at all the night before, within an hour of taking the mirtazipine I felt myself revved up.

Up until a few nights ago I was falling asleep in front of the TV after taking it.  Now it's having the opposite effect.

I must sleep; I cannot go the entire year tapering off mirtazipine w/out sleep.

I don't know what the answer is right now.  I took two Tylenol PMs last night and managed to sleep but I am aware this won't work more than one or two nights in a row.

[Altostrata]

You might try a slightly lower dose of mirtazapine.

[MissTrish]

Well.  I am back.  I'm not sure whether to start a new topic or not as I'm no longer on Lexapro.

 

Last posting I was on .7 mg Lexapro and 30 mirtazapine, and suddenly could not sleep at all.  The mirtazapine had become over-activating.

 

The thought of doing a slow taper, while not sleeping at all, on the mirtazapine just scared the fire out of me.  So I went insane and once more thought the medical profession could help me.  I went to the acute care psychiatric clinic associated with the hospital where I see a psychiatrist (they can only see me in regular app'ts every 4-5 months) and asked for nortryptyline because (a) my birth father has taken it successfully for 30+ years and I thought I might have a genetic predisposition to do well on it and ( it's in the same class as amytryptiline and I took that with reasonable success for years.  So I started at 25 mg, and a week later because I still wasn't sleeping more than an hour or so a night, went up to 50 mg.  I started sleeping for a while, but as with all drugs, within a couple of weeks the side effects just grew unbearable.  Oh, in the meantime I did manage to taper down, over a few weeks, to 15 mg mirtazapine.  (Idiot doctor I saw suggested I could come off it completely in 4-5 days).  And finished the Lexapro taper.

 

So, not having been on the nortryptiline long, I went back to 25 mg and yes, had w/d, but the side effects (including not sleeping again, and over sedation to the point of being anxious) were worse than the w/d.  Then 25 mg was too much, so I've been at 1/2 a 25 mg capsule for 11 days, along with the 15 mg mirtazapine.  And up until the last few nights have been sleeping actually enough to get by, with the help of 1 mg melatonin.

 

Here's what's happening.  Increasingly I have had days of feeling good - really good.  Too good.  That scares me.  It's not a normal good - it's a hyperactive good.  And I'm also always on the verge of tears along with that good.  And for the past few nights I'm back to only getting maybe a couple of hours sleep at night.  I'm one of those weird people who are overstimulated by just about anything, and I'd eaten some food w/cinnamon in it, which always revs me up and I thought that might be the reason.  But that wasn't the case last night.  I can tolerate the occasional dose of antihistamine, which helps w/the hypers, although too much of it makes me feel really depressed.

 

I'm worried that I have suddenly become bipolar, and that would be a real problem because I cannot tolerate bipolar meds.  But part of me thinks that I have had the numbing effects of medications removed and my brain just doesn't know how to behave.  Does that make sense?  Is this normal?

 

I cannot handle stress at all.  I've had to cancel things I've looked forward to for a while.  And I have more things coming up that are causing me stress.  And at this point I don't know whether I need to stay at the current dose of both meds or begin tapering one or the other.  My intuition tells me I need to let my brain settle down, but I'm not sure I trust my intuition these days.  As always, I feel like if I could sleep reliably I'd be okay.  Heard that one before, have you?

 

Also, have any of you heard of, of used, the CITA method of w/d?  It's different from the 10% method and according to the posts, there are people who have done it successfully.  I'm personally terrified of coming off that last dose of mirtazapine, no matter how low, when I get there.  I have read too many horror stories.

http://www.citap.org.uk/SSRI-Tables.pdf

 

I'd appreciate any thoughts or suggestions as I'm overthinking everything and therefore don't really trust my own plans/schemes.  Plus I'm just so tired.

[Altostrata]

Thanks for keeping your story all in one Intro topic.

 

Very sorry you've had these additional experiences with psychiatric drugs.

 

Hypomania is a withdrawal symptom. It can also be a symptom of too much activation from a drug. It's hard to tell what's going on, your situation has become complicated by going on and off drugs.

 

The CITA schedule tapers with irregular dosing at faster than 10%. I don't doubt people have used it successfully, there's a wide range of tolerance for dosage reductions. We recommend the 10% method to accommodate the more sensitive people.

 

Given your recent history and current state of suffering adverse effects, please think of yourself as being among the more sensitive to dosage changes and treat your nervous system very gently.

[MissTrish]

You are right; it is very confusing to me as to what is a side effect of the drug and what is withdrawal.  I guess trial and error is the only way to know.  Yesterday I swung back the other way toward depression, although I'm sleeping a bit better.  The hypomania seems to have calmed down now that I've had no exposure to cinnamon or other spices in a number of days.  The main thing I notice now is that mid-afternoon (I take the drugs at night) I can feel my heart start beating more rapidly which I think means the drug/s are wearing off. 

 

Of course tomorrow could be another story - one thing about this journey is that it's unpleasant, yes, but never boring.

[Altostrata]

You may wish to try theanine in the afternoon. Also some magnesium http://survivingantidepressants.org/index.php?/topic/1300-magnesium-natures-calcium-channel-blocker/
 

[MissTrish]

I dropped from 12.5 mg nortryptyline to 6.25 (went to a liquid taper) probably about mid-December and after a slight bumpiness did surprisingly well.  Was getting an average of 7 hours sleep a night which is not something I can complain about!  So a week and a half ago I dropped from 6.25 to 5 mg and have increasingly not done so well.  I'm irritable, restless, waking very, very early, have a band of pain around my head that's getting worse, and my eyes water and I'm starting to itch.  I know these are all anxiety symptoms.  One night I took a hydroxyzine and it helped tremendously, all through the next day.  But I can't take that daily or it starts to have its own troubles.  I took a half of one this morning and it has helped ease the headache back a bit.

 

Why would I do well with this large drop, then go south quickly on a smaller drop?  I'm thinking I need to go back up, although not sure whether to do the entire 6.25 or not.

 

My thinking on this smaller one was that if I got to 5 mg, I could get a 10 mg capsule prescribed and just cut it in half and not have to deal with the liquid taper for a while.  I knew I had an app't w/my psychiatrist coming up.  (Which got canceled, long story involving psychiatric availability and Medicare).  So right now my best option is seeing my family practice doctor and hoping she will prescribe the liquid form of nortryptyline for me, and refill my mirtazapine.

 

I didn't see the theonine suggestion above until now for some reason.  I may try magnesium although I know I can't take it daily - it makes my fingers and feet tingle.  I do take a lot of epsom salt baths, hoping to absorb it that way.

[chicken]

It seems strange to be on Nortriptyline and Mirtazapine. When Cipro wrecked my mirtz taper the doc bridged me over to Nortryptyline.  I got the impression from my doc that one should not be on both Nortriptyline and Mirtz. Are you using the Nortrytiyline to cross over from Mirtz?

 

How are you liquid tapering the Nortrip now?

 

I am dissolving a 10mg capsule into 20mg of liquid. Nortryp tastes horrible so I didn't want to use 10mg of liquid.

[MissTrish]

What happened was I was on 30 mg mirtazapine and a tiny amount of Lexapro, and suddenly when I took the mirtazapine at night I got revved up instead of sleeping.  So the plan was to transition from mirtazapine onto nortryptyline (50 mg), only I wasn't able to come off the mirtazapine nearly as quickly as they would have liked.  My psychiatrist office has me on their books as being off mirtaz.  However, I had a full three month supply, and more since I did get down to 15 mg, and now down to 11.25.  But I couldn't tolerate the nortryptyline at the high doses, even at 25 mg.  So I went down to half of that (12.5), and because I was having problems with that, I am now down to 6.25.  My plan is to be off the nortryptyline first and get down to 7.5 mg mirtazapine.  It's not going as smoothly as I'd like; I'm kinda stuck on both of them.  

[chicken]

I couldn't tolerate nortryp at higher doses either. 40mg was as high as I got and I had to to reduce it to 20 quickly because of very high blood pressure. 20mg and below is pretty much just used for pain and not for depression or mental issues. Nortrpt isn't causing any issues with me now. I just hope it stays that way during my taper. I'm at 18mg now.

 

From my experience and I speak for myself only, I would taper the mirtz first. Mirtz was a big problem for me. I got it down to 3.75 before I noticed any problems. I quit at 3.75 and was slammed with withdrawal about 5 days later. I had to go to the ER and was reinstated and they added cipro (antibiotic) for a UTI. Cipro really messed things up with the mirtz and I was never able to stabilize at any dose after the Cipro. If you can avoid it, don't take any antibiotics until you are well off your meds and your CNS has returned to normal.

 

I hope it all works out for you.

[MissTrish]

Mirtazapine w/d scares me greatly; I have heard too many stories just like yours.  An update here - after carefully monitoring myself yesterday and last night I discovered that my symptoms abated in early evening, and kicked back up again big time shortly after I took my evening dose of meds.  The high energy/shivers/freezing kicked in.  I took a hydroxyzine an that helped a bit, but that's not something I can personally take regularly.

 

My plan tonight is to take the mirtazapine about an hour before the nortryptyline to see if that's what's causing it.  If so, then I'll have to make a drop there.

 

Oh boy; not going to be fun.

 

My other plan is to ask my nurse practitioner tomorrow for liquid versions of both so I won't have to be cutting mirtazapine and making liquid out of the nortryptyline.  My bathroom sink looks like a drug dealer's set-up with my razor blade and mixing paraphenalia, lol!

 

Thank you, chicken!  I appreciate you sharing your experience.  I am terrified of the mirtazapine taper.

[MissTrish]

So I was at my doctor's today and she could not find a liquid form of mirtazapine.  A pharmacist could compound it but my insurance would likely not pay for it.  Have any of you successfully made your own liquid?  How do you do that?  Does it dissolve well?  I've been making my own with nortryptyline but it's a powder within a capsule and easier.

[chicken]

Trish,

I don't think there is a liquid version or mirtz available in the US. The only liquid form is for veterinarian use on animals. Some states don't  even allow the liquid form, even for vet use. If it is available in your state, I suppose a vet could write a script for your pet and you could take it. Don't think that would be legal though.

 

I've never tried making a liquid out of mirtz so I'm not sure how soluble it is. I think Rhi has a lot of experience with some of the non-soluble meds. She has made some suspensions out of the non-solubles. Maybe she could chime in on this one.

 

The nortryp does dissolve pretty well. I have found that it will settle if you let it set too long. I shake mine up right before I take some out with the syringe.

[MissTrish]

I did get the nortryptyline in liquid form.  Will switch over tomorrow.  Would love to hear how others cut their mirtazapine.

Thanks, chicken!

[chicken]

Trish,

Are you feeling pretty well on these lower doses now?

 

I'm thinking about really holding a long time when I hit really low doses on the nortrypt. I'm not so concerned about immediated withdrawals as I am the delayed onset withdrawals that Dr. Shipko speaks so much of. I'm thinking a really long hold on a lose dose will give the receptors a good long time to grow while having a tiny bit of the drug present.

[MissTrish]

Well I've run into a bit of a snag.  

I'd love to hear from you, Chicken, and any others, with any wisdom on this issue:

1) The mirtazapine (I'm almost sure it's the mirtazapine) is revving me up.  I am way overstimulated.  And the reason I think this is the drug rather than w/d is that it amps up when I take the drug at night and eases off around dinnertime.

2) I cut from 3/4 tablet (15 mg tablet) to 1/2 (to 7.5) last Sunday night.  I definitely could tell the difference between the w/d symptoms from that cut and this other revving up.

3) What to do?  I'm tempted to cut again just to ease off on these awful nervous symptoms.  I can't think, my eyes are burning and my nose is running.  This happened to me when I was taking Lexapro as well, and got better with each cut.

Is it better to shake and jitter w/drug-induced shakes and jitters all day or to cut and suffer w/d?  If cutting, how much and how often?

 

Can I add mirtazapine to the topic?  Right now it's got tags of "SSRI" and "Lexapro" and I'm not on any SSRI anymore.

[MissTrish]

Update:  after a little experiment last night, I've found that it is in fact the nortryptyline that is causing the extreme agitation in me.  So good to know; am on my way off that little dose.