ndmaar: Tapering mirtazipine

[ndmaar]

Hello everyone. Just a quick question regarding mirtazapine.

I'm currently on a tiny dose of 0.1 mg of mirtazapine and I sleep ok with it (5-6h), but if I don't take it I get max 1 hour of sleep.

Is there any point to try to taper even more down to 0.05 mg or even 0.01 mg or should I stay on 0.1 mg for some time, and try to take it every other day and so on?

My main concern atm is sleep.

 

Hi ndmaar,

 

You've tapered much more quickly than we would suggest. I realize sleep is your main concern but we will need more info about how you've felt during the two week taper.

 

This is actually someone else's thread, although it didn't have a name in the title until now, so if you don't mind, please start your own thread in this forum, "Introductions and Updates". You can use it like a journal to keep your info all together.

 

We're glad you've joined us!

 

Hi ndmaar,

 

You've tapered much more quickly than we would suggest. I realize sleep is your main concern but we will need more info about how you've felt during the two week taper.

 

This is actually someone else's thread, although it didn't have a name in the title until now, so if you don't mind, please start your own thread in this forum, "Introductions and Updates". You can use it like a journal to keep your info all together.

 

We're glad you've joined us!

My fault, I apologise. I moved the POST from this thread in tapering. Or thought I did! Then the doorbell rang and had to see to that.

Sorry, doorbell again!

[tezza]

Opening thread for new member

[tezza]

I moved these posts here but accidentally merged the three posts into one post.

[ndmaar]

Thank You, tezza, for kind greetings.

 

If it is more appropriate to have my own thread, so be it. Though I think it is not neccesary now to post my whole story, and I'm not sure how much I will be updating, as I wanted to share my story as a successfull one when I will be recovered.

 

Brief pre-history.

All problems started 2 years ago after mixing marijuana with heroine (I wasn't an addict, tried heroine then for the first time, and what concerns pot - smoked it just a few times in my life). I was just very unlucky, this incident totally crippled my nervous system and psyche, and that's why I had turned to psychiatry.

In June of this year I CT'ed olanzapine after taking antipsychotics for 1 year and 4 months (though it wasn't a full CT, but one week taper, when I tried to stop abruptly I had severe depression, when I was barely able to get out off bed). Anyway, of course, it was a big mistake. On the 10th day harsh insomnia had started, for 7 days I didn't sleep at all. Then for a few weeks I've taken zopiclone.

 

Mirtazapine.

After zopiclone I switched to mirtazapine 30mg, on which I stayed for 3 months, until I found out what was the reason of my insomnia.

Armed with new knowledge i tried to do a fast taper with a next pattern: 30, 15, 15, 15, 7.5, 7.5, 6, 5, 4, 3, 2, 1, 1, 1, 1, 1, 0

Which is interesting, when I was lowering the dose of mirtazapine, three times at 15mg and one time at 6mg my derealization was nearly gone. I nearly cried out of happiness because of that, felt so alive, so energetic, life didn't seem unreal at last. Silly me, I thought that when I taper off completely there would be no derealization again, that's why I continued with fast taper.

Second night with no mirtazapine I wasn't sleeping. Three next weeks I took 5mg of diazepam once a week and slept fine all week.

Then I returned to 1mg of mirtazapine and weaned off till 0.1mg in 11 days.

Withdrawal symptoms started on the second day of 15mg and included: nervousness, irritability, hysteria, depression, intensification of intrusive obsessive neurotic thoughts especially when mirtazapine free (last one is the most bothersome). Now there is only elevated cortisol, overall instability of CNS, intrusive thoughts and derealization.

 

And here we come to my original question.

Is there any point to try to taper even more down to 0.05 mg or even 0.01 mg or should I stay on 0.1 mg for some time, and try to take it every other day and so on?

[tezza]

It's not a good idea to take on alternate days, this causes the drug level to go up and down in your bloodstream. That, alone, triggers withdrawal for some people. If you feel stable and are sleeping well on 1 mg, then, if it were me, I'd hold there for quite some time and allow the CNS to catch up.

 

You should be able to taper off that last 1mg.

 

I've tapered down to 1 mg very slowly. I've taken over a year to make it from 7.5 to 1mg.

 

I'm sure you will write a success story, I plan to, as well. We have a special thread here for those, too. In the meantime, you can use your thread to ask questions and we'd like it if you could let us know how you're doing, but it's up to you.

 

Did I misread or did you say the WDs started at two days back on 15mg?

 

I'm sorry you had a bad drug experience that led to psych meds!

[mammaP]

I am sorry for the earlier confusion Ndmaar, it's best to have your own thread for questions specific to your dosage

etc. This will be your 'journal' where you can post updates. We need a history of what you are taking in order to

give the best advice.  The every other day method is not recommended because it throws your CNS into turmoil,

a steady dose is always best and reducing slowly. 

 

I have no experience of mirtazepine so can't personally advise you but someone will be along very soon who can. 

[mammaP]

I see Tezza got here before me, she's better placed to advise you  

[ndmaar]

tezza, I'm now on .1mg, not 1mg. And I wonder will it make sense to reduce that dose even more, if not now, but possibly later in the future? At what dose would you, yourself, stop taking mirtazapine? But for now, I think, you are right, I should stay on my current dose for some time.

The WDs (depression at first) already started on the second day of my taper, yeah.

[tezza]

It sounds like you went too fast. If symptoms get too bad, you may wish to updose and try to stabilize. Then, you could taper off more slowly. I will probably leave it off when I get down to .1 mg if my taper continues as well as it is, now.

 

I was on 7.5 mg last July (2012), so I've tapered that slowly. You can see in my signature I'm at 1mg now.

[Altostrata]

Welcome, ndmaar.

 

What are your symptoms at .1mg mirtazapine?

 

If you're not having adverse effects from the mirtazapine, given you've tapered so fast, it might be a good idea to stay at .1mg for a while, perhaps a couple of months, then taper off it.

 

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

[ndmaar]

Altostrata, I am very sorry for leaving your post without reply. Was in the bad mood, and later thought that I'll figure everything out myself.

 

I just now (wonder why so late) have realized that most of my symptoms are due to protracted withdrawal after CT of olanzapine, and three previous unsuccessfull attempts to quit olanzapine also have affected my condition very negatively. What bothers me most is overall neurotic state and persistent intrusive thoughts, which at times become unbearable. My sleep though has improved, I can sleep for 7-8hours on .1mg mirtazapine

 

I'm thinking about updosing to 1mg of mirtazapine (=less intrusive thoughts), but there is one negative adverse effect - cravings for cigarettes. I can resist if I try hard, but most of the time I give up and have 1-2 cigarettes a day, which can sicken me even more sometimes. In October when I was mirtazapine free I didn't smoke at all.

And also if I updose, and then taper for say 2-3 months, I'm afraid that in the end of it I will feel again the same as now.

 

Is there some way to get a relief from protracted WD of antipsychotics and particularly from intrusive thoughts? 

I'm taking magnesium - it helps, have ordered inositol. After fish oil I get some strange unpleasant derealization. B vitamins and GABA also affect me negatively.

 

Thanks for the support, caring environment and encouragement that can be found on this forum.

[Altostrata]

It's good that your sleep has improved. Sleep is healing.

 

See our Symptoms and Self-care forum for gentle ways to manage your symptoms, which should fade over time.

 

Also see

http://survivingantidepressants.org/index.php?/topic/1112-non-drug-techniques-to-cope-with-emotional-symptoms/

http://survivingantidepressants.org/index.php?/topic/82-the-windows-and-waves-pattern-of-recovery/

[ndmaar]

Urgent advice needed. Not for me, but for a friend.

 

A tragic story. She has heavy OCD. She's uneducated in psychiatry and was relying on doctors. She was taking different psych meds on and off for like 10 years. This year she had a course of ECT. After that she was taking mirtazapine 45mg, paroxetine 20mg and risperidone 1mg for approximately 1,5 months. But she can't remember what meds she was taking prior to that, maybe partly to ECT, partly to other reasons. She stopped all of her tablets and attempted suicide on November 28th by strangling herself, it was unsuccessfull, severe nosebleed started and she was forced to stop. She went to psych ward herself. There they were giving her only paroxetine, after a week she went home and didn't take any meds. Interestingly, after a suicide attempt she felt a relief of her OCD symptoms and was feeling much better for nearly two weeks. Today she had a major breakdown, was feeling awful, worse than before suicide attempt. I believe that it is a WD. Is there something that can be done? Does she have to reinstate all the 3 meds she was taking earlier or only antidepressants or ...?

 

Thank you. I'm sorry to bring on such a sad topic.

[mammaP]

I am so so sorry to hear about your friend. I think it would be a good idea for you to start a thread 

here in intro on her behalf.  Put a sudonym for her in the title so we know it is for her.

Thank you for being there for her.  When she is feeling up to it she can come and join us on her thread. 

[ndmaar]

Have been holding on 0.1mg mirtazapine for 2 months, and it is 3,5 months since I started my chaotic tapering. Have been doing mostly ok, and seeing improvement, but even minor things (taking inositol, going to the swimming pool, staying outside in -10°C=14°F, drinking kefir) can send me right back to hell. Sleeping like a healthy person on most nights, but sleep is easily negatively affected by many things. And if I don't take these 0.1mg - am not able to fall asleep and stay awake all night long.

 

For a few weeks already am contemplating updosing to 1mg, but can't decide whether to do it or to stay on 0.1mg for a few more months. Wouldn't it be too late for updosing?

[Altostrata]

It sounds to me like your nervous system is stabilizing, although slowly, at 0.1mg. I would stay there for a while.

 

Don't take inositol and avoid other things that seem to increase stress on your nervous system.

[ndmaar]

Have crashed very badly after smoking 3 cigarettes in 4 days in the end of the January. Insane heat and dryness sensitivity, constant hot flushes, sometimes panic attacks, movements and sensations in the nervous system which are hard to describe, a total mess. For most of the time I stayed alone in the coldness and dark of my room. When physical symptoms started to abate I realized that my mindset and my thoughts have changed to the worse, much worse. Thoughts of long forgotten negative events of the last years started to pop out of nowhere and frighten me. I felt very vulnerable and weak mentally; very dark, gloomy, hopeless dreams started. It seemed like I have forgotten everything I've read and thought about in the months before this crash, like the memory and connectedness to that all was wiped. Then after doing blood test physical symptoms reappeared again. So in the end of the February I ended up already suicidal.

And one of the new symptoms is that for 2 weeks already I'm having pain the area of kidneys, sometimes it moves to the area above kidneys and middle of the spine, sometimes it is located in the sides of the abdomen. When the pain is the strongest I feel unwell in overall and body temp is slightly increased. Digestion also seems to be affected negatively, especially after the breakfast. I am а little worried about kidneys, because I had them failed after a suicide attempt in Nov2012. Then, after a week on hemodialysis they started working and after a few weeks tests showed that all is well with them.

This week I've done urine test and GP says according to it everything is fine with kidneys, and she doubts that blood test and ultrasonography will show something negative. I'm afraid to do blood test, because my nervous system perceives losing blood as a big stress and for at least a day after I feel like in the throes of the withdrawal (I had one done in December and one in February).

And one of the strange new symptoms is that I had a bad reaction to either bananas or peanut butter. And probably sour cream as well. If it is a bad reaction to fats - maybe the endocrine system is also involved?

 

I updosed to 1mg mirtazapine on February 28. Next day after the updose was even worse, second much better, third again a little worse. One week on 1mg, it's a rollercoaster, but quite better than before updose and while writing this I am able to feel optimistic. Next day after the updose, which was the worst mentally, the pain in the kidneys was also the most intense. Then it seemed to decrease, but now I'm not so sure. So, could it be that all this pain is solely withdrawal related?

Now I have a thought pulsating in my mind - "updose to 5mg!". And as much as I wouldn't want to do it, probably I should?

 

P.S. I believe I could have pulled through on 0.1mg if I would've been more careful. During the crash I realized how much progress I've made in the months before.

So glad to log in SA.org again after a month's break.

[tezza]

It's nice to see you back! I don't know whether the pain is WD related or not, a GP would be better able to advise on that. I don't think I'd jump up to 5mg so soon, given what you say you felt after up dosing to 1mg.

 

Are you logging and rating symptoms daily according to severity? I would strongly suggest that if you don't. Also notate any changes such as dosing, supplements and anything you feel could have an effect on how you're doing.

[Altostrata]

Yes, withdrawal can cause a lot of mysterious pain.

 

Many people do well with fish oil and magnesium supplements, see
http://survivingantidepressants.org/index.php?/topic/36-king-of-supplements-omega-3-fatty-acids-fish-oil/
http://survivingantidepressants.org/index.php?/topic/1300-magnesium-natures-calcium-channel-blocker/
 

[dalsaan]

Hi ndmaar

 

Resist the urge to up dose to 5 mg. wait and see what happens on 1. As Alto says withdrawal reactions can bring weird pain reactions. I would hold for 4-6 weeks at least and just monitor what happens

[tgirl]

Terza are you still on remeron?

[ndmaar]

I'm ndmaar, and I'm on 2.7mg ))

And this is pure hell, but well, it's been like that for the last 7 months, but I've been through so much in the last years and this year so I don't care anymore )) Holding on to nothing and somehow being able to be positive.

Sorry it's hard for me to type much. I wish you luck in your taper. It's totally possible and believe me, there are enough success stories. Read wulfgar's topic thoroughly, there are lots of useful info.

[tgirl]

I feel the same. Am tryin to remain possitive, but, I don't feel I can make it another day let alone another minu

[Altostrata]

It isn't easy -- this may be the most difficult thing you do in your life. Be patient, the body wants to fix itself.