Jump to content

MrsWDSyndrome:My husbands taper from remeron. Are we doing this right?


MrsWDSyndrome

Recommended Posts

Hi!  I just typed up my signature so I feel like the basic story is down there already!  My husband, who is pretty much through his hellish ordeal with benzo w/d is now working on tapering off remeron. He has gone from 30 mg to 4 mg.  He is feeling like it's getting harder, again. More severe symptoms, and when he feels like the w/d symptoms stabilze after a cut, he is then bombarded by side effects (heavy head, dizziness, morning panic, etc.).  He is right now 2 1/2 weeks since his last cut, from 4.4 mg to 4 mg.  This is from an email he sent me this morning from work. This is a typical morning,lately, for the few weeks following a cut.

 

I feel so short of breath. I feel like I am vibrating inside. My stomach wants no food, no drink, and is loud and destructive and crampy. My skin is hot on the outside but I feel cold on the inside. Anxiety is very high. Depression makes me feel like I could cry at any moment. My mind is racing. It’s like living a nightmare.

 

 

When he stablizes, lately especially, he still feels pretty horrible, so he's fighting the desire to cut fast and "get the hell off of this stuff,"  basically.  I will say that mornings are undoubtedly the worst for him.  He usually gets a nice reprieve in the evenings, then takes his remeron, goes to sleep, and boom, there it all goes again.

So, really, what we'd love is some input. My inclination is that maybe he needs to stick to closer to 5% cuts than 10% and maybe commit to once a month cuts rather than the typical 3 weeks that he tends to wait.  (Oddly he made 2 10% cuts several months ago that were essentially painless.  We're still trying to figure out how on earth that happened!)  Also, is it common that as one gets to the very low doses, the taper gets more difficult?  It's seeming that way to him.  Not sure if this is a common phenomonon.

Any suggestions or comments are appreciated!

Wife of severe benzo w/d survivor, and now dealing with w/d of remeron/mirtazipine.

 

My husbands history (abbreviated)

Made final jump from Ativan in June of 2012, after a far too fast taper suggested by doctor.  Now at 19 months post-jump he feels he's 90% recovered.

 

While in acute w/d he was hospitalized (before we understood what was going on) in July 2012 and was put on 30 mg of remeron. (He had previously been taking 7.5 mg for quite a few years.) He began tapering this around November 2012.  His basic taper method has been 5-10% cuts every 2-4 weeks.  He is now down to 4 mg of remeron. 

Link to comment
  • Moderator Emeritus

Hi MrsWD. Your husband's email describes just what a few people here are suffering in withdrawal

right now. If there are symptoms it is better to hold for quite a while. I'm sure that isn't what he will

want to hear but he is having withdrawal symptoms that will get worse if he cuts again too soon. It 

might help to updose a little back to the previous dose and then hold until he is comfortable, then

hold another 3-4 weeks after stabilising. 

That is what I would do in his situation. Updosing isn't failure, it is what is needed sometimes. Many

of us have to updose sometime in our tapers.

 

I think you are right to suggest smaller cuts and longer holds. I had a good taper too with very little

discomfort until I got to the lower doses. I have had to learn patience and hold for months at a time 

to avoid withdrawal symptoms.  Things will settle down again, it just takes time and sadly his nervous

system could still be sensitised from the ativan withdrawal.

 

I hope things settle down soon for him. Take a look around the site, there is a wealth of information 

and suggestions for self care while tapering and in withdrawal. You have come to the best place for

that info. 

**I am not a medical professional, if in doubt please consult a doctor with withdrawal knowledge.

 

 

Different drugs occasionally (mostly benzos) 1976 - 1981 (no problem)

1993 - 2002 in and out of hospital. every type of drug + ECT. Staring with seroxat

2002  effexor. 

Tapered  March 2012 to March 2013, ending with 5 beads.

Withdrawal April 2013 . Reinstated 5 beads reduced to 4 beads May 2013

Restarted taper  Nov 2013  

OFF EFFEXOR Feb 2015    :D 

Tapered atenolol and omeprazole Dec 2013 - May 2014

 

Tapering tramadol, Feb 2015 100mg , March 2015 50mg  

 July 2017 30mg.  May 15 2018 25mg

Taking fish oil, magnesium, B12, folic acid, bilberry eyebright for eye pressure. 

 

My story http://survivingantidepressants.org/index.php?/topic/4199-hello-mammap-checking-in/page-33

 

Lesson learned, slow down taper at lower doses. Taper no more than 10% of CURRENT dose if possible

 

 

Link to comment

Hi MrsWD,

 

When I tapered Remeron, I definitely had to slow it down to 5% of current taperer near the end.   And I didn't make a cut any sooner than before 4 weeks.

 

I had a similar type experience with Doxepin.

 

CS

Drug cocktail 1995 - 2010
Started taper of Adderall, Wellbutrin XL, Remeron, and Doxepin in 2006
Finished taper on June 10, 2010

Temazepam on a PRN basis approximately twice a month - 2014 to 2016

Beginning in 2017 - Consumption increased to about two times per week

April 2017 - Increased to taking it full time for insomnia

Link to comment
  • Moderator Emeritus

Hi MrsWD

 

You've both done a great job so far. It's not easy. Be proud of how far you have come

 

I am tapering off remeron. Down to 1.8 ml (equivalent to 1.8 grams). It has got harder. I agree that smaller cuts, longer holds are the way to go.

 

 

From here I would hold as long as it takes to stabalise, then cut at less than 10 percent and see how you go

 

At times I have cut and had to go back up again because it was too much.

 

I use insomnia as the symptom to monitor and tell me when I've gone too far. I know how to read it now and can usually work out pretty quickly whether things will resolve with a hold or whether I need to backtrack and increase my dose.

 

Does you husband have a symptom that can act as a marker to indicate where he is at- ok to continue tapering, needing to holding or needing to updose?

Please note - I am not a medical practitioner and I do not give medical advice. I offer an opinion based on my own experiences, reading and discussion with others.On Effexor for 2 months at the start of 2005. Had extreme insomnia as an adverse reaction. Changed to mirtazapine. Have been trying to get off since mid 2008 with numerous failures including CTs and slow (but not slow enough tapers)Have slow tapered at 10 per cent or less for years. I have liquid mirtazapine made at a compounding chemist.

Was on 1.6 ml as at 19 March 2014.

Dropped to 1.5 ml 7 June 2014. Dropped to 1.4 in about September.

Dropped to 1.3 on 20 December 2014. Dropped to 1.2 in mid Jan 2015.

Dropped to 1 ml in late Feb 2015. I think my old medication had run out of puff so I tried 1ml when I got the new stuff and it seems to be going ok. Sleep has been good over the last week (as of 13/3/15).

Dropped to 1/2 ml 14/11/15 Fatigue still there as are memory and cognition problems. Sleep is patchy but liveable compared to what it has been in the past.

 

DRUG FREE - as at 1st May 2017

 

>My intro post is here - http://survivingantidepressants.org/index.php?/topic/2250-dalsaan

Link to comment
  • Moderator Emeritus

Welcome MrsWDS! I'm sorry you are both struggling with this.

 

Your husbands CNS was likely still in a very fragile state (probably will be for a time) even though he felt much better. I was tapering way too frequent in the beginning and ultimately became VERY ill. I would make another cut as soon as I felt better, not realizing the 'windows and waves' were possible/probable. I began the taper from that drug in July 2011 and have quite a way to go. (Risperdal)

 

I began a taper from 7.5 mg of Remeron July 2012 and finished it December. (Just to give you an idea how slowly I tapered, this could be too fast for another person, some could go faster.) I don't follow any "plan" other than listening to my body. There is no tapering schedule that is 'one size fits all'. We suggest 10% OR LESS of each successful cut, no more OFTEN than every two weeks but this is far too fast for many of us.

 

It does get more difficult at lower doses in many cases. I would hold for a good, long time before cutting again (even if he decides to updose a bit).

 

You've come to the very best place for support and information!

Link to comment
  • Moderator Emeritus

I suspect that your husband has been tapering too fast, faster than his CNS has been able to keep up with, and it's catching up with him. (For example, those two 10% cuts that seemed to go well at the time.) This is a common, almost universal experience in tapers. There's a lag time effect that people don't take into account.

 

Here's something I wrote recently in another thread to explain it (with a couple of edits because that's how I roll):

 

***The problem is that our brains remodel and rewire themselves to adapt to the presence of the drug while we are taking it. These changes take place gradually and cannot be undone quickly. There is usually a certain amount of resilience built into our amazing nervous systems, but as Alto says, they're not made of rubber.

 

We remove some of the drug and the body begins to try to remodel the nervous connections to rebalance.  It manages to get a partial balance, not robust but adequate. Then we remove more of the drug when in this state, and the body/brain continues to try to remodel; the adaptation is enough that we can function, but still not really strong because there hasn't been enough time. If we keep removing faster than our brains can adapt, our balance becomes more fragile and precarious.

 

Then we remove even more, and even more, and I think eventually we get so far ahead of our ability to heal and remodel the brain that people experience a "crash" or just go into a state of ongoing unstable withdrawal that doesn't seem to ever settle down.

 

I suspect that we can get into a state of withdrawal where the brain just can't rebalance itself because the chaos caused by the withdrawal is interfering with the chemical processes required to heal and rebalance.

 

That's the mechanism that I speculate is behind this "lag time" phenomenon, and this is why I am such a strong proponent of just holding and not changing anything when you get unstable. (And of course of slow tapers with long holds, so we don't get ahead of our brain's ability to adapt in the first place.)***

 

I think your husband's best hope at this point is a slight updose back to the 4.4 and then a long hold, at least six weeks (nothing wrong with a couple of months though) followed by a slower taper (because yes, most people have to go more slowly at the end of the taper).

 

I also think he needs to read some of the posts in this forum himself, because in my experience people generally have enough trouble taking this kind of advice when they get it first hand and read other peoples' stories too. Mostly we don't have much success with second-hand advice and helping here.

 

There's a state we get in when tapering, where we just get obsessive and sick and we just want to cut, cut, cut, and it's impossible to see that the cutting is what's harming us. I experience it regularly myself. I consider it another withdrawal symptom caused by derangement of my neurotransmitters and HPA axis making it difficult for my frontal lobes to function, so I can't think well and rationally. When someone's in that state it takes a while to talk them down and usually they go through a lot more suffering first.

 

It's up to him, but getting off faster isn't going to make the suffering go away. There's no way to accelerate the healing and remodeling process that his brain has to go through, either while still tapering or after he gets off the drug. It's not the drug that's making him sick, it's the fact that his brain is adapted to the presence of the drug and he's yanking it out faster than his brain can adapt to its absence.

 

And as bad as it is today it can definitely get worse. Just ask the folks here.

Started on Prozac and Xanax in 1992 for PTSD after an assault. One drug led to more, the usual story. Got sicker and sicker, but believed I needed the drugs for my "underlying disease". Long story...lost everything. Life savings, home, physical and mental health, relationships, friendships, ability to work, everything. Amitryptiline, Prozac, bupropion, buspirone, flurazepam, diazepam, alprazolam, Paxil, citalopram, lamotrigine, gabapentin...probably more I've forgotten. 

Started multidrug taper in Feb 2010.  Doing a very slow microtaper, down to low doses now and feeling SO much better, getting my old personality and my brain back! Able to work full time, have a full social life, and cope with stress better than ever. Not perfect, but much better. After 23 lost years. Big Pharma has a lot to answer for. And "medicine for profit" is just not a great idea.

 

Feb 15 2010:  300 mg Neurontin  200 Lamictal   10 Celexa      0.65 Xanax   and 5 mg Ambien 

Feb 10 2014:   62 Lamictal    1.1 Celexa         0.135 Xanax    1.8 Valium

Feb 10 2015:   50 Lamictal      0.875 Celexa    0.11 Xanax      1.5 Valium

Feb 15 2016:   47.5 Lamictal   0.75 Celexa      0.0875 Xanax    1.42 Valium    

2/12/20             12                       0.045               0.007                   1 

May 2021            7                       0.01                  0.0037                1

Feb 2022            6                      0!!!                     0.00167               0.98                2.5 mg Ambien

Oct 2022       4.5 mg Lamictal    (off Celexa, off Xanax)   0.95 Valium    Ambien, 1/4 to 1/2 of a 5 mg tablet 

 

I'm not a doctor. Any advice I give is just my civilian opinion.

Link to comment
  • Moderator Emeritus

Very well explained  Rhi! 

**I am not a medical professional, if in doubt please consult a doctor with withdrawal knowledge.

 

 

Different drugs occasionally (mostly benzos) 1976 - 1981 (no problem)

1993 - 2002 in and out of hospital. every type of drug + ECT. Staring with seroxat

2002  effexor. 

Tapered  March 2012 to March 2013, ending with 5 beads.

Withdrawal April 2013 . Reinstated 5 beads reduced to 4 beads May 2013

Restarted taper  Nov 2013  

OFF EFFEXOR Feb 2015    :D 

Tapered atenolol and omeprazole Dec 2013 - May 2014

 

Tapering tramadol, Feb 2015 100mg , March 2015 50mg  

 July 2017 30mg.  May 15 2018 25mg

Taking fish oil, magnesium, B12, folic acid, bilberry eyebright for eye pressure. 

 

My story http://survivingantidepressants.org/index.php?/topic/4199-hello-mammap-checking-in/page-33

 

Lesson learned, slow down taper at lower doses. Taper no more than 10% of CURRENT dose if possible

 

 

Link to comment

Thank you everyone for your very thoughtful responses.  Nothing you suggest comes as a surprise and that's good!  I really just wanted to a kind of consensus that by and large, slow and steady is the way to go, and at this point maybe even slower and steadier.  This process has just been surreal, and now, with just 4 mg left to go, after 19 months of benzo w/d, there's that little part of your brain screaming "JUMP!" and on the benzo board my husband is seeing a few members jump when they get to three or so mgs.  It seems wrong, and it's good to get reinforement that it is.  There's a good chance he will be joining here.  I think he's just going through a bit of withdrawal forum exhaustion, but for the time being I will check in with questions and follow ups.  As it is, I read a post in the Family and Friends section last night that pretty much blew me out of the water, the one about what to expect when a loved one is in withdrawal.  Wish we could have seen that prior to all of this.  Better yet, I wish his doctors had!  Thank you all!

Wife of severe benzo w/d survivor, and now dealing with w/d of remeron/mirtazipine.

 

My husbands history (abbreviated)

Made final jump from Ativan in June of 2012, after a far too fast taper suggested by doctor.  Now at 19 months post-jump he feels he's 90% recovered.

 

While in acute w/d he was hospitalized (before we understood what was going on) in July 2012 and was put on 30 mg of remeron. (He had previously been taking 7.5 mg for quite a few years.) He began tapering this around November 2012.  His basic taper method has been 5-10% cuts every 2-4 weeks.  He is now down to 4 mg of remeron. 

Link to comment
  • Moderator Emeritus

The benzo boards these days are not good sources of advice or support. At least not Benzo Buddies. The kamikaze gang has taken over. That's why I'm no longer there, I just got tired of hitting my head against the wall trying to convince people it's possible and helpful to taper safely.

 

If you follow peoples' threads there, you will see that the aggressive style of tapering they do does not lead to good outcomes. (Not if you want to be able to hold a job and keep your marriage and that sort of thing.)

 

Oh, and I am well acquainted with that little voice saying "jump!" or "cut cut cut more more more!" I actually think now that when that happens it's another withdrawal symptom, brought on by a combination of stress hormones/cortisol imbalance due to withdrawal, and neurological disruption which disables frontal lobe (logic, planning) functions. I try to treat it like any withdrawal symptom--as a sign that I'm going too fast and it's time to hold for a while.

Started on Prozac and Xanax in 1992 for PTSD after an assault. One drug led to more, the usual story. Got sicker and sicker, but believed I needed the drugs for my "underlying disease". Long story...lost everything. Life savings, home, physical and mental health, relationships, friendships, ability to work, everything. Amitryptiline, Prozac, bupropion, buspirone, flurazepam, diazepam, alprazolam, Paxil, citalopram, lamotrigine, gabapentin...probably more I've forgotten. 

Started multidrug taper in Feb 2010.  Doing a very slow microtaper, down to low doses now and feeling SO much better, getting my old personality and my brain back! Able to work full time, have a full social life, and cope with stress better than ever. Not perfect, but much better. After 23 lost years. Big Pharma has a lot to answer for. And "medicine for profit" is just not a great idea.

 

Feb 15 2010:  300 mg Neurontin  200 Lamictal   10 Celexa      0.65 Xanax   and 5 mg Ambien 

Feb 10 2014:   62 Lamictal    1.1 Celexa         0.135 Xanax    1.8 Valium

Feb 10 2015:   50 Lamictal      0.875 Celexa    0.11 Xanax      1.5 Valium

Feb 15 2016:   47.5 Lamictal   0.75 Celexa      0.0875 Xanax    1.42 Valium    

2/12/20             12                       0.045               0.007                   1 

May 2021            7                       0.01                  0.0037                1

Feb 2022            6                      0!!!                     0.00167               0.98                2.5 mg Ambien

Oct 2022       4.5 mg Lamictal    (off Celexa, off Xanax)   0.95 Valium    Ambien, 1/4 to 1/2 of a 5 mg tablet 

 

I'm not a doctor. Any advice I give is just my civilian opinion.

Link to comment

Phew... symptoms seem to be lightening this past couple of days.  Thanks again.  Rhi, I especially appreciate your responses.  My husband is definitely going to keep this very slow - I will make sure of it! ;)  We agree with the benzo boards getting very kamikaze. I think he really needs to, and is getting toa place of acceptance that this is a process he will be going through for the long haul, even when he's down to only 4 mgs.  He did taper faster from the 30 mgs to somewhere around 10 or so, but he did so at a HUGE price.  Now, in hindsight, we realize that he became completely hypomanic and experienced crazy personality changes and nearly threw his whole life away.  It seems that now that his benzo w/d has ended,  more or less, and he's slowing down his remeron taper, he's still suffering when he makes the cuts, but he's not doing the Jekyll and Hyde thing. :wacko:  I can't believe this stuff is legal.

Wife of severe benzo w/d survivor, and now dealing with w/d of remeron/mirtazipine.

 

My husbands history (abbreviated)

Made final jump from Ativan in June of 2012, after a far too fast taper suggested by doctor.  Now at 19 months post-jump he feels he's 90% recovered.

 

While in acute w/d he was hospitalized (before we understood what was going on) in July 2012 and was put on 30 mg of remeron. (He had previously been taking 7.5 mg for quite a few years.) He began tapering this around November 2012.  His basic taper method has been 5-10% cuts every 2-4 weeks.  He is now down to 4 mg of remeron. 

Link to comment

Try to think that 4 mg is a small amount and it is not causing much harm (side effects) at that small dose. Only a quick taper can do that now.

2010: Mirtazapine 30mg followed by Zopiclone 7.5 mg for sleep post surgery due to pain.
2012-> Tapering Mirtazapine and Zopiclone at different rates unsuccessfully.
2013: Hospitalized 10 days due to complete Insomnia. Forced back up to 45mg Mirtazapine, 7.5 mg Zopiclone and also Theralene 1 ml.
2013-03: Lab showed Vitamin D deficient. Found the vitamin d and insomnia connection. Supplementing vitamin d. Sleep improved by 1-2 hours
2013-04: Dropped mirtazapine to 30 due to severe side effects. Quit Theralene. Zopiclone 7.5.
2013-05 - 2013-11: Mirtazapine taper monthly 25 20 15 11 8 4 2.5 mg
2013-12 Holding M at 2.5. Need to taper Zopiclone due to daytime nausea and vomiting. Taper zopiclone 1/4 red every 5 d. Last Z 2013-12-19
2013-12-31 M:2.5. Reinstated Zopiclone 3.75 due to Insomnia
2014-01-06 M:2.5. Taper Z 1.9 ... 2014-01-14 M:2.5. Z 1 mg.
Jumped of Zopiclone 01-20. Jumped mirtazapine 02-16.

Theralene: 10mg 02-09. 8mg 03-09. 5mg 03-15. 4mg 03-24. 3mg 04-08. Jumped 04-21.
Zopiclone free for 251 days. Mirtazapine free for 224 days.

Link to comment

Thanks Wulfgar, that's a good thing to keep in mind.  I posted a question on the Tapering section if anyone would like to take a stab at it.  It addresses something we both are trying to understand better. Basically it boils down to "How do you know when you've hit stabilization?"  Do you actually feel good, essentially symptom-free, or just that the misery comes down to a more manageable level? This is something that seems pretty basic and essential in tapering safely, and something we're yet to feel like we've nailed. My always optomistic husband is pretty much convinced he'll never feel good while still on the remeron!  I'm hoping he's wrong but I really don't know.

On a positive note, MrWD seems to leveling out with his symptoms. I won't say "stabilizing" since we're still trying to figure out what that is!  But he's definitely at the very least, en route to stabilization... I think.

Wife of severe benzo w/d survivor, and now dealing with w/d of remeron/mirtazipine.

 

My husbands history (abbreviated)

Made final jump from Ativan in June of 2012, after a far too fast taper suggested by doctor.  Now at 19 months post-jump he feels he's 90% recovered.

 

While in acute w/d he was hospitalized (before we understood what was going on) in July 2012 and was put on 30 mg of remeron. (He had previously been taking 7.5 mg for quite a few years.) He began tapering this around November 2012.  His basic taper method has been 5-10% cuts every 2-4 weeks.  He is now down to 4 mg of remeron. 

Link to comment

For me the most prominent WD symptom is insomnia. Remeron/Mirtazapine lowers cortisol and blocks adrenaline receptors. When I taper i feel the effects of adrenaline and cortisol. Anxiety and insomnia etc.

 

The effects of Mirtazapine during 24 hours between doses differs a lot. For guys almost half of the drug have have been eliminated when we take the next dose. There seems to be very few who tries to take Mirtazapine two times a day so i can not suggest this method. If my problem with insomnia was not so bad i would definitely have tried this though.

 

This is my method for taper (i have problems following it though for the urge to get of is quite strong for me also!) I use a diary to monitor sleep and other symptoms. When sleep/symptoms have stabilized and I've been on the same dose for more than 3-4 weeks its time for next cut. I suggest writing down a number of how the symptoms are between 1-10 where 10 is the worst its ever been. For sleep i estimate between 0-8 on how good my sleep was. I do not measure time durning the night as that can interfere with sleep. So if i know i only slept 3 hours but feel more rested that can make maybe 5 on my scale. If i slept maybe 6 hours total but feel awfully unrested that can be maybe a 3 on my scale. I think a diary is very important! We forget how things where.

 

A good exercise is to try to define what symptoms is because of side effects and what symptoms is withdrawal. (Had lots of side effects on higher doses) There is no correct answers to this but for me at my low dose, i think most symptoms is from the withdrawal process and that i need to go slow for this reason.

2010: Mirtazapine 30mg followed by Zopiclone 7.5 mg for sleep post surgery due to pain.
2012-> Tapering Mirtazapine and Zopiclone at different rates unsuccessfully.
2013: Hospitalized 10 days due to complete Insomnia. Forced back up to 45mg Mirtazapine, 7.5 mg Zopiclone and also Theralene 1 ml.
2013-03: Lab showed Vitamin D deficient. Found the vitamin d and insomnia connection. Supplementing vitamin d. Sleep improved by 1-2 hours
2013-04: Dropped mirtazapine to 30 due to severe side effects. Quit Theralene. Zopiclone 7.5.
2013-05 - 2013-11: Mirtazapine taper monthly 25 20 15 11 8 4 2.5 mg
2013-12 Holding M at 2.5. Need to taper Zopiclone due to daytime nausea and vomiting. Taper zopiclone 1/4 red every 5 d. Last Z 2013-12-19
2013-12-31 M:2.5. Reinstated Zopiclone 3.75 due to Insomnia
2014-01-06 M:2.5. Taper Z 1.9 ... 2014-01-14 M:2.5. Z 1 mg.
Jumped of Zopiclone 01-20. Jumped mirtazapine 02-16.

Theralene: 10mg 02-09. 8mg 03-09. 5mg 03-15. 4mg 03-24. 3mg 04-08. Jumped 04-21.
Zopiclone free for 251 days. Mirtazapine free for 224 days.

Link to comment
  • 3 weeks later...

Thank again everyone.  I'm sorry I don't get to post more often, but please know that I read everything and we appreciate all of the good advice we get here.  And it's so nice to know we're not alone (sort of, but that sounds kind of sadistic at the same time!).

 

Anyway, update:

It has been 44 days since my husbands last cut of .4 mgs - which brings him down to 4 mgs.  Wow, lot of 4's there!  I will mention that this has been his longest hold in a long time. Maybe his longest hold yet.  The first 20 days or so were just hell for him, real acute w/d symptoms, but still managing to go to work on a daily basis and fulfil the daily requirements of life.  That said, it wasn't easy, lots of crying spells, intense panic, tinnitus, his never ending "head symptoms," nausea and cramping, etc.  After that 20 days and right up until now he's hit this very familiar cycle which has been the norm  pretty much since day one of this remeron taper. This is his daily experince, in a nutshell -

 

He wakes up early in the morning (about 5 am) with super intense anxiety, fear, shaking, not feeling like he is going to be able to cope.

By about 7 or 8 am things start to settle down for him.

Around 10 or 11 am, intense dizziness and "heavy head" feeling, somewhat short of breath, depressed, anxious, sometimes seems like food revs him. This continues most of the mid-day until...

About 5 pm or so, he feels pretty much great, fine, happy dad/husband.

Takes his remeron around 7:30 or 8.

Passes out hardcore for the night.

Wash, rinse, repeat.

 

So the questions -

Because this is so cyclical, and daily, is what he's experiencing simply the effect that remeron has on him?

Is it possible that the reason he feels so good by 5 pm is because the remeron is no longer really affecting him by that point? 

Is this stabilitazion for him, even though he still feels so many horrible symptoms first thing in the morning (cortisol mornings?) and mid-day?

Alto, I'd love to hear your opinion as well.

Thank you all!

Wife of severe benzo w/d survivor, and now dealing with w/d of remeron/mirtazipine.

 

My husbands history (abbreviated)

Made final jump from Ativan in June of 2012, after a far too fast taper suggested by doctor.  Now at 19 months post-jump he feels he's 90% recovered.

 

While in acute w/d he was hospitalized (before we understood what was going on) in July 2012 and was put on 30 mg of remeron. (He had previously been taking 7.5 mg for quite a few years.) He began tapering this around November 2012.  His basic taper method has been 5-10% cuts every 2-4 weeks.  He is now down to 4 mg of remeron. 

Link to comment
  • Administrator

I don't know, MrsWD. We have a few people here who are having very odd reactions to mirtazapine and dosage reductions.

 

Why does your husband take his remeron around 7:30 or 8? Does he go to bed then?

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

Link to comment

I don't know, MrsWD. We have a few people here who are having very odd reactions to mirtazapine and dosage reductions.

 

Why does your husband take his remeron around 7:30 or 8? Does he go to bed then?

 

He knows that once he takes it it will knock in out in about an hour or two, so yes, he takes it around 7:30 knowing that he'll be sleeping by 9:30.  We've wondered about the possibility or sensibility of splitting up his dose and taking it twice daily but it scares us to do anything too drastic to his system since he's clearly so incredibly sensitive. Neither of us want to taper too quickly, for certain, but this crazy cycle he experiences does make us wonder if it's the withdrawal or just him having an odd reaction to the drug.

Wife of severe benzo w/d survivor, and now dealing with w/d of remeron/mirtazipine.

 

My husbands history (abbreviated)

Made final jump from Ativan in June of 2012, after a far too fast taper suggested by doctor.  Now at 19 months post-jump he feels he's 90% recovered.

 

While in acute w/d he was hospitalized (before we understood what was going on) in July 2012 and was put on 30 mg of remeron. (He had previously been taking 7.5 mg for quite a few years.) He began tapering this around November 2012.  His basic taper method has been 5-10% cuts every 2-4 weeks.  He is now down to 4 mg of remeron. 

Link to comment
  • Administrator

I'm not sure what's going on. The stability of the pattern suggests it's due to the drug, either adverse effects or withdrawal symptoms.

 

Does he take any other drugs or supplements in the morning?

 

Remeron has a long half-life, which complicates things. A dose taken at 8 p.m. is still in effect, although somewhat diminished, at 8 a.m., though I suppose that with a dose as small as 4mg, it might be metabolized faster.

 

It sounds like your husband is experiencing the early-morning cortisol surge like so many of us. Many of us also find this wears off in mid-morning.

 

The "heavy-head" etc. at 10 or 11 a.m., which would be about 14-15 hours into Remeron's half-life, sounds like symptoms of Remeron depletion, or maybe a reaction to an active metabolite that's been produced as the drug has been metabolized.

 

Your husband's prior benzo withdrawal may have sensitized him to these reactions.

 

Feeling better in the late afternoon is also a familiar pattern for people with withdrawal symptoms.

 

http://www.drugs.com/pro/mirtazapine-tablets.html

Plasma levels are linearly related to dose over a dose range of 15 to 80 mg. The mean elimination half-life of mirtazapine after oral administration ranges from approximately 20 to 40 hours across age and gender subgroups, with females of all ages exhibiting significantly longer elimination half-lives than males (mean half-life of 37 hours for females vs. 26 hours for males). Steady state plasma levels of mirtazapine are attained within 5 days

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

Link to comment

Thank you, Alto. This is very helpful. In the morning he will sometimes take a magnesium, but otherwise, no.  I agree the benzo withdrawal definitely sensitized his already sensitive system.  Do you have any inclination either way as to his next step?  Do you think it's best he keeps holding, or start thinking about going ahead and doing a small cut? 

Wife of severe benzo w/d survivor, and now dealing with w/d of remeron/mirtazipine.

 

My husbands history (abbreviated)

Made final jump from Ativan in June of 2012, after a far too fast taper suggested by doctor.  Now at 19 months post-jump he feels he's 90% recovered.

 

While in acute w/d he was hospitalized (before we understood what was going on) in July 2012 and was put on 30 mg of remeron. (He had previously been taking 7.5 mg for quite a few years.) He began tapering this around November 2012.  His basic taper method has been 5-10% cuts every 2-4 weeks.  He is now down to 4 mg of remeron. 

Link to comment
  • Administrator

I guess so. Maybe a smaller amount will have fewer side effects?

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

Link to comment

That's his hope, that a smaller dose might equal less side effects (or whatever it is he's experincing).  I think we'll start planning for a conservative .2mL  cut in that case.  Thank you again Alto!

Wife of severe benzo w/d survivor, and now dealing with w/d of remeron/mirtazipine.

 

My husbands history (abbreviated)

Made final jump from Ativan in June of 2012, after a far too fast taper suggested by doctor.  Now at 19 months post-jump he feels he's 90% recovered.

 

While in acute w/d he was hospitalized (before we understood what was going on) in July 2012 and was put on 30 mg of remeron. (He had previously been taking 7.5 mg for quite a few years.) He began tapering this around November 2012.  His basic taper method has been 5-10% cuts every 2-4 weeks.  He is now down to 4 mg of remeron. 

Link to comment

Please sign in to comment

You will be able to leave a comment after signing in



Sign In Now
×
×
  • Create New...

Important Information

Terms of Use Privacy Policy