success ☼ Bayboy: Mirtazapine withdrawal

[Bayboy]

Hi.  I used Mirtazapine to withdraw from clonazepam after 1 year.  I was on it for a total of 2.5 months.  It worked as I successfully tapered off the benzo, however, I am now 22 days into withdrawal and it has been HORRIBLE, improved for a week and now horrible again.  Main symptoms are insomnia, depression and anxiety.  My dose was 30 mg and then down to 15 mg for 7 days and then off.  What a roller coaster, after getting off clonazepam but one night I will sleep 5 hrs, the next 0, the next 9 and than 2 hrs etc.  The symptoms wax and wane with some windows but the windows have been closed since day 19.  Any experience with this medicine and its withdrawals are very much appreciated, I don't want to reinstate but the symptoms are horrendous.  BTW, the withdrawal started on Day 5 as reported by other members.  Will this get better?

 

Bayboy

Edited December 11, 2016 by scallywag
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[dalsaan]

Hi Badboy,

 

I'm on mirtazapine and have been tapering a long time. Your taper was very quick and it sounds like your body isn't coping. I know you don't want to reinstate but I would. There is no telling how long your symptoms could go on for. I lasted 3 months once trying to tough through withdrawals. I had hellish insomnia and I could barely keep my eyes focussed let alone do anything else.

 

You could try a small amount say 5 mg. stabilise on that and then taper more slowly from there

 

Take care

 

Dalsaan

[wulfgar]

Hi,

Dalsaan suggestion is sound. Reinstatement helped me get my sleep back.  Insomnia was my most prominent wd symptom. With to little sleep i think our healing capacity is reduced.

/Wulfgar

[Bayboy]

Thanks for the suggestions,

 

I guess I thought since I have only used it for 2.5 months, it wouldn't be that bad, but it is.  Strange thing is, week 3 (I'm in week 4), things swung around and I was sleeping 6 hrs per night on my own.  But than the insomnia came back.  Was that your experiences as well?

 

Bayboy

[Bayboy]

Also, its awesome to find knowledgable people on here that are supportive, my wife like so many other collateral casualties of this battle is suffering from compassion burnout.  I don't blame her.  I have a question about reinstatement should it come to that, a lot of sources warn that the body could reject this med after 3 weeks off, could you speak to that in your collective experiences to alleviate some fear of reinstating.

 

Bayboy (not Badboy lol)

[mammaP]

Hi Bayboy, we have other members who have only been on mirtazepine for a

short time but had terrible withdrawal after stopping. I agree with Dalsaan that

reinstating might be the best way forward for you. Hold there for a good few weeks

to stabilise before starting to taper slowly. We recommend no more than 10% of the 

current dose.  Here is the topic on reinstating. http://survivingantidepressants.org/index.php?/topic/3079-about-reinstating-and-stabilizing-to-stop-withdrawal-symptoms/

 

And one on tapering mirtazapine .  http://survivingantidepressants.org/index.php?/topic/5301-tips-for-tapering-off-remeron-mirtazapine/?hl=mirtazapine

 

Lastly could you put your drug history in your signature strip for us please? It is a big help to us

when we can see at a glance what you have been taking, doses and when started and stopped or cut.

 

Here is how to do that. http://survivingantidepressants.org/index.php?/topic/893-please-put-your-withdrawal-history-in-your-signature/

[dalsaan]

Withdrawal is not often very linear, we've probably all experienced ups and downs in the way you are describing.

 

Re reactions to reinstating, some people do find they have become hypersensitive to their drugs. In part that's why I recommended a relatively small dose. I also recommended that dose because the sleep effects of mirtazapine are more prevalent at lower doses than higher doses and because you would have less to taper off when the time comes.

 

I have never had difficulties reinstating and I did it a couple of times before I found this site and worked out what was happening to me.

 

I fully understand your hesitation to reinstate. We've all been there. Listen to your body. If your nervous system is struggling it's well worth considering. None of us like being on these drugs and we wouldn't recommend this course of action if we had a better alternative.

 

Dalsaan

[acetyl]

Jeez, this has me worried with the rapid taper I want to do to try getting off it after 3 weeks.

[arwen]

My only experience was with Paxil, but I suppose the idea is the same. Even if initially I tapered slowly, I hurried at the very end. After a couple of months I developed a bad withdrawal, and I had to reinstate the tiny quantity, because my life was unbearable. Now I feel better. I still have a lot of issues, I don't really know what the future will bring, I am not yet a "success story", but there is a huge difference, I am normal again. There is no shame in reinstating, please try, and then taper much slower! You can reinstate at a lower dose, just try and see. Just be careful, the antidepressants don't start their effect immediatly, even after withdrawal and reinstall. For me it started working again after around one week, but it can be longer.

[Bayboy]

Thanks arwen and others, I am learning so much already, I started going to a naturopath back when i was still on the benzo and was given all sorts of herbal remedies, none of which even touch the withdrawal.  I think they might even make it worse.  Milky oat seed, passionflower and skullcap.  The only one that kind of works is melatonin but its so hit or miss.  At max, I got 4 hours out of the melatonin.  Any thoughts to these supplements or suggestions for others to ease symptoms.

[Petunia]

Hi Bayboy,

Many people find that magnesium and fish oil are helpful.  Apart from this, there seem to be mixed reactions with other supplements.  When the nervous system is unbalanced due to withdrawal, even supplements can have adverse effects, so if you do try something, please start with a very small amount and see how you do.

 

Have a look at our section on self care, especially the pinned posts at the top.

 

http://survivingantidepressants.org/index.php?/forum/8-symptoms-and-self-care/

 

Petu.

[wulfgar]

I have not actually reinstated but i had to up my dose because of terrible wd:s several times and upping my dose has always helped my insomnia. Reinstatement of mirtazapine low dose, in almost all the user stories I've read has worked quite well.

And Yes, my wd insomnia has had a cyclic pattern for each taper and also now that I'm of. For me i have a bad wave one week after reduction and then after 3-4 weeks. When i tapered to fast the 3-4 week insomnia did not let go.

[Bayboy]

Wulgar,

 

This last time and it WILL be the last time, when did your 3-4 week insomnia let go?  How long did it last?

[wulfgar]

Bayboy,

 

You can ask as many questions as you like! I am very happy if i can give anything back for all the good I've got here. For me 3-4 weeks after each taper had usually been the worst. Then slowly/gradually better but it takes months for me. When i tapered to fast the first time though i ended up hospitalized because of insomnia, so my wd insomnia did not let go that time. Please understand that we are all a bit different though. My pattern might not apply. I have all my adult life had a hard time getting to sleep so wd insomnia from mirtazapine had been extremely hard. Insomnia is tricky. It "feeds" from so many things.  When we have insomnia for a long time i think the body unlearn how to sleep. So, insomnia can maintain itself i believe. Thats also one reason behind me suggesting a reinstatement. Reinstatement, regaining sleep, and a careful taper can probably/possibly get you feeling better sooner than toughing it out.

 

if you don't have liquid mirtazapine, i have found that many brands can be cut into halves, quarters and even 1/8:s with a good knife on a wooden cutting board. So reinstating at 7.5 would be easy. There is a topic on this bbs making liquid mirtazapine also.

[Bayboy]

Thanks again,

 

Day 23 - I used Benadryl last night, 50 mg, and got 7 hrs so I feel pretty good today, have had a mild window all morning…I would reinstate if I didn't get any relief for sure, but I seem to now and then which is why I push through, I am not that stubborn.  This is why I'm interested in timelines.  Isn't it strange how docs don't believe in withdrawal lasting this long, yet, everyone who has experienced this, gets hit hard with the second wave, sometimes the waves break and sometimes they don't.  The first bad wave (week 2) lasted 6-7 days and then lifted, as I stated earlier, I thought i had won, only to get smashed around the 3 week off mark.  This is day 4 of the second wave and so far, today is better than the last 3 but I don't get too optimistic anymore but try to go with the flow.  Keep pushing through brother.

[Rhiannon]

Also, its awesome to find knowledgable people on here that are supportive, my wife like so many other collateral casualties of this battle is suffering from compassion burnout.  I don't blame her.  I have a question about reinstatement should it come to that, a lot of sources warn that the body could reject this med after 3 weeks off, could you speak to that in your collective experiences to alleviate some fear of reinstating.

 

Bayboy (not Badboy lol)

 

We find that often when people have been off the drug for a while and gone through some withdrawal, they're too sensitized to it to reinstate at a full dose. Your brain has reshaped its chemistry around the drug, like a plant growing on a trellis, and when the drug is yanked away that creates a certain amount of biochemical chaos. Your brain is still recovering from the trauma of benzo withdrawal as well and trying to rebuild itself from that as well. So yanking drugs out and shoving drugs back in can lead to results similar to what you'd see with a plant and a trellis--not smooth recovery.

 

What we find most typically is that people in your situation do better with a partial reinstatement, to give the brain some support. There seems to be a huge difference between "some" (even a little) and "none" in withdrawal.  Generally a small reinstatement produces improvement in symptoms at first, but there are still some wobbly times for a while, with some withdrawal symptoms (not as bad as they would have been) which eventually stabilize.

 

I would guess that in your situation a reinstatement of about 5-10 mg would be a good place to start. If the smaller reinstatement doesn't cause worsening symptoms within 4-5 days you could increase by up to another 5 mg or so. I wouldn't go higher than 15 total at this point, but 15 should be okay if you don't have a bad reaction initially with the smaller dose.

 

It's always impossible to say for sure, particularly in your case, where the CT (more or less, what you did was pretty much a CT) is complicated by benzo withdrawal. Still, I think a small reinstatement at this point is safer than not reinstating at all.

[Bayboy]

Update,

 

Day 25 - Have not reinstated yet, re: I keep having temporary windows where my brain tells me to keep going.  Sleep has been inconsistent but with or without benadryl/ melatonin, I average about 5-6 hrs.  Its the anxiety/Dep that is the toughest.  The waves are rough, adrenalin surges, negative thinking….I've also had eye floaters since I started to wean benzo and begin Mirt.  They are still here and get worse under times of stress.  Here's what I need to know, for those who (Wulfgar?) who made it past the second wave several times, how many days did it last?  I know everyone is different but I'm looking for a frame of reference, were there any windows during those waves or horrible everyday.  For Dalsaan who lasted 3 months, were you toughing it out everyday or were there breaks that allowed you to keep going?

[cymbaltawithdrawal5600]

Almost everyone here does better with a partial reinstatement and a slow taper from that as several members have recommended. If you prefer to 'tough it out' no one can predict how things will go for you down the road nor give any frame of reference on how long it will take for you to feel better. You could read the Symptoms and Self Care forum to see what helps. I went cold turkey Nov 2012, found this forum too late to reinstate and still suffering from insomnia and depression. Who knows how long before I feel recovered. I don't think you want that for yourself.

[Altostrata]

Welcome, Bayboy.

 

There is no real pattern or way to predict how long you might have these symptoms. It could be months or years.

 

That you are still suffering fairly serious withdrawal symptoms a month later is an indication you are not going to be one of those who recover quickly.

 

Please consider reinstating a small dose as soon as possible.

[dalsaan]

I toughed it out everyday in regard to debilitating insomnia. The other symptoms waxed and waned. Insomnia is always my key indicator and it has always been the symptom that has made me reconsider where I am at. Not sleeping has multiple consequences - it's exhausting, it risks or exacerbates emotional distress, and it limits healing. Sleep deprivation I also has significant health consequences regardless of its source.

 

I understand your reluctance but I absolutely wholeheartedly believe that toughing it out isn't the way to go. Please listen to what we are saying.

[Bayboy]

Thank you all....I will update soon

[Altostrata]

Miami1, I moved your post to your topic http://survivingantidepressants.org/index.php?/topic/6124-miami1-stabilizing-on-mirtazapine/

 

It will get more attention there. That is your topic for discussing your situation.

[Bayboy]

Well...threshold has been reached, depersonalization has set in and Dep is in full effect, will reinstate at 7.5 and let you know. I can go no further. I hope it provides relief, thanks for your support

[dalsaan]

Hi Badboy

 

You'll need to give it a week or so before evaluating how effective it's been.

 

Dalsaan

[Bayboy]

Hi all,  after only one night of reinstating at 7.5mg, here's what I've noticed, no Dep or depersonalization this morning, anxiety greatly reduced, no sadness and much more hopeful, it felt like a normal spring day.  I am not 100% but feeling much better and that is after only ONE dose!!!  Of course, you were all right and it was definitely WD and for that I thank you immensely.  I was "toughing out" because I thought perhaps 3-4 weeks was the worst, but it would not let up and was getting worse.  I was simply, not-functioning and that is no way to live.  The obvious only way forward is EXTREMELY slow as you have all mentioned.  So, hopefully I will stabilize at 7.5 and hopefully not have to return to 15 mg.  It seems like liquid titration is the way forward, someone suggested returning to 15 mg first, just wondering why and how to tell if that is necessary.  Again, thank you for being supportive and not jumping all over me when I was being a stubborn mule.  My hats off to anyone who could tough through that crap.  FYI, I have been off benzos now for about 50-60 days, and there is no way I'm using those to get by, they were horrible to come off of, took me 3 attempts.  It was only REMERON that helped so I can't hate it too much.  I will stay in touch but returning for tips and advice as I withdraw.  You guys are a credit to anyone struggling through this

 

Bayboy

[cymbaltawithdrawal5600]

If over the coming days you seem to get more stable you may not have to go back to the full dose. Maybe slight increases but it is recommended that you try a dose for at least 4 days or longer to see how it goes. And take your dose at the same time each day. Some members use a spreadsheet to make note of their daily symptom pattern because our memories are so unreliable in withdrawal. A simple diary will do. Most members really don't do well trying to tough it out, especially if they go past the time when reinstatement might not work. I got here too late to reinstate so I have to tough out whatever comes. A slow taper seems to give the best results.

[wulfgar]

Great news! Just stay put and be gentle with yourself. For me stress or high intensity training was bad when tapering. Might try to stay away from those!

 

Good luck to you!

Wulfgar

[Karma]

We find that after removing the drug rapidly from the system that the central nervous system may become a bit hypersensitive.  Due to the hypersensitivity of the central nervous system, if you reinstate too much of the drug (depending on the drug) it can be too activating and may actually make symptoms worse.

 

This is why we recommend reinstating at a lower dose.  With the heightened sensitivity, we frequently find that reinstating a lesser amount is sufficient to minimize the withdrawals and allow a person to stabilize.  After that you need to listen to your body and understand your own symptoms to discover whether a little more of the drug will be helpful.  You can always post your symptoms here to get guidance on your options.

 

Here is a thread that discusses logging your symptoms and rating them in order to tell whether you are improving, staying the same or declining: http://survivingantidepressants.org/index.php?/topic/1779-rate-symptoms-daily-to-catch-withdrawal-early/

 

Karma

 

 

[dalsaan]

That's great news I'm very glad things have taken a turn for the better for you

[Bayboy]

Thanks Dalsaan.  Would anyone know if combining 5htp with low dose of these meds is too much of a risk.  I understand the risks for serotonin syndrome when combined with SSRI/SNRI's or equivalents, but what if the dose is really low, i.e. when tapering.  I'm sure there is some science behind this and I have reviewed the thread on it, but has anyone attempted this.  I assume Serotonin is low during tapering and withdrawal but due to the receptors being down-regulated, perhaps the neurotransmitter isn't low at all, its just the receptors that are not working properly.  Did I answer my own question?

[dalsaan]

I think you have answered your own question.

[wulfgar]

Serotonin syndrome is highly unlikely. Feeling worse, quite possibly.

 

This is my take on Mirtazapines effect on serotonin (mirtazapine affects many different things):

Mirtazapine antagonizes serotonin receptors which causes the effect of serotonin to be lowered. This is the opposite of the more common SSRI:s which causes more availability of serotonin.

On the premise that the brain adapts to changes of serotonin due to medication, the brain will uppregulate the receptors when on mirtazapine and downregulate when on SSRI. When tapering the dysregulation comes into play. Nither up or downregulation is good and will cause you to feel bad when tapering.

When tapering mirtazapine and adding 5-htp (and it realy does increase serotonin) i think you run the chance of increasing the effect of serotonin further on upregulated receptors. This is in the direction of serotonin syndrom but i think the effect of 5-htp is not enough.

 

I personaly would be careful in trying to tweak any brain chemistry when stabilizing. That would be doing the opposite.

[Bayboy]

Thanks Wulfgar, that makes sense.....unnerving but it is what it is. I hope that the neuroplasticity of the brain corrects this mess.

[Bayboy]

Wulfgar,

I think you can relate to this.  Much like yourself, I have been very active my entire life, playing all sports both individual and team.  We need the endorphin release but there is a fine line that one cannot cross while in withdrawal or tapering.  I experienced this for the first time in the past month when trying to play hockey.  Was flying for the first 20 minutes and than all of sudden, wanted to be anywhere but at the rink, was in pain both mentally and physically.  So I left, which confused my friends because that is so unlike me and could not settle down for rest of day.  I know you mentioned stay away from HIT training but as you passed monthly hurdles when tapering, did your ability to exercise return at all?.  I don't want to abstain because exercise is so beneficial.

[wulfgar]

I had no letup from exercise intolerance during my entire taper, sorry to say. The intolerance changed intensity though. The feeling i got when pushing to hard was absolutely awful. Like being poisoned. I was so bad for a while due to to fast taper that i could not even walk round the block without puking. Im beginning to feel my body starting to function again now that I'm a few months of. Condition wise I'm a train wreck right now though.

 

I have started to run a bit and do light strength training. I do feel that i probably could push myself much harder than that now without getting nauseous and fatigued, but my sleep is worse on my run days so I'm going to go slow so not to upset any equilibrium and end up in wave/withdrawal or such again. This is very frustrating!!! I so long for racking up 150k+ on the bar and squat till till the endorphins pour out my ears. Don't se that happening anytime soon though. I get shivers/longing just writing about the post exercise endorphins/kick.

[Bayboy]

Thanks, didn't mean to stir up any negative emotions....you will hit the iron heavy again someday, your resilience and mental fortitude are apparent in your posts. Sometimes starting out again and watching your fitness and strength level increase even in small increments is very satisfying. Keep fighting, it will come.