Abriton: Help with tapering tiny doses of mirtazapine

[Abriton]

Hallo all

This is my first post as a member. I have been reading the site for some months. I had a small hip surgery in February this year - 2014,
After the surgery they gave me Remeron they said to help me sleep. They did not tell me it was an anti depressant. I would have refused it! When I got home after 5 days, I took it for a couple of weeks, and then researched it. When I found out it was addictive I saw a wonderful local psychiatrist here in Portland,OR, who deals with this. He talked to me about tapering and ordered a liquid compound 1mg/1ml. I started the taper at 7mg and probably went too fast as I got down to zero and had a day of awful withdrawal. Thanks to this site, I went back to 1mg, and started tapering in ml with a tiny syringe from the pharmacy. I am now down to 8ml and have been going down 10% every 2 weeks. I think I should wait 4 weeks in between drops. The next drop will be to 7.2 ml.

I had a lot of waking in the night and am now sleeping about 5 hours, but waking about 3/4 am. I have heart pounding when I lie down and when I wake up, but I have 10mg propanolol as needed. I am eating well. I have started Natural Calm magnesium citrate for sleep and the heart pounding and I think it is helping. I never took medication before all this happened and was normally very well. I am 74, female.

Can one have some withdrawal symptoms while tapering?

Any advice and suggestions for the rest of the taper would be appreciated. Should I go right down to 1ml and hold? Also any advice on natural supplements to help with symptoms. I am going to see one of the top Chinese doctors here today to see if he can help.

Thanks so much
 

Edited June 23, 2014 by Altostrata
deleted extraneous lines

[Rhiannon]

Hi there fellow PNW person!

 

First: I am very confused about your doses. Please be careful and make it clear to us how much you are taking. You say you are taking 1 mg in 1 mL but you are tapering down from 1 mg but you are taking 7.2 mL. That is not possible.  If you are taking 1 mg in 1 mL and you are taking 7.2 mL then you are taking 7.2 mg. Please help us get this clear, because we can't give you advice about dosing if we don't know what you are actually taking.

 

So please find out for sure:

1. What your dilution factor is (are you still taking 1 mg in 1 mL or is it something else now?)

2. How much you are taking in milligrams (mg), and be careful with those decimal places (did you mean that you are taking 0.72 mL, which would be 0.72 mg, which would work if you're tapering down from 1 mg).

 

Second, yes, you can be having symptoms while tapering. That means you're tapering too fast and it's time to stop and hold. You might also need to adjust your dosage back up a bit if you have cut it down too fast. People often get good results by stopping and just staying where they are, but it can take a while to really get settled down and feel well again. Don't expect results overnight or even in one week, it may take a few weeks or a month or two.

 

Unfortunately we haven't found that alternative doctors know any more about psych drug withdrawal than conventional doctors do, and often adding in supplements just makes things worse, so be cautious.

 

I'd say, stop tapering now for a while.  Get clear about what dose you're taking (in milligrams) and help us understand clearly, so we can advise you about cuts.

 

And take a look at the charts here (starting on page 4): http://survivingantidepressants.org/index.php?/topic/6036-why-taper-paper-demonstrates-importance-of-gradual-change-in-plasma-concentration/

 

These show you why you need to taper especially slowly at the end of a taper. 

[Altostrata]

Welcome, A. (Is that your real name?)

 

If you're having difficulty right now, if I were you, I'd stop tapering and hold for a good while, maybe a month or two, to let your nervous system settle down.

 

Yes, how much are your taking now?

 

What did your psychiatrist say when you had withdrawal symptoms?

[Abriton]

Thank for the replies. Yes, I am taking 0.8 ml now, and am holding for a few weeks. Next drop would be 0.72 ml. My pharmacist confirmed that 1ml equals 1mg, so I am using a 1ml syringe which he gave me. I also found out that a good compounding pharmacy can compound the original pill form medication into capsule form in any strength. They are giving me 0.8 mg to take on the plane when I go on a short trip.

 

As I am English, my screen name is A briton!! The psychiatrist did not comment but agreed with my plan. He is really great, and in Portland, OR. He founded Hazelden which has a stellar reputation and now has his own practice, if anyone is in the area, I can tell you.

 

I am so grateful for this site as I would not have known what to do. Do you think that these tiny drops to the end are good?

 

Thanks

[Rhiannon]

 

And take a look at the charts here (starting on page 4): http://survivingantidepressants.org/index.php?/topic/6036-why-taper-paper-demonstrates-importance-of-gradual-change-in-plasma-concentration/

 

These show you why you need to taper especially slowly at the end of a taper. 

[Abriton]

http://www.chinesemedicinetimes.com/section.php/75/1/tcm_in_the_treatment_of_ssri_withdrawal_syndrome

 

This article may be of interest. I have purchased the Bupleurum Dragonbone pills by Plum Flower, readily available online, and intend to use them as documented in the case here, as soon as I taper completely.

 

Of course I will report, but it may not be for a while.

[Altostrata]

If you can recommend that psychiatrist for tapering off drugs, we would appreciate your adding his contact information here http://tinyurl.com/7cp8l8v

[Abriton]

I need help please. I have losartan BP medication which I was put on a year ago after a cortisone shot caused huge spikes. Been OK but now am having BP spikes just after I go to sleep which wake me up. It is terrifying, and I have a headache and nausea with them. I have been sitting up most nights and not sleeping although tired as I am afraid of how high they will go if I am asleep. I will see my BP doctor and she said to increase the med till then, but it makes no difference. I have stopped all supplements in case it is that, and stopped a protein shake that has sucralose as I found out it can cause this. Otherwise I have a great, clean diet, no caffeine, alcohol, grains, salt or sugar. I follow low carb, fish and vegetables.

 

My question is do you think it is the mirtazapine taper? I am presently holding at 0.8ml of the liquid, having gone down very slowly at 10% from 1mg. I don't want to attribute everything to that. I take it in the evening about 9pm. Is there a case for taking it during the day? I will continue to hold and do not want to go back up! I am afraid of a stroke!

 

Thanks all

[Abriton]

PS to my above post. I am having a rough time. I am very worried about blood pressure and am not able to sleep. Sat up all night as it gets worse if I lay down and sleep. I feel it is withdrawal, although I have been at 0.8ml for two weeks. Shall I go up? If so how much? If I do not go up. Will I adjust if stay at 0.8?

 

Why does one get withdrawal after holding for 2 weeks? Even if I could bear the withdrawal, the blood pressure spikes are frightening me.

 

Any advice would be appreciated.

 

Thanks

[Altostrata]

When did you resume taking 1mg mirtazapine? Did you ever have this reaction to the drug before? When did the blood pressure spikes start?

 

At what time do the blood pressure spikes occur relative to when you take mirtazapine?

 

You may be interested in wilma's recent symptoms http://survivingantidepressants.org/index.php?/topic/6604-wilma78-mirtazapine-abrupt-withdrawal-due-health-problems/

[Abriton]

I tapered down from 7mg, with the liquid 2/3 months ago, too fast, and had a bad day of withdrawal at zero, so the next day went to 1mg and have been holding and going down 10% since. Spikes occur about 3/4 hours after taking.

 

The blood pressure problem started over a year ago, after a cortisone shot. That is when I went on the BP med. It has been good up to recently. It may not be anything to do with the taper of course.

 

Thanks

[Altostrata]

It may be because your system was sensitized by your drug reactions and withdrawal.

 

Do you take losartan at the same time you take mirtazapine?

[Abriton]

PS. This BP reaction is only recent. I did not have it before, in fact my BP has stayed low for a long time. The only thing I can think of is that I had a new prescription by a different lab, that I have not had before. I have ordered a refill of another lab, and will see if that makes a difference, although they should all the same!

 

Have you heard of mirtazapine doing this? I am only on 0.8ml.

[Abriton]

I just saw your last post above. Yes I take it around the same time as the mirtaziapine. Is there any value in taking the mirtazapine much earlier in the day? It is not as though it is helping me to sleep! I am sure I am sensitized. I am, in any event, very sensitive to all medication.

[Altostrata]

My guess is you are having a paradoxical reaction (blood pressure spikes) because your blood pressure is being reduced too low by the combination of drugs.

 

One way to find out which is causing the blood pressure spikes is to separate the time you take the 2 drugs. For example, take losartan 2 hours before taking mirtazapine. Keep a record on paper of your reactions.

 

http://www.drugs.com/interactions-check.php?drug_list=1489-0,1640-0&types[]=major&types[]=minor&types[]=moderate&types[]=food&professional=1

 

 

Interactions between your selected drugs

losartan ↔ mirtazapine

Applies to: losartan, mirtazapine

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution is advised during coadministration of these agents. Close monitoring for development of hypotension is recommended. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

 

[Abriton]

Thanks so much. I am very grateful to you and this site.

[Abriton]

Altostrata, thank you so much I moved the mirtazapine 8ml to 7pm. BP much better, and sleep. I will move it up an hour a day till I get it to midday. This would seem sensible since it is contributing to insomnia. Slept 9 hours last night! Mind you I have many days to catch up! I stopped the Berberine yesterday too (aka goldenseal). I do have my blood sugar under control with diet and although the herb helped, maybe I do not need it now. My blood sugar and pressure was never high till after the one cortisone shot. That is one evil medication! The cause of all my problems. There is a site called Kenalogneveragain with many informative postings. There is a lawsuit or two against Kenalog. It seems it can crystallize in the body for a very long time. Folks who have multiple shots, report terrible after effects! There seems to be no remedies either.

[Altostrata]

It was a drug conflict then. Doctors are supposed to watch out for this, but don't.

 

Good to hear you're feeling better.

[Petunia]

Hi Abriton,

I'm glad that Alto was able to help you sort this out and you are now feeling better. 

 

Please would you put your drug and tapering history in your signature, it helps people understand your context when they read your posts.  Your signature appears under all your posts. Here is how you do it:

 

http://survivingantidepressants.org/index.php?/topic/893-please-put-your-withdrawal-history-in-your-signature/

 

Petu.

[tgirl]

How are you doing?

[Abriton]

Hallo Silver Star and all

 

Thanks for asking. I have been completely off Remeron medication since August. I owe it all to this site and followed all tapering instructions with the help of a psych doctor and a liquid compound. It took me 6 months in all, and I was only on Remeron for 3 weeks after it was given to me in hospital!

 

I had some residual rebound insomnia and palpitations, but now, after 3 months am sleeping well and palps are slight. I want to let everyone know about EMDR therapy. It has helped me so much to deal with these residual symptoms.

 

I am eternally grateful to everyone in this wonderful site. I count myself lucky that my dependence was short and not too severe, and I did not fall into the trap of taking more meds. I take Natural Calm magnesium powder stirred into hot water at bedtime, multi vitamin and D3.

 

Love and support to all

[Abriton]

PS to my post. Sorry I see that your name is tgirl! I don't know the site that well! Still, Silver Star would be a nice name too!!

[tgirl]

A,

That is great!

It's also promising!

Please continue to let us know how you are getting on.

[Rhiannon]

Abriton, would you mind telling me the name of the psychiatrist in Portland who helped you taper? I may need his help someday myself.

[tgirl]

A,

Can you tell me how long the compound pharmacy liquid lasted you?

[Altostrata]

Very good to hear, Abriton. If you can recommend that doctor, please add his or her contact information to this topic http://tinyurl.com/7cp8l8v

[Abriton]

Hallo all

 

I was only on Mirtazapine for a few weeks after being given it in hospital for sleep after surgery. Did not know about the addictive properties I am very sensitive and never normally take medications. Thanks to this site I was able to taper with a liquid compound over 5 months, finishing 4 months ago, with no withdrawal at all. Great! However, I had rebound insomnia, waking all through the night for some time. I always slept well. Now, I go to sleep immediately, and wake up at either 3.30 or 4 if I am lucky, every night. Can anyone tell me if this is a normal effect after tapering, and how long it might go on?

 

I have tried ALL the usual natural remedies to no avail. Health and diet is good otherwise. I do not do caffeine or alcohol. Will I ever be able to sleep longer like I used to?

 

Thanks

[dalsaan]

Hi Abitron

 

Sleep has always been a key issue for me through my taper. I think remeron disturbs your sleep architecture at the same time as it provides a sleep crutch. Take the later away and you are left with the former.

 

I have had my best sleep when taking a combination of magnesium and taurine. On their own the don't seem to do too much, together they help me get a deeper sleep. I still wake up but I am more refreshed in the morning

 

If you haven't already, you might give that combination a go

 

Dalsaan

[Altostrata]

Abriton, please help us out and put your withdrawal history in your signature; see these instructions Please put your drug and withdrawal history in your signature
 

It could take some time for your nervous system to settle down. See Tips to help sleep -- so many of us have withdrawal insomnia

[Light]

Hallo all

 

I was only on Mirtazapine for a few weeks after being given it in hospital for sleep after surgery. Did not know about the addictive properties I am very sensitive and never normally take medications. Thanks to this site I was able to taper with a liquid compound over 5 months, finishing 4 months ago, with no withdrawal at all. Great! However, I had rebound insomnia, waking all through the night for some time. I always slept well. Now, I go to sleep immediately, and wake up at either 3.30 or 4 if I am lucky, every night. Can anyone tell me if this is a normal effect after tapering, and how long it might go on?

 

I have tried ALL the usual natural remedies to no avail. Health and diet is good otherwise. I do not do caffeine or alcohol. Will I ever be able to sleep longer like I used to?

 

Thanks

 

I had severe insomnia from Remeron withdrawal years ago. I worked itself out over a few months but I had been on it for 5 years as well as a cocktail of other meds. 

[compsports]

Hi Abitron

 

Sleep has always been a key issue for me through my taper. I think remeron disturbs your sleep architecture at the same time as it provides a sleep crutch. Take the later away and you are left with the former.

 

I have had my best sleep when taking a combination of magnesium and taurine. On their own the don't seem to do too much, together they help me get a deeper sleep. I still wake up but I am more refreshed in the morning

 

If you haven't already, you might give that combination a go

 

Dalsaan

Dalsaan,

 

I was thinking of trying the magnesium and taurine combination.   Any particular brands you recommend?  I have mag glycinate but it seems activating on its own.   So that is why I was asking.

 

It is pretty clear to me that until I see the ENT in January regarding nasal obstruction issues that I won't be sleeping on the machine without some type of help.  Obviously, I don't want take the Temazepam except for rare occasions.

 

Thanks!

 

CS

[dalsaan]

Hi

 

I use magnesium complete from Cabot health and 1000 mg of taurine. The mag supp has all the different types of mag so seems to do the trick. It only works if I take them together. Sometimes it poops out and I have to take a break from it

 

CS, I would take a sleeping tablet if I was desperate and they worked for me. But I would be very very careful with them

 

D

[cymbaltawithdrawal5600]

Hi

 

I use magnesium complete from Cabot health

 

I happened to go searching for this because I wanted to see what types of mag salts were included. Many people here prefer one over the other and long ago my research on mag found that the 'aspartate' formulation was the best absorbed. I am betting that individual results with this supplement nearly all of us use and recommend has to do with the type taken. Maybe that is why some people have erratic results when they try to use it and why I had to reduce my glycinate formulation because it made my body feel 'bad'.

 

So I found this video by Dr. Sandra Cabot from her website's shop 'The Liver Doctor' informative (and I hope it is not BS):

 

[compsports]

Interesting CW as I feel that even on practically microdoses of mag glycinate that I don't react well to it.   And many folks swear by it.

 

Anyway, I found some promising machine settings that I used for a nap this morning.   When I woke up, I had alot of energy to accomplish tasks which never happened with previous naps.   So to avoid confounding the issues, I am going to avoid taking any supplements for sleep or start the insomnia program I mentioned in another thread to see how this works for sleep.

 

Stay tuned.

 

CS

[cymbaltawithdrawal5600]

I had started out with citrate (the one I took much higher doses of) and then switched to glycinate because that one was recommended by Alto. Anything other than the 'stearate' salt has to be purchased at a health food store locally (or online) because places like cvs or grocery stores only carry the cheapest kind (cheaper meaning that it is less costly to formulate).

 

I had no idea that there was anything to there being differences amongst the formulations being something to think about overall. Apparently Dr. Cabot thinks so but like I said, I don't know if it is bs (for clever marketing purposes) or based on actual scientific studies that including 5 different types in a low milligram dose tablet (hers is 100mg per) is a great idea.

 

Dalsaan is happy, it might be worth checking out. I know I still need some and I might try adding some taurine because I still don't feel I am sleeping well. I wake a lot.

 

And come to think of it (would require a search) I think Alto said she takes straight glycine if she wakes during the night.

[compsports]

Sorry you're not sleeping well CW.   Good luck with the taurine.

 

In the past, I have tried taking straight glycine to get back to sleep but it never really helped.

 

I am just trying not to add too many variables to the equation which I have definitely been guilty of doing big time in the past.    That is why I really need to hold off on the supplements for now.   Of course, I could write tomorrow and say, OMG, what a horrible night, I want my magnesium now:)  Hopefully, that won't be the case.

 

CS