MRothbard: intro

[MRothbard]

Hi Everyone,

 

I've been on and off these drugs for about 7 years. I had almost quit them for good when after taking steroids for an ear infection anxiety returned with a vengeance. This was september 2014. I cut my Lexaprop dose in half about a month ago and seem to be doing fine with it.I'm now taking 10mg of Lexapro and 30mg of Mirtazipine. 

 

About a month ago I was feeling sleepy and unmotivated all the time and started drinking coffee again, and then alcohol in the evening. I also thought I could handle cutting the Mirtazipine in half too. Nope. Anxiety and intrusive thoughts big time.

 

​I've since gone back to my 30 mg dose or Mirt. Quit coffee and alcohol altogether.

 

Eventually I'd like to be off these things but now is probably not the time to start tapering. I'd like to be more stable first. I'm on this forum to get advice on how to do that when the time comes and also to help however I can.

 

Thank you.

[Petunia]

Welcome MRothbard, thank you for posting. You have come to the right place for support with getting off these drugs.

 

Its not a good idea to cut your dose by half. We suggest reducing by no more than 10% of the current dose every 4 weeks, this reduces the risk of withdrawal symptoms arising. Please read through this which will explain why:

  

Why taper by 10% of my dosage?

 

When did you try cutting your mirtazapine in half? How long have you been back on 30mg? How are you feeling now?

 

Here are some topics for tapering your specific drugs, only one at a time though:

 

Tips for tapering off Lexapro (escitalopram)

 

Tips for tapering off Remeron (mirtazapine)

 

I agree that you should wait a while to become stable again before beginning a proper taper.

 

Just so you are aware, there is a potentially harmful interaction between lexapro and mirtazapine:

 

http://www.drugs.com/interactions-check.php?drug_list=1640-0,1013-565

 

Interactions between your selected drugs

mirtazapine ↔ escitalopram

Applies to: mirtazapine, Lexapro (escitalopram)

Using mirtazapine together with escitalopram can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should seek immediate medical attention if you experience these symptoms while taking the medications. Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Why does your doctor have you on 2 antidepressants?

 

Please feel free to write whenever you want, you will find a lot of friendly help and support here.

 

Petunia.

[MRothbard]

Hi Petunia,

 

I'm not experiencing any of the physical serotonin syndrome symptoms. This  combo of Lexapro and Mirtazipine has worked for me in the past so I guess that's why I'm on them now. As far as how I'm feeling–a bit of morning anxiety, but not overwhelming. And some throughout the day. Intrusive thoughts of weird existential worries. But everyday seems to be getting better.

 

Seems with me that I can tolerate stimulants like caffeine for a while and then all of a sudden the anxiety/depression hits me like I've caught a virus. The change happens overnight. Any insight into that?

[Petunia]

You can start having unusual reactions to all neuroactive substances once the nervous system becomes sensitized by withdrawal. From what you have described, it sounds like you are experiencing some withdrawal symptoms. If you are having this reaction to caffeine, it would be better to not use it. Many people find they can no longer tolerate caffeine while in withdrawal, see:

 

Caffeine in coffee or tea: Tolerance issues

 

If I were you, I would not do any more tapering until your current symptoms settle down, also see:

 

What is withdrawal syndrome?

[tgirl]

How are you doing MR,

T

[MRothbard]

Long story short, my prescription ran out more than a week ago so I was kind of forced to not take mirtazipine this entire time. The doctor would not honor refill requests faxed to him. At first I didn't experience any withdrawal symptoms at all, except difficulty getting to sleep. Now some are creeping up on me–anxiety and difficulty staying awake in the morning.

 

I have an appt. with my psych. doc this friday. I'm wondering if I should tough it out and stay off the mirtazipine altogether or maybe reinstate a smaller dose. I'm at 30mg right now.

 

I know everyone is different but on average, do people experience worsening withdrawal systems after having quit the drug for two weeks or so? Or is it worst at the outset?

 

Thank you

[brassmonkey]

Hi MRothbard--  Welcome to the group you found us just in time.  Short answer Don't do it!!!!  A CT off of 30mg of mirt will put you in a world of hurt for a long time.  These drugs are extremely powerful and must be tapered off of slowly to avoid WD syndrome.  We have a large number of members who have CTed or fast tapered Mirt and are really wishing they hadn't.

 

What is withdrawal syndrome?

 

Why taper by 10% of my dosage?

 

Tips for tapering off Remeron (mirtazapine)

 

Thank you for putting your information in a signature block, it really helps us understand what is going on.

[ten0275]

MR, hey.

 

merged this topic w/ your thread. please continue to use this area as the place for personal updates and questions regarding your personal tapering.

 

that said, you should not "stick it out." you should reinstate, re-stabilize, and then taper from there when you are ready. the symptoms that are "creeping up on you" (anxiety and difficulty staying awake in the morning, etc) are often the tip of the iceberg and usually intensify rather than abate.

 

please do not cold turkey this medication.

 

hang in there.

 

dave

[gemini]

I would not reduce by half. I did that with my current drug latuda and I thought I was having an internal avalanche and my system was shutting down, global organs failure!

[MRothbard]

Long story short, my prescription ran out more than a week ago so I was kind of forced to not take mirtazipine this entire time. The doctor would not honor refill requests faxed to him. At first I didn't experience any withdrawal symptoms at all, except difficulty getting to sleep. Now some are creeping up on me–anxiety and difficulty staying awake in the morning.

 

I have an appt. with my psych. doc this friday. I'm wondering if I should tough it out and stay off the mirtazipine altogether or maybe reinstate a smaller dose. I'm at 30mg right now.

 

I know everyone is different but on average, do people experience worsening withdrawal systems after having quit the drug for two weeks or so? Or is it worst at the outset?

 

Thank you

[MRothbard]

OK. I found  couple pills so I think that'll hold me til friday. I feel like a junkie sometimes. I wonder if kicking heroin is any more difficult. Thanks for the advice

[MRothbard]

Doctor finally confirmed a refill . WTF? Really irresponsible.

[tgirl]

Good news! Keep us updated!

Hope you get relief!

Tgirl

[MRothbard]

Doctor was in India, so he couldn't authorize the refill. Symptoms are abating, doctor thinks that must mean I still "need" the drug, I think it was withdrawal symptoms. i don't understand why they a re so resistant to the notion of withdrawal symptoms. 

 

Anyway...

 

Any advice on how long I should be stable before attempting a 10% reduction? Which should go first, the Lexapro or Mirtazipine?

[Altostrata]

Welcome, MRothbard.

 

Very few doctors know anything at all about withdrawal.

 

So you're back on your regular dosing schedule?

 

Do you have any adverse effects from your drugs? Are you taking anything else? Please put ALL the drugs you take in the Drug Interactions Checker http://www.drugs.com/drug_interactions.html and copy and paste the results in this topic.

 

Are you taking mirtazapine for sleep? Why did you start it?

[MRothbard]

I am back on my regular dosing schedule

 

Adverse reactions:  Fatigue, emotionally "blah", 

 

In addition to the Mirt. I am taking 10mg lexapro and Irbesartan (avapro)

 

 

mirtazapine ↔ escitalopram

Applies to:Remeron (mirtazapine) and Lexapro (escitalopram) 

Using mirtazapine together with escitalopram can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death.

 

hydrochlorothiazide ↔ escitalopram

Applies to:Avalide (hydrochlorothiazide/irbesartan) and Lexapro (escitalopram) 

Treatment with escitalopram may occasionally cause blood sodium levels to get too low, a condition known as hyponatremia, and using it with hydrochlorothiazide can increase that risk. You should seek medical attention if you experience nausea, vomiting, headache, lethargy, irritability, difficulty concentrating, memory impairment, confusion, muscle spasm, weakness or unsteadiness, as these may be symptoms of hyponatremia. More severe cases may lead to hallucination, fainting, seizure, coma, and even death. Escitalopram can also affect your blood pressure and heart rate. You may need a dose adjustment or more frequent monitoring of your blood pressure and pulse to safely use both medications.

 

mirtazapine  irbesartan

Applies to: mirtazapine, irbesartan

Irbesartan and mirtazapine may have additive effects in lowering your blood pressure. You may experience headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart rate. These side effectsare most likely to be seen at the beginning of treatment, following a dose increase, or when treatment is restarted after an interruption. Let your doctor know if you develop these symptoms and they do not go away after a few days or they become troublesome.

[Altostrata]

Well, now you know. That combination of drugs is not good for your health.

 

Are you taking mirtazapine for sleep? If so, when did you start having sleep problems?

[MRothbard]

sleep problems = lat september, but the mirtazipine seemed to help with the anxiety and depression as well, both of which Lexapro couldn't get rid of on its own.

[tgirl]

Hey Mr,

 

How are you feeling now? Any improvements?

Tgirl

[MRothbard]

Been awhile. I decided to stay on the anti-d's over the winter. Thanks for asking tgirl. I've decided to start tapering now that winter is over, so we'll see. I'm going to have to give up caffeine and wine so my body and brain don't have to contend with that stuff as well. Wish me luck!

[MRothbard]

Question: Can I smash up the pills into a powder and take a reduced dose that way? Provided I have a reliable scale?

[Fresh]

Hi MRothbard ,  yes you can use scales to weigh out custom doses of both lexapro and mirtazapine.

You can also make your own liquid solution for precision dosing. 

See the link on "How to make Liquid from  Tablets" here  http://survivingantidepressants.org/index.php?/topic/2693-how-to-make-a-liquid-from-tablets-or-capsules/

Basically , if you dissolve one 30mg tablet in 30mls of water , you can draw up the exact amount you want in a syringe - each ml has 1mg of medicine.

 

See the links on tapering lexapro and mirtazapine 

http://survivingantidepressants.org/index.php?/topic/406-tips-for-tapering-off-lexapro-escitalopram/

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

 

Which are you planning to taper first?   We recommend just one at a time , the most activating one first.

 

Best wishes and welcome back ,  Fresh

[MRothbard]

Thanks Fresh. I asked my doctor about crushing and measuring the powder, he said crushing the pills might effect the bioavailability of the active ingredient. So I'm going to try chopping off a bit of the pill and taking the bigger part. Very scientific  .  Tapering off the Mirt first.

[ChessieCat]

Hi MRothbard,

 

Did you read the links that Fresh gave you on making your own liquid from both Mirt and Lex?  The more accurate you can get your dose the better.

[Fresh]

Yup , I started my pristiq taper that way , chopping off a corner.

 

Remember that the tablets have 30mg of mirtazapine , plus lots of buffers and fillers , so they weigh much more than 30mg.

 

Weigh a few tablets and get an average pill weight (pw).

Divide that by 30 to get the weight equivalent to one mg of active ingredient.  

 

See the thread on "Using a Digital Scale to Measure Doses"   here  http://survivingantidepressants.org/index.php?/topic/1596-using-a-digital-scale-to-measure-doses/

 

[MRothbard]

Kinda what I'm doing. I weighed a pill, it actually weighed about 30 milligrams. I shaved off parts of the pill til I got to 27 milligrams. Now I'm using that pill as my standard for cutting the others.

[MRothbard]

So far so goodish. Having anxiety spike in the mid afternoon but nothing I can't deal with. Can you have the windows/wave pattern even with a 10% reduction?

[Fresh]

Yes , you can. These can be triggered by external stressors , or come from apparently nothing.

 

You might want to take daily magnesium around lunch time to see if that helps. Also look for connection

between things like added stimulants (coffee , tea) to see if there are any correlations.

 

Doing things like taking a short walk may also help head off a spike if there;s a daily pattern.

[nz11]

 I weighed a pill, it actually weighed about 30 milligrams.

You might like to double check this weight.

[MRothbard]

Been a long time. I'm down to 10mg Lexapro and 3.75 mg or Remeron (Mirtazipine). I've been taking it really slow, especially now that it's winter. but I think the really slow taper has paid off. I've had very few bad days. I have noticed when I drink I feel utterly demotivated and negative about everything the next day. So note to everybody out there in this process: keep the alcohol to a minimum.

 

But I'd also like to offer some hope. After almost ten years of being off and on this stuff I think I'm looking at finally being off them completely pretty soon. So it is possible, and you can do it too.

 

I also have a question. Is rapid heartbeat a withdrawal symptom? I get these surges throughout the day of a period of about an hour where it's noticeably higher and kind of uncomfortable.

 

Thanks.

[scallywag]

Rapid heartbeat/palpitations can be a symptom of withdrawal.
 
Irregular heartbeats and palpitations.
 

From Alto's post #5

 

Irregular heart beats and palpitations are very common withdrawal symptoms. If your symptom started during or after withdrawal, it is likely a withdrawal symptom and an indication you have tapered too fast. Like other withdrawal symptoms, this goes away with time. Also, walking helps regularize autonomic function and heart rate. Make sure you get at least a half-hour of walking every day, if you can tolerate it. ...

 
Heart palpitations and low blood pressure.

[MRothbard]

thanks scallywag

[MRothbard]

So, who woulda thought quitting a measly 3.75 mg dose would be any big deal?  Yeah, so I guit the Mirt. altogether and having some symptoms. Nothing overwhelming thankfully but they are affecting my outlook on everything I do.

 

At the same time I decided to quite drinking and quit caffeine, and started working out again. Probably too much too soon. I think I'm feeling some withdrawal from the coffee and booze as well.

 

Feel off the wagon yesterday, drank a small coffee at 2:30 pm and then a bunch of wine in the evening, couldn't get to sleep til 3am.

 

I just feel kinda numb and sad. Like there's glass ceiling my emotions keep hitting and can't get past.

 

Anyway, soldiering on, gonna try to stay Mr. Clean for a while. any tips words of support would be super.

 

Thanks, MRothbard

[KarenB]

You might want to take it easy on those work-outs.  Often, they can be activating in a bad way.  Same with alcohol, caffeine...but you already worked that out . 

 

How and when did you stop the mirt?  People often need to go extremely slow at the end of their tapers. 

[MRothbard]

yeah caffeine and workouts = crap feeling the next day. cortisol overload???

 

I was on the 3.75 mg for couple months then quit it altogether about a week ago.

[KarenB]

Yup, both those things stimulate cortisol, and when in w/d it's just too much for our systems to cope with.  Ends up making us feel yuck. 

 

So having basically cold-turkeyed off the mirt, are you thinking of just riding it out?  If it gets worse (and there's a good chance it will), reinstatement would be a good idea.  It can allow you to stabilise, and then you can later taper off more gently.