how can i help Mum, am worried sick

Hi Lori,

I'm really sorry to hear of your mum's suffering.

I'm concerned about her symptoms. Has she been referred to or seen a gastroenterologist recently? Her symptoms may well be nothing serious but I don't think mirtazapine would cause them.

Diarreah yes but passing blood clots and loss of appetite are worrying. I'm not a doctor but I think she needs a colonoscopy done if it's red blood. If it's dark/black then the bleed is higher up and may need an endoscopy.

Everyone reacts differently when coming off, some have little to no withdrawals and some like myself have many. I had stomach spasms, anxiety and diarreah but I never passed blood and my appetite was ok.

It would be recommended to reduce slowly and gradually. Coming off the could take 6-12 months. Whilst it may seem like an evil drug mirtazapine does and can help many people. It just doesn't agree with everyone.

Considering it's your mother, then with her age, I really think it's best she gets examined. It may be nothing serious but best to get checked out. The mirtazapine alone shouldn't be causing loss of blood and it also increases appetite

I think Paul's reply is excellent and I can add very little except to say she must not delay in getting advice on the bleeding even if it means going to a&e over the w/e. But the docs advice on mirt withdrawal in going from 30mg to zero seems crazy knowing the problems so many people on this forum have had in dropping quickly. Like Paul and others I'm on a slow taper taking many many months - it's the only way for me. If it were me I would re-instate 30mg this evening and review the situation tomorrow morning being prepared to go to a&e or if feeling a bit better see a gp on Monday without fail

I must say I am surprised the GP is not taking the gastrointestinal symptoms more seriously, chronic diarrhoea with fresh blood and clots needs further investigation and your mother needs to go back and tell him/her she wants some tests - scans or colonoscopy.i do hope she can get the help she needs, if only to set her mind at rest. She must be so worried, on top of the original anxiety.

Hi Lori,

Am sorry to hear what a tough time your mum has been having, it sounds really awful.

I'm afraid I don't know anything about the bleeding, but it sounds like if she had it while on the tablets and also since stopping then it's unlikely this is a side-effect of the medication? Like you say her GP really needs to investigate further if it persists. Having said that I think stomach related issues are a common problem with Mirtazepine though.

I'm not an expert but from my own experience with withdrawal, I suspect the taper was too fast. I tapered slowly and still had terrible withdrawal including anxiety, insomnia, profuse sweating, nausea, heartburn, lack of appetite, stomach pains, aching, and shivering. The worst symptoms lasted about two weeks and I would say it was around six weeks before I felt back to normal. From the research I did at the time I think it is quite common for people to feel awful, and start to worry about something more sinister going on. Just know that it will pass.

It seems a lot of GPs just don't appreciate how severe the symptoms of withdrawal can be with this drug. I had no warnings that I might have any physical symptoms, but was as least told that it needed to be stopped slowly.

I hope your mum starts to feel better very soon, and that this all is proven to be a side effect of the drug/stopping the drug. Try not to worry, as hard as it is!

Tell her to ring 111 and decribe her symptoms i dont believe the mitraz has caused the bleeding an clots bit it does warrent further investigation 111 can arrange for an appt to b seen at a and e by a duty go tell her to ring now

I echo what others have said. Your mum should have been put into the fast track system to be seen within 2 weeks with those symptoms. Please insist that she is. Her GP sounds like a total incompetent.

Hi Lozzie

There are a couple of points that stand out to me.

The higher dose can exacerbate anxiety, I was on 30 for several years, I had an episode of stress due to my work, GP increased my Mirtazapine to 45mg. My anxiety didn't go away, it did come and go but eventually I realised it was becoming more constant. So I changed jobs to a much less stressful area. But the anxiety persisted. I won't bore you with an account of everything but eventually I decided to research mirtazapine because I was also putting on loads of weight. When I read accounts here I realised that my anxiety may be due to being on the higher dose of Mirtazapine. So I started to reduce it. I'm reducing by 7.5mg at an interval of 3 weeks for each reduction. After about a week on a lower dose my symptoms of anxiety subsided substantially. I'm now on 22.5mg. I've decided to remain on this dose for longer as I have an exam in 2 weeks and my husband is due to have a quadruple bypass in the next couple of weeks. Despite these events I'm so much calmer and nicer than I was 4 months ago.

Your mum's anxiety may have been made worse by the dose being hiked up to full dose so quickly. In addition the dose was reduced far too quickly. Even though your mum was on them for only 6 months her body became used to the drug.

The problem I've encountered is that GPS aren't experts. They go on the BNF which is far too generalised. I've read many accounts on here and the things that stand out are:

Higher doses can make anxiety worse.

Withdrawal must be done slowly and in small steps otherwise people may experience 'cold turkey'.

Has the GP considered counselling to help your mum deal with your dad's illness?

I hope some of this helps. I'm sure you'll get lots of replies. I hope your mum starts to feel better soon.

Hi Lozzie, I concentrated on the withdrawal, I didn't mention the GI symptoms.

To reassure you these symptoms can be caused by stress. Yes they could be a sign of something more suspicious, but stress definitely causes some people to have diarrhoea and with extreme diarrhoea there could be some bleeding. However, I agree with the other replies that the GP should at least consider investigating this further if only to put all your minds at rest. There are minor tests such as stool sampling and non-invasive tests like ultrasound that could shed some light.

I agree try a different GP.

This taper is way too fast.  I was recommended to reduce to 30 mg, stay on that for two weeks then come down to 15mg and this was still too fast.  I am on it for depression so that may make a difference.  However, I was still struggling after the two weeks with side effects, so cut a 30mg and 15 mg tab in half and took those instead.  I am now down to 15 mg, but am having real problems with sleep. The blood clots sound like something else though.

Hi,

Just an update, spoke to mum yesterday and she said she would try and get an appointment for today. I have now been informed that she has been admitted to hospital as she is so weak and they have said she may need a blood transfusion and go on a drip whilst they try to find out what is wrong with her. I do know she has completely stopped the tablets within the space of 5 days which was really stupid of the gp to do to her.

I am so relieved that at least she will be looked after properly now.

Lori

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