120ml duloxotene and 15ml mirtazapine cold turkey

I am on 120 duloxetine and was on 45 mirtazapine. I got off the mirtazapine last November and just taking the duloxetine. Be very careful quitting both at the same time. I also put alot of Weight on. I still having problems sleeping after quitting the mirtazapine. ....... I hope u will b ok. X

It really would be best to reinstate and then do a sane, slow taper.  Coming off two at once is really rough, not advised.  Like Effexor, Cymbalta can be nasty in its own right, as can be mirtazapine, so doing a cold turkey of both is really pretty insane.  The worst is yet to come, I fear.  It takes four days for a new level of drug to reach a steady state in the blood, in your case NONE.  

When you go on these meds, the idea is to raise serotonin (and norepinephrine) levels with the idea being that a higher level will make you feel better.  This increase causes the start up side effects you may have had. But, what no one explains, is that the body doesn't like this high level; it wants homeostasis and so will make oppositional changes to bring about homeostasis in the presence of the drug(s).  This means remodeling of your neurons, to produce less serotonin because the drug is keeping a too high level in the gap, while also pruning back the number of receptors, making you less sensitive to serotonin.

When you come off your drugs colt turkey, you are left with these changes unopposed, meaning huge destabilization.  That means withdrawal symptoms.  Unfortunately, the nervous system is much slower to return to the pre-drug state than it is to adapt to the drugs, and this can mean months and even longer of sometimes proufoundly awful symptoms which can include anxiety, depression and insomnia the likes of which you have never known.

The idea of the slow taper is to allow your nervous system to adjust to small changes in drug level so that by the time you come off, most of the recovery has already taken place.  When you come off CT, ALL the recovery has yet to be done!

Too fast tapers and cold turkeys result in windows and waves of recovery, usually not linear.  You can feel great for awhile, then get hit by a wave of symptoms, feel good again, and then get hit by another even worse wave months out from coming off.  

Doctors don't seem to recognize this pattern of recovery and don't know what to do about it when it happens other than blame the patient, that you are "relapsing" and need to be on meds (often for life, they say!).  Well, it helps to understand that in fact it IS withdrawal, because your nervous system became addicted to the drug, unable to operate normally with its absense due to that remodeling I mentioned.

Tapering by 10% per month of the previous month's dosage is a harm reduction approach for most patients, taking into account that the most sensitive will probably be ok with such a slow taper.  Some are less sensitive and might tolerate 20% per month.  Yes, this takes a long time, but allows you to remain functional while doing it.  I've seen many a person on a withdrawal support forum rendered jobless, even homeless, due to the loss of functionality due to withdrawal from cold turkey and fast tapers.  Yes, even over a couple of months is fast, because the nervous system is just so much slower at adapting to the absence of the drug than it is to adapting to its introduction.

Having crashed and burned 10 months out from coming off of Effexor too fast, been there done that and am now slow-tapering.  See the 10% topic in the following link:

https://patient.info/forums/discuss/depression-resources-298570

Hi Jayne ,

i have to agree with Betsy , i was told to come of mirtazapine straight away no tappering i was taking 45mg for 14yrs ..i wasn't even told to expect any side effects but just a few days later i became extremly unwell with the worst nausea then vomiting dizzy, sweating, profond itching a constant runny nose followed by restless legs and an upset stomach not to mention the inability to sleep , i can honestly say i have never felt so unwell the worst of the symptoms lasted for 8 weeks and even now i still get days of nausea and loss of appetite to date i have lost 8kg and since i was only around 50kg to start with the weight loss has had a devasting effect .

My consultant said such extreme withdrawel is rare but certainly not unheard off ,i was told to go back on the mirtazapine and tapper slowly but at that point i was already 5 weeks into the nightmare and choose not to restart thinking it couldn't possibly go on much longer but i was so wrong .

I understand that we are all different and you maynot suffer in that way but please be very careful and perhaps seek some advise from a Dr .

I wish you well and hope everything will turn out well for you x