Advice on reinstating Mirtazapine

Hi tempest1

I reallyreally need reassurance please help!

I went off Mirtazapine cold turkey. 8 weeks ago had total nausea for 4 weeks lost a stone. Then anxiety started. At 5 and a half weeks off Mirtazapine I decided to reinstate-went on

a quarter tablet for 5 days not any better with anxiety. Then went on half a tablet for 8 days. Last Sunday was very poorly with anxiety decided to go on my original dose of 15mg. Have been on it a week now. Went to work 4 days last week. My mind was taken up every single minute with pricing, stocking and serving customers. At the start of each shift I was very poorly but as the day went on I started to feel better each day. I am very poor on my days off as my brain is not filled every single minute with something to do- tidy, price or stock up. How long will it take before I can get back to normal? I have been on my full dose for 7 days now. I am off today and tomorrow and very poorly as I am doing things but my brain is not occupied every single minute. Please please help!!!

Yeah I would say it's probably been the hardest week of my life, just dont know what to do for the best. The nausea and sweats have reduced a lot but the anxiety and lack of sleep because of these tremors has been terrible. I'm worried that they don't seem to be letting up and was too scared to take the mirtazapine again last night, I'm sorry I ever went on it :-(

I understand you are scared about going back on it, but you are risking more (potentially permanent) problems if you don't.  It is never advised to just stop taking psyche meds cold turkey, you need to taper off.  Some drugs, like Prozac, have such a long half life that they are essentially self-tapering, but outside of that, you should never just stop taking a medication. 

Describe your tremors.  Are they like jolts?  How often do you feel them?  Every few minutes?  How long does each one last, a second or two?  Do you feel like you are "falling"?  Are certain parts of your body affected more than others, e.g., limbs, fingers, etc.

I think many on this board would share your thoughts that they never would have gone on this drug knowing what they now know.

Hi John, 

Thanks for replying again. I've just been to the doctors and gave me a prescription for 15mg to take for 1 week, then take 15mg every other day for 1 week then stop! 

The tremors are like acute little vibrations in the muscle, sometimes just one 'blip', sometimes vibrates for a few seconds. I'm getting them every few minutes during the day, in the night though when I'm trying to sleep they are every 10-15 seconds. Mostly in the legs but sometimes in my back, arms, face, anywhere really. My muscles are aching everywhere :-( 

I'm also getting jolts when I'm drifting off to sleep (hypnic jerks?).

All started when I went down to 15mg from 30mg 11 days ago

This sounds about right.  This is apparently how the body responds to antidepressant withdrawal.  I have been told my my sleep apnea doctor that hypnic jerks are normal.  I never had them before, but I do now.  They sure don't feel "normal."  With hypnic jerks, it will feel like you are falling.  They occur at the interface between waking and sleeping states, i.e., as you are drifting off to sleep.  Like I said, there is some risk to having these tremors/jerks be permanent if you suddenly discontinue.  Look up tardive dyskinesia for more information.  This alone should be enough to encourage you not to quit the psyche meds abruptly.  Let us know how it goes.

Hi John, yes I have read about tardive dyskinesia which has scared me half to death and why I have gone back on them. I've taken 15mg the last 2 nights but the twitching hasn't subsided so far yet. I was apprehensive about going back on them because I started getting visual disturbances when I was on them so not sure if I'm doing the right thing or not and my doctors seem completely clueless about it all! I'm so scared right now :-(

Hello John how long do you think it will take for me to stabilise. I have been on the 15mg for 7 days. I really appreciate the support and feedback.

I would say this depends on how long you have been taking mirtazapine.  If you have been on it for years, then you will need to taper very slowly.  If you have only been on it for a month, then tapering can be shortened.  You will have stabilized on 15 mg if you are no longer having withdrawal symptoms, i.e., twitching, brain zaps, etc.  I would give it another week or so at 15 mg and then depending on how you do consider starting to taper down to 11 mg.

Thank you for your advice John I guess I am being impatient I have only been on my 15mg for 7 days. I was on Mirtazapine for 9 months.

I would give it another week or two to allow your body to stabilize.  Are you still having twitching/brain/body zaps?  If so, you are not likely not ready to reduce your dose.

Sorry I didn't get back to you John I just discovered your reply. I didn't have twitching or brain zaps that was Robbie I have just had the excruciating anxiety and I am now on my original reinstated dose of 15mg for 15 days. In your experience will I stabilise soon or could it take another few weeks. Really appreciate support and advice. Have you any examples of people the same as me?

Hi.  I couldn't say.  I never reinstated the drug, only discontinued.  Plus I was only on the medication for a month.  I would hope that you stabilize at 15 mg.  Once you do, taper off slowly to prevent withdrawal symptoms.

Thank you John!