Coming off Mirtazapine for insomnia: success story!

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I wanted to write my story for anyone out there trying to find encouragement during withdrawal process. When I started coming off Mirt I kept searching for success stories, but forums are usually filled with struggle stories instead. If you are in the weeds of withdrawal, may be this post will give you a little bit of hope. 

I was put on 15mg of Mirtazapine in January of 2017. My main symptom at the time was severe insomnia: 0 sleep for days, may be 5-6 hours of sleep in a week. But I also experienced episodes of terrible anxiety, bordering panic and depression symptoms. Looking back, I'm convinced this was brought on by a few weeks of continuous Ambien and Xanax use for sleep. I was 36 at the time, never had any psychological issues before, never took any meds. I was suffering for about a month until I found a doctor who stabilized me with Mirt. 

It worked almost immediately. Within one week I started sleeping for the first time in a month. Anxiety and depression faded as sleep returned. I was on 15 mg for 2 weeks, but I felt too sedated the next day. Went down to 7.5mg after 2 weeks. Then down to 5mg after another 2 weeks. And from there on did a 0.5 reduction every 2 weeks or so. Finally jumped off after being at 0.5mg for 5 days. 

I had some rebound insomnia with earlier tapers, but once I got below 4 mg it was pretty smooth (because of the lower reduction, I guess?). When I jumped off back in June for the first 10 days I felt great. But slowly sleep started getting worse and worse: and at 2 week mark it hit me hard. 

I went back to 1mg and stayed there for a coupe of months – sleep normalized immediately. I got 0.2 and 0.1 mg pills and decided to go as slow as I can. In the end I took way longer than I should have, but I was going through some life-changing transitions at the time and insomnia was not something I was prepared to deal with. It took me about 6 month to go from 1mg to 0.1mg, doing 0.1mg cuts every few weeks. Then I was taking 0.1mg every other day for a few weeks. Then every 2 days for 2 weeks and then I stopped. I had a few setbacks during this time, but not as troubling as the ones I had before: only 1-2 nights of bad sleep.

It's been 2 month since my last dose and I think I'm ready to say: I'm Mirt free and I sleep well!

So if you are taking this medication for SLEEP here's some advice I can offer:

1. In my experience, lower doses of the pill worked just as well – or better – than the original 15 or 7.5mg. From what I've read 3.5mg seems to be the perfect dose for sleep for most people. I did great on 1mg as well: asleep within 15 minutes, which is very fast for me even before insomnia problems. So if your doctor prescribes it for sleep, I suggest trying the lowest possible dose: it will be easier to withdraw from later. 

?2. When stopping this medication go slow and and jump off from the lowest dose possible. In a lot of the stories I've read people have jumped off from 3.5, 5 or even 7.5 mg. This medication seems to have effect even at 1mg (at least for some people). I took too long, but I'm guessing you should be ok going from 1mg to 0.1mg in month or so. You can either make your own solution or find a compounding pharmacy that will prepare small dose pills for you.

3. Expect delayed withdrawal. I was usually hit with insomnia 10-14 days after lowering the dose and it seems to match other stories I've read. 

4. If you are being prescribed Mirt for sleep, I suggest you only take it short term and try to fix the underlaying issues that are causing your insomnia and at least manage it better without medication. Taking Mirt long term can make you dependent on it and make your initial insomnia problem worse once you stop. Keep a good sleep hygiene. Have your hormone levels and thyroid functions tested. Make sure you get adequate levels of Magnesium, vitamins D and B-6 and Zinc (all these are crucial for melatonin production). Include exercise in the first half of the day, if possible. Get out into the sun light first thing in the morning. Wear blind fold and/or ear plugs to bed (this easy trick was surprisingly helpful for me). And this one is my favorite trick of all: listen to podcasts or audio books when you can't sleep (a monotone voice, no dialogue works best). I find this extremely efficient in turning my mind off. Best case scenario – it will make you fall asleep. Worst – you will learn something new smile

5. And lastly, try not to fight for sleep when insomnia does strike. It's easier said than done. But fighting make things much-much worse: it adds anxiety and sadness on top of exhaustion. And will most definitely not make you sleep. When it's 3 am and you just know sleep will not come tonight – just try to accept it. The truth is that we are built to handle some sleep deprivation. Yes, you will not feel great the next day. But usually it's not as bad as you think it will be when you are laying there awake in the middle of the night. And worrying about it will not make you fell better. 

If you are fighting the insomnia fight right now – hang in there!

?Unfortunately, there's no short cut. But it will get better. 


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  • Posted

    Good to hear that you are finally off this horrid drug.  I was on Mirtazapine (7.5 mg was as much as I could handle) for one month.  I developed a breathing complication due to the flu and had lost a lot of weight (45 lbs in 1.5 months), was experiencing some anxiety and was having trouble sleeping.  I was already taking Prozac so I wasn't taking Mirtazapine for its antidepressant effect.

    I felt very bad on this drug almost immediately.  As many experience, the first few days were rough; very tired.  The tiredness subsided after a few days, but the morning nausea did not.  The drug also made me unproductive and I didn't want to do anything.  I lost interest in hobbies and had a hard time just taking a shower or taking care of daily activities. 

    I decided to taper off the drug, which I did over 2 weeks or so.  I was only on the drug for a month so I didn't see the point in extending the taper longer than I had been on the drug even though some on this forum would disagree with that approach.  Ultimately, I went down to 1.875 mg and then discontinued. 

    One alternative to having a compounding pharmacy make low dose tablets is to make a liquid preparation.  A compounding pharmacy can also do this.  I think the liquid is easier to handle.  You could also do this yourself, but make a new batch every couple days.

    After about 3-4 days I started experiencing withdrawal symptoms, including brain/body zaps (electric shock jolts and twitching in part of your body) among other things.  The insomnia started back up again.  I started taking 0.5 mg of Ativan, which helped a little, but I suspect I have developed tolerance to such a low dose and I am unwilling to increase my dose for fear of becoming dependent.

    After about a week of discontinuing Mirtazapine, I began to start feeling normal again.  I became more productive, I didn't have that nauseous feeling upon waking; life just became more normal...  I still have some insomnia due to my breathing condition.  I have just started taking Ambien (2.5 mg at night) for insomnia and so far I am having a good experience.  I feel relatively well rested and am not waking up at 3:30 - 4:30 am now.  Hoping you can share your thoughts while on Ambien as it appears you did not have a good experience.  Thx.  John


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    • Posted

      Hi John, 

      Ambien is a wolf in sheep's skin. It's not a benzo, but their mechanism of action is very similar.

      I also started taking Ambien for insomnia at 2.5mg. It worked great! My doctor was surprised it worked at such a low dose. I didn't take it nightly. I think it took me like 3 month to go through 10 pills I had after my hospital stay. Insomnia didn't resolve and I asked for a refill and started taking 5mg pills, telling myself its still a low dose (still only took it sporadically). But over the next few month my insomnia got worse and by mid December I started taking Ambien nightly – just to get through the holidays, I told myself. 5mg didn't work as great anymore and my doctor suggested I try Xanax (the stupidest advice ever). After 3 weeks of alternating these drugs I tried to stop and that's when all hell broke loose. I basically went through a mini benzo withdrawal. My guess is that Xanax was more the cause than Ambien, but knowing everything I know now, Ambien is only slightly better than Xanax. 

      I think it's perfectly ok to take sleeping pills on occasion. But I will never again make a mistake of taking it nightly for longer than a few days (Ambien is actually suggested for no longer than 2 weeks of continuos use).

      Everyone is different. I know people who were on 10mg of Ambien for a few years and got off with only minor problems (though, with more than one attempt). You never know how your body will handle the drug. 

      If you have "some" insomnia, I wouldn't rely on a sleeping medication nightly (doesn't sound like your insomnia is debilitating). 


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  • Posted

    Hi Maria, I’ve just started to take magnesium as I think I’ve got a deficiency. I’ve had blood test and all came back clear. B12 and folate was higher than normal but I had been taking vitamin b. Apparently researching magnesium deficiency it says that it doesn’t show as only shows in your bones and nerves. I also found that antidepressants can cause it. I really wonder whether that’s what caused my anxiety and depression. Off mirtazapine 6 weeks now and am so pleased I got off this horrible drug! 
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    • Posted

      From what I remember there's no blood test for magnesium levels. But 400mg is a safe dose to take, regardless. 

      In my personal experience, Mirtazapine was not horrible. It actually helped me (and fast too). I was lucky to not experience terrible side effects other people complain about. But I didn't want to stay on it: it helped me through my Ambien/Xanax withdrawal and I was done with it. The tricky part was to get off it without bringing back the issue I was taking it for: insomnia. It took a long time, but I think it can be done safely. 

      My only other side effect from it was a slight weight gain (which I lost now). 

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