How to come off mirtazapine safely

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Been on Mirtazapine for approx 4 months, currently 22.5mg. Also taking 40mg Seroxat. What's the best way to come off Mirtazapine? The side effects outweigh the benefits. The medical profession have just left me in limbo. They were quick to put me on to the Mirtazapine but have offered no help in coming off. The waiting list to see a physchiatrist is months. The duty doctor just told me to go from 30mg to 15mg & then come straight off them. My own doctor said that there's not much she can do other than help me with the insomnia by prescribing me a week's supply of 7.5mg Zopiclone but no more after because they're addictive. So i feel that i am well & truly in complete limbo at the moment. Due to the insomnia, they advised me to go back on 30mg but the side effects were too harsh. They then advised me to drop to 22.5mg but still the insomnia continues & side effects are harsh. I've been sleeping 4 hours per night roughly for the last 2 weeks, which is having a detrimental impact on my mental & physical health. I feel the sooner i can safely get off the awful drug the better. The longer i take it the worse the withdrawals will be. I do realise that some withdrawals are inevitable but i obviously would like to limit the severity & duration. Any help would be appreciated.

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  • Posted

    Mirtazapine is a horrible drug to get off. I have been on a year but only 7.5mg and the past couple of weeks mirtazapine has given me hell I think it has stopped working! Some I'm going cold turkey starting from today, I've had enough off this horrible drug! If I was on 22 mg like you I would wean off it 1st to a lower dose for 2 weeks then another lower dose after that....good luck 😊

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    • Posted

      I've only been on approx 4 months now. Started on 15mg then 30mg. I was told drop it to 15mg but after a week i wasn't coping to well with the withdrawals, insomnia being the worst of these. Put back on 30mg but couldn't stand it so went down to 22.5mg for the last few days & not tolerating this much either. Tempted to drop down to 15mg but not sure that's a good idea. But really don't want to prolong this suffering any longer. Haven't got any 15mg tablets, i split a 30mg in half so not sure how i'll drop it to 7.5mg other than using a tablet cutter. The doctor doesn't want to know, the local mental health team having basically washed there hands. So i am currently under the crisis team short term, who occasionally contact there consultant for advice. I have no clear plan or direction on where to go from here. Completely frustrated & confused on what to do for the best.

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  • Posted

    Hi Tim

    It is advisable to taper no more than 10% per month, or 5% every 2 weeks. Or listen to your body - if WD symptoms are present wait a little longer before you reduce your dosage.  Under no circumstances just stop taking them.  The doctors suggestion of just stopping on 15mg is ill informed.  I know because like you I had no help from the medical profession.  They have no idea or refuse to admit that mirtazapine presents with serious withdrawal if tapered too quickly or just stopped cold turkey.  In fact they don't like to use the word withdrawal for antidepressants, preferring the word discontinuation syndrome!!!!!!!

    I was on mirtazapine for less than 6 months.  I was taking 15mg.  I just stopped cold turkey on 31 May this year.  They did not work for me.  I went to weeks my gp for help with withdrawal, mainly horrific and crippling insomnia and was was basically just left to get on with it.  I went many  weeks with either 2-3 hours sleep a night or in several instances no sleep at all for the entire night.  Whilst the medical profession are not eager to provide a patient with sleeping tablets to address the crippling insomnia,they will readily supply other equally horrendous antidepressants to ease insomnia.  Their argument is sleeping tablets are addictive.  So are antidepressants like mirtazapine if you need a stronger dose to cope, or can't come off them for fear of severe and protracted withdrawal.

    So now that I've had my mini rant I wanted to let you know that if you are prepared to conduct a very slow taper as suggested above you can reduce your withdrawals and successfully be free from mirtazapine but it is long process.  It has taken me 4 months.  I take magnesium supplements at night and probiotics.  I try to take a walk every day and as a back up (my security blanket) I have a supply of sleeping tablets which btw I have not taken now for over two weeks.  Buy a good quality pill cutter.  This will help with the tapering.  I believe you can also get mirtazapine in liquid form which would improve the accuracy of tapering but I don't know whether that option is available easily on NHS.  I also saw a counsellor and I have had a little advice from (of all places) a decent vitamins and health food shop.

    Anyway to summarise, I am now medication free, no mirtazapine and finally no Zopiclone.  I know we are all different and these drugs affect us all differently but I just wanted you to know that it can be done.  I was abandoned by the doctors so I completely understand where you are coming from and I want you to know that you are not alone.

     

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    • Posted

      Hi Christine,

      Thank you for the information. I dropped from 30mg to 15mg the main problem i really had was insomnia. There solution was to increase the dose back to 30mg. After 2 days i decided it wasn't a good idea. Then i suggested 22.5mg, been on this for 3 days. The insomnia is not improved whatsoever. So i thinking of dropping back down to 15mg & staying there for a couple of weeks & then drop down to 7.5mg for a couple more weeks & then stop because i'm not sure i could go lower with a pill cutter. I don't think they will agree on liquid because of ignorance they don't see withdrawal from mirtazapine as an issue, believing it to be one of the easier ones to come off.

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  • Posted

    Hi again Tim

    If insomnia is your main issue (and I completely get it) you could try a little experiment.  I have read that the 15mg dose of mirt is the best for dealing with insomnia and not at the higher doses.  If you have a 30mg tablet try cutting that in half and taking that about half an hour before you go to bed.  

     

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    • Posted

      Hi Christine,

      Yes, when i was taking 15mg i had no problems falling asleep but woke up in the middle of the night & couldn't get back to sleep. Now on 22.5mg it takes me longer to fall asleep but still waking up in the middle of the night

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    • Posted

      This is currently happening to me. It's pretty horrendous. Take anything you can for sleep like magnesium tablets. Calcium tablets too. Valerian and tulsi are meant to help. Unfortunately there's nothing much else you can. There are BZs like valium but that's even more addictive and you'd struggle to get doctor to prescribe it! I'd mention it though.

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  • Posted

    Hiya Tim, I'm going through the same process and before I moved house (have an amazing gp now) I must have seen 10 different doctors, all with different opinions. I totally agree with Christine, withdrawal isn't taken seriously and most GPs just aren't trained to deal with it. They just believe what they are told from the drug reps. Telling you to take half a tablet for 2 weeks and then nothing, is like telling a heroin addict just take it every other day and then stop. It ain't gunna happen. I did that a year ago when I was on citalopram and was shaking in bed. I thought I had a cold but was withdrawal.

    I've been on 7.5mg for 2 months now, down from 30, which has literally taken me 18months. I cut 15mg tablets into 8ths and have that every month. Even then I suffer but you can't cut any more. Another option is the get the dispersable tablets and measure it out that way (there's a good thread on here about that). But I'd suggest, if you do a drop, don't be tempted to go back up when you are struggling. Any drop is a step forward. I'm off work on long term sick but 50% of this is due to symptoms from the drug that's meant to be helping me. That's how bad it is, insomnia, dizziness, stomach problems and really achey back and shoulder blades. I was on zopiclone too and then it stopped working. At no point did the doctors say it was the drugs causing it or that it would be so bad.

    I'd suggest stay on what you are for about 6 weeks, then reduce by an 8th or a quarter every month. Use a sharp knife or pill cutter.

    Please let us know how you get on.

    Dan

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    • Posted

      Hi Dan

      You made a good point there regarding keeping the drop in dosage no matter how hard the struggle is.  I think it is important to tell yourself that this is WITHDRAWAL and it will get better.  I also think the doctors underestimate how crippling insomnia is.  I would not have believed how long and protracted the withdrawal symptoms are  from this drug.  I even researched heroin withdrawal cold turkey at home and it was less protracted than mirtazapine.  I'm not using scare tactics.  I just think it's important that anyone wanting to come off  mirtazapine take it very slowly and accept that the slower you taper, the less the symptoms of withdrawal will be.  Also to accept that there will be withdrawals no matter how slowly the taper.  I had no understanding from my gp.  One medical professional actually said to me, when I was absolutely incapacitated by lack of sleep, that I had ONLY been on it for 6 months.  After taking mirtazapine for 2 -3 weeks it's got its hooks well and truly into your system.

      My heart goes out to each an everyone battling this drug because the truly appalling aspect is the refusal from the medical professionals to accept that there are serious withdrawal symptoms and the subsequent lack of support when in withdrawal 

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    • Posted

      Hi Dan,

      I have just had a call from the local crisis team. They told me the plan is to take 22.5mg for 2 weeks, 15mg for 2 weeks & then 7.5mg for 2 weeks & then 0.

      They also said that they would not offer any sleeping tablets or diazipam at present.

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    • Posted

      Hey Tim, that's way too quick. Seriously. Believe me I've tried it! I think depending on your genetic make up, some people suffer less. But I'd say at the very least cut your 15mg tablets into quarters. They snap in half then use a sharp knife (I use a Swiss army knife!) to cut length ways down the half a tablet. And do a drop every month. I found out I'm even sensitive to different batches, so it's something to bear in mind. I got my doctor to prescribe me 6 months of tabs and spoke to pharmacist about getting all same batch. I'm using actavis brand, which are easier to cut. Teva are circular and harder to cut.

      I hope that helps. Lack of sleep is a total killer, I've decided to come off my 7.5mg and I'll be the same! As long as we all get the support we need it should be easier :-) Hope that helps and please keep us updated.

      Dan

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    • Posted

      Couldn't have put it better myself. Apparently NICE published a report a few months ago on antidepressant withdrawal and how serious it should be taken. I'm sure it was new news t some medical professionals. Which doesn't fill you with confidence. I'm sort of lucky as I'm a biochemist by trade but poor folk taking doctors words as gospel are suffering needlessly. Also an interesting Guardian article about exactly what we're discussing. I'll post on here if you've not read it.

      Cheers

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    • Posted

      The only problem i have is they're prescribing the medication so don't have many extra tablets. I only have 2 weeks supply of 22.5mg, lots of 30mg that i can split them. So i could do 22.5mg for 2 weeks, 15mg for how long? & then they give me 2 weeks supply of 7.5mg. So if i wanted to go lower i would have to split a 30mg tablet into smaller pieces? What would be your plan? Really appreciate your advice

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    • Posted

      i was on mirtazapine for 2 years. started at 15mg and worked up to 45mg in a bery short space of time,

      i have severe emetaphobia and anorexia so i guess they thought putting me on this drug would help me gain weight. it did not iv lost 3 stone in the 3 years iv been on it and had worse anxiety surrounding my emetaphobia to the point where in the past 3 months iv not even left the house. 3 times the doctor has tried to get me to do the drops youve mentioned.

      go to 30mg for a week then 15 then nothing.

      i strongly advise against this. it was hell and o had to go back to 45. since then iv been dropping down by 3.75 every two weeks. im now down to 33.75mg (its taken almost 2 months to get here) its been horrible but im able to ride each drop out better than i was able to to do the drop straight down to 30 and 15!

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