I am in a bad way

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I changed over from sertraline to mirtazapine about 8 weeks ago. I did it gradual but maybe not gradual enough, I am not too sure. I started on 15mg if mirtazapine whilst tapering off 100mg of sert-50mg to nothing over a couple of weeks, now on 30mg of mirtazapine for about 3weeks. I feel awful. So down, angry and feel like smashing everything up. Feel useless and in such a bad place. I have terrible self harm thoughts, like I wanna stab my arms - I haven’t yet. I also want to smash cups and things which again I haven’t. I don’t know which way to turn so I just don’t do anything, I just keep it all inside but I feel horrendous and I have awful nightmares. I am hoping it will all settle down soon. 

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  • Posted

    Hi Alfa 

    did u feel like this when on Sertraline? Or has this just started from you went onto mirtazapine?

    maybe you could call emergency doc for advice ?

    kaz

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    • Posted

      Hi Kaz, when I was on sertraline I stayed awake all night and had so many problems functioning in a normal way due to lack of sleep.  I have been on Mirt before and it worked ok and I suspect it might take a while to settle in but I would have thought I would be feeling better after 8 weeks not worse 
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  • Posted

    Sorry to say that tapering off 100 mg sert over a few weeks is not tapering but a cold turkey as far as your nervous system is concerned.  Mirtazapine is a very different type of AD than sert and 15 mg is just barely kicking in the serotonin receptors, acting more like an antihistamine (with sedation) at this point. Are you doing this under the guidance of a doctor?  You are in sertraline WD.  I had something similar happen when I came off venlafaxine too quickly. I didn't realize I was in WD, but was so low and was losing weight due to no appetite, and I couldn't sleep.  My doc put me on Mirt when allowed me to sleep and eat, but very quickly I was up to 37.5 mg and still so apathetic, I couldn't get off the couch.  It was only after I reinstated the lowest dose of venlafaxine that things completely turned around, and it finally dawned on me that I'd been in WD from ven.  The mirt just couldn't counteract it.  I wish I had just reinstated the low dose of ven but no one knew.  So, now I am SLOW tapering off both drugs, as that is what I wanted, to get off ADs after 20 years.  I'm doing quite well, though low motivation is the biggest issue.

    Under the guidance of your doctor, your best bet would be to reinstate a small amount of sert, maybe half of the lowest dose.  If you feel much worse after a few days of doing so, then stop.

    I have seen others report that mirt has the side effect of causing rage, so this one may not be for you, and the sooner you can get away from it the better, because mirt can be hellacious to get off of once it has its hooks in you.  Along with reinstating a bit of sert you could step off the mirt and try to get off of it quickly since you've only been on it a couple of weeks (?).

    Doctors don't seem to realize that these drugs are not directly interchangeable and that one can be in WD from the first one while trying to replace it with another.  And they each have their own start-up side effects.  They also don't realize that for some folks, a "taper" over a couple or few weeks is just way too fast.  The nervous system built itself around the drug, taking its action into account, and must rebuild itself to adapt to less drug.  It's not like taking aspirin, where when you stop and it is out of your system its effects are gone.  Stop taking these drugs quickly and you are left with all the remodeling unopposed, which can mean chaos.  If you can stand the horridness the nervous system will eventually adapt, but that's just it, can you stand it, and there's no knowing how long that will take.

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    • Posted

      TY ok much for the info, doc did advise but was very blasé about it saying just reduce to 50mg then every other day, then maybe twice a week, I used them until they ran out. Makes sense I am in withdrawal, will see if I still have some and taper off slower, ty x

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  • Posted

    I went from 15-30 and been taking 30 for nearly 2-3 weeks. The 30 made me feel like crap. Few hours in evening felt better. Slept okay for about 5 days on 30 then really struggled with sleep. 2-3 hours at the most. I was almost like it did the opposite affect!!!! And the anxiety on a morning and afternoon, horrible thoughts, depressed, anxious. I've been to docs this morning and I'm coming back down to 15mg, I'm not staying on 30mg any longer, doc was good he could not understand though why the 30 had been so bad. Even when I was tapering citalopram 40mg to start Mirt I never felt that bad. So starting back on 15mg tonight. Also go propanolol 80mg slow release and some diazepam when needed. I not saying Mirt is horrible because 15mg when I first started in April worked great for me, and when I had a big wobble  about 3 weeks ago, I thought yeah 30mg would sort me out. No actually I made me have the worst 2 weeks of my life!!!! I have suffered anxiety on and off for 8 years and these 2 weeks have been awful. So back to 15mg for me and see how that goes can't be any worse than how I felt on 30mg.

    All the best!!!

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    • Posted

      Hey Richard, be careful going back to 15mg as if you jump 50% down to that dose (as you say above you are going to do) it could rock your CNS even more.  I would go down in stages; of course the 10% every 3-4 weeks would usually apply but I can imagine you want to hurry away from the disturbing 30 mg dose.  So step down as slow as you can - hope you get some relief soon - many folk have complained of added anxiety going from 15 to 30, bear that in mind because going down again too fast can rock the boat.

      Wising you well.

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    • Posted

      I've only been 30mg 2 weeks, so hoping it's not going to be too bad. I can't stay on 30mg and longer it is sending me mad. I took 15mg last night for first time and slept better. Doctor said as I have only been on 30 for a couple of weeks any side effects should be minor if any. Wish I had never stepped up in the first place. He's also given me propanolol slow release and some diazepam.

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    • Posted

      Ok, 2 weeks ... I hope this resolves your symptoms.  Wow you got quite a few other mess to help you, easy with the Diaz - more addictive than the Mirt - 2 weeks & you're having to taper they say?  Wishing you well Richard 🙏

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