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I know from my own experiences of this forum over the years that it's very difficult for others to give definitive advice as there are so many unique factors. But I am interested to hear what others would do if they were in the same situation as me.
I suffer from acute episodes of insomnia which then cause horrific anxiety attacks, which then cause insomnia. When it happens, it happens really bad and I had a huge crash last summer - the worst it's ever been. Outside of these "episodes" I am completely fine, for months and sometimes years - no anxiety, no insomnia. Last summer when the crash happened I was put on Mirtazapine and Escitalopram. It's no exaggeration to say that the Mirt literally saved my life. Yes it makes you put weight on which is horrible. Yes it (like all other antidepressants) is usually hard to come off. Yes there are start up side effects. But what it did for my sleep and to save my life made it worth it ten fold.
Because of the weight gain I have been tapering off it pretty much since I started taking it, at a 10% taper once a month - anything more than this gave me WD. I have managed to taper down to 2.7mg now. My Escitalporam dose is 5.5mg
I have been absolutely fine for months and months - I didn't even feel the Mirt was causing me to sleep anymore but I was still sleeping fine. Then on Tuesday this week an upsetting event occurred which triggered another spiral. I didn't sleep at all and then have had acute anxiety attacks in the early evening every day since. I whacked my Mirt dose back up to 5mg in order to sleep, and last night had to put it back up to 7.5mg. I have also had to take 2.5mg Diazepam the last two evenings at about 6pm because the anxiety attacks have been so bad. I am very aware that messing around with my Mirt dose is a bad idea - I need to stick to one thing. The conflict comes because I have worked so hard at tapering, it has taken so long, and I have recently lost 9 pounds from it, that it's soul destroying to just lose 6 months work in the space of two days. But I also know the most important thing is stabilizing myself.
Does anyone have any advice on what Mirt dose they would stick with, if they had been on 2.7mg and then suffered from another insomnia episode? Just to reiterate this episode was not caused by withdrawal, it was a life event that was nothing to do with my meds. Would you also increase your Escitalopram to deal with the anxiety or do you think it's better to do one thing at a time and use the Diazepam to help deal with that on a short term basis? (Once I sleep fine, I have no anxiety).
All thoughts and opinions welcomed xxx
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