Mania on mirtazapine withdrawal

Posted , 5 users are following.

hi all, i've been coming off mirtazapine under community mental health team.

Been on mirtazapine for over 6 years, mostly 15mg for sleep but recently 30mg and then 45mg for depression. wasn't working so psych said to drop from 45mg to 15 mg overnight. wasn't sure but she insisted.

never had mania before, i went manic 5 days after the drop and they said go back to 30mg, took a week to stop mania/hypomania (no psychosis). got over that, 2 weeks later they said to drop to 15mg, was ok apart from headaches/diarrhea/sleep disturbance,  week later dropped to 7.5mg for 3 days, then 0mg, the week after went manic, then crashed the next day, went up again manic yesterday crashed the same day, now i feel like i've had my power cable unplugged.

also been having normal discontinuation stuff like cracking headache, diarrhoea, thirst, nightmares, no appetite, sleep disturbance,muscle tension and dizziness and weirdly one  spontaneous orgasm, but compared to the mania/hypomania/crashing its nothing.

they gave me some diazepam but i don't want to take it because they want me to get a medication free baseline period and i don't want to mask symptoms.


they're saying its a rare discontinuation syndrome but haven't said how long it will last. i called them yesterday to tell them the mania was back but they didn't call me back and now its the weekend. tbh i'm getting a bit scared and not sure what to do. each high seemed to be a few days after a drop in the mirtazapine and i've had a high after the drop to 0mg now, so i'm hoping this will be the last one.

have any of you experienced this before? there's not much on the internet or in the scientific research papers.


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  • Posted

    Sorry for your suffering.amazed psychiatrists can say discontinuation symptoms are RARE when you only have to look at the amount of posts here to come to your own conclusion.i had been on 45mg 6 years,been 100% mentally well on them,had it not been nightmares,night terrors,and bizarre insane dreaming that I get from this drug,would stayed on it for life,( even with the extra weight gain I can ill afford). I'm tapering and holding each taper 4 weeks,and still get nausea,cracking headaches,night sweats ( need change pjamas many times night)anxiety spikes and feeling really off hits me hard between 2 weeks too three weeks after a reduction,then feel completley well before reducing again (although symptoms have habit rreappearing any time ) 

    If you are really struggling,maybe call psychiatric crises team,you are certainly not alone,and hope you feel better soon.

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  • Posted

    Hi Jen 

    inlike yourself was taking of 45mg mirtazapine overnight..on day 2 every withdrawls started hitting me to the point where I thought I was losing my mind

    make me so mad when GP,s and physc said no withdraws .id been on different doses over 16 months but last dose was 15mg then off.. doc wouldn't give me them so I'd no choice regarding tappering as I'd no tabs left

    whole time I was on them I never got rid of the side effects so they just didn't work for me at all, tho I know a few people who they work fantastic for I just wasn't one of them 

    im now heading into wk 15 free of them, if there is anyway I can help you out send me a private message as I know what your going through

    good luck


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  • Posted

    Hey Jen, do you have bipolar disorder? In tha t respect anti depressants can precipitate mania, but mirt is less likely. Also a manic episode is more likely to happen while on the mirt. Stay inside if you can until the mania passes, where it is safe. I would guess you havent slept either. Just ride it out, hopefully you have someone to stay with you. I think those jumps off were too big and too fast. The dr may be able to prescribe a mood stabilizer short term. if you already take one, talk to Md. About increase the dosage for a few days. Good luck. Keep us posted
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    • Posted

      thanks Gretel, I haven't been diagnosed with Bipolar but there appears to be quite  a lot of evidence that I do but haven't been diagnosed properly. my psych is going to start me on a mood stabiliser and said i may have cyclothymia but i've only been on their books for a couple of months so maybe they're being cautious. It just feels like they're not listening to me. thanks for your practical advice, i have texted my therapist to ask her advice also. 

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  • Posted

    Hard to believe that the so called professionals have done this to you, bouncing your central nervous system around with different doses of a very powerful anti psychotic drug that Mirtazapine is well known to be.  The golden rule that seems to work for most is to reduce this drug by no more than 10% every month (5% every 2 weeks for some).  I'm sorry to say that upping and downing the doses at such large differences is what is making you feel so ill.  The mania, the crashing, its ridiculous that the p.doc's don't have the training in this, or don't know what can happen - RARE !!!!  Makes my blood boil ...  

    Bear in mind that after a change in dose discontinuation symptoms/withdrawal symptoms can take up to 2 weeks (being the most common) and sometimes 4 weeks.  

    Do some research, print out and take with you the advice you find acceptable on here somewhere.  Well I hope this is the last of your symptoms, you might be one of the lucky one's ~ many have to reinstate because their symptoms continue, not wanting to scare you - on the contrary - you can reinstate if necessary then do a slow taper.  

    If Mirt stopped working work you at 15 mg I guess thats why they upped to 30 then 45? Either way, sometimes Mirt can 'poop out' / stop working.  When the increase didn't work they told you to drop far too fast.  

    Well I hope you feel more settled, Diazapam, another one hard to discontinue, don't blame you for not wanting to take that.  I wish you well, and hope your suffering is short lived.

    Best wishes.

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    • Posted

      thank you calmer, things got worse after i posted, but today am feeling less manic and awful, so hopefully in another week i'll be feeling much better, although my sleep patterns have gone completely awry now, good times! here's hoping the lamotrigine will help things and that i wont have to take the diazepam too often, dont want to get reliant on that. thank you for you reply smile

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    • Posted

      Hope the lamotrigine does help, from what I've learnt only Mirtazapine can relieve WD from Mirtazapine, so if all else fails at least you can do that 😊

      my fingers are crossed for you.  

      Ket us know how it goes for you.  

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  • Posted

    I recently got diagnosed with Bipolar I am in my mid teens so they havent told me what type. Recently I was on 30 mg of remeron(mirtazapine) for sleep and mood. I went off it one week and I had a manic episode it last a little under 6 days and I was hallucinating to the point where I do not remember parts of it. Even though I missed one dose and then went back on it the mania persisted and I can't lie I loved it. I had episodes before but never as strong and with such strong hallucinations. I didnt have any other withdrawal symptoms other than mania and decreased need for sleep but thats tied in with the other one. I would never recommend going off meds no matter how you may feel not cold turkey at least.

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