Mirtazapine Withdrawal Insomnia

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Hi, I'd been on 30mg/day mirtazapine for about four months before I decided to stop because it was making me so drowsy (although doing wonders for my depression). I tapered down to 15mg/day for a week as per my psychiatrist's advice, and then stopped taking it at all. I was fine on 15mg, but now I literally can't fall asleep without chemical help. It's been about a week. I'd been using diphenhydramine, which worked for a few days but obviously built a tolerance, and now I'm trying Nytol herbal tablets - the pharmacist said I couldn't use any other antihistamines because I'm also on 200mg/day sertraline, and have been for about a year. I was wondering how long this insomnia is likely to last, and if there are any other sleep remedies I could try. I've been given diazepam in the past to help me sleep, but I can't see my GP to get another prescription for two weeks. I'd be really grateful for any advice or information; I'm building up quite a sleep debt and I don't really know what to do. Thank you!

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  • Posted

    Hi Frazer,

    I really despair at the number of doctors that think people can just come off mirtazapine so quickly. It is a very powerful drug and coming off it quickly can permanently damage your nerve pathways. Your body needs time to readjust itself to working without the mirt and it must be done slowly. Some recommend only a 10% drop every month! I find that too slow personally, but I came off 30mg over a period of four months. For the last 2 mg I made my own liquid suspension and dropped by 0.2mg every two days. That way I avoided any withdrawal symptoms. If I were you, I would reinstate a small amount of mirt (the smallest you can manage on - maybe a quarter of a 15mg tablet) then reduce that over several weeks to give your body a chance to rebalance itself. Good luck

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    • Posted

      Sorry, that should read I dropped by 0.1mg every two days.
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    • Posted

      Thank you for your help, I'll try coming off more slowly! Can I ask, how did you make the liquid suspension?
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    • Posted

      Yes, you need a 1ml syringe with markings on at 0.1ml intervals, a pill crusher, a clean medicine bottle or small jar, a small acurate measuring jug. I crushed up 4 x 15mg mirtazapine pills until they are a fine powder (although the outer coating does not grind up as fine as the white mirt inside, but that's fine. So long as the white mirt is a fine powder. Then I measured 60ml of half water and half maple syrup and poured into the medicine bottle. Then poured in the powder and shake it vigorously. So 1ml of the liquid equals 1mg of mirtazapine. However, mirtazapine is not soluble in water and so you must shake it vigorously every time you take out a dose to ensure you are getting an acurate measure of mirtazapine. Also you shoulld store it in the fridge. It is recommended to keep it no longer than four days, but I kept each batch for two weeks without a problem.
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  • Posted

    Hi Fraser

    Evergreen is absolutely right, we are here to mop up peoples suffering & try to give help for a successful withdrawal from the poserful Mirt.  

    Personally I would say, as you got down to 15 mg, go back to 15 mg, this will either help instantly with the sleep, or it may take up to a week, but don't despair, it will come back.  Then do a slow taper from there, a 10% every 2 tgo 3 weeks is moderate, see if you can tolerate this, if you still get insomnia/anxiety you may have to slow it down further, but some get on ok with this.

    About me

    For advice on tapering Mirtazapine slowly at the recommended rate of no more than 10% every 3 or 4 weeks, please see the following which is within this forum,

    https://patient.info/forums/discuss/depression-resources-298570

    and then click on the link "REDUCING AD'S USING 10% WITHDRAWAL METHOD".

    Doctors don't seem to know precisely how difficult this AD is to withdraw from, if youur doctor is unhelpful, maybe print off the advice and take/show ~ that is exactly what I did.

    Best wishes.

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  • Posted

    Hi Frasier, I concur with Evergreen and Calmer.  I am doing the 10% taper off mirt.  I just have a couple of questions for you.  You have been on sert for how long?  How was your sleep on sert without mirt?  What was the reasoning for adding the mirt?  Just curious if the mirt was added to help with sleep.  I know that my sleep was not great when I was on Effexor alone.  A lot of SSRI/SNRIs cause insomnia, so there might be a double whammy in here.

    I am down to 14 mg and my sleep is still good, though if I get woken up in the night for some reason (like having to let a dog out at 4 AM last night!) then I have trouble falling back asleep.

    A lot of people lose their sleep with cutting too quickly, rebound insomnia since mirt is rather sedating at low doses and in general, as you have found.  So, a long, slow slide off is the best way to retain sleep, letting the body adjust to the absence of the med gradually.

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    • Posted

      Hi Betsey, I've been on sertraline for roughly a year, and the mirtazapine was added when my mood started to drop again after a while. I hadn't been sleeping worse than usual when only on sert - I've always slept badly - but my dreams did become unusually vivid, which was sometimes bizarrely entertaining! My psychiatrist suggested it because he's had experience of mirt working well alongside sertraline in other patients. The effect on my mood when I started the mirt was almost immediate and very noticeable (which is unusual for antidepressants, as we all know too well!), but the sedation and constant hunger eventually became too much for me to handle. Anyway, thanks for your help, and good luck with your withdrawal.
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    • Posted

      Frazer, that is good to know.  My doc put me on mirt when I was in wd from Effexor, but the mirt couldn't hold up to that and I was worse than ever, so he added back the Effexor since I had tolerated it in the past (nobody recognized I was in withdrawal, just thought I had relapsed!).  He told me that the two together worked synergistically, and that it was called California Rocket Fuel!  Within one hour, my symptoms had turned around, a true sign of dependency, but I have to wonder if the mirt along with made it work better.  Mirt certainly wasn't working on its own other than helping me sleep!

      I hope that reinstatement and going slower will allow you to keep your sleep.  Wishing you luck :-)

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    • Posted

      Oh no, if my experience is anything to go by, mirt alongside an SSRI is astonishingly effective, if you're lucky and don't get or can cope with side effects. I was quite shocked actually, since my history with SSRIs was mediocre at best. My psychiatrist has suggested that I could try reboxetine (spelling..?) along with sirt instead of the mirt; that's probably what I'll go for next - just in case you find Effexor alone not quite enough. Good luck!
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  • Posted

    Hi,

    Im haveing the same  issue right now, no sleep after comming off the MIRT, what did you do? My GP will not give any BENZO, Please let me know how long the Insomnia last?

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    • Posted

      I'm having the same problem. I just found a tea with valerian root and passionflower, and it worked just as well as the xanax that I have. Wasn't expecting it to work, but I slept for the first time in a week!

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    • Posted

      Hi

      That is good news, Im on my 3rd day (again) off right now, I had to take 7.5 the other night, as I was 3 days with out sleep, Dr gave me some GABApentin  to help me sleep as I get off the MIRT and it has worked last couple days.

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