Morning anxiety during withdrawal

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I have stopped mirtazapine 10 weeks ago at the beginning of April after tapering off from 15 mg since December 2019. I went faster than recommended because I had no major issues in lowering the doses first to 7.5 then to 3.75 and 1.875. After 1.875 I dropped 0.1 mg every 3-4 days till reaching 0.1 then jumped off. Normally I expected the rebound insomnia to appear and it did at 0.4 mg. After stopping completely the first 3 weeks and a half I slept around 3-4 hours per night in one block being unable to fall asleep again once waking up (usually around 3 am). After that period I started to have random nights with longer sleep (5, 6 even 7 hours) but in the last two weeks things went wrong again coming under 5 hours and constantly waking up around 4.30 - 5.00 with a very strange feeling that I am not able to describe in words. It's like I am shaken by an electrical burning without being able to determine where it starts and where it ends and once awake I feel weak, trembling and somehow anxious. I have to get out of the bed and start moving around waiting 1-2 hours till I get better. I checked on the forums about this feeling and I may think about a spike in cortisol that is waking me up. I did a blood check at 08.00 in the morning and the level of cortisol was in range but very close to the upper limit.

During withdrawal I am already using a variety of supplements to help like magnesium glicinate, holy basil extract, l-theanine, lemon balm, ashwagandha, b and d vitamins and for the nights when I cannot fall asleep naturally I took valerian but it is effective for me only in dose larger than 600 mg which is affecting the stomach and gallbladder. I also do a lot of breathing and mindfulness meditation.

Any ideas about this strange morning feeling or similar experience during withdrawal ?

0 likes, 21 replies

21 Replies

  • Posted

    look at surviving anti depressants. lots there about cortisol spikes including shutting out the early morning light.

  • Posted

    @sept76 thank you for the info. I checked and found useful information describing exactly my situation.

  • Posted

    hello I wonder if there is anyone that can offer some sort of advice, I was taking mirtazapine for just under 8weeks and decided I wanted to come off them as I was only taking them due anxiety and panic over the virus but I felt I was in a much better head space about it and choose to come off, I was taking 15mg for the most part of the 8 weeks and then tapered to to 7.5mg, I did that for a week and half until my doctor advised me to just stop altogether, first few days I felt great but after about 4 days I started getting very anxious and panicky for no reason, im worried as I'm not sure if this is withdrawal or just me being anxious as my doctor has said but this is normal for me to feel anxious for no reason at all, its effecting my sleep alot and the in my opinion is useless, suggesting im just an anxious person and that maybe i should try going back on the meds, i really dont want to be on them as I didnt ever feel like i needed them before the pandemic and dont feel the need to take them just for the sake of it, please can someone give me some insight im desperate, I feel like im going mad , this anxiety is crippling


    • Posted

      how are you now? i am also going thru withdrawal since dec 2020 and i must say i am having a very hard time as well. feeling hopeless and fearing my life is over and I will never be me again

    • Posted

      did your symptoms improve ? and how long have you been on mirtazapine

  • Edited

    I just decided to use this thread to make updates to my withdrawal journey as I keep going.

    Now I am in the week 14 since stopping and things look like this:

    1. generally feeling better than the weeks before but still stressing looking for a new job
    2. constantly falling asleep around 10:30 pm much easier than last weeks
    3. no more adrenaline rush at falling asleep
    4. sleeping mainly 4:30 hours but also twice I slept 6 hours. Interesting that I sleep always complete cycles of 1:30 hours.
    5. still having problems waking up at 3:00 or 4:30 due to cortisol raising without being able to sleep again
    6. still cannot nap at all during day (it happened to drift for 1 or 2 minutes but I wake up immediately with kind of panic).
    7. lower anxiety during morning but random episodes of deep fatigue during afternoon
    8. decided for a while to replace the morning and afternoon sessions of running with fast walking in order not to add more cortisol
    9. increased sessions of mindfulness, binaural beats, breathing exercises and cold showers with good results in BP (115/65 and under 60 heart rate).
    10. this week no digestive issues as I also reduced supplements only to morning (Mg, Fish Oil reach in DHA, NAC and randomly B vitamin complex).

      I will update next weeks looking forward for improvement in insomnia and morning difficulties.

  • Edited

    After a pretty bad week 15 with a zero hours sleep night and difficult mornings things went very well during week 16 as I finally managed to have at least 6 hours sleep each night. Looks like that as I am able to sleep more the body is recovering and both adrenaline rush and morning dreadful waking up are less present. I even had a nine hours sleep night (the first in 2 years) so looks like I needed 3 months and a half to see the signs of getting over the rebound insomnia generated by mirtazapine withdrawal.

    Really happy to see that I can feel normal again after the weird and strange feelings I have experienced being on mirt. Also it is good that now I managed to fall asleep again after waking up around 3 am or 4:30 am which was impossible in the first three months. Still very interesting that I have only complete cycles of 1:30 hours sleep.

    And one combination that works now to help me fall asleep in the evening if my first natural try fails : 1 mg natural source melatonin + 200 mg L-Theanine + 30 drops Lemon Balm tincture.

    • Posted

      how long have you been on mirtazapine before stopping and which dose

    • Edited

      I have been on mirtazapine for 9 months till cleared out. Mainly I have been on 30 mg but as I used it for the sleep issues I tested also 15 mg or 7.5 mg for some weeks. The doctor suggested 30 mg for antidepressive effect, but I know that I was not in depression, but in burnout.

      Last residual symptoms of withdrawal lingered for almost one year and two months but now I am completely free on any withdrawal side effect and also clear of any medicine.

    • Posted

      glad to hear that you are okay now

      when did your insomnia improve?

    • Posted

      Withdrawal insomnia started to improve after four months since last dose but at six months I may say that I started to have enough sleep, even if it was broken. There were many waves and windows typical for withdrawal but there was a constant improvement with tiny steps.

  • Posted

    what can cause cortisol raising? and how did you managed to solve that problem so what you describe hre doesn't happen to you anymore, i think i have this, the only difference is that i'm still tapering, i'm at 1.6 mg and i really want to know what you have done to make all that hell go away! 😃

  • Posted

    Actually it did not go away completely but it is less severe than it was during first weeks of withdrawal. I think that I had it also during tapering but probably it was hidden by the sedation given in the morning by mirtazapine.

    You may look on surviving antidepressants forum where there is an extended topic on the cortisol morning reaction. Seems like our receptors being deregulated by mirtazapine have a overreaction to the morning cortisol curve. Cortisol spikes and generally any increase of cortisol is generated by stress both mental and physical.

    Overall my sensation is that with time passing as the brain is healing and getting to work again without mirt things settle and the more we sleep the less cortisol we have as good and enough sleep is listed as a major cortisol reduction factor. Once rebound insomnia is going away probably also the mornings will be better.

    Holy basil extract and phosphatidylserine are the supplements that are mentioned to reduce cortisol and I am taking them in the morning.

  • Posted

    New updates for weeks 17 and 18 of withdrawal.

    Unfortunately one step back regarding sleep as I had a lot of nights with 4.30 hours and only a few with 6 hours. I tend to fall asleep earlier (9:00 -9:30 pm) but I wake up around 2:00 am and cannot fall asleep back. I see that initial falling asleep was easier these weeks, also tried a few evenings to take 1 mg of melatonin with two hours before the desired hour for going to bed and it worked well becoming sleepy before passing two hours but not helping to maintain the duration. As I wake up in the middle of the night around 2:00 am the cortisol awakening response is not as severe like in the case of waking up after 4:30. I am still amazed by the exactitude of the sleep cycles as always waking up is at an end of 1:30 hours and always from REM phase as I remember what I was dreaming.

    Occasionally a few adrenaline rushes during the day and still not feeling well during morning when cortisol is rising (the worst sensation peaks around 07:00 - 08: 00 am).

    Also blood pressure goes lower but I think it is related to the supplements that I take.

    Finally I also had a few days with energy crush in the afternoon just one hour after the lunch, but on a positive side I also had my first 10 minutes afternoon nap in the last two years 😃. I wish it was longer but otherwise I still cannot sleep during the day, having strange form of anxiety as soon as I lay my head on the pillow and close my eyes. The anxiety goes away immediately if I wake up and start doing something.

    As you may see after 4 months of stopping the mirtazapine the insomnia is still present and I may say that it is the last obstacle in considering my experience a success story. I wait for future improvements hoping to get to at least constant six hours of sleep as I had in the previous windows.

  • Posted

    Today I have five month of being mirtazapine free. A little update on current situation:

    • sleep has generally improved as my average sleeping time for last month is getting to six hours after many months when I was dealing with constant 4.30 hours. Also lately I have nights with 7 and 8 hours but in two sessions with a wake up in between. The good news is that now I am able from time to time to fall again asleep in the morning hours, after 4:30 am if I wake up in the middle of the night. The dreadful anxiety I was speaking about in the previous posts is almost gone.
    • no more energy crush during the day as I have made changes in my diet upping the protein intake during breakfast and addition of healthy fats (raw organic coconut oil)
    • I noticed that now I see an immediate improvement in my mood after taking a small dose of 5htp. I have used 5htp in the past as a serotonin booster but it was not working. Now I take 80 mg around 7 pm and it probably helps with melatonin production as I fall asleep with no problem around 10 pm. I do not take melatonin anymore and also no other supplement in the evening.
    • During last month I had a bad wave of around one week started by use of antihistamine. I have ragweed allergy and as it its season peaks now my reaction was severe. But taking one Benadryl first day and one doxylamine the next one in order to stop my nose running and my eyes tearing brought me back from 7 hours sleep to 4.30 hours for 7 days in a row and it was not good at all. So be careful with any antihistamine use during tapering and withdrawal as they will stop the progress of healing the sensitivity of antihistamine receptors damaged by prolonged use of mirtazapine.
    • finally during last month I had no other symptom specific to withdrawal and I still feel confident about being my old self again after two years of medical trial and errors.

      I will be back with another update as soon as I will make eight hours the normal of sleep pattern. (Well I am more confident now that this is possible compared with the first months of withdrawal).

    • Posted

      i was just about to buy doxylamine to help me sleep.....bad idea?

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