Need advice to come off Mirtazapine after 2 months

Advice to come off Mirtazapine after 2 months

Hi.

If you would like to skip the details on the last 2 months and get to the question, you can skip to the "**********" I left, although I'd appreciate the company of being read.

I'm 27 years old and I want to explain briefly my experience, hoping I could get replies from people who relate to it or parts of it, and get advice on how to get through this.

I had anxiety issues all my life but they weren't completely incapacitating. I tended to have very physical symptoms of anxiety like fatigue and muscle twitches, which would typically pass; A LOT of IBS.

Starting march this year I had been experiencing worsening of anxiety probably from being 3 months jobless, I used to sleep very late at night, probably 3-4 am, and wake up very late too, 1-2 pm; I was categorically depressed, extremely fatigued during the day, but played videogames and so on. A GP gave me tramadol, 5 drops each meal (that's 3 times a day) until I saw a psychiatrist. I first did my blood and thyroid tests that came out great. Then I had some throat twitch or spasm when falling asleep, like swallowing, that would wake me up and not let me sleep. This caused me panic form fear of not being able to sleep, and after just 2 or 3 nights I ran to the psychiatrist. I had already stopped tramadol and first I was given just quetiapine for a few nights, and could sleep, although spent the days immensely anxious and afraid of these twitches, my sleep and my health.

---7.5 to 15 mg---

Then a different psychiatrist changed it to mirtazapine 7.5 mg for about 4 nights, then up to 15 mg, plus Zolpidem(nocte) 10 mg to sleep and regularize sleep schedules.

The reason for mirtazapine was that I had vortioxetine in the past, an SRRI, and it gave me nausea that persisted for 3 weeks, and mirtazapine is an atypical antidepressant unlike vortioxetine. I also had sertraline for no more than 2 weeks some year before that, with no side effects, just no benefits, and I was impatient. I suspended both vortioxetine and sertraline back then without issue, and didnt take any meds for years after that, until now.

Anyway I began sleeping again although at very frist it was complicated and anxious from the crazy anxiety I constantly had. Then things got more stable but I was very depersonalized, I was disconnected, derealized, I couldn't focus on complex tasks (I'm a programmer, I also like drawing and painting digital art). I could hardly listen to music without it being numb, I couldn't watch a movie on the telly without feeling anxious.

I had sometimes these brief moments of intense tranquility and happiness, when I felt back to being myself, lasting about 30 minutes, but they were rare and few.

I had a lot of pressure to feel better because of a 2 week disney trip with my sister and her husband's family, that had been postponed for more than a year. I hated the thought of being there while depersonalized.

So I consulted another psychiatrist and he suggested paroxetine 12.5 and risperidone on top of the mirtazapine to help the depersonalization.

I got serotonine syndrome after 2 doses, and I took 3; most likely due to the paroxetine. I had isolated horrible panick attacks, high pulse rate, chills that felt like burning skin all over my body, I tought I'd lose my mind. The effects passed after about a week, but I was still depersonalized and with anxiety.

---30 mg---

So I got my mirtazapine dose raised to 30mg. Since I take it at night, the first night I felt some physical anxiety that I could tell seemed from the medicine, but then went to sleep maybe with the help of Zolpidem.

The next week I didn't notice much improvement, I was still anxious and fatigued during the day, and not myself; although I lowered the Zolpidem dose to half, which felt good. The sudden moments of happiness and of feeling myself I described wouldn't happen again after the 30mg dose though, although I could rarely get "close" to it when I managed to relax once.

I went to disney, the happiest place on earth, and it wasn't nice for the most part. The first half I could spend the days very very anxious, sometimes worse, and not myself. Some rides would even scare me when I know I wouldn't get scared, I wasn't reacting to things I love the way I would, which in itself made me feel worse. The last few days of vacation were better, but the times I enjoyed or even laughed I still could tell I wasn't myself. I also found that most of the times I couldn't take naps or sleep during the day because I get anxiety dreams, sleep paralysis, that tick on my throat, etc etc, but I slept well every night during the trip's 2 weeks and until now when I'm writing this (just an extra 1-2 weeks).

The doctor said that improvements should've been seen during the first week of the 30mg dose, but I don't think mirtazapine has helped much at any dosage either for anxiety or depersonalization. She tried to mention improvements that I think could've happened just with the passing of time and my own adaptation, like some other time I had a big anxiety episode, and not because of the medicine.

She even made up improvements of things I didn't even say I had, like "you no longer have so much nightmares". Mirtazapine made me dream a lot, some of them anxiety dreams (worse than nightmares) and yes, it wore off. But it's no improvement to improve from an issue that I didn't even have without mirtazapine.

So, recap, it's now been 4 days on 7.5 mg, then about 3 weeks on 15 mg (when I took the paroxetine and the risperidone and had serotonine syndrome), and 4 weeks on 30 mg. So that's About two months now.

She suggested to add aripiprazole, an antipsychotic, on top of the 30 mg mirtazapine; 1/4 of a 15 mg pill for 4 days, then up to 1/2.

I'm not taking more pills, didn't even buy it.

After the disney trip I've spent the last few days at my hometown where I was born (I live alone in big city), and I have noticed more improvements being here, which, being at the end of the 4th week of the 30 mg mirt dose, I doubt they are from the mirt, but from being with my family, feeling safer with my dad, etc. I wish I had gone here before taking any medicine.

It sometimes is discouraging to know that people think I'm well when I'm not yet well nor entirely myself (for instance, I still don't play my music). And worse, that I can't explain how I feel or feel understood because no one else here has felt this way. Also, I don't try to explain to protect them from my suffering when I know they are enjoying themselves; what I go through sounds scary to everyone.

Sometimes I feel like I act like myself from memory.

---

Anyway, the 2 main reasons why I want to come off mirtazapine are these (apart from it not having done much or nothing against my anxiety and depersonalization):

First, I have a little journal, which is somewhat incomplete. The first time I wrote on it about feeling depersonalized I believe was after taking the first 7.5 mg dose, which was right after my anxiety crisis started. Although at first I attributed it to having been a few days through a lot of anxiety, now I suspect mirtazapine to be the culprit of this so prolonged feeling.

Second, because I've read about getting off it, and sounds horrible. I'm scared of the medicine, I'm scared of getting off it, and I'm more scared of getting off it the more time I spend with it, because I know, irregardless, everyone gets off it at some point, except most people got benefits while taking it.

I've been through the worst experiences and doubts of my life and now, from what I've read, I may be up for even more.

Since I've improved since being with my dad, I'm also afraid to interrupt that to get off the medicine.

I was very suicidal at my worst moments, I've come to feel in ways I didn't even know existed, and to get off mirtazapine makes me fear for my life because of what I may feel. But to stay on it makes me afraid of it changing me for bad when I haven't felt myself, plus knowing that I have to get off it at some point anyway and most likely go through it anyway. I'm afraid of the insomnia some people have mentioned they are left with, I don't know for how long, while I also have to come off zolpidem at some point, which I also don't know if I ever needed. I wish I had never taken it, and now I want to get off it the best way possible.

I always thought I had so much to give to others, and the last two months I'd hardly wanted to have a conversation. I fear for my life and my loved ones form whom I want to be well again.

I would like some guidance on what I should do after 2 months of mirtazapine, how I should do it, and what your experiences have been. I trust that more than I trust psychiatrists now, who seem to know nothing.

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