Next steps reducing Mirt and bringing in new med

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Hi everyone best to come back here and give updates so here is mine and any comments and advice will be gratefully received. 12 weeks of Mirt which went up to 45mg for a few weeks and really did not help with depression, and left a terrible morning every day. Reduced to 30mg for a week, 22.5 mg for a week, 15mg for a week, and now 7.5 mg for 10 days. Started Lofepramine 7 days ago 70mg. I struggled a week ago, now for the last 4 days mornings are still a challenge but I am getting up instead of laying in bed in a half awake state. One thing the CMHT person helped with last week was making sure I put the effort in to break the cycle of mornings and getting up as a set time with an alarm, with tasks to perform like making sandwiches for the children etc. In myself I feel things are improving as far as you can say that, its always in a wobbly way but I hope I am getting there.

Seen the GP today and with respect to the cross taper of Mirt to Lofep the guidance I am getting is to now go alternate nights on the 7.5 mg of Mirt and stop in a weeks time and increase Lofep at that time. I would prefer to reduce the Mirt further but they don't issue liquid form and I am already splitting a 15mg pill in half.

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  • Posted

    Hi H

    Totally agree with your choice to cross over/WD from Mirt' more gradually, plenty of folk on this forum having trouble when jumping from 7.5 to zero!

    Whilst withdrawing ... go with the 7.5mg as you are, then if poss break tablet into 1/4 for 3.5 mg, and stay with that for 2 to 3 weeks or until you feel stable.  Then crush the 3.5 mg tablet into powder form & dilute in 100 ml warm water.  Drink 3/4 of it & throw the rest - do this for 2 - 3 weeks or longer if you feel unstable, can do alternative nights after this if prefered, again until you feel stable.

    The key things to remember with Mirt WD, never suddenly stop even at 7.5, and most important of all - withdrawl symptoms take 2 to 3 weeks to kick in, so always wait for that long between doses.

    Hope this helps a little - can go even more slowly if desired, hope all goes well H, keep us posted.

    Wishing you well x

     

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    • Posted

      thanks. have to say feel much more at ease with the idea of going down by half again than the on one day off the next idea. i have a pill cutter that can also crush them, so diluting like you say could be an option. does this properly dilute in warm water so you can be confident you have a reasonably even strength of mixture?
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  • Posted

    I am not totally sure how well it dissolves, have only read this instruction which sounded pretty good to me ... let us know maybe?  

    CITA's recommendation is to do 6 nights on the higher dose (7.5) and one on the lower dose, for 2 - 3 weeks; then 5 nights on the higher dose and 2 on the lower dose (spacing the lower dose through the week i.e. Monday & Thurs for example) then 3 lower doses per week etc ...

    There is quite a lot of angry folk out there suffering greatly with wd ... may as well do it slowly (even though switching to another AD).

    x

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    • Posted

      hi thanks. tried the dissolving option and worked well. The pill cutter i have has a crusher so as you said dissolved in warm water 100 ml then drink half. As before when i reduced dose the sleep last night was not as much, 2 hrs wake then 2 hrs more before a bit of lying awake and dozing before the alarm went off.

      I have been on this for 12 weeks so the reduction plan you mention seems slower than I would have thought I should do. I have dropped from 7.5mg to 3.75 mg last night and would like to stick with that for a week or so until the sleeping stablises more again then take a view. Took about 10 days at 7.5 mg to feel that I was happy to change down again. On the whole I feel better for reducing the mirt back even this far. So far getting up when the alarm goes and not staying in bed ruminating seems to be going ok and I am making better starts to the days. My goal would be to keep that going this week and start to form that as a good habit, breaking the cycle I was in. I am not sure on the higher dose of Mirt I could have even considered that, I was too out of it in the morning.

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  • Posted

    Hope it goes well for you H; that waking/half awake when the alarm goes off and ruminating ... totally know what you mean.  Glad the dissolve worked for you.  

    Sounds like you're being kind to yourself, take care & keep posting.

    smile

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    • Posted

      Hi thanks again. Same again today, 3.75mg last night, 2 x 2 hr blocks of sleep then half awake, taking time to just think about breathing deeply until alarm went off and must have dozed as I stopped doing it then did not realise I had if that makes sense. I would imagine I will feel tired later but will need to push through. Now its summer really noticing the lightness even with eye covers, could do with blacking out my bedroom window.

      First night of IAPT Healthy Minds course last night. The main thing I took from it was about the need for routine, which got shot for me, and now I want to keep that alarm the same every day no matter what and break the bad cycle I was in.

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    • Posted

      Hi

      I think you're doing well H, at least you are getting some sleep during your wd and it does get better in time.  

      I know what you mean about the light mornings ... that's why I'm putting off my wd until later in the year (my Psycologist said to stay on AD's for at least 6 months to a year and it will be a year in Sept).  I've done major work on my bedroom window ... blackout and heavy curtains - just need a pelmet now to total blackout !!!  

      The IAPT Healthy Minds course - is that unique to your area?  I googles but can't see it locally (Nottingham)?

      Have you thought of meditation too?  Train the mind?  As we train our bodies to be fit, its poss to do same for the mind.

      Best wishes H

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    • Posted

      Hi, was very tired last night what with the shorter previous nights and getting out on the bike all week so far. So was about 5 hours with a wake up in the middle. Still found the start today quite challenging compared to the rest of the week but still got up and got going.

      Healthy Minds I googled before I went on it and did not find anything either. The material I was given has the breakdown of the 4 weeks into Overcoming unhelpful ....1. bodily sensations 2. thoughts 3. behaviours 4. sleep problems.

      I would say so far as above the reminder that routine is important was what I have taken from it. Interesting reading if you google how long does it take to form a habit. The myth seems to be that 21 days is hard and fast. People can achieve this in a shorter or longer time frame. Another myth seems to be if you miss a day it is a problem. Research seems to show otherwise. Not sure if links are allowed here but these two articles were interesting:

      http://www.forbes.com/sites/jasonselk/2013/04/15/habit-formation-the-21-day-myth/

      http://www.theguardian.com/lifeandstyle/2009/oct/10/change-your-life-habit-28-day-rule

       

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    • Posted

        There is an IAPT CBT course which runs here so maybe it is similar to the course you are doing, II havn't done it but I did a CBT and then a Mindfulness course - training the mind/brain to be strong/positive/kind/not judging - even of self ....

      Read the articles, v good - the "missing a day" could work either way depending on wether a positive/negative state of mind?  There's a good book I read re sleep problems "Say Goodnight To Insomnia" - if sleep were an ongoing problem it could be helpful.

      Does the Lofepramine have start-up problems like some other AD's have?  

      Keep up the good work, biking, rising with the alarm, building a routine ... all very positive actions.  Must say I've slipped gym wise, and the Mirt' has helped me gain over a stone in weight ggrrrrr

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    • Posted

      Hiya, Lofepramine so far no noticable affects for me. Still on the lower dose. Sending you a PM for a bit more, you will understand why when yu get my message.
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