reduction and next steps

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hey there everyone. Not posted for a bit but hoping for a spot of advice. I have been on Mirt for about 3 months, 15 upped to 30 then upped to 45mg. 45mg was the last try to see if this drug helped. Its not made much of an inroad so now looking at reducing down and perhaps trying something else. Dropped to 30mg last night, will do 30 again tonight, and seeing the community mental health team tomorrow to talk next steps. Would be grateful of any thoughts on speed of reduction from now. I was thinking probably up to a week on the 30mg before dropping to 15mg. then can you do 7.5mg? is that splitting a pill, I am in the UK so not sure if 7.5 mg can be prescribed. They are talking about switching me then to Lofepramine. I am not sure I really want to go down that road. This is going therefore from a NASSA drug to a TCA drug. I hear more positive things about combining a low dose of Mirt with an SSRI. Lots of questions here, just trying to be a bit more informed before my meeting tomorrow.

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13 Replies

  • Posted

    I just want to warn you that withdrawal effects of mirtazapine can be delayed - you think you are OK and then they hit you. I was only reducing slightly, every few days, but the WD hit me two weeks after starting the reduction, and just got worse from then on, even after I'd gone back to 30 mg. So based on my experience, I would advise waiting a couple of weeks after each reduction, to make sure you aren't going to get the WD symptoms.
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    • Posted

      thanks Pixie, how long had you been on it when you made the reduction?
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  • Posted

    I've been on 30 mg mirtazapine for 6 years, in combination with 225mg venlafaxine. Strangely enough I can miss part a third of the venlafaxine dose sometimes (by accident) and not notice the lack.
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    • Posted

      does venlafaxine help at all with mornings. I find on mirtazapine the mornings are really challenging.
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    • Posted

      Hi h9000. Sorry for delay in replying. I found early mornings worst so psychiatrist suggested taking 150mg venlafaxine at night with the mirtazapine, and 75mg venlafaxine as soon as I wake in the morning, that worked, gives me a boost, and I've stuck with it. It's that 75mg in the morning that I occasionally forget, but I don't notice until I go to bed and find the tablet still sitting there! So I suppose I don't need it so much now.
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    • Posted

      thank you pixie, helpful for future discussions. i had the CMHT meeting yesterday which was a good chance to talk but no decisions as it was more of an assessment. I made clear not keen on big med changes without a proper discussion on it, and due to that they were leaning towards taking me on for that alone. So for now I will stick with what I have changed, the drop from 45mg to 30mg of Mirt. Combining with Venlafaxine I will keep in the mind as a possible option.
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  • Posted

    Hi H

    Yep, I agree with Pixie, can't rush off Mirt ... no no no ... nasty if you do.  They say 10% reduction every 2 - 3 weeks.  But no ones thinks this is really necessary and do it quicker ... everyone's different.

    Hope you "get off ok" - look at some other discussions on this forum coz there's loads of advice there.

    Best wishes to you H.

    C

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    • Posted

      thanks well have been on 45mg for just a couple of weeks so I guess going down to 30 might not be too bad.
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  • Posted

    DO NOT, go off mirt, but do reduce to 7.5. If possible. Any of the SSRI are compatible. So no reason to WD mirt and don't because what happened to me was I thought it was the new SSRI that was the problem when hindsight proved I was in mirt WD. So go low mirt over to new med. you should be fine. Once you get stable you might want to re visit the thought to discard mirt. Then again people don't realize some of these AD are life long members and can't be quit, without creating a huge physical mess. I know first hand. So, please stay with mirt. Don't let them take it away before the new meds because you won't get far. Only sick as a dog.
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  • Posted

    I think mirtazapine and wellbutrin are the only drugs in their own class. But check. BTW 45 on mirt has never helped anyone on this site or others sites I've read and only caused problems. So you aren't alone .

    i would avoid desyrel serzone and bolvidion

    would go with Celexa escitalopram fluoxetine ( the last in particular has the lowest WD effects of any AD....from my own investigation. ) 

    lexapro is the most popular in the US I believe at this point. Good luck.

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    • Posted

      Thinking could make Rose the official Mirt' adviser - am certainly backing all this up for my own use.  Thanks a million Rose for 'being there' and staying with us all to help on our nightmare journey !!!

      Can't remember if you said you were on a low dose still or switched to another AD ?

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    • Posted

      I've just looked up NaSSA sntidepressants, also termed tetracyclic antidepressants, and found that Bolvidon (Mianserin) is in the group, as well as Mirtazapine and 3 others. Wellbutrin seems to be a different structure, an aminoketone, also marketed as Zyban as an aid you giving up smoking. It's fascinating what you can learn from the internet! Well, I find it fascinating, anyway.
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    • Posted

      be nice to understand it all, mind you the medical professionals don't seem to be that up on it all either, as much as you would hope. Main difference between different meds seems to be there are some that help with sleep like Mirt, and some with milder side effects.
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