Tapering Mirtazapine - Driving myself up the wall!

Hi Ness

Sounds like all the symptoms of withdrawal there.  The shortness of breath isn't common, I wonder if this is part of the anxiety?  Mirt' wd symptoms do come in waves, a couple of good days a couple of bad then suprise you think you're well again and another wave comes along.

4-5 years is an extended amount of time for Mirt', I just think it would be best to go a little slower, give the brain time to catch up when the physical symtpms pass too, and wait until you feel fully stable before doing another drop.  

I hope it goes well for you, I'm tapering also, having a day of fatigue ~ seems to come around day 4 or 5 for me, eases around day 10-12 then I feel great again !

Best wishes 

Thanks. I think you may be right and it's an anxiety thing although thankfully it seems to have passed again today. I'm seeing my GP next week before the next drop so will definitley just check it out with him. He's pretty good with this kind of thing. I'm getting a bit bored of this wave thing. It's almost cruel how it convinces you all is well then nope, not ok.

It turns out after doing some research, I've actually been on it for 6 years. I was quite surprised that it's been that long. I'm not worried about how my mind is going to cope through this process, maybe thats a tad naive but it is always the physical bit that I'm going to struggle with. I think with my thoughts, I have the ability to rationalise that it's a temporary state but who knows, I've not come off it completely yet so that could change. Once I do the next drop, I will be staying there till mid may as I have deadlines due and I heard that less than 15mg is when it starts to get challenging.

How are you doing with your taper? What dose are you down to if you don't mind me asking? Fatigue is rubbish so rest up if you can. Blankets, tea and a good book/tv may be in order.

Sending good thoughts.

Hi Ness

You are lucky to have an understanding doctor, most say you can quit within a few weeks, but OMG many have tried and ended up back on full dose, that is crucifying for the confidence of ever getting off them, so I bang on a lot about going slow off Mirt' as I think its key to success.

I was on 15 mg for over a year and began a slow taper October time, am now at about 4.5 mg, I have been doing a 5% every 2 weeks, occasionally a tad more.  I was lucky to get the liquid version from my doctor, but it is expensive so I had to beg !  I think it is ony available in UK, are you UK?  

My taper is going well (touching wood), my sleep is good, no nausea, its just the odd bouts of fatigue (in waves !!)  Those darn waves !!  And feelings of lowness, a few days, maybe 4 or 5 each time now.  I wouldn't worry about it getting tougher if you go slowly, but if you go from 30 to 15 you may well get sick, but if going from 45 to 30 was easy it may be ok for you, we're all different, there is no knowing until you try, sadly!  The lower doses are more sedating though, you may well find this, even at 7.5 some folk really struggle, I had bad fatigue at that too, but it improved.

Yes I aim to rest up when fatigue hits, I do my share of exercise and am pretty active so I do reward myself with a good book, sofa, blanket, cat one side, dog the other for a little while in an afternoon when needed !

Wishing you well  

 

Hi,

Yea my doctor is pretty amazing. Not just for this but most things in general so I am definitely lucky in that regard. I hear what you mean about doing it within a few weeks. It can totally throw you for a loop. I had an experience a couple of years back when they wanted to switch my meds. The plan was to taper over a couple of weeks and then switch. I got to the end of near those two weeks and was a mess so we went back up to my original dose of 45mg and stabilised there. It put me off trying to get off for a while and kind of thought that I'm just going to be on them the rest of my life. However I wasn't doing so great at the time anyway whereas this time, I've been tentatively ok for a while.

I am UK based. It's good that you've found a plan that works for you and that your main issue is fatigue. Hopefully that should wear off soon. I've heard other people mention the liquid and I can see why some people would go for that option.

I figured I would try the 45mg to 30mg and see how it goes. You just don't know how your body is going to react. I've had friends who have come off 45mg cold turkey or a rapid taper and were fine whereas others have struggled. Just like trying to find the right meds to work for you, it's trial and error. It's been a couple of days now since I've had symptoms of this drop so I'm hoping they have mostly passed now.

Glad you're doing things that are good for you. It's really important especially when you're having those days when your mood is a little lower than usual.

Sending good thoughts.

It takes as long as it takes.  If you are willing to ride out such severe symptoms, then hold extra long between cuts.  

There is an interesting scientific paper that looks at receptor occupancy rates for a variety of SSRI/SNRIs.  Mirt is not one of these but it stands to reason that it operates similarly.  At the Minumum Effective Dose for each med, receptors are occupied at 80%.  As you drop below this level, receptors free up at a frighteningly fast rate; small cuts lead to big drops in occupancy, and that means big-time destabilization of the nervous system and big symptoms.

Mirt's MED is 15 mg.  So, below this dosage, things can get much worse, especially if you a) drop by too much and/or b) drop too fast.  On a withdrawal forum I am on, they recommend 10% cuts every 4 to 6 weeks. I know that for where you are at, you won't be patient enough to do this.  At the very LEAST, you should hold for four to six weeks between cuts.  This is to allow the nervous system to get caught up.  If you cut too soon, even if you feel better, you will exceed your nervous system's ability to keep up and modify back.  

That is why I say it takes as long as it takes, regardless of what we WANT.  You must listen to your body.   If it is bad no, it will only get worse the lower you go if you cut by large amounts.  If you break a 15 in half for 7.5, that is a 50% cut as far as your NS is concerned, not 25% of your starting dose.

I hope that helps, probably not what you wanted to hear!

Thanks for your reply. It sounds like an interesting paper and it certainly makes sense.

My GP has told me that I have to stay at this dose for at least a month and before he agrees to any drops, he wants to assess the situation first. Initially we'd talked about going from 15mg to 0 but he wants to go to 7.5mg next at least and again hold for a month. I trust him so don't intend to get ahead of myself on that. I don't think I'm strong enough to put my body under that much stress of doing it too quickly.

Sometimes as awful as all this feels, as long as I can say it's only a withdrawal symptom it makes it more tolerable. I can freak out less. Does that make sense? I find myself constantly checking to see if other people have the same symptoms as a way to reassure myself. It's borderline unhealthy but it weirdly keeps me going at the moment.

Be good to yourself.

I'm happy to hear that your GP sounds to be quite reasonable, understanding the need to give your nervous system time to adjust.  Seems like so many docs are into pushing their patients off too fast, causing a lot of suffering. 

And checking symptoms and looking for reassurance is EXTREMELY common in withdrawal - it seems to be a withdrawal symptom in and of itself LOL!  

It does help to be reminded that this is withdrawal, not YOU.  I wish more people would find that reassuring :-)

Good luck!

Hi Ness

Im at the same rate as you so completely feel your pain right now

I still haven't got over the drop from 45 to 30

Withdrawals were really bad at 2am

I'm off to see the doc

I took 7.5 early hrs and has helped so much

I'm not putting dose back up as it was the cause of my panic attacks

Just going to take the remainder this evening

Has taken away worst of withdrawals

I struggle with day then seems to settle down in the evenings

I'll let you know what doc says

Hope you feel better soon

S x

He is very good and knows what he's doing. I ended up asking him about all the little odd and more disturbing issues I had in that first phase of the drop and he just knowingly nodded his head and reassured me that those were to be expected, especially with the length of time I had been on it. He ultimately just said "Your body is going to be freaking out for a while, it won't know what you're doing, it's not going to like it. It needs time to adjust"

I'm so relieved to hear that others check symptoms too! Haha, it could totally be something in itself aswell.  Thank you, I suppose it's finding the ways that work for you but if you can see that this is just the process and hopefully not permenanat, then I think it makes it easier to get through it. You know eventually there is an end point.

Hi Suzannah,

I'm sorry you're finding it tough as well right now. Are you splitting the 15mg or are you down to 7.5mg?

I hope your appointment goes ok and that he can either offer reassurance or something helpful! I can understand you not wanting to go back up to the above dose but maybe it's definitley about riding it out and stablising here for a period of time. I gave my body just over an extra week of feeling moderatly stable before moving down.

What kind of withdrawals are you feeling? The worst of mine are in the morning and last thing at night after I've take the meds. However the anxiety pretty much runs at a constant all day though I have been an anxious person for a long time, even on the meds so it's nothing overwhelmingly new. I manged to finally get a little bit of decent sleep last night which feels better this morning and so far only a tension type of headache going on.

Check in with me later and do let me know how it goes.

Good Luck! Sending you good thoughts x

Hi Ness

I'm still tapering from 45 to 30

Day 14! I'm waking in the night with anxiety that then turns into indigestion and nausea. Finding it increasingly hard to wake my brain up and can't deal with anxiety until it's engaged.

Ive nefer had anxiety before. I started having panic attacks 3 years ago after an increase of my meds from 30 to 45. Within 7 weeks i had my first panic attacks ever!! We didn't realise it was the meds straight away

Mental health put me on citalopram as well but that made anxiety worse so I weaned off that and did feel better on 30 of mirt

Although the panic attacks stopped i was left with bad anxiety.i cant handle any more meds.

So were weaning me off mirt to see if that was the problem. Withdrawal is hell. I don't take drugs so didn't think I'd ever have to deal with this.

My main anxiety is that I'm too ill to look after my kids and have no support.

So struggle on regardless

Keep telling myself that it will all end soon

Im sorry that you are struggling if I'd known what these meds were like before i never would have taken them

But they did get me out a hole at the time

Doc said is fine to take 7.5 in morning if I'm struggling and take the rest at bedtime. And to not do anymore drops for at least 3 week

S x

Hi Suzannah,

Ok. You are doing so well to make it to day 14. I think once it gets to a certain point, it's worth reminding yourself that you're almost through the worst of this reduction. It shouldn't last too much longer. I completely hear you on the anxiety front, and waking up with it is always difficult because you don't have the capacity whilst you're half-asleep to rationalise yourself through it. I feel your pain.

It's so hard to unpick the anxiety. I had an increase in certain irrational and anxious thoughts a few years back which I never would have considered before. It's difficult to know whether they were a reaction to medication or if it was just the natural progression of my Mental Health problems. I doubt I will never know as even if they were med induced, they exist know and it's so hard to unthink something once it's been thought of.

With the time-frame though it makes sense that your anxiety attacks could have been fuelled by the med increase. I suppose you will be able to measure it once you are med free.

Worrying about your kids in all this is totally understandable. They are your responsibility. How old are they? It's difficult doing this with no support at home. Do you have friends who can help out? Or extended family? As for feeling ill, think of it as if you had food poisoning or the flu, you would be ill then too but you'd figure it out. This is no different.

It will end soon!

You know, I've been so terrifed about this process ever since I made the choice to come off them last year and I think my anxiety is being fuelled by that fear in addition to the withdrawal. I kind of need to get a grip on that fear. If I knew everything that I did now, then....I would still have taken them. They served a purpose amd yes untangle what changed things for me because there was a lot of things but I think the meds had a part to play, even if it was only small. I'm still here and that for a long time was an unthinkable prospect. So I would do it again.

Your doc sounds like he knows what he's doing. You take this as steady as you need to! x

Thanks Ness

No unfortunately i have very little support my friends work or have family of their own. Doesn't help i was moved 30 miles away from my friends and family

I now know i have no choice but to at least reduce the meds and see if I feel any difference.

Scary part is because the withdrawal is making me so Ill its fueling the anxiety that I can't look after my kids which is Rediculous because I've been doing it 8 years! But I haven't felt well in years. Always tired always lethargic. Didn't matter when I was in my relationship because he liked me at home.

Now im single i want to get back out there and am frustrated because these meds make me feel so ill. Even when I'm stable I've had increasing hip/back pain. My chest and heart gets tight. I know these are symptoms of anxiety but i wasn't put on them for that. I dont understand how i can be anxious I'm not scared of anything apart from being ill and not being able to care for my kids

Hoping i feel better soon as confidence is taking a knock. But I was fine on 30 before. You are right! Just gotta ride it out. When I feel better i can rationalise my thoughts.

Don't be scared it's the same as going on them in first place you don't know how you are going to feel.

Know what you mean about picking through anxiety. Half the time i have no idea what I'm anxious about. Just feel anxious. All the time!!

Has been worse since med increase hence the reduction.

I think ive always had a fear of being ill. Mainly because my ex would get angry at me about it in the end that's why we split

I want councilling as think my bad relationship has led to a lot of my negativity. But I need my head clear first before i can tackle any of that.

Do you find you get better in evenings? I usually pick up around 3pm then have a mad rush round the house making sure everything's done for next day as I'm useless in mornings

I hope you feel steady soon like a little break before we do it all again

S x

My screen froze twice and I lost my entire reply! Definitely been one of those days

I’m sorry that you have such little support. Doing this with people is hard enough but when you’re doing it on your own whilst raising small people will just be making it feel that much more challenging I imagine.

I have really good friends and my family don’t live too far away but it’s hard to explain what this feels like. Most of my friends have never been on psych meds so they would find it difficult to grasp the process of withdrawal, so I don’t talk to them about it. I don’t have the sort of relationship where I feel that I am able to talk to my family about this either. They are so terrified that I am going to become unwell again, that even the slightest change and they want me to go back up to my regular dose. I understand their fear, it was a scary time but equally I have to go through this process because I have to know whether I do need to spend the rest of my life on meds or if I don’t.  It could be either way. In all honesty though, I feel really alone at the moment.

That’s a justifiable fear to have, although I would say that you have 8 years of evidence that tells you that your anxiety is playing tricks on you. You have done 8 years of doing it so there is nothing to suggest that that will be different. This is the point where you begin to change your life I guess and make it into something you want to engage with, like going out and meeting new people. The feeling unwell won’t last forever. I get that it would feel like you’ve lost your confidence a bit too. It sounds like you’ve been through a lot and I hate to use this word but this tapering can make you feel vulnerable. It’s like you’ve lost a few layers of defence in the process and you feel a bit shaken by it.

I wish I wasn’t scared but the anxiety and fear has been a building process, especially with the health anxiety (Never had it pre-mirt). However I wonder how much of that comes from the meds or how much of it was just the natural progression of my Mental health problems.

You know, I don’t remember going on them. I was so acutely unwell and spent about 5 years in and out of various psychiatric hospitals, 3 or 4 months in, a couple out, then back in…I had so many drugs thrown at me, I wasn’t even present half the time and so I can’t remember what it felt like to go on them and I didn’t care at the time how my body felt because everything felt awful.

I hope you manage to get the counselling you need. It sounds like being able to talk to someone and work on that aspect of yourself is really important. It’s all about timing with these things I guess.

I’m steady usually from mid-morning to the evening. The worst of it hits me around 9pm and then I take my meds at 10, and everything just kicks up a gear.  The nights are extra hard because I live alone and I’m always afraid that somethings going to happen and they’ll be nowhere there to help. Last night I felt like my body kept forgetting how to breathe or my heart forgot how to beat for a few moments. It was so quick and yet so terrifying. Also my swallowing is a little weird at the moment. Can you relate?

X

Yes Ness! !

I feel like I've swallowed a golf ball!!

Same last night. I think i hold my breath sometimes during anxiety attacks especially when my belly joins in.

Have to remind myself to breathe. And when it happens during night I'm still half asleep and not awake enough to deal with it.

Do you struggle to wake in mornings?

Ive never had health anxiety before mirtazapine either but then again i have never felt so ill either.

Sounds like you've been on a roller coaster in and out of hospitals. I've been so tempted to book myself into the priory lol. But then i realised that there is no one to have my kids. My sons autistic too so have to think of his mental health too.

I can remember when I first went on meds but don't really remember side effects. Didn't really get any with mirtazapine and it served me well for 3 years. But it has messed with my insides i am now sensitive and allergic to everything!

Im so pleased you have lots of support and know what you mean about not being able to talk to them about it. Ive found they either don't understand though lack of experience or they're fine to listen the first few times but are then bored of it. Like aren't you over that yet? You taking your meds? Etc

My famiky have a history of mental health but don't want to support me as it could set them back.

Im surprised you get worse after taking meds at night?! I'm the opposite my body calms down like a crack head getting a fix. Is the only time i can settle and eat something. I'm taking my meds early atm around 5pm justnto get a few hrs of peace. It all kicks off again in the morning.

Sounds like everyone around you have your best interests at heart but i whole heartedly support you

We've got to at least try

Much love

Im here if you need a chat

Youbare not alone

You're doing great even though you don't feel it

Will all come good in the end

S x

That's a relief to hear although sorry you're experiencing it too. Sometimes my swallowing feels so uncoordinated.

Not really, I've been waking up naturally a little earlier than usual at about 6am. On days when I don't have to get up, I try force myself to sleep a little longer even for half an hour because I don't get to sleep till 12-1am. My doctor did say it might make me sleepier though so I think it's a normal thing.

It has been a bit of a rollercoaster, which may be putting it mildly. Seriously checking yourself into a place to withdraw isn't always great. I had to come off nitrazapam during one of my stays and it was horrific. All I wanted was to be at home. It must be challenging doing this and taking care of your kids. Extra demanding with your son I imagine. It sounds like you're doing a pretty amazing job though.

I think it serves a purpose for the time but then you have to decide when that point changes. It sounds like you've reached that place. Hopefully things will settle in time in regards to the anxiety. I'm the same with the allergy and sensitivity stuff but just figured it was me!

I can understand why your family might struggle to be supportive even if I don't agree with their position. I think that's what family is partly for.

I know it's weird that I get more anxious after. I think it's because it's the only time I really stop and have nothing to distract myself with. My thoughts have a habit of taking over. I'm glad you're getting some relief at least for a little while during the day!

Of course I'm here for you too. I really think that given time and perseverance we can get through this. You aren't alone in this either.

Xx