Unsure whether to wean off or not

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I was put on mirtazapine in May 2013 after I was attacked by my brother a few months before. I was low, anxious and agoraphobic. I was desperate. I couldn't eat and didn't sleep for 6 months. I weighed around 6 stone and felt ill. I am so against meds but gave in and took them but I said I'd only take 7.5mg. It helped, I felt calmer because I could finally sleep. I worked on the agoraphobia, I slept and ate well. I gained a stone and felt really well. Then at the end of 2013 my family got intouch causing me intense fear and anxiety and I was forced to attend my mums wedding. My anxiety got too much for me having to see my brother there and I started feeling full of anxiety and intrusive thoughts. My GP suggested increasing to 15mg. I agreed so in December 2013 I increased. I have been on 15mg since.

I have always worried mirt didn't help me that much since being on the 15mg but I am much calmer and although I still have anxiety and agoraphobia on and off life is calmer and I cope better if family get intouch. I sleep so well and I love food. So in some ways I can see mirtazapine has helped. I'm now 8 stone and healthy bmi, I was so thin and frail before. I never slept and was an anxious wreck.

I became ill last summer with chronic fatigue and I was sure mirtazapine was a big reason, I feel tired all the time no matter what time I take it the night before, i suffer from unreality feelings and zombie feeling every day. My GP said it sounded like CFS and I have now been diagnosed with an underactive thyroid. I have been very unwell with the thyroid but i have wondered if mirt was a big fatigue cause. I'm taking thyroxine now for my thyroid and feeling much better up the fatigue issues carry on which I'm told is due to my general anxiety issues and thyroid causes fatigue. I didn't have crippling fatigue until last year so I've been told mirt is unlikely to be the cause.

In the last month I've had a setback with my anxiety. I go through stages of well periods where I feel much better and I'm out and about again then wham a setback hits. Usually if my family get in touch and I have to see them I get very stressed and anxious. The last year brought back my anxiety strong as I was so ill physically wjd bed bound a lot that I developed agoraphobia and social anxiety again too. It's been a huge shock and a tough year having health issues and a return in my anxiety. My anxiety in the last month hit hard and it has been quite physical which is unusual for me but put it down to Christmas and me wanting it perfect. I get anxious every December.

I sat talking to hubby about mirtazapine. After 3 years should u wean off. I'm on 15mg. Surely that's a long time and I should come off it and it's not helping me right now through this setback or this tough year should I be off it? My husband says he can see my point but when you think how bad I was 4 years ago he thinks it's helped me. I see his point completely as there was a time he couldn't work as I'd need him home and I was traumatised and anxious all day. Yes I'm in a setback now but it's not on the scale it was 4 years back. So yes mirt has helped in some ways but I also wonder was my brother attacking me enough to cause anxiety every single day since. I have agoraphobia which I work on, I could do appointments again etc then I got ill and wham I'm starting again on the exposures but I do get out each day, not alone but I'm working on it. I've social anxiety where I can't socialise at all since being poorly this year all linked in with the agoraphobia, and general anxiety. I had worked hard on the agoraphobia and social anxiety and overcame it a lot until last year when my health issues began and it all returned.

So right now I'm worried do I start to wean off or like my hubby thinks now isn't the right time and as he says there's no need to. I just worry it causes my general anxiety as I've had it daily since being on mirt; but yes I did have it daily before but since mirt I seemed to develop fears of everywhere and everything and I've not had 1 day off from it. Maybe I'm looking to blame mirt as that's easier but it's a worry I have hanging over me as I've not had 1 day off anxiety in a few years even when I've gone through better periods. I am in a setback right now with my anxiety, so maybe it's not the right time to wean off when I am already struggling with anxiety because I've heard withdrawal is hell and having anxiety moiety especially about health since being unwell it terrifies me.

I know I shouldn't put pressure on myself to come off it. I'm 37 and have plenty of time to wean off and right now why make my life harder but I worry it causes a lot of my fatigue and general anxiety. I never had anxiety this bad until the last few years. It used to be just health anxiety here and there but since I was attacked and put on mirt it became general all day and the added phobias which ok started before the mirt hence why I went on it but the general anxiety seems to be worse and daily. I have 3 kids and I plod on doing my best for them but get upset often I let them down having anxiety and now health issues. I can't due to health and agoraphobia do big days out, meals or cinema. All I could do again until I became ill last winter with the thyroid. I'm working on it again but get so fatigued still at times which then causes my anxiety. Since being ill this year my hubby takes them to any appointments and I feel I let them down. I still take care of them, take them to school, we go on holiday every summer an hour away... I beat myself up far too much.

Sorry this is one big ramble. I feel unsure what to do and I'm thinking right now is a silly time to even consider weaning off it.

Julie

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14 Replies

  • Posted

    Hi Julie,

    I think you should continue with the mirt - as it is helping with sleep and weight.  It is unlikely to be causing the fatigue.

    The problem you have is generalized anxiety - which 15mg of mirt will not help much. I recommend you see your GP and ask for drug which is more effective against anxiety - such as an SSRI  (eg sertraline).  Take that IN ADDITION to the mirt.   That is what I do - and it works well.

    Personally I have no intention to come off the mirt, but you can if you want to but do it when you feel much better.

    Best wishes. 

     

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    • Posted

      Thank you so much oldboy.

      My issue is i had an allergic reaction to an SSRI and trycyclic effected my heart so mirt was really a last resort. Hence why I've jist stuck at it.

      If it's unlikely to be causing the general anxiety I think I will stick at it because it does help my sleep and eating. I couldn't go back to insomnia and not eating, I was and wreck. My husband says I'm much better on it but I've had comments from people saying why do you take it and you're still anxious all these years later? They don't realise how bad I was before mirt. Yes ok I have anxiety again and agoraphobia but it's been triggered this time by ill health

      Thanks for your kind reply.

      Julie

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  • Posted

    Hi Julie

    I would say that you're not ready to come off of the mirtazapine yet. You would know if you were and would not need to second guess yourself. Even if you do decide to come off of the medication.it needs to be done properly and with supervision from your health care professional.

    I've been on these types of antidepressants for approximately 15 years and know that I will probably always have to take them. Maybe I can reduce my dose eventually but I'm not going to worry about it if i can't. I'm on 45mg of the mirtazapine and 20mg of citalopram .But the citalopram have only been added in the last 2 yrs. I am going to see my doctor next week as i am hoping to come off of the citalopram. As I don't think it's helping me much. But it will be being replaced with venoflexene to take in the morning.

    The most important thing is that you feel well. And worrying about whether you need to come off of your medication or not will cause anxiety.

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    • Posted

      Thank you Caroline.

      That's very true, I'm not ready and worrying about coming off it and worrying it's causing my general anxiety, fatigue and high cholesterol causes me more and more anxiety.

      My anxiety was much better until my health issues a year ago. I started worrying mirt had wrecked my health and my thyroid. Yet I'm still to afraid to wean off it.

      To can't take any other meds as I'm allergic to the SSRI family and the tricyclic effected my heart so that's why we tried mirt. It has helped my sleep and appetite. I'm a healthy weight at last. It's just the fact I still have anxiety and thr illness this year has brought back my general anxiety and agoraphobia I've had comments from people, why do you still take mirt if you're anxious? It makes me worry why do I even take it. My hubby said to me prior to mirt I was a nervous wreck to the point he couldn't go to work, I'd shake all day, afraid to be alone or alone with my kids, intrusive thoughts and I'd have to call my friend all day if hubby had to go into work. It was hell. So although I've general anxiety now and agoraphobia again I am a lot calmer on mirtazapine. I've learnt to cut off the toxic family and dealt with it all much better because prior to mirt I was crying all day hurt that my brother did that to me and my mother and sisters bullied me for 2 years after, demanding I forgave him. They were awful to me and made my life hell. So I think mirt definitely helped me cope better once on the 15mg. So maybe it's done more good than I realise.

      Thank you

      Julie

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    • Posted

      Hi Julie

      What a terrible time you've had with your family. You take care of yourself and your family first. They need you.

      Maybe as oldboy said your doctor could give you something for the anxiety. To take in conjunction with the mirtazapine.

      Take care. Hope that you feel better soon.

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  • Posted

    Sorry Julie, got 2/3 of the way and needed to stop reading. I would definitely say remain on the mirtazapine, it's a good antidepressant and helps with anxiety and to gain if you have weight issues.

    As a psychiatric nurse myself I've been on them for several years and have no intention of coming off them. Yes they have negative effects but the fact I sleep now most of the night is a massive plus as a chronic insomniac due to anxiety. The fatigue you felt is most probably the under active thyroid.

    I think you are over thinking everything, and might I suggest maybe slightly obsessive as I can be too, as I yearn for perfection. This inability in realistic terms to achieve perfection increases the anxiety and I can understand family issues exacerbate this as I have that also.

    I'm also on sertraline 150mg on an evening which also helps anxiety as I have physical problems which add to my anxiety and depression.

    Don't worry about weaning of them, it's a low dose and you'll know when you feel mentally well enough to try this but get support to do this when the times right, one small step at a time.

    An analogy is telling someone with high blood pressure to wean off the medication if they have good readings. They have good readings as they are on medication if you get my point.

    Try not to over think the reason for anxiety, it's there and part of helping to treat it is with medication and maybe CBT Cognitive Behaviour Therapy however it wasn't for me tbh.

    I hope you try and just relax, sleep well, try and maintain your good weight and try walking and mindfulness is the 'in thing', lots on Amazon Kindle, however I distract myself with TV.

    You'd be surprised that lots of psyche nurses are prescribed medication, so understand more than you know.

    I would stay on them record the fatigue in a diary and what you've done and dose of thyroxine as I genuinely think it's that however mirtazapine can cause some sedation but not really in lower doses. I take mine at 10.15pm and I'm up for 6 to 7am.

    Hope this helps, try not to worry about coming off them yet. Try to distract yourself when you feel anxious and a diary of fatigue and what you are doing, when it happens etc.

    Best wishes x

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    • Posted

      Thank you so much Lynn.

      Sorry if my post was long and hard to follow.

      Yes I do strive for perfection. I'm forever wishing I was the old me who could take her kids to appointments alone etc.. comparing myself to other mums is a big thing I do. I have had therapy and been told I need to stop beating myself up and wishing this all away.

      I've found therapy not that helpful either. I did it for a year, it helped a little. I found self help books helped even most.

      My sister is a psyche nurse and on medication herself for panic attacks and anxiety.

      I have started cat again, I've decided to give it another try. My therapist last week diagnosed general anxiety disorder and very low self esteem as I beat myself up thinking I let my family down.

      I agree it's not the right time right now and probably it is my thyroid still causing the fatigue issues. I have to pace myself daily because if I overdo things I crash and end up needing to rest for a day. Slowly that's got better since on the thyroxine.

      Thanks again for your reply.

      Julie

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    • Posted

      Julie don't beat yourself up hun, just know you're not alone. I'm the same and was one told if you achieved perfection you can only go down so best to get to 80% if that makes sense.

      Lots of us want to be who we were, me included and accepting it is hard so I certainly understand. I keep thinking contentment is maybe better but I'm not minimising how hard it is or how you feel but just know I get help from watching nature programmes on TV, which help me relax and it was on the news the other day reading lots of Facebook makes you stressed as you think everyone has the perfect life when in fact they don't.

      Just try and manage one day at a time maybe have an app to record anxiety levels and if it relates to anything apart from family issues.

      I'm right there with you on that one, my brothers back from abroad in 2 weeks and dreading it is an understatement.

      There are many people like us, I'm 54 and lots of various ages so just know you're not alone.

      To a better new year 😊

      Lynn x

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    • Posted

      Hi Lynn.

      Oh I agree about Facebook, I came off it this summer for 2 months as I couldno face seeing all the mums off here and there with their kids and I was poorly with my thyroid and anxiety. I felt guilty.

      I just need to learn to stop beating myself up, install some positive thinking into my life as I'm very negative since all this began and always jump to the worst conclusion. I have health anxiety since being unwell and for example today I've had weak legs and fatigue with low bp. It sent my anxiety rocketing and I worried I was in an energy crash and was my health getting worse again. My hubby said it's from the weeks of high anxiety recently and noe I'might left exhausted and weak. It probably is that but my anxiety races in my mind worrying I'm ill or will collapse. It's frustrating how anxious I've become since being unwell physically. My body needs a rest not more worry lol!

      Thank you for your kind words.

      Julie

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  • Posted

    I think that you should give yourself more time on the Mirtazapine especially as you have been diagnosed with an underactive thyroid. I am a lot older than you and after the menopause I was put on thyroid meds and it took over a few years before they got the balance right. Now in my seventies I find myself on Mirtazapine 45gms and Venlafaxine 150. I took a dive after I had my gallbladder removed 2 years ago and this year had aknee replacement. I feel really good although I don't like being on the meds. Perhaps I will be on them for life, if so then I feel grateful for the possibility of them being there. In my 20s I had a serious breakdown and there were no drugs available to sort me. Like you I don't feel confident about coming off them, presumably your GP put you on them so why not go and ask for a review and be honest about how you feel. Good luck

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    • Posted

      Thank you.

      I guess I do need more time as I've been going through enough this year.

      I spike to my gp a few months back and he doesn't think it's a right time to wean off meds at all. He said I've been through a lot of trauma the last few years and why risk a huge setback. I'm in a setback right now but hoping therapy will help with that. He said why risk coming off thinking it'd not helping if you've still some anxiety issues and you could come off and feel even worse which is true, it's just with still having these anxiety setbacks I think why bother taking it I guess. This last year I've setback but as he said the illness with my thyroid has caused that as I went downhill and bed bound with it for a long time and lost all my confidence again. I guess prior to the ill health it was helping as I overcame so much of my anxiety and agoraphobia I was battling.

      Thank you.

      Julie

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  • Posted

    Hi,

    Let me give some good advice, doint listen to people on the internet, everyone is diffrent and have diffrent issues and take many more medacations then what they are telling you. Talk to your Doctor, when you talk to your Doctor it is ther job to listen no matter what.

    Good luck

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  • Posted

    Hi I know exactly what you mean about general Anxiety that's all I had,it was nothing like the chemical imbalance sort of Anxiety that you can get with Mirt w/d's

    The Mirt causes actual fear, it's a thousand times worse than any regular everyday Anxiety

    I thought medicine was there to make you feel better,I feel worse than for taking it

    Hang in there!

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