When to jump off Mirtazapine in a slow taper?

I'd say that's a good indicator that you're close, for me the rebound insomnia was the worst thing so if you're able to sleep without it then that's really great, particularly given the reason you took it in the first place.

I suppose another approach is to step down in reasonable size chunks now but give each step more time to test that you're ok - does that make sense?

yes i go to bed see if i can sleep then depending on how long i get say i go at 10 sleep till 2 then i take nytylto get 4 more hrs dont no how ill get on with sertraline yet i start tom off Citalopram have you been on sertraline hope its ok thanks

I have been on Sertraline in the past, the startup side effects were similar but didn't last as long, it might be easier for you as you've already had time to adjust to different levels of neurotransmitters etc. due to the Citalopram - good luck! 😃

so are you saying i should already have a start up in the brain due to been on Citalopram so the side afects shouldnt be so bad im on 25 starting tomorrow straight from Citalopram 10 thank you so much for helping me appreciate it

A lot of people successfully switch from one SSRI to another, hopefully it won't be too bad - I'd expect to feel some effects but fingers crossed they're mild and short-lived 😃

Hi there, i Mitazapine an SsRi...i am going to docs tomorrow as i am feeling so awful at the moment and dont know what to expect from my appt, i am on 37 1/2 mg of mitrazapine at the moment, i cant eat,sleep relax i am a mess. i am losing weight so rapidly.

no mirtazapine isnt an ssri

It does Charlie and it's a good suggestion - it makes sense to try dropping by a bigger chunk than the .01ml I'm currently doing and see how I do before trying to jump the whole way off at once. Thanks all for your helpful suggestions/advice!

Mirtazapine is more sedating at lower doses (like 7.5mg and 15mg) and more activating at higher doses - I'd say your dose is on the more activating end of the scale. I would raise this with the doctor.

No, it's not an SSRI.

so would you think maybe to space the dose in the morning and at night might help. i have taken zopiclone tonight and i feel calm and relaxed, so wonder if a lower dose in morn so say still my 7.5 and the 30 mg at night of the mitazapine.

I'm not surprised you feel calm after zopiclone, I'm surprised you haven't nodded off - it knocks me out within 20 mins! (be aware that whilst they're not, allegedly, as addictive as benzos they are only for short-term use)

I'm not sure on the dose splitting - if you were aiming for sleep I'd take the lower dose at night but I don't know if splitting it either way will have much effect as you'll always have a relatively high level in your system. (Mirt has a half life of between 20 and 40 hours)

My gut feel is that perhaps you're still on too high a dose overall as you're experiencing so much agitation and the weight loss (the opposite of many people on Mirt!) is important to mention to the doctor. (tricky as these are also symptoms of anxiety, as I'm sure you know)

I know you've recently come down from 45mg - was that due to feeling jittery etc?

I think it's worth bearing in mind that everything seems much worse if your sleep is affected so I think the doctor needs to think about that carefully beyond the zopiclone.

Is Mirt the only thing you've tried for anxiety? (it might just not be the one for you, although I'm surprised the doctors haven't tried something else rather than just increasing the dose)

Hi Charley,

thank you for your reply. I wish and hope that the doctor understands the way you seem to. No i haven't been offered anything else for my anxiety although i have been having problems for a long time, they seem to go more with the depression side of things although i would strongly say that i don't suffer with depression. That is a one type fits all way of thinking. I used to be on Dosulepin and a small dose of diazepam until the goverment said it had health risks and that was about 2 years ago.

i am never able to see the same doctor and in the ten minuets allowed they just write another prescription.

i think many years ago i was put onto sertraline but changed to Dosulepin becasuse it made me manic. I DONT KNOW another drug for anxiety.

Sertraline and others like Citalopram, Fluoxetine etc. are SSRIs, the Dosulepin you were on is a tricyclic - there are other drugs in that family that are still prescribed e.g. Amytriptyline. Tricyclics are older drugs but it might be that the method of action of SSRIs and Mirtazapine just aren't helpful for you.

There are also alternatives like anti-convulsants like Pregabalin and Gabapentin which are often used for anxiety.

There's no quick answer but that does NOT mean no hope - it's just a case of finding the right key for the lock 😃

I wonder if you could push for a psychiatric referral? (psychiatrists specialise in medication)

Hi Charlie got 4 hrs sleep on my own last night took first sertraline today but dont no yet only taken 1 so hopefully your right unless the Citalopram is still in me thanks for listening Sandra

4 hours with no assistance from medication is great, sounds like progress to me.

Good luck with the Sertraline switch, I hope it's a smooth transition for you 😃

Charlie is setrline a good anti depresent for depresso4 and anxiety if so why did you come off it feeling a bit anxious this morning just have to ride it out only day 2 thanks talking to you realy helps

I was on it for 18 months, for me I wasn't sure it was doing much and I felt emotionally flat so I came off.

Sertraline works very well for lots of people for depression and anxiety, you just need to give it time and see.

I really hope it works for you 😃

aaHi Charlie 2hrs sleep last night back to the nytol im realy worried ill never sleep on my own again as i incrrease my sertraline to 50 as you go up dose that improve sleep Thanks Sandra

There'll be good nights and not so good nights but on the whole it should improve over the weeks.

It's not that Sertraline will make you sleep, it should improve your health so that you can sleep better.

Very early days, keep going 😃

Charlie only been on this med 3 days i sufer bad with acid refux it caused my acid to flare up prety bad will that go or should i stop it carnt put up with thar i am eating befor i take it also anxiety feels worse or will that pass Sandra

Yes, heartburn is listed as a side effect - as with all SSRIs the side effects should get less over time.

Also don't forget how anxious you've been over the change of medication so that is probably contributing to how you're feeling and not helping your reflux.

But do recognise that you have taken charge of the situation, you have changed doctor and medication which are huge steps 😃

Hi Charlie im going to take 40 of emzoprmol on a morning when i take the antidepressant instead of 20 on the morning and 20 at night stomach still sore with stomach cramps only on day4 they take forever to kick in thanks Charlie

You're 4 days closer to the side effects reducing 😃

Hi zCharlie ive been off mirt nearly 5 wks now still having trouble sleeping get 4 to 5 hrs not enough eyes sunk in my head any idea when these withdraws will subside 9 days on sertraline 2 weeks on thurs doc pho ing to assess hope to up from 25 to 50 will that make any difference to my sleep thanks for helpi g me much appreciated ☆Sandra

Although 4 to 5 is not much, and not really enough, it's more than I was getting when I withdrew, some nights it was zero and the average was about 3 so I hope it helps to know that you're doing better than I did 😃

When the Sertraline settles your sleep should improve, it takes a different amount of time for each person but each day, each hour, is another step closer. You are still early days on the Sertraline so don't worry that it's not going to work, it needs more time. We're all different but it took me 4 weeks or so on 50mg Sertraline for my sleep to become more normal, you might be quicker 😃

Charlie im frightened he took me off the mirt to quick and itll take months to come back thanks for answering Sandra

Don't be frightened, it will ease.

GP told me 8 weeks, but for some people it's quicker.

Also, you're only just starting on Sertraline and that needs time to work, be kind to yourself.

I know people talk about breathing a lot, but rather than deep breathing I've found Buteyko more relaxing - Google it and listen to a guided session 😃

im scared ive got mirt withdrawals then it could take mths for my sleep to come back Sandra

It will come back eventually but if you feel you need help in the meantime (whilst the Sertraline is settling) perhaps talk to your doctor about using a very low dose of Mirtazapine for sleep - I found that an 8th of a 15mg (1.875mg) tablet could knock me out and in fact chipping off a piece about the size of a grain of rice still had an effect - it's a very powerful antihistamine, much more potent than e.g. Nytol. Then you can taper off that slowly once the Sertraline is improving mood etc.

You must talk to your doctor first though.

Personally I think you've come so far that if you can manage a little longer it'll be better not to use the Mirt but talk it through with the doctor.

im not going back on mirt iwas thinking about a small 12point 5 if i can take it with what im on to help a bit or somthing else short time Sandra

phenergan

Phenergan is an antihistamine, it's 'first generation' so will make you sleepy!

so would that be worth a try will it be better than nytol do you think thanks Charlie

They're both antihistamines but it might work better than Nytol for you, some people do report that Phenergan is more effective.

I know it's tempting to take a full dose but perhaps try to take a small dose and see how you get on?

Hope you get some rest!

doc wont prescribe phenegan so sticking to nytol ive uped my tablets to 50 from 25 now just a waiting game how are you Sandra

You don't need a prescription for it, the actual active compound is Promethazine - Phenergan is just a brand name:

https://www.nhs.uk/medicines/promethazine/

I think Boots and Lloyd's both carry it under the brand 'Sominex' but you'll have to ask the pharmacist for it as it'll be behind the counter.

I'm ok-ish, thanks

That is awful Sandra, i have had prescriptions for it without any trouble,

but i cant take them. Maybe because you asked for Phenegan they didnt know what it is. They just don't get it do they.