When to jump off Mirtazapine in a slow taper?

Well I think you were right, because about a day after I posted this I had a relapse. It was nothing to do with the medication - I had a stressful / traumatic event that just triggered everything off again - so I'm now back up to 7.5mg and have lost 6 months of taper in just two days. I'm trying to accept it for what it is and come to terms with the fact I may be on this medication at some dose or other for the rest of my life. You're right on WD - there are people out there who don't suffer with it, I know some of them personally. But from what I can see they are the luck minority. Once I've stabilized again I will continue on my slow taper of 10% and just see where life takes me. Good luck with your end of taper xx

Thank you for the well-wishes. Best of luck to you and please continue to go easy on yourself.

Linda I empathise with you, it is truly awful. Have you heard about Mirtazapine being more sedating at lower doses, eg at 7.5mg? There is a lot of publication about it out there. My psychiatrist seemed to rubbish it but he didn't say "it's not true" just "I haven't heard of that" (and I wasn't too impressed with him anyway). The jury still seems to be out but what I can tell you in my personal experience was that when I very first started on Mirt I went from 15 to 30mg after about 3 days - I was borderline suicidal from severe insomnia so I was just expecting overnight miracles and desperate for something to work. On 30mg the sleep got even worse - I constantly woke up and it felt like I was in a light / unrestful sleep the whole time. I dropped down to 22.5mg and then back to 15mg and held at that for about a week and pretty much as soon as I got back down to 15mg I started to turn a corner.

Everyone's experience is different but if you haven't already it might be worth having a read about the information out there regarding Mirt being more sedating at a lower dose and seeing what you think. Good luck - it truly is awful x

Yes one Dr i saw said this a couple of years ago but every time i went back because my anxiety was so high they raised the dose. now i am on 30 and 37.5 every other night since last wed and was told to continue this for two weeks. i feel like i am going mad and everyday and night is such a struggle.

Have you thought about trying something else for the anxiety? For example I am on Mirtazapine (for the sleep) and Escitalopram for the anxiety. Arguably I don't need the Escitalopram because my anxiety is only ever caused by very severe insomnia. But I did find it worked for me. You can only be prescribed both by a psychiatrist I believe - apparently the risk of seratonine syndrome is low as they're different kinds of AD. Might be something worth discussing with a proper psychiatrist who knows the medicine. I have to say that I have read a lot of people having less positive experiences on the higher doses of Mirt than the lower (eg 15 or below). Of course, everyone is different - it's about finding what works for you. One thing to bear in mind is that with every dose change up or down there will be some side effects that take about 2 or 3 weeks in my experiene to subside. So it's hard to make a judgement call before that whether something is positive or negative for you. Hang in there - this WILL get better xx

Thank you Gillian for you reply. If i should get refered maybe its something to think about. These health Proffesionals dont like us suggesting things though. xx Are you in the uk ?.

Just one of the many studies that shows how lower doses of Mirtazapine are more sedating and higher doses more activating:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6322815/

(In case your psychiatrist is interested!)

Here's another one:

https://www.researchgate.net/deref/https%3A%2F%2Fproceedings.med.ucla.edu%2Fwp-content%2Fuploads%2F2016%2F11%2FDose-Dependent-Sedating-and-Stimulating-Effects-of-Mirtazapine.pdf

Irregular heart beats are mentioned as a serious side effects in the Patient Information Leaflet for Phenergan:

https://www.medicines.org.uk/emc/product/5588/pil

im just sticking to nytol ive uped my dose to 50 ive got bad stomach pains is that right Charlie duno whats going on Sandra

Stomach pains are not a usual side effect according to the Nytol information, upset stomach (feeling sick) is and the recommendation is to take the medication with food so perhaps a bedtime snack is in order?

I don't suppose you're lactose-intolerant?

Stomach upset/discomfort is a side effect of antihistamines in general so despite what Nytol says in its leaflet it is probably causing your pain.

do you mean stomach upset from upping the ssri?

Hi Sandra, i had a lot of tummy troubles when i dropped 30mg Mirtazapine to 15 mg. I had a ct scan which showed a lot of gas, they thought it was a problem with my gall bladder. It was painful, are your bowels moving ok ?.

think its my acid since i went to 50 ive took gaviscon still killing me and developed a cough with it Sandra

I think you need to talk to the doctor or at least a pharmacist about this.

The cough could be a symptom of acid reflux.

yes i think your right charlie idont no which meds are causing it Sandra

hi charlie my doctor tried to change me again onto deluxatine but i am staying on sertraline sick of changing ill just have to try and eat more my appetite is poor at the moment she thinks its the sertraline ill try a couple more days with more food im 2 weeks in so hope the food works shes told me to carry on with the nytol so ill see what happens Sandra

Try eating little and often e.g. healthy snacks between meals, I know it's a cliché but carrot sticks are good and if you want a treat the wholemeal pitta bread with crunchy peanut butter works for me!

It probably is the side effects causing loss of appetite, it did for me, but it did come back.

Charlie do the night sweats stop eventualy im sleeping 5 hrs dose that get better im 3 weeks now do you find Citalopram better carnt remember all this on Citalopram do things improve on sertraline Sandra

Each drug has a slightly different side effect profile but the side effects should reduce in time, how long depends on the person but it does sound like things are improving for you.

Hi Sandra, just wondering how you are getting on ? X

sweats at night 5 hrs sleep still anxious but early days only 3 weeks on them thanks for asking how are you doing Sandra

Thanks charlie how long have you got to go now till full afect hope your doing better Sandra

Not brilliant, had a telephone consult with the Doctor yesterday as feeling so awful but in speaking to him he wants me to stop the Mitrazapine and start something else. He was dismissive of withdrawal effects and said i would just stop and start something else in a weeks time. I have declined his offer and will struggle on for a bit longer. I don't feel strong enough mentally or phsyicaly at the moment.

i have only just started eating a little but sleeping is still horrendous, my eyes are so sore and bloodshot.

hi zcharlie im on 60 for 3 wks doc phoninh this aftrrnoon guns ask if i can increase to a 100 what do you think Sandra

Hi Sandra, if you're now stabilising on 60mg (I thought Sertraline came in steps of 25mg?) and you feel that 100mg would be helpful then you should definitely discuss that with the doctor. Be prepared that increasing dose may bring back some side effects but possibly not as strong as they are at startup.

Can I ask why you feel an increase is needed now?

i was on 25 for 1 week then bren on 50 for 2 weeks still feel a bit anxious or will it settle am i jumping up to soon Sanara

shes uping to 75 see if im any better on that thanks charlie

Going to 75mg rather than jumping to 100mg sounds sensible and you might find you don't need to go higher. Sounds like you've got a supportive doctor at last.

Good luck, hope it helps and well done for taking control 😃

Glad to hear your doctor seems to want to help you, why sertlaline just out of interest.

Hi Sandra, can i P.M you. Linda

Charlie im getting terrible nigjt sweats with sertraline are you geting them with Citalopram dont no wether i can stand thesr for good let me no befor i increase the dose thanks Sandra

Nope, I don't get night sweats but they are a reasonably common side effect of SSRIs.

It might be worth asking in the Sertraline forum to see how other people have dealt with them?

Here's a thread on the Sertraline forum discussing night sweats:

https://patient.info/forums/discuss/has-anyone-experienced-night-sweats-with-sertraline--61720

hi charlie still anxious on 75 night sweats and acid 4 wks now is that normal do you get these on Citalopram what do you think im woried i dont improve thanks Charlie Sandra

Charlie which do you prefer best i need to be on the right one i dont no what to do Sandra

Hi Sandra,

With all SSRIs you have to try them for several weeks and the time it takes varies from person to person. Similarly, different SSRIs work better for different people so what works for one person won't necessarily work as well for another.

I think 4 weeks is still pretty early, I didn't settle on Sertraline for about 2 months.

You can get very similar reactions from pretty much all SSRIs so some people get night sweats with Citalopram, I got some hot flashes but no sweating.

Can you give 75mg a bit more time?