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Withdrawal?? 4 wks of Mirtazapine - now switching to Vortioxetine (Trintellix)

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Mermaid3011
Mermaid3011

Hi everyone,

I need your experiences with switching from Mirt to another Antidepressant/Antipsychotic please.

I have been taking Mirtazapine 15 mg at night for 4 weeks. Because of the weight gain issue I have asked for a replacement and after seeing a specialist yesterday I will be starting Vortioxetine (Trintellix) this week.

The two medications are very similar in chemical structure, medical effect etc. and I am wondering if I have to wean off Mirtazapine or if I can just switch from one to the other.

According to the product description the withdrawal symptoms of Trintellix seem to be the same as those of Mirtazapine:

"Stopping this medication suddenly may lead to side effects such as dizziness, abnormal dreams, numbness or tingling sensations, agitation, anxiety, nausea, vomiting, sweating, or other symptoms."

That's why I am thinking that a switch should have no major side effects since both drugs are of the same "family".

Vortioxetine (Trintellix) is a fairly new drug that has just been approved last year here in Canada for distribution, so I don't expect anyone to have experience with exactly this combination, but maybe you have been switched to Lithium or some other AD/AP.

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  • evergreen
    evergreen Mermaid3011

    Posted

    I can only give you my opinion and that is that I think you may well have withdrawal symptoms if you just stop the mirt. However, as you have only been on a low dosage and for a relatively short time, then I would think the withdrawals will be mild. I would probably halve the dose of mirt for a week before coming off them though.
    • Mermaid3011
      Mermaid3011 evergreen

      Posted

      Thank you Evergreen! That's what I was considering as well. And I believe it makes sense to do the switch just before the weekend, so I have at least 2 days to see if there are any side effects and how bad they are.
    • Calmer
      Calmer Mermaid3011

      Posted

      Hi Mermaid

      I'm routing for you, sound like you're being real sensible and doing lots of research ... we'd all love to switch to this new drug if it is quite easy, keep us posted won't you.

      When you mention taking a lower dose "over the weekend" to see the side effects of the lower dose - I think you'll see elsewhere on the forum that the effects sometimes hit 2 to 3 weeks later on - therefore if this happened to you and you had a bad effect, and also whilst moving on to another drug, would you be able to see the true picture, i.e. what is causing the symptoms drug (a) or drug (b).  This Mirt is a nightmare to quit and I'm not sure dropping off so quickly, even after only 4 weeks is a wise move.

      But hey, we're all different, lets hope you have an easier ride than most.  Good luck to you.

       

    • Mermaid3011
      Mermaid3011 Calmer

      Posted

      Thanks so much calmer! 

      Yes I am quite excited that they finally came out with a drug that is so similar, but doesnt mess up your metabolism. 

      According to the link that Kathy posted further above, tapering off Mirtazapine before going on Vortioxetine goes to 15 mg and then you can just switch over. A wash out period is not required. (Crossing fingers)

      Now just to be sure I am starting out with half the dose (5mg instead of 10mg) of Vortioxetine, since I am also on Bupropion and Sertraline. I don't want to risk Serotonine Syndrome. That's what the pharma company who is distributing Vortioxetine suggests. 

      I'll be reducing Bupropion from 450mg (which is quite high anyway) to 300mg and Sertraline from 200 mg to 100 mg. Together with just half the starting dose of Vortioxetine (5mg instead of 10mg) I should be fine. 

      I'll definitely keep you all in the loop. 

    • Mermaid3011
      Mermaid3011 suzie78191

      Posted

      Hi Suzie, no I didnt. I just felt miles better and finally had some energy again. But my dog also put me on 4x0.5mg Clonazepam per day. That sure helps with anxiety.
    • suzie78191
      suzie78191 Mermaid3011

      Posted

      hi mermaid,

      were you able to sto with the clonazapam once settled in on the setraline?

    • Mermaid3011
      Mermaid3011 suzie78191

      Posted

      Hi Suzie. I am not sure what you mean with "sto". 

      The clonazepam never really made me feel much, but once or twice I forgot to take my mid day dose and thats when I realized that it DOES make me less agitated, calmer, less anxious.

  • Mermaid3011
    Mermaid3011

    Posted

    Hi everyone! Just a little update if anyone cares to know. 

    I stopped Mirtazapine 15 mg 3 nights ago and exchanged it with 5mg Trintellix. The medication has the same chemical structure and effect, but apparently Trintellix doesnt come with the weight gain issue. That's why I did an immediate switch without tapering off Mirt to a lower dose.

     

    I've been feeling well so far.

    Day 1 - Mood was very good - I felt a tiny bit of a lower abdomen pain/pressure, which could have also just been digestion. 

    Day 2 - Mood was very good - no real side effects, all dandy.

    Day 3 - Mood seemed to go down just a tad, no side effects so I decided to up Trintellix to the regular 10mg adult dose.

    Day 4 - Mood is good, I've slept well and I've lost a pound (yay)!

    Let's hope the trend contiues!

     

    • Calmer
      Calmer Mermaid3011

      Posted

      Hi Mermaid,

      All sounds very interesting, making notes as we speak, all the very best on the transition and future of Trintellix, rooting for you & watching your blog with deep empathy smile

    • Mermaid3011
      Mermaid3011 Calmer

      Posted

      Thank you so much Calmer!! it feels so good to be around people who know... and maybe my experience can help others too!
  • Mermaid3011
    Mermaid3011

    Posted

    Day 5 - slept well, vivid dreams, but that's not unusual for me. 

    Started the day with 2 lbs lost! Yay! Walked a lot today, went to yoga, cleaned up my balcony. Energy is good and now I'm relaxing. 

    The only thing I can feel is a slight pressure headache. Could also be from stiff neck.

    So... I'd say so far things are going very well. No major side effects. No withdrawal. No nausea. Let's cross fingers things keep going that way.

    • Calmer
      Calmer Mermaid3011

      Posted

      That's great, keep up the blog Mermaid, I'm with you !
  • Mermaid3011
    Mermaid3011

    Posted

    Day 6 on 10mg Trintellix/Brintellix (as well as (spread over the day: 2 mg clonazepam, 100 mg Sertraline, 300 mg wellbutrin, 2x500 mg Metformin).

    No changes - I am still feeling very well, am active, met friends for brunch and walked 5k with my dog (who is pretty annoyed by my outburst of activity, at least he's sound asleep now).

    No side effects, feeling myself again, energy is up, anxiety is not noticeable (other than constipation thanks to all the meds, I think each one of them has that as a side effect).

    Now I should add that Wellbutrin has a rep to make dieting easier and to help with losing weight. So does Metformin (but in a much smaller range). 

    I believe that the combination of them all  PLUS anxiety and depression going into remission makes my weightloss possible. It has never been easy, but these days, it's different. Doable.

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