Having trouble tapering. Can't get lower than 7.5mg. Can anyone help?

Treatment and medication
1

Hi,

Can anyone help. Have had some real difficulty tapering to come off mirtazapine.

Just a brief history:

Originally tapered too quick from 30-22.5-15-7.5-3.75 and then off over about 3 weeks. After 4 months on. So then went back on at 2mg but felt awful again. So then went back to 7.5 again. Felt alright and did this for 7 days and then tried to go down to 5.75 but am now feeling awful again. I really want to come off this stuff but just don't know how. Can anyone please help. I feel like I'm going crazy.

Should I just stick it out a bit longer on 5.75 or go back to 7.5. If I go back how long would someone suggest I stay on this level and what dose should I follow next.

I just don't know what to do...,

2

Hello Andy

We all are having trouble coming off this terrible,I think that you are trying hard I would stay on the 7.5mg till you are stable,and then only slowly taper off,T he advice which I have been given is a 10% drop and less in some cases  hang on in there you will find a lot of help from these good people on this forum

I have been on 10mg for 5weeks now and I am still getting withdrawals so you not alone

 

3

Andy

You're in the same boat as me ! Have recently posted my problem of coming down from 7.5 (tapering from 15 to 7.5 was  a lot easier). Anyway the good folk on here pointed out that my drop from 7.5 to 5 was actually a 33% drop - far too much. Your drop was about 25% - also too much!. I went back to 7.5 a few days ago and feeling better. I will stabilise and then do a slow 10% reduction - which on 7.5 sounds a small drop but am sure that this is the only way that you and I will cope ! Yes want off this drug but we have to be patient and do it very slowly to let the body adjust. Good luck - keep us informed of your progress

4

Thanks orchid1 and my cloud. I guess I am impatient to come off these horrible pills. I am not working at the moment and want to come off and then start work. But if I do the 10% drop it will take forever. I dont feel really able to cope when I am on them but cant seem to come off.

 

5

Hi Andy, 

As you have found, no matter how badly and fast you want off this med, your nervous system has other things to say about it.

Your taper was way too fast. Each time you cut, it was 50% as far as your nervous system was concerned.  On top of that, your system never had a chance to do the remodeling, up-regulation of serotonin receptors, it needed to do before you challenged it with yet another 50% cut.

It takes four days for a new dosage to become steady state in the blood, and then another couple of weeks for the body to respond to this new level of drug, by hopefully up-regulating in the case of reducing the drug.  Then, you need another week of stabilizing at this new level before challenging your system with another cut.

Bigger cuts lead to bigger destabilization and withdrawal symptoms.  The bigger the cut, the longer it takes for the system to make the adjustments.  The withdrawal community has found 10% to be the least-harm approach for most people.  About the fastest you can go is 10% every three weeks.  At this rate, the disruption is so small for most that they hardly feel any withdrawal at all, and so can go on living without losing functionality.  

I think you are thinking that at 10% you would be feeling horrible the whole time, but that is not the case.  

You can't force this to go faster by cutting bigger and more often; it just doesn't work that way and that is so many people fail, go back on, fail again, etc.  So much more time is wasted doing that compared to just doing the 10% when you are stable and only continuing cutting when you are feeling stable.   Never cut on top of withdrawal symptoms!

Your system has been through a lot and so you should stabilize on your reinstatement dose for at least a month before trying again; tapering too soon could make even the 10% taper fail.

Lots of us are making liquid mirt if we can't get ahold of the liquid version from the doc.  Mirt doesn't go into solution very well, so you need to be sure to shake well right before measuring with an oral syringe.  Evergreen on this forum made a liquid mirt solution using half water and half syrup to help suspend the mirt.

Mirt gets very difficult to taper at the low end under 7.5 mg.  This is because even small cuts lead to a proportionately larger number of receptors being freed up by the drug, along with the need for the nervous system to up-regulate (add more receptors), so lots of destabilization. 

If you make a cut and bigger symptoms develop than you can handle, up-dose to the previous dose, stabilize and then try a smaller cut.  You really need to listen to your body in this process.

 

6

Hi Betsy,

Thanks for your really helpful and most informative comment. It has helped me to get to get to grips with what is going on on my head.

Will try and follow your sound advice.

Do you also know much about use of magnesium and mega 3 to help with WD symptoms. Have also seen that the seasick bands have been recommended for the nausea. Do you know if there is any evidence for this too?

7

I haven't seen scientific evidence for the supplements but anectdotal a plenty.  I've heard of the sea bands but searching the support forum do not see much info on it being successful for withdrawal.  I think they can be helpful for healthy people but when the nervous system is out of whack they may not work.  The brain is made of something like 60% fat, so the omega 3 fattly acids in fish oil are excellent for a brain that is rebuilding.  I've heard they really help with brain zaps.  Mostly our diets are deficient in magnesium and it is important in autonomic regulation.  A chelated form such as magnesium glycinate is most readily absorbed while not causing digestive upset.  Work up to 400 mg/day of elemental Mag, the recommended daily allowance.

8

Thanks Betsy. Really appreciate all your advice.

9

Hi Betsy,

Sorry to bother you again. Not sure what to do. Am trying to do as you suggested and go back on to reinstated dose but finding it difficult as to know what that is. Went back to 7.5mg as that was what I felt good on before but still feel terrible. Do I give it more time or go up again? And if I go up by how much? I am so worried the more I go up again the longer it is going to take to come off this bloody horrible drug. Do you have sny suggestions please. Thanks.

10

Hi Besty

So glad to read your posts, thank you!! I wonder if you can help me please.   I have been off of Mirtz for just over 3 weeks now and I have to admit I did come off of them fairly quickly as the weight gain was making me feel really uncomfortable, I also decided to com off of Mirtz as I was starting to feel less depressed.  I did experience bad headaches and feeling sick, however I knew I could deal with that.  But this weekend I have been hit with such deep depression I feel as desperate as I did 2 years ago when my depression first appeared.   I am so scared all the time that everything is going to go wrong again and I cant see a happy future.  I also feel such a failure as i really thought i had beaten this horrible condition and now its back!! Could this be a blip from coming off of Mirtz or is the depression back for good!! I wont under any circumstances go back on antidepressants so that is not an option for me.  Is it possible to explain how it works am I missing too much serotonin and will I ever be able to make my own again without the help of drugs?  I would really appreciate any help please, thank you

11

I had the same problem dropping below 7.5. I should have settled for that because I left it too long and ended up having to reinstate 30mg. Started slow taper again and any signs of a problem below 7.5 and I'm going to stop there. 

Perhaps the answer is to stay on 7.5 for a decent length of time, maybe 6 months and then do the last minuscule taper. That's what I may aim for.

I hope it helps to know that what you are experiencing is quite common.

 

12

I can relate to this.  I've reduced by 10% every 2 weeks from 15mg and have been feeling very low, anxious, upset tummy and extremely tired all the time, despite sleeping 8 or 9 hours a night.  I've now been on 11mg for 3 weeks and think I will continue on 11mg for a couple more weeks to see if things improve.  So frustrating, just want to come off mirt but it's going to be a looong process.

13

Thanks guys for your comments. I think the hard thing for me is that I have never felt too good on it. Always spaced out. So don't know really what a stable state is. I probably should have never kept on it in the first place.

14

I relate to this too. I have bin on 11.25 mg and this was so sedating, totally feeling drugged en very tired and weak muscles, i could only sit. I am not a person who is sitting the hole day, i was a very activ person.

Now all that is gone.

It´s trough, how lower you get how more tired you are and depressen maybe because of the tiredness.

I have reinstated 15 mg of Mirt and will go on with that for a long time, then to 7.5 mg for a long time and then off.

I can not bare the enormous tiredness between 15 and 7,50 mg.

But that can i do next year, it´s now to soon.

15

So am i. Maybe i can not tolerate any antidepressant, have tried many also ssri´s, they where the worsed of all.

I don´t like messing with my head, it feels not good.

I wish i had never taken them and was keeping it by benzo´s, they helped me more than this crap. I know benzo´s are also not good but better for me than this!!

16

I'm thinking of going back to 15mg too but I really don't want too - would like to persevere with the reduction but the tiredness is really doing my head in!  Is it common that tiredness is greater on the smaller doses?

17

I had the same as you, the tiredness did not wore off. The tiredness was greater at 11.25 then 7.5 mg but that is for everyone different.

I also did not want to go back to 15 mg but is was unbeareble.

Yes it´s common that the lower the dose the more tired or sedating it is for the most.

That´s why i will try next year what i have written above.

It is for many people a struggle come off Mirt.

18

I also did not want to go back to 15 mg but is was unbeareble.

Mistake: but most be because.

Sorry i am from Holland and my English is not very well

19

Thanks Karin,

You are right it is unbearable. I probably will have to go back to 15mg. I just dont get how I was ok before on 3.75 and then on 7.5 but now I am not. The whole thing is extremely puzzling.

20

This deep dark depression is withdrawal-based.  When we go on these meds, the level of serotonin is artificially raised, but the nervous system doens't like this and pushes back with oppositiional compensations, down-regulating (removing) serotonin receptors and decreasing the amount of serotonin released.  This creates a new "homeostasis," with the drug built in.  When you remove the drug too quickly, the compensations are now left un-opposed, so you have an imbalance again!  The problem is, these compensations take a long time to reverse themselves.  In the meantime, you are at risk for such horrible mood problems.  This is all caused by the drug and now it's absense and has nothing to do with your original depression. This is very important to understand.

The whole point of the slow taper is to very gradually get your nervous system to adapt back, so that most of the healing takes place while you are tapering.  The taper is so slow as to keep you comfortable and functional in the process.  There may still be withdrawal symptoms but they should be at a tolerable level, otherwise you are going too fast for your nervous system to keep up with.

Though you hate the idea of going back on ADs, your best bet is to reinstate a very small amount, get stabilized, and then do a proper taper from there.  

What dose did you jump from?  It has been only 3 weeks, so if I were you I would go on the last dose you were on before you went off.  You will be saving yourself a lot of suffering, because withdrawal from a cold turkey or too fast taper can in fact go on for months and even years for those who have been on ADs for years.

Like you, I wish I could stop and never take my AD ever again, but having done that and failed, I now know that I am between a rock and a hard place:  don't want to be on them but suddenly NOT taking them is not an option because my nervous system can't handle big drops in drug.  So, a 10% taper is it for me, and really the kindest thing I can do for my brain.  You simply can't rush the nervous system because you want it to be so!

If you haven't already, read the 10% taper topic in this link:

https://patient.info/forums/discuss/depression-resources-298570