In a terrible state, what should I do?

Treatment and medication
1

Hi,

I really hope someone out there can help.I was prescribed mirtazapine in november 2015 due to a complete breakdown. By March 2016 I had made some changes in my life and decided I wanted to come off. I was not sure what to do but did what I thought was ok and took roughly 4-6 weeks and came off. Unfortnately I had spectacular withdrawal symptoms so reinstated and decided, from advice on this and other forums, to do a much slower taper. Last week I eventually came off again, following a 30% reduction every 4 weeks. I had got down to 0.35mg, which I thought was a more than conservatively low amount at which to stop. Unfortunately yet again I have had some terrible withdrawl symptoms.  Everything was ok till day 6. I am really loathed to re-instate but don't know what to do? Any advice would be greatly received.

Also would any-one recommend getting some other drug from the doc to help come off. Or is that a bad idea?

Thanks

2

Hi Andy, sorry for your pain I know what you going through. I try to come off Mirtazapine 2 times .... unsuccessfully high anxiety insomnia shaking GI problem with sevire nausea, you name it I had it. Now I'm doing it very very slow. Only 10% reduction every 4-6-8 weeks is depend on my condition. Here everybody recommend only 10% every 4 weeks. I'm on 2.8 mg. and holding it for long time, becouse my sevire anxiety. Mirtazapine is a strong medication lots of people has a problem to come off. 

how many mg you were taking? 

I don't think there is anything out there what make your condition better only time. I would not take anxiety pills because is even harder to come off. I know I came off 10 months ago and I still suffering. 

Try to stay away coffee sugar gluten and dairy and any stimulating suplement, like gaba or vitamin. Is make your symptoms worst.

Sorry again for you pain and suffering. 

Let us know how you doing

3

Hi eva,

Thanks for your kind words. I got down to 0.35mg. Which I thought was pretty low. Perhaps it wasn't the dose but the speed of taper. Not sure?

Yes I thought adding another drug might be a bad idea.

4

What dose were you on ?

Did you withdraw as you tapered down or was it just when you stopped ?

5

Hi Sarah,

I have never really felt comfortable on them. Suffering with a fuzzy head and stomach cramps. As I withdraw symptoms just get worse and worse

I was on 0.35mg and had been for 4 weeks before I stopped.

6

I don t feel comfortable on them either. I'm on 45mg and plan to taper.

I wander what your maximum dose was that you tapered from. 4 weeks on such a low dose seems, sensible. Did you have withdraw symptoms in the 4 weeks before you stopped or only when you stopped ? Have you only started having symptoms since stopping completely as that could indicate you need to drop lower.

7

Sorry to read of your suffering Andy, Mirt can be a terrible drug to taper from.

If it helps, I tapered to 0.1 mg, then

0.1 for 6 days a week, then 5 days, then 4 days etc

Then at 0.1 once a week on Fridays until I had the courage to stop.  It was as though I was tricking my own brain in a way.  

I do think your taper was very fast, it took me 16 months tapering a 5% drop every 2 weeks from 15mg ... crazy.  Been off 5 weeks now, sleep is difficult but I kind of expected that, I'm told it restores slowly, and that I should be patient !!  

I'm interested to know how you felt for the third and fourth week at 0.35mg Andy?  

In mho, there are only 2 things you can do now, try and hang on or reinstate back to 0.35mg.  Then if the latter, wait to stabilise (never jump up to a high dose, this send the CNS crazy), and then with baby steps drop down 5% every 2 weeks.  

I have heard of people reinstating and taking Prozac to use as a bridge whilst then tapering off Mirt, also folk who has used Amitriptylene once off - but I don't think anything really covers wd symptoms of Mirt.  

I hope this helps.

 

8

Hi Calmer,

I was on 30mg initially then started to taper in March 2016. So took me a year. Week 3 and 4 were pretty much same as weeks 1 and 2.

Took my last dose Sunday 19th. So had a whole week ok. Then it all hit me last night. Today has been absolutely awful.

Am thinking of reinstating tonight. I don't think I can take much more.

I was thinking of going to 0.1 but thought 0.3.5 was pretty low.

9

I started taper march 2016 when I was on 30mg. The 4 weeks before I stopped were ok not brilliant but ok.

Have only had symptoms really after stopping. All was ok until 6th day, ie yesterday then it all went wrong.

I thought 0.35 was pretty low but perhaps I need to go lower. Like Calmer did to 0.1mg.

10

Hi, how you able to go down 0.1 mg?

I'm dry cutting and measuring with a Gemini scale but I could not go under 0.5 mg. maybe that's why I had a bad withraw. And I made a mistake to go back on 7.5 mg. doctor recommended. I should of go back on 1.0 mg. 

to late now but this s time I want to do it right.

my doctor dos don't want to give me liquid form. 

Thanks 

11

Yes ask your doc for a script of low dose Prozac and do a "prozac bridge."

Prozac has a really long half life compared to other ssris it's half life is about 7 days wheras mirtazapine

is only c. 30 hours. The shorter the half life means that when you come off , the last dose quickly depletes from your system and then the rapid lack of serotonin causes the withdrawal effects.

The benefit of switching to Prozac is that it's such a long half life means it takes over a month to leave your system from the last dose ,so transferring over from mirtazapine to Prozac

prevents a rapid drop in serotonin instead the Prozac will just wean itself off naturally over a month or so to depletion of serotonin.

This results in fewer withdrawal effects and a much smoother ride.

You have two options

1. If your withdrawal are too uncomfortable and you want them gone now! go back to the lowest dose of Mirtazapine that you were in without any withdrawls and continue again until you no longer have unbearable withdrawls, but ideally no longer than a week or 10 days

then stop Mirtazapine and start the Prozac Bridge the next day

2. if your withdrawals are manageable for a few more days. Then stop the Mirt and start the Prozac Bridge immediately.

The Prozac Bridge method :-

Take one dose of Prozac at 10 mg, one each day for the next two days; or if your symptoms are so bad take 20mg per day for the next two 2 days or 3 days if severe.

Then you get on with life and just wait for the Prozac to gradually go away over the next several weeks.

Since the small upfront stack of Prozac you built up in the bloodstream is much smaller than the levels one gets to after a month or more of normal 20 mg daily dosing, the prozac depletes quite

quickly to near 0 and just leaves a tiny amount in the blood so there is no sudden cliff edge drop in seretonin. Hopefully by then you will be

med free and also symptom free and you probably won't even have noticed.

So you should ask your doctor for say a weeks worth of 10mg Prozac which gives you enough for the 10mg,20mg, 2 or 3, day options

You might also ask for a few Diazepam or Lorazepam to help whilst you wait for the heeby jeebies to subside.

12

Andy

Based on my experience I would go back to 0.35mg and stay on it until you feel ready for a very slow reduction. I too thought that stopping on such a very low dose after tapering would be no problem. Other people appear to have no problem but not me. I went onto liquid Mirt and following advice from Calmer on this forum I dropped very slowly 10% per month to a tiny dose 0.05mg in Jan before I slowly stopped. Even then some anxiety and insomnia has returned which varies day to day but am pleased to be off this powerful drug.

13

Hi eva,

I made a liquid solution. I have 15mg tablets and break them in half to 7.5mg and then mix that with 7.5ml of water and then shake.

1ml of solution is equivalent to 1mg of the drug. Its not exact but does work. You have to get a syringe though so that you can then draw off the exact amount.

Hope that helps.

14

Thanks my cloud. I guess I had not heard many people going much further than 0.35mg before. Thought that would be more than low enough. But perhaps from what you say and what calmer has said it isn't low enough. Makes you wander what on earth is in this drug?

15

Hi Steve,

Thanks for you comments.

Is this quite a common method? Have not heard of it before?

Is this what you did? If not, how have you heard about it?

Also what are the risks? There never seems to be any way of coming off this awful drug without some risk.

Thanks

16

Andy

I know other people drop from 7.5mg with few problems and I found it very diffficult to accept why a drop from 0.5mg which I had been on for a couple of weeks caused me so many problems especially when my doc said just stop at 7.5mg. Anyway I went back on 0.5mg stabilised and did this very slow taper.. If I could do it I'm sure you can. Good luck

17

The method was primarily developed to help people come off the harder antidepressants such as venlafaxine and Seroxat which are notorious for discontinuation syndrome

I used it to come off citalopram and had no problems. I have also been on Prozac on its own and quit cold turkey with no issues. But not everybody is the same

There will be some risks depending primarily how you react to the Prozac, which will depend on how you react to ssris in general. if you are somebody has bad side effects with all meds and you suffer from discontinuation syndrome with every medication then you may not necessarily benefit from switching to another med.

Ultimately however you should discuss with your doctor because he will know your history and what the best options will be for you.

you shouldn't attempt this without medical advice/supervision.!

Best of luck

18

Thanks for all your comments and support my cloud.

19

Hi Eva

To get even lower on the dose you may need to make a liquid, click on my name & follow the link to 'making a liquid' under my status.  

So are you at 2.8mg now?  If you're having lots of anxiety its a sure sign that maybe a 5% every 2-3 weeks may well suit you better??  Just a thought.

Thank you for the thumbs up regarding gluten and gaba ~ I have read of this elsewhere, not quite sure what is meant by gaba, can you help please?

I think those preventions of stimulants must continue for quite some time even after reaching zero ... it takes quite a while for the brains chemistry to alter.

Wising you well.

20

I am sorry to err on the side of caution here, no other AD can cover WD symtoms of another AD, Prozac will not take away any symptoms left by Mirt.  And I would recommend you stay on Mirt right down to 0.1 mg & beyond (as above).

Prozac is one of the few AD's that can be taken with Mirt, I think it could support you whilst going off, but not replace.  Chances are you won't need anything else, I didn't, but we're all unique.  

Benzo's are even harder to come off than Mirt', ugh ...