Jump to content


Click here to find a mentally interesting date at No Longer Lonely Keep Crazymeds on the air. Donate some spare electronic currency you have floating around The Cloud




Some Crazymeds mugs to help you wash down your meds. Get mugged for at Straitjacket T-shirts for more. 11oz mugs are $13. 15oz mugs are $14.
Mentally Interesting mug
Mentally Interesting mugs
Medicated For Your Protection mug
Medicated For Your Protection mugs
Team Bipolar mug
Team Bipolar mugs
I <3 Wellbutrin mug
I <3 Wellbutrin mugs
Photo

Tapering Off Mirtazapine


  • Please log in to reply
11 replies to this topic

#1 FearAndLoathing

FearAndLoathing

    DIY Trepanist

  • Members
  • Pip
  • 26 posts
  • Diagnoses:"agitated depression", insomnia, anxiety
  • Current Meds:mirtazapine 45 mg, bupropion SR 300 mg

Posted 08 March 2012 - 05:14 PM

Hello,

I am trying to get off mirtazapine. I suffer from anxiety and depression. I was on up to 22.5 mg per day for about 6 weeks, but not really feeling much better on it and suspicious it may be contributing to my early morning wakeups. Its also definitely making me hungry.

I reduced my dose from 22.5 to 15 mg for 1 week, then to 7.5 mg. After 6 nights at 7.5, started having some pretty acute anxiety today. I am going to hold at 7.5 for a few more days if I can tough it out and the anxiety goes away. The trouble is that the smallest pill available (I think) is 15 mg, scored, so its hard to go below 7.5. I am going to try to cut the half pills in half with a razor blade. Has anyone heard of smaller pills available or had any experience cutting them down? It looks like its going to be hard to cut them.

Also I am surprised that my anxiety is kicking up 7 days after cutting the dose. With the 37 hour half life I would have thought it would have hit me sooner. Has anyone had this experience and does anyone have any ideas on how to get through it without adding klonopin or some other drugs in?

Thanks!
  • 0
Prior meds: lexapro, zoloft, pristiq, nortriptyline, klonopin




Enable Crazymeds to keep ranting about being crazy and taking meds. Donate some spare electronic currency you have floating around The Cloud



Stick to your treatment plan with buttons and magnets. 2.25″ $4 & 3.5″ $4.50 at Straitjacket T-shirts
Pile of Pills buttons at Straitjacket T-shirts
Pile of Pills buttons
Batshit Crazy buttons at Straitjacket T-shirts
Batshit Crazy buttons
Medicated For Your Protection buttons at Straitjacket T-shirts
Medicated For Your Protection buttons
Mentally Interesting buttons at Straitjacket T-shirts
Mentally Interesting buttons



#2 Rockie

Rockie

    Amateur Psychopharmacologist

  • Members
  • PipPip
  • 377 posts
  • Diagnoses:Depression, panic, agoraphobia, bipolar features, IBS
  • Current Meds:Valium 5 mg QD and 5mg PRN, Calcium and Magnesium Supplements

Posted 08 March 2012 - 07:16 PM

Moving down from 15mg to 7.5mg is a big change in mechanism of action. At 7.5mg it's just effecting histamine rather than histamine, serotonin and alpha 2. It may take a few weeks or longer for your brain to adjust to this change. You may also experience discontinuation issues from the lack of histamine antagonism once you're off of it completely. So I'd give it at least two weeks to a month (once you're off of it) to really know if you're experiencing backlash anxiety or if it's just your anxiety returning from being off meds.

Also, a 37 hour half life means it'll take around a week to clear your system, so this does make some sense in terms of the delayed anxiety effect you're experiencing.

I'd invest in a pill cutter rather than a razor blade since the pills are so dense with a hard coating (don't want to get cut yourself). I've chopped them down to 3.75, before, but I had to be very careful and still had some of them crumble.

Hard to suggest anything to help with the anxiety you're experiencing upon discontinuation (if it is, in fact, from discontinuation) if you don't want to try other meds. The only things that come to mind are CBT, meditation, and exercise.

Edit: Forgot to add that 15mg is the smallest dosage per pill that I know of. Also, are you getting enough sleep? I know that it's one of the known symptoms upon discontinuation, but it could also be exacerbating your anxiety.

Edited by Rockie, 08 March 2012 - 07:23 PM.

  • 0

Previous Meds
AD's: Prozac, Zoloft, Paxil, Luvox, Celexa, Cymbalta, Effexor, Lexapro, Wellbutrin, Remeron, Emsam, Imipramine, Nortriptyline,Trazodone, Viibryd, Nefazadone
AED's: Topomax, Trileptal, Klonopin, Ativan, Lamictal, Oxazepam, Triazolam
AP/AAP's: Seroquel
Other: Buspar, Ambien, Nadolol, Propranolol, Pramipexole, Hydroxyzine

"The pink ones keep you from screaming".
- Grandpa Simpson


#3 VisualSnow

VisualSnow

    Amateur Psychopharmacologist

  • Members
  • PipPip
  • 258 posts
  • Diagnoses:Migraine, Anxiety
  • Current Meds:Cymbalta, Zofran, Protonix

Posted 08 March 2012 - 08:10 PM

Mirtazapine is a very funky med, as the effects on the body really do change depending on the dosage and a lot of things seem very backwards with it. I tried to get off a number of times, and the final time I did cut the 15mg tabs in quarters (or as close as I could get) with a pill splitter. I was told by my doc that due to the longer half life, the body isn't as sensitive to tiny changes in dose from day to day.

FWIW, it took quite a bit after getting completely off the medication for withdrawal to go away for me. I know it has a reputation of having little to no withdrawal, but there are the lucky few who have a rough time. Assuming that 1) you have clearance from your doc to quit it, and 2) you aren't at risk for any life-threatening issues getting off, I would reserve judgement for a month or two and then evaluate how you are doing off of the med. I thought I would never be able to get rid of it, but what I thought was recurring symptoms ended up being withdrawal. Of course, YMMV.
  • 0

#4 FearAndLoathing

FearAndLoathing

    DIY Trepanist

  • Members
  • Pip
  • 26 posts
  • Diagnoses:"agitated depression", insomnia, anxiety
  • Current Meds:mirtazapine 45 mg, bupropion SR 300 mg

Posted 09 March 2012 - 05:03 AM

Argh, was awake pretty much all night last night. This is pretty much what happened last time I tried to stop it. Of course the million dollar question is whether its withdrawal or recurrence of depression/anxiety. I would like to try to ride out the symptoms and stay at 7.5 and see if I level out, but its pretty tough to deal with being up all night.

I have used klonopin for anxiety and insomnia with a decent effect. I have been on the merry go round of trying to get off klonopin, getting insomnia and then going on mirtazapine a couple of times. I can use one to get off the other, but can't get off either without getting back on the other.

I never had an issue with insomnia or early wake ups or even anxiety until I started on the antidepressants, which is what makes me think that although mirtazapine helps me get 6 hours of sleep, it make be whats making me wake up with anxiety.
  • 0
Prior meds: lexapro, zoloft, pristiq, nortriptyline, klonopin

#5 VisualSnow

VisualSnow

    Amateur Psychopharmacologist

  • Members
  • PipPip
  • 258 posts
  • Diagnoses:Migraine, Anxiety
  • Current Meds:Cymbalta, Zofran, Protonix

Posted 09 March 2012 - 01:22 PM

What else have you tried for the anxiety/depression? Maybe a different class would be better for you. Also, have you tried taking your meds at a different time?

As far as coping with the withdrawal, for me I just rode it out and dealt with the insomnia. Most nights I didn't even sleep at all, but eventually it got better. Unfortunately, I got in the habit of not sleeping until the wee hours of the morning, and I am just breaking out of that. The latter part is my own stupid fault and not the medication.

If you're stuck between a rock and a hard place with your meds, it may be time to give the pdoc a call (if you haven't already) and have him/her help you come up with a plan.
  • 0

#6 FearAndLoathing

FearAndLoathing

    DIY Trepanist

  • Members
  • Pip
  • 26 posts
  • Diagnoses:"agitated depression", insomnia, anxiety
  • Current Meds:mirtazapine 45 mg, bupropion SR 300 mg

Posted 10 March 2012 - 06:38 AM

I was on nortriptyline, zoloft, and lexapro recently. They each gave me terrible anxiety and insomnia after about 2 weeks. The mirtazapine was suggested partly to help me get some sleep after the insomnia. It has been good for that in the sense that after starting it I was able to sleep, but never much more than 6 hours. When I awaken its a very disturbing condition where I repeatedly drift off to sleep and then have these fragmented anxiety dreams (not really dreams so much as images or thoughts) and I wake up again, and the cycle repeats itself what seems like every minute or so. Yet I feel tired enough that I don't want to actually get out of bed.

Given that I take the mirtazapine at night and it helps me fall asleep I am reluctant to try it during the day.

Last night I happily was able to sleep. I took 7.5 of mirtazapine and 100 of trazodone as well as some valerian root. This was a pleasant surprise because when I recently tried trazodone for sleep after stopping klonopin it didn't work at all. So I will stay the course at 7.5 and try to taper to 3.75 later. I was happy to find that cutting the pills into quarters with a pill cutter seems to work pretty well when I tried it today.

I have been in touch with my pdoc, he thinks the insomnia/anxiety is a recurrence of symptoms rather than withdrawal. I think I disagree. The only way to know in any event will be to persevere with the tapering as long as I can tolerate and see where I end up.
  • 0
Prior meds: lexapro, zoloft, pristiq, nortriptyline, klonopin

#7 FearAndLoathing

FearAndLoathing

    DIY Trepanist

  • Members
  • Pip
  • 26 posts
  • Diagnoses:"agitated depression", insomnia, anxiety
  • Current Meds:mirtazapine 45 mg, bupropion SR 300 mg

Posted 12 March 2012 - 04:18 AM

Well I took 7.5 of mirtazapine along with 1 pill of valerian (half of what I had started with) and 50 of trazodone last night, and slept as well as I have in a long time. Yay! I have been on 7.5 of mirtazapine for 10 nights now, itching to cut it down to 3.75. The other option would be to knock out the valerian or trazodone and see what happens, or cut a trazodone in half. Decisions decisions. '

Anyone have any thoughts on the potential interaction of valerian with mirtazapine? I know it has a strong effect on UGT but it seems that mirtazapine is metabolized by CYP2D6, CYP1A2, and CYP3A4, I can't find anything to suggest UGT plays a role. It seems that valerian has some inhibition of some of the cytochromes above but the conclusions I have read is that it is not likely to have much clinical significance.
  • 0
Prior meds: lexapro, zoloft, pristiq, nortriptyline, klonopin

#8 VisualSnow

VisualSnow

    Amateur Psychopharmacologist

  • Members
  • PipPip
  • 258 posts
  • Diagnoses:Migraine, Anxiety
  • Current Meds:Cymbalta, Zofran, Protonix

Posted 12 March 2012 - 05:35 AM

It is a CNS depressant, as is Remeron, as is trazodone... does your pdoc know you are taking Valerian? My neuro was okay with the occasional sleepytime tea with Valerian in it (since the amount is marginal), but wanted me to stay away from the pills due to all of the other CNS depressants I'm on. The relative safety of Valerian with other meds and specifically CNS depressants are going to depend on 1) the exact meds, 2) the dosages of those meds, 3) patient's body chemistry, including liver function, and 4) certainly other things I am forgetting.

According to NIH, Valerian interacts majorly with all CNS depressants and moderately with:

Medications changed by the liver (Cytochrome P450 3A4 (CYP3A4) substrates)
Some medications are changed and broken down by the liver. Valerian might decrease how quickly the liver breaks down some medications. Taking valerian along with some medications that are broken down by the liver can increase the effects and side effects of some medications. Before taking valerian, talk to your healthcare provider if you are taking any medications that are changed by the liver.


Of course we all know interactions don't automatically mean you can't do it, but since Remeron is metabolized by the pathways specifically called out in the drug interactions for Valerian, it's enough to think about it and weigh the pros and cons.

Remember: Supplements are drugs too, and if it's strong enough to help you, it's strong enough to have side effects and potentially major interactions.
  • 0

#9 fearful

fearful

    DIY Trepanist

  • Members
  • Pip
  • 14 posts
  • Diagnoses:MDD/Dysthymia, agoraphobia
  • Current Meds:Klonopin 2mg, Cymbalta 30mg, Trazodone 100mg

Posted 18 March 2012 - 06:46 PM

So, after 6 weeks the main reason you want to stop the medication is due to sleeping well, but waking early? and increased appetite?
I'm just asking to clarify.

I'm especially interested in how Remeron has worded/not worked for you because I am thinking of asking my doctor for Remeron and have been researching it. We seem to share problems and some medications - I suffer from severe anxiety and depression and Remeron, from what i have been reading, seems to help many people with both.

If your anxiety is worse now - does this mean it WAS helping with your anxiety?

I'm wondering why you didn't go up to 30mg, or even wait to try 45mg - only because I have read that there is a big difference (for some) between the (15mg, 30mg, 45mg) dosages, with the higher having less side effects for many.

I am also on Klonopin and Trazodone for anxiety/insomnia, but took myself off Traz. and reduced Klon. to see if my depression would improve (it has not).

I gather you are just trying to get off all meds?

Also had that thought and did recently, which I have done many times before (never helps me). I am getting more anxious and depressed as i age and after many years of many medications my anxiety is 100 x worse than when i started, so i understand that certain meds can make anxiety worse, anyway, there are lots of things that have made it worse for me and it is lasting, so i'm still looking for a good med-based solution. My tolerance for Klonopin was that 8mg/day didn't do much at all.

I weened off Trazodone and Klonopin, and Wellbutrin (correctly, took my time) but i still cannot leave my apt. due to anxiety, even though i am back on meds, was hoping at least one would improve (anxiety or depression) but nothing, continues to worsen.

So my next thought is to try Remeron ... so I'm wondering why you want to stop so badly or trying a higher dose?
  • 0
Past meds: Effexor, Celexa, Prozac, Zoloft, Lexapro, Emsam, Depakote, BuSpar, Ambien, Ativan, Abilify, Wellbutrin. Others I can't remember due to the above.

#10 FearAndLoathing

FearAndLoathing

    DIY Trepanist

  • Members
  • Pip
  • 26 posts
  • Diagnoses:"agitated depression", insomnia, anxiety
  • Current Meds:mirtazapine 45 mg, bupropion SR 300 mg

Posted 20 March 2012 - 03:47 AM

Well, its sort of a long story, but the gist of it is that I started mirtazapine to try to sleep after being on several nortriptyline, zoloft, and lexapro for depression, all of which gave me horrible anxiety and insomnia. Although the mirtazapine allowed me to sleep, I still wake early in the morning and with anxiety. I am not sure that it has helped at all with depression, and given the side effects of the other meds, suspect that it might also be contributing to my anxiety and early morning waking.

It also does make me hungry and seems to give me some muscle aching. Running is my only form of effective therapy and the muscle aches are interfering with that.

I am afraid to try a higher dose, quite honestly. I seem to have worsened when I increased from 15 to 22.5 and any med change seems to be followed by 1-2 weeks of worsening after I cut the dose back down. No med seems to work "as advertised" for me, mirtazapine included. Most people sleep like logs on it, not me. So I have no faith that it will be better at a higher dose.

Currently I have weaned off the trazodone and valerian and I am only on 3.75 of mirtazapine at night for about 8 days. Going to cut it in half again tonight. Currently not sleeping any better :mad: .
  • 0
Prior meds: lexapro, zoloft, pristiq, nortriptyline, klonopin

#11 fearful

fearful

    DIY Trepanist

  • Members
  • Pip
  • 14 posts
  • Diagnoses:MDD/Dysthymia, agoraphobia
  • Current Meds:Klonopin 2mg, Cymbalta 30mg, Trazodone 100mg

Posted 21 March 2012 - 09:24 AM

i understand now, thanks for your reply. and yes, i have also read that the higher doses are less sedating. good luck! it seems like you are doing well and are down to a very low dose. hopefully you can get some real sleep soon. i also have problems sleeping and have not found a good solution. trazodone only helped for ~ 2 weeks. hoping if i can somehow (no idea how) reduce this crushing anxiety, sleep will naturally follow.

i'd love to know if you fine anything that does work for you.
  • 0
Past meds: Effexor, Celexa, Prozac, Zoloft, Lexapro, Emsam, Depakote, BuSpar, Ambien, Ativan, Abilify, Wellbutrin. Others I can't remember due to the above.

#12 FearAndLoathing

FearAndLoathing

    DIY Trepanist

  • Members
  • Pip
  • 26 posts
  • Diagnoses:"agitated depression", insomnia, anxiety
  • Current Meds:mirtazapine 45 mg, bupropion SR 300 mg

Posted 27 March 2012 - 04:22 AM

Well, I took 3.75 mg for 8 nights, then cut down in half, an eigth of a pill, approx 1.875. Took that for 3 nights, then just got fed up, impatient, overly optimistic, impulsive, and just decided to stop it. I've been off it for 4 nights and surviving. I've been taking a little of the much scorned kava kava tea before bedtime, chamomile tea, and 25 to 50 of benadryl. Last night I took a 450 mg valerian root capsule. Still sleeping but the early morning waking is fighting back, slowly drifting from about 6 1/2 hours of sleep to 5 1/2. I have to force myself to stay up late because no matter when I go to bed I wake up about 5 1/2 to 6 hours later. The anxiety in the am is still pretty strong, does get a little better over the course of the day.

I also upped my fish oil dose recently, now taking about 2 gms of epa a day. I have also been on magnesium (slo mag) 2 pills twice a day, and a multivitamin. Can't tell if this stuff is doing nothing or preventing me from withdrawing from mirtazapine a lot worse. Certainly not a miracle depression cure.

I keep telling myself, one day at a time, tomorrow will be better.
  • 0
Prior meds: lexapro, zoloft, pristiq, nortriptyline, klonopin


0 user(s) are reading this topic

0 members, 0 guests, 0 anonymous users




Keep Crazymeds on the air. Donate some spare electronic currency you have floating around The Cloud





Keep up with Crazymeds and and/or my slow descent into irreparable madness boring life. Pick your preferred social media target(s):
Follow Jerod Poore on Facebook
Wear my StraitjacketBatshit Crazy Blog
Crazymeds | Promote Your Page Too
Play Dress-Up with your Imaginary FriendsCrazymeds: The Blog


Just a few designs from our Crazymeds' Clothes Line. See more ways to let my meds express your feelings at Straitjacket T-shirts. Shirts, hoodies & more, $15-$43. Or search the Amazon for your retail Nirvana.
Batshit Crazy shirt
Batshit Crazy shirts
Mentally Interesting shirt
Mentally Interesting shirts
Medicated For Your Protection shirt
Medicated For Your Protection shirts
Breakfast of Champions shirt
Breakfast of Champions shirts