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Aka Remeron, Remeronsoltab, Avanza, Axit, Mirtabene, Mirtaz, Mirtazon, Norset, Promyrtil, Remergil, Remergon, Remeron SolTab As with other psychiatric drugs, we recommend trying a 10% taper of mirtazapine per month, based on the last dosage you took. If you get withdrawal symptoms from a 10% taper, go down by smaller amounts. See Important topics in the Tapering forum, particularly why-taper-by-10-of-my-dosage A very common withdrawal problem with mirtazapine is rebound insomnia, which reinforces the need for very gradual tapering. From FDA information at http://www.drugs.com/pro/mirtazapine-tablets.html From Malhi, et al 2003 Dual-Action Antidepressants: Mechanisms of Action and Clinical Use Per http://www.drugbank.ca/drugs/DB00370, Half-life is 20-40 hours. Mirtazapine tablet dosages are 7.5mg, 15mg, 30mg, and 45mg. The "orally disintegrating" version melts in the mouth and is widely available as a generic or brand-name Remeron SolTabs. Reduce by splitting tablets Request that your prescription be filled with the lowest dosage tablets or combination that includes the lowest dosage and split them into quarters for the smallest decrements. (A quarter of a 7.5mg tablet would be 1.875mg.) If you are very sensitive to dosage reductions, you may wish to weigh tablet fragments, see Using a digital scale to measure doses Reduce by titrating a liquid A liquid is easier to measure in order to taper by small amounts using an oral syringe. Unfortunately, mirtazapine liquid is not widely available. In the UK, mirtazapine liquid is available from Rosemont Pharmaceuticals in Leeds. Ingredients of the liquid are here: https://www.medicines.org.uk/emc/medicine/31587. Shelf-life after being opened is 6 weeks. Ordering information is here. Make your own liquid from a tablet To taper, many people make liquids from mirtazapine tablets themselves. While water solubility of mirtazapine is "slight" according to http://www.drugbank.ca/drugs/DB00370 you can make a suspension of it yourself with a tablet and water or a pharmaceutical liquid such as Ora-Plus. See How to make a liquid from tablets or capsules (to see the links to the documents mentioned, click on the gray arrow in the upper left of the quote.) Refrigerate the DIY suspension for up to 5 days, then discard. Have a compounding pharmacy make a liquid for tapering Compounding pharmacies can make a liquid from the tablets. You will need a prescription written for the customized drug preparation. The only drawback is this can be quite expensive. While your pharmacy may say the liquid is good for a month, people have noticed potency decreases over that time: Please note the do-it-yourself liquids are kept for less than a week. Reduce by making a liquid with the "orally disintegrating" tablets You may be able to dissolve the orally disintegrating tablets ("Soltabs") in water and use an oral syringe to take a measured dosage. I couldn't find any reports of doing this but, since the orally disintegrating tablet is designed to dissolve in saliva, it seems likely to work. After making the liquid, I would take the dose immediately and discard the rest -- do not count on it keeping for any length of time. For instructions on how to make a liquid, see how-to-make-a-liquid-from-tablets-or-capsules If you do this and it works, please let us know in this topic. Using a combination of tablets or capsules and liquid Rather than switch directly to an all-liquid dose, you may wish to take part of your dose in liquid and part in lower-dose tablets or capsules, gradually converting to all liquid as you get to lower dosages. This can be very convenient and reduce any problems switching from one form of the drug to another. If your doctor prescribes liquid and tablets or capsules at the same time, most likely, he or she will have to indicate "divided doses" in the prescriptions to get the drugs covered by insurance. Cut up or crush tablets, weigh fragments or powder with a digital scale In principle, this would be a more precise way of tapering than cutting up tablets: Cut up or crush the tablet If crushed, make sure the shell fragments are evenly distributed in the powder Weigh the tablet fragments or powder for a dose with a digital scale If powder, put the powder into an empty gelatin capsule to make it easier to ingest Tapering mirtazapine and venlafaxine or "California rocket fuel" This is a combination of mirtazapine and venlafaxine (Effexor) that has some popularity among psychiatrists, but also can have dangerous side effects. If you are taking this combination, you probably will want to taper the Effexor first with the hope that the remaining mirtazapine will maintain sleep. See About going off mirtazapine plus venlafaxine (Effexor) aka "California rocket fuel"

ADMIN NOTE This essay first appeared in Dan998's success story. Also see: Tips to help sleep: so many of us have that awful withdrawal insomnia What is the sleep cycle? Melatonin for sleep Supplements for sleep * Sleep and withdrawal by Dan998 I thought it would be a good idea to write an article about sleep. Everyone’s symptoms and experiences will be different, but the vast majority of our members suffer terribly from issues surrounding sleep. For me, sleep was probably my biggest struggle. Right from the beginning I had a hard time sleeping and it’s probably only in the last year or two that it has returned to what I would call normal. Sleeplessness closely followed my pattern of windows and waves. Arriving a few days before and improving a few days afterwards. I’m convinced that these two things are closely linked to each other. During the worst of withdrawal I might have been lucky to get an hour of sleep per night. This sometimes went on for months and undoubtedly contributed to the mental confusion and cognitive incapacity that I have previously described. The cortisol mornings were particularly brutal. Fear, dread and panic rising from my core and quickly filling every part of my body as soon as I woke up. Getting a good night's sleep is vital for all humans, not just those in withdrawal. I still occasionally get nights where my sleep is interrupted and I always feel groggy and slow throughout the following day. Thankfully, like everything else on the withdrawal rollercoaster your ability to sleep will improve with the passage of time. Dosage timing - Some psychotropic drugs are activating, some have a sedative effect. You can use this to your advantage. Citalopram used to make me feel slightly drowsy, so I took my dose at night to help me sleep. Try to stay away from sleep meds if you can as most of them are highly addictive and you’ll quickly build up a tolerance to them. Take a nap - Sleep can often be elusive. Get it whenever you can. If you feel tired in the afternoon, then by all means take a nap. Every minute of sleep is valuable. It doesn’t have to be reserved for bedtime. Blue light - Blue light interferes with our natural circadian rhythms. In nature, blue light is only available during the daytime. The blue light emitted by T.Vs, computers and smartphones disrupts these natural rhythms and signals to our brains that we should be awake. Make use of the blue (night) light filters available on most computers and phones. If you’re watching TV, the movie setting often has a warmer colour temperature. I personally wouldn’t go online after about 10pm as I found it far too activating. Instead, I’d watch wildlife documentaries or sports as these provided much gentler viewing. Bedtime stories - Ok, I didn’t have actual bedtime stories. I would listen to talk radio. A soothing voice, quietly whispering in the background would help me drift off. I used to listen to BBC Radio 5 as it didn’t have any annoying adverts. Nowadays, you’ll probably find all sorts of podcasts, audiobooks and background noises to listen to. Make sure it’s nothing too stimulating. Boring is best. Darkness - I found blocking out the light really helped my sleep. The darker the better. I messed about with blackout curtains, but some light always got past, and it only took the tiniest sliver to wake me up. In the end I solved this problem by screwing a sheet of ply board over the window, this also helped block out most of the street noise too. Secret sleep - Sometimes you don’t realise you have been asleep. It seems that you’ve been laying there awake for hours and hours. In fact, there are many different levels of sleep. Just because you didn’t have any dreams, doesn’t mean you haven’t been asleep. So, even if you're not tired, you should go to bed at the same time every night. Lay down, make yourself comfortable and close your eyes. You'll be giving your body a rest and you might even grab an hour or two without even realising. I hope these hints and tips are of some benefit to those of you who are struggling with sleep. Things do get better as time goes on. Hang in there. Better days, and nights, are ahead of you. *

Hi. I'm HOPEFULLY coming out of what could be called a 7 month mental breakdown induced by antidepressant roulette ....I've read so many of your stories over the last few months (which have been the worst) and they have helped me...so I feel like I should share my experience in case anything in it can help someone else. First is a short version of what happened to me. Below that is a list of specific things that helped me. And below that, I've shared a longer version in case you'd like more details. I'm truly in awe of how behind psychiatry is. No one should have to suffer like this. WHAT HAPPENED TO ME - I was on Wellbutrin and Prozac for a few years - couldn't quite get the balance right (turns out SR and XL were getting messed up so that didn't help). I was always a little too anxious or a little too depressed. It wasn't bad, but could have been better so I thought I'd try something new. First, I got off Wellbutrin CT. Prozac alone was hell - probably bc of Wellbutrin withdrawal. Then I cross tapered Prozac with Pristiq. Pristiq worked for a month then stopped- I was in hell again - probably delayed Prozac withdrawal. Then I added Ability to the Pristiq - horrible side effects. Then I stopped those CT and I took Viibryd. Pristiq/ Ability withdrawal + Viibryd side effects, and after all I'd already been through, worse than hell. I took Klonopin and 10mg Prozac to wean off of that. I started to feel slightly human again. I got back on Wellbutrin and Prozac and felt more human. Then had to wean off the Klonopin - worse than what's worse than hell. Now I'm just on the Wellbutrin and Prozac like I was originally and I finally feel like a person again. What a nightmare - 5 withdrawals in 7 months. Anyway...I've learned some things.... THINGS I'VE LEARNED - Medicine tips: 1. Try to stay consistent with a pharmacy/manufacturer if you're taking generic bc that can make you respond differently to the medicine (I think that was a problem with my wellbutrin originally - also XL is smoother than SR and it's important to stay consistent with that as well) 2. Adding Prozac while weaning off an anti-d can really help with withdrawal 3. Wellbutrin can increase the concentration of Prozac in the body if taken together which is important to know when tweaking the dosage 4. Don't CT anything even if you're on something else or getting on something else. 5. Changing is a REAL b**** so only do it if you have to. 6. If you have to take a benzo to help with withdrawal, don't take it everyday or for too long bc you'll have another withdrawal and nothing to help with that one. Anxiety: 1. When panicking, holding ice, getting in a really hot bath, running or doing push ups can be good bc your heart is racing due to a threat it doesn't understand...when you give it a real reason to race and then take it away...your heart feels the threat is removed and will slow down a bit. Plus your mind will focus on that pain instead of on the more painful racing negative thoughts. In some messed up way, it's like a less harmful version of cutting. 2. Lavender oil is very calming, and smell is the only sense with a direct pathway to the amygdala which is the part of your brain associated with mood and emotions. Smells that remind you of happy times work as well. 3. Warm baths helped me more than anything. Increasing body temperature can help regulate mood. Sometimes, putting cold water on for a little helps as well bc that can help circulation and increase oxygen. Switching back and forth can help with the chills/hot flashes that come with withdrawal. 4. After bath, I put towel down on floor and did some stretches to open chest and hips bc that's where we carry a lot of grief. I recommend making it part of a morning routine. 5. Writing affirmations on paper with a pencil or pen can be therapeutic. Find words that resonate with you - simple sentences. It sounds silly, but it actually helped. 6. If people are pissing you off, but you know you shouldn't be confrontational in this state, write them letters that you don't send. 7. Fresh air really helps, even if you just open a window. 8. The mornings are the worst bc of Cortisol. 9. Google Alternate Nostril Breathing and do that for longer than feels comfortable. Also, when taking deep breaths, the exhale should be longer than the inhale and is more important, but if you do it for a really long time, make them equal so you don't get light-headed. 10. There's a good mediation app called "Insight Timer" and another called "Calm". 11. I read a book called "Love Warrior" that was a good distraction and very relatable. If you have stress relating to a toxic relationship, "Women Who Love Too Much" is also a great book. 12. Binge on a Netflix series to distract your mind. The Moth app is good for that also if watching is too hard. 13. Hugging or cuddling releases oxytocin and can really calm stress. Massages obviously help a ton as well. 14. Imagine a happy place in detail - the smells, sounds, textures etc...for a proper amount of time. Get lost there. 15. Talk to yourself and tell yourself the things you wish someone would say to you to calm you down. You'll feel crazy at first, but it helps. 16. People who've had easy experiences don't write on message boards, but there are plenty. So don't get discouraged only reading horror stories on here. They're the worst cases. 17. Focus on today. Making big changes to address the underlying issues that caused the original anxiety and depression are things to consider once you're stable. And whatever in your life is getting messed up bc of the state you're in, focus on fixing those later when you're better as well. Be honest with work, family, friends etc and hope for compassion. In the meantime, think of the next right thing to do and the next breath. One thing at a time, one moment at a time. Everything else will be much less daunting and easier to fix when your biochemistry isn't going haywire...so cut yourself some slack. Nausea: 1. Pepto can help. 2. Chocolate Boost Plus is good for when you're too nauseous to eat but need to keep weight up. Banana and peanut butter smoothies with chocolate protein powder helped me. Whole foods has a bunch of shots, smoothies etc if you can't make them. 3. Pedialite can help with dehydration. 4. Three fingers from your wrist is the pressure point for nausea. 5. Ginger helps more than you'd think. Ginger candies to suck on are good. Despite what people say, I found Ginger Ale made me more nauseous. Loved Ones: 1. It's helpful if other people can make many of the daily small decisions for you bc thinking at all can be really overwhelming. 2. Complicated conversations about politics, business etc should happen in another room. It's important to focus on simple and positive things to help your brain heal 2. Google SSRI withdrawal symptoms and show them to your loved ones so they know what to expect and so they know your behavior is the result of a chemical clusterfuck and is not reflective of a new or old you. 3. Explain to loved ones that if you sense their anxiety about your anxiety or their fear or impatience, you will feel it magnified and it will slow your recovery massively. You need to be around supportive people who will tell you you're going to be ok and keep you calm. That's crucial. From Me to You: This is only temporary. You will get through this and be yourself again, no matter how impossible that seems while you're in it. I know my story isn't very encouraging, but I really believed the new me was going to have to live like that forever, and I really didn't think I'd survive if that was the case. But I did survive and I'm here now - feeling like the old me with a new appreciation for everything, and the hope that what I went through will somehow help someone else. Here's the more detailed version if you think it might provide some useful information - about what NOT to do For a few years, I was on 300 wellbutrin and 40 prozac... I couldn't quite get the balance right for anxiety/depression, and I thought maybe being on just one drug would be a better idea. My doctor suggested I CT the wellbutrin and up my prozac from 40 to 60. I stayed on just Prozac for the month but crashed - fatigue, anxiety, depression - and A LOT of it. I still don't know if that was wellbutrin withdrawal but, in hindsight, I suspect it may have been. I went to a new doctor who suggested I try Pristiq bc my mom does well on Effexor (strong proof that members of the same family tend to do well on the same drugs) and it was the improved version. Also bc I had done well on Cymbalta years earlier, except for the intense fatigue, she thought another SNRI might be good for me. I weaned off Prozac in a couple of weeks while taking the Pristiq. It worked really well for about a month on it's own and then I crashed again - fatigue, anxiety, depression - and A LOT of it. Again, in hindsight, I wonder if the prozac had a delayed withdrawal bc that can happen even though doctors don't acknowledge it much. I raised the Pristiq by 25 for a couple weeks and it didn't help. Studies have shown that increased levels of Pristiq doesn't increase efficacy of the drug...it's just more to get off of later. So I went back down to 50 and my doctor then added 5mg of Ability. I had awful side effects - restlessness, jumping out of my skin, major depersonalization, etc. She suggested Rexulti which has less side effects but isn't covered by insurance and would have been 1k a month so I tried Geodon instead for three days - same class of med, same problems. So I gave up on Pristiq. Stopped CT and started 10mg of Viibryd. That's when things started to get really really bad. I basically compounded Pristiq withdrawal with Viibryd side effects. I eased up over a month to 40mg - the therapeutic dose. I woke up in a panic attack every morning, I couldn't function at all, I could barely talk or eat. I felt terrified and almost catatonic. I took 20mg at 11am and 20mg at 3/4pm, and you have to take it with food which is hell when you're that nauseous. It got a little better after 5/6 pm everyday which was strange. It also got a little better at 40mg in that my good windows would last a little longer but my bad ones were still awful and still lasted for the majority of my day. I added Valium in the morning but didn't want to get addicted so I'd go three days or so then experience increased depression when I stopped. My doctor kept telling me to be patient, that things would turn around, but after two months of feeling like I was dying everyday, unable to function and having suicidal thoughts, I lost any bit of patience I had left. He had also told me that he thought a lot of this was psychological not chemical and that I should spend more time talking to my therapist. Anyone who has been through awful side effects and/or awful withdrawal very much knows the difference between issues that can be resolved by a therapist and issues that need a good psychiatrist. The only thing I needed to talk to a therapist about at the time was the physical pain I was in due to the medicine. I saw another doctor who told me to wean off the Viibryd - that I should be feeling better by that point. I honestly thought I wouldn't make it through another withdrawal period, but the Viibryd was so bad for me that the withdrawal was actually less miserable than the side effects had been. She also told me to take Klonopin .5mg in the morning and at night. My anxiety was way worse in the morning so I took it then, but fortunately, didn't get addicted to the full 1mg a day bc I didn't take it at night. She also added Prozac - 10 up to 20 while I weaned down on Viibryd. After being off of the Viibryd for a little over a week, I needed to figure out what anti-depressant was next. I honestly felt too scared to try anything else so I added 300xl of Wellbutrin to the 20 Prozac - a little less than I was on originally - before I started all the changes. Still not finished - then I had to withdraw from the .5 Klonopin I'd been taking for a month. I cut in half for a week then half of that for 3 days. I suffered terribly that whole time and then for a few days after my last dose. I am writing you from the other side. So...I basically went through all of the hell to circle back to where I started, and I definitely didn't have it in me to get off altogether bc I know adjusting to life without meds after 16 years on them is going to be a bigger task than I have the energy for right now...but I did learn some things....