rspwed: Introduction and what to taper first?

13 posts in this topic

Hi there,

I'm a long time SSRI user, over 10 years on Lexapro, currently taking Mirtazapine and Buspar. I have been feeling pretty crappy the last few days and it has been on my mind to taper off of these drugs.

I have a few questions I hope someone can help me with. I replaced lexapro with mirt in January and was wondering if some of what I'm feeling could be withdrawal from the lexapro? I was taking 40mg a day when I switched, it made me nervous to be on such a high dose.

Also, I'm taking 7.5mg of mirt and 45mg of buspar currently. Is there a recommendation as to which to taper first? And why? I think the buspar is waking me up. For a while I was taking 15mg of mirt and 30 of buspar and slept really well on that, but the mirt was making me really irritable, so I reduced the mirt and upped the buspar.

Any help would be greatly appreciated.

Thanks for reading.

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Welcome rspwed

Gee how can a doctor justify hitting an  adverse reaction (?) to an antibiotic with 40mg of a (mother of all brain bombs-a moabb)  most potent antidepressant lexapro??!!??!

It may not have even been an adverse reaction to the antibiotic but simply the antibiotic triggering wdl symptoms from the lex which i assume was cold turkeyed 9 months prior. What were the symptoms of that adverse reaction to the antibiotic i wonder.

I would have thought if an adverse reaction to an antibiotic then the answer is stop the antibiotic.


It is revealing to note that 40mg of lex is equivalent in dose to 113mg mirt.

Or 7.5 remeron/mirt is equivalent to 2.7 of lex.

Not sure if the brain will be happy with this apparent unfair exchange.


So the buspar is perhaps being ramped up to silence any wdl symptoms from lex.

You might like to add a date when you did the most recent change in doses.


Hopefully the mods will be in soon in the meantime:


These links are very informative and worth spending time reading


Tips for tapering off busipirone (Buspar)



Tips for tapering off Lexapro (escitalopram)


taking multiple drugs which one to taper first.


Welcome to sa, you have come to the right place.


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Hi rspwed, welcome to the forum,


Thank you for filling in your signature, that makes it easier to understand your drug history.


When you say you have been feeling crappy, what do you mean. If you could describe your symptoms that would be helpful. How long have you been feeling like this, did it only just start?


How did you stop taking Lexapro in 2015? Did you experience any withdrawal symptoms during the nine month prior to your Ciprofloxacin reaction?


You are right, 40mg of Lexapro is an extremely high dose. Why did you switch to Mirtazepine and not just reduce the dose of Lexapro? Were you trying these drugs to treat the Cipro reaction?


Like NZ11, I'm also wondering if some of what you have been experiencing is Lexapro withdrawal. Mirtazapine is a different kind of drug, and you have been taking it at a lower dose, compared with the high dose of lexapro which you were on, so perhaps you are having some break through lexapro withdrawal.


After long term lexapro use, without careful tapering, I would be surprised if anyone would escape without at least some withdrawal symptoms and a recovery period.


These drugs are not like aspirin, once out of your system, you are back to normal. Over time they make changes to the way the brain and nervous system functions, these changes take time to reverse. This post explains it better than I can:  Brain Remodelling (Rhi's Description of Brain Healing)


NZ gave you the link with information about which drug to taper first, and here is our Remeron topic:  Tips for tapering off Remeron (mirtazapine)


Your situation is complicated, its difficult to know what might be causing symptoms now, or what to suggest.  Cipro reactions can produce the same kinds of symptoms as antidepressant withdrawal, and take just as long to recover from. Both kinds of drugs act on the nervous system and can cause disruption to normal functioning, which can take a while to recover from.


When we have a bit more information, we might be able to suggest something, but for now, please read through the links, if you have any questions, you can ask them here on your thread.



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Thanks for the replies.


 I didn't feel any withdrawal symptoms from the lexapro during the 9 months that I was off of it. I jumped off at 2.5mg after taking that for at least a year. The dates are a little jumbled in my head, especially for this last year as I scrambled for any kind of relief.


 So last March (2016) I went to the doc because I thought I might have a UTI. She prescribed the Cipro. I took one dose before bed that night, when I woke up I felt odd, but didn't think too much about it. Took my second dose and went off to work.

Within 2 hours I was completely messed up. Major anxiety, and very strange feelings I can't really describe. Never took a third dose. I was done with that. I called the doctor and told her what happened. She prescribed another anti-biotic, which I'm not sure I even bothered with.

 Anyway, I had a bunch of left over lexapro, and after 2 days of anxiety and panic attacks, I started taking 2.5mgs of lexapro again. My choice, started out with a low dose because I thought that would be all I need. Saw the doc, let her know what was going on. She agreed to have me continue on the lexapro. So a couple weeks of that and upped to 5, not working, 7.5mg, not working. then 10, then 20, then 30 all this time having horrible anxiety and rotten side effects, suicidal thoughts, no appetite, terrible insomnia. By this time, I'm seeing a therapist and a psychiatrist PA has taken over my prescriptions. I asked for a change from lexapro, I was feeling okay at 40mg but was only getting about 3 hours of sleep a night and was completely disinterested in sex. (I'm a 50 year old married man, BTW).

So in January of this year I asked the psychiatrist PA for a switch, he suggested the mirtazapine at 15 mg because of the sleep benefits. I actually felt pretty good and was sleeping better, but I had crazy mood swings and was really irritable.

I asked about reducing the mirt and increasing the Buspar to try and relieve the irritability. That seems to have worked, but the insomnia is back.


My issues right now are insomnia, and rotten morning anxiety everyday, shakiness of my hands and arms. Every couple weeks I have a bad day or two with depression and crying jags and feelings of hopelessness.


So there's a little more detail with my situation, sorry I didn't post more detail in the intro.

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Thanks for the links nz11. I read the which to taper first link right away, of course. Given the premise of tapering the most activating drug first, I believe I should start tapering the Buspar.

The mirtazapine is given for sleep issues, as well as anxiety, so that should make the choice clear, right?


Thanks again. I do feel terrible on many days, but I suppose that's not clear from my original post.

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Please can someone help me? I don't know what to do. The anxiety in the morning is a killer. Insomnia is ruining me.

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Given the premise of tapering the most activating drug first, I believe I should start tapering the Buspar.

The mirtazapine is given for sleep issues, as well as anxiety, so that should make the choice clear, right?


Thanks again. I do feel terrible on many days, but I suppose that's not clear from my original post.

Thanks to off label prescribing things are not as clear as they perhaps could be.

The way i see it is mirt is an ad and therefore activating, buspar is a type of anti-anxety drug and by defn sedating.


I am so so sorry you are in this dreadful position.

I agree with Petu that this is complicated.


What date did you drop the remeron from 15 to 7.5 last week? last month?

Have things worsened considerably since this change?

How is the anxiety throughout the day ..does it recede? Can you manage it without wanting to run to a doctor?


I cant help but feel the major player here is the withdrawal symptoms from 40mg lexapro which may have been delayed or masked up till the recent changes.

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I've edited my signature to add some dates. Things have been kind of fuzzy.

I've been reading around quite a bit here, and I think the lexapro is playing a major role, as well.

I've had some symptoms that I didn't realize are associated with withdrawal such as being cold all the time, and diarrhea.

The anxiety recedes as the day goes on, but the last week or so it hasn't receded as much as it was before.

I haven't changed anything in a month and I think I need to give myself a break and not change anything for a while. I'm hoping I can get through this without changing anything, but it's very tempting to want to try something new to feel better.

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Thank you for adding more information and dates to your signature.


You have made a lot of drug changes over the last year, this can be very destabilizing to the nervous system. I agree that holding for now is probably the best idea. It may take a while before you stabilize, but it will probably happen in a windows and waves kind of pattern. From what you have written, it sounds like you are in this pattern already.


See: The Windows and Waves Pattern of Stabilization


This topic also has some good information: The rule of 3KIS: Keep it simple. Keep it slow. Keep it stable.


The daily cycle you describe of feeling worse in the morning and better as the day progresses is quite common once the NS becomes sensitized. One theory is that its linked to our natural cortisol cycle. This also settles down over time. Here is more related information: Waking with panic or anxiety -- managing cortisol spikes - Symptoms ...


Here is the link to our symptoms and self care section, you may find some useful ideas to help manage symptoms as you wait to stabilize.  Especially read the topics pinned at the top.

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Thank you, Petunia.

It does feel like a windows and waves type pattern.

Thanks for the links. I'll check them out.

I'm seeing my psych PA tomorrow. I'm going to tell him I'm going to hold steady where I'm at for another month or two.

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Do you think my insomnia is related more to withdrawal from the Lexapro or the large amounts of Buspar?

nz11 thinks the Remeron may be more activating than the Busar, but it's such a small dose of Remeron.

Does anyone have any opinions on that?

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P.S. Petunia, I love Dr. Weekes. Thanks for the video.

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I'm coming to believe that while AD's are part of the problem for sure, that Ciprofloxacin is the main culprit behind this misery.

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