dalsaan

☼ Dalsaan

415 posts in this topic

HI everyone,

 

My history:

 

first prescribed an AD - Effexor (75 mgs I think) at the start of 2005 was on it for 8 weeks and had extreme insomnia (an adverse reaction?) Dr said all ADs have side effects you have to live with it.

 

Changed Dr, he put me on Remeron (or Avanza as its known in Australia. Worked ok, continued to have trouble sleeping but not the extreme insomnia I experienced with the Effexor.

 

Stayed on remeron until 2008 when I went off suddenly - ran out of prescription, dr away etc. Had nausea, dizzyness, motion sickness (on land) visual disturbances and extreme insomnia. Dr prescribed sleeping tablets etc, after 8 weeks couldnt hack it anymore went back on to remeron 30 mg.

 

Since then have had 4 more tries at getting off, tapering slower and slower. Have also excluded a whole heap of illnesses that I thought might have been masked by my ADs. I did this because no dr has ever mentioned withdrawal. Every time, same thing.

 

Asked for a referral to a psychiatrist instead of just trying to work with GP. Psychiatrist said "I have never had anyone have any trouble discontinuing remeron, I tell my patients to stop cold turkey". Try taking an antihistamine or switching to prozac as it has a long half life, here is a script if you ever decide to do it.

 

read more, decided its withdrawal, got remeron tabs converted to liquid and have been tapering at 1ml per week from 15 ml. Currently on 8 ml. Just had a crap week - emotional all over the place, chills, more significant insomnia (down from 4.5 hrs to 2.5). Have decided I need to slow it down even more.

 

I have some questions if anyone can help.

 

Has anyone else had a problem with remeron, I havent seen much about it on the forums

I know you advise against skipping days but would you advise against alternating doses eg 8 ml, 7.5 ml, 8 ml, 7.5 etc then 7.5 consitently then the alternating routine from 7.5, 7 just to lessen the step?

 

with the sleep stuff I feel slightly wired when I lie down to sleep, kind of like the switch is stuck on. Could this be cortisol, does magnesium lower cortisol and if so how much should i take and when?

 

any help much appreciated. I feel like my medical practitioners know nothing and I have to work this out (with a little help from my new friends hopefully!)

 

take care

 

Dalsaan

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Hi Dalsaan. Welcome to the group. I'm sorry, I don't have experience with the medicine you're taking. But I do know it is important to have a consistent dose every day to let your brain and nervous system adjust more gently. You've been through a lot, and the story of the doctors acting like they've never heard of such problems is typical, and it never ceases to amaze me that they keep telling people this. Could they really be that blind? I know others will come and have better advice for your specific situation. I just wanted to welcome you and tell you that we're all in this together now and we're making it.

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I was put on Remeron for sleep while also on Pristiq (a version of Effexor, I think) while hospitalized for depression. It worked, but a few weeks after I was discharged I found that Remeron caused flu-like symptoms and greatly aggravated a circulatory problem I have called Reynaud's Phenomena, a fancy term for getting cold hands and feet in cool weather. I was able to taper off over a month or so (I don't remember the intial dose), but that was likely fairly easy because I continued the other antidepressant.

 

Avoid alternating doses! The problems arise not just from the drug in your body, but from neurological changes in the brain. Take your tapering off just as slowly as possible in your circumstances.

 

I hope that Alto will be along soon to offer additional advice. In the meantime, please review the topics under "Symptoms and What Helps" for some really useful ideas.

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Thanks shanti and Jemima. I really appreciate your advice and support

 

One other question I have - has anyone tried what my psychiatrist recommended, moving onto Prozac to use its long half life as a taper

 

Thanks once again

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Yes, I switched from Paxil to Prozac after trying for many months to taper my Paxil below 20 mg. It was just too difficult. I did the Prozac switch in December and my taper off of Prozac since then has been much smoother. I think it's worth a try for anyone having a hard time.

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Welcome Dalsaan!

 

I think you'll find lots of good information and support here.

 

The main things I wanted to add right now are:

 

First, as others have said, better not to alternate doses.

 

Next: Needing to go very slowly is not uncommon. There's a lot of variation. Clearly experience has shown that you need to go slowly. Since you're running into some bumps now, perhaps this would be a good time to hold your taper for a while (that is, stop tapering for a while, stay on the same dose, see if things settle down a bit). Most people find it necessary to adjust their tapers as they go along and to take holds from time to time to allow the healing process to catch up with the reductions they have already made.

 

Most people also find it necessary to go more slowly as they get lower in dosage. Think in terms of your current cut as a percentage of your current dose not as a percentage of your original dose. 1 mL is less than 10% of 15 mL but it's more than 10% of 8 mL.

 

And generally when people make 10% cuts they have to hold longer than a week--usually at least two weeks.

 

You're down almost to half your original dose so you may need to make your cuts correspondingly smaller. If you make 10% cuts you may need to try allowing more time between them.

 

Mainly, I would say, take heart. You've got a liquid compound, which is excellent. You've been successful so far. At this point I think, given the history you describe, your best bet would be to stop tapering for a month or two (or as long as necessary) to allow things to stabilize and catch up with the 53% reduction you've already made in a fairly short time. You're growing a new brain and repairing a damaged HPA axis. That doesn't happen overnight.

 

Then when you restart the taper try cutting by smaller increments and taking longer breaks.

 

It can work. You can do this. Just be patient. It's not a race--and even if it were, as you can see going faster often leads to crashes and having to stabilize and then start all over.

 

If it's a race, it's the kind of race where the tortoise wins.

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Welcome, Dalsaan.

 

The folks up above have given such good advice, I don't think I can add anything.

 

Since you have liquid Remeron, you have a lot of control over the rate of your taper. Rhi has a good point, you're down in dosage so your decreases now represent a larger proportion of your dose.

 

Since you've started to get withdrawal symptoms, if I were you, I'd hold for a bit to see if they go away. Don't forge ahead with decreases.

 

Once you stabilize, try a very small decrease, even .25mg, and see how you feel. You might be able to make these micro-drops more often than every week, or you may find you need to hold longer.

 

It's safer to slow down a taper than count on a switch to Prozac. Sometimes it doesn't work. It really should be used only when a taper becomes unbearable or there are other serious adverse effects from the medication.

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Thanks for your help. I'll take the tortoise option. I had another very average sleep last night so now I am thinking I might need to back track rather than just stay where I am for a month. I know that sleep deprivation is might greatest risk to success. Any thoughts. Should I ride it out for a while on 8 or go back up to 9 or 10.

 

Also would you read my history of indicating a kind of hypersensitivity? I still drink coffee in the mornings and struggle without it due to sleep deprivation. Should I have a go at giving it up entirely or would this put too much pressures on my system- withdrawing from another substance now.

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Sorry for all the questions. I feel like this is the first time I have had access to any informed support/advice. I really appreciate your help

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Well, thanks, Dalsaan.

 

From your history, which includes severe withdrawal symptoms and a need for a very gradual taper, I suspect you might be hypersensitive.

 

Caffeine has a very long half-life and could be contributing to sleep problems. If I were you, I'd try a bit of a reduction in that.

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Hi Dalsaan and welcome...

 

I have not taken remeron. Have gone thru the withdrawal process a few times. Unfortunately doctors do not know what we know. This is a great support group, not just with information but also with understanding and needing a place to vent.

 

Liquid is so much easier. Make you drops smaller is dose and take your time in between drops. It really is easier on us than larger cuts in dose.

 

You asked about magnesium. It helped me during a lexapro taper. Ask Alto about her dosage.

You have to be careful as too much can upset the stomach. Calcium is supposed to have a calming effect. Try not to do too much in the line of supplements. there can be adverse reactions due to the withdrawal. Lots of people take Fish Oil for depression.

 

I once had a doctor tell me he "did not believe in WD". You aren't alone and you don't have to do this alone.

 

Nice to meet you

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The fact that you're able to sleep at all is a good sign. I had terrible insomnia for two or three months after tapering off Lexapro.

 

I couldn't tolerate coffee (or even regular tea) at all during early withdrawal and now I've completely lost my taste for it. The one thing I found that tastes like good coffee but has no caffeine is chicory. I got it from an online store called Nuts.com.

 

And don't be at all embarrassed about asking questions. I think I can speak for most of us here on the forum in saying that we all were quite bewildered about what was happening to us at first - while doctors either denied there was anything happening to us or mistook withdrawal for relapse. I don't remember if I asked lots of questions at first, but I do remember hanging onto this forum like it was the last life raft thrown off the Titanic.

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Hi Dalsaan

 

Welcome to the forum. Gosh, such good advice has already been given and Nikki is right, there is a lot of support and compassion on this forum.

 

Regarding your sleep, there is a good chance that it is cortisol building up in the evening. Magnesium can help calm you to sleep; so can Melatonin, phosphatidylserine and Seriphos. Check out this link http://survivingantidepressants.org/index.php?/topic/1852-how-to-reduce-cortisol-both-rx-and-natural/

 

Since you are probably hypersensitized, if you do decide to try a supplement for sleep, only change one thing at a time and give it a week to see if it works or if it causes any ill effects. If it causes ill effects go ahead an stop it, but give it some time to work.

 

I take large amounts of magnesium (800-1000 mg) but I have celiac disease and have absorption issues. I've used melatonin and phosphatidylserine successfully to help with sleep.

 

Once again, welcome.

 

Love and light, Karma

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Hello Dalsaan

 

Just like to welcome you also!

I m quite new to this site, I would not have known what to do if I hadn't the help and support from the caring peeps on this forum

 

I wish you well

 

Debbie x

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Thanks everyone for your warm welcome and support

 

I am after some more advice. I have been on 8mls for a couple of weeks now. Mostly it's going ok but I really can't sleep. I have always had significant trouble sleeping when I have dropped this far. I think it's a cortisol issue because I feel a bit wired. It's like a switch is stuck on, not hyper but just too alert and can't drop off to sleep

 

My question should I go back up in dose and hope this resolves the sleep issues? I'm really reluctant but I don't it's going to resolve spontaneously. It never has before

 

Also does anyone have ant recommendations for dr's in Australia that know anything about withdrawal?

 

Take care

 

Dalsaan

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Altostrata.

 

I just saw your post here http://beyondmeds.com/2011/07/28/ssriprotractedwithdrawal/. Your discussion of the cortisol sleep stuff rings so true. I can be totally exhausted and as soon as I lie down my body goes hang on a minute we need to stay alert and I'm awake, too awake to sleep. I think I'm down to no sleep now. Or at best some light sleep after 4am

 

Would reducing my external stress be positive or would it make no to no different?

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Yes, minimizing external stress can help.

 

With the chills, etc., it sounds like your system is having difficulty with decreases of 1mg. You might updose a bit, stabilize for several weeks, and decrease by much less than 1mg -- .25mg, for example.

 

We have topics about reducing the influence of cortisol in the Symptoms section.

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When I drop the dose I do get isomnia which is triggered by the cortisol. After a week I can return to falling asleep.

 

I have tried other alternatives for sleep which worked, but I have developed such sensitivites to all medications that I get a rebounding depression.

 

Propanolol is a Beta Blocker which is not addictive. It did stop anxiety dead in it's tracks and it did allow me to fall asleep. If I took it for more than two nights I had that rebounding depression.

 

Google Rescue Remedy. They are natural tinctures that have been around since forever. they can help with anxiety and sleep.

 

There are benzos like Xanax. I get a rebounding depression from them and a hung-over feeling from just a tiny amount. They are very addictive.

 

There is another medication....can't remember how to spell it. Hydrzizine????? It is the isolated drug that is in Bendryl which causes sleepiness. It knocked me out, but again....

I was hung-over and felt a bit depressed.

 

Ask Shanti for a natural remedy....she' very good at this.

 

Hope you get some sleep.

 

Hugs

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Update. Sleep still elusive. Have gone back up to 9ml but hasn't resolved insomnia. Am contemplating going back to the start 15 ml. And beginning my taper again working with smaller drops and less often

 

It's all a bit disappointing, frustrating etc etc

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Hi everyone

 

Update - Went back up to 10ml. Have started to sleep again. Getting about 4-5 hrs which is a lot better than it has been. I am going to stay on 10ml for at least a month and spend some time getting my sleep routine as good as it can be.

 

Still learning about this stuff. I think mirtazapine withdrawal is a double whammy - rebound insomnia from ad effects and rebound insomnia from decrease in antihistamine. No wonder it's harsh

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That's great news, Dalsaan.

 

I think you are 200% right about mirtazapine withdrawal.

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Sleep has dropped off again. Averaging about 3hrs which is not enough. My sleep debt is bigger than my mortgage

 

Today someone at work said can I pick your brain about something. I said good luck with that

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Hi dalsaan,

 

I note that you get compounded mirtazepine. Is it prepared as a "fixed oil" base (almond oil, etc) or is it held in suspension in another medium?

What is the shelf-life? (2 weeks, 30 days? longer) When I was looking to taper mirtazepine, my compounding pharmacist called the compounding association of which he is a member and they said it was a suspension either in an oil base which was stable for 30 days or another medium such as Ora-Plus (a commercially prepared suspending vehicle) with a shelf life of 2 weeks. Just curious as to how your mirt is compounded. What is the concentration of your compounded mirt? (how many mg/ml). Thanks. :) Hugs, Annej

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Hi AnneJ,

 

I'm not sure what its suspended in. I asked my pharmacist about stability last time I got a script filled. She said should

be ok for 1-3 months (which doesnt inspire much confidence) but we agreed next time should would make enough for 2 weeks only.

The stuff I am taking now is only recent (1 1/2 week old).

 

the ratio is 1mg=1ml

 

My sleep has never been great and I am finding it hard to budge

 

dalsaan

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Dalsaan sorry about the sleep deficit. I have that now. Lack of sleep for me compounds problems....from very little ones to big ones. Memory loss too.

 

When you do go to sleep, you are gong to feel much better. Does reading help? When I am very tired and I read during the day I will nod out.

 

I have been doing water aerobics almost every day and it still hasn't knocked me out.

 

Is there something you can take to actually put you to sleep?

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Hi AnneJ,

 

I'm not sure what its suspended in. I asked my pharmacist about stability last time I got a script filled. She said should

be ok for 1-3 months (which doesnt inspire much confidence) but we agreed next time should would make enough for 2 weeks only.

The stuff I am taking now is only recent (1 1/2 week old).

 

the ratio is 1mg=1ml

 

My sleep has never been great and I am finding it hard to budge

 

dalsaan

 

dalsaan,

 

Mirt is only "partially soluable in water" and I suggest you check with a reliable source - a compounding pharmacist who is a member of one of the recognized compounding associations to double check that your suspension is in the correct medium. The fact that your pharmacist told you that the suspension "should be OK for 1-3 months" is an indicator that she is not familiar with the facts of compounding this drug. Ask her what reference she used to prepare the suspension. There are established protocols for the compounding of mirt (or any other drug that is not fully soluable in water).

 

Mirt is stable when prepared in a fixed-oil solution (almond oil or other accepted oil) for 30 days - no refrigeration required.

 

When prepared in a commercially prepared suspending vehicle (contains water) it is stable for 10 days only and must be refrigerated.

 

I stopped sleeping for 6 entire days after a rapid taper and then cold turkey off of Mirt. I had no other choice but to c/t - I was having severe adverse effects that did not appear for 30 days. I c/t'd it after 2.5 months of use. While I was still off of benzos, my doctor had me try Trazadone 50 mg at night. It worked for me and I slept. Traz works for some and not for others.

 

Once you are certain your mirt is properly compounded (THIS IS A POTENTIAL PROBLEM IN YOUR CASE) - you may want to consider a slight updose. Some people have found that there sleep remained intact by updosing and then slowing down the rate of taper and doing this over a few years.

 

The problem commonly seen is having great success going from 30 mg to 15 mg and then getting hit by severe, unrelenting insomnia and/or anxiety when trying to taper from 15 mg or 7.5 mg. This is the level where mirt acts on receptors that are integral to antihistamine production. Tiny, tiny dose reductions, and slowly with the use of a properly compounded suspension or a cheaper way and possibly more precise depending on one's compounding pharmacist, is to dry taper using a scale. :) Hugs, Annej

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Compounding pharmacies use centrally published recipes to make suspensions.

 

Dalsaan, your mirtazapine suspension should conform to one of these recipes. The recipes indicate the shelf-life of the compound. Your pharmacist should be able to discuss this with you.

 

I've found it's pretty common for these compounded liquids to last for a couple of months.

 

If you think your compounded pharmacy is sloppy, you should find another one.

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I tend to think its something other that the mirtazapine compound because I get to sleep but wake up at about 3 am and then that's it. When I have tapered too quickly or gone ct I can't get to sleep at all. So this is better than that but still not enough to support daily functioning. I'm taking tryptophan at bedtime at the moment. Started about 4 days ago. This seems to drop the arousal a but. Maybe I should take it at 3 when I wake up and see if that helps me drop off

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Not a great day, ive got really bad pms to go with my usual sleep deprived wd

and I feel like I could strangle someone who needs it

 

aaaaaaaaaaaaahhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhh

 

sorry, just needed to vent

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As long as it's someone who needs it!! LOL!!

 

Oh, y'all make me laugh when I need it most!

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My sleep seems to be on the improve. I have started taking taurine 2 mg at night and have cut down coffee to one in the morning, cut out all refined sugar and am on low carb diet. Roughly following the blood sugar diet

 

Will taper off the one coffee as well but have to go a bit slow because I get blinding headaches

 

Overall my system is a lot less aroused and last night I had the best sleep for a long time. Fingers crossed things are turning around

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Hi Dalsaan,

 

It's good to hear your sleep is getting better. I tapered a little off Remeron last night by mixing mine with water. I don't have the intestinal fortitude to try breaking it in half. :unsure: You said it was relatively easy to go from 30 down to 15, do you remember the symptoms you experienced with that cut?

 

I mixed 30 mg with 10 ml of water and took off 1 ml. I wish I was brave enough to try halving the tablet like you did; however, I'm doing fairly well at this time and don't want to rock the boat.

 

I sincerely hope and pray for your success!

 

Love,

 

Tezza

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Hi Tezza.

 

I don't recall any major symptoms going from 30-15. It's always been below 15 that I have trouble with and the lower I go the more trouble I get if I'm not careful. I'm at 9 ml now and will drop 10 percent in about a weeks time.

 

Hope things stay ok for you

 

Take care

 

Dalsaan

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Good to hear, Dalsaan.

 

When you have a chance, please start a topic about taurine in the Symptoms forum -- how you started it, what kinds of reactions you had, etc.

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Well, I spoke a bit too soon. Didn't sleep at all last night, was anxious and teary this morning. Not sure why but it's disappointing. I thought I had turned the corner

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Dalsaan...

 

giving up sugar is fantastic. Give yourself a huge pat on the back for that. As for coffee, can you switch to decaf, so you aren't putting yourself thru another wd of sorts?

 

The morning anxiety and being teary eyed is a biggy for so many. I think the tears may come from the frustration of having the anxiety.

 

Hugs

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