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zamwessell: Remeron rodeo

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zamwessell   
zamwessell

Hello, this is zamwessell, and I am new to the forum as of this afternoon. I'd like to give a bit of background, and ask for some advice.

 

Back in mid-July 2015, I had a bout of anxiety and insomnia due to worrying about the beginning of a new relationship. I initially asked for some help for this, and my doc prescribed Wellbutrin, but after 5 days of being numb, I stopped it. Then asked for something different and was prescribed Ambien 5 mg. Was on that for 16 days, but it was not working to get me to sleep, so I ended up at a Psych ER at the local university hospital. They suggested Remeron, so I went on that at 7.5 mg to begin with. That combination was still not working, and I ended up in the hospital for 5 days, where they took me off Ambien and put me on Ativan. I'm sorry to say, I don't remember the exact dosage, but I believe it was 1 mg in am and 1 mg in pm. I was able to taper off of that beginning October of 2015, after switching to Valium.

 

Over the course of a couple of months, I reached the final dose of Remeron that my doc and I agreed on: 30 mg. I was on that, doing well, until mid-September of last year, when we decided things were stable enough in my life that I could start tapering off that. Not knowing any better, we agreed on a taper schedule: 3 weeks each at 22.5 mg, 15 mg, 7.5 mg, and 3.75 mg (if I felt I needed to - I did, but probably only stayed at that dosage for a week).

 

Only a week later, I began having pretty bad insomnia, coming in waves, with a few good nights and plenty of bad ones. I also noticed I was very cold, then would get very hot while trying to get to sleep. I also had muscle jerks, just as I was beginning to fall asleep, which would keep me from being able to fall asleep - a vicious cycle. This all continued for 7 weeks, until I couldn't take it any more and contacted my doc. She suggested going back on at a low dose to try to reinstate. I reluctantly agreed and that went well for about 7 nights. Then on nights 8 and 9, I noticed it took me longer to get to sleep, and by night 10 at 7.5, I didn't get any sleep at all. That was a Friday night. I contacted the on-call psychiatrist at the university's psych department, which was my only option on the weekend, and they said going up to 15 mg was fine, so that's what I did.

 

I so wish I had seen this forum prior to trying to reinstate. I definitely would have suggested starting only at 3.75 mg, but, alas, that didn't happen. Not knowing any better, I was under the impression that going back up, maybe even to where I was prior to starting the taper, was what I should do.

 

So, now I've been on the 15 mg for 6 nights. It takes me a couple of hours to get to sleep (I've been taking the dose about 10 pm), and have experienced the brain zaps others have talked about, as well as the muscle jerks just as I'm falling asleep, though to a slightly lesser intensity than when I was in withdrawal. I wake up numerous times, and realize I've been dreaming, so I just try and say to myself that you did get to sleep at some point, so try to get back to sleep. I have been able to get back to sleep, and have probably averaged 4-5 hours these past 6 nights. Last night was worse than the night before, however.

 

My questions are numerous, but I guess the main ones are: have others experienced this scenario, have I gone too high in going up to 15 mg, and what are some recommendations? I know that you all are not doctors, but I'm willing to consider experiences in what others have gone through.

Edited by scallywag
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KarenB   
KarenB

Hello Zamwessell,

 

Thanks for sharing your experience, and with such helpful details and dates.  Can I clarify that you are still taking Valium?  It would be good to have this in your signature too. 

 

Reinstating is the right thing to do when a person has tapered too fast, as your doctor unfortunately had you do.  However, as you've wondered, we do suggest a lower dose in order to avoid putting your brain and Central Nervous System through extremes. 

 

4-5 hours sleep would actually be considered pretty good for somebody in w/d.  How have you been functioning during the day?  You note that the muscle-jerks are less intense now.  So with these things in mind, I'm wondering if things are slowly starting to stabilise - which would mean it might be better to remain at 15mg, rather than put yourself through another dose change. 

 

Have a read of the reinstatement thread and see what you think.  You can discuss it further here. 

 

In the mean time you may like to try Fish oil and Magnesium which many people useful during withdrawal.   

 

Once you are stable, we recommend a gentle taper, reducing by no more than 10% of your current dose each month.  This allows your brain time to adjust as you go, and lessens any withdrawal.  Keep it Simple; Keep it Slow; Keep it Stable

 

Tips for Tapering Remeron

 

Have a read of those and then you can come back to this thread to discuss things further.  This can be your journal to record your tapering and healing progress, and to ask questions. 

 

Welcome to SA,

Karen

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zamwessell   
zamwessell

Thank you, KarenB. Actually, I had successfully stopped the Valium back In early 2016 - I was able to taper off of it. However, I forgot to put in my intro that my doc has given me another prescription for it, 2 mg, to take if I started having trouble, 1-2 tablets as needed for sleep. And last night, I took one, but it didn't help.

 

Yesterday, I went to exercise in order to feel somewhat normal, but I'm beginning to think that my swimming is hindering my recovery. The last two times I've swam, that night I've gotten absolutely no sleep, which was the case last night, unfortunately. I read some of another member's history of coming off of Remeron, where he mentions that strenuous excercise actually stimulated his nervous system too much and he found it made his symptoms worse.

 

So, as I was still awake at 2 am last night, I took one of the 2 mg Valium in a bit of a desperation mode, but I still did not sleep. I was wondering if it would be better to just try and not take the Valium or if I should just "give in" and take it if I have to in order to get some sleep again. I can't stand feeling like a zombie after little to no sleep, but I'm scared to start on a benzo again, after successfully getting off of it last year.

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scallywag   
scallywag

zamwessell -- Welcome to Surviving Antidepressants (SA)

 

The swimming may be connected to sleep issues.

- When you swim, are you doing a vigourous aerobic workout? For how long?

- At what time of day are you going to the pool?

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zamwessell   
zamwessell

Hi scallywag, I've been swimming at least twice a week for the last couple of years. It's my own made up version of water aerobics, not too crazy, but I keep moving for an hour straight. I always go between 4-5 pm. I tried to keep this up during withdrawal, too, but was probably only making It once a week. But as I said, last Friday (1/28), which was the first time (I think) I swam while back on 7.5 mg, I didn't sleep at all that night, and contacted that on-call doc for advice. They said go up to 15 mg, so I did. Yesterday was the first time I swam while on 15 mg, and again, no sleep.

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scallywag   
scallywag

Some people find that they can tolerate only gentle exercise. You may want to see what happens when you reduce the intensity or the duration of your workouts. You'd have to give it several tries, one data point wouldn't be conclusive.
 
Your increase from 7.5 to 15 mg was last Satruday, Jan. 28. It can take 2 weeks or more for your CNS (central nervous system) to stabilize after updosing:
How long to stabilize after reinstating or updosing.  

Remeron is sedating a lower doses, and less so at higher doses. Please read the first post in the Tips from Tapering Remeron topic.
 
Here are a few excerpts:
 

...
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
 

....
Discontinuation Symptoms
There have been reports of adverse reactions upon the discontinuation of Mirtazapine Tablets, USP (particularly when abrupt), including but not limited to the following: dizziness, abnormal dreams, sensory disturbances (including paresthesia and electric shock sensations), agitation, anxiety, fatigue, confusion, headache, tremor, nausea, vomiting, and sweating, or other symptoms which may be of clinical significance. The majority of the reported cases are mild and self-limiting.

Even though these have been reported as adverse reactions, it should be realized that these symptoms may be related to underlying disease. Patients currently taking Mirtazapine Tablets should NOT discontinue treatment abruptly, due to risk of discontinuation symptoms.

At the time that a medical decision is made to discontinue treatment with Mirtazapine Tablets, a gradual reduction in the dose, rather than an abrupt cessation, is recommended.
...



From Malhi, et al 2003 Dual-Action Antidepressants: Mechanisms of Action and Clinical Use
 

Mirtazapine has a high affinity for histamine receptors and is therefore sedating at low doses. This is countered to some extent by its enhancement of noradrenergic neurotransmission at higher doses, making mirtazapine less sedative as its dosage is increased
 
In comparator studies and controlled trials the most common side effects of mirtazapine (occurring in 10% to 30% of patients) were somnolescence, weight gain, and constipation. The weight gain associated with mirtazapine use is equivalent to that seen with TCAs [tricyclic antidepressants) and significantly more than that which occurs with SSRIs.40,45 Furthermore, despite having little affinity for cholinergic receptors, mirtazapine can cause dizziness and dry mouth. However, unlike venlafaxine, it rarely causes sexual dysfunction and does not have any significant cardiovascular side effects. ...

 

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zamwessell   
zamwessell

Thank you for your reply. I think I'll have to stick to walking for now.

 

I again realize you can't dispense medical advice, but I still have the question of taking the Valium or not. In your opinion, based on what you have seen and read throughout your time on this forum, is it wise for me to take the Valium, if I have a really bad night, or try and tough it out? My prescription is for 2 mg, and to take 1-2 tablets for sleep. I took one last night at 2 am, and it did almost nothing, except give me a bit of a calming effect, but no sleep.

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scallywag   
scallywag

What is the sleep problem you're having --

  • can't get to sleep
    -- or --
  • wake up multiple times during the night and take too long to back to sleep
    -- or --
  • wake up too early and can't get back to sleep?

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zamwessell   
zamwessell

Since I've been on 15 mg, most nights have gone like this: after getting in bed, it took 1-2.5 hours to get to sleep (took dose at 10 pm approx), then would wake up at some point, realize I had been asleep, and managed to get back to sleep at some point, and would wake again once more, then get back to sleep. I'd usually be completely awake by 5 am.

 

Last night, I took my Remeron dose about 9:30 pm, but never even got to sleep. Looked at the clock at 12:30, and again at 2 am, when I got up and took the 2 mg Valium. Like I mentioned, I could tell I took it, as I got kind of a calming effect, but I was never able to get to sleep. Feel pretty ragged today, just lying on the couch with my eyes closed so far.

 

I guess what it really comes down to is whether or not I'll stabilize at 15 mg, without the Valium, as long as I stay away from strenuous exercise?

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KarenB   
KarenB

If you can give it a few days or a week to allow for the stabilising to happen, that would be preferable (in my opinion) to taking the valium.  As you've realised, the swimming was worsening things and you can do something about that.  Are there other things you can do to optimise conditions for sleep?  You could check for things like caffeine, sugar or junk foods in the afternoon/evening, watching a screen in the hours before bed...

 

There's more ideas here:  http://survivingantidepressants.org/index.php?/topic/53-tips-to-help-sleep-so-many-of-us-have-that-awful-withdrawal-insomnia/

 

If you look at this as a difficult week to get through - as opposed to 'yikes, this is my life now!' - you may be able to ride it out more easily.

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zamwessell   
zamwessell

Thank you for the advice, KarenB. I've decided to try and not take the Valium tonight and see how it goes. I'm also planning on taking an epsom salt bath, and I've started on some fish oil supplements. And no more swimming for now, just hopefully, some walks.

 

I visited New Zealand in 2005 and it was one of the best trips of my life. I'd love to go back someday. Thanks again.

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KarenB   
KarenB

Yay!  I'm glad to hear you had a good time here.  Hope you are able to ease your way through the night tonight.

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zamwessell   
zamwessell

I just wanted to state for the record that I was able to get pretty decent sleep last night, and I didn't have to reach for the Valium. That is a definite win for the night.

 

I took the epsom bath about 8:00 pm, and took the last fish oil dose about 9 pm. I read for a while, then got ready for bed and took the Remeron just about 10 pm and climbed into bed. Probably due to the fact that I had not gotten any sleep the prior night, I fell asleep rather quickly, at least in terms of recent history, probably before 11:30 pm. I woke up 3-4 times, but was able to get back to sleep with not too much times going by.

 

I so hope this means I my (hopeful) stabilization was not harmed by the bad night Friday, and that my week ahead will not be as difficult as I had feared. However, I'm not going to assume anything, that's for sure, and will continue to take it day by day.

 

I have an appointment with my med-dispensing psychiatrist on Friday, and will be telling her about what I've learned, and I will be firm in my conviction that a 10% taper, when I'm stabilized, is what I want to do. She, of course, has advocated a much faster taper again than what I'm comfortable with, but I will be very firm.

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zamwessell   
zamwessell

Well, an update is necessary.  I thought I'd started to stabilize, but now I'm really in doubt.  I also thought that it was the strenuous exercise that was making me not sleep, as it happened twice in two weeks.  But, this past Thursday, Friday and Sunday (2/9, 2/10, & 2/12), I didn't swim, but I also didn't sleep.  Saturday night was the only night in the past four where I actually got sleep, and then I think I was so exhausted from two no-sleep nights in a row, that my body just took over.  I also tried the Valium again, on Friday night (2/10), this time 4 mg and there was no effect that I could tell.

 

Does anyone else here have knowledge or experience with Remeron, specifically?  I really don't want to use the benzos again, but I'm beginning to think that my CNS will be permanently damaged from lack of sleep.  I've become very jumpy in the last week or so, and I'm still experiencing the muscle jerks, hypnagogic I think they're called, when I try to go to sleep.  And, instead of the pattern where I get to sleep, then wake up a few times a night, seems to have been replaced with nights of no sleep at all.

 

I'm starting to lose hope that I will stabilize at 15 mg.  I had a good talk with my doc on Friday; she hardly batted an eye when I told her about the 10% taper I want to do, and said she'd contact the compounding pharmacy I want to use, so we can try and get it covered by my insurance.  Everything seems like it's falling into place - all except my sleep normalizing.

 

Would it be advisable to try and go down in dosage a bit?

 

How long will it take for me to be able to sleep??!!

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KarenB   
KarenB

Sleep is often one of the last things to settle down.  Most of us here have been through that stage where our sleep was horrendous - and we've survived.  It's horrible, but you too will survive. 

 

It's been just over two weeks since your up-dose?  Holding is what you need to do in order to allow enough time - especially for sleep to stabilise. 

 

From the Remeron thread:

A very common withdrawal problem with mirtazapine is rebound insomnia, which reinforces the need for very gradual tapering.

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GoodSarah   
GoodSarah

I used remeron for awhile. It did help for a few months. Then it just totally pooped out- didn't work at all except to make me groggy the next morning. I tried to take a break then go back but it never worked for me again.

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zamwessell   
zamwessell

Thank you KarenB and GoodSarah for the replies. I really appreciate the time you took to send me a message.  And, KarenB, of course you're right about holding at the 15 mg - it's just so hard to be sensible after a night of no sleep.

 

After my last update, I actually had a good run for two weeks, getting pretty decent sleep each night, thank the maker.  This week, however, has not been great.  I just never know when the night will be bad, and I'll get no sleep.  It's happened twice this week: Sunday (2/26) and last night (Wednesday, 3/1). I'm assuming these are the "waves" I've read about so much on this forum. It's so freaking frustrating.  And, unfortunately, with insomnia, it's not a physical symptom that can get better during the day; it just stays awful.  I feel wiped out, unable to concentrate and just drained.

 

I know things will get better, and I will stabilize more as time goes on, but it's hard to stay positive on the days where I feel I can't take it much longer.

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KarenB   
KarenB

Yeah, waves have a way of dropping us down suddenly.  And even though we know of their existence, they still manage to surprise most of us.  Glad you had a good few weeks in between waves though.  You'll get another good patch sometime. 

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zamwessell   
zamwessell

Update: I continued to have the pattern of no sleep nights followed by exhausted sleep nights; at least two more, into last weekend and Sunday night.  By Monday (3/6), I just couldn't take the pattern any more. I stayed home, curled up on the couch, and gave up for the day.  I called my doctor, who suggested trying the Valium again, but this time take 2 mg in the morning, and 2 mg at night, before going to bed, around the time I take my Remeron.  Back when I was on Ativan in 2015, that was the way I was taking it: one morning dose, and one evening dose.  

 

I agreed to try it, as I was starting to not being able to function on the days after getting no sleep.  I have a job and obligations I have to keep, and it was just becoming unbearable, not being able to get regular sleep.  So, for the last two nights, I've taken the Valium at about 9 pm, and have slept.  I forgot to take the AM dose, but have decided to not take it, if I can sleep with just a PM dose.  I'm glad that I have been able to sleep, but now I worry about being back on a benzo. This is exactly what I was trying desperately to avoid, but I just couldn't take the insomnia any more.

 

So, my question is now, how long am I going to "need" the Valium in order to sleep?  When I was on Ativan in 2015, I stayed on it for about 7 months, before tapering.  And, I was able to do a pretty fast taper, at least according to the advice given on this forum.  Once I switched to the dosage equivalent of Valium, I was able to go down by 1 mg, every three to four weeks.  I have no idea if I could do that again now, and probably should not attempt it.  And, you all advocate tapering off ADs first, but if I only take the Valium for a short time, should I get off of that first? Put another way: I realize that once I start tapering the Remeron, it will take just over three years to get off, going down by 10% each month.  With this site's recommendation of going off ADs first, does that mean I should stay on the Valium for that long of a time, just to get the AD out of my system first?

 

I have a face to face with my psychiatrist on Friday, and of course we will discuss all of this, but I would really like your take on this situation.  I'm not sure what to do now.  I guess I made the decision that establishing a regular sleeping pattern at this point was more important than my attempt to "stick it out," and being non-functional with the crippling insomnia I was experiencing.

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KarenB   
KarenB

I think that in your situation of having only used valium for a short time, it would be best to discontinue this first.  Our usual recomendation to taper ADs first is for those who come to us having been on both for a longer period of time. 

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zamwessell   
zamwessell

KarenB, that is what I was thinking, too.

 

I have a further update, though:  my sleeping has gotten a bit better, but my mood has gotten much worse over the past couple of weeks.  I just don't feel like doing things any more, I'm getting by doing the bare minimum in order to get through the days, and I don't want to make plans, as I just don't know how I'll feel only a few days into the future.  So, I've made the difficult decision to go back up to 30 mg on the Remeron.  I feel this will give me a better chance to feel on more of an even keel, at which point, I can decide on when to taper in the future.  I haven't started this yet, so I'm not going to update my signature yet.  I'm waiting to hear back from my psychiatrist.  I'm just feeling overwhelmed, and like I'm trying to fix everything in my life all at once, and it's too much.  I ran the taper program that you folks posted in this forum somewhere, and there isn't much of a difference for tapering from 15 mg vs 30 mg - maybe a further few months (for 30 mg), but not outrageous.  

 

I had really hoped that I would stabilize at 15 mg, and be able to go down from there, but that's not looking doable at this point.  Big sigh.  But, I know now that when I am ready to taper off this drug, I will have to go by the 10% rule, and listen to my body , and take the time I need to adjust to the cuts, and not go through what I did these past few months.  

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