Mango: Opinion on plan to taper Mirtazipine

[Mango]

I had gotten this suggestion from you in March where you suggested that I remove some of older narrative. I was just wanting to do that. 
 

 

I've updated your signature. In order to get you more line spaces available, I moved some of the information for each year onto the same line and added bolding to make it more legible. That may be the best way to do this so you're able to keep adding more information, although eventually, you may want to remove some of the narrative, especially for the older information. 

[Shep]

@Mango Here is a direct link to your signature where you can make changes.

 

Account Settings – Create or Edit a signature

[Mango]

Would you please delete I’ll narrative from beginning through May 28, 2022?

thank you

molly

[Shep]

7 hours ago, Mango said:

Would you please delete I’ll narrative from beginning through May 28, 2022?

thank you

molly

 

That would mean deleting most of your thread, Mango, including posts by staff and other members. It's helpful to have all of your information in your thread. We rarely delete posts on this site. 

[Mango]

I was down to 1.85mg about 10 days ago and then tapered to 1.65mg. I had actually been floating btw 2.25 mg and 1.65mg for a couple of weeks. Then finally I held at 1.65 mg.
Shortly after I started getting insomnia, major panic and anxiety that lasts all day. I haven’t  had panic like this for over a year, especially daily.  
I decided I must have started withdrawal symptoms for some reason so I decided to go,back to last dose where I didn’t have these symptoms so went to 2.25mg. It hasn’t helped. In fact, maybe it’s worse. 
I ended up in ER and they couldn’t find any medical issues…just high anxiety. 
 

Anyhow, is it possible Mirtazipine cut activated withdrawal. I thought for sure raising it to 2.25 would help. 
or, perhaps, something activated the PAWS from the Paxil I went off of in 2020.  I am so distressed about this as I’m becoming housebound and.so fearful of even getting off the couch. I have tried lots of breath work, meditation tape but nothing works. 
 

what do you think happened? Maybe not related at all to Mirtazipine. 
 

[Shep]

14 hours ago, Mango said:

what do you think happened? Maybe not related at all to Mirtazipine. 

 

You went from 2.25 mg mirtazapine in March down to 1.85 mg in April. This is nearly an 18% reduction in one month. Way too fast - we recommend tapering no faster than 10% a month, based on the previous month's dose (not the originally prescribed dose).

 

Why taper by 10% of my dosage?

 

14 hours ago, Mango said:

Anyhow, is it possible Mirtazipine cut activated withdrawal. I thought for sure raising it to 2.25 would help. 

 

By continuing to taper too quickly and then upping the dose to mitigate the damage caused by the aggressive taper, you are setting yourself up for hypersensitivity and kindling.

 

Hypersensitivity and Kindling

 

I would go into a very long hold and see if you can stabilize before making any other changes. Your nervous system needs time to recover. 

 

 

[Mango]

So I will leave Mirtazipine at 2.25mg and hold for 3 months?
 

Thanks you for your suggestion and guidance. 

[Mango]

I have such severe Cortisol spikes that wake me up daily for years and takes me hours to recover. I have read that Phosphorylated Serine sold as Seriphos can help lower Cortisol. 
Since I am on a taper hold, do you think it would be ok to try the Seriphos at this time?

 

 

Thank you. 
Molly

 

[Shep]

@Mango Please see:

 

Phosphatydilserine, aka phosphatidyl serine (Seriphos or Cortiphos)

 

As with any supplement, start with a low dose and only add in one supplement at a time. 

[Mango]

I found out that Nortriptyline is available as liquid. I want to taper from 60 mg to 50 mg to start. Right now I take 50mg and 10mg capsules. I thought if I got the liquid it would be easier to taper rather than making my own solution. 
Im concerned about going to liquid because I am very sensitive to these drugs. Would it be best to start using liquid for my 10 mg dose and give it a week or two to see how I react to liquid before using it to taper?

 

I want to know how often does switching to liquid form to AD cause symptoms?  I’m just so fearful of symptoms. 

 

thank you. 

[Altostrata]

@Mango What happened to the mirtazapine?

 

We advise attempting a 10% reduction to minimize risk of withdrawal. 60mg to 50mg is a 16.66% reduction. 

 

If I were you, I'd continue the 50mg capsules and replace the 10mg with the liquid form, taper from the liquid portion. 

 

See Tips for tapering off nortriptyline 
 

[Mango]

I was going to taper in two phase. First to 55 mg  and then after a month to 50mg. 
 

I will take your advice and switch to liquid and taper from that. 
 

thank you

[Altostrata]

60mg to 55mg is less than a 10% reduction and probably tolerable. Please let us know how you're doing. 

[Mango]

If I were to reduce by 2.5%/week and then hold at end of month, would that be ok?

 

or if I reduce by 2.5% for first day of a week and then hold for rest of first week, and then make 5% reduction the first day of second week and hold remainder of week, etc until I am doing 10% by end of month. 
would that make sense?

 

Thank you

[Altostrata]

Any of those methods might work -- you'd have to see how you react. If you react poorly, you're going too fast.

[Mango]

To get ready to taper Nortriptyline, I switched from 10 mg Capsule to prescription liquid and thought I would do that for a week to allow my system to adjust before I start tapering liquid. 
Can switching from capsule to liquid cause side effects, and if so do they eventually stabilize?

 

Thank you.

 

Molly

 

 

 

 

[Shep]

@Mango We recommend a gradual switch from capsule to liquid. You may want to do 25% liquid & 75% capsule, then 50%/50% split, then 75% liquid & 25% capsule and then 100% liquid, allowing for a couple of days at each increment. This allows the nervous system time to adjust to the change. Don't start your taper while you're making the switch - only one change at a time. 

 

Some people report upticks in symptoms, but it should sort itself out, especially if you do a gradual change while keeping the same dose. 

[Altostrata]

12 hours ago, Mango said:

Can switching from capsule to liquid cause side effects, and if so do they eventually stabilize?

 

 

Have you felt an effects from the switch so far?

[Mango]

Thank you Altostrata,
 

I’m having insomnia, early morning wakening. But my doctor also has me on hydrocortisone and I read that may cause insomnia. And increase in health anxiety. 
 

 

[Mango]

I think I’ll just go back to capsule, stabilize for a week and taper from there. I’m having insomnia and more anxiety. My doctor also has me on hydrocortisone so it could be that. 
Is it ok to go back to capsule? I’ve been on liquid 5 days. 

[Altostrata]

9 hours ago, Mango said:

But my doctor also has me on hydrocortisone and I read that may cause insomnia. And increase in health anxiety. 

 

Hydrocortisone does not appear in your signature. When did you start it, at what dosage?

 

On 4/17/2023 at 1:42 PM, Mango said:

I decided I must have started withdrawal symptoms for some reason so I decided to go,back to last dose where I didn’t have these symptoms so went to 2.25mg. It hasn’t helped. In fact, maybe it’s worse. 
I ended up in ER and they couldn’t find any medical issues…just high anxiety. 

 

It may be that you have mistaken adverse effects of hydrocortisone for sudden "withdrawal" symptoms.

 

Please stop adjusting mirtazapine while you sort this out.

[Mango]

I haven’t touched Mirtazipine since April and won’t until I get down to 50mg of Nortiptyline. 
 

Just started Hydrocortisone on Aug 18. I was on 20 mg spread thought out the day. I have just reduced it to 15mg since we thought it might be affecting blood pressure. The first 4 days it helped w mood and body pain but then I started liquid Nortriptyline on Aug 21 and haven’t felt as good a mood. 

what to do??

 

[Altostrata]

10 hours ago, Mango said:

...

I’m having insomnia, early morning wakening. But my doctor also has me on hydrocortisone and I read that may cause insomnia. And increase in health anxiety. 

 

This is a good example of too many moving parts. We can't tell what's going on because of other drug changes that might be causing symptoms that look like withdrawal etc.

 

If you are under medical care with continual drug changes, we may not be able to guide you in a taper at all. How long are you supposed to be taking hydrocortisone? What is this intended to treat?

 

What times o'clock do you take your current drugs, with their dosages? Are you still taking clonazepam BID? If I were you, I wouldn't change any psychiatric drug until you've got a stable hydrocortisone dosing schedule.

[Mango]

You are right. Too many moving parts because I forget to only change one thing at a time. After I got messed up in the Spring, at your suggestion, I made no more tapers or changes so my CNS would be able to stabilize.  And now when I intended to start Nortriptyline taper due to possible health affects I start hydrocortisone! 
My Dr had another patient who had similar problems like me (persistent aching over whole body, especially limbs, and persistent depression/anxiety) and she was really helped by the hydrocortisone so that’s why I was started.

 

I’m going to ask my doctor to wean me off of that so I can get back on plan to taper Nor…

 

9 P.M.  60 mg Nortriptyline, 2.25 mg Mirtazipine, .125mg Clonazepam 
9AM.  .125mg Clonazepam 

AM, Noon, PM hydrocortisone 5mg

 

So, should I go back on capsule or stay on liquid 10mg Nor..?

 

Thanks so much for your help. 
 

[Altostrata]

Did the hydrocortisone resolve your problems?

 

2 hours ago, Mango said:

9 P.M.  60 mg Nortriptyline, 2.25 mg Mirtazipine, .125mg Clonazepam 
9AM.  .125mg Clonazepam 

AM, Noon, PM hydrocortisone 5mg

 

You also take hydrocortisone at night? That is a lot of drugs all at once. Please put ALL your current drugs in this Interactions Checker and post the report or a link to it in this topic.

[Mango]

I take hydrocortisone at breakfast, lunch, and dinner times.  The hydrocortisone has helped with body aching. Also, initially I got a boost in mood which was wonderful since I’ve been depressed and crying for 5 years!

But I still wake up with that terrible anxiety in pit of stomach. 
 

I don’t know whether to stop that or go back to capsule Nortriptylin. I’ve been on liquid for 6 days now. 
 

thank you. 
 

https://www.drugs.com/interactions-check.php?interaction_list_id=183586390&drug_list=703-0,2379-0,1640-0,1734-0

 

 

[LukeUK]

Sorry to hear that you're suffering.

 

All I can really offer in terms of advice is that as the doses get lower for mirtazapine be very careful and do not rush. I am young and was very fit and healthy and going to zero mg has absolutely destroyed my health for months.

 

As you're suffering from a variety of effects from various drugs, I would strongly advise you to take things as steadily as possible even though your signature says that you're at a very low dose. Low doses of mirtazapine can be very potent.

[Mango]

Thank you LukeUK. I’ve been in hell for years after a to fast taper of Paxil which I had been on for 20 yrs!  I had no ideas I was in severe withdrawal. 
anyhow, I try to be cautious and slow now yet part of me just wants off everything now. I had hoped to get off all these meds so I could do psilocybin therapy 

anyhow, I’m curious what you meant when you said your health has been destroyed. Would you be willing to share what you experienced?

 

thank you

[Altostrata]

@Mango we can't tell anything until you stay on a consistent dosing schedule and we can see a baseline pattern. Unraveling polypharmacy is a lot to ask of peer support, and if you keep making drug changes, we just cannot do it.

[Mango]

I have been on consistent doses and stable for past 3 months since I wanted to taper fm 60-50mg on Nortriptyline. I learned that it came in liquid 10mg and thought that would make taper easier. So I decided to not taper immediately but just take the 10mg in liquid for a week to let my CNS get used to liquid from. (I had searched this website to find out risks of switching from capsule to liquid and couldn’t find anything. I’m not very savvy in navigating this site.)

I guess the ringer was when my Dr ordered the hydrocortisone. It never crossed my mind that this might affect me considering other drugs I was on. 
So,I hope you won’t abandon me. These drugs have been a nightmare for me last 5 years and I’m aged!

So now I’ve been taking the liquid nightly since 8/21. I have decided to stay w it unless you suggest otherwise. I will not do a taper until any anxiety or this depression dip pass. 
my Dr would like to reduce Hydrocortisone to 10mg/day. I have suggested I just wean off of it because taper of Nortriptylin is most important to me. 

[Altostrata]

You've thoroughly discussed the benefits and risks with your doctor of daily hydrocortisone over an extended period?

[Mango]

I’ll talk w her today. I was on a 2 week trial so we did not discuss long term use.  I’ve decided to go off of it. I don’t need anything else to give me anxiety, and the boost to my mood has subsided. 

 

 

 

 

 

 

[LukeUK]

On 8/27/2023 at 4:00 PM, Mango said:

Thank you LukeUK. I’ve been in hell for years after a to fast taper of Paxil which I had been on for 20 yrs!  I had no ideas I was in severe withdrawal. 
anyhow, I try to be cautious and slow now yet part of me just wants off everything now. I had hoped to get off all these meds so I could do psilocybin therapy 

anyhow, I’m curious what you meant when you said your health has been destroyed. Would you be willing to share what you experienced?

 

thank you

 

I became severely physically unwell after stopping the drug over 4 months ago and have not fully recovered. I only used the drug for 5 months.

 

If you go to my page/thread you can see it. I won't take up your thread with it.

[Mango]

I read article by Adele Frame on NIH website about starting this website. In that article she mentions that she had severe muscle aches for 1.5 years. Can anybody elucidate on this?

I have been suffering muscles aches in my limbs and then if I walk or stress them going up a hill, I get deep pain in my thighs. I have had all kinds of nerve and muscle testing and nobody can identify what’s causing it. It’s very distressing because it’s getting worse and so limits my walking ability. My gait is also shaky and I will get severe foot pain. 
I have had major trouble with depression and now it’s flared up again. 
could this be related to too fast withdrawal of Paxil in 2020? And then various meds on and off in 2021. 
I have been stable on meds since July 2023. 
thank you so much. 

[Altostrata]

Hello, @Mango You've brought up this question before. We have explained that you may still have withdrawal symptoms from going off Paxil in 2020, but you also have had many drug changes that may have added adverse reactions and withdrawal effects from other drugs.

[Mango]

I am so outraged again at Pharmaceutical companies. I take .125mg Clonazepam twice a day. My pharmacist has just informed me that there are no companies producing that strength any more. 
so not only do I have to change strength I will also probably have to change brand. That should be more fun withdrawal! Sometimes I just feel like stopping it all and be done w it! What would be the difference. I’m still going through withdrawl from 2020 taper of Paxil. 
 

Anyhow, do you know of any place to get this .125mg  Clonazepam?

 

Thanks!