Mirtazapine withdrawal

Hi all,

 

My name is Ivan. I have been on and off this site over a number of years. I have had three serious bouts of depression and have been prescribed benzodiazepines each time. Thankfully, I have been benzo free now for many months. However, I have been on a concoction of anti-depressants and Epilim. For the past few months I have been down to just one drug: Mirtazapine. However, I have been on a very high dosage, 90mgs a day, which is twice the recommended dose. One feature of my time on Mirtazapine has been that I have had a lot of trouble with sleep - getting to sleep and waking up in the middle of the night and having immense trouble getting back to sleep again. The consequence of this has been that there have been days when I have been dog tired.

 

One day last week I forgot to take the tablets and slept really well. So I decided to undertake some googling and found that there is evidence to suggest that very high doses of Mirtazapine can cause sleep issues. I did think this was strange as the drug is prescribed off label to assist people with sleep problems.

 

What I decided to do next was conduct an experiment over the weekend and took only 45mgs each night. This meant that I was still on a very high dose but half of what I had been taking.

 

The result is that I appear to be having withdrawal symptoms: pinging sensations throughout my body. I did ring my psychiatrist who grudgingly allowed me to continue on the lower dose whilst warning me that I was increasing my risk of depression by doing so.

 

He also reminded me that I had come down from using many drugs and this was a concern for him. In July last year I was taking 90mgs of Mirtazapine, 100mgs of Epilim and 40 mgs of Lexapro not to mention the 10mgs of Mogadon and the 1 mg of Ativan that I was also taking.

 

In response to me telling him about the withdrawal symptoms, he said that they would eventually go away. So I am writing this to see if anyone else has gone through withdrawal from Mirtazapine and if they could share their experiences with me and give me some sort of encouragement as a result. When I got off the Lexapro there were no side effects but this seems to be different.

 

All the best and thanks for reading this,

 

Ivan.

 

 

Hi. I’ve been mirtazapine for about 4.5 years. I was put on 15mg for sleep. A common dose for that. I was bumped to 30 and could not sleep so it does not surprise me that you could not sleep at 90. Mirtazapine becomes more energizing as you go up in dose and more sedating as u come down. I’m in the process of getting off entirely as it caused me to gain a lot of weight and made generally feel like crap. I’m now down to 3.75mg and it’s having a very sedating affect on me and it seems the lower I go the worse I feel. My life is on hold for now until I can get off. I wake up every day feeling what I would call comatose and sick. In the past I have been on Xanax and doxepin and the mirtazapine has by far the hardest for me to get off of. My one bit of advice is taper slowly. Cut 10% every 3-4 weeks. Count on it taking well over a year to get off 90mg.

Pokey

I cold turkeyed off of Mirt and my withdrawal lasted 2.5 months. I was on a low dose but I'm very sensitive to meds. Quitting Mirt helped my depression, actually, and also helped sleep.

Definitely go slow.

 

I took Benadryl for a couple of months after stopping Mirt because Mirt is acting on histamine receptors and I was allergic to everything after stopping it.

Hi. I’ve been mirtazapine for about 4.5 years. I was put on 15mg for sleep. A common dose for that. I was bumped to 30 and could not sleep so it does not surprise me that you could not sleep at 90. Mirtazapine becomes more energizing as you go up in dose and more sedating as u come down. I’m in the process of getting off entirely as it caused me to gain a lot of weight and made generally feel like crap. I’m now down to 3.75mg and it’s having a very sedating affect on me and it seems the lower I go the worse I feel. My life is on hold for now until I can get off. I wake up every day feeling what I would call comatose and sick. In the past I have been on Xanax and doxepin and the mirtazapine has by far the hardest for me to get off of. My one bit of advice is taper slowly. Cut 10% every 3-4 weeks. Count on it taking well over a year to get off 90mg.

Pokey

 

Sorry you've had such a hard time with Mirtazipine Pokey. I was on 30mg but felt like a zombie so I cut straight down to 15mg a couple of years ago with no side effects luckily. I'm now on 15mg, it helps me sleep, but that's about it. I jumped from Valium 2 months ago and would love to get off Mirtazapine, but I'm going to have to give it a few months yet as I'm still having WD symptoms from Valium. I guess then it will take me some time to taper off 15mg of Mirtazipine .... These drugs are a nightmare aren't they 

yep all these psychotropics suck!!

I took 22.5-30 mg/day for about 2 1/2 years.\\When I stopped I did a 2 week taper (15mg/7 days/7.5mg/7days) then stopped.

 

Zero WD sxs.

LUCKY!!!

Thanks very much for your replies. Pokey, thanks for letting me know about how energising Mirtazapine gets on higher doses. Why I was deluded into thinking I could get off this drug without any side effects was that a few times I forgot to take my doses at night and nothing happened except that I slept much better. But after four days on 45mg I felt dreadful - a weird aching through my body. I called the psychiatrist and he clearly was not in favour of such a significant drop especially as I am travelling halfway around the world from Melbourne to London and onto Germany in less than two weeks. He also asserted that given I was on the concoction of drugs I mentioned in my first post and am now only on Mirtazapine - in his opinion - I exposing myself to a greater risk of depression and when I get depression it is really bad. So what I have done is reinstated the dose. My sleep is definitely nowhere near as good and I still have withdrawal symptoms two nights after going back up to 90mgs. I am taking the drug earlier in the evening but it does appear to me that it is at its most potent in the first couple of hours.

 

I would like to reduce the drug so that it has a positive rather than negative impact on my sleep. But I have promised myself if I do attempt this, it will be slowly and with the agreement and guidance of my psychiatrist and my doctor.

 

I really do appreciate the input from you Pokey and from you builder and NoMorePills. Thanks again,

 

Ivan.

 

 

Just an update: It is now three and a half days since I put the Mirtazapine dose back up to 90mgs. I still have nasty sensations throughout my body. I went to see my GP on Thursday and he encouraged me to stick with my arrangements to travel to Britain and then Germany in nine days' time. He says the literature indicates that as a result of mucking my metabolism around for even only four days it takes up to two weeks to settle once the dose has been stabilised. I just hope he is correct as I would hate to feel like this whilst travelling.

 

One message from this to everyone who reads my posts is that Mirtazapine is an extremely powerful drug whose impact on the body shouldn't be underrated in the way I stupidly did. Reducing this drug should be done slowly and with the guidance of a psychiatrist or GP.

 

Best of luck to anyone who reads this.

 

Ivan.

 

PS A reflection: This site is amazing. I have been on and off it over the years. It obviously involved an enormous amount of effort to set up. It is extremely well organised and, as a consequence, really user friendly.

Builder you did well!

Started mirtazipine taper. 10%

Usual zaps, numb lips, tingling.

Let’s hope it eases up-))))

Dick

It's beginning to look like I have succeeded in doing myself out of a trip to Europe. The aching and tingling shows no sign of going away. It is now five nights since I reinstated the 90mg dose. I guess I have mucked my metabolism up and am paying the price. The doctor assures me that my body will correct itself and most likely before we go, but as the one going through this, I will only know for sure if and when there is an improvement and it is only eight days till we are scheduled to leave. I can't imagine myself standing in an art gallery in Germany feeling like this. I only wish I had consulted my psychiatrist or GP before I did this dumb thing. What amazes me is that I was only on the reduced dose for four nights and I got such a reaction.

I decreased my Mirtazapine from 30mg to 15mg in December, it was my third attempt. When I’d previously attempted this I squirmed all night and had little sleep. Third time lucky I suppose, one night of discomfort and then I was ok, but that was before Valium withdrawal started (March 19). Have been on Mirtazapine a few times (15-45mg) and previously had no trouble ceasing it before Valium. Dr says they’ve been interacting with each other at excretion in the liver (sigh), but wants me to continue both for the time being to lessen withdrawals. Fun times.

I've been on 3.75 for years. I have to do something now because of restless leg. I just had about 10 leg convulsions and I decided to get up and log in.

 

Looks like one drug listed for RL is gabapentin. I already take 100. I wonder if it's knocking on my door and wanting more. crazy. All these drugs recreate symptoms they were desiigned to help with.

 

 

Um mirtazipine

So far on day 6 of taper from 15, taking about 13 mg.

I feel panicky again (had helped), nausea, and two migraines (very rare for me).

I dunno whether to speed up like some many who have come off in two weeks, or hold.

I think both will be as difficult as I have GAD anyway.

Past 8 weeks have been withdrawing from Diaz 25% then quetiapine taper n stopped and now mirtazipine taper. I am totally exhausted.

Can it be done? Do I just man up a bit.?

Thanks.

Dick

Hi Dick

 

I was on 15mg of mirtazapine and came off in quarters , I used a pill cutter, I dropped a quarter every 10-12 days it wasn’t pleasant at all and it’s before I knew better I suppose but I got through it, symptoms were nausea, jerks, brain zaps, insomnia, exhaustion, anxiety, lots of leg twitching, some was a bit like benzo w/d but didn’t last as long and wasn’t this bad I think I was over it it around 6 weeks but my sleep took a lot of time to settle , I was still on 4mg of diazepam at the time so maybe that helped a bit , not sure.

 

Go with how you feel everyone is different but you’ll be glad once your off it.

Hey Dick,

 

My psychiatrist told me to keep Mirtazapine steady while wd’ing from diazepam. He was saying that mirt helps you come off it. But he also says they’re both metabolised in the liver, so there can be interaction. I’m not brave enough to go off both at the same time so haven’t tested the theory. I’m actually willing to increase mirt from 15mg back to 30mg, but he says don’t do that either. From my experience with it, I’ve generally took it for the amount of time that I’ve felt it helpful. This time it’s been 5.5 years. I also feel that it does lose efficacy after a while a we need a break from it. And if you’re lucky, never need it again! Probably not for me, as it’s the only AD I can tolerate. I’m thinking it’s the lesser of two evils 

 

Sending best wishes

Rose

 

 

Thank you all for advice and good wishes.

It is mirtazipine became intolerable in reduction so close after Seroquel where I read it can take 3-6 months to stabilise.

I was eager and silly to reduce mirtazipine which has reduced my panics and helped with sleep.

I have reinstated and may stay on it for a while yet as I was functioning better on it than back in 2017

Thanks again.

I th8nk I was over ambitious

Best wishes

Dick

Hello again,

 

I am afraid I did miss out on my overseas trip. Five weeks since I reduced the Mirtazapine dose from 90mgs to 45mgs I am still suffering strange sensations throughout my body. I am now on 67.5mgs and Lyrica 75mgs or 150mgs to counteract the effect of the messing up of my metabolism by the fluctuating dosage of Mirtazapine. It really does look as if I will have to come off Mirtazapine altogether and go on a different AD, Pristiq. But all of this looks problematic. My life is on hold while I am going through this. I never imagined that a reduction of Mirtazapine over only three nights could have such a major impact on my body.

 

The psychiatrist and my GP are really puzzled by what has occurred. Normally, if a Mirtazapine dose is reduced and then restored, the body resettles back to its usual state. I had little trouble getting off a huge dose of Lexapro last year so I was fooled into thinking the same would apply to Mirtazapine - silly me!

 

I am seeing the psychiatrist on Tuesday morning. He is likely to start me on the process of weaning off Mirtazapine as the Lyrica is making little difference to my symptoms and was only meant as a stopgap. He was hoping my body would get back to normal once I had been on 67.5mgs for a couple of weeks.

 

These psychiatric drugs are so powerful. I have certainly learnt a painful lesson from the last five weeks: don't fiddle with high doses of ADs without advice from a psychiatrist. But one thing I must say is that I always felt 90mgs was too high. I was struggling to get to sleep on this amount. Apparently Mirtazapine is great for sleep on low doses but does the opposite as the dose gets higher.

 

I would really appreciate some feedback. And I will update everyone on Tuesday. To everyone who reads this, I wish you the best of luck.

 

Ivan.

Here's an update. Last week the psychiatrist recognised that I would have to come off Mirtazapine. So that's what I did. This time last week I reduced the dosage from 67.5mgs to 60mgs. Every other night I went down by 15mgs until last night I was on 15mgs. I met the psychiatrist this morning and he told me not to bother taking the last fragment of a tablet. So I am now on nothing. I know this goes against the guidelines for withdrawing from an anti-depressant but given that I had awful symptoms which haven't changed in the last week it was felt best just to get off the drug and allow my body to recover.

 

The plan is to go on Pristiq once my body has returned to normal. The psychiatrist doesn't really know what chemical reaction is going on in my body. indeed, he says what has happened to me is very unusual. I think that it was fortunate that this reaction occurred when I was at home. I could have suffered a similar set of symptoms as I was changing time zones from Australia to the UK.

 

The psychiatrist calls my symptoms "discontinuation" as he maintains anti-depressants are not addictive. He says that SNRIs are more likely to cause this than SSRIs. My experience would reflect this, as I got off 45mgs of Lexapro with no trouble last year.

 

I hope what I have experienced helps anyone in a similar position to me.

 

All the best to members who read this.

 

I will update you in a couple of weeks time when, according to the psychiatrist, I should be a lot better.

 

Bye for now,

 

Ivan.

 

 

Good luck Man!!

 

I am very interested in your path. I am only on 3.75 but it's been 5 years, and I have restless leg now and it feels like the end of something, maybe me! I have also just lost my psych cause they were weird, and have to go to her boss now. I have people who say just jump and people here who say take a year. I don't know.

Thanks drad dog for your reply. I have just got up very early, as on my first night without Mirtazapine I couldn't sleep and there is an intense burning sensation throughout my body. To be honest, I am frightened. The psychiatrist says it should go away but I was on such a huge dose - 90mgs a day, that my body really is in uncharted territory. I guess I just have to promise myself as I did with the benzodiazepine withdrawal that I will hang on and be determined. The difference is that I knew benzodiazepine withdrawal had an end point. People's experiences on this site reaffirmed that. However, with this drug and the massive dose I was on nobody can reassure me in the same way. When a senior psychiatrist asserts that what is happening to me is strange and unusual and that he is unclear about what chemical reaction is occurring in my body, it is unsurprising that I feel scared and fear that these symptoms could be permanent.

Ivan, the effects will not be permanent. Just as your body adjusts to accommodate the drug, it will adjust to not having the drug. Unfortunately adjusting to not having the drug is much more painful. I don't know how long it will last, but it will begin to gradually fade and then disappear.

 

I think you should consider a substantial period of time being drug free. Most antidepressants have a very limited effect for the average person (around 5-10% better than placebo, although a recent review found less than 4% benefit over placebo on the Hamilton Depression Rating Scale) while the risk is a substantial withdrawal syndrome after becoming physically dependent, not to mention other adverse events. None of these drugs have empirical evidence suggesting they will improve your condition beyond one year's use. They have not run any randomized, placebo controlled trials longer than that, so they really have no idea at one point they begin harming more than they help. I think it's pretty likely that they will harm everyone eventually, if they are taken for long enough. The reason your nervous system adjusts the medication by down-regulating GABA, 5-HT etc receptors is that it does not like having so much GABA, serotonin or whatever exerting effects on the nervous system. I would say your nervous system probably knows its own optimal structure best. After all, your DNA has successfully survived by replicating itself for millions of years

There is also a Mirtazapine support group if you are interested: http://www.benzobuddies.org/forum/index.php?topic=80102.0

Thanks very much data_guy for your time and consideration. I really feel that it is only when I start to feel a little bit better that my confidence that I will eventually recover will grow. 

 

The problem for me is that I have a history of extremely severe depression. My psychiatrist believes that I have to be on antidepressants or there is a very significant possibility even probability that I will get depressed once again.

 

However, I  do agree with you that I need an extended period when I am drug-free so that my body can recover from the pummelling that it has taken. I am amazed at just how many drugs the psychiatrist had me on. At the end of last year I was on Epilm, a high dose of Lexapro,  Propanolol to counteract the impact of benzodiazepine withdrawal and twice the recommended maximum dose of mirtazapine that is allowed in public practice in this country.

 

So I think that my psychiatrist just throws everything he can at a problem and hopes that it will not lead to side-effects which sadly did happen with the Mirtazapine.  Furthermore I am determined to resist his proposal to put me on Pristiq otherwise known as desvenlafaxine because it has the same potential for nasty side-effects as does mirtazapine.

 

Thank you for the link to the benzo buddies thread. I had a quick look at it and again thanks to other people posting I now know that it is possible to get through this.

 

Thanks very much for the time you've taken to give me some advice. It is much appreciated.

Now I have a really upset stomach along with diarrhoea. So this withdrawal is developing into something really nasty. I will let everyone know if things start to turn around. I know how much people seek encouragement on this site and I would like to be one of those whose experience suggests that there is light at the end of the tunnel.

 

All the best,

 

Ivan.