[mikem]

Hi everyone.

I have been on Mirtazapine for about 3 months (15mg) which is augmented with Escitalopram (20mg). I have suffered with a really bad 'suicidal' depression.
The Mirt has really helped with my sleep - I went for approx. 6 weeks with very little and could hardly function.
I have recently tried to cut down the Mirt. by tapering (shaving off a small section) until it was 7.5mg.
What I hadn't expected was the awful side effects. I have been waking with severe stomach anxiety, crunching chest 'panics' and burning / pins and needles in my arms. In addition I have had bouts of uncontrollable crying.
My guess is that I have tried to come off the Mirt. too quickly and that the tapering process needs to be much longer.
Can anyone relate to this?

Best wishes

Mike

[Melancholia77]

I don't know whether all your symptoms can be blamed on the withdrawal from mirtazapine as I was on it briefly and stopped abruptly. I didn't get any of the symptoms you're getting although I have read of people that had a lot of trouble coming off it. But from what you say, you've come off it very gradually and 7.5mg is not a massive drop.

I'm wondering why you decided to come off it if it was helping so much? Also, if you're feeling so bad, the escitalopram can't be helping much and I think you need to go back to your doctor to talk things over.

Hope you feel better soon.

[messianictalmud]

Well before Xmas my GP reduced my Mirtazapine down from 30mg to 15mg on the Psyciatrists advice.
Now started CBT with my IAPT worker who has now had me back to my GP to review my antidepressant meds, as I have been more tearful and having rushing thoughts since the Mirtazapine was reduced.
So now my GP has told me to start taking the 30mg as of today then I have to go see her next Friday, in the meantime she says she's going to contact the Psyciatrist and discuss more appropriate medication, I left the GP today saying oh well lets hope the Psyciatrist will agree!

[Ed09]

To be safe I would scale down any anti-depressant over a month at least, if not longer. Some people do get really bad withdrawal effects. If you consider that it takes a long time for your body to get used to the drug and for the drug to have a beneficial effect, it follows that it may take a long time for your body to adjust to the absence of the drug.

Mirtazapine has a half-life of 20-40 hours, so any tablet is in your body in a meaningful way for that period of time. By dropping the dose quickly and halving it, you really are reducing the amount of the drug in your blood. To lower from 15mg I'd suggest maybe trying to take 15mg on monday night, 7.5mg on Tuesday, 15mg on Wednesday, 7.5mg on Thursday and so on. I'd do that until I was sure I wasn't getting any bad side-effects. Then you could drop down to 7.5, 7.5, 7.5 etc.

I've heard of cases where people had to do that for months to come off Citalopram, but persevered and managed to get off it with no side effects. If you get bad side effects just resume your normal dose and start again with a less severe drop, even if it means shaving a 15mg tablet into quarters.