not sleeping well again

[gregcool]

So its been 5 weeks since i cut down my olanzipine by 1/8th and to start with my sleep wasnt to bad for it,some nights getting 8 hrs,other nights 7 hrs..but since last sat iv been waking around 5.30am for no reason and strugling to fall back to sleep.and yesterday i went for a good 6 mile walk,so my body would be tired.went to bed last night at 11.30pm and still woke in the dark around 5.30 am..this lack of sleep is making me feel down,just knowing that this sleep time is so short....iv been taking barroca tablets for a week to try and boost my system, but not sure if thats having any efects..my concern is,i plan on droping another 1/8th after xmas but fear my sleep will be efected even more...before i droped these meds i had to have a alarm set for 10 am to wake me up,those day have gone

[uru]

The barroca probably doesn't have an effect.

Do you a e to drop the meds? Can't you keep taking them if they were helping?

[gregcool]

They were only helping with my sleep,not my anxiety..and since iv been on them iv gained 4 stone in weight..plus they can cause type 2 diabitis.since iv droped them down iv lost over a stone in weight and have more energy and have had some pritty good days in myself..so staying on them has been no good ....i need to come off them for many reasons...allthough i slept well on them,i allways woke after 10 hrs feeling tired and crap all day..since cutting them down iv had far more energy and less heavy in my head..so staying on them isnt realy worth it

[uru]

Ah right, I see.

Could you try doing more excercise? 6 miles is pretty good though I don't know how you could increase it without going to the gym or running or something.

[gregcool]

Well that 6 mile walk was quite intence...many hills to climb along the way,so dont think i need to do anything more than that really..i plan to walk 5 miles per day,weather permiting of course...im not the only one suffering with sleep since droping this med,so i know its def the reduction but hear your sleep returns after a while,so i guess ill just have to wait for that before i reduce again

[pulisa]

Greg, a lot of people would call your reduced sleep a decent night's sleep. I know it's tough when you were used to sleeping in until mid morning but it's better for you not to rely on this drug for mega sleep as this is all it was actually doing apart from piling on the pounds.

Could you get yourself into a routine for more early morning stuff? Can you start any earlier at the charity shop? I always get up at 530am as I have a lot of things to do before the start of my day proper but I understand it can be frustrating waking early with hours to kill and more time to ruminate?

[MyNameIsTerry]

I always get up at 530am as I have a lot of things to do before the start of my day proper

I think thats part of motherhood :D

---------- Post added at 09:47 ---------- Previous post was at 09:41 ----------

Greg,

With your thyroid issue your sleep is going to be tricky. However, the level of sleep you were getting before was very long as you have said, it just made you feel rough anyway. So, did you need so much sleep? How many hours would you have had before your thyroid issue kicked in?

I know from experience that if you are anxious over not sleeping, getting less becomes a trigger. It just to be for me. Nowadays I don't have that problem, but I do still have to conquer having an earlier sleep pattern which is a big ingrained issue for me. But I did learn to cope of less sleep by enduring it until my subconscious realised there was no point telling me I should be anxious about it because I just pushed on anyway.

I know it worked me me because I have been getting more since the period where I broke that problem. Now for the past 7 days I have been so busy with Xmas stuff and other things that I've not had time to have more than about 4.5 hours a night. This is far too little for me and in the past I would have been a jumpy anxious mess. I am pretty tired the first half of the day and then my usual pattern of waking up seems to come through and I could stay up all night again. So, I know that no longer triggers me because otherwise the last week would have been pretty bad.

So, perhaps don't compare to the last few years and look to before it all started and compare more to that? The thyroid is going to be an issue the more you come off this drug and will need addressing too.

[gregcool]

Thanks pulisa..yea you are right about the amount of sleep being pritty decent..i just have to except this now and apreciate other people get less.iv just been spoiled with 11 hrs sleep for the last two years now..your right ,6.30 am is prob all i need as i dont feel tired in the day,wheres as before when i was getting all that sleep,i was waking up tired and stayed tired all day as the meds i was on makes you feel that way,despite having so much sleep...so on the other hand i have to except im waking and my body dsnt need anymore sleep..theres nothing i can do at that time of morning other than watch tv in bed.the charity shop dsnt open till 9am...

Terry i dont know how you function on 4.5 hrs..i now that feeling tho mate from my days of bad insomnia..i was waking feeling ill and confused through the day..you are right about my thyroid tho mate as it was the thyroxine medication thst started off my insomnia..iv been to the doctors and they said there is nothing eles they can offer to help me sleep apart from a few sleeping pills..he said its unfortunat and happens to some people..they can put me on something eles ,but i would need to at least come off my current meds,which is going to take me months,not just the olanzipine,the trazadone 250mg..iv been on that for three years now and will take quite some time to come off....i need to get off olanzipine first,but my fear is that ill suffer even less sleep as i reduce further..i do feel anxious about my sleep now tho....it is taking me longer to fall asleep now wheres before on full olanzipine,i was falling quickly...not going to reduce any further untill after xmas,that would be two months on this reduction,and feel thats enough time on this dose...so wonder how i will feel when i reduce again

[nicola1980]

Funnily olanzapine never made me drowsy so I always take my 2.5mg in the morning as I feel I get more benefit from it in the day, well I did at the start as it helped my racing thoughts and the severe agitation. I'm up at 4am most mornings as I just wake up and can't get back off so I have a couple of nice peaceful coffes then potter doing washing, drying etc. My mum's an early riser too she's always up by 5am. I would like another hour or so but at least I get all my jobs done early!

[gregcool]

I think it works for people different.i tried 2.5mg before and it just made me tired after about 1hr of taking it and more anxious..so in the end i kept it till pm only..i feel for you waking at 4am..but sounds like you have a plan for when you wake...i woke again last night around 4am and was able to drift back..i just wish i would sleep through even if its till 6.30am without waking...iv been taking barocca every morning for just over a week now and have found i have much more energy through the day and into the evening..and when it gets to 11.30pm and i go to bed i find it hard to fall to sleep..not sure if thats the barocca or just my body without the full olanzipine...

[MyNameIsTerry]

I haven't slept all the way through much in 9 years now. I could probably count them on my hands. However, briefly waking and rolling over to fall back alseep within seconds is pretty normal I reckon. It's a problem if you wake up and panic or can't get back to sleep, if you can I wouldn't worry.

I think part of the issue is that you had a real bad experience with insomnia and you've been put on the knock out juice. This helped because you were spark out and now you need to adjust to what is more likely closer to normal. Think back to before all this started, all those years before anxiety, and did you sleep all the way through then?

I think it's more likely changing this powerful med over the vitamins. Your body doesn't use everything you ingest, it wastes it, it's pretty efficient at self regulation whereas these powerful meds overide our natural side. You could stop the vits for a few days to see what happens but I think it's good you have more energy and as long as it's not ramping up your anxiety, it sounds like it's worthwhile.

...yeah 4.5 hours builds up on me like today where I was exhausted but guess what? Now I am waking up again and feeling clearer in my head. So, my heads telling me to stop up all night again. :doh:

[gregcool]

Cheers terry..well when i think back before anxiety i think i slep around 7 hrs a night natural sleep tho..no drug induced sleep..id be happy just not waking for no reason....cant imagin not sleeping through for 9 years mate.you must have just adapted to it,i supose you do in time.i dont wake and feel any kind of panic tho,the head zaps have gone again last few days,so thats good....4.5 hrs mate,thats not good,no wonder you feel a bit shit for it...i def feel more energy since taking barocca been going on epic walks and dont feel tired in the day despite my sleep patern....could be that and the reduction of olanzipine that is giving me more energy ...ill see how things go...iv just ordered my barocca so i font run out...i might see how i feel after that batch .give it a few days off and report back

[MyNameIsTerry]

I used to think that way about not wanting to wake up but in some ways it's just anxiety with the "what if" issue. You learn to roll over and fall back asleep.

As long as you are not feeling like crap all day, you are getting the sleep you need.

[sandie]

I am barely functioning on between 2 and 3 hours sleep each night, and it has been this way for weeks. I am convinced it is the meds (Mirtazapine) - I seem to be the exception to the rule - it hasn't helped me sleep at all.

I am going to try to wean myself off the damn things.

[MyNameIsTerry]

Perhaps too "activating", Sandie? Albert said recently that he took a 45mg dose before bedtime and it kept him up all night. It's said to be activating at certain doses so maybe adjusting it down or spreading it across the day will resolve this but you need the Mirt gang for that.

[JessicaAdamson]

You should consult with your gp to give better meds and try therapy to improve your sleep and proper treatment of your insomnia. Medicines like Ambien and other sleeping pills are for short term treatment only.

[sandie]

Terry - my GP wanted to increase my meds to 45 mg some weeks ago, and I refused - if I'm not getting any sleep at 30 mg I can't see increasing the dosage is going to be of any benefit.

Two nights now on my reducing the dosage by cutting the pill in half. Unsure as to how long I should stay on 15 mg, but will ask the GP on Monday for a prescription for 15 mg tablets so that I can cut them in half to get the 7.5 mg dose.

[MyNameIsTerry]

Some meds just don't work for us and we have to keep looking. Citalopram worked ok for me the first time but Duloxetine has been a very different story.

I thought the Mirt guys have said the lower doses are better for sleep? I've seen then split their doses up in unequal volumes to get around problems with activation.

[gregcool]

Cheers guys...well im still waking for no reason,i did last night and have no idea of the time as i didnt want to wined myself up so didnt look at the clock,i just rolled over and drifted back..then woke at 8.30 am...but last few days been waking and spending my day in a anxious way again.iv been making a diary for the last two weeks and looked back on it last night...i spent 1st 2nd 3rd dec feeling good all day and another couple of days after that feeling good..but nothing since them days..im waking feeling kind of heavy again and feeling negetive all day and night...bummer..i wonder when and if ill get anymore good days

[sandie]

You are quite correct Terry - the lower doses of Mirt are mean to be much better for sleep issues - especially 7.5 mg. But from the onset I was prescribed 15 mg and then 30 mg, and my knowledge of Mirtazapine was non-existent so I went along with the GP's prescribed dose. Had I known then what I know now I would have halved the pill and only taken 7.5.

The last 2 nights I have halved a 30 mg pill, and I am hoping that when I see the GP next week he will let me have some 15 mg pills so that I can halve these when I am ready.

Terry - your are really knowledgeable about the half-life etc of the ADs; how long would you advise I stay on the reduced dose of 15 mg ?

I started on 15 mg on 19th October (switched from sertraline which I weaned myself off over 2 weeks). GP increased my Mirt to 30mg around the beginning of November - so I have been on these for about 6 weeks.

I will of course ask my GP on Monday, but to be honest, not sure if I fully trust his advice. The speed at which they put me on ADs, as well as the initial high starting doses of both doesn't fill me with confidence that they could advise properly about weaning off at a sensible rate.

To be honest, a small part of me would be happy to go cold turkey, but I know this is not wise.

[MyNameIsTerry]

I reckon at an absolute minimum it's best to allow your blood plasma to stabilise at the current dose before you make further changes. It makes sense to me that if you made further adjustments whilst your blood alone is still correcting it's volumes of the drug, it would only make any possible withdrawal symptoms worse.

This stabilisation is called "steady-state" and it takes 3-5 half lives for a drug to reach this. Some are faster than others e.g. Ven reaches it in 3 days. The standard pharmacokinetic model shows it as 5 but this is just a standard calculation so some variance will be seen like with the Ven. This is just when you start taking a drug, when you withdraw it's less clear. Whilst it takes 5 half lives for a drug to be reduced to below clinical significance (<5%) it takes 7 to be 100% clear. So, when you stop completely you can know after 7 half lives your liver has cleared all of it. You have to be careful with this with some drugs like Diazepam as that has 2 different calculations involved and because that drug stores outside of blood plasma, it's not as simple but with normal antidepressants the models are pretty sound.

Mirt's got a half life of 20-40 hours. So, If it were me I would be cautious and aim for the 40 hours and give it the full 5 half lives to be sure before dropping again. If you want to be extra cautious, 7 half lives, but that may make little difference as it's <5% remaining by the fifth one.

The 20-40 hours is a wide range and it will be based on how peoples livers are functioning. Drinking plenty of water helps the liver flush toxins out quicker so it may affect the time taken but then you have people with with liver deficiency conditions who would be more the longest time. If you are healthy it's likely you could be in the middle of that but age does affect drug elimination rates (children have been observed to clear quicker, pensioners slower, which makes sense as it's a metabolism thing).

So, you could for example o:

20 X 5 HL = 100 hrs / 24 hrs (to get the no of days) = 4.17

OR

30 X 5 HL = 150 hrs / 24 hrs (to get the no of days) = 6.25

OR

40 X 5 HL = 200 hrs / 24 hrs (to get the no of days) = 8.33

If you are in no rush, you could play safe. These meds are never so simple and withdrawal isn't just a matter of a calculation like this but why make life harder? If you were taking SSRI's for example, changes to the receptors have been made so it takes a bit longer for not only the body to get used to less Serotonin in the space but also for those plugged holes to be unplugged. That is going to take a bit longer than the above but I know for my when I withdrew from Citalopram it wasn't more than double the elimination calcs anyway, but we are all different. So, what I'm saying is don't think a liver elimination timetable like above dictates it solely as there can be more in play but the above does mean that at least you don't potentially make it harder with sharper drops where even your blood isn't completely stable. We only need to look at Ven standard release to see they have to split the dose because the half life is so short they end up in withdrawal the same day and part of that is the fact the levels of the drug in their blood plasma have significantly reduced.

I hope that helps.

I know what you mean about GP's, I've had the same. I respect him, and I would be more willing to trust him with anything physical, but I've found his knowledge of antidepressants on a par with my postman :D so I do my homework now, something I learnt from the people on here. I know I wouldn't trust my GP with a withdrawal schedule because he had me drop in 50% chunks last time and this is not the advice that MIND or Rpsych give and these people are specialists. Well Rpsych will be, they are made up of the people ou GP's send us to when they don't know what to do.

MrAndy posted these ages ago as he always advocates slow tapering. They are worth a look and something to discuss with your GP. I think my GP only reduced me by 50% at a time because thats the dosage they come in and thats really old fashioned thinking really:

http://www.mind.org.uk/information-support/drugs-and-treatments/medication-stopping-or-coming-off/planning-withdrawal/#.VQk6VdKsWSr
http://www.rcpsych.ac.uk/healthadvice/treatmentswellbeing/antidepressants/comingoffantidepressants.aspx

Something to keep in mind from Rpsych (and for Greg & Andy too as they have been through some rough times recently) is:

During withdrawal:
Be prepared, sometimes withdrawal can take longer than expected.
Rest, drink water, eat healthily, and be kind to yourself.
Take time off work if you need to.
Dose adjustment
Go slowly – reduce by small amounts.
Ask if can reduce very slowly at end with liquid instead of pills.
Keep some tablets in reserve so you can stop extra slowly.
Increase your dose temporarily to control symptoms if needed.
Be aware that your symptoms may come back, at any time, if the dose is reduced further .
Don’t be ashamed to go back on antidepressants if needed.
Don’t feel bad if you can’t come off at 1st or 2nd attempt.

This one is relevant to you, Sandie:

DURING
Reduce slowly
Research suggests:
if treatment has lasted less than 8 weeks, stopping over 1-2 weeks should be OK
after 6-8 months treatment, taper off over 6-8 weeks
if you have been on maintenance treatment, taper more gradually: e.g. reduce the dose by not more than ¼ every 4-6 weeks.

[sandie]

Brilliant Terry ! Thanks for such wonderful comprehensive advice.

I have a script for some Mirt at 45 mg - which I have not yet had dispensed.

I have been taking 30 mg for around 6 weeks, and have now had two nights when I reduced to 15 mg by cutting the pills in half.

Do you think that perhaps it would be better if obtained the 45 mg tablets, and cut these in half, - ie, 22.5 mg. This is a tapering 7.5mg. Stick with this for say 4 -5 days, and then go down to 15 mg for another 4-5 days. Then move down to 7.5 mg.

I am seeing my GP on Monday and will request some 15 mg tablets, which I can eventually cut down to 7.5 mg.

If I do this over the course of say 3 weeks - ie, while my husband is home, I would hope it makes for a less uncomfortable withdrawal, and I will have some support.

I am rather hoping that if I get down to 7.5 and sleep kicks in, I might actually stay on the Mirt.

I do wonder how much of a person's individual weight and size is taken into consideration when prescribing ADs. I am 5' 6" and weighed 9st 6 lbs when I was given the starting dose of 15 mg Mirt. Now presumably, if somebody taller and much heavier than me presented with similar anxiety issues, then he too would be started on the same dose.

As I believe that 7,5 mg Mirt is now no longer available in tablet form, is this why GPs use 15 mg as a starting dose - because they don't want a patient to start tampering with a pill by cutting it in half or quarters etc.

[MyNameIsTerry]

Thats an interesting idea and it will make for a slower taper. If your GP isn't bothered, I can't see why it would be issue. If you were tapering up, then it's perhaps a more cautious thing given Mirt seems to have different effects at different dosages (like SNRI's really) but coming off it's not going to be that much different in that respect other than to perhaps decrease the withdrawal effect a bit.

MrAndy says reduce by 10% from the starting dose. You can't always do it with some of these meds (some are tiny like Greg & Andy's Olanzapine, some are hundreds of beads in a capsule like my Duloxetine) but getting it closer to that and farther away from 50% drops seems sensible. Having said that, dropping 50% isn't an issue for some people so it's an individual thing but since you have a prescription, and as long as your GP is fine with it, it seems sensible. If you were planning to stick closer to a 10% reduction, halfing that 45mg would make it more accurate and your GP will probably have more confidence in this. There is also the option of halfing the 22.4 to make 11.2 or approx.

It's certainly worth doing while you have the support. I've always found going onto meds a nightmare but so far with my one time coming off it was very easy by comparison. I guess it depends how far recovered you are as you will be much stronger in yourself.

I'm not sure whether weight/height plays a part with it being about brain neurotransmitters, receptor sites, etc. Age plays a part in it though when I've been reading the pro sections on some on Drugs.com. The thing about age though is that it can be a reduction due to increased risks of other physical problems.

I guess the factor in weight/height is going to be the volumes involved. In a supplement they tend to measure rat/mice volumes by weight but thats because there are larger volumes involved. I'm not sure about antidepressants but I would expect the volumes to be very small given where they are & what they do and the 2 most abundant by far are glutamate & GABA, neither of which tend to be involved with these meds (although they are developing ones that will).

I doubt most GP's approve of pill cutting, they like to prescribe and assume you are taking what they give you. Kimberley2 has an experienced GP and he had her cutting the pills to taper on as she was very worried about taking meds. He also had good knowledge about the differences in SSRI's between anxiety & depression. All that says she has a good GP to me. I guess GP's being professionals, they worry that the dosage is accurate enough to be consistent. This is not too bad if the pills are scored down the middle but when it comes to ones like mine with hundreds of beads or tablets where the patient is guessing where the middle is, they may worry the dose isn't stable from one day to the next. But pill cutting is very popular and lets face it, it's better than huge reduction as Greg & Andy can attest to.