Tapering Mirtazapine - Driving myself up the wall!

[NessMonster]

Hi there,

I've finally reached a place in my life where I am ready to come off Mirtazapine. I've been on 45mg for the last 4/5 years (can't exactly remember) and before that I went through a whole string of various medications. I guess I'm curious to see what my adult brain is like without me throwing chemicals at it.

My anxiety has been kind of excessive lately but after having a chat with my GP, he's still happy for me to give this a go. The way I experience anxiety is largely physically which has gradually progressed to mildish health anxiety so any changes which impact my body are ones that I am overly sensitive to.

I guess what I am looking for here is some reassurance. I've pretty much exhausted the google search researching mirtazapine withdrawal which isn't doing me much good.

5 nights ago I did my first reduction from 45mg to 30mg. I've had a few slight issues which are definitely as a result and normal...headaches, waves of nausea, extra anxiety spike, various aches and pains. I can deal with them. Yesterday though I started to notice that I'm a little short of breath. Nothing that is outwardly visible but I notice it and it seems to have carried on till today. Has anyone else experienced this?

I'm kind of freaking myself out because one of my fears is of developing an allergy and I keep thinking maybe I've randomly developed an allergy to my medication (I know, ridiculous). However it also could be that some of my family has had various chest viral infections the last few weeks and I have been staying with my Mum for the last week who has been ill with pneumonia. Maybe I've just picked up a bug...

Yep! I know, totally spinning myself in circles with this one.

[sandie]

Firstly, congratulations on feeling strong enough to take yourself off meds !

The drop from 45 to 30 mg is not really a taper it is a BIG reduction; my understanding is that tapering from any AD med should be at the rate of around 10%, so ideally tapering from 45 to around 40mg, then down to 35 mg etc.

If you have coped well with the reduction to 35 mg, perhaps you might light to think about staying on this dose for a couple of weeks until you are not experiencing any side effects. You were on a large dose of Mirt for a long time and it is inevitable therefore that you experience some withdrawal and I suspect quite strongly the symptoms you describe are exactly that - withdrawal side effects.

Please don;t rush this take it slowly and gradually. I took myself off Mirt at the end of last year, each time by around 5 mg. This necessitated splitting pills.

Talk to your GP about having some 15 mg pills as well as 30 mg. You can them move from 30 mg down to 22.5 mg, ie, one and half 15mg pills.

If you take it really slowly and gradually you are less likely to experience unpleasant side effects.

Good luck !

[NessMonster]

Thanks for the reply. I think I can take most of withdrawal effects as long as I know that they are withdrawals if that makes sense?

45mg to 30mg does seem a steep drop but it's not felt as bad as I thought it would. It's all just waves of unpleasantness at the moment, although only on day 5.

The plan is to stay here for another 2 weeks (totalling 3 weeks at 30mg) then drop to 15mg. I know that's more than 10% but my GP already mentioned the splitting pills if I need to. I'm going back to see him in a couple of weeks before the next drop as he wants to stay on top of this. Then stay on 15mg till mid-may (end of my semester) then do the final bit when I have some time off.

I'm equally terrified and excited by it.

The breathing thing though unsettles me. After I finished writing that post, I did wonder if maybe it's just the spike in the anxiety that's causing.

[Doze]

Breathing irregularly, hyperventilating or breathing too shallowly are all fairly common syptoms of anxiety. I have a thing where I don't breath properly and I suddenly feel out of breath and ligtheaded. It's unpleasant but can generally be remedied by belly breathing. Not big deep breaths, just normal breaths from the belly.

Also when tapering off, if you want to reduce the drop it is possible to take 15mg one night, then 30mg the next. Do for that a week and you're gradually reducing the level of the drug in your system. Then start taking just take only 15mg, theoretically the drop down shouldn't be a noticeable.

[MyNameIsTerry]

Also when tapering off, if you want to reduce the drop it is possible to take 15mg one night, then 30mg the next. Do for that a week and you're gradually reducing the level of the drug in your system. Then start taking just take only 15mg, theoretically the drop down shouldn't be a noticeable.

It will unbalance steady-state but it can depend on the half life how much disruption it causes. I question just how much these "on & off" methods do in the meds with half lives that could be close to the next full dose. But unbalancing will mean not allowing a more steady rate of the higher level but this might mean side effects that come & go (certainly in a shorter half life one like Ven it would be tricky) so whilst this is one way, there is always reducing inbetween 30 & 15mg with pill cutting?