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Thread: Tapering down..

  1. #1

    Tapering down..

    Hi, new member here. I was a member a long long time ago but theres no way i could ever remember my login details!
    I've been on mirt for 8 years now, the last 2 at 45mg but recently had some conversations with my doc about my anxiety and restlessness and he seems to think that at higher doses Mirtazapine can heighten this due to the increase in Noradrenelin for some people (but not all!)
    So he wants me to drop to 30mg for a few weeks and see how i feel. If this doesn't work then he wants me to change completely to something else.

    I felt that to be honest i didn't want to drop straight to 30 so ive been taking a 30mg pill and half of a 15mg to make 37.5mg. I'm on day 3 and while i definitely can feel something is different i don't feel too bad at the moment... My mood is a little darker, anxiety a touch higher and a bit spaced out but all manageable so far..

    So this will be a diary of sorts, for myself to look back on and hopefully a usefull thread for others in the same position.
    If anyone has been in a similar position tapering down please feel free to chime in with your experiance and how it went for you.
    Thankyou

  2. #2
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    Re: Tapering down..

    Hi Tony, Yay... someone else in the same position as me .. I posted yesterday "Coming off Mirtazepine". I haven't been on this med as long as you have... think it's about a year on it for me. I actually insisted on coming off this because I don't feel it's doing anything at all for me. I have been on 45mg and the psychiatrist reduced it last week down to 30mg. I must admit I thought this was quite a drastic reduction but trusting his judgment and expertise. My God, I have felt so weak and lifeless, general fatigue, achey limbs, mood darker, anxiety probably about the same, bad headaches, loose stools. I have to reduce again this week by another 15mg!!! eek! He is taking me off the med over the course of four weeks so wish me luck. Good luck to you and sounds like you are doing it the safest way.. always better to go slowly and reduce by small amounts when coming off any anti depressant. Glad that you're feeling okay .. Looking forward to reading your diary of how it goes
    __________________
    Yvonne
    Colchester Essex

  3. #3
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    Re: Tapering down..

    Good luck to both of you! I have just tried going up to 30mg, but the adrenaline impact has made me completely hyper, so am going back down to 15. Even though I was only on 30mg for five days, I am still walking down by doing 22.5 one night, then 20 etc.

    I would say that going as slowly as you feel able must be the best way - anything you can do to help your body with the adjustment must be a good idea.

  4. #4
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    Re: Tapering down..

    anxiousjomo... what do you mean about the adreneline ?? Are you telling me this med increases the adreneline ...OMG! You know something I don't know obviously... would like to hear your comments. Hope you get on okay with coming off it.
    __________________
    Yvonne
    Colchester Essex

  5. #5

    Re: Tapering down..

    Hi Yvonne, and anxiousjomo.
    Yes i do think slow and steady is the way with this one, but i have read numerous reports of people dropping 15mg at a time and a fair few have side effects which arent too bad.
    I'm on day 4 now and to be honest i do feel like the withdrawel symptoms are increasing... Just very tired, fuzzy head and a feeling similar to nicotine withdrawal strangely enough?

    But i slept better last night, so i'm taking that as a good sign. Not sure how long i will stay on 37.5mg, long enough to feel stable i think and then think about dropping to 30mg.
    Thanks for reading, its reassuring to know i am not alone with this.

    ---------- Post added at 12:53 ---------- Previous post was at 12:49 ----------

    Yvonne, i was told by my doc that at higher doses it can increase the release of
    noradrenaline, which is very helpful for depression but not so good for anxiety. Which would explain a lot for me. So hence why i've been advised to taper down to 30mg to see if i find that more helpful.
    People react differently though so no need for you to worry, especially as you are reducing your dose.

  6. #6
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    Jul 2017
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    Re: Tapering down..

    Yvonne - https://proceedings.med.ucla.edu/wp-...irtazapine.pdf


    Basically Mirt has three main mechanisms - histamine (so acts basically like over-the-counter sedating anti-histamines), norepinephrine (i.e. adrenaline), and serotonin.

    The histamine side of things are what causes the somnolence (and the weight gain, and dry mouth etc), but tolerance can build to this - hence why Mirt quite often stops working for sleep for people. So then you are left with the remaining two avenues - the serotonin obviously helps with depression/anxiety, and the adrenaline can really help with depression.

    But some people, like me, seem to respond only very mildly to the histamine side of things (over the counter anti-histamines have little effect on me too), but quite a lot to the adrenaline.

    When I went up to 30mg it felt like I had downed 6 cups of coffee! Which obviously does not help much with sleep!

    There are people on here who, because of this, split the doses (half at night, half in the morning).

    I am going back down to 15mg and then will maybe try taking it in the morning to see if that works better. Then, if I need more help on the serotonin side of things, I might try 5-HTP supplements (being on such a low does of Mirt means no risk of serotonin syndrome, so is safe to do the two together)

    The great thing about Mirt as opposed to the SSRIs is that, for me at least, the effects of experimenting with the dose are not that bad, so I am free to try things out in order to find the best way to take it.

  7. #7
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    Re: Tapering down..

    Tony, really pleaased to hear that you aren't doing too badly on the 30mg. I can relate to your symptoms. You are coming off the med in the right way as far as Im concerned.. the slower the better I think. As you know I'm coming off it much quicker as per psychiatrist's instructions and I will be reducing by another 15mg today. I'm not overly concerned, I've felt really rough this last week and hopefully it can't get any worse. I've been awake since 3.30 am this morning, so obviously Im very tired, but in general, lethargic, weak, headaches, eyes a bit sore, very achey legs. I'm coping. One positive is that I have been more motivated.
    JoMo.. thank you so much for explaining to me the components of the med. I had no idea norepinephrine was adreneline.. how stupid am I? Didn't realise it contained histemine either - this explains the somnolence as you say and the sleepy dopey feeling. Really grateful to you for commenting
    __________________
    Yvonne
    Colchester Essex

  8. #8
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    Re: Tapering down..

    Not stupid at all! I only know because of Dr Google ;-)

    I am struggling a bit today, but have to just remind myself it is because I only got a few hours sleep, and even the happiest most mentally stable person in the world would feel rubbish in my position!

    Just try and be kind to yourself, and let your body do whatever it is going to do with all these chemicals.

    Have you read Dr Claire Weekes, by the way? I have found her books on anxiety incredibly helpful. There are audiobooks too, and I often listen to her when I am having a tough time

  9. #9
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    Re: Tapering down..

    Hi anxiousjomo

    Yay.. you got your info from Google. I tend not to research my meds these days, did it years ago and used to scare the hell out of myself. well done you and I am so glad I now know what norepinephrine is.

    Sorry to hear that you're having a bad day, lack of sleep.. yes - I woke at 3.30 am and could not get back to sleep ..so you feel even more lethargic and weak during the day so it doesn't make you feel very good does it. You seem to be reducing the med in the right way.. I hope tomorrow is a better day for you and hope you sleep better tonight.

    Oh well Claire Weekes is my guru I'm 61 years old and discovered Claire about 15 years ago. I have all her books and all her recordings. She knew this illness inside out. Of course her key words include acceptance..now this is something I find so very difficult. When I'm out and feeling bad I hear her voice in my head telling me to float lol. So many other writers on the subject of anxiety and depression have copied her coping techniques and claim them as their own. One thing Claire says is, if you follow my advice you WILL get better. However if you have difficulties in your life... ie a difficult partner..etc etc etc.... Well, now many of us do have these underlying problems in our lives which we can't just make disappear. This is where other therapies come in useful of course - i.e. psychotherapy..

    Great to chat x sending healing vibes
    __________________
    Yvonne
    Colchester Essex

  10. #10
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    Re: Tapering down..

    Thanks Yvonne - and completely agree with you regarding Claire. I discovered her only about a year or so ago, and she has helped a great deal. Acceptance is certainly very hard, and something we have to work at on a daily basis. I am a long way from getting there...For me all the deep buried stuff - the legacy of a depressed mother, an unpredictably angry father, a shy and isolated childhood etc - hangs like a brick on the end of that balloon that is trying desperately to float.... My job also doesn't help (I am a lawyer in a large multinational law firm - so it can be very stressful)

    Sometimes I think if we all knew how many other people out there were awake at 3am along with us, it would make us feel a bit less alone. It is hard when my wife is there happily snoring away beside me

    I try and see each day as its own project. How I was yesterday is no indication of how I will be today, nor is today an indication of how I will feel tomorrow. So I just try and make today as positive as I can - I try and be a good father to my son, a good husband. I try to do well at work so that I can keep providing for them both. Even if I feel terrible on the inside, if I manage to make the outside at least a little positive, I have achieved something.

    Sending healing vibes to you too. Hope you managed to get a bit more sleep last night.

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