359 replies to this topic

[mimi10]

I cut Monday night from 4.3 to 4.0.  By Saturday I wasn’t really feeling much in the way of withdrawal so cut again Saturday night to 3.7.  Already starting to feel that cut, maybe should have stayed at 4 a little longer.  Going to try to hold on at 3.7 and see how things go, sleep was not so good last night and this morning headache, tinnitus and anxiety are starting up.  Usually don’t feel the cut until day 4.

[fishinghat]

It is so hard to have patience. You are doing well though. Hang in there.

[mimi10]

Day 4 and things are going about the same after a dose reduction so far.  I’m still at 3.7.  I’m not sure what to do, just found out I am scheduled for surgery nov 22 and doc would like me off the mirtazapine by then, says I should just stop playing around with this taper and stop the mirtazapine.  Apparently he has never had a patient that had withdrawal from mirtazapine. I told him that wasn’t going to happen but I will do my best.  Wondering if I should try small cuts a little more frequently or do a big cut and hold on until things settle.  Even if I try cutting by .3 or .4 every week I still won’t be off by then. Ideas?

[fishinghat]

Drs advice is usually sound but it is only that - advice. The decision is yours only. He doesn't have to suffer the withdrawal, you do.  Mirtazapine withdrawal is fairly common and your dr should know that. Just my opinion for what it is worth, I would stick to your taper unless there is a danger with taking it when having surgery (which I will check on).

[mimi10]

Thanks hat.  His concern had to do with if I am required to stay for a couple days they will give me 7.5 mirtazapine because that is the smallest dose available and an arrthymia he detected on the pre-op physical which may be the mirtazapine. 

[fishinghat]

Now I understand his/her concern with the situation. Mirtazapine  has been associated with QTc prolongation and/or ventricular arrhythmias as well as atrial arrhythmias. That is a valid concern and should be weighted carefully. Unluckily you don't want a cardiac event during surgery nor do you want to be in withdrawal at that time. I have included below some information about the use of mirtazapine  during surgery. The first article mentions that a 41% reduction in blood levels of mirtazapine  due to pre-surgical diets. That means that your 3.7 mg dose would be roughly equal to a 2.2 mg dose after the surgery. You would certainly wake with an increased risk of anxiety and insomnia afterward. By stopping the  mirtazapine  you lower the risk of a cardiac event. Tough decision for sure. I wish I could help more.

 

 

https://pubmed.ncbi....h.gov/34269840/

Pre and post surgery mirtazapine  blood levels were reduced 41% by bariatric surgery. This was found to be due to the low calorie diet used for this surgery. Mirtazapine  is fat soluble and there fore any diet that restricts fat intake will reduce the amount of mirtazapine  absorbed by the body. No negative effects on the surgery were noted.

 

 

https://pubmed.ncbi....h.gov/23055861/

Abstract

"This case describes a 15-year-old patient who experienced postoperative hypotension following an elective Ross procedure for aortic stenosis/insufficiency. The patient was taking paroxetine and mirtazapine for depression which were held prior to surgery. Hypotension occurred approximately eight hours postoperatively and required vasopressor support. Upon reinitiation of antidepressant therapy, hypotension resolved and vasopressor support was discontinued. A year later the patient required conduit replacement, and antidepressant therapy was weaned off during the three weeks prior to surgery. No hypotension was observed following the second surgery. Paroxetine withdrawal has been well-documented within adult literature, but there is little information regarding mirtazapine withdrawal. Furthermore, cardiovascular effects have not been well-documented, and even less is known within the pediatric population. Withdrawal symptoms in these agents may be explained by cholinergic rebound and/or rapid decline in serum concentrations upon abrupt discontinuation. It may be reasonable to consider tapering antidepressants with short half-lives prior to elective surgery in which patients may not be able to take maintenance medications for more than 24 hours."

 

Note - Hypotension is low blood pressure.

Note - Many research articles exist describing the benefits of prescribing Mirtazapine  to reduce pre-surgical anxiety.

Note - A few abstracts were found where Mirtazapine  was used pre-surgery to avoid post surgery pruritis and/or nausea. 

[mimi10]

Hat, thanks so much for that info, very interesting.  I’m still feeling a bit rough from the last cut 6 days ago, sleep has gone from normal bad to awful again.  I am just going to have to stick with this taper and hope for the best for my surgery on the 23rd not the 22nd (typo).  I’m on day 6 of the 3.7 dose and am going to hold at least through the weekend and try to get sleep to improve before trying another small cut.

[mimi10]

I decided to try another cut last night, I have reduced my dose to 3.2.  I am trying very hard to be patient but I feel like a lot of the bad hip and back pain is being caused by the drug. I may hold at this dose until after surgery on 23rd, but if things don’t get too bad may try to get another small cut in maybe 2 weeks.  

[mimi10]

Day 6 of last cut, still at 3.2, no sleep last night, typical for day 6.  Other symptoms are tolerable so far.  Going to hold a bit and hope sleep stabilizes.

[mimi10]

Day 3 with a dose of 2.8, we will see how this goes.  12 days before surgery, hoping things stabilize by then.

[mimi10]

Hi guys,

just checking in.  I cut dose to 2.4 last night, still on schedule for surgery next Tuesday, had a covid test done this morning, had to be done within a week of the surgery, results in 2 days.  I’ll be holding for now until end of the month.

How are you guys doing, hat, IUN (haven’t heard from you in ages, hope you’re ok, frog and Mxpro?

[fishinghat]

Doing great, thanks mimi. Sounds like you are doing OK. Yes, time to take a break from weaning and get the surgery out of the way. Best of luck and let us know how your surgery went.

[frog]

Good luck with surgery Mimi I really hope it helps

 

I haven't been around much as I'm doing fine anxiety wise nothing to report

[mimi10]

Just checking in, surgery went ok but no real relief so it’s on to pt and maybe another doc, follow up in a few weeks and will see where to next.  I have continued to make small cuts to the mirtazapine and as of last night started a 1.8 dose and guess I’ll see what this cut throws at me.  Hope everyone is doing well.  Been busy trying to get ready for holidays, shopping, wrapping, decorating and all that good stuff.  Picking grandson up tomorrow so we can shop online for his gifts for his mom, dad and sister.  Supposed to bake with my daughter on Friday, so hoping this cut is not terrible.  I’ll let you guys know how things go.

[fishinghat]

Thanks for the update mimi. Sounds good so far. Just keep it slow and steady and you will be OK. Have a good time with your grandson.

[mimi10]

Still here, still struggling with this awful mirtazapine.  This is day 9 of a 1.5 dose and sleep is just not settling down this time, only sleeping about 4 to 5 hours a night.  Going to hold for a bit and hope sleep starts to settle, kids are coming to my house for Christmas Day so no cuts before then.  

[invalidusername]

Hi Mimi...

 

My apologies if you are wondering why "IUN" hasn't mentioned anything here yet! I have been monitoring from behind the scenes and Hat has done his usual amazing job of keeping you covered with his knowledge and support. Your initial story came about when I was at a very busy point and I couldn't keep up, but I would normally be involved with all discussions on the forum as you will no doubt have seen.

 

I can see that you have been through more than your fair share during your amazing efforts and wanted to say that you have been, and continue to be, in my thoughts.

 

Wishing you all the best for the holidays.

 

God Bless

 

IUN

[mimi10]

IUN, so glad to see you back, you were missed and I was hoping that you were doing well and just too busy at the time.  Good to see you back.  Happy new year to all here, hoping for a more settled year, an end to this awful virus and a return to normal.  I am still sitting at a dose of 1.5, been about 3 weeks and the most difficult cut so far, going to stay for a little bit more and see if things get a little more stable and then maybe trying to go to 1.2.  

[fishinghat]

Time and patience

 

It sounds like you have got a good feel for how to handle this now. Well Done,

 

Happy New Year

[invalidusername]

Thank you for your kind message mimi - and a belated Happy New Year. 

 

As Hat says, you have got the right idea with the withdrawal process here - the cut will inevitably get more of a pull as you get closer to ground zero. The % becomes steeper each time. The idea is that we get you to 0mg in a timely manner so that you don't need to return. There may be times when you need that extra bead to get you through a bad part, but all in good time!

[mimi10]

Hi guys, I’m still here, still struggling with this mirtazapine, these low doses are really difficult.  I am currently on a dose of 1.0 and have been on it for only 3 days now.  Sleep is pretty rough and an assortment of other things.  I’ll be holding here for a couple of weeks to see if things can settle down.  I hope everyone is doing well, frog has been very quiet and I’m hoping that’s a good thing and means she is doing very well.  Hat and IUN, thanks guys for simply being there, it’s comforting to know.

[fishinghat]

Hi Mimi

 

It is a long slow process but luckily there is no time limit. You are doing great, hang in there.

[invalidusername]

Well done Mimi...

 

You are showing amazing strength. Very difficult to see when you are in the situation yourself. We don't say what people want to hear, so when I say that after all you have been through, the fact that you are still soldiering through REALLY is something else.

 

Hat and myself have been there. We know what it takes. But you will come through this a stronger person that you have ever been. Both Hat and myself have done - and so will you.

 

Have faith, keep it slow, stay calm and carry on (as us Brits quoted at the eve of WW2)

 

IUN

[frog]

Hi Mimi! (and everyone else)

 

I realized I hadn't been on here for a long time and wanted to pop in and say hello and I haven't forgotten you all. 

 

I've been doing really well on Lexapro. Last weekend my husband and I went with a couple friends to Lake Tahoe and I went skiing for the first time in my life. The entire trip was WAY out of my comfort zone and I got a little wallop of physical anxiety the first morning but overall it was really fun and I'm super proud of myself and absolutely could not have done anything even close to this a year ago. 

 

Mimi I'm so sad to hear that your surgery didn't help, what's next on the list of things to try? I've also finally agreed to get surgery (vestibulectomy in my case) as kind of a final attempt to deal with the pain. We'll see how it goes! 

[fishinghat]

frog, great to hear from you. So glad that you had a good trip and enjoyed yourself. Hopefully there will be many more.

[invalidusername]

Hey Frog - great to hear from you! Well done for your trip and not letting the initial anxiety colour your concern for the rest of the trip. Well done!! Can only be up from here on in!

 

I did a weekend break for my research and only had to one anxiety moment where I had dinner at the hotel which was really crowded, but just let myself feel it knowing it would pass. 

 

Keep in touch when you can my lovely

 

IUN

[mimi10]

Hi guys,

I am now on a dose of .8 mirtazapine and keep wondering if I can do this.  This is day 9 on the dose and with these lower doses things are relentless.  Sleep has been terrible the past 4 days, nausea doesn’t let up until late afternoon along with nervousness, bowels have not been so great either.  I take the mirtazapine about 930 at night and am usually asleep about 10 but keep waking up at various times and then awake about 3 and usually can’t get back to sleep. Nausea and nervousness set in about 7am and generally last til late afternoon then it all lifts and I feel completely normal, can finally eat something and feel settled.  Then 9pm I take the mirtazapine and it all repeats again. From experience, do you guys thinks this is withdrawal or the mirtazapine is causing these issues.  Right now I’m think that I will try to hold at this dose for at least a few more days.  Husband and I are supposed to go away for a couple weeks later in February, hoping for some sort of stability by then or I don’t know how I’ll be able to handle it.  Any ideas or light you can shed on this would be most appreciated.  

[fishinghat]

Definitely withdrawal. It sounds like you are trying to keep a schedule and that does not work. You have to go very slowly with these types of meds. I would stay at your current dose until you return from your trip. Give your body time to heal and get some stability. The further down you drop in dose the larger the episode in withdrawal. As you get lower in dose you need to go slower and slower. When you get feeling GOOD then drop again. 

[mimi10]

Thanks hat.  I will try to slow things down, and I will be holding until there is more stability.  It’s hard to judge, I try to go by sleep because I have never felt good the whole time I’ve been on mirtazapine.  It helped with sleep in the beginning but there were always many uncomfortable side effects which is why I wanted to get off this drug.  I appreciate your help and will be back, take care, stay well.

[mimi10]

Hat, I think I messed up.  I had cut a weeks worth of .8 mirtazapine and when I sat down to cut another weeks worth I somehow cut the pills to .06.  I remember having a hard time getting the scale to weigh accurately so I wound up not cutting the proper weight pills.  So instead of being at day 9 of a cut from 1.0 to .08, I was actually on day 2 of a cut from .08 to .06.  I don’t usually feel the cut until day 4 but maybe because it was right on top of the last one I felt it sooner.  I should have been reaching the timeframe where things start to settle if I had stayed on the proper dose. Well my dilemma now is do I continue at .06 and try to ride this out and stay on that dose to early March when we return or do I go back up to .08.  My gut tells me to try to ride it out but I would very much like to hear your thoughts, if you would be so kind.