Coming off mirtazapine and feeling crap!

[Irishwhiskey]

I've been on mirtazapine and pregabalin for about 2 years for what was severe anxiety and agoraphobia, which at its worst had me scared to even get out of bed. Before the mirtazapine I had a hellish year or so of trying various combinations of other drugs which either didn't work or had intolerable side effects, so I've had plenty of experience of starting/ discontinuation effects of mess.
I've been getting better and better and anxiety got down to the point where I only had the occasional wobble say in a supermarket, but could manage it fine and was not avoiding going out because of it.
My GP was slightly reluctant to let me try and come off everything yet, but I felt like I needed to see that I could be well without medication if that makes sense?? So dropped from 45mg to 30mg a few weeks ago, and apart from a couple of panicky days everything seemed fine. Dropped from 30 to 15 this week, am on day 4 today, and things were ok ish, but very nauseous. However today I have felt like absolute crap, sick and very shaky, and anxiety back with a vengeance. Managed to get myself out the house to church this am but felt so anxious and almost disconnected, scared of standing up in case I fainted, twitchy and unable to concentrate. I'm also feeling very very low in mood.
Has anyone here successfully managed to get off and stay off mirtazapine? Part of me feels like I shouldn't risk continuing and should just get my dose back up incase things get bad. However that would feel abit like failing to me....before I got ill I had never had any hint of anxiety, so I should be able to manage daily life without medication??
Sorry for the long post, just wondering if anyone had any experiences of getting of this drug?

[ShootingStarsinthesky]

Hi Irishwhiskey, Sorry to hear you are having a hard time. I do not have any experience with Mitazapine but have been on and off of different ADs and know that I had exactly the same withdrawal symptoms. Sometimes your Dr may be able to give you something to lessen the withdrawal symptoms but if not things do get better as the washout of the drug continues. Its horrible so you have my sincere sympathy, take it easy, don't worry nothing worse will happen.

[Irishwhiskey]

Thanks for your lovely post shootingstars,
Feeling a little better and heading off to bed shortly. I guess I'm just worrying about whether this is a normal effect of coming off the drug (and upsetting the biochemistry my brain has become used to on it), or if reducing the drug is just uncovering that I'm not able to cope without it...if that makes any sense?! I desperately don't want to 'need' to be on it, but equally I'm terrified of going backwards and then having to deal with increasing doses etc again. If I continue reducing then stop mirtazapine altogether and can't cope I will end up back where I started, but having wasted several months of what was relativity good mental health. On the other hand if I don't allow time to gradually cut down and eventually stop I won't know what I'm like without it in my system.

[ShootingStarsinthesky]

The rubbish part of these drugs is that although they help and many people wouldn't function at all without them the withdrawal symptoms are very like the symptoms which sent them to start them in the first place. As you say the brain has to get used to the withdrawal of a drug which is making it re-uptake biochemicals. It is only by you going past this type of withdrawal that you will know how you are without medication. It is tough to withdraw and very tempting to be seduced into thinking you are ill again and need to stay on them. You need to give yourself a chance. Good luck.

I have had problems with anxiety and I have found the 2 best things that have helped me over the years to be the easy and straightforward help of Claire Weekes - Self help for your nerves book (most libraries carry a copy of this) She was an Australian GP who originally was a Scientist. When she was a Scientist she worked too hard and had problems with her nerves she worked out how to reverse this anxiety and when she trained as a doctor she had a special interest in anxiety and its treatment. She is no longer with us but her advice is the best I have ever read. The second was learning Mindfulness Meditation from my local Mental Health Team. There are many courses that offer this outside of mental health and it is the best for calming the mind and so so easy. Take care.

[NanaNina]

Irishwhiskey I think you are reducing too quickly. Are you doing this under the supervision of a GP/psychiatrist? But then they don't always know how to reduce. I have been reducing an AD I have been on for a very long time this summer but replacing it with another. I was ok at first but then the psych wanted me to reduce on alternate nights and they was horrendous. I had really bad withdrawal symptoms (and yes they are just like the original illness) and I truly thought I was losing my mind. I only stopped them for 2 alternate nights. Fortunately I managed to get my CPN and she phoned the psych and he said to go back on the dose I was on before he advised on alternate nights. I had actually worked out myself what was happening. I felt physically ill for a longish time after this though. I ended up devising my own regime for reduction of this AD (much slower than the psych suggested) and he agreed. Am now down from 200 mg to the last 10mg and should be off this week.

I am also on mirtazapine 45mg for depression but it's made me put on a lot of weight and I don't think it did much to alleviate the depression either, so I am considering coming off, but after the experience described above I have started looking into reduction of this drug on the internet. I somehow managed to get on a website of the Royal College of Psychiatrists and saw something on there about reduction of mirtazapine but can't recall the details, but I think the golden rule with all ADs is to do it very gradually.

Maybe have a look at that site and there is a wealth of info on the internet about safe drug reduction. The thing is if you reduce very gradually you will be able to tell if you feel you are slipping back (ok this might be a withdrawal symptom) so don't reduce any more until you feel ok again, and if the "slipping" continues it may well be a sign that the depression/anxiety is returning. Sorry I'm not a medic but I just think we have to research stuff for ourselves these days and we are fortunate to have the internet.

Like you I don't know what to do now though because part of me is wondering if the mirtazapine is working well with the new AD whereas it didn't with the last one. Have to follow the advice I've given you!

[Irishwhiskey]

Thanks so much for your replies yesterday shootingstars and nananina...made so much difference when I was having a really low day. Had a dodgy start to the day and felt quite tearful (which is very unlike me), but got to work and was easily distracted it seems... ended up having a laugh with my wonderful workmates.

Shootingstars thanks for the encouragement re pushing through the withdrawal to see what I'm like off meds...my GP basically said that the slightest hint of anxiety returning that we would have to go back up on the meds, and was very keen to reassure me that lots of people relied on them and it wouldn't be a bad thing if I just needed a little bit to keep me going (etc etc). Which is fine to a point, but also shows ignorance to the fact that there will likely be symptoms involved in the weaning process?! I'm also very interested to find out more about Claire Weekes, will have a google!

Nananina I actually think with hindsight that mirtazapine has done me more good in terms of mood/anxiety than I give it credit for, but it feels like quite a subtle drug if that makes any sense?? I have to admit that weight gain/loss are on of my motivators for stopping it though. Interesting that you think I was withdrawing too quickly...for me it seemed quite slow, although it's the first one I've electively chosen to come off as supposed to having to. I will try and read more around it, and google the royal college of psychiatrists advice. I'm definitely not going to cut down further until I've done more research, and am feeling much much better!

I'm just thinking how labile my moods are at the moment...this morning I felt awful and like I wouldn't get through the day, this evening I felt really good. Some days it can change either way in minutes. A bit of me is saying this was never ever an issue before I started screwing with my brain chemistry, but then I was very close to housebound when anxiety at its worst and now have an almost 100% normal life... Shit happens I guess!!!

I hope your both doing ok today, and sorry for rambling on about me! If I can offer either of you any support at any time, please please just say!

[Fionadarragh]

Hello. I been have practise Claire weeks books for 30 years. Face float accept let time pass. Facing means to face panic head on. Go right to threw to the other side. Float means float your self we’re you are going. Accept all the symptoms not shy away from them. In knowing it’s your body over doing it natural job. Let time pass give you the gift of time on your side. What a beautiful gift to have. Her books give you real tools to make a full recovery from central nervous system. Good luck.