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Coming off mirtazapine...

(18 Posts)

I am a regular round mental health, but just wondering if anyone can help me re. coming off mirtazapine?

I am slowly coming off lithium at the moment and am now in month 5 of my 6 month weaning off process - yay!! So nearly there, and no negative effects.

I think I will be off lithium fully in about 4 weeks time.

I then plan to get off my mirtazapine - it is the lowest dose 15mg so am really really really hoping it won't be too bad. However, I had a MASSIVE sleeping problem which mirt basically resolved, so am very worried about coming off this one.

What is the best way to do this? Inexplicably my psychiatrist is completely clueless in this area hmm and just says "do what feels best to you" hmm

Am thinking to do it over the course of a month? Does that seem sensible / too fast / too slow?

We want to try for DC #2 asap but don't want to rush this process as it would be a disaster to have to go back on the drugs.

Thanks for any help or encouraging words...

kizzie Wed 12-May-10 19:23:33

sorry ive never taken mirtazapine in the past so not sure about withdrawal but wonder if it might be worth giving yourself a little break in between coming off the lithium and then starting the mirt withdrawal.

It sounds like youve done brilliantly with the lithium but it might just help your body to normalise itself and completely get used to the fact that the lithium is gone.

Sorry havent got any more helpful advice x

thanks kizzie so much for replying. I knew it was a long-shot that anyone out there had experience of coming off mirtazapine but thought I'd give it a try!

What you suggest sounds sensible. I really should make sure I'm fully ok off the lithium first.

I guess I just don't want the age gap to be too large, if we are lucky enough to have a 2nd...

But realise it's better to take it slow and be well, than rush things and risk being pregant and ill

Keziahhopes Wed 12-May-10 21:13:50

hi - could you ask your gp to give you some sleeping tablets to take for sleep problem to help you adjust to no mirtazipine? Seems strange psychiatrist not aware of how to come off meds he deals with!

tiredlady Wed 12-May-10 21:25:42

All the advice is to come off anti depresssants very slowly. Mirtazepine has much less of a withdrawal type syndrome than some of the SSRIs but still, if you've been off it for a long time, you might feel funny.
You are already on the lowest dose so stopping shouldn't be such a huge problem.

Are they scored? Can you break them in half? I can't remember. If you can, then take 7.5mg everynight for 2 weeks, then 7.5mg every other night for a week,then stop. If you can't break them in half, then just take 15mg everyother day for 2 weeks then stop.

There are no formal guidelines to stick to. Every psychiatrist might suggest a more rapid or less rapid way of doing it.

Don't forget, just because you might feel strange coming off them, that doesn't mean you need to go back on them.

Yes, it is definitely a great one for sleep, but hopefully if you are more positive and less depressed than you were then your sleep may just correct itself. I fear your GP would be very reluctant to prescribe any hypnotics for you.

Good luck

GetDown I have no advice, just wanted to say I know you can do this, you are really strong as you've been through so much to get where you are now. You can do this

cpanda Thu 13-May-10 11:48:08

off your original topic I know, but can I ask . . .

in view of the fact your suffered terribly with PND after your baby, how do you feel about the possibility of it happening after the 2nd? The reason I ask is because having got PND after my 2nd and subsequently realised that I had it even worse 1st time around, I am consumed by horrible regret feelings, ie: i'm so stupid to have had another, what was I thinking etc etc. trying to work on sorting these feelings out. any advice?

this certainly isn't intended to offend you and in no way am I making a judgement on your plans, just looking for advice to get out of the horrible hole I'm in.

Cpanda you shouldn't have regretful feelings - there was no way of knowing you'd have PND again. I was pretty stupid to have a third by that reasoning but I love him so much I couldn't possibly have any regrets.

cpanda Thu 13-May-10 17:05:21

of course I KNOW I shouldn't have these regretful feelings, just as you shouldn't feel anxious about your sleep. It's beyond my control, as is your sleep anxiety. It just goes over and over in my mind, like I brought this on myself. silly, I know and seemingly never ending. awful blush

God yes it is awful to have these thoughs going around and around in your head, isn't it? I wish there were a magic cure. My regret with DS3 is that I didn't think it through thoroughly enough (ie prepare myself for what could happen). I just went merrily into 'oooh oooh another baby please!' I'd forgotten what I'd been like after the other two. Funny how the mind blocks out the bad stuff. But I think GetDown is so savvy about her PND and sleep issues (she's given me so much advice about my problems) I am sure she'll be very well prepared for what 'may' or 'may not' happen

Thanks all so much for replying, I feel like I'm around friends on this section smile

Keziahhopes - thanks, yes, I do have a small stock of zopiclone, but really hate using them IYSWIM... and they are only short term as well and don't really "solve" insomnia if that makes sense. But I do use them when I am desperate and they may well be an option.

tiredlady thanks so much you sound like you have been there?? It's great to here that mirt doesn't have so much of a withdrawal problem as the SSRIs, that is very encouraging indeed. Yes the 15mgs are scored so I can break them in half and cut down gradually. I was thinking of actually shaving tiny bits off and doing it that way blush as these things are so pyschological for me blush It took me nearly a year to get off olanzapine, because I was convinced it helped me sleep!

becky you are my pal smile I know you know what it's like to go through insomnia and what a total debilitating nightmare that it is! Thanks for the encouragement that I will get there... I truly hope so.

With regards to having a second, yes cpanda I know exactly what you mean. It scares me so much that the same thing will happen again. I ended up in a mother and baby unit first time round I got so bad... it was truly the worst time of my life and I vowed never to have another one. But now my DD is 2.5 she is so much fun, chatty, we have so much fun together. And I would be so sad to see her an only child. And I have learnt a lot of coping strategies re. the PND, tho of course they won't necessarily mean I won't get it... it's so tricky to know what to do...

cpanda Thu 13-May-10 17:47:25

thanks, don't mean to come across all doom and gloom. just at the moment I feel no2 has destroyed my old life and I'm starting all over again. mope mope!

no you are not doom and gloom - it's a real consideration. It does scare me that it may be the wrong decision confused But I suppose I just feel this PND is temporary whereas an only child is permanent, if that makes sense?

...and it might be different this time. There is no way of knowing. You are much more prepared this time, and stronger I am sure.

I'd say looking back I was worse with DS1 than DS2 and worse again this time around with DS3. I was helped by the fact that DS2 was a total dream baby and he just did what the text book say babies do!

kizzie Thu 13-May-10 18:37:42

Just to give a slightly different view to this. When i had PND I saw a brilliant support worker who i have stayed in touch with. She had PND after both her daughters were born but the first time was much more severe than the second time.
So - yes she did get it again but she wasnt debilitated in the same way and it cleared up quicker.
So thats an alternative to:
- you dont get it again
- you get it again the same (but have better coping skills)
- you get it again worse (but have better coping skills)

FWIW - I wasnt able to have anymore children because of fertility problems - but if I had my (v severe) PND wouldnt hav e stopped me x

thanks kizzie sorry to hear you weren't able to have any more sad It's great you had a brilliant support worker and that her PND wasn't as bad second time round.

The mother and baby psychiatrist I saw whilst I was in the unit, was wonderful. She said that of ALL the ladies she has seen over the years she has never told ANY of them not to have another child. She said that you are at more risk of getting it again if you had it first time round, but there are always things that can be done for you, and ways to get round it.

She also said that they found out what "worked" with me first time round so if it did happen again they would be able to treat me straight away and hopefully stop it getting so bad.

That is encouraging in a way, but also scares me a bit that they will be ready to pour pills down me at the slightest wobble - I dearly want to breastfeed (first time round had to stop after 3 weeks and this I found heart breaking) and would be very restricted on what drugs I could take if b/feeding. Also am scared they may want to medicate me straight away - e.g. right after labour, when I am in a fragile state??? Don't know if they can do this or not. I really hope not. Also worried if I will get paranoia about them "watching me" or "waiting for me to fail". Hmmm, I don't know.

I guess it's all speculative at the moment, it may not happen for me. My periods at the moment are about every 6 weeks confused and very very light. I didn't get my periods back until DD was 18 months old shock So I don't think my body has fully recovered from the shock of a DC yet, and may well not let me have another!!!

cpanda Thu 13-May-10 19:21:55

"this PND is temporary whereas an only child is permanent, if that makes sense?"

I hadn't thought of it like that, what a really really good point. The problem at the moment is I lack clarity of thought which is why I resort back to the same old same old 'if onlys'.

Girls you all make really good points. thank you, you've actually given me a real lightbulb moment.

thanks cpanda it's great that we can encourage each other isn't it?

I'm sure things will improve for you... it must be so tough adjusting to life with number 2. One day when they are older they will put an arm round you and say "thanks for everything you did for me mum" , and it will all be worthwhile.

Keep pressing on towards that day!

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