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Original poster

Tapering off Mirtazapine

36 replies

FloridaGirl90 · 01/04/2022 10:18

Hi - I have been taking Mirtazapine 15mg for about 4 years now for insomnia. It has been great for my sleep despite some minor blips but I would like to taper off this medication as I have put over a stone on in weight and despite exercising every day cannot seem to shift it.
Would this sound a reasonable way to taper ...
Alternate for one month 15mg one night then 7.5mg the next
Then the second month 7.5mg every night
Third month 7.5mg one night, then nothing the next night
Then would you suggest trying to split the tablet down into 3.75 mg ??
Thanks in advance

OP posts:
WayshrineNotFound · 01/04/2022 13:29

I have heard taking alternate doses can lead to more withdrawals, since you'll have differing levels of the drug in your system. No personal experience really on that myself. (I've done it myself in the past and it's not gone well, but I was doing a very quick taper than anyway, which was more likely the reason.) If you can divide the tablet into quarters (as you'd need to for the 3.75 mg), you could always try 3/4 of a tablet for the first month?

RCP recommendation does say that for people who've been on ADs for years, you should try 10% reductions at a time, but that's not very easy to do with tablets. I did ask my GP about the liquid version of mirtazapine, which does exist, but it's much more expensive and rarely prescribed, I believe. Some people do end up making their own liquid from tablets, if they want to do a really slow taper; I cannot be bothered with that personally, and it's not recommended by the NHS.

I'm on my 4th week of tapering down from 30 mg - currently taking 22.5 mg. Everything else is fine, but I'm definitely starting to struggle with the sleep, and a bit worried about the knock-on effect of that.

PebbleMillAtOne · 01/04/2022 20:27

Talk to your GP

Babyg1995 · 01/04/2022 20:39

Hi I'm tapering from tonight as I can't cope with the weight gain anymore I'm on 45mg gp has suggested 30mg for 6months then 15mg for another 6 months don't alternate doses it would lead to worse withdrawal I would ask your gp for advice.

Original poster
FloridaGirl90 · 03/04/2022 08:40

I didn’t realise that alternating the dose could have such an effect, I assumed (wrongly!) that it would be ok as you’d still have a build up in your system (wrong terminology I know sorry)
I’ll try and split the tablet into quarters, but it’s quite difficult

OP posts:
MrsPelligrinoPetrichor · 03/04/2022 08:44

I have tapered off drugs before, get a pill cutter and nibble a tiny amount off each week. Expect to it to take months rather than weeks. You need to do it really slowly and leave a week in between reducing. Ask the GP if the medicine comes in liquid form which makes it easier.

MrsPelligrinoPetrichor · 03/04/2022 08:45

Pill cutters are very cheap from a pharmacy.

PromisesMeanNothingSue · 03/04/2022 08:48

What you’re describing is exactly how I taper meds, @FloridaGirl90, and it works well for me.

I take 7.5mg per day of Mirtazipine, and have no trouble at all if I don’t take it (other than not miraculously falling and staying asleep the way I do when I’ve taken it). I don’t take it when I’m away in my van, because I sleep so well there anyway, and I don’t get withdrawal symptoms (unlike my SNRI where even a late dose starts the brain shivers!).

Original poster
FloridaGirl90 · 03/04/2022 08:52

Thanks for your helpful replies everyone, I’ll get a pill cutter tomorrow
Have any of you who may have struggled with weight gain on Mirtazapine found the weight start to shift when you start lowering the dose, I do lots of exercise but cannot shift the stone I have put on

OP posts:
Doggirl · 03/04/2022 09:27

I've not yet tapered off mirtazapine- am still in the depression for which I've been prescribed it- but have twice come off citalopram, which is also one that needs a slow withdrawal.

I was on 40mg, so the 1st week every other day took 35mg ie 7/8ths. 2nd week 35mg. 3rd week alternated 35mg and 30mg. Sometimes the week at each stage became 10 days- particularly when I was more than half way, when 5mg down was proportionately more of a reduction. Getting off the last 10mg was actually most difficult (in hindsight perimenopause was probably a factor here).

I used nail clippers to break up the tablets. The GP also offered to prescribe a mix of strengths, so I could take multiple lower dose rather than break single tablets- although that then means you're paying more than one prescription.

I went with people's experiences online with how long to taper off, rather than a doctor's. There seemed to be a common theme that what doctors recommended was typically far too short a taper, in terms of withdrawal effects.

PeskyYeti · 03/04/2022 10:17

When I came off mirtazapine last time, dr had me withdrawal slowly from the 15mg to 7.5 for 6 months then come off it. No side effects, didn't lose any weight when I came off it though!

Had to start taking it again may 2020, and upped the dose to 30mg in July 2020. Dr said a higher dose has, in trials, seen less side effects.

Yeah that didnt help me, but just in case you suddenly get worse symptoms when you reduce.

Babyg1995 · 03/04/2022 16:26

Yes I'm now day 3 tapering down to 30mg and zero appetite feel sick actually but it's bearable and I'm happy with that because my appetite was out of control forcing myself to have small meals .

Babyg1995 · 03/04/2022 16:28

Sorry meant to day say I'm 2lb down in 3 days

rainbowninja · 05/04/2022 19:30

Hi, I'm on Mirtazapine and also want to taper but very nervous about it so following with interest. Does anyone else get a dry mouth with it?

I'm going to speak to my GP about it but I'm
also having some tests run on my hormones and for another genetic nutritional deficiency which might be contributing to my symptoms so I might be better to wait until I get those results back.

I've also heard that 10% is the safest way to go if you've been taking AD's for a while.

allthepeaches · 27/03/2023 21:01

Hi @FloridaGirl90 How did you get on? Any tips? I'm planning to start to taper down from 15mg. My GP has been useless and basically advised I cut my pill in half for a few days and then stop. I'm really worried about my sleep being affected - I had bad PND and anxiety and insomnia. Been on 15mg for about 15/6 months very successfully and no longer depressed but 2 stone heavier. Feeling really let down by my GP. I requested liquid form so I could taper slowly but they said no even though the NHS website says it's available!

Original poster
FloridaGirl90 · 28/03/2023 08:22

@allthepeaches Hi, I literally started tapering down just over two weeks ago. For the first week I alternated 15mg and 11.25 mg nightly, second week 11.25 mg nightly, I'm now on my third week of 11.25 mg, I plan to do this for another week then start alternating 11.25 mg and 7.5 mg for a week, then 7.5mg for 3 weeks till I eventually get down to nothing. I am hoping there will be minimal side effects, like you my biggest worry is if the insomnia comes back. I would happily carry on taking Mirtazapine if it wasn't for the weight again, I have piled a stone on yet exercise 4/5 times a week!!

OP posts:
allthepeaches · 03/04/2023 16:15

@FloridaGirl90 hope it's going well for you! Great to hear you tapering plan? Are you cutting your pills or using another method? I'm trying to get my gp to prescribe me liquid

rainbowninja · 03/04/2023 19:27

Hello! I’d forgotten about this thread 😅 I managed to reduce mine from 30mg to 20mg using a pill cutter I bought on Amazon and some scales that weigh mg’s. I did that by reducing it by 10% every 4 weeks and so far so good. Apparently it’s called the hyperbolic method? The closer you get to coming off it completely the slower you go.

allthepeaches · 03/04/2023 21:32

@rainbowninja so good to hear it's going well. I've joined a Facebook support group for tapering off mirt but it's filled me with dread and any positive stories are overtaken by people having the worst experience of their lives withdrawing. I know I can't know if I'll have a bad withdrawal or not but I just need to pluck up the courage/confidence to begin

rainbowninja · 03/04/2023 22:30

Hi @allthepeaches I hear you, that’s why I’ve gone super slow then it’s easy to go back up if you make a change and it doesn’t feel right. Do it in small increments and allow your body to adjust with each one.

Original poster
FloridaGirl90 · 04/04/2023 20:40

It’s going well so far, next week I’m going to alternate 11.25mg and 7.5mg for a week then three weeks on 7.5mg then try and drop again
I’ve been cutting the pills with a pill cutter

OP posts:
allthepeaches · 21/04/2023 20:51

How's the tapering going @FloridaGirl90 ? I still haven't started. I'm interested to see if you're one of the lucky ones who avoids bad withdrawal (hoping you are)

Original poster
FloridaGirl90 · 22/04/2023 13:19

@allthepeaches its going well so far, I’m down to 7.5mg now for another two weeks, then 3.75mg for another four weeks
I am a bit worried the withdrawal effects will start once I’m off it completely
no weight loss yet, would anyone know when this is likely to start, I exercise regularly, how long does it take your metabolism to return to what it was before?

OP posts:
allthepeaches · 07/05/2023 09:26

Hope it's continuing to go well @FloridaGirl90 I'm waiting on my doctors to see if they'll prescribe me liquid form. The Facebook support group is still freaking me out, I think I'll stop checking it!

rainbowninja · 08/07/2023 23:00

How is everyone doing? I’m down to 15mg now from 30mg but my mood had crashed a bit so I think I might need to stabilise before going any further. I’m not sure it’s related to the pills, I just had a period of stress and it brought me down a bit.

For those still taking it, what time do you take it? I leave it as close to bedtime as possible which for me is 11pm but thinking this might be quite late?

Original poster
FloridaGirl90 · 09/07/2023 10:01

Well … it was going well, I took 3.75mg for four weeks then for one week 3.75 every other night then stopped. After five days I had to go back on 3.75, I could feel the insomnia creeping back in, not sure but some of it probably just in my head, maybe over thinking?
Anyway I’m back on 3.75 every night, I’m going to give it another go for a month this time alternating one night on/one night off and see how I get on,
then either try snd stop again completely or miss two nights etc

OP posts: