Is it safe to take AD's on and off?

[cnote]

Hello! I'm no newbie here! I started having major anxiety about 5 years ago or so. My Dr. was fast to throw be the benzos, which helped.

Long story short, I got unknowingly hooked to ativan and was suffering ups and downs of ativan tolerance withdrawal for 5 years. The withdrawal is anxiety... so the Dr's answer to that is more ativan. He didnt know it was tolerance withdrawal. Anyways, after 5 gradually increasing years of HELL (that's putting it nicely) I got benzo-wize and saw a specialist who helped me get off the ativan SLOWLY, but as I came off the ativan, he gave me Remeron aka Mirtazapine. It's an old anti-trycyclic or whatever. But it HELPED A BUNCH with sleep and appetite.

I was only on Mirtazapine for about 2 or 3 months.


Now, I've been pretty much anxiety free for over a year!!! Yippee! =)

But a month ago I started taking Mirtazpine again, low dose, b/c I was suffering from some sort of weird anxiety. I was really anxious feeling, like really wired and amped up, and was having insomnia really bad.

I took it for 1 month and it was great. But then I weened off after one month and now I'm back in the same boat with insomnia again.

I've been off of it for 1 month... and am thinking about starting it back up again.


The Million Dollar Question:

Is it SAFE to take an antidepressant for 1 month or 2, then ween off.... then take a months break or more, then start it back up?

I just don't like the thought of being on a med for 6+ months at a time. Thanks~!!! :)

[nursegirl6572]

And listen to Nursegirl; she sounds a lot like my wife, who's always telling me to stop whining and move on.  Easier said than done, but true. .

LOL.  That certainly wasn't my message...but that works too.  Ha ha.

That's the crappy thing about us anxious people...we're our own worst enemies.  We take something...overanalyze it to DEATH, and wonder why we're so anxious?  LOL

I'm so envious of the people who can say..."Hm, I feel a little anxious...oh well"..and never give it another thought.  NOT fair!!  :0)

[Paxiled]

And C, I'm a fan of the way you go on and off meds.  Just my opinion.  The longer one stays on them, the more used to them the neurotransmitter system gets.  By the way, I don't think Remeron is one of the drugs that does this, it's mostly, as far I've read, the ssris and snris because they target serotonin so precisely.  And listen to Nursegirl; she sounds a lot like my wife, who's always telling me to stop whining and move on.  Easier said than done, but true.

[Paxiled]

No, I didn't say brain "damage."  What I said were permanent brain changes, meaning the brain can't go back to the way it was before the drug.  Research is research; it's just information, not truth, but although the brain is very adaptable for most, it isn't for all.  That's the beauty and the tragedy of human life -- you can never apply the general to the individual, so we're always in a perpetual experiment.  Just the way it is.  You stay well, C.

[cnote]

Yup. My Dr. keeps telling me that, saying "you have anxiety, you are just wired that way. You can learn to deal with it without meds, but, sometimes you can't, so take them if you need them, stop them when you don't. Enjoy your life."

I never denied I have anxiety... but there was a time when I thought I was "cured" from it after getting off of ativan.

But I'm sure that's not the case. Even though it's a good thing I got off ativan. :)

God Bless.

[nursegirl6572]

Well, it sounds like a plan.

Just work on that acceptance.  While there sometimes is a direct CAUSE, sometimes it's JUST the chronic anxiety.

I like that you said it out loud.  Now do that 5 times a day!  :0)

Glad you took my post as it was intended.  Let us know how you're doing okay?

[cnote]

Thanks for writing as well. But I am no so certain that AD's can cause brain damage. I did some research last night and found no studies of brain damage, especially with Remeron, b/c it's been on the market for a very long time. I hear that depression or anxiety in itself can cause brain damage per-say, but not permanent, b/c the brain is constantly changing, and growing new receptors and channels/pathways all the time. The brain has more healing capabilities than we think. :) Atleast I wanna believe that. :)

Thanks for writing. I'd like to think my insomnia stems just from insomnia... but my Dr. does not think that's the case. He thinks insomnia stems from something, and in my case, he believes its anxiety or stress. Life is full of mysteries. :)

[cnote]

Hi Nursegirl6572! You are a ROCK STAR! Thanks for writing back so quickly! :) First an foremost, I am not offended at all. I wanna hear it like it is. :)

As for your statements about Ativan. I believe some people can take it PRN etc. with NO problems. For years.

For me, I DID NOT take Ativan every day. It was PRN, but sometimes I'd take it for 1 week, or 2 at a time, then ween off, etc. etc.

But after 5 years of PRN use like that, my symptoms were getting worse, and my Dr. was upping my ativan dosage b/c .25mg wasnt doing anything, .5 wasnt doing anything, 1mg wasnt doing much, 2mg is the highest I had to take.

I truly believe my brain, even with PRN use, is VERY sensitive to drugs, and it got dependent, even on a PRN use.

You knew how I was back then, so paranoid about getting addicted to ativan, so I would use it sparingly.

But I know looking back at my journals, that the reason I was taking more and more is b/c my body was building up tolerance slowly but surely. Sure, some people have ZERO issues with staying on benzos, and coming off, but there are thousands of people who have MAJOR issues. I believe I was one of them. It helped in the beginning, but I should have educated myself before allowing my Dr. to prescribe it for 5 years. Benzos are technically supposed to be a 2 week treatment maximum. Not a 2 weeks on, 2 week of, 2 weeks on, 2 weeks off... b/c at that point, the 2 weeks you  are off and you are feeling rough is not b/c of anxiety, but b/c of ativan withdrawal, which feels like anxiety X100. Atleast in my case. :)

Okay! You and I could debate on this subject like crazy all day and night. haha. I totally respect you and think you are awesome!! :)

Now, I think you are getting somewhere about me denying that I have anxiety still... and that I'm trying to just blame it all on pill use now.

I could go on and on about how "this article" and "that article" states AD's cause brain damage etc. etc. And all I'm doing is subconsciously pumping my brain full of fear and probably misinformation, since nobody really knows what's going on in the brain. It's not like they can cut it open like any other organ in the body and dissect it and sew it back up.

The truth is, I PROBABLY DO NOT have ANY possible brain damage. Or even serotonin fatigue. I STILL HAVE ANXIETY.

I STILL HAVE ANXIETY.... I STILL HAVE ANXIETY.

THERE! I said it! lol. But, It's weird, it's tough to accept now after what I went through, b/c even my own Dr. admits that I have really gotten a control over my anxiety, but he still wants me to take the Remeron if I want to. He said what you said... "You fear the medicine way too much, and you end up just fighting with yourself so much, just take it for a while, it won't hurt you if you wanna just take it for a month or 2 and come off, do what makes you feel better. Most people in life want to feel better and not fight with themselves, and they just take something. You fight with the medicines etc."

Lol. He's right. Even though I'm better, I will probably STILL always have anxiety to an extent. It may not be that bad, but, I still have it.

After lastnight, I probably will take Remeron again.

I DID NOT SLEEP AT ALL, and felt like my heart was racing somewhat, keeping me awake, but I did NOT feel anxious. But I KNOW it's a symptom of being anxious.

I'm tired of the insomnia. It's been going on too long. Therefor, I'm going to do what I know works for me.

A guy at my work tells me when I'm acting like a Debbie Downer. We have some good jokes about it. lol. I told him a couple months ago to watch me when I take a month or 2 trial of Remeron.

The next couple of days after taking it, I asked him if he saw a difference in me and my attitude, and he started laughing b/c I was so energetic and being so comical, that he was clapping his hands saying "YES! HUGE DIFFERENCE!"

One major thing he said he noticed while I was on it for a month or so is that I QUIT talking about my sleep problems, my sleep worries... I just stopped anything negative, and JUST WENT ON WITH MY LIFE, and was ENJOYING IT. Even with a little weight gain. But I have faith I can control my appetite needs somewhat when I'm on it, and keep working out. :)

Okie Dokie... guess this guy is gonna start up some Remeron this weekend.

Peace and Love! Thanks again nursegirl6572!

[nursegirl6572]

But my Dr. at the time made me feel like I had a "disease" and I "needed" ativan forever.

I agree and disagree with this.  I've been taking PRN Ativan for 22 years, but the difference is, I've never taken it regularly (for more than a few weeks anyway, when panic was at its peak).  So, for ME...I DO feel it's one of the valuable tools in my treatment plan.  And for me...I DO feel as though I'll "need it forever".  The problem in your case is...it should have remained as a PRN med...and different options should have been explored after you had been on it for a while.  I DO remember those conversations we had though...about the Ativan.  We DID discuss the issues of tolerance and dependency...and you DID do your own homework...so I think its only partially fair to blame the doctor.  At the time, I clearly remember you making an informed decision about that.  Understand, I'm not trying to make you feel badly...I'm just trying to remind you of how things went.  When we're in misery..it's very easy to want to find a clear culprit and point our finger like mad.  I think you're doing this a little bit.

I KNOW you feel a lot of the issues are related to the Ativan, and you're probably right, but at the time, it DID help you.  I just wish you would have taken it as needed, versus regularly, then you wouldn't probably have had any of the issues you had with it...with tolerance/dependency.

You always have struggled with the acceptance of your anxiety, you have always overanalyzed and always sought to find ANY other reason for your symptoms besides anxiety.  I still see you doing the same thing.  I'll be very honest with you my friend...while I do not discount that the Ativan gave you problems and in the end caused an exacerbation of the anxiety...I sincerely think you're running with the Ativan cause.  You FINALLY have something more concrete and reasonable to point your finger at for the anxiety.  Problem is...WAY before the Ativan EVER would have been an issue...the anxiety was there, causing some significant issues for you.  

Anyway..I've rambled...back to my original point....I agree with your doctor in that anxiety disorders DO usually require lifelong treatment..not always in the form of meds, but something.  It's just NOT usually something that will just go away forever.  Those of us with an anxiety disorder are stuck with it.  We have ups and downs...like you describe.  I'll go for years without a panic attack and all of a sudden, get thrown right back into it...then I may have a setback that lasts another year....it's always been like that.

I think if you could ACCEPT that that's what you're looking at, long term...you would maybe do a bit better.  The issue I see is that when you're good, you're great..but when the anxiety resurfaces, you start chasing your tail all over again, trying to make sense out of it, figure out a cause, and start figuring out the next treatment.  No doubt that regular, long term benzo treatment isn't a great option, and like I said, had that been handled differently, you wouldn't have gone through the extra unnecessary struggles.  But, don't forget that at one point, it WAS a reasonable option, and it helped you and most importantly, you NEEDED it.  Try to put that behind you...it stinks, but it's over.  (I kniow, easier said than done)

At this point, I would recommend therapy (CBT).  I don't think your symptoms are bad enough to warrant a med, and I worry that you just have too much difficulty with the idea of needing to take a med.  I think that will cause you more anxiety, more than anything (worrying about being on a med).  

I think with some acceptance...you will do fine.  You've been down the therapy road and have done well...reemploy that part of the treatment, as well as the other things you've done in the past.  Mention to the therapist what I said about you possibly having a hard time accepting that this is something you're stuck with..and see if the therapist can help you find some understanding.  I did the same thing for a while , where each time I would have a reemergence of anxiety/panic...I would be like "what?"...and I had a billion and one reasons as to "why"...when in reality..the REASON was simply because I have panic disorder.  Once I stopped evaluating the anxiety so much, it was easier, like a burden lifted.

When I made the more harm than good comment...I meant in terms of not allowing the medication to work optimally.  I think it could actually cause an exacerbation or anxiety and/or depression if you take it on and off.  Your brain isn't going to know what to do.  I think if you're going to go on it and come right back off of it...I wouldn't even bother.  I'm not saying this is something you would need to stay on long term, but I'm saying...to go into it with your mind made up like it is...I don't think you'll allow it to help you like it could.

You're a smart, insightful guy...I think you're holding yourself back some, c.  It's been like this from day one...and you're still doing the same things. Time to let some things go...find some acceptance and ask yourself..."how am I going to prepare myself to cope with anxiety anytime it pops up?"  I don't think that taking Remeron for a few weeks is your answer..just my opinion, bud.

Let us know what's up okay?  We're here for you, no matter what you decide.  We can give you our input, but at the end of the day, these are decisions you have to make.  We understand that!!!

(Hope you take my post as it was intended...just very honest..I'm NOT judging you in any way, hon.  We have a LONG history together.  You know I dobn't pull any punches.  Just don't want you to be upset..I want to try to help you here)

XOXO

How's the family, btw?  Your music?

[Paxiled]

Your doctor is wrong.  Recent research is more and more coming to the conclusion that some people do suffer permanent brain changes from these meds.  And many people don't.  It's a crap shoot out there for any individual, and we just don't have accurate information on numbers here.  We assume the vast majority won't suffer permanent change, but we really don't know.  It I were you, though, I would probably not turn to an anti-depressant just for insomnia if you're doing well, and Remeron isn't used that often precisely because of the horrible weight gain problem associated with it.  (My psychiatrists only uses it on geriatric patients who won't eat, since it makes just about anyone eat).  Don't you have a good therapist by now to talk this through with since otherwise you're doing so well?

[cnote]

Thanks for the quick reply!

I'm not super anxious, or having any anxiety per say, but am feeling a little "not me"... not sleeping... sounds like more a touch of depression than anything.

With my short term experiences with Remeron, I notice that I am a CREATIVE MACHINE after taking it for a few days, it's like I'm a whole different person. And I love it.

However, I hate how it makes me crave sweets and salty food like crazy. lol. Which turns to weight gain.

The reason why I DON'T like the thought of being on something for long term is, that after going through the crazy terrible withdrawal that I did with Ativan (Lorazepam), then realizing that ALL this time, (for 5 years) most of my terrible anxiety that I was trying to find the root of, was actually the damn medicine... when it was leaving my system each time.

So that being said, going an entire YEAR with VIRTUALLY ZERO ANXIETY, med free, was remarkable. So therefor I truly believe the ativan was the culprit of most of my anxiety. I DO KNOW though that I was experiencing TRUE anxiety at one point, b/c that's WHY I had to take ativan. But I truly also believe that I should have been pointed in the direction of therapy vs. just throwing pills at me and labeling me. But my Dr. at the time made me feel like I had a "disease" and I "needed" ativan forever.

But now I keep thinking, did the ativan use for 5 years, and the withdrawal permanently  screw up my brain, or alter it somehow? That's why I have insomnia all of a sudden out of nowhere, and strange restless legs during the day?

But then I rationalize and say, "No, b/c you went almost an entire year without any drugs, and without any anxiety or sleep issues."

With all that being said, I'm just VERY careful on taking psyche prescription meds after what I went through WHILE being on, and coming off Ativan.

So that's why I was seeing if anyone sees any harm in taking Remeron on and off, in a pattern like that, almost as a "as needed" type basis. Except not PRN. But more of a month or 2 at a time taking it, then a month or 2+ or whenever I decided I may need it again.

You say it might do MORE HARM than GOOD to my psyche.
What do you mean by that? Do you mean like a permanent brain damage type deal? Like a serotonin fatigue? Or do you mean it's just confusing to my brain, and can cause "short term" depression/anxiety every time I quit?

My Dr. said that its not possible to do such permanent damage to my brain, but I don't trust most Docs anymore with their drug pushing tactics. lol. No offense. I know a lot of docs aren't like this, but I know a lot in my area that are. :)

I'd love to hear back from you! Thanks again!! :) Again, I'm not having anxiety as in fear, panic etc. I'm just feeling a little "over wired"... and can't seem to "relax" fully. :) But COULD I go on without any meds? Sure. But the insomnia *****. I've been taking benedryl here and there, and sometimes Tylenol PM. I don't want to take those forever either.

Thanks again!

[nursegirl6572]

HI there c-note!

Is it "safe" to take it like that?  Yes...but it won't be very effective.  Remeron is a tetracyclic antidepressant, and while it is a little different in its mechanism of action compared to the SSRIs and TCA's, it still requires time to build in the system for the most optimal efficacy.  To go on and off may actually end up exacerbating your symptoms.

That being said, Remeron does tend to act more rapidly than the SSRIs, so it would be likely that you would see improvements a couple of weeks sooner.

I just cannot see the point of taking a medication like that, it kind of defeats the purpose of the med (which is to create more balance and less ups and downs).  I think if you want to give it a try..do so, without focusing so much on how long you'll be on it.  That's insignificant, really.  You've been on this rollercoaster long enough that I'm surprised you haven't finally realized that it's OK if you need something long term (not speaking of the benzo situation, btw).

My opinion is...give it a try...but if you're going to be stopping/starting...honestly...I wouldn't do it..you may actually do more harm than good to your psyche!

Let us know what you decided!  Good to "see" ya, as always!  :0)