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358304 tn?1409709492

mirtazapine (remeron) withdrawal.

So I have been on Mirtazapine (Remeron) for about 2.5 months. I tried weening off a few weeks ago. I ended up weening off too fast. I ended up having these adrenaline surges 3 nights in a row, not allowing me to fall asleep. I caved in and started Remeron up for a bit, and did a SLOWER ween.

I took my last dose 6 days ago. At first, it wasnt HORRIBLE... but I did FEEL a difference. I remember a few days of feeling easily moved to tears... emotional... but OKAY. But the last 2 days have been rough.

The night before last, I took 1.5mg of Melatonin to help me get a good nights rest, b/c insomnia is a side effect of quitting Mirtazapine.  I fell asleep at 12am, and woke up at 4am, WIDE AWAKE. It was not a good feeling. I was then having terrible anxiety in bed. Shaking, and not able to get tired again. Yesterday I was a wreck. Just could not focus at work. My heart rate all day was 112bpm. UGH! And I could barely eat ANYTHING yesterday.

Finally last night, I told myself, "it's OKAY to take an over the counter sleep med, here and there"... I HAD TO GET SOME SLEEP.

So last night, I took 2 Unisom (which is recommended). I fell asleep at 12am and woke up this morning at 7:15am. I was pleased that I got 7 hours of sleep! But when waking, I still felt anxious! Heart rate went up a bit.

I'm at work as I'm writing this. And today as I still feel a bit anxious, but I do feel better than yesterday. That's for sure.

After reading some forums this morning. I TRULY believe I'm going through a TRUE Mirtazapine discontinuation syndrome. Basically withdrawal.

I KNOW I will be fine. I just keep telling myself, to give it a few weeks and see how I'm doing. I'm logging every day, so I can look back and see progress.

I KNOW this will get better. Even though it's hard to see a light at the end of the tunnel right now, I KNOW THERE IS A LIGHT. :)
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358304 tn?1409709492
nursegirl,

     You ROCK! I'm writing this all down too so I don't forget, when I'm feeling good. I tend to do that when feeling good on the meds. I think "I'm good, I don't need therapy right now." But I HAVE to. And I am.

The obsessing! YES! That's what my wife said to me, and I know I do. She said you pick one thing, and you CAN'T STOP thinking/obsessing about it. Whether it's remeron withdrawal, or sleep, or whatever...

Let me ask you a question Nursegirl.

People who DO NOT UNDERSTAND anxiety, like a lot of my friends... they always tell me "just quick thinking about it, just take deep breaths and relax."

For me, when I'm that bad, I JUST CAN'T THINK MY WAY OUT OF IT. It's almost impossible. Therefor when it's that bad, medication I believe is necessary.

Nursegirl, do you believe there is some general anxiety disorders that simply have to be treated with medication at times b/c it's just not possible for the person to think their way out of it or flip off that switch? Just curious.
Helpful - 0
480448 tn?1426948538
My Dr. yesterday put this into perspective. He said "You are 30 years old, you need to be LIVING your life and ENJOYING your life. There is NO need for you to be putting yourself through torment if medicine and therapy can HELP you."

Absolutely!

I think you've formulated a great plan!


I think looking back, what made me crazy was negative obsessive thoughts when coming off Remeron this time around. I tend do "catastrophic thinking". I remember when weening, I kept fearing the "what if i get the cortisol shocks again when weening? what if i can't sleep? what if my anxiety comes back badly? will i ever sleep again? do i have fatal insomnia? will i die?"

Exactly!  This is what I was talking about in my last post.  Most anxiety sufferers deal with the "what ifs", but you take it to a different level, where you ruminate about something, searching for the "answers".  I remember when you FIRST came to the forum, it took you a LONG while to accept that you indeed had anxiety, you went back and forth for quite a long time.  Then, you find a theory that is the LEAST scary for yourself, and convince yourself of that, if that makes sense.  I think if you can find a place of acceptance and just resign yourself to the fact that anxiety IS often perplexing and that you WON'T always have the answers, that treatment is largely trial and error, you'll do better.  You won't torture yourself with all of the tail chasing.

When you go to see the therapist, I would recommend requesting frequent sessions initially, if possible.  In the beginning, if you can be seen a few times a week, that's so helpful.  Have him recommend a few books for you too, and home exercises that coincide with your in office sessions.  I would also ask for him to work on the "obsessive" thinking.  

You're no dummy...sometimes you're TOO smart for your own good.  :0)
Helpful - 0
358304 tn?1409709492
Yes, this is the same Dr. I've been seeing for years. I hated him 2 years ago, b/c of the benzo disaster. But, I can't be mad at him for it, b/c he was trying to help me... He was doing what he thought was in my best interest. And ativan did help me for a while, but also for a while, it bit me in the butt... and it was hell to pay.

BUT! He DOES indeed CARE about me and my family. My wife and kids see him and love him. He calls me and checks on me. To me that shows it's just not about a paycheck, or me being a good customer. HE TRULY CARES. I don't know of any other Dr. who calls their patients from their cell to check on them at 8:00pm.

The psychologist I'm going to go see DOES do talk therapy and CBT. I did 1 session with him years ago when getting off ativan. I remember him telling me "Yes, I do believe you are going through ativan tolerance withdrawal, and you need off. But, I do believe through your history/past, you do indeed suffer from anxiety to a degree, and that needs adressing."

So I will continue to see him!!! I HAVE TO this time. Not just take the pills, and tell him im feeling good. I want to get the TOOLS and learn to cope with anxiety and stress vs. having a mental breakdown and having to resort to Remeron all the time. But this time around, I am in NO rush to RUSH off the Remeron. If I need it, I need it.

My Dr. yesterday put this into perspective. He said "You are 30 years old, you need to be LIVING your life and ENJOYING your life. There is NO need for you to be putting yourself through torment if medicine and therapy can HELP you."

He's right.

I think looking back, what made me crazy was negative obsessive thoughts when coming off Remeron this time around. I tend do "catastrophic thinking". I remember when weening, I kept fearing the "what if i get the cortisol shocks again when weening? what if i can't sleep? what if my anxiety comes back badly? will i ever sleep again? do i have fatal insomnia? will i die?"

I have to remember, I can not see the future, so I need to learn to NOT do that to myself.

Thanks SO much for everything.
Helpful - 0
480448 tn?1426948538
Sounds like a very good plan.  Is your doctor the same one you've had for years?  I remember your doctor before always being an amazing guy, always going above and beyond and being super caring.  That helps a whole lot.

The psychologist you're going to see, does he work with you on CBT methods.  Of course, while he can make recommendations, only the MD will be able to actually make changes to your script.  

I think you REALLY need to hunker down and dive into changing this thought process and conditioning.  You've always been the kind of anxious person that gets stuck chasing your tail.  You need to learn how to stop micro-analyzing everything, and NOT getting stuck on HAVING to have a concrete answer for everything.  As you know, with anxiety, that's a rare thing to come by.  I think THAT particular struggle with your anxiety is your biggest downfall.  Of course, that's nothing new coming from me, I've told you that umpteen times, lol.  You're probably tired of hearing me say it!   :0)  (Well, too bad....neener neener)

Just try to be patient and start working toward changing those thinking patterns.  It takes time and isn't easy that's for sure, but I have no doubt you'll be successful.  When you put your mind to something and give it your all, you do very well.

You just have to take the power back from your mind.  Right now it's in charge.

Hang in there my friend...and of course keep us updated!
Helpful - 0
358304 tn?1409709492
nursegirl, just updating you.

I took 15mg of Remeron last night.
Got pretty relaxed. Didnt feel like I had to pace around anymore.
Slept from 11:30pm - 8:20am. I remember waking up once around 7:00am, but I fell back asleep.

So, so far successful. I woke up still a little anxious this morning. Still no appetite, but making myself eat.

I'm sure after a few days, everything will start mellowing out once again, and I will be good ol' me again. Eating like a pig, and feeling like doing things. :)

My Dr. is such a nice man. He called me last night from his CELL PHONE, and asked how I was doing. He said I already sounded much better, and he assured me I'd be feeling better in the next few days.

That's one thing with me. I can't reassure myself when going through times like this. It's just so dang tough. I probably asked my wife, my mom, my brother, and my sister a 100 times yesterday "do you think I'm going to feel better soon?" lol. I love them all so much, they put up with so much sometimes.

I'm confident that slowly but surely I will be feeling better soon.

I can't wait to see my psychologist who helped me get off Ativan years ago. I'm going to let HIM control my medicine this time, and ween ME down. Not let myself ween me down. That's HIS job, to see how I'm feeling on a certain dose, and to see when HE feels it's a good time for me to cut down again. All while learning coping skills.

Thanks for listening once again. :)
Helpful - 0
480448 tn?1426948538
I think you will feel better going back on, because with either scenario (mine or yours, lol), adding the Remeron back to your regimen should improve how you're feeling.

Let me know!
Helpful - 0
358304 tn?1409709492
Nurse girl. I went to the Dr this morning. He got me in asap. My heart rate was 120. Yuck! He gave me 0.25mg xanax. I DID NOT want to take it!! My brother finally convinced me to just take one. One didn't do too much. So I took another and felt better. My Dr told me to start 15mg again starting tonight. I am going to stay on 15mg til Nov 7th at least and see my old psychologist, and let HIM control my medicine. Not me. So do you think I'm going to feel better soon once starting the 15mg again? Thanks! :)
Helpful - 0
480448 tn?1426948538
Sorry you had another bad night!

I know you don't like to take meds for long periods of time, but have you considered just staying on the Remeron for now if it seems to help?  I can't see any harm in that?  Then, once you get back into therapy and start working on your coping, you can revisit coming off the Remeron again.

Let us know what the doc says okay?  Thinking of you!
Helpful - 0
358304 tn?1409709492
Nurse girl... things are OUT of CONTROL. Its 3am and I still can't shake this HORRID anxiety and insomnia. I tried having my Dr paged at 1am BC I could only sleep for 30 min with the help of 2 benedryl. I was then just shaking non stop in bed. I felt insane. He was not reachable, so I just said screw it. Its not worth this. M y brother told me this the other night when I told him how bad I was doing. He said "why are you doing this to yourself? You obviously can't function at work or anything. You are anxious mess. Take the pill. You obviously weren't ready to come off it." I finally took my brothers advice tonight at 2am and took 7.5mg remeron. I'm not tired yet... but I'm feeling a little less anxious already. So the sedation effect might start working soon. Pray I get some sleep tonight.

My plan is this. I'm going to see my GP tomorrow. He will probably give me a clean bill of health, then tell me to stay on 7.5mg for a while again. Then when I see my psychologist in November, I can address this problem better and I'll let him tale control of CBT, while on remeron, then I'll ween off when HE wants me to. I feel kind of guilty about taking it tonight. But I had NO choice. Love ya Nurse girl! Thanks for always writing me! I'm stuck in a BAD funk... need to feel good soon! :) It will happen! :)
Helpful - 0
358304 tn?1409709492
But I'm sure there is some anxiety that im just giving myself as well. :)
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358304 tn?1409709492
Love hearing from you Nursegirl! The family is doing fantastic!

I know you find it hard to believe that it is Remeron withdrawal. But I TRULY do believe so.

I was on a fairly good amount for 3 months roughly. 15mg to 7.5mg to 3.75mg etc. etc.

The reason I know the adrenal rushes were from remeron withdrawal is b/c once I started a low dose again, immediately they stopped, until I slowly dropped dosage again, but they were not as intense. I never have adrenal shocks like that with normal anxiety.

Symptoms I have now are: Anxiety all day, rapid heart rate, insomnia, trembling, low low appetite.

I have got to give this a 2-4 week stretch and see if it gets better. I'm sure it will. :)

Also, I made an appt. yesterday to see my old psychologist who helped me get off ativan. I'm going to ask him to do to CBT-I with me. :) I think that's going to be a good move.

Thanks for the virtual hugs! :)
Helpful - 0
480448 tn?1426948538
Missed your last post....

Just needing a hug today and some "YOU CAN DO IT!" :)

YOU GOT IT!!  Virtual hugs coming your way, and lots of cheering and encouragement.  If there's one thing I DO know about you is that you're a smart, insightful guy who puts his mind to something and gets it done.  You WILL overcome this like you have everything else!!  I have no doubt in my mind about that.

BTW, how's the family???  :0)
Helpful - 0
480448 tn?1426948538
Hey bud!  Sorry you're still going through this.

You know my opinion, I honestly don't think this is related to the Remeron.  The discontinuation of the Remeron may possibly be causing some mild symptoms, but I still think this is mental conditioning.  You've got yourself convinced that you need to take SOME kind of pill to help you sleep, and you also are conditioned to expect anxiety to occur at night (we're very good at the self fulfilling prophecies!).  That's a common thing.  

There are a few reasons I don't think it's the Remeron...

1.  I truly think if this was Remeron w/d, you would feel the same level of symptoms all day long, NOT just at night, in the isolated manner you describe.  

2.  You weren't on the Remeron very long (and at a low dose right?)

3.  You DID do a thorough taper, then resumed tapering to wean down even more..

I would recommend addressing this as an anxiety/mind-lock problem.  This kind of thing is SO typical with you ( I KNOW you well!!  LOL).  You're your own worst enemy.  You get an idea in your head, over-analyze it until you convince yourself of that idea.  Then, it takes you a while to figure out that you might not have been correct to begin with.  You're a guy who functions better with "concrete" answers, not guesses or theories, and unfortunately, with the anxiety game, 99.999% of the stuff is guesswork, which is why I think you work so hard to convince yourself of your own personal theory..it makes you feel better/.

I think you need to start addressing your thinking process.  Are you back in therapy?  If not, can you pick it back up?  You have a therapist nearby that's well versed in CBT?  That would be the way to go IMO.

We have a LONG history, and you know I'm only giving you my 100% honest take on the situation, it isn't meant to make you feel badly, or isn't meant to dismiss what you're going through, I know it stinks and is very real, *I* just happen to think it's anxiety and panic causing these nighttime issues, not the Remeron or cortisol dumps.  It doesn't mean it doesn't need addressed, or that it doesn't bite!

Hope that helps a bit.  Even if I'm wrong (huh?  me?  wrong?  lol)...the good news is, if it IS truly the Remeron causing the nighttime attacks, then with time, it will improve.  Time is the best healer for that kind of situation.  Also, regardless of whether or not the Remeron is the culprit, I think you'd agree that you need to address the mental dependency you have with the need to take something to sleep.  We already talked about that before, and you seemed to agree.

As always, pulling for you, keep us updated okay?

Helpful - 0
358304 tn?1409709492
after doing more research, it DEF. sounds like mirtazapine withdrawal. Some people are fine for a few days b/c the long half life of the drug. Then they get hit.

All the symptoms I'm having, insomnia, lack of appetite, and nervousness... ALL S/X of quitting Remeron.

Now since I did a SLOW taper, from what I've researched, I should be progressively feeling better within the next 2-4 weeks.

And it's not always about "the medicine being out of your system." It's also about "your brain readjusting WITHOUT the medicine" that can be withdrawal.

Just needing a hug today and some "YOU CAN DO IT!" :)
Helpful - 0
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