1636 replies to this topic

[invalidusername]

You can put tablets under the tongue to dissolve. I often do this with valium if I have eaten recently, which can slow down the onset.

 

I am sometimes a little dry in the mouth, so I  take a rinse of water before putting the pill under the tongue. It takes longer than a liquid, so be patient. When all gone, rinse your mouth and swallow to prevent aftertaste. 

[fishinghat]

IUN is right. Also the liquid is usually like 2 or 3 drops under the tongue and comes with an eyedropper. It is easy to feel the drops fall in the mouth and shouldn't be a problem. Either way us fine.

[invalidusername]

Actually, I cannot feel the drops and have to get Mrs. IUN to administer!

[ForLyla]

I'll try the tablets tonight. I'm not holding out much hope tho

[fishinghat]

I love your optimism Forlyla. It reminds me of ...well me. lol

[ForLyla]

It didn't work. Would Ambien cause a lot of trouble?

[gail]

Lyla, have you tried Benadryl? About Ambien, others will answer as I never took it.

Trazodone is good, takes a few weeks to work. How about two brandies? Serious here.

[fishinghat]

It didn't work. Would Ambien cause a lot of trouble?

Ambien works on the gaba receptors just like benzos and has a nasty withdrawal. Not as bad as benzos but bad enough. It can also cause sleep walking. I wouldn't think this would be for you.

[ForLyla]

Hmm what about Remeron? I'm going to try acupuncture today. Not a huge fan of alternative medicine but it made me sleepy last time.

[fishinghat]

TCA antidepressants are usually not my first choice.

https://dailymed.nlm...e4-4f832f26f38e
From manufacturer's drug insert.

 

Mirtazapine is a potent antagonist of 5-HT2 and 5-HT3 receptors. Mirtazapine has no significant affinity for the 5-HT1A and 5-HT1B receptors.

 

Mirtazapine is a potent antagonist of histamine (H1) receptors, a property that may explain its prominent sedative effects.

 

Mirtazapine is a moderate peripheral α1–adrenergic antagonist, a property that may explain the occasional orthostatic hypotension reported in association with its use.

 

Mirtazapine is a moderate antagonist at muscarinic receptors, a property that may explain the relatively low incidence of anticholinergic side effects associated with its use.

 

REMERON (mirtazapine) Tablets are rapidly and completely absorbed following oral administration and have a half-life of about 20 to 40 hours.

Agranulocytosis
In premarketing clinical trials, 2 (1 with Sjögren's Syndrome) out of 2796 patients treated with REMERON (mirtazapine) Tablets developed agranulocytosis [absolute neutrophil count (ANC) <500/mm3 with associated signs and symptoms, e.g., fever, infection, etc.] and a third patient developed severe neutropenia (ANC <500/mm3 without any associated symptoms). For these 3 patients, onset of severe neutropenia was detected on days 61, 9, and 14 of treatment, respectively. All 3 patients recovered after REMERON was stopped. These 3 cases yield a crude incidence of severe neutropenia (with or without associated infection) of approximately 1.1 per thousand patients exposed, with a very wide 95% confidence interval, i.e., 2.2 cases per 10,000 to 3.1 cases per 1000. If a patient develops a sore throat, fever, stomatitis, or other signs of infection, along with a low WBC count, treatment with REMERON should be discontinued and the patient should be closely monitored.

QT Prolongation and Torsades de Pointes
The effect of REMERON (mirtazapine) on QTc interval was assessed in a clinical randomized trial with placebo and positive (moxifloxacin) controls involving 54 healthy volunteers using exposure response analysis. This trial showed a positive relationship between mirtazapine concentrations and prolongation of the QTc interval.

Discontinuation Symptoms
There have been reports of adverse reactions upon the discontinuation of REMERON (mirtazapine) Tablets (particularly when abrupt), including but not limited to the following: dizziness, abnormal dreams, sensory disturbances (including paresthesia and electric shock sensations), agitation, anxiety, fatigue, confusion, headache, tremor, nausea, vomiting, and sweating, or other symptoms which may be of clinical significance. The majority of the reported cases are mild and self-limiting. Even though these have been reported as adverse reactions, it should be realized that these symptoms may be related to underlying disease.
Patients currently taking REMERON should NOT discontinue treatment abruptly, due to risk of discontinuation symptoms. At the time that a medical decision is made to discontinue treatment with REMERON, a gradual reduction in the dose, rather than an abrupt cessation, is recommended.

Akathisia/Psychomotor Restlessness
The use of antidepressants has been associated with the development of akathisia, characterized by a subjectively unpleasant or distressing restlessness and need to move, often accompanied by an inability to sit or stand still. This is most likely to occur within the first few weeks of treatment. In patients who develop these symptoms, increasing the dose may be detrimental.

Hyponatremia
Hyponatremia has been reported very rarely with the use of mirtazapine. Caution should be exercised in patients at risk, such as elderly patients or patients concomitantly treated with medications known to cause hyponatremia.

Somnolence
In US controlled studies, somnolence was reported in 54% of patients treated with REMERON (mirtazapine) Tablets, compared to 18% for placebo and 60% for amitriptyline. In these studies, somnolence resulted in discontinuation for 10.4% of REMERON-treated patients, compared to 2.2% for placebo. It is unclear whether or not tolerance develops to the somnolent effects of REMERON. Because of the potentially significant effects of REMERON on impairment of performance, patients should be cautioned about engaging in activities requiring alertness until they have been able to assess the drug's effect on their own psychomotor performance (see PRECAUTIONS: Information for Patients).

Dizziness
In US controlled studies, dizziness was reported in 7% of patients treated with REMERON, compared to 3% for placebo and 14% for amitriptyline. It is unclear whether or not tolerance develops to the dizziness observed in association with the use of REMERON.

Increased Appetite/Weight Gain
In US controlled studies, appetite increase was reported in 17% of patients treated with REMERON, compared to 2% for placebo and 6% for amitriptyline. In these same trials, weight gain of ≥7% of body weight was reported in 7.5% of patients treated with mirtazapine, compared to 0% for placebo and 5.9% for amitriptyline. In a pool of premarketing US studies, including many patients for long-term, open-label treatment, 8% of patients receiving REMERON discontinued for weight gain. In an 8-week-long pediatric clinical trial of doses between 15 to 45 mg/day, 49% of REMERON-treated patients had a weight gain of at least 7%, compared to 5.7% of placebo-treated patients (see PRECAUTIONS: Pediatric Use).

Cholesterol/Triglycerides
In US controlled studies, nonfasting cholesterol increases to ≥20% above the upper limits of normal were observed in 15% of patients treated with REMERON, compared to 7% for placebo and 8% for amitriptyline. In these same studies, nonfasting triglyceride increases to ≥500 mg/dL were observed in 6% of patients treated with mirtazapine, compared to 3% for placebo and 3% for amitriptyline.

Transaminase Elevations
Clinically significant ALT (SGPT) elevations (≥3 times the upper limit of the normal range) were observed in 2.0% (8/424) of patients exposed to REMERON in a pool of short-term US controlled trials, compared to 0.3% (1/328) of placebo patients and 2.0% (3/181) of amitriptyline patients. Most of these patients with ALT increases did not develop signs or symptoms associated with compromised liver function. While some patients were discontinued for the ALT increases, in other cases, the enzyme levels returned to normal despite continued REMERON treatment. REMERON should be used with caution in patients with impaired hepatic function (see CLINICAL PHARMACOLOGY and DOSAGE AND ADMINISTRATION).

Activation of Mania/Hypomania
Mania/hypomania occurred in approximately 0.2% (3/1299 patients) of REMERON-treated patients in US studies. Although the incidence of mania/hypomania was very low during treatment with mirtazapine, it should be used carefully in patients with a history of mania/hypomania.

Seizure
In premarketing clinical trials, only 1 seizure was reported among the 2796 US and non-US patients treated with REMERON. However, no controlled studies have been carried out in patients with a history of seizures. Therefore, care should be exercised when mirtazapine is used in these patients.
Interference with Cognitive and Motor Performance
REMERON may impair judgment, thinking, and particularly, motor skills, because of its prominent sedative effect. The drowsiness associated with mirtazapine use may impair a patient's ability to drive, use machines, or perform tasks that require alertness. Thus, patients should be cautioned about engaging in hazardous activities until they are reasonably certain that REMERON therapy does not adversely affect their ability to engage in such activities.

In the tabulations that follow, reported adverse events were classified using a standard COSTART-based dictionary terminology. The frequencies presented, therefore, represent the proportion of the 2796 patients exposed to multiple doses of REMERON who experienced an event of the type cited on at least 1 occasion while receiving REMERON. All reported events are included except those already listed in Table 4, those adverse experiences subsumed under COSTART terms that are either overly general or excessively specific so as to be uninformative, and those events for which a drug cause was very remote.

 

It is important to emphasize that, although the events reported occurred during treatment with REMERON, they were not necessarily caused by it.

 

Events are further categorized by body system and listed in order of decreasing frequency according to the following definitions: frequent adverse events are those occurring on 1 or more occasions in at least 1/100 patients; infrequent adverse events are those occurring in 1/100 to 1/1000 patients; rare events are those occurring in fewer than 1/1000 patients. Only those events not already listed in Table 4 appear in this listing. Events of major clinical importance are also described in the WARNINGS and PRECAUTIONS sections.

 

Body as a Whole: frequent: malaise, abdominal pain, abdominal syndrome acute; infrequent: chills, fever, face edema, ulcer, photosensitivity reaction, neck rigidity, neck pain, abdomen enlarged; rare: cellulitis, chest pain substernal.

 

Cardiovascular System: frequent: hypertension, vasodilatation; infrequent: angina pectoris, myocardial infarction, bradycardia, ventricular extrasystoles, syncope, migraine, hypotension; rare: atrial arrhythmia, bigeminy, vascular headache, pulmonary embolus, cerebral ischemia, cardiomegaly, phlebitis, left heart failure.

 

Digestive System: frequent: vomiting, anorexia; infrequent: eructation, glossitis, cholecystitis, nausea and vomiting, gum hemorrhage, stomatitis, colitis, liver function tests abnormal; rare: tongue discoloration, ulcerative stomatitis, salivary gland enlargement, increased salivation, intestinal obstruction, pancreatitis, aphthous stomatitis, cirrhosis of liver, gastritis, gastroenteritis, oral moniliasis, tongue edema.

 

Endocrine System: rare: goiter, hypothyroidism.

 

Hemic and Lymphatic System: rare: lymphadenopathy, leukopenia, petechia, anemia, thrombocytopenia, lymphocytosis, pancytopenia.

 

Metabolic and Nutritional Disorders: frequent: thirst; infrequent: dehydration, weight loss; rare: gout, SGOT increased, healing abnormal, acid phosphatase increased, SGPT increased, diabetes mellitus, hyponatremia.

 

Musculoskeletal System: frequent: myasthenia, arthralgia; infrequent: arthritis, tenosynovitis; rare: pathologic fracture, osteoporosis fracture, bone pain, myositis, tendon rupture, arthrosis, bursitis.

 

Nervous System: frequent: hypesthesia, apathy, depression, hypokinesia, vertigo, twitching, agitation, anxiety, amnesia, hyperkinesia, paresthesia; infrequent: ataxia, delirium, delusions, depersonalization, dyskinesia, extrapyramidal syndrome, libido increased, coordination abnormal, dysarthria, hallucinations, manic reaction, neurosis, dystonia, hostility, reflexes increased, emotional lability, euphoria, paranoid reaction; rare: aphasia, nystagmus, akathisia (psychomotor restlessness), stupor, dementia, diplopia, drug dependence, paralysis, grand mal convulsion, hypotonia, myoclonus, psychotic depression, withdrawal syndrome, serotonin syndrome.

 

Respiratory System: frequent: cough increased, sinusitis; infrequent: epistaxis, bronchitis, asthma, pneumonia; rare: asphyxia, laryngitis, pneumothorax, hiccup.

 

Skin and Appendages: frequent: pruritus, rash; infrequent: acne, exfoliative dermatitis, dry skin, herpes simplex, alopecia; rare: urticaria, herpes zoster, skin hypertrophy, seborrhea, skin ulcer.

 

Special Senses: infrequent: eye pain, abnormality of accommodation, conjunctivitis, deafness, keratoconjunctivitis, lacrimation disorder, angle-closure glaucoma, hyperacusis, ear pain; rare: blepharitis, partial transitory deafness, otitis media, taste loss, parosmia.

 

Urogenital System: frequent: urinary tract infection; infrequent: kidney calculus, cystitis, dysuria, urinary incontinence, urinary retention, vaginitis, hematuria, breast pain, amenorrhea, dysmenorrhea, leukorrhea, impotence; rare: polyuria, urethritis, metrorrhagia, menorrhagia, abnormal ejaculation, breast engorgement, breast enlargement, urinary urgency.

 

Other Adverse Events Observed During Postmarketing Evaluation of REMERON
Adverse events reported since market introduction, which were temporally (but not necessarily causally) related to mirtazapine therapy, include cases of the ventricular arrhythmia Torsades de Pointes. In the majority of these cases, however, concomitant drugs were implicated.

 

Cases of severe skin reactions, including Stevens-Johnson syndrome, bullous dermatitis, erythema multiforme and toxic epidermal necrolysis have also been reported.

 

Increased creatine kinase blood levels and rhabdomyolysis have also been reported.

[ForLyla]

Thanks guys. I actually feel good so far today. Had a terrible sleep and feeling good - almost like I've gotten used to it now. Only thing is my heart is pounding which has been consistent the last week and makes it harder to fall asleep. I think the heart pounding is from lack of sleep though.

[fishinghat]

Yes, lack of sleep (sleep depravation) causes adrenaline to be released (therefore the heart pounding) as well as imbalances in gaba, serotonin, dopamine and a few other neurotransmitters. That is why sleep depravation is used for the purposes of torture.

[invalidusername]

Crazy goings-on here... I suddenly feel happier that I only have one drug going round my system at the moment. 

 

ForLyla - alternative therapy might not be for all, but never underestimate alternative meds. I am currently looking into Kanna. Much like all the other natural wonders, these things are coming out the woodwork and hopefully set about a better place for mental health.

 

A starter read for anyone interested in the non-scientific parts;

 

http://www.thelastam...ma-hiding-nose/

[ForLyla]

All of a sudden I feel a great deal of panic as to what's causing my insomnia. I hope its just withdrawal syndrome

[invalidusername]

Its a classic symptom of withdrawal - worry ye not dear girl. It won't hang around...

[ForLyla]

Even after all this time? I've had wd for 2.5 years now and never had insomnia like this.

[fishinghat]

The 2.5 years hasn't all been the same withdrawal. First the benzo and then the antidepressant. It is only the time since coming off the last one, the antidepressant that counts.

[ForLyla]

The last change I made was the updose in late Feb. Shouldn't I be beyond a setback in sleep like this.

[fishinghat]

Three and a half months? Well I can see still having some insomnia but ut definitely should be better by now.

How many mg of melatonin did you try sublingual the other night?

[fishinghat]

I went back and read your last 10 or 15 posts. A couple of questions if you don't mind.

Have you been taking the melatonin nearly every night the last 4 weeks?

Also if your baby has waked you up every couple of hours for a month or two this generates something called a conditioned response which may take your body time to recover from, even longer if it still happens from time to time. I was reading some forums by mothers with new babies and a lot of them said it took a year or more to get back to a normal sleep rhythm when the b aby finally quieted down at night, These were not scientific studies or anything but makes sense. This would be bad timing when it happens at the same time as withdrawal.

[ForLyla]

No I just stated melatonin a couple nights ago. I thought maybe it was my body getting used to the rhythm of baby waking but it seems unlikely that it started 4 months in. I was able to sleep alright before last week. I'm assuming this is some phase of withdrawal but worried about underlying conditions as well with my heightened sense of anxiety.

[fishinghat]

"I'm assuming this is some phase of withdrawal but worried about underlying conditions as well with my heightened sense of anxiety."

You know if you were still dropping your dose I would understand but to be on the same dose for 3onths with no improvement and maybe some worse...… well, you got me. A person would typically get some improvement by now. I don't know what to say except to wait and see.

If I remember right I asked you this before but Cymbalta is the only drug you take right?

The only thing I can think of that would make it drag on this long is high doses of caffeine or sugar everyday or heavy daily workouts and I know you aren't doing that.

[ForLyla]

FH I am doing a lot better than I was in many respects. If I was sleeping somewhat normally then I imagine I'd feel close to normal most days. 25mg Cymbalta is the only drug I take but remember that I was (and perhaps still am) going through benzo withdrawal as well which can be prolonged for several years.

 

I've had some strange occurances lately. My skin is no longer dry and has cleared up for the first time in over a year. I no longer have to use any moisturizer most days. Prior to this bout of insomnia, I was feeling the closest to normal I've felt since last summer as well when I was finally starting to get over the benzo insanity. Perhaps this is wishful thinking but maybe this is the end stage of withdrawal. Maybe it's like having a cold where the cold is gone but you still have residual symptoms, like a sore throat from coughing so much.

[fishinghat]

You have been off the benzos for nearly a year so most symptoms, but not all should be nearly faded. I am not surprised with where you are at symptom wise if you were still weaning. If you think the sleep is the main culprit then it is a matter of patience. Cymbalta withdrawal is fluid and ever changing. Symptoms come and go and for the most part all you can do is take it easy, eliminate what stress you can and wait. I just wish I could help more.

[ForLyla]

Thanks FH. I know that withdrawal syndrome can take several years to get over. I've been off benzos since Feb 2017 but had alcohol setbacks that lasted several months.

I spoke too soon. My skin had been great for weeks but had my first big breakout again today. Also feeling really foggy headed today for the first time in a while. Too bad because I felt pretty good yesterday. I took a multivitamin last night and my heart seemed to calm down. Didn't do much in way of sleep though.

[fishinghat]

Yup, ever changing. What a ride.