Insomnia, mirtazapine, promethazine (& tinnitus)

[Jayeffster]

A reaction to sertraline, prescribed for an anxiety condition, caused me to develop insomnia. To counter that I was prescribed low dose mirtazapine instead. Starting at 15mg that I eventually tapered to 7.5mg. It worked fine and I used it for about 3 and half years. Some of that alongside promethazine, and also for quite a while on its own.

My anxiety issues came and went so how effective it was for that I cant say. Though I had a whole year free of anxiety while also using mirtazapine.

I tapered off it 3 times, with mixed results finaly playing the long game and got free of it without issues. Occasional use of promethazine dealth with any sleep issues after that.

At the end of January this year my insomnia resurfaced in a big way, after beating the latest bout of anxiety. I went on mirtazapine (7.5mg) (no promethazine) which fixed the insomnia and was fine for well over two months.

Mid April I made the mistake of having a drink and skipping a day. Next one I took had some horrible after effects. I was on and off it over a week. With extreme mood swings and just feeling wretched a lot of the time. Somehow I was managing to sleep but that broke eventually. Particularly when rather mild tinnitus I was able to ignore previously suddenly blew up.

I got the mirtazapine issue fixed, by staying regular on it and using 25mg promethazine. But I decided I wanted out and to try something else due to the roller coaster ride I'd just had with it. So after a fortnight I started an accelerated tapering program. I actually made the landing pretty easily and managed a lot of the final week being able to sleep without taking anything.

I had intended to use promethazine in that process but as I'd used it solid at 25mg for a fortnight I think I was having side effects from it. (Possibly bradycardia)

In all that I was able to manage my tinnitus using sound therapy methods to help me mask it to sleep. Then I started on melatonin. I have just finished week 3 of being on 2mg slow release and my sleep is completely broken. My sound therapy methods are not helping and seem to keep me awake even if they block the tinnitus. The only nights I get a solid block of sleep is the occasions I risk a promethazine.

At my wits end right now and seriously thinking of going back on mirtazapine as it actually worked and more to the point worked even through my tinnitus, with or without promethazine.

I'm about to start taking magnesium glycinate alongside the melatonin. I hear thats good for both insomnia and tinnitus. I also started using 1mg quick acting melatonin as well. But possibly even 3mg isnt enough for me or maybe melatonin just isnt the way to go.

It's weird that the final week after a took my last mirtazapine I was sleeping without taking anything, But I guess I was still coasting the after effects of it. I understand a side effect of quitting mirtazapine is insomnia, so it's no suprise the melatonin isnt working as intended. Though you'd think it would have kicked in by now.

So yeh, this is where I am right now. Strangely not actually having my anxiety issues as the insomnia and lack of sleep is kind of keeping me occupied, but not in a good way. My tinnitus seems worse too but lack of sleep is probably a big part of that.

So long story short, do I go back to mirtazapine, stick it out with melatonin as prescribed, get them to up the dose/switch to fast acting/both, or try something else?

(Really sorry btw I am a chronic over thinker & not in the best place tright now, I will come back and try and edit this down)

[optimismrus]

Sounds like you're going thru hell. I recommend staying with the melatonin. I was able to wean off of my sleeping pill a couple of years ago and occasionally I'll have a difficult time going to sleep, but I consider it worth it to be off the drug. I'm on two antidepressants for depression and anxiety, and consider those prescriptions necessary. I'm glad you were able to vent here re your prescriptions. Tell us more about yourself. Best wishes 🥰

[Jayeffster in reply to optimismrus]

I feel like the melatonin should have worked by now. Possibly there's reasons it hasnt. Not including the tinnitus issues. I appreciate sleep hygiene & mental attitude are a factor but with mirtazapine I always found that within a few days it kicked in regardless. For that reason alone I am very tempted to go back to it. Particularly as once I got straight on it a few weeks ago after the blip I was sleeping fine regardless of the tinnitus. I have some magnesium glycinate arriving tomorrow. If that doesn't make a difference I think I'll throw the towel in on melatonin. Though I'll talk to the doctor first, maybe I just need stronger/faster acting melatonin.

[LostHashbar]

I understand you might have an “aversion” (shame?) of having to take antidepressants, but all that sort of yo-yo/off and on with the medication could be the real problem. Also you said you “had a drink” and then had problems, but you seem to blame the medication more than the drink. I’ve been fighting depression for more than 40 years, and I understand you maybe don’t want the stigma of “drugs”, but constantly playing around with them like that is counterproductive at least. I, too, wish I could live without medication, and I’ve tried, but for me, it is NOT a question of “mind over matter”, and there’s no quick fix. I certainly wish there was, I desperately wish there was. I had never tried mirtazapine until about 3 years ago, but I’ve been taking it in conjunction with venlafaxine and propranolol, and on a daily basis, and have had no problems and have been relatively functional, so I think regularity is key. But that’s just my opinion.

[Jayeffster]

I only ever really took mirt for insomnia as it needs to be a higher dose to properly treat depression. I don't have an issue with taking anti depressants but dont feel its something I need. However as mirtazapine is also an antidepressant if you get in a mess with it obviously it can effect your moods etc even with the dose I was taking. Like I said I used it for a long time without issues, so I might have to go back to it if there really isnt an alternative. But I would rather fix my sleep issues with something tailored more for that rather than use something that has a (positive) side effect in that it promotes sleep, such as low dose mirtazapine.

If I do go back on mirt I will treat it with more respect and not do daft things like thinking I can have a drink on it. And also take it regularly, with no on/off. Until I start the slow tapering process which Ive done before without issues.

But as I asked what I'm more interested in now is whether to stick with melatonin as is, up the dose or try something else. Part of why it might not be working, yet, is perhaps because I have hit post mirtazapine insomnia which possibly takes a few weeks to get out of.

[jojo15210]

The melitoniun ( however you spell) it did not wotk for me at all i got put on remeron 7.5 milgrams and seems to be helping

[Jayeffster in reply to jojo15210]

Im pretty sure remeron is a brand name of mirtazapine. It has always been my go to for chronic sleep issues in the past, promethazine being the go to for short term issues. With the recent issues Ive had with both though I am hoping there is an alternative.

[Ryanlion]

Hi

I agree with member Losthashbar, all this swapping about doesnt help. If Mirtazapine was giving you no problem why not stick with 7.5mgs, if it gives you sleep. You could even try less than 7.5mgs and see if you get some sleep. I'd bite the arm off of anyone who could give me an antidepressant that gave me sleep. I am so unfortunate & sensitive to most medication. Ive just spent 5 weeks on Amitriptyline to help me sleep (which it did) but cause me colossal depression. I am sick of trying new stuff. Count yourself lucky, take it and get on and enjoy your life. I know i would

[Jayeffster in reply to Ryanlion]

I'm not 'swapping about' I did mess around with mirt, and paid the price, but once I started being consistent with it it started to work again. I only started on melatonin once I was clear of mirt and have also been consistent with that. The downside of mirt is its a long term committment for a short term issue. Also due to the effects it had on my mood in the last few weeks on it I am very wary of going back to that. (Even though I used it for 3 years without any of those sort of issues). I also cant go lower than 7.5 as I think the lowest available here is 15mg that I would cut in half. Though perhaps maybe there is a lower dose version,

[53Arnhemmy]

Hello Jayeffster, I am familiar with mirtazapine, I used it for 7 years while tapering of benzos and another whole year without benzos.

My experience is that mirtazapine is very good for sleep and I used 3.5 mg all the time.

Tapering off did not last very long and for some days I was fine, then the withdrawal begun.

Not so much anxiety but my whole body seemed under electric current for quite some time and sleeping was not easy. I also used melatonin 0.3 mg per night but that was more a psychological thing. I decided to stick it out and after 2 months I began to feel a bit better and my body was calm again. Sleep has always been one of my weak points in my life so I tried supplements like l-theanine or valerian, or combination supplements with Ashwagandha and holy basil. All in all supplements were too instable for me and I ended up with sertraline 50 mg. Now I feel stable and good and my sleep has much improved.

At least no more benzos for me butI am very happy with sertraline only, I even hope to go to 25.mg in some time.

These are my experiences and although Iappreciated mirtazapine I chose to stop with it because of the weight gain that comes with it.

Hope to have been of some help.

[Jayeffster in reply to 53Arnhemmy]

Mirtazapine withdrawal is something I managed to dodge in the past. The first time I tried to taper off it I rushed it and insomnia hit hard. When I did come off it a couple of years ago I played the long game doing 2 day, then 3 day, then 4, 5, 6,7 etc gaps between each very gradually over months and months. Seems to me to be the only way to come off it without hitting issues. Part of why melatonin isnt working properly yet could be due to after effects of coming off mirtazapine. I have no idea how long mirt withdrawal is meant to last but if its anything like your experience I guess im not clear yet. I 100% am not going near sertralene again though, that's why I got insomnia in the first place.

[SteppingLightly]

I am new to this sight, and as sorry as I am to hear of your situation, I am also fascinated as my husband is experiencing his first bought of depression/extreme anxiety and extreme insomnia. He is also taking prescriptions for the first time, and one is sertaline. It has been a debilitating situation for him, and by default, for myself as well. I will try to research these issues more fully to try to understand if he is being affected the same way you are. I wish I could be more helpful to you, & i will share anything I find. Please know how much it has helped me just realizing all this things may be connected. I’m embarrassed to say I don’t keep track of all his details as well as you have accounted for yours, and this all feels very overwhelming for me, so I can’t imagine what he or you are feeling. I appreciate so much you expressing your situation with such details, and I hope others with more experience will offer guidance.

Thank you so much again for sharing and giving me a place to start. :)❤️

[faucet]

Sorry you are not feeling well and hope you feel better soon. I have been on mirtazapine for 5 years now, 30mg. I have never had an issue except the time I tried to come off them. I also take 10mg of melatonin to help with my sleep. But we all react differently to different meds and hope you find something that helps you.

[Tigglypoo]

Hi I take 30 mg mitazpine been on it for 5 months, I don't think it'd helping my anxiety, iam afraid to stop it .they say the lower dose is better ,Iam waiting to see gp .any advice how to tapper off this drug wud be a help.

Depression is horrible at moment, and feel very lonely hate this medication.

[Jayeffster in reply to Tigglypoo]

Highest I ever used was 15mg, but I was taking it for insomnia which its better for in a lower dose. If your tablet has a groove you can cut it in half and take a half instaed every few days. Then every couple of days.Then every other day. Then every day. If you do it slow and steady your body should adjust. Then you can switch to the 15mg and repeat the process to the point you are just on 7.5mg every night. After that gradually have skip days and increase the space between. It will take months but over time you would hopefully get to the 4, 5, 6 etc days gap without hitting withdrawal issues. Best to make a planner of some sort to track it all.

[Tigglypoo]

Thank you ,yes sounds like a plan .I will keep a diary and see how it goes .