Severe help

[[Ma...]]

On 25/12/2023 at 22:38, [[B...] said:

 

On 01/01/2024 at 06:26, [[B...] said:

 

Edited January 6 by [Ma...]

[[Bo...]]

@[op...] thanks 

[[op...]]

Boges,

Thanks for emailing me to weigh in - and also tagging me here. My heart breaks for what you are going through.  I saw a comment earlier in the thread in which @[ho...] who was trying to parse apart a few different things that may be going on for you, which might be useful. What I can share is just my personal experience with mirtazapine, but it differs for everyone.

I found that mirtazapine actually stopped my akathisia - I cannot tell you why it did this, but it did. That being said, it's been a hard drug to taper, likely because it's still covering up some left over benzo sxs. I have read, from others, that they believe mirt may have caused them akathisia. I don't know what's happening for you. These drugs treat us all differently.

That all being said I would try to find a dose to stabilize on and then taper very slowly and incrementally. I would personally not just stop taking it. If I were suffering as much as you seem to be, I might get the compounded liquid because the pills are so hard to cut and file and weigh b/c they are so tiny, so the liquid would just be easier. 

I sincerely hope you can stabilize and start a taper - this sounds so grueling.

I am tagging some others who tapered mirt to see if they have opinions @[Fi...] @[Ho...] @[ju...] @[Ox...]

 

openroad

[[Bo...]]

Thank you so much. 
I guess first step is figuring how to do two doses to see if that helps at all since I’m ultra rapid metabolizer? Would that likely help to setup now ? I have my compound pharmacist that I use with Klonopin that I would use to change a liquid however, is liquid going to be metabolized quicker and more of an issue for me or should I definitely try to do that now and get used to a liquid format before making any changes?  

 Did anyone take it more than one dose a day? 
im so lost on what to do…. I’m scared behind words to make change yet again. I know we all have to try to see if there’s some thing that can help us.

I take 7.5mg dose at 9:30pm each night,

Or keep it more 12hrs apart?

do I do 50/50 split or take more at 9:30? How do I know how much to do?

im using tablets aurobindo for last 2 1/2 weeks, prior to that 2 wks 15mg tablets cut in half that were an orange brown color at the psych hospital. 
 sure that change didn’t help plus covid 12/23-12/30. 

these are usually helped by 9:30pm dose but then have severe RLS, myoclonic jolts, brain racing clicking and spinning, internal akathisia, lights flashing behind eyes. Goes on for couple hours sometimes longer and is scary.  

Wake up 3/4am each night and  chemical anxiety starts, nausea  stomach cramping, itching and body burning, joints pain and stiffness yet weak jelly legs also, body buzzing, doom feeling building all thru morning symptoms on and off thru afternoon. Been bed bound last week by this.

So I guess take two doses might help but timing , amounts etc I wpuld love to get thoughts/what others learned might be best. I I know everybody’s different, and we all react differently, but if people just have some guidelines on how to handle the most successful way that people have observed or seen or learned that helpful.
With the symptoms starting around three 4 AM same time every day is that an indication that yeah I might need to be dosing twice a day.?

I really didn’t want to be on this medication and I guess now with how to stabilized I am I can’t just try to look for a quicker taper… A slow taper I guess is what I have to do. It’s just scary when I already have acathisia and not knowing what could  make it worse or not. 

Thank you.

 

Edited January 6 by [Bo...]

[[Ho...]]

Hi,

I'm a slow metabolizer and know how you metabolize makes a big difference. I tried to read through your diaries on this string and it's a little difficult for me to follow, but it seems as if, after you take your mirt, there's an almost immediate and awful response. I think you may want to taper it very very slowly and start as soon as you can. 

Your terror is making you worse. It's an awful thing to hear and for me to say, but it's true. The terror multiplies the pain. If you can find a way to manage tat terror you'll be ahead of all this faster. Always remember you will get better. This is awful but temporary. Please hear that! Tell yourself that! You will heal. In time you'll feel a whole lot better. Time is your best friend. You have time. You will heal.

Breathe. You're in acute and it's hardest to get through, I know! Anything to distract, anything at all. Please, please stay away from the psych ward. They want to help but just aren't able to. They mean well but you're the one who suffers. 

I'm using a solution made from a powder by a pharmacy. I went from 15 mg to 7.5 and then to 3.75 in a few months. Since then I've gone very slowly and being the hardheaded person that I am, learned the hard way to go as slow as my body dictates. I'm now on .7mg. I use a dropper to take it and drop down only .025 at a time. I'd love to do it weekly but biweekly is the best I can do.

Until I learned that, it was like being in acute for several days and when you get slammed back like that, you get confused, scared, depressed and alarmed. But it always passed. 

I asked my doctor for some gabapentin. I know it's another med but for me, every afternoon and early evening my skin burns and I'm very uncomfortable. Taking the gabapentin (100 mg) gives me relief. I know I'll have to taper off of it too, but it doesn't scare me at all. I sometimes take another dose at night if the RLS is bad, because for me it calms it and lets me sleep. I'm not saying you should do that but want to be transparent about what is helping me. My doctor says I should feel free to take it as often and as much as I want. Seriously, like candy.  I tell you!  But I like not to suffer so I'm using it, but sparingly.

I'm sorry for what you're suffering too. I also feel confident it will slow down and pass. With the covid and the mirt and the overall recovery from benzos it gets confounding because you can't tell what symptom is from which problem! So maybe don't try to parse it out. Just know that your body is healing, even while you suffer. Things are being put back in place, slowly but surely.

Do whatever you need to do to get some relief. Whether distraction, baths, food, deep breathing or even gabapentin, go easy on yourself and be as gentle as you can.

Hugs,

HCHC

[[Ho...]]

Oh, and if you want to split the dose 50/50 two times a day, I'd go ahead and try it but not double the dose! However, mirt doesn't usually need to be taken twice a day, and your symptoms intensify after taking it. 

Have you considered taking it in the morning instead of at night, to see if the restless leg calms down? Sleep would be so nice for you!

[[Bo...]]

Thanks @[Ho...]…. If the akathisia wasn’t so constant I’d be able to not be filled with terror. I just don’t know how to do the 24/7 aka and now this. It’s so so so scary.

How long were you on it? It will be 5 wks for me Monday and I’m in such a bad place bc people say to have gotten off of it quickly given adverse and akathisia could get worse from it when I started posting about 2 1/2 wks in. … I just didn’t know what to do and how to start etc. So complete teeeifed bc I havd to try to scroll thru all the boards to make sense of what to do/not to do and now so so scared.(my family couldn’t do it).

so pure Mirtazapine powder used or tablets crushed and made for your compound? Do you mind sharing? I talk to my ckmounded again Monday… we talked yesterday and he is gong to see if I still do well on the base he used for Klonopin taper which I did well on.(I’m sensitive to so many things bc of all the meds I was rolled thru the last 4yrs, just unreal given I didn’t hage any anxiety issues until one dang panic attack in hospital for covid symptoms 2020 started all this, and I didn’t know better to not see a psychiatrist for it bc dr said to….flipping covid)

Did you stair step from pills to liquid or make switch right away all at once?

thanks for the help. I appreciate y’all being there for me so much because I am just so so scared. I am my body so physically sick from being through everything I have in the past four months and sitting at 95 pounds just trying to start a taper is overwhelming. I wish I could just focus on trying to heal from buying and not have a whole new taper now ahead of me it’s just so daunting considering it took me 3 1/2 years for Klonopin. I was so drained from that and I just can’t believe howThat ended. Only reason I ended up in the psych ward which I knew to stay away from was because my SI was so bad and my actions ended up there… And then second time I was so severe my parents took me the second time.
24 seven relentless severe acathisia I just pray it will start to cease, but I’m so scared because mirtazapine seems to make it worse and I’ve got some TD things showing up after having started the mirtazapine so that’s why a slow slow off of mirtazapine with something that’s making worse is just again such a tough thing to try to determine .

Glad you’re doing well and I hope you continue too… Wishing you really good healing for this year.

 

 

Edited January 6 by [Bo...]

[[ho...]]

On 05/01/2024 at 19:57, [[B...] said:

Thank you so much. 
I guess first step is figuring how to do two doses to see if that helps at all since I’m ultra rapid metabolizer? Would that likely help to setup now ? I have my compound pharmacist that I use with Klonopin that I would use to change a liquid however, is liquid going to be metabolized quicker and more of an issue for me or should I definitely try to do that now and get used to a liquid format before making any changes?  

 Did anyone take it more than one dose a day? 
im so lost on what to do…. I’m scared behind words to make change yet again. I know we all have to try to see if there’s some thing that can help us.

I take 7.5mg dose at 9:30pm each night,

Or keep it more 12hrs apart?

do I do 50/50 split or take more at 9:30? How do I know how much to do?

im using tablets aurobindo for last 2 1/2 weeks, prior to that 2 wks 15mg tablets cut in half that were an orange brown color at the psych hospital. 
 sure that change didn’t help plus covid 12/23-12/30. 

these are usually helped by 9:30pm dose but then have severe RLS, myoclonic jolts, brain racing clicking and spinning, internal akathisia, lights flashing behind eyes. Goes on for couple hours sometimes longer and is scary.  

Wake up 3/4am each night and  chemical anxiety starts, nausea  stomach cramping, itching and body burning, joints pain and stiffness yet weak jelly legs also, body buzzing, doom feeling building all thru morning symptoms on and off thru afternoon. Been bed bound last week by this.

So I guess take two doses might help but timing , amounts etc I wpuld love to get thoughts/what others learned might be best. I I know everybody’s different, and we all react differently, but if people just have some guidelines on how to handle the most successful way that people have observed or seen or learned that helpful.
With the symptoms starting around three 4 AM same time every day is that an indication that yeah I might need to be dosing twice a day.?

I really didn’t want to be on this medication and I guess now with how to stabilized I am I can’t just try to look for a quicker taper… A slow taper I guess is what I have to do. It’s just scary when I already have acathisia and not knowing what could  make it worse or not. 

Thank you.

Hi Boges11,

Just some other perspective here, and obviously the decision is up to you.

I am in large support group on Facebook for those who have akathisia and have looked at studies and heard many many stories of folks who took Mirtazapine.

The gist is it helps some folks permanently, others it helps temporarily then makes akathisia worse or return after a few weeks, and finally for others it causes or worsens akathisia.

If it was me and I'd only been on mirtazapine for a month, I would look into doing a faster taper (perhaps a few months), with doses spread out to avoid interdose withdrawals. 

If it's clear after attempting the above taper it's still making the TD-like symptoms worse and the akathisia worse after a couple weeks, despite starting the taper, I'd consider working with a medical provider you trust to get off it in a few weeks to a month tops.

Tardive is not something you want to mess with. You can end up having it permanently. It's not like akathisia which can go away.

Just be careful.

The key here is a slow taper if possible at all to avoid shocking your CNS more which is already freaking out from the acute withdrawal of Klonopin.

Thinking about you and wishing you the best.

 

Regards

 

Edited January 7 by [ho...]

[[Bo...]]

I’m freaking out beyond words , I was having tongue swallowing issues a week ago or more are food was stuck on back of tongue and body wouldn’t swallow, then so many twitches and the dang myoclonic jolts are every night I take my med, started with Klonopin but only had when I tapered too fast and then never again. Stared day 2 of taking Mirtazapine and I wanted to stop but was in the dang hospital and they were intentionally ignoring me bc my akathisia was so bad and I was screaming and moving at times and they thought I could control it. So was stuck and too scared to spit out for fear of repercussions.

I am a mess trying to gauge what to do. Slow taper but fast enough to not get tardive but slow enough to mot cause aka to get worse and   Be doubled over throwing up bc at 95lbs already and room spinning migraines joint pain and leg weakness but stiff has all already been an issue.
Have so many symptoms and no idea what’s coming from what and severe mania type akathisia that is do hard to get calmed down.

If it weren’t for the akathisia if have never been in this spot bc I could manage 100 other things from K without searching fur something to help during taper last couple yrs. I coped thru the hell. Once 24/7 akathisia hit after coming off I didn’t know what todo and stil don’t but I’m getting done sleep now so a reprieve.

Body feels dependent on mirt ughhhhhhhhhhh

 @[ho...] @[op...] @[Ho...]

[[Ho...]]

@[Bo...], Someone on thid forum was given Seroquel and it made her akathisia through the roof. It took a while for her to figure it out. Her name is @[Re...]. It seems pretty clear that the mirt is driving your severe akathisia, right? You could message her for how she got off from Seroquel. While it's not the same thing, she was severe like you and was sent over the top by an antidepressant. There are enough parallels for her story to be relevant to yours and I think you may find some direction there.

A slow taper might not be endurable! You've been on it a pretty short time. I really hope @[Re...] has something for you. I'm no medical professional but I think you need to get off the mirt asap. I'm shocked at the way medical professionals reacted to your issues. You deserve so much better!

I went from a tablet to a liquid without stepping and had a few bad days. I finally posted here and someone got back to me and told me it was probably due to a bioavailability issue. In other words, my body metabolized the mirt pill and the mirt compound differently and it took a few days for my body to adjust.

I'm glad you've gotten a bit of sleep. Praying for more for you!

HCHC

 

 

[[Li...]]

If memory serves, @[Re...] elected to do a relatively rapid, blind taper off the Seroquel/quetiapine, supervised by a psychiatrist who has experience tapering multiple psychiatric medications.

[[Ju...]]

On 25/12/2023 at 22:38, [[B...] said:

Oh how I wish the last few months has gone differently. Please someone give me hope I can make it from this. I still can’t believe after doing my slow taper and how things spiraled so badly and knowing what all not to take ever and it all written out how that was used against me. 
 is Mirtazapine now adverse reacting is that I’m trying to gauge…. Impossible I know after reading this but I’m scared beyond what can say and horrified on what to do.

My body is on fire internally 30min-2hes after taking 7.5mg Mirtazapine at 9-10pm. Body starts jolting and extreme RLS, eyeballs start shaking and try to roll back in head. Chest pain and heart pain, intense mental akathisia. Stomach rolling.

Please  help. Very insane situation and still can’t believe this happened bc I took my K taper so carefully and knew all what to stay away from, persevered thru hell and was get myself back spring 2023 and functionality, love feeling and joy towards end of it. Had sleep come back to 5-6hrs taking .5mg gummy kid melatonin only after last few yrs at 0-3hrs. 
Jumped at .005mg end August’s and severe acute akathisia and in dark closet for 8 wks bc eyes severe and light caused aka worse. Had intense tons of symptoms no sleep etc. all beta blockers once and caused worse, spec clonidine and severe reaction.

4 mos off Klonopin 3 ye taper, 2 months of psych hospital hell bc severe SI and action on one , all the med changes, 3 days into now Covid positive and all the neuro symptoms ramped up that day. Not sure if it also is Mirtazapine neurotoxicity bc I’m reacting badly after taking now…. Didn’t in psych hospital. The severe psychological torture every second at every hospital I’m not sure how I’m here. That with the physical hell I’m just do so beat up.blockers trialed

I'm beyond freaking out as intense panic in gut twisting and turning having jolts in gut. This is all so so so hard.
I’ve had 120+ symptoms they K taper so I’m used to persevering through hell, but had been recovering pretty well towards lower doses with anbout 10 20 symptoms per day varying but predictable ….all hell broke loose at .018mg. 

Severe body clenching and eye pain and now Mirtazapine is very drying and can cause eye problems and so freaking out. Had to come off 1 wk Elavil in 2021 bc of eye color changes and 6 wks of hell followed but was still on K at that point. 

the akathusua is my biggest hardest thing and how it affects so much. I know I made mistakes here recently and went against everything I knew not to take but I was forced to. 

Laying still now body extreme vibration buzzing internally clenching involuntarily jolting involuntarily, 
This can happen with covid remeron and Klonopin but I've not had it had this severe before. I am unable to lay really. It’s like my brain is screaming inside and I want to scream running…. Again had this to a degree during K taper but not constant. Want to scrape face off, yank eyes out. During acute K I was pulling hair literally out bc aka was so so bad and pulling skin and scraping face. All stuff I couldn’t control. So heartbreaking bc I didn’t want to be doing it. I repeat same things over and over fast all day long. Rock at times, just disaster.

Can't close eyes during day bc they burn and hurt so badly, pressure and akathisia behind them. Just dart open and so much burning pain and I've tried 3 eye drops types today. 

Please help with any encouragement and what might think about the Mirtazapine. I’m so angry I’m on this bc it’s not helping and here I persevered thru K taper whole time saying I’d never get back on anything after.

12/3- start mirtazpne 7.5mg, 12/12-12/15 forced 15mg, 12/16 cut in half back to 7.5mg

12/18- change brand bc came home from hospital,

12/23- tested positive for covid, negative 12/30

Lord please please guide me and I appreciate all thoughts.

Sounds like you need to stop taking everything and let your body detox. It will reset back to normal but it takes some time.  Fear is the main culprit for ppl studying staying on or switching drugs trying to feel normal.  I've been thru all of it, addictions to benzos,opiates, methadone, still smoking cigarettes. Accepting its gonna happen and you'll get thru it,is vital.  Being scared will screw it up. When I started meditating more, things went so much better.  I don't know how you feel about scripture but the resurrection isn't what most think, well it had 2 meanings.  When the moon is in your sun sign(zodiac) you have what we call the christ seed every month that releases from the claustrum in your brain and it travels to the bottom of your spine, the solar plexus. If you can keep the body clean of everything at that time(3 days) and clean of crap foods no sugar lil honey shouldn't hurt, the seed travels thru the csf cerebral spinal fluid and goes thru your pituitary gland producing a white substance(milk) and then the pineal gland secretes a yellow substance (honey), that's your land of milk and honey.  When it hits the pineal gland you have healing at the cellular level from everything,  doing spiritual practice thru this time is also important. This is gonna be long lol personally 7 mins of meditation and chanting, because the vibration from chanting jeeps mhelps toxins out of your lymphatic system which is the living waters.  Lympsystem is responsible for keeping your immune system well.  I chant om for 7 mins taking deep breaths thru the nose in between.  Take the breath in and hold it for 7 secs if you can, tighten up your butt muscles hold it all in tight and release with the om. When your done you will feel a difference, might even clear sinuses if that's a prob lol after that I take my knuckles and Tao along the collarbone, shoulders, back where I can reach. Starting at top of stomach pushing down lightly, just rub downwards over and over just 30secs or so,  drag your hand across your stomach a few times. Then at your inner thigh where it meets the pelvic, kinda do a chopping motion with your hands all down the inner thighs. Do a cpl head rolls to the left and right. Jump up and down or just bounce a few times.  You've just opened all the lymph nodes then thump on your chest right between the neck and rib cage is a spot that feels hollow, that is your thymus gland, where apes pound before battle, they know it speeds up recovery and metabolism. Your basically telling the thymus that you've opened the floodgates and it's ok to release.  Sounds like a lot but it's not.  About 15-20 mins. After the 3 days of this and staying clean from drugs and processed foods, you'll feel enlightment, euphoria, blissful state for a cpl weeks.  The healing will help tremendously. That is the resurrection gifts from God, also the story of Santa going down the chimney and out leaving gifts.  If the body is not clean, the seed gets crucified and expels with your waste. This has been secret for centuries among the secret societies. We are more powerful than we even can fathom.  I know this was alot, but if it helps one person,  then I'm not sorry, God bless

[[Bo...]]

Thank I have been clean eating for most of 3yrs now thru benzo taper. Whole foods snd can really only tolerate 7-8 things. Have done the ohm and I need to work on chanting. Just 24/7 akathisia terror can be hard to work thru and do anything else but survive. Wasn’t trying to chase more meds at all but once in this hospitals you don’t have a chance to not take something bc refusing for me ended badly and used against me.

my fault I ended up in them but now way worse off and traumatized.

@[Li...]yes have talked to him and knew Rebecca’s story and others quite well before all this transpired and went way south for me bc I was starting to get hellacious akathisia and was reading everything. Just unfortunate bc not sure my body can handle anything fast at this point, maybe had it been the two weeks (thought it was 3 at the time and then got covid so didn’t want to do a thing before that ended)…..but now I’m at 5 weeks snd panicking.

talking to Mark Horowitz Tuesday but fear I’m in for long slow taper after 4 yrs of Klonopin from 7wks on that from one panic attack. So hard to wrap my head around what all happened and is happening. And I had been doing so so good spring last yr , still yuck but loving things doing a lot I couldn’t do and just felt myself and sleeping good. Crushing. Dang akathisia ruined it all.

[[Fi...]]

Hi @[Bo...]

I know we exchanged messages and I'm sorry this continue to be so hard for you. 

I shared with you that when I was thrown into a benzo setback due to anesthesia, I chose to take Mirt. 

My body was so sensitived, and the Mirt made me hyper. My legs would ache at night and I was anxious. I ended up taking the medication in the very early morning instead until I got lower, then I switched back to the evening. 

Maybe take it step by step. You feel like you want to split the dose into two doses. Why not try that? You will have a continued steady stream of the medication and perhaps it will be less intense on your system.

I found during my taper, taking actions often made me feel more empowered. 

Once you have information about splitting the dose, you can evaluate your next steps. 

Final Healing 

[[ho...]]

Something to keep in mind @[Bo...] is that you implied you couldn't control your movements and that they were involuntary.

On 07/01/2024 at 10:17, [[B...] said:

I was screaming and moving at times and they thought I could control it

Folks with akathisia are able to control their movements. In fact they have an urge to move to relieve the uncomfortable sensations they feel in their body and mind.

Tardive dyskinesia particular and other extra pyramidal symptoms cause uncontrollable movements.

I think you have both going on.

My personal recommendation is looking into a faster taper with the Mirt (one month perhaps?). But 100% do what you feel is best. Don't let anyone pressure you

Akathisia often goes away eventually, while tardive tends to be more permanent and I don't think you want that. Are you on a high dose of it?

Edited January 9 by [ho...]

[[Bo...]]

@[ho...]

thanks… I’m still trying to figure out what I’m gonna do. I just talk to Mark Horowitz. As we know everything‘s trial and error. 
Yeah, they thought I could control my aka stuff crashing around laying down and just having to move and constantly talk with the vocal tics, which I really could not calm myself down, but that wasn’t involuntary so much

The facial grimaces in the eyes kind of closing, blinking comes on with stress, but I need to see like it seems like it comes on like Thursday to Sunday. Then the beginning of the week is not so bad and it’s just hard to get handle even though I’m doing like daily summaries. It’s hard for my brain right now to compare notes cause I’m just so debilitated.

So for now, I think I’m gonna switch to compound liquid because trying to get accuracy with my scale even though it’s more of high-tech lab grade, I still don’t wanna have to be trying to shave and we because the pills are very in weights quite a bit and trying to get to liquid at this point if my body will tolerate it is going to be helpful.

I pray that I can tolerate the formula that I did when I was on Klonopin and then I guess they’ll just add the mirtazapine powder to that. Again, I pray that this doesn’t really upset my body because I’m sitting in a really really debilitated state right now with a lot of symptoms about 25 to 30 symptoms pounding me.

I’d love to get off this sooner rather than later but I just don’t know my body will be able to handle the extreme symptoms like throwing up and I’m at 95 pounds right now so I can’t afford to risk losing more weight. But I don’t want to be on this long-term but I don’t really have a choice. I’ve got just I guess see how my body does as I make the decrees and what I can hang in there with. I’m so unstable starting out which is why I never wanted to be on another medication after Klonopin. This all is still very very hard for me to accept because I’m in such worse shape trying to handle than I was initially. Heartbreaking and I just pray that God gives me the strength and heals us all.

I need a lot of support and I appreciate y’all very very especially knowing that y’all are on your own trials with this.

 

Here’s a question I asked on surviving antidepressants, if anybody can help me out

 

Compound liquid-

my compounder pharmacist who I use during my Klonopin taper, so I trust, he’s going to make up a compound mirtazapine liquid for my taper.

One formulation I’ve seen at the beginning of this was 1 mL equals 15 mg of mirtazapine per the UK instructions for their liquid

I believe this is OK but can he make up a more diluted batch or say one milliliter equals 2mg?

have people asked for this and how has this turned out? 

I did an.25mg = 10mL for Klonopin compound and it worked out fine but just curious how it’s worked out for others for Mirtazapine.

also, I’ll abide by a two week change over kf bottles bc people mentioned degradation when waiting a whole month. Is this still the preference is 2 week new bottle?

Thank you.

 

[[Li...]]

Tip of the hat for reaching out to Mark Horowitz @[Bo...].  

Re: your questions about a compounded liquid, might I encourage you to ask your compounding pharmacist about options for dilution as well as the two-week beyond use date?  He’s the only one who can address these topics because he’s the only one who knows what formulations are available and how he will determine the beyond use date.  Other questions you might want to ask about the formulation he intends to use include: 

(1) What drug source will be used?  Regular tablets or bulk powder?

(2) What are the other ingredients in the formulation?

(3) Has the formulation been stability tested? If so, what were the results?  See Note 1 below. 

(4) What is the BUD (Beyond Use Date) for the compounded product?  What regulatory standards/guidelines were used to determine this? See Note 2 below. 

Note 1: Stability is the extent to which a compounded drug product maintains the same properties and characteristics it possessed at the time it was prepared.  There are different types of stability including chemical, physical, microbiological, therapeutic, and toxicological. What you want to find out first is the chemical stability of the compounded product. Chemical stability is the degree to which the product retains its chemical integrity and labeled potency over time.

Note 2: To learn more about Beyond Use Dates (BUDs) and how they are assigned:

The Pharmacist Guide to Assigning a Beyond Use Date to a Compounded Sterile or Nonsterile Preparation

For example, my understanding is that the two-week (14 day) BUD is from the US Pharmacopeia; it applies to nonsterile, non-preserved water-containing compounded liquids that have not been stability tested.

[[Bo...]]

Thanks @[Li...]

He’s going to use same base that he did for my Klonopin compound since my body agreed with that. It was good for 30 days but I think started losing some potency which might have affected me bc changing to new bottle always rocked me a little.

I will go for two weeks this time change out 

any tips you can give me for Mirtazapine from just your experience here?. I’m scared beyond words since I’m coming thru BInd only 4 1/2mo off K and a very difficult last few months….. and my taper wasn’t at all easy. I am unsure how to gauge what my symptoms are attributed to given so much has happened so it’s not like with K that I could slow down my taper bc I knew it was only K … now it will be hard to know if it’s Bind stuff or mirt needing to slow or both etc.

and in terms of being an untra rapid metabolizer…. Do we clear the drug faster in this case where it could lead to interdose from your research? Conflicting info I am getting.

juts feel so so so upset after 4yrs of this.

Thank you 

[[Li...]]

 

@[Bo...]

I don’t have personal experience with taking or tapering mirtazapine so regrettably am not in a position to comment. The moderator who has been helping you on SurvivingAntidepressants sounds like they know what they are doing as does your compounding pharmacist (I spoke with him a while back about a project I was working on and was favorably impressed).  In your shoes, I would rely on these resources for advice and counsel.  I would also endeavor not to fall into the trap of paralysis by analysis (i.e. overthinking a situation so much that no action is taken and potentially larger problems arise). 

 

[[Bo...]]

 

Doing horrible….. split to liquid comp 50/50 with tablet Thurs night. Have been having adverse and severe problems since first couple weeks onMirtazapine….. please help with any asvics if anyone has had same bring. I. Touch with Mark Horowitz and benzo coaches. I’m not sure how ro survive this as Mirt is neurotoxic and cause worse aka, started rage and chemicals all day doom and dread, yet I can’t even make a move with it. Please any thoughts anyone has to make it.

 

log  

18/24- Thursday 

7am- awake, and trying to fall back asleep… In and out of sleep with dread, feeling 

10am-eat breakfast, hungry and irritable going to back feeling

12:30pm- rage feeling just want to throw everything and rip my eyeballs out joints hurt, overwhelmed with wanting to just scream and rip my skin and scream nonstop urge

1pm- talk to Nicole with mom 

2:30--eat lunch and just aka overwhelmed 

3pm- want to rip teeth out toes off, throwthings across the room, rip eyes out feeling, grind teeth into mouth guard 

4pm- rage continues, laying on couch want to rip body apart, grind teeth, scream ateveryone back arching up and down, scream out loud by akathisia tics, urges to do awful things ,  blinking  eyes hard,

7pm- eating dinner awful crying and wanting to rage feeling and self harm

8pm- continues above call parents cry more so overwhelmed with symptoms beyond my ability to cope and so scared

9pm- akathisia calmed down

9:55pm- took 7.3mg split liquid

11pm-

Brain racing, scary thoughts , 

Stomach sour and nausea coming on

2am- awake, eyes glued shut, hypnic jolts, rls and keg pain severe , internal akathisia and back arching, clenched teeth 

4am- still awake, can’t fall asleep but so tired eyes burning , jolting 

6am- still awake switch rooms, 

 

1/19/24- Friday 

7am- fell asleep at some point

9:30am- woke up to fear and doom; akathisia feel, crushing upset and want to throw things feel

10:15am- eat breakfast, rocking in bed

11am- complete vocal tics akathisia walking around and rocking and saying same thing panicked voiceover  over

12pm- walk to field and sit with blitz in sun

1pm- eating lunch , argue with Brandon about food

2pm- wanting to rip skin off, 

2:30- rocking on bed biting mouythfguard, wanting to claw eyes out 

3:30pm- severe legs moving back and forth want to jump up and down and scream, ate a snack and wondering if that amped things up - natural baby food cracker 

4pm-  bloodwork and vocal tics,rocking non stop 

10pm- 1/2 liquid 1/2 pill for 7.3mg Mirtazapine 

11pm- intense internal akathisia, intense panic feel , body pain jolts all over, face twitching, trouble swallowing 

12am-1am- intense panic continues, still awake , stomach rolling; brain shaking, 

7am- awake maybe, so confused.

9am- awake, dread, stomach popping noises, fingers can’t bend they hurt so badly like this every morning few weeks. 

Terrified. Nose stopped up and green like this for weeks

 

1/20- Saturday 

10:15am- eat breakfast, rocking in bed

11am- complete vocal tics akathisia walking around and rocking and saying same thing panicked voiceover  over

2pm- order food on heb, 

6pm- talk to Danielle, drained by end miss my friends 

8:30pm- eat dinner

9pm- sore throat, stuffy nose ears hurt

10pm - take med half and half, thrust hurts migraine etc

11pm- migraine continues ear ringing horrible 

1145pm- RLS severe, joint pain toss and turn non stop , ears ringing, head internal aka , jolts, 

1am- rls still bad, jolting 

 

1/21- Sunday 

7am- awake not sure when, fingers stiff  and bad joint pain, eyes hurt opening, 

Stomach gurgling, headache internal aka starting , sore throat in and off 

8am-10am- joints hurt, stomach gnawing, eyes hurt and skin burning around them, buzzing legs, try to sleep but intense chemical anxiety and awake but dreaming, hate it,  vocal tics galore , urge to want to throw things and scream, muscle weakness  dry skin always 

10:30am- eat breakfast, tinnitus screaming so much more than K taper 

12-1pm- work on computer 

2pm- aka bad, neck pain into head and headache.  Eyes hurt, anxiety building, chest heavy and trouble breathing , throat spasms and nose spasms, trouble swallowing stomach bulges moving around and tight tight stomach, air pushing up into chest, bad body odor like all of K acute

3pm- talk to mom not doing food; covid test faint line; migraine so bad, stomach such tight muscles always 

6pm/m- eat food; doom feeling non stop and chem anxiety intense vibrating and twitches,  burning all over

7:00pm- eat food, walk downstairs hard to walk, weak and legs stiff and hurt; always feel doom, tight chest non stop, trouble swallowing,  burning body mouth gums,

8:44pm- back arching up and down vocal tics coming on ‘having a hard time right now’, body agitated rocking legs , bad chemical anxiety feeling chest tight stomach pressure so tight , rocking feet  clenched body 

10:15pm- take meds 50/50 pills and liquid 

1115- tummy hurts, achy joints, 

12:45am- ??

severe brain electricity and feel like going to have seizures every second. Worst I’ve had , RLS very bad, brain stalling, panic attack feel but not, lights flashing behind eyes

5:30am- up bathroom, very sick to stomach, indigestion feel, heart pain, congested, intense RLS, achy joints , can’t swallow well, aka building took ginger piece , pain in tummy got worse things moving

 

1/22/24- Monday 

730am- bad heart pain- shooting pains on left side, , head feels off, burning all over, pressure like crazy everywhere, buzzing and k  a young in bed can’t sleep due to severity of all, tight chest hard to swallow 

9am- toxic 5min sleep whole body internal tremor horrific, bug crawling feel but painful nightmare of bugs woke awake to , horrific buzzing burning tons of body pressure like going to explode everywhere, nerve endings are nuts, terrified by how bad this is and I’ve barely survived K acute breathing on floor gasping for air barely eyes open  

10:30am- eat breakfast

1130am- crying bc so bad, have no idea what is normal in this bc stuff is severe 

Exhausted, congested, stomach rolling and nauseated, muscle pain, joints hurt, feel so sick, aka snd overwhelmed by fear, 

1145- in pain nauseated so so sick , whole body feels like death, crying 

1pm- can’t speak or move- in coma like state, scary this was like this in acute first few weeks off K, can’t move anything and vody feels paralyzed and in sleep but can hear around me 

3pm- talk to Brandon and parents- so severe and need everyone’s help trying to survive

5:30pm- hobble downstairs

545pm- eat more, feed dogs, very sick barely can help out; back upstairs

6pm- laying down, crashing feel just awful 

8pm- stressed bc so sick and scared, akathisia coming on, stomach pressure so constant all day every day tight and burps painful, pain all over, vibrating all

Over, irritated , exhausted, 

9pm- crying to dad, heart skipping most days now and adrenaline surge every time heart skips, overwhelmed by symptom severity, stomach yuck, chemical panic feel and throat pressure, exhausted and want to cry and cry this is so bad

9:30pm- take med 50/50 

10:30- exhausted, body buzzing 1115pm- stomach muscles not as tight 

1215-all night Exploding RLS, violent GI issues, lower cramping , stomach noises are so loud never before been like this, nausea extreme 

Bad intrusive thoughts severe internal aka, nerve pain, can’t sleep but tiny bit asnd jolted awake by GI problems and extreme need to throw up and stomach cramps 

Head hell pressure, weird sensations all over ear pain. 

Chest pain and heart skipping beats, stabbing heart pain

Akathisia rolling and RLS horrible can’t sleep.

 

Edited January 23 by [Bo...]

[Guest [...]]

I’m so sorry to hear what you’re going through @[Bo...]

I wish I had some knowledge to offer in regard to the Mirtazapine, but unfortunately I have very little, other than my short term experience before benzo’s where I asked to be switched to escitalopram because of the terrible RLS I experienced from it. 

It’s heartbreaking to read your story, and I just want you to get off it as fast but as safely as possible. 

I totally agree with Libertas… avoiding paralysis by analysis. 

My heart goes out to you, and my thoughts are with you. 

Sending you love! ❤️

[[ho...]]

I'm gonna be honest @[Bo...]. I really really think you should get seriously screened for tardive dyskinesia and tardive dystonia by a neurologist to consult on what is best to do to stop they dystonia and/or dyskinesia.

I definitely thing a lot of your symptoms are akathisia. But there are some that are very typical for tardive. 

If the following symptoms you described are happening involuntarily that indicates those symptoms are likely caused by tardive dyskinesia and tardive dystonia - back arching up and down, blinking eyes hard, vocal tics, hypnic jolts, clenching jaw, vocal tics [particularly grunts, sounds], face twitching, swallowing issues, etc.

Tardive dyskinesia can affect other parts of your body. You may:

• Make repetitive finger movements like playing the piano.
• Thrust or rock your pelvis.
• Walk with a duck-like gait.

If any symptoms are happening voluntarily because you feel an urge to move, or tic, or rock - that means those symptoms are from akathisia.

Tardive is normally a pretty permanent thing eventually and it can worsen if you don't get off the offending medication. But caution must also be taken too work with a neurologist so as to not get off too rapidly when your CNS is already so upset.

I know akathisia is living hell. I've had it myself and I'm still healing and tapering of the benzo they put me on to mask the symptoms [ironic I know]. 

But akathisia will come to an end. And I think long term you don't want to be stuck with severe tardive the rest of your life.

For reference this study mentions Mirt as being a top inducer among anxiety meds of movement disorders
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7298955/

Edited January 29 by [ho...]
fixing spacing

[[Si...]]

I am thinking of you @[Bo...].  I hope you are not too frightened.  Your mirt dose is pretty low.  I had a lot of these things too, repeating words, arching back and shaking chest, screaming, rocking, aka, it's a hell, I just wanted you to know you're not alone

[[Ra...]]

On 30/01/2024 at 02:22, [[h...] said:

I'm gonna be honest @[Bo...]. I really really think you should get seriously screened for tardive dyskinesia and tardive dystonia by a neurologist to consult on what is best to do to stop they dystonia and/or dyskinesia.

I definitely thing a lot of your symptoms are akathisia. But there are some that are very typical for tardive. 

If the following symptoms you described are happening involuntarily that indicates those symptoms are likely caused by tardive dyskinesia and tardive dystonia - back arching up and down, blinking eyes hard, vocal tics, hypnic jolts, clenching jaw, vocal tics [particularly grunts, sounds], face twitching, swallowing issues, etc.

Tardive dyskinesia can affect other parts of your body. You may:

• Make repetitive finger movements like playing the piano.
• Thrust or rock your pelvis.
• Walk with a duck-like gait.

If any symptoms are happening voluntarily because you feel an urge to move, or tic, or rock - that means those symptoms are from akathisia.

Tardive is normally a pretty permanent thing eventually and it can worsen if you don't get off the offending medication. But caution must also be taken too work with a neurologist so as to not get off too rapidly when your CNS is already so upset.

I know akathisia is living hell. I've had it myself and I'm still healing and tapering of the benzo they put me on to mask the symptoms [ironic I know]. 

But akathisia will come to an end. And I think long term you don't want to be stuck with severe tardive the rest of your life.

For reference this study mentions Mirt as being a top inducer among anxiety meds of movement disorders
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7298955/

@[ho...] I have akathisia from paxil as paradoxical reaction. Now i am tapering. I am at one mg. From few days i feel twiches on eyes, face, lips, legs. Occasionaly i feel urge to smack my lips especially when i am in acute stress. I have tingling and numbness sensation on face, forehead, hand feet. My thumb and hand shakes when i hold something. Sometimes by thumb jerk very badly. 

What do you think these are symptoms of tardive dyskinesia???