Bye Bye Mirtazapine - Week One

As I mentioned in my last post, I started coming off my antidepressant, Mirtazapine, on 26th December 2017. I will admit to feeling anxious about it as my mental health has improved so much since I started taking it - I actually feel the happiest I have felt in years. But I could not cope with the weight gain that has been Mirtazapine's gift, and it has been making me feel miserable. None of my old clothes fit and I cannot afford to size up in clothing every other month. I have also found it increasingly difficult to move around, and having Cerebral Palsy means that realistically I need to keep my weight down to reduce any additional strain on my joints, and to allow my body and physiotherapy to work to its best potential. A big downside is that my custom made AFO's do not fit as well as they should any more because my calves and ankles are bigger, so they are very uncomfortable to wear.

At the time of writing it has been a week since I started to reduce my dose, so how has it been?

Appetite
Since weight gain was my prompt to speak to my GP about coming off Mirtazapine, so far I have actually noticed a slight improvement to the raging hunger that has dominated my life for the past eight months. I am still hungry all the time, but I would say that the edge has been taken off. I don't feel that awful emptiness any more which made me need to eat NOW, and I haven't woken up in the night to eat. This didn't happen every night before though, so it's not really noteworthy.

Mood
I am mostly still feeling in a really positive, happy mindset about the coming year, so no big changes there. All good! I am currently really poorly with a fluey-type virus so am feeling down about feeling sick. I have also injured my wrist and am in pain, frustrated and upset because its my right wrist and I am right-handed. But that's totally normal because nobody likes being in pain or feeling ill. However I have been having bad dreams (see below) that have been upsetting me a bit.

Sleep
Here is where I am noticing some changes, and they aren't pleasant ones. Since taking Mirtazapine, my sleep has improved dramatically. I have been going to sleep around 45 mins - 1 hour after taking it, and have been mostly sleeping through the night. The only downside has been that it keeps me asleep so I have found it a real challenge to wake up early and get out of bed. But honestly, that has always been an issue haha!

A few days after reducing the dose it started taking me longer to fall asleep, and I was back in the familiar zone of reading, light off, toss and turn, light on, read my book etc etc. I do eventually drop off to sleep and it probably doesn't take me as long to sleep as it feels like, but still a change from falling asleep almost the second after I switch off the light.

I have also been having some very unpleasant, very realistic dreams where people I know and love are standing in front of me and telling me that I am useless at my job, fat, hideously unattractive, will never get married or have children, that I am not worthy of being happy... basically all the things that torment my innermost private thoughts. The people in my dreams are literally standing in front of me reeling off a long list of all of the things that are "wrong" with me and laughing in my face and coming back at me with more of the same when I try to defend myself.

The dreams are so vivid that I wake up really upset and wondering if it really happened, and I can't shake them off so I start to feel upset.

Weight
No change yet, but I am still eating Christmas chocolates etc like there is no tomorrow. Clothes are no looser, for the same reason! AFO's are still tight and uncomfortable. I have decided that I am going to have to go back to Slimming World. I joined a couple of years ago and did really well, so I am hoping that it will work its magic now that I have more to lose this time. I am going to join online this time around, as I am now at work when my old group meets.

Thoughts
No racing thoughts, although some demons are popping to the surface following lots of bad dreams. They have really tested me because I am having to chase away intrusive, self destructive thoughts. So far I am managing to do this by telling myself that they are only dreams, but I really do hope that these don't continue because it's horrible.

Here's to the next 7 days being easier!

Bye bye Mirtazapine! I'm coming off my antidepressant!

Another mental health breakthrough: I am currently tapering off Mirtazapine, the antidepressant that I have been prescribed since April 2017, when I had my last big mental health crash.

First of all, I credit Mirtazapine for saving my life at a time when I was very suicidal. It calmed down my racing thoughts, my harmful thoughts, my irrational thoughts. It helped me to sleep after many months of insomnia and it made me start to see through the blackness that had enveloped me in an unrelenting grip of despair. I don't know where I would be now if I hadn't have started to take it.

I want to say that I’m coming off my antidepressant because it is because I am fine and dandy and absolutely don’t need to take it anymore, but that isn’t entirely true – I wish it was! While I am thankfully feeling in a much better headspace now, the main reason for coming off Mirtazapine is the constant and unrelenting weight gain. Mirtazapine is well known for causing weight gain, primarily because it is also prescribed as an appetite stimulant (to both humans and animals, apparently). I knew this when I started taking it but at that time I really didn’t give a hoot, all I wanted was to not feel that low and suicidal ever again and I didn’t care how I achieved it. But in the back of my mind, I thought “Oh it probably won’t really affect me like that”, because I have always been on the slim side – never thin – but never over a UK size 12, and when I am stressed/depressed I normally completely lose my appetite and consequently tend to lose weight when I am struggling with mental health.

When I was prescribed Mirtazapine in April 2017, I was a UK size 8-10 and weighed 9st 7lbs. Today, eight months later in January 2018, I am a UK size 14-16 - mostly a 16 to be fair, I am absolutely squeezing into a 14 - and weigh 12st 8lbs (post Christmas, but still!!!). Holy shit, do I eat while I’m taking this! My appetite has been insatiable, honestly. Pre-Mirtazapine, if I fancied chocolate I would happily just have one square and put the rest of the bar in the cupboard for another day. Christmas chocolates would still be around at Easter. I ate Easter eggs so slowly that I would still have some left when August Bank Holiday came around. You get the picture, I was generally a season behind everyone else when it came to food. And I’d think nothing of it, because I’d always been the same, My friends and family would often comment on how they didn’t understand how I could eat things like that as they would devour a whole bar of chocolate in one sitting and couldn’t leave chocolate in the house and not eat it. To me, that was unimaginable and I genuinely didn’t understand how they could eat things like that.

Now, oh I get it completely. Mirtazapine hunger has often woken me up in the middle of the night and seen me raid the cupboards at 3:30pm and then still take a packet of crisps back to bed. I have felt hunger like never before, to the point where I feel totally empty and physically ill if I can’t eat something substantial NOW. It has made me eat breakfast – which I was never able to do before, because I simply wasn’t hungry when I woke up. And then I have gone on to eat a second breakfast an hour later. Forget single portion chocolate bars, I need the sharing size because I know the standard bar won’t satisfy my craving. I am eating huge portions for dinner, when I always naturally used to eat small portions, and then eating dessert AND THEN constantly snacking until I go to bed. Food has been a constant thought because the hunger has been a constant feeling. And I have always known it was piling on; my clothes have been telling me that it’s time to size up, again. I’d think, “Hey, you need to curb your eating, you’re getting bloody fat” but at the same time I just couldn’t not eat, because the hunger was all encompassing.

It was my contraceptive pill review in December 2017 that made my mind up for me. When the nurse weighed me, I said “I know I’ve gained weight since I was last here” and she smiled at me reassuringly as if to say, “Don’t worry, everyone says that, it’ll be ok”. Then when she actually weighed me and input the outcome into the computer, she did a double take and said that I have gained three stone THREE STONE! since I was weighed in June 2017. She looked through my records and said that I have never been anywhere this weight or gained so much so quickly since her data started in 1998. In fact the heaviest I had ever been was 10st 7lbs (I asked her) and I normally hovered quite naturally between 9st 7lbs and 10st, give or take, so this was really unusual for me. Then she saw that I was taking Mirtazapine and she said it made sense, that she had known patients to gain 6st a year whilst taking it (something I was right on track for!), and said that no matter how much exercise I did or however healthily I ate, while the hunger was there I would find it very difficult to shift weight because that hunger switch was set to “on” constantly and it is impossible to ignore. 

We had a long chat about how I was in general and she was really kind to me because she knew it was something I was finding difficult to cope with. She suggested making a GP appointment to see if I could change to a different antidepressant, so that’s what I did. 

A week later at my appointment, My GP and I decided together that I would stop taking the Mirtazapine and rather than switch me straight onto another antidepressant, I would see how I feel emotionally as I may do well without anything at all. I very much hope that I will be able to stop antidepressants altogether now that I do feel in a better place, although this will remain to be seen, as we are not sure if the Mirtazapine is doing its job and working its magic, or if I really am “over” the crash and am genuinely on a more even keel with my mental health. My GP said that I could just stop taking the Mirtazapine as I am only on a 15mg dose, but I felt reticent to just go cold turkey, so after researching online, I am halving the dose to 7.5mg and tapering off from there. I started reducing the dose on 26/12/17 and already my appetite is calming down. No way back to normal yet, but heading in the right direction. I will keep you posted!