Anyone here ever used a micro taper to slowly get out of adverse effects?

I’m not talking about the brass monkey slide. I’m talking about maybe a daily micro taper…

Is there a consensus about whether that works or doesn’t work?

@Chippy

@LostinCanada

21 minutes ago, Finni said:

Anyone here ever used a micro taper to slowly get out of adverse effects?

I’m not talking about the brass monkey slide. I’m talking about maybe a daily micro taper…

Is there a consensus about whether that works or doesn’t work?

@Chippy

@LostinCanada

I don't see why not. Trying to mitigate withdrawal and lessen the reaction isn't easy and this could help. You did have that little window so I just don't know if you should rock the boat. Look at the member Willy, it has taken him a year to start stabilizing...it is paroxetine but the principle is similar.

You might want to give his story a read on here and SA.

I don’t know what the right answer is @Finni, but personally I went through a long period of trying to make different changes to ease symptoms — and in the end the only thing that has truly helped me, even though the improvement is slight so far, is a long hold. It’s been 3.5 months and counting, and I’m planning to hold for a minimum of 6 months. But admittedly I don’t think I’m experiencing any sort of paradoxical reaction.

Have you heard of the coach Chris Paige? His view is that some paradoxical reactions are a result of a previously destabilized nervous system and the best course of action is actually to hold for a long time:

I’m not trying to sway you one way or another, I just want to make sure you have all the info before making a decision 💜.

@LostinCanada

Yesterday was very, very frightening the amount of the cold turkey withdrawal feeling and akasthisia. Electricity felt like it was shooting through the center of my brain at its worst

Now I am seeing that what I describe as the floaty disconnected feeling, sometimes nauseated feeling I think it’s just another adverse reaction.

Today it’s particularly pronounced. It almost feels like I should be hanging onto something when I walk.

Very weird and spongy and disconnected with electricity at the same time. Burning eyes, electric pain in back and breast tissue coming and going. Aching legs.

So I’m on this alternating pattern of what feels like just different adverse reactions in varying degrees.

Still, I wonder about the days when things aren’t as extreme and I’m having those dirty windows…

The vestibular issues are still there. The electricity is still there. The pounding is still there. It’s just I’m able to cope better.

I’ll check out Willy.

Edited July 18Jul 18 by Finni

20 minutes ago, SarahMc said:

I don’t know what the right answer is @Finni, but personally I went through a long period of trying to make different changes to ease symptoms — and in the end the only thing that has truly helped me, even though the improvement is slight so far, is a long hold. It’s been 3.5 months and counting, and I’m planning to hold for a minimum of 6 months. But admittedly I don’t think I’m experiencing any sort of paradoxical reaction.

Have you heard of the coach Chris Paige? His view is that some paradoxical reactions are a result of a previously destabilized nervous system and the best course of action is actually to hold for a long time:

I’m not trying to sway you one way or another, I just want to make sure you have all the info before making a decision 💜.

Thank you, Sarah! ❤️

Does anyone know if this person is on this forum?

8 minutes ago, Finni said:

Does anyone know if this person is on this forum?

Shep stepped away from SA and is not on here. She is amazing.

The problem with your individual case is all the drugs prior and possible withdrawal still happening from them.

The most important factor is how you feel within an hour of taking it. I know you are on the fence and no one can tell you the right answer because you will have withdrawal from mirt even if you are having an adverse reaction whether tapering or stopping completely.

@Willy

1 minute ago, LostinCanada said:

Shep stepped away from SA and is not on here. She is amazing.

The problem with your individual case is all the drugs prior and possible withdrawal still happening from them.

The most important factor is how you feel within an hour of taking it. I know you are on the fence and no one can tell you the right answer because you will have withdrawal from mirt even if you are having an adverse reaction whether tapering or stopping completely.

To make things even more confusing, sometimes big activation doesn’t happen until around 2 hours after dose now…

Except the dizziness/ vestibular symptoms always ramp up within 30 minutes

Do you know what happened to “Sotanna” the one Shep was replying to?

Just now, Finni said:

@Willy

To make things even more confusing, sometimes big activation doesn’t happen until around 2 hours after dose now…

Except the dizziness/ vestibular symptoms always ramp up within 30 minutes

Do you know what happened to “Sotanna” the one Shep was replying to?

Sottana jumped off the paroxetine at 6 mg in 2022 and is still going through hell on the last SA updates.

The thing is, if you can taper off at 10% through an adverse reaction, that is better than a full jump. His jump and withdrawal was worse than what he thought his reaction was.

Also if 10% gives you more than you can handle, a cold turkey will be harder.

4 minutes ago, LostinCanada said:

Sottana jumped off the paroxetine at 6 mg in 2022 and is still going through hell on the last SA updates.

The thing is, if you can taper off at 10% through an adverse reaction, that is better than a full jump. His jump and withdrawal was worse than what he thought his reaction was.

Also if 10% gives you more than you can handle, a cold turkey will be harder.

Oh, geez Louise. 😔

1 minute ago, Finni said:

Oh, geez Louise. 😔

None of us would have willingly signed up for this hell if we knew.

Just now, LostinCanada said:

None of us would have willingly signed up for this hell if we knew.

We had no idea what was possible!

2 hours ago, SarahMc said:

I don’t know what the right answer is @Finni, but personally I went through a long period of trying to make different changes to ease symptoms — and in the end the only thing that has truly helped me, even though the improvement is slight so far, is a long hold. It’s been 3.5 months and counting, and I’m planning to hold for a minimum of 6 months. But admittedly I don’t think I’m experiencing any sort of paradoxical reaction.

Have you heard of the coach Chris Paige? His view is that some paradoxical reactions are a result of a previously destabilized nervous system and the best course of action is actually to hold for a long time:

I’m not trying to sway you one way or another, I just want to make sure you have all the info before making a decision 💜.

Great interview!

It seems to me that a feeling of not having taken AD would be a big sign of tolerance developing. For weeks and weeks and weeks now.

Am I right?

@chippy

@LostinCanada

I’m still on an every other day “cold turkey” pattern that feels like it’s just getting worse.

I’m trying to be incredibly incredibly cautious before I do anything. I talk to Angie Peacock again tomorrow.

P.s. I know it probably doesn’t mean anything, but when I first started the run of 15 mg tablets that all weighed .1026 g (my target pill weight) naturally, the extremes weren’t as extreme.

I’m still on the same run of those tablets, but I’m right back where I was. I think I have one more.

Edited July 19Jul 19 by Finni

Hey @Finni - I found Sottana on BB - he is still not in a good way : 44 months out

4 minutes ago, SpiroC said:

Hey @Finni - I found Sottana on BB - he is still not in a good way : 44 months out

Thank you ❤️

Bless him. I’ll try to contact.

2 hours ago, Finni said:

seems to me that a feeling of not having taken AD would be a big sign of tolerance developing. For weeks and weeks and weeks now.

Am I right?

I think you are right.... unfortunately you body still is dependent despite tolerance.

I asked ChatGPT to write up my case as a resident physician would when presenting at Grand Rounds…

Clinical Case Summary

Patient: 57-year-old woman with a history of extreme medication sensitivity, prolonged benzodiazepine withdrawal, chronic vestibular disorder (MdDS/vestibular migraine), central sensitization, and previous serotonin syndrome.

History

The patient tolerated mirtazapine 7.5 mg nightly for approximately six years. Following discontinuation of diazepam, the dose was increased to 15 mg in late 2024. She has consistently reported marked sensitivity to medication changes throughout her treatment history. Mirtazapine was increased again to 22.5 mg in December 2025; subsequently, she suffered extreme activation and began lowering the dose back down to 15 mg over the course of two months.

Previous medication history includes:

• Severe and prolonged diazepam withdrawal.

• Significant withdrawal phenomena after discontinuation of Depakote.

• Paradoxical or poorly tolerated responses to multiple psychotropic medications, including hydroxyzine, propranolol, gabapentin, Seroquel XR, and olanzapine.

• CYP2C19 and CYP2D6 poor metabolizer status on pharmacogenomic testing.

Current Clinical Problem

Approximately seven weeks ago, following a medication timing disruption, the patient entered a prolonged period of severe autonomic and neurologic activation. Symptoms have persisted despite maintaining essentially the same nightly mirtazapine dose.

Primary symptoms include:

• Intense generalized internal “electricity.”

• Severe solar plexus pain and autonomic distress.

• Deep pressure involving the head, torso, and back.

• Vestibular symptoms including rocking, bouncing, and internal motion sensations.

• Burning sensations involving the pelvis, back, and trunk.

• Marked early-morning escalation of symptoms.

• Subjective sensation of “cold turkey” withdrawal despite continued dosing.

• Episodes of profound physical terror that the patient consistently describes as bodily rather than psychological.

The patient reports sleeping approximately 6–7 hours on many nights but often awakens with increasing physical activation that progressively intensifies through the morning.

Temporal Pattern

Symptoms generally worsen:

• Overnight.

• During the early morning hours.

• Through the morning, often peaking late morning or around noon.

The patient also reports periods later in the day during which she feels as though the medication has “worn off.”

Importantly, symptoms fluctuate considerably, with severe waves alternating with partial windows of improvement rather than showing continuous deterioration.

Functional Observations

Despite profound physical symptoms:

• Mood has improved compared with earlier months.

• Episodes of screaming and prolonged emotional dysregulation have substantially decreased.

• Interest in activities has partially returned during better periods.

• The patient consistently differentiates emotional state from physical suffering, describing the distress as overwhelmingly physiologic.

Medication Preparation

Because of extreme dose sensitivity, medication has been prepared using precision weighing techniques.

Methods have included:

• Filing tablets to a target weight.

• Use of intact tablets matching the target weight.

• Transition toward powder preparation following consultation with a compounding pharmacist, who advised that the tablet powder is expected to be uniformly mixed.

The patient has questioned whether preparation method may influence symptom severity but no definitive relationship has been established.

Differential Considerations

Several competing hypotheses remain plausible:

1. Persistent withdrawal-related nervous system dysregulation following prior medication disruptions.

2. Tolerance or interdose instability involving mirtazapine.

3. Adverse activating response to mirtazapine despite stable dosing.

4. Combination of central sensitization with medication-related nervous system instability.

Current clinical observations do not clearly distinguish among these mechanisms.

Features Supporting Withdrawal Physiology

• Similar overnight activation previously occurred during diazepam withdrawal.

• Similar activation occurred during Depakote withdrawal.

• Prominent autonomic symptoms.

• Fluctuating windows and waves.

• Marked morning symptom escalation.

Features Supporting Possible Medication Activation

• History of activation during previous mirtazapine dose increases.

• Symptoms frequently intensify following the nightly dose.

• Reports of feeling simultaneously sedated and physically overstimulated.

Features Arguing Against Simple Abrupt Nightly Withdrawal

• Patient generally sleeps 6–7 hours despite severe symptoms.

• Medication is taken consistently at approximately the same time nightly.

• Symptoms fluctuate rather than showing progressive deterioration between doses.

Current Clinical Question

The principal management dilemma is determining whether the patient’s presentation reflects:

• inadequate receptor occupancy requiring an increase in dose,

• medication-induced activation requiring cautious dose reduction,

• or prolonged nervous system instability in which neither intervention is clearly indicated.

At present, the available history does not conclusively support any single explanation. The clinical picture contains evidence compatible with multiple mechanisms, and further management requires careful weighing of the risks and potential benefits of continued holding, cautious tapering, or dose adjustment in collaboration with the treating clinicians.

If I were presenting this at a case conference, I’d end by saying:

“This is an unusually medication-sensitive patient with competing clinical signals. The major challenge is that the same symptom cluster can be interpreted through more than one pharmacologic mechanism. Management decisions should therefore be based on longitudinal patterns and cautious observation rather than any single day’s symptom severity.”

Well, I need to make a decision

Taper or divide my dose.

Different brands of adverse reactions going on. I’ve emailed Adele Framer but haven’t heard back.

My body has found its rhythm and has a definite pattern of one day feeling like I have not had any mirtazapine and I’m in this cold turkey horrible withdrawal- feeling that comes with a lot of crying and terror..

and then the very next day I feel overmedicated, floaty, tingling, and with bursts of terror.

I wanted to wait long enough to really see if this pattern was established and it does seem to be.

The cold turkey days are getting worse and the floaty days are getting worse.

It seems like @pokey did not have much luck splitting the dose, but I’m not sure if he was having adverse reactions.

Those are my choices. I don’t feel like it’s much of a choice anymore to hold.

Although I keep doing it somehow.

When it’s time to take my dose at night, I’m afraid to rock the boat because at least now I can predict what my days are going to be like.

Edited July 22Jul 22 by Finni

I'm sorry @Finni. I don't have an answer for you, but we're here for you 💜.

Is there any merit in me taking the time to switch over to homemade liquid so that I can taper even slower than what my lab scales can weigh?

@LostinCanada @Chippy

34 minutes ago, Finni said:

Is there any merit in me taking the time to switch over to homemade liquid so that I can taper even slower than what my lab scales can weigh?

@LostinCanada @Chippy

At this point it would mean a lot of liquid and I don't think it would make much difference as far as accuracy. That scale makes a 0.0002g cut which is very small in comparison to your dose at this point.

1 hour ago, LostinCanada said:

At this point it would mean a lot of liquid and I don't think it would make much difference as far as accuracy. That scale makes a 0.0002g cut which is very small in comparison to your dose at this point.

Yes, it’s tiny

It was so surprising when I tried to go down from .1026 g to .1020 g…

My body/brain felt it and reacted strongly.

I’m hopeful that it won’t be so jarring to go from .1026 g to .1024 g

It’s the middle of the night

I felt the cut

Can’t believe this

It’s terrifying

I’m realizing I should not have made any changes because of the stress I’ve been under. When it feels paradoxical, it’s just so hard not to.

My mom fell and broke her hip two days ago and is in the hospital.

Edited July 23Jul 23 by Finni

That was such a tiny change. I think I’ll just pretend like my scale made a mistake or something.