Pokey, you said Horowitz doesn't see your mirt and doxepin as an issue? What could you do differently right now if it is a problem? I was just looking online. I don't know your history well enough to know how well your tapering is going, but I'm concerned for you. Soldier on, friend. 😌🌻

Taking mirtazapine with doxepin can be done under careful medical supervision, but it carries risks such as serotonin syndrome and additive sedation.

Key RisksSerotonin Syndrome: Combining mirtazapine with doxepin may increase the risk of serotonin syndrome, a rare but potentially life-threatening condition. Symptoms include confusion, agitation, hallucinations, tremor, muscle rigidity, shivering, fever, rapid heart rate, excessive sweating, nausea, vomiting, diarrhea, and in severe cases, coma or death. Immediate medical attention is required if these symptoms occur while taking both medications. 

 

Additive Sedation: Both drugs have sedative properties, and their combination can lead to excessive drowsiness, particularly in elderly patients or those with other medical conditions. Monitoring for sedation and adjusting doses accordingly is essential. 

 

www.droracle.ai

11 hours ago, Pokey449 said:

maybe its just due to not being stable yet which I hope

Hey mate. That’s it bud. Hang onto that thought. Hoping for some stability soon for you. Good you’ve been getting some sleep. It all helps with the healing process even if sometimes we feel the sleep isn’t good enough. The body knows what it’s doing. 

morning @Chippy I got another night of about 6-6.5hrs of sleep. Hard to know for sure as my iPhone was dedicated to using an app last night for doing the sleep study I’ve been talking about. I managed to get that sleep study completed last night. I should have results back in 2-3 days. I think it will be telling.  
I think @gardengirl2 you “hit the nail on the head” with what’s going on in my sleep that’s in addition to WD. I feel like I slept pretty deeply last night but I woke up twice in physical distress. Pain,headache, very groggy. I’m fairly confident that the doxepin on top of the mirtazapine is a bit to sedating as you suggest & making my sleep apnea worse. Depressing my respiration. I say this because I awaken with sxs common to sleep apnea. Now that I think I’m in the early stages of a window it’s easier to see such sxs more clearly now as the WD sxs abate. A window relieves  the WD sxs while allowing sxs due to other causes to float to the surface if that makes any sense. 
If my sleep study reveals worsened apnea then I’ll have to deal with that outside of withdrawal from the doxepin. Not sure how because doxepin in the lower dose range is more sedating as is mirtazapine & I can’t taper 2 drugs at the same time. 
I have signed up for another session with Horowitz to get his take on the problem. But I’m pissed. My psych providers in all their wisdom 🤔🤨 should have seen this coming. 

 

 

49 minutes ago, Pokey449 said:

morning @Chippy I got another night of about 6-6.5hrs of sleep. Hard to know for sure as my iPhone was dedicated to using an app last night for doing the sleep study I’ve been talking about. I managed to get that sleep study completed last night. I should have results back in 2-3 days. I think it will be telling.  
I think @gardengirl2 you “hit the nail on the head” with what’s going on in my sleep that’s in addition to WD. I feel like I slept pretty deeply last night but I woke up twice in physical distress. Pain,headache, very groggy. I’m fairly confident that the doxepin on top of the mirtazapine is a bit to sedating as you suggest & making my sleep apnea worse. Depressing my respiration. I say this because I awaken with sxs common to sleep apnea. Now that I think I’m in the early stages of a window it’s easier to see such sxs more clearly now as the WD sxs abate. A window relieves  the WD sxs while allowing sxs due to other causes to float to the surface if that makes any sense. 
If my sleep study reveals worsened apnea then I’ll have to deal with that outside of withdrawal from the doxepin. Not sure how because doxepin in the lower dose range is more sedating as is mirtazapine & I can’t taper 2 drugs at the same time. 
I have signed up for another session with Horowitz to get his take on the problem. But I’m pissed. My psych providers in all their wisdom 🤔🤨 should have seen this coming. 

 

 

Hey mate

 

im pleased to see you are looking a bit better on the stability front. 
 

That is what you need now more than anything. 
 

It is possible to taper 2 drugs at the same time. The best way to do it is to be nice and stable and get one going well at first without issues before adding in the second. Of course you could do them at a slow rate. You never have to taper at 10%. Just a small amount on one. Be ok with the reduction. Then add just a small amount of the other. 
 

Or you could taper one, one month. Then the other the next. Can always pop a hold of some sort in the gap. And repeat.
 

Lots of ways to think about it. 
 

But. Stable. First. 
 

In terms of other issues, I’m not a doctor so I’m not sure what to say about non taper issues. If the answer is to taper one of or both drugs then regardless of the medical issues you don’t want to taper unstable. Unless it’s life threatening or something. Or a sensible assessment against the risk of the adverse effects vs wd symptoms. But you saw what trying to mess with your dose too much can do whilst not stable. Not good. 
 

Let’s see what the sleep study says. Be interested to see Dr Hs take on it all. 

Good for you for taking care of your sleep study. I know that took some doing. Yes, we'll be waiting with bated breath to see what the study shows and if Horowitz has any thoughts. I'm so glad you're able to get some sleep. Keep up the good fight, Pokey. You're doing it. 👍

@Chippy @gardengirl2 well I got my sleep study report. Nothing in it that points a finger at what is making me wake up feeling so rotten at night & early am  unless it’s my heart rate while sleeping. It went as low as 35 but averaged 58. A question for my cardiologist. I don’t recall my HR ever going that low. 
My apnea hypopnea index (AHI) actually went down indicating I only have mild apnea. O2 saturation was OK too. Snore level at the lowest dB most of the night. I’m wondering if I truly need CPAP. 

I shared my sleeping difficulties and how miserable my symptoms are at night with my primary care doctor this morning. His recommendation: either up my mirtazapine to 15mg or try Cymbalta😱🤔😩☠️ I said I would talk with my psych doc about that ……..I have NO INTENTION of doing that of course. 
So I’m still at square one trying to figure out what’s making me feel so miserable when I wake in the night. The reason I don’t think it’s WD sxs is because soon after getting up & having breakfast the really troublesome sxs seem to evaporate although I’m often still very tired. 

@Pokey449 that bradycardia down to 35 definitely deserves a cardiology review sooner rather than later. Glad the sleep study showed only mild OSA. So tricky to know what is going on. Withdrawal can affect all kinds of autonomic functions of course, including heart rate and blood pressure. Sorry this is scary for you. I can only imagine how frightening it is to go to sleep each night. But you are a survivor and the human body is tough. All those stories of endurance, people getting trapped on cliff tops, lost in jungles and deserts, slipping into icy lakes etc. The human body can survive a lot, just remember that. 

Pokey, I totally agree with @Sminismoni. A heart rate of 35 is extraordinarily low, even for super athletes. When will you see your cardiologist next?

And hallelujah on your seemingly improving apnea. Now let's get that translated into some quality sleep for you. 

xxoo Jamie

8 hours ago, Pokey449 said:

His recommendation: either up my mirtazapine to 15mg or try Cymbalta😱🤔😩☠️ I said I would talk with my psych doc about that ……..I have NO INTENTION of doing that of course. 

😱 🙀 🫨
 

8 hours ago, Pokey449 said:

So I’m still at square one trying to figure out what’s making me feel so miserable when I wake in the night. The reason I don’t think it’s WD sxs is because soon after getting up & having breakfast the really troublesome sxs seem to evaporate although I’m often still very tired. 

Hard to know pokey. I suspect it all is. Dr h says. Can have 5 symptoms and 5 causes but it’s much more like to have just 1 cause. Sleep in wd is the pits mate. We’ve all been there. 
 

Always good to get checked out though. 

Dear @Pokey449, I am so sorry for your difficult nights. And it is incredible, that your general practitioner has no other idea but throwing more of those meds in your system. How crazy is that? Has he listened to what you told him about your withdrawal and about your problems with those meds?? Boy, what system. My son said the other day to me: “seriously mom, if I ever get a disease, I would rather go to some old wise Shaman than to trust myself to this modern medicine system.” I suspect he’s right. (I still would go and have my heart checked, if I was you, this is just a general comment. But then I would research carefully whatever they recommend)

 

@Sminismoni, I love your comparison of our journey with withdrawal to getting lost in a jungle or being trapped on a cliff. 😂 That’s how it feels sometimes, doesn’t it? I just finished a novel about an Antarctic expedition 150 years ago. It’s true.: it is incredible what the human bodies able to survive. And we will be survivors! 
 

 

@Sminismoni @gardengirl2 @Chippy

i am not sure I believe that HR of 35 from my recent sleep study. I wear a smart watch and it records my HR at night and I’m consistently in the mid 50s while sleeping. Maybe it was just a one off. But I’ve contacted my cardiologist about it.
Also I’m not sure why my # of apneas  would go from 16/hr in my sleep study a year ago to 6/hr the other night. Will discuss with my sleep doc. 
But all that aside I keep waking in the night & early a.m. feeling rotten despite getting some sleep. Very hard to describe the sxs. Akathisia is best I can come up with. A terrible creepy crawly feeling that causes me to draw my body up into a ball. Sometimes with nausea   Groggy, headache, unsteady on my feet. Fatigue. Feel ROTTEN. But sxs usually improve once I finally get up.  Exhausting!!  I fear I’m going to die from all this. Sometimes wish I would🫩

Hard to plan or do anything. I’m hoping to make a trip to see my family soon but I’m hesitant to make plans, book a flight not knowing from one day to the next if I’ll feel capable of going and then once being there if I’ll be fit to be around. This misery has consumed my life to the point I’m just existing, surviving is all. 

@Nemina  what was the book you just finished about an Antarctica expedition 150 years ago. Was it about the Shackleton expedition? That was quite the survival story. I’ve always wanted to go see Antarctica. I lived in Alaska for 25 years and spent a lot of time in its Arctic regions. Nice to get away from WD stuff here once in a while 😁

1 hour ago, Pokey449 said:

This misery has consumed my life to the point I’m just existing, surviving is all. 

Kinda how I feel most days to some extent, it’s exhausting isn’t it. We will get through this eventually mate. 

1 hour ago, Pokey449 said:

@Nemina  what was the book you just finished about an Antarctica expedition 150 years ago. Was it about the Shackleton expedition? That was quite the survival story. I’ve always wanted to go see Antarctica. I lived in Alaska for 25 years and spent a lot of time in its Arctic regions. Nice to get away from WD stuff here once in a while 😁

Exactly! Shackleton expedition (by the way: 110 years ago, my mistake ). What an incredible story. The book was fantastic. The funny thing is: somebody wrote about it on SA, they had the cover of the book as avatar as an encouraging inspiration. I was interested and got the book (German translation). I loved it. Those guys lost their big ship quite soon in the beginning of the trip. Then they had to return with little boats. The story of how they stranded on some island, crossed the Antarctic Ocean with a tiny boat, and finally had to walk by foot over the last island to find human beings  is just incredible. They had to leave most of the men behind on that empty island. Of course in freezing temperatures. They couldn’t come back to get them for months. Every single man survived.

A truly inspirational story. 
Really, you have lived in Arctic regions? Must be incredible. Have you seen the polar lights? Ice bears? I would love to go there someday.

Edited April 1Apr 1 by Nemina

Oh, by coincident I just found the member with the ship in the avatar! Hello @N2deep, thank you for the great inspiration. I loved the book.

Edited April 1Apr 1 by Nemina

@Nemina  yes I lived in Alaska for 25 years. Spent lots of time working, hunting, fishing, floating rivers & backpacking above the Arctic Circle. Never saw a polar bear but I've seen and been close to many grizzly bears, wolves, caribou, moose and dall sheep. Saw the northern lights (Aurora) many times in the winter. Worked with or for Alaska's indigenous people on environmental health & natural resource issues. My wife and I left Alaska in 2013 to retire as my wife had had it with the long winters. I never wanted to leave. Ive  made my son promise, when the time comes, to take my ashes back to Alaska and place them on the gravel bank of my favorite river where there's a wide view of the White Mountains "for me to look at into eternity".

20 minutes ago, Pokey449 said:

@Nemina  yes I lived in Alaska for 25 years. Spent lots of time working, hunting, fishing, floating rivers & backpacking above the Arctic Circle. Never saw a polar bear but I've seen and been close to many grizzly bears, wolves, caribou, moose and dall sheep. Saw the northern lights (Aurora) many times in the winter. Worked with or for Alaska's indigenous people on environmental health & natural resource issues. My wife and I left Alaska in 2013 to retire as my wife had had it with the long winters. I never wanted to leave. Ive  made my son promise, when the time comes, to take my ashes back to Alaska and place them on the gravel bank of my favorite river where there's a wide view of the White Mountains "for me to look at into eternity".

This sounds like an amazing life Pokey. I’m jealous! 
 

I want the same for me when the time comes. My favourite hill. 

@Nemina - I'm so glad you enjoyed it. It's incredible what humans are capable of when our backs are against a wall.

5 hours ago, Pokey449 said:

@Nemina  yes I lived in Alaska for 25 years. Spent lots of time working, hunting, fishing, floating rivers & backpacking above the Arctic Circle. Never saw a polar bear but I've seen and been close to many grizzly bears, wolves, caribou, moose and dall sheep. Saw the northern lights (Aurora) many times in the winter. Worked with or for Alaska's indigenous people on environmental health & natural resource issues. My wife and I left Alaska in 2013 to retire as my wife had had it with the long winters. I never wanted to leave. Ive  made my son promise, when the time comes, to take my ashes back to Alaska and place them on the gravel bank of my favorite river where there's a wide view of the White Mountains "for me to look at into eternity".

Sounds wonderful. Wild nature.  I’m happy for you for having such special memories.

Well I guess, maybe,I’ve finally opened a window to let “Spring” in. I slept 7 hours last night. Awoke 1x I think and was not in distress or feeling bad like usual. Went back to sleep and managed to utilize my Cpap all night.  Whatever it was/is I’ll take it. Feel like an almost normal human being this morning. 
I got the results of my home sleep study. Nothing shocking to report there. In fact it showed better results than the previous study. Looking at the heart rate graph it shows a total of 2 beats at 35bpm, both widely spaced from each other. I tend to think they are artifact as the rest of the entire night my HR was in the 50s. I shared with my cardiologist and they were not concerned about it. So I’ll quit worrying about that. 
So IF I’m in a window now how long do I stay here before resuming my taper?? 

23 minutes ago, Pokey449 said:

Well I guess, maybe,I’ve finally opened a window to let “Spring” in. I slept 7 hours last night

Fantastic news mate!

 

So pleased 😀 

 

23 minutes ago, Pokey449 said:

So IF I’m in a window now how long do I stay here before resuming my taper?? 

That is a bit of a piece of string. There is no exact number. I’d want you to look nice and stable for a while before you considered it. Weeks not days. Min 6 imo. 

@Chippy are you saying hold

6 weeks before resuming my taper??

10 minutes ago, Pokey449 said:

@Chippy are you saying hold

6 weeks before resuming my taper??

I’m saying see how you go. You want to see some stability for a good while before even thinking about it. Id suggest 6 weeks of stability would be a good guide. 

1 hour ago, Pokey449 said:

Well I guess, maybe,I’ve finally opened a window to let “Spring” in. I slept 7 hours last night. Awoke 1x I think and was not in distress or feeling bad like usual. Went back to sleep and managed to utilize my Cpap all night.  Whatever it was/is I’ll take it. Feel like an almost normal human being this morning. 
I got the results of my home sleep study. Nothing shocking to report there. In fact it showed better results than the previous study. Looking at the heart rate graph it shows a total of 2 beats at 35bpm, both widely spaced from each other. I tend to think they are artifact as the rest of the entire night my HR was in the 50s. I shared with my cardiologist and they were not concerned about it. So I’ll quit worrying about that. 
So IF I’m in a window now how long do I stay here before resuming my taper?? 

Finally a window....great news....

5 hours ago, Pokey449 said:

Well I guess, maybe,I’ve finally opened a window to let “Spring” in. I slept 7 hours last night. Awoke 1x I think and was not in distress or feeling bad like usual. Went back to sleep and managed to utilize my Cpap all night.  Whatever it was/is I’ll take it. Feel like an almost normal human being this morning

Oh, fantastic! I am very happy for you.