Hi Pokey, yes, it is me, Svetla.

I am not good, @Pokey449, my body and my mind  are in terror. My sleep was bad and now my body is in tremor.

I am so sorry for you also. What a nightmare, inhumane suffering.

What will be your questions for Dr Horowitz?

We need to encourage each other to survive.

Svetla

Edited February 3Feb 3 by skamen

Hi @skamen Svetla. I’m going to Ask Horowitz  about possible adverse drug reactions between the 2 drugs I’m on and the timing of dosing of the two meds I take. I take one in the morning, one at bedtime. I think I need to move the one taken in the morning closer to bed time so I can hopefully get a better nights sleep. The question is how to do it without causing unpleasant symptoms. 
i had been taking 7.5mg of mirtazapine for 3 years and i was STUPID and allowed my doc to add doxepin to my daily meds. A HUGE MISTAKE for allowing it to happen but here I am. 
My sleep is a mess!!! Ands it’s wearing me completely out. I really feel if I don’t get it under control I’ll get so run down that my health will give out and I will die. Not to mention it’s so MISERABLE, as you know, living with poor sleep all the time. It’s HELL!!!

On 2/1/2026 at 9:09 AM, Pokey449 said:

Yesterday I went back to my morning dosing routine. Got 7 hours of fractured sleep last night. Not great but I’ll take it.But something very untoward is happening in my sleep even when I get 7 hrs. I wake up multiple times feeling very unwell. Groggy headed. Headache, restless, unsteady on my feet when I get up, sometimes in pain. I thought at first it was poor cpap therapy due to congestion but I get the same symptoms off cpap as well. I think it’s the doxepin having a very negative affect on my brain & body.

It's good you are doing somewhat better.  Please remember, your nervous system was jolted when you split that dose, and that  could take a while to recover from.  

 

On 2/2/2026 at 5:09 AM, Chippy said:

On 2/1/2026 at 9:50 AM, Pokey449 said:

Im not sure why mixing forms makes a difference but there’s a lot I don’t know even at 76 🤣

Im not sure it's a massive issue. I have just heard a few say they had issues when being on both. See what the big man says. When is your appointment?

For many people, it is not a problem to be on part liquid and part solid forms of the drug. 

 

10 hours ago, Pokey449 said:

I cut 1.5% for 10 days and another 1.5% 5 days ago. So 3% in the last 15 days.

I would suggest you stop changing your dose for now.  What your nervous system desperately craves right now is stability!  Since you are currently destabilized, it would be helpful to just stick with the same dose for now, dosing it at the same time of day, in the same way, for a while, to allow your nervous system to stabilize.  

29 minutes ago, Pokey449 said:

I take one in the morning, one at bedtime. I think I need to move the one taken in the morning closer to bed time so I can hopefully get a better nights sleep. The question is how to do it without causing unpleasant symptoms. 

Do it by slowly changing the time you take it by 1 hour each day. Take it one hour later each day, until you are at the time you want it.  

But Horowitz told you, @Pokey449, to do this split of the he drug and you did it... And it is still Hell... At what time do you think your Mirtazapine? I take it at 10 pm, it is usually taken pm time.

Our agony and terror are endless.

Svetla

@getofflex I am 100% in agreement with you on keeping my dose where it’s currently at so I can stabilize but I still want to ask my questions of Horowitz. My psych doc is a really kind, caring and flexible guy. He’s all fine with me doing a slowwww taper but the complications of tapering are beyond his skill set. 

 

 

 

Yes @skamen you are correct about what he told me. He told me to split my doxepin dose 1/2 in the am and 1/2 at bedtime and it was to traumatic to my brain. I want to discuss other options and I especially want to know about how the P450 enzyme that metabolizes mirtazapine & doxepin work and if one is causing the other to be either ineffective or toxic. Hope I made sense 😁 

Hope you get some very deserved rest tonight Svetla. 
 

ps. I take the Mirt at bedtime 

8 hours ago, Pokey449 said:

As I mentioned before I have tapered before  did fine but I’m not sure I will survive this one. 😩

Sorry you are feeling bad @Pokey449 I can empathise with you totally on that one. But when I am bad

I just NEED to be alone, as it's the only way I can do it. When in a horrible state, I just cannot face anyone.

Stay strong Bud, and stay safe.         B.🤞

Hey Bud!

 

Im so sorry for all the suffering recently I know it's been a hell of a time.

 

I just want to reiterate what @getofflex has said.

 

You had a meeting with Dr H and that went really well.

 

He identified you are likley having Interdose WD from Doxepin.

 

To deal with this he suggested you split your current dose which you did.

 

The sudden change in dosing caused issues so you have reduced back to the original dose times so you can stabilise. This might take a little time.

 

I can see from your posts above you are wandering around a little with your thought processes.

 

If you make changes all the time based on new hypothesis your CNS won't like it. You also won't be able to see what is working and what isn't. It's important to be very deliberate.

 

I think a good chat with Dr H tomorrow is great plan.

 

However from where I am standing you basically need to hold here get some stability and then look to split your dose and hour apart and then increase over time until you take the second half at the time you want.

 

10 hours ago, getofflex said:

I would suggest you stop changing your dose for now.  What your nervous system desperately craves right now is stability!  Since you are currently destabilized, it would be helpful to just stick with the same dose for now, dosing it at the same time of day, in the same way, for a while, to allow your nervous system to stabilize.

Please listen to Getofflex this is exactly what you need to do bud. I think Dr H will agree.

 

Hope you get a good nights sleep tonight mate.

 

Chippy

Morning @NT1100B @Chippy  well yet another s**ty nights sleep. Awoke again in the wee hours with the same restless nasty symptoms. I was clearly getting  interdose WD sxs before I tried changing taking my daily doxepin dose 1/2 in the am and the other 1/2 at bedtime. I only did that the one time based on Horowitz’s recommendation and reverted back to taking the full dose in the morning. That’s where I’m at now. I understand the need to hold & stabilize before moving on  The thing is though I will continue, most likely, to get interdose WD sxs in the wee hours waking me up  if I continue to keep taking the full dose in the a.m. How will I know if/when I’m stabilized if I keep having interdose sxs in the wee hours?? Seems like I just have wait a bit and then start taking a 1/2 dose 1 hour later each day or every 2 days until I get the other 1/2 dose at the time I want, such as at 8pm, 12 hours after the morning dose. 
 

Morning/Afternoon here!

 

6 minutes ago, Pokey449 said:

Seems like I just have wait a bit and then start taking a 1/2 dose 1 hour later each day or every 2 days until I get the other 1/2 dose at the time I want, such as at 8pm, 12 hours after the morning dose. 

Basically yes just as you said. You won't be looking for full stability of course as you haven't had that anyway. But to get to the point where you feel your system has had a good chance to find some balance from the disruption of your split attempt and recent dose changes. How long is hard to know. Just have to take it day by day and see. I would think a couple weeks rather than days tbh. But just take it day by day and see how you are. Dr H will have some thoughts on this so good youre speaking with him tomorrow.  

Oh, @Pokey449, I am so sorry for our endless suffering. At least, you have tomorrow an Internet call with Dr Horowitz. Hope he can give you a solution for decrising the ongoing agony... I will wait for the feedback he will give you. So sorry, Pokey. During my nightmare I remember that I am not alone, we all suffer from this horrible poison.

Svetla

 

Just for clarity, so we can understand:

 

What is it that makes you believe that it is interdose withdrawals, and not general instability and symptoms from tapering Doxepin in general?

3 hours ago, Pokey449 said:

Seems like I just have wait a bit and then start taking a 1/2 dose 1 hour later each day or every 2 days until I get the other 1/2 dose at the time I want, such as at 8pm, 12 hours after the morning dose. 

Hi @Pokey449 That sound the like the way to go to me. Dr Horowitz will confirm that or whatever, so I would 

see what he says first. But it really does sound like you have it sussed Pokey. As Chippy says, consistency is key.

Take great care Bud,          B.🤞 

@Luke Doxepin has  a 15-17 hr half life. Which the level in my stay starts to take a dip.  My sleep wrecking sxs hit me  in the wee hours 18-22 hrs after my last dose. Horowitz confirmed when I zoomed with him last week it was very possible I’m having interdose WD sxs and that’s a good reason to split my dose into 1/2 in the am 1/2,at bedtime. 

 

@Luke p.s and yes im currently likely having sxs now as well from general instability.  AND also im wondering about ADR causing some of my sxs as both Doxepin & mirtazapine are metabolized in part by one of the same enzymes which could cause possible issues.All I know is my sxs have been getting progressively worse with time it seems. I think there’s more going on than just run of the mill tapering WD sxs. 

36 minutes ago, Pokey449 said:

All I know is my sxs have been getting progressively worse with time it seems. I think there’s more going on than just run of the mill tapering WD sxs. 

 

 

Are you taking both Doxepin and mirtazapine for sleep?  What times of the day do you take these?  If you take them close to the same time, you might consider gradually spacing them apart by an hour each day. 

 

This is from drugs.com, the drug interaction checker: 

 

Interactions between your drugs

 

Major

doxepin  mirtazapine

Applies to: doxepin, mirtazapine

Using doxepin together with mirtazapine can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should seek immediate medical attention if you experience these symptoms while taking the medications. Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. It is important to tell your doctor about all other medications you use, including vitaminsand herbs. Do not stop using any medications without first talking to your doctor.

 

Here is the link to that report: https://www.drugs.com/interactions-check.php?drug_list=935-0,1640-0

 

 

 

 

 

 

 

Edited February 4Feb 4 by getofflex

The other thing to consider, is you may be having an adverse reaction to one or both of these drugs.  The way to know that, is how to you feel in the 4-5 hours after taking the drugs?  If you feel worse in this time, it's probably an adverse reaction.  You may benefit from doing a daily drugs and symptoms journal.  

 

Keep track of taking your drug, symptoms, eating, sleeping, etc.  Write the time on the left, and describe the event on the right.  Pay attention especially to how you feel before, and then after, you take your drug.  Do this for each 24 hour period.  Look for patterns in your symptoms.  Here is an example: 

 

January 31, 2023

6 AM woke with anxiety

8 am took 2.5 mg lexapro

10 am stomach is upset

10:30 am ate breakfast

11:35 am got a headache, lasted one hour

12:35 ate lunch

4 pm feel a bit better

5 pm took 2.5 mg lexapro

6 pm ate dinner

9:20 pm headache 

10:00 pm took 50 mg Seroquel

10:30 pm feeling dizzy

10:30 pm fell asleep 

2:30 am woke, took 3 mg Ambien

2:45 am fell asleep

4:30 am woke, but got back to sleep 

Edited February 4Feb 4 by getofflex

@getofflex yes serotonin syndrome was considered before I added doxepin to my brain already being on mirtazapine. My psych provider asked an in house psychopharmacologist to look into this. Given I would be on very low doses of both it was ruled out. I followed up on that on my own by asking two pharmacists about it and they ruled it out as well. In turn I wasn’t having any of those symptoms early on when I was on higher dose of doxepin. I really don’t think I’m having serotonin syndrome. Certainly not having it’s more scary sxs. 
BUT I am wondering about ADR due to how the two meds are metabolized by one of the main enzymes that breaks down both meds. Possibly causing one to become toxic. It’s pretty complicated chemistry that I will ask Dr. Horowitz about tomorrow. 
I do feel I’ve been progressively getting worse with time.  Sxs following a repeatable pattern now. Which would imply an ADR   If that is the case the thought of how to deal with that scares me to death. I hope Horowitz has some answers so I can mitigate what’s happening as I’m about totally exhausted. 

6 hours ago, Pokey449 said:

I hope Horowitz has some answers so I can mitigate what’s happening as I’m about totally exhausted. 

Hi @Pokey449 I sincerely hope you get some good answers off Dr Horowitz today. You have suffered

long enough and need to get stable and back to comfortable very soon. Wishing you all the best Bud.

Take care,         B.🤞

@NT1100B @Chippy @skamen @getofflex I just got offline with Dr. Horowitz. the nuts and bolts of what he said:

 

1) since I have a long history of being on/off these kinds of meds I likely have a very sensitive system-kindling may be an issue and is what is making this taper more difficult. I should have know better ( I said that, he didn't)

2) I am NOT likely to be experiencing an ADR now that I am at a lower dose of the doxepin (29mg)since I did not have any such ADR reaction at the higher dose that I started with, 50mg almost a year ago

3) If there was/is any adverse reactions it will be reduced as one goes lower in dose. But he does not think that's what's happening

4) As I go lower in dose in Doxepin I should not become more sedated like I thought I might

5) What's most likely going on with me now, the miserable symptoms that I am getting in the wee hours of the morning, is most likely due to inter-dose tolerance withdrawal between doses since doxepin only has a 15hr. half life. So Im getting a dip in the level of the medication in my system and thus going through a mini-withdrawal between doses

 

His recommendation at this point: start splitting my doxepin dose in 1/2 and move it later 1 hour every 1-2 days until I reach my target time that I want to take the 2nd 1/2 of the dose. Bedtime being the most likely target time. This was not clear when I talked with him last week. I tried splitting the dose in 1/2 last week but I moved the 2nd half to bedtime right away and got hammered :o((

 

So hopefully things will start smoothing out once I split taking my dose in the am & pm. Now I just need to quit kicking myself. Ive been doing that a lot. I should have never allowed doxepin to be added to my daily pill box. I KNEW BETTER but i didnt listen to that more seasoned voice like I should have. The same voice that tells you don't eat that greasy burger or drink that 3rd scotch, and you do it anyway :o/ 

 

Dr. Horowitz isn't cheap but you get a lot of expertise in a short amount of time. If you're really struggling consider a session with him. And he seems like a really nice, caring fellow

 

Pokey

2 hours ago, Pokey449 said:

@NT1100B @Chippy @skamen @getofflex I just got offline with Dr. Horowitz. the nuts and bolts of what he said:

 

1) since I have a long history of being on/off these kinds of meds I likely have a very sensitive system-kindling may be an issue and is what is making this taper more difficult. I should have know better ( I said that, he didn't)

2) I am NOT likely to be experiencing an ADR now that I am at a lower dose of the doxepin (29mg)since I did not have any such ADR reaction at the higher dose that I started with, 50mg almost a year ago

3) If there was/is any adverse reactions it will be reduced as one goes lower in dose. But he does not think that's what's happening

4) As I go lower in dose in Doxepin I should not become more sedated like I thought I might

5) What's most likely going on with me now, the miserable symptoms that I am getting in the wee hours of the morning, is most likely due to inter-dose tolerance withdrawal between doses since doxepin only has a 15hr. half life. So Im getting a dip in the level of the medication in my system and thus going through a mini-withdrawal between doses

 

His recommendation at this point: start splitting my doxepin dose in 1/2 and move it later 1 hour every 1-2 days until I reach my target time that I want to take the 2nd 1/2 of the dose. Bedtime being the most likely target time. This was not clear when I talked with him last week. I tried splitting the dose in 1/2 last week but I moved the 2nd half to bedtime right away and got hammered :o((

 

So hopefully things will start smoothing out once I split taking my dose in the am & pm. Now I just need to quit kicking myself. Ive been doing that a lot. I should have never allowed doxepin to be added to my daily pill box. I KNEW BETTER but i didnt listen to that more seasoned voice like I should have. The same voice that tells you don't eat that greasy burger or drink that 3rd scotch, and you do it anyway :o/ 

 

Dr. Horowitz isn't cheap but you get a lot of expertise in a short amount of time. If you're really struggling consider a session with him. And he seems like a really nice, caring fellow

 

Pokey

Good Pokey. Sounds all sensible to me mate! The one thing I would add is perhaps holding before making your first move with the split dose. Just give your system a chance to calm before tweeking anything. You’ve had a few bumps recently that’s made it all worse haven’t you. 
 

Not sure if you covered that with him. 

28 minutes ago, Pokey449 said:

Dr. Horowitz isn't cheap but you get a lot of expertise in a short amount of time. If you're really struggling consider a session with him. And he seems like a really nice, caring fellow

 

Pokey

Spot on @Pokey449 You now have a plan my good man. Just do it at your own pace, listen to your body

and mind and get comfortable mate.

Take care,        B.🙏🤞👍

@Chippy Horowitz told me no need to wait to start splitting the dose, but can if I want to. I may wait another day or two to start the split. Feeling much better today. 

4 minutes ago, Pokey449 said:

@Chippy Horowitz told me no need to wait to start splitting the dose, but can if I want to. I may wait another day or two to start the split. Feeling much better today. 

Great mate. Glad you covered that with him. Good job bud! Yeah do what you think is best nice and gentle. At least it’s only an hour now. Not race to nice the times. Ease it over. 👍