Morning B, Chippy, Svetla et al. I’m pleased to report I got a bit more sleep than usual last night. Makes a world of difference how one feels. But I have no faith it will continue.  That’s one thing I can’t reconcile with this WD business, it’s bad days better days zigging & zagging. It’s not often clear what makes the difference. 
im continuing with taking the 2nd 1/2 of my dose 1/2-1hour later each day until I am taking it at bedtime. Per Horowitz splitting my dose between morning & bedtime should help with eliminating interdose WD sxs due to doxepins 15hr 1/2 life and hopefully I will sleep better.
 I hope you all are having a good day. Keep me posted. 
Pokey 

Morning Pokey afternoon here. 2pm.

 

I hear you bud. I was smashing an 8/10 yesterday and felt great.

 

Today, well it's terrible.

 

And Im crashing as the day goes.

 

As you say, why? No reason at all. Just how it is.

 

I genuinely have never found ANY correlation between anything that makes this better or worse. It just does what it wants and I cant help it. It's sorry frustrating. 

 

Hope your next shift goes ok. Lord knows you deserve a break mate.

 

Chippy

It is a good news, @Pokey449. Your body starts to get used to.

I had a broken sleep cut by the endless adrenaline rushes. I hate them, they haven't left me alone for a year now, it is a torture..

Svetla 

22 hours ago, Pokey449 said:

Ones overall health is impacted from these poisons.  I guess all we can do is take the best care of ourselves as we can. For me today that means resting, I’m just to tired today. 

Hi @Pokey449 Thanks, yes you are thinking along the right lines. Get to a comfortable level and stay there.

The older we get, this living hell misery just isn't worth it. I know if the MIRT hadn't made me put a lot of weight

on.....I would have STAYED on it. £25000 gone and counting, and a brain like a cabbage, living like a hermit in

a living hell. WHAT kind of retirement is THAT going to be?????  I will SEE what happens. Take CARE Pokey, take

things slow, and please stay in touch. WE are with you Bud.

All the best,       B.

Morning/Afternoon ( depending on your location) 😁 fellow sufferers of these poisons:

The doctor who reviewed my case a year ago and claimed it would be ok to take low dose doxepin with low dose  mirtazapine should have his license revoked and then be drawn & quartered. 
Further reading about this drug combination has revealed a list of possible negative life debilitating & some potentially life threatening interactions a mile long. I take part of the blame though as I should have done deeper research on the combination. 
Last night I awoke at least 3 times with the same set of symptoms I’ve been getting for sometime. Aside from pain and other physical discomfort my primary concern is that it seems to be suppressing my respiration. I didn’t have them at higher doses. I’m waking up short of breath with my body starved for oxygen. I’m concerned this is only going to get worse as I go lower in dose with the doxepin. Supposedly it becomes more sedating below 25mg. It’s commonly prescribed in doses of 3-6mg for sleep. In short, I’m afraid of dying in my sleep. I’m not sure how to proceed short of stopping CT and I dont think I could tolerate that. 
I may have to talk with Horowitz again as I know for sure none of my local docs have a clue how to deal with any of this. 

2 minutes ago, Pokey449 said:

revoked and then be drawn & quartered. 

Pokey you got me! 🤣🤣🤣🤣 big belly laughs. 
 

2 minutes ago, Pokey449 said:

Further reading about this drug combination has revealed a list of possible negative life debilitating & some potentially life threatening interactions a mile long.

Where did you read them. Best to not maybe just focus on the plan?

 

4 minutes ago, Pokey449 said:

I’m waking up short of breath with my body starved for oxygen. I’m concerned this is only going to get worse as I go lower in dose with the doxepin. Supposedly it becomes more sedating below 25mg. It’s commonly prescribed in doses of 3-6mg for sleep. In short, I’m afraid of dying in my sleep. I’m not sure how to proceed short of stopping CT and I dont think I could tolerate that. 
I may have to talk with Horowitz again as I know for sure none of my local docs have a clue how to deal with any of this. 

I understand your concerns mate. Perhaps a call into Dr H would ease your mind. Wish we knew more about what’s happening with you. But if the doctors don’t know!!!!!

Yes, @Pokey449, stop read on this. Go to the success stories here or on SA.

Svetla 

27 minutes ago, Chippy said:

I understand your concerns mate. Perhaps a call into Dr H would ease your mind. Wish we knew more about what’s happening with you. But if the doctors don’t know!!!!!

@Chippy I’ve emailed his secretary this morning. He has an option for a 10 minute Question/Answer session. I may go that route as I’ve already spent $550 (751 £) on 2 25 minute Zooms with him. He’s on the pricey side. 

20 minutes ago, Pokey449 said:

@Chippy I’ve emailed his secretary this morning. He has an option for a 10 minute Question/Answer session. I may go that route as I’ve already spent $550 (751 £) on 2 25 minute Zooms with him. He’s on the pricey side. 

Sounds good. It adds up doesn’t it 

Hi @Pokey449 sorry you are still suffering Bud, BUT sometimes we have to go THOUGH the bad to get

to the GOOD. Now by all means ask Doc Horowitz, but as you say.....MONEY. You are already clued up more

than most doctors Pokey and you know your own body better than any of them. SLOWLY.....SLOWLY.

Take care Bud,       B.🤞👍

On 2/11/2026 at 7:53 AM, Pokey449 said:

That’s one thing I can’t reconcile with this WD business, it’s bad days better days zigging & zagging. It’s not often clear what makes the difference. 

This is very typical for withdrawal from psych drugs. We call this windows and waves.  

 

Windows and Waves Pattern of Stabilization

 

I'm sorry for the hell you are going through.  I get it - I've been there and done that, and still have some residual protracted WD.  I hope Dr. Horowitz is able to help you again. 

 

Good day everyone.  I put in a request for a 10 min question/answer session with Horowitz. That’s only available if you’ve had a 25 or 50 minute Zoom with him. Which I’ve had two but I can’t afford another. My question to him is pretty straightforward. I’m concerned I’m becoming over sedated with the mirtazapine/doxepin combo especially as I go lower in dose on the doxepin or the part of my brain that regulates respiration is being affected. I think my respiration is being suppressed while sleeping. I’m waking up with a jolt, air starved, groggy, headache and unstable on my feet when I get up. After im awake for a while and do some deep breathing the symptoms wear off. Either I’m being to sedated in my sleep or the drugs are affecting the part of my brain that regulates my breathing. If so that’s some scary S**T!!!! 

21 minutes ago, Pokey449 said:

Good day everyone.  I put in a request for a 10 min question/answer session with Horowitz. That’s only available if you’ve had a 25 or 50 minute Zoom with him. Which I’ve had two but I can’t afford another. My question to him is pretty straightforward. I’m concerned I’m becoming over sedated with the mirtazapine/doxepin combo especially as I go lower in dose on the doxepin or the part of my brain that regulates respiration is being affected. I think my respiration is being suppressed while sleeping. I’m waking up with a jolt, air starved, groggy, headache and unstable on my feet when I get up. After im awake for a while and do some deep breathing the symptoms wear off. Either I’m being to sedated in my sleep or the drugs are affecting the part of my brain that regulates my breathing. If so that’s some scary S**T!!!! 

Hi,

 

Psychiatrist jumping in here. Whilst your symptoms could be autonomic nervous system dysregulation of respiration (withdrawal), I strongly recommend getting a sleep study to rule out obstructive sleep apnoea. It is more common than you think and yes, it can be lethal. If you have OSA your brain will be oxygen starved and that will definirati sliw down healing.

1 hour ago, Pokey449 said:

Either I’m being to sedated in my sleep or the drugs are affecting the part of my brain that regulates my breathing. If so that’s some scary S**T!!!! 

Hi @Pokey449 Sorry to hear of your genuine fears Bud, I hope the chat with Mark eases your mind.

Take care my good man.         B.🤞

1 hour ago, Sminismoni said:

Hi,

 

Psychiatrist jumping in here. Whilst your symptoms could be autonomic nervous system dysregulation of respiration (withdrawal), I strongly recommend getting a sleep study to rule out obstructive sleep apnoea. It is more common than you think and yes, it can be lethal. If you have OSA your brain will be oxygen starved and that will definirati sliw down healing.

 

Good point.

 

Just to add, I'm in touch with people who were diagnosed with it in withdrawal and then recovered from it again.

@Sminismoni I was diagnosed with OSA 12/24 with an AHI of 16 and was put on APAP. I Couldn’t acclimate to APAP and was switched to BIPAP 5/25. Sleep has been getting worse, waking with these scary sxs whether I’m on my PAP or not. If I’m having autonomic dysregulation of respiration will PAP

even successfully treat it? 

My Sleep doc, who I don’t think understands the potential complexity of what I may be dealing with, just  told me the other day to stop PAP for now and that he wanted a Bipap titration study. Thing is my EPAP/IPAP pressures seem relatively stable.  My AHI last night was 5 but I still woke with very troubling sxs after being on PAP. I haven’t stopped PAP 
I think what’s going on is an idiosyncratic reaction between mirtazapine &!doxepin and no one medical person knows what’s going on or how to address it. FYI I’m tapering the doxepin VERY SLOWLY. 
Perplexed & Worried

 

Pokey. 

1 hour ago, Pokey449 said:

@Sminismoni I was diagnosed with OSA 12/24 with an AHI of 16 and was put on APAP. I Couldn’t acclimate to APAP and was switched to BIPAP 5/25. Sleep has been getting worse, waking with these scary sxs whether I’m on my PAP or not. If I’m having autonomic dysregulation of respiration will PAP

even successfully treat it? 

My Sleep doc, who I don’t think understands the potential complexity of what I may be dealing with, just  told me the other day to stop PAP for now and that he wanted a Bipap titration study. Thing is my EPAP/IPAP pressures seem relatively stable.  My AHI last night was 5 but I still woke with very troubling sxs after being on PAP. I haven’t stopped PAP 
I think what’s going on is an idiosyncratic reaction between mirtazapine &!doxepin and no one medical person knows what’s going on or how to address it. FYI I’m tapering the doxepin VERY SLOWLY. 
Perplexed & Worried

 

Pokey. 

Ah well that adds to the picture. I would get the BiPAP titration done, but I think your theory about the doxepin and Mirtazapine stacks up. They are suppressing respiratory drive, and increasing noradrenergic tone, and the BiPAP can't outrun that. 

 

I am so very sorry about this Pokey. I would fly over and adopt you if I could, wave a magic wand and make it all better. I meanwhile have my own issues tonight with increased noradrenergic tone: my melatonin and Vit D tablets have once again gotten "stuck" in my oesophagus thanks to sphincter spasm (noradrenaline mediates this). Fun times when your autonomic nervous system doesn't work. Time to swallow some yoghurt and honey.....

@Sminismoni you said the mirtazapine & doxepin are suppressing respiratory drive and the BIPAP can’t outrun that. If that’s the case how would a BiPAP titration study help? To begin with I have one hell of a time sleeping in a sleep lab all wired up like I’m getting ready for a launch into space. The only sleep studies  I’ve ever had where I actually slept they had to drug me. Once with Valium and once with Ambien. Given my current state & the medication I’m on such drugs are the LAST thing I want in my system. I think they’d just complicate matters worse?????

 

it sounds like what you are saying I’m suffering from drug induced dysautonomia?? If that’s true What if anything can I do about it?? 
 

You’re the first person I’ve conversed with that seems to understand what may actually be happening. My docs here just give me “ I don’t know or taper faster”. No help!!!

11 hours ago, NT1100B said:

Hi @Pokey449 Sorry to hear of your genuine fears Bud, I hope the chat with Mark eases your mind.

Take care my good man.         B.🤞

Second this @Pokey449 you deserve a break from all this soon. 

7 hours ago, Pokey449 said:

Once with Valium and once with Ambien. Given my current state & the medication I’m on such drugs are the LAST thing I want in my system. I think they’d just complicate matters worse?????

100% mate. No more drugs!!!!!

 

 

Morning everyone. I’ve been awake since 3am. I awoke about 1am I think feeling starved for air. I was using my CPAP too. According to @Sminismoni the drugs maybe suppressing my respiration. I don’t get why it is happening now though. This was not occurring earlier in my taper  when I was at a higher dose than I am now. My sleep doc wants me to do another sleep study but I don’t think I can cope with that now.  Anyway I tossed my Cpap mask last night and went back to sleep only to awaken later short of breath again. That was the end of my sleep for the night. The rest of the night was spent tossing and turning due to experiencing a very restless creepy crawly feeling that came and went in waves. A god awful feeling that wouldn’t allow me to rest & sleep. Akathisia-like.  I don’t know where all this is coming from. I slept 6 hrs the night before. I have not decreased my dose for 14 days now. I am in the process of moving my doxepin dose from being taken in the morning at 8:00 to bedtime. I’m only advancing the dose by 1/2 hour each day. So slow & easy. I’m currently at 12noon for taking that dose. 
I truly think what’s going is an idiosyncratic ADR  between the mirtazapine & doxepin & is not tapering sxs. I don’t know if I can survive this. I’m losing the will to want to survive it. I feel awful   I’m 76 and feel like I’m quickly running out of time for having any good days left.  I anticipate it will be at least another year to 18 months to finish the doxepin taper and then fear there will be PWD issues like B is dealing with. Cant imagine being 80 and still dealing with this S**T!!  I fear my good days are running out. 🥲

 

 

14 minutes ago, Pokey449 said:

Morning everyone. I’ve been awake since 3am. I awoke about 1am I think feeling starved for air. I was using my CPAP too. According to @Sminismoni the drugs maybe suppressing my respiration. I don’t get why it is happening now though. This was not occurring earlier in my taper  when I was at a higher dose than I am now. My sleep doc wants me to do another sleep study but I don’t think I can cope with that now.  Anyway I tossed my Cpap mask last night and went back to sleep only to awaken later short of breath again. That was the end of my sleep for the night. The rest of the night was spent tossing and turning due to experiencing a very restless creepy crawly feeling that came and went in waves. A god awful feeling that wouldn’t allow me to rest & sleep. Akathisia-like.  I don’t know where all this is coming from. I slept 6 hrs the night before. I have not decreased my dose for 14 days now. I am in the process of moving my doxepin dose from being taken in the morning at 8:00 to bedtime. I’m only advancing the dose by 1/2 hour each day. So slow & easy. I’m currently at 12noon for taking that dose. 
I truly think what’s going is an idiosyncratic ADR  between the mirtazapine & doxepin & is not tapering sxs. I don’t know if I can survive this. I’m losing the will to want to survive it. I feel awful   I’m 76 and feel like I’m quickly running out of time for having any good days left.  I anticipate it will be at least another year to 18 months to finish the doxepin taper and then fear there will be PWD issues like B is dealing with. Cant imagine being 80 and still dealing with this S**T!!  I fear my good days are running out. 🥲

 

 

Morning Pokey

 

So sorry mate. 
 

I think these are all really good questions to consider. For the minute though I think you just need to keep moving your dose gradually over and then hold at the final dose time for a while to allow your system to try to settle and to see if the split is having the desired effect. Then if things are still rough there are clearly some more avenues to look at here. Also Dr H will be able to answer some of this for you hopefully. 
 

One thing at a time my friend. 
 

I hate how much you’re suffering at the moment and I truly hope you get better nights shortly. All this is a mind field to navigate isn’t it. It’s just not fair. 
 

Chippy

1 hour ago, Pokey449 said:

Morning everyone. I’ve been awake since 3am. I awoke about 1am I think feeling starved for air. I was using my CPAP too. According to @Sminismoni the drugs maybe suppressing my respiration. I don’t get why it is happening now though. This was not occurring earlier in my taper  when I was at a higher dose than I am now. My sleep doc wants me to do another sleep study but I don’t think I can cope with that now.  Anyway I tossed my Cpap mask last night and went back to sleep only to awaken later short of breath again. That was the end of my sleep for the night. The rest of the night was spent tossing and turning due to experiencing a very restless creepy crawly feeling that came and went in waves. A god awful feeling that wouldn’t allow me to rest & sleep. Akathisia-like.  I don’t know where all this is coming from. I slept 6 hrs the night before. I have not decreased my dose for 14 days now. I am in the process of moving my doxepin dose from being taken in the morning at 8:00 to bedtime. I’m only advancing the dose by 1/2 hour each day. So slow & easy. I’m currently at 12noon for taking that dose. 
I truly think what’s going is an idiosyncratic ADR  between the mirtazapine & doxepin & is not tapering sxs. I don’t know if I can survive this. I’m losing the will to want to survive it. I feel awful   I’m 76 and feel like I’m quickly running out of time for having any good days left.  I anticipate it will be at least another year to 18 months to finish the doxepin taper and then fear there will be PWD issues like B is dealing with. Cant imagine being 80 and still dealing with this S**T!!  I fear my good days are running out. 🥲

 

 

Something really important to know about Mirtazapine: it is more sedating at lower doses (paradoxically) The lower you go, the more it is likely to be suppressing your respiratory drive.

 

Edit: The same is true for Doxepin because at lower doses the action of both Doexpin and Mirtazapine is almost pure Histamine receptor blockade. This causes sedation and suppressed respiratory drive. The reason you are not sleeping despite higher sedaive action is because your brain is activating the fight or flight response to the decreased respiratio . Does that make sense? So that also explains why things are worse now at lower doses. Unfortunately I don't think you can stabilise this symptom by holding a taper, because it is a function of the drug itself, not WD. Hope that makes sense.

 

Happy for you to run my theory past Dr H. It's just my best guess.

Edited February 14Feb 14 by Sminismoni

@Sminismoni you are describing what sounds like could be a very worrisome problematic scenario. Let me try to state/ask things one step at a time. I’m pretty shaky today

1) I’m not tapering the mirtazapine, only the doxepin but based on what you described that won’t mske any difference. Sxs will get worse as I decrease the doxepin?

2) I asked Horowitz if I would become more sedated as I lowered the doxepin closer to the low dose 7.5mg of mirtazapine that I’m on. He said no as I recall. But how it would impact respiration was not an issue for discussion at the time. 
3) I do feel like things have been slowly getting progressively worse and more difficult to manage with my tapering lower. Seems it explains why my CPAP has gotten less effective too. 

4) it sounds like sxs ( sleep, respiration, restlessness etc) will not improve or will get worse with continued tapering of the doxepin. I don’t think I can survive that! I’m barely hanging on today 

5) I was at 50mg of doxepin when I started my taper. I was doing ok at approximately 50-35mg I think ?? Would it make sense to go back up on the doxepin and taper the mirtazapine instead?? I hate to do that, a year wasted but what I’m experiencing now is not sustainable. And it doesn’t sound like it’s going to get better. 
 

My local psych provider has no clue as to why I’m having so much trouble. He just is ok with a slow taper.Thats all he knows to do. My CPAP doc no clue either. 

Horowitz has no Zoom appointments available for another two weeks. But I do  have a 10minute email/voice appt with him Thursday.  
 

Thanks for your input. It all makes sense with what’s been happening. But im

scared of what it all may mean for going forward. I’m really angry at myself for allowing this to happen 

 

 

@NT1100B @ChippyWell after hearing what Sminismoni explained to me yesterday it’s appears I may have spent the last 10 months tapering Doxepin to no avail. The pattern of my symptoms and how they have progressed fits like a glove with his explanation of the situation. The lower I go on the doxepin in combination with the stable low dose of mirtazapine that I’m on my symptoms seem to be getting worse & worse. My sleep and apnea have worsened. Last night I could not use my BIPAP hardly at all. I awoke twice with obvious shortness of breath, headache, pain  and malaise. My breathing was definitely OFF!! Hard to sleep if you can’t breathe. 
I’m not going to change anything until I run this by Horowitz but it’s looking like my only solution is to reinstate doxepin to my original dose and then taper off the mirtazapine which I should have probably done in the first place. My current psych provider has no clue about any of this, despite being a nice caring guy. 
My sleep doc wants to do a repeat sleep study because of all the troubles I’ve been having with my BIPAP but I think that’s likely a waste of time until I can correct the current situation.  What a F’ing mess!!!!!!!😤