41 minutes ago, Pokey449 said:

That it’s “typically easy to get off an AD in a few weeks” 😤

😂😂😂😂😂 wow. Wow wee Pokey! I had to laugh or I’d cry. Drives me mad. 🤬

 

43 minutes ago, Pokey449 said:

So I’ll have a prepared list of questions so I’m optimizing my time with Horowitz. He’s a personable guy, I think very smart and knows the subject matter well. If you can afford it I think a session with Jim Svetla would be worth your $$ and time 

Pokey

It’s more art than science a lot of this. I think his best judgement is still invaluable. I’ll be keen to hear what he has to say. 
 

 

14 hours ago, Pokey449 said:

Morning folks. Last night was another night of waking in the wee hours with very uncomfortable sxs.  I tend to think I’m having symptoms from an adverse drug reaction(s) to the doxepin in combination with the mirtazapine. I think it’s making my sleep apnea worse for one in some way. Perhaps suppressing my respiration. Other sxs include headaches, nausea,?what I call Akathisia  and pain. But after I get up and have breakfast & move around a bit the sxs dissipates. I don’t think WD sxs would go away that easily??? Will be interested in how Horowitz sees that. Most interested in his advice as to what to do next. I don’t think I can keep this misery up. It’s killing me 

Wishing you a better sleep tonight mate. And as I said before I look forward to DrHs thoughts on all this. 

Yes, these are important questions and we all hope for you that a good solution will be found. Have a good night, @Pokey449 you will  be in my prayer. ❤️‍🩹

Thank you @Nemina 🙏🙏🙏

Good morning Pokey. How are you today? I see that you’ve got your questions ready for Dr Horowitz. I really do hope that he has some answers for you. Please keep us updated on the outcome of the meeting. 
 

Thinking of you. 
 

Nick 

@NT1100B @Chippy @Nemina @Sminismoni @skamen @NBJ71  i just finished my Zoom with Horowitz. He had no magic bullet for me. He was pretty much cut n dried about it, albeit very polite. 
Becsuse this is not my first taper he said the reason im having so much trouble is because I’m suffering from the kindling affect. Given my age, not my first taper and kindling affect is why this taper is so much more difficult & painful for me. My options boil down to hold at the dose I’m at until symptoms abate or go back up 0.5mg and hope that helps and hold there until i stabilize. I’m going to hold where I’m at and hope relief comes soon. I told him given this taper has been so painful I’m thinking that once I get to 25mg I may just stop tapering and remain there the  rest of my life. Given the way things have been going I don’t want to spend the next 2 years, or maybe more, going through this hellish agony on a daily basis. Life is to short now to be going through this hell on a daily basis. He thought given my age that was not an unreasonable thing to consider. 
So no quick easy door out of this. Only Slow and easy, slow and easy. 

Hey Pokey

 

I suspected he might say something along these lines. For what it’s worth I think he’s right. In fact I think this is what many suffer with. A dysfunctional nervous system caused by a history of drugs and tapers making things ever more complex. 
 

Yeah I think a hold is a good idea. Your systems been through enough changes. I did wonder if an updose may help but it’s hard to know. It can take a long time for things to settle. And they can only do that if they are left alone. More changes means more disruption often. 
 

I also agree it’s not unreasonable for you and I take that view. If you can get confortable that’s the main thing.
 

Sorry mate wish there were quick solutions but as you said. Slow and easy. 

4 hours ago, Pokey449 said:

So no quick easy door out of this. Only Slow and easy, slow and easy. 

Hi @Pokey449 Sorry about that Bud. I think it may be why I am having trouble as well Pokey

too many different drugs. So massive amounts of patience needed, and as you say Bud slow

and easy, but like you say, hold until you are stable and comfortable, and just stay at that if it works.

We are with you all the way, take care,     B.🤞

Feeling awful today. Sick even. Awoke very early. Couldn’t breathe adequately. Had to take off my Cpap mask and deep breathe. Restlessness really bad. Akathisia I guess, really bad.  Literally feel sick. Don’t know if I agree with Dr. H’s assessment of what’s going on. He suggested I updose by 0.5mg.  I’ll try that and hope it helps. Don’t think I’ll be here much today. Can hardly get out of my recliner. You all take care. 
Pokey 

31 minutes ago, Pokey449 said:

Feeling awful today. Sick even. Awoke very early. Couldn’t breathe adequately. Had to take off my Cpap mask and deep breathe. Restlessness really bad. Akathisia I guess, really bad.  Literally feel sick. Don’t know if I agree with Dr. H’s assessment of what’s going on. He suggested I updose by 0.5mg.  I’ll try that and hope it helps. Don’t think I’ll be here much today. Can hardly get out of my recliner. You all take care. 
Pokey 

So sorry Pokey

 

Hope the up dose helps. No more changes after that though I dont think. Lord knows your system needs some stability now. I do wonder if a little up dose will help though.

 

Hope you feel better soon mate.

Chippy :You mean you’re skeptical if an updose will help ???  I’m skeptical it will. I held my dose of 30mg for 65 days, 29.5 for 10 days and my current dose of 29mg is now at day 23. So I’m not rushing and still feeling rotten/awful/terrible & not sleeping much.

I’ll be upfront and admit to having some thoughts of a final solution. Its at a level at times that’s  more misery than any human being should have to bear

1 minute ago, Pokey449 said:

Chippy :You mean you’re skeptical if an updose will help ???  I’m skeptical it will. I held my dose of 30mg for 65 days, 29.5 for 10 days and my current dose of 29mg is now at day 23. So I’m not rushing and still feeling rotten/awful/terrible & not sleeping much.

I’ll be upfront and admit to having some thoughts of a final solution. Its at a level at times that’s  more misery than any human being should have to bear

I actually wonder if it might but Im not sure at all which is why I havent said. I know I bang the stability drum but I think it is important. Dont forget you split your dose and that may be destabilising too. I think that is what you need a hold for to let you system deal with the split. Are you taking the second half when you want it?

 

You dont need to think on those lines mate. We are all long time gone bud, we may as well fight whilst we are here. Things can easily improve with some time.

 

If you try the updose then just sit there for some time and see if things settle down. They will eventually just can take a long time. Brains always fighting on your behalf.

I take the first 1/2 of my dose at 8am and the 2nd  1/2 at 12noon. That is as far as I’ve got. I think it best to leave that second 1/2 dose time as is as I think you imply????.  Do the up dose and wait it out in hopes of stability & elimination of symptoms???

 

2 minutes ago, Pokey449 said:

I take the first 1/2 of my dose at 8am and the 2nd  1/2 at 12noon. That is as far as I’ve got. I think it best to leave that second 1/2 dose time as is as I think you imply????.  Do the up dose and wait it out in hopes of stability & elimination of symptoms???

 

Yeah leave it at Midday, It is doing some spreading of the dose for you just not quite what you were aiming for.

 

Your call on the up dose mate, but either way Hold Hold Hold after that. Wish I could fix it all for you. You're a great guy and don't deserve any of this.

Horowitz told me to updose 0.5mg. The liquid doxepin that I have is in a concentration of 10mg/ml. To get 0.5mg that means I need to measure 0.05ml of the liquid doxepin. I dont have anything that will measure that small of a volume accurately. I need a lab pipet for that. So I think my choice is either updose 1mg which I can measure or hold where I’m at. Any thoughts one way or another. 

1 minute ago, Pokey449 said:

Horowitz told me to updose 0.5mg. The liquid doxepin that I have is in a concentration of 10mg/ml. To get 0.5mg that means I need to measure 0.05ml of the liquid doxepin. I dont have anything that will measure that small of a volume accurately. I need a lab pipet for that. So I think my choice is either updose 1mg which I can measure or hold where I’m at. Any thoughts one way or another. 

I’d hold rather than updose that much. 
 

But read this for help diluting down the stock liquid. 
 

https://antidepressantrecovery.org/topic/251-using-manufactured-liquid antidepressants/

Oh @Pokey449 I am so sorry. This is really hard. Maybe going up with the dose will help you with breathing at night and I think this is nOw very important. You seem to be oxygen deprived in your sleep. This is not good for your brain and for the rest of your body. And , of course, it feels awful.

Tapering is a means for a better life not the goal in itself. The goal is to have quality of life. So maybe in your case going upward is the right direction. Maybe you feel better soon with the updose, I really hope that for you.❤️ 

 

 

@Nemina thanks Nemina. When I reflect back how I’ve been doing from where I started to where I’m at now with this taper I think my breathing/oxygen levels at night have been getting worse. I think the medication is affecting my night time respiration despite what I was told yesterday. Problem is I dont know what to do about it. I can’t just stop the medication. 
@Chippy I have syringe that can accurately measure 0.6ml of the liquid doxepin. That would = 0.6mg.  I don’t think 1/10 milligram difference will be that big of a deal???

7 minutes ago, Pokey449 said:

@Nemina thanks Nemina. When I reflect back how I’ve been doing from where I started to where I’m at now with this taper I think my breathing/oxygen levels at night have been getting worse. I think the medication is affecting my night time respiration despite what I was told yesterday. Problem is I dont know what to do about it. I can’t just stop the medication. 
@Chippy I have syringe that can accurately measure 0.6ml of the liquid doxepin. That would = 0.6mg.  I don’t think 1/10 milligram difference will be that big of a deal???

Hey mate. I’m sure that will be fine. I hope it goes ok bud. I’ve got it all crossed for you. 

8 minutes ago, Pokey449 said:

Problem is I dont know what to do about it. I can’t just stop the medication. 

No, you definitely cannot do that. As far as I have understood @Sminismoni, the lower doses are the problem. That’s why I think there is hope in updosing  the way Horowitz told you, that it will help at least for now.

Take good care!

On 2/14/2026 at 2:22 PM, Sminismoni said:

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.

This is what I was referring to. 

@Nemina thanks Nemina. When I reflect back how I’ve been doing from where I started to where I’m at now with this taper I think my breathing/oxygen levels at night have been getting worse. I think the medication is affecting my night time respiration despite what I was told yesterday. Problem is I dont know what to do about it. I can’t just stop the medication. 
@Chippy I have syringe that can accurately measure 0.6ml of the liquid doxepin. That would = 0.6mg.  I don’t think 1/10 milligram difference will be that big of a deal???

@Nemina the thing is Dr H  said sminismoni’s postulate about lower doses of both drugs suppressing respiration was incorrect??

Given what I’ve been experiencing on a hands on  daily basis since starting my taper I’m not 100% convinced of that. My sleep & my CPAP therapy have been getting progressively worse the lower I go it has seemed. If something else is happening I don’t what it is, other than withdrawal + kindling. I’m be very worried I may be slowly slipping into a dead end. Hopefully the updose will change my anxiety. 

Hi @Pokey449 I have my 🤞for you Bud, trial & error, but let's hope you improve, slow and gentle

Pokey with tiny change and you will see. Just reading Brassmonkey success thread today, and he was

adamant on holding a LONG time, he said the brain HAS to find stability.

But as I said to Svetla, WE know our own bodies better than anyone. Take it very slow Bud.

Take care,       B.🤞

1 hour ago, Pokey449 said:

My sleep & my CPAP therapy have been getting progressively worse the lower I go it has seemed.

If your sleep is getting worse as you taper down, it may mean you are tapering too fast, and not stabilizing in between dosage reductions.  It would help if you could put the dates and dosages of each dosage reduction from the past several months in your drug signature, so we could see how much and how fast you are tapering. Then, we can advise you accordingly.