Forced to Quit My Antidepressant
May 10, 2015 1:53 PM   Subscribe

After six months of runaround from my sliding-scale clinic after my prescribing physician left the practice, I just found out that my Mertazapine/Remeron prescription will not be refilled. I have six 15mg tablets left. I'm also on Quetiapine/Seroquel which was just refilled. How can I best make it off the Remeron?

I've been uninsured for several years and have been dealing with my psych stuff through a sliding-scale clinic for about the last five. In that time I've seen four med-prescribers come and go. The last one was around just long enough for me to start becoming comfortable with her. In the six months she's been gone, the system has treated me terribly, including lying about putting me on a waiting list that didn't exist. They'd been pretty good about refilling my meds until now. The pharmacist tells me the doctor rejected my refill request as "inappropriate".

Last week, I was able to finally get an appointment set within their system for May 22. In the meantime, my husband's new insurance kicks in and I have an appointment set with my last doc at her new private practice for May 29th. If appropriate, I will be able to get the Remeron again after one of those dates. I am most likely canceling the appointment with the clinic in favor of the private practice.

How do I survive until then?

I've been on Seroquel (a large night dose and two smaller day doses) for about five years. Just got it refilled and the prescription is slightly more pills than necessary for the rare "as needed" dose. Can that as needed dose help Remeron withdraw?

I have been on 15mg of Remeron for sleep and depression for almost year. I found out today that the clinic doc did not approve my refill. I have six pills left. Can I safely start taking half until I run out? Cut them into quarters? (I do have a good pill splitter) I know I don't have enough to titrate properly, so I guess the next best thing is how to do it least uncomfortably? The withdrawal is not dangerous, right?

Yes, I've googled, but sites like Crazy Meds are amping my anxiety with the horror stories. It's Sunday, so neither office is open. The clinic likely won't be any help. I don't know how much help the private practice doc can be before my appointment. She does know me, but will she have access to her records from the old place?

I have experienced cold-turkey Seroquel withdrawal in the past. That was pure hell! Please help me not go through that with the Remeron. I'm already having an anxiety attack over it and I took my full dose last night!
posted by MuChao to Health & Fitness (12 answers total)
Can you ask your gp for a 3 week prescription and then join a membership at Walgreens or cvs? .. Mirtzipine isn't that pricy...
posted by flink at 2:08 PM on May 10, 2015

I withdrew from mirtazapine (15mg) a few years ago by taking one every other day for a few weeks, and then stopping completely. The only withdrawal-related effect I noticed during the transition period was that it was marginally harder to sleep on the nights when I didn't take it, and I could feel a mild but distinct med hangover the mornings after I did take it. No bad effects when I stopped outright, and I think I could have handled stopping outright without the every other day period.

As a disclaimer, though, I don't seem to react to med withdrawals in a particularly normal way - I've stopped SSRIs (fluoxetine, citalopram and setraline, both for reasons of idiocy and for reasons of medical necessity) cold turkey in the past and not really noticed. No brain zaps, no flu-like symptoms, etc.

Depending on how you're doing generally at the moment and how much you're interested in treating your body like a science experiment, you could start by skipping a dose one day, seeing how you feel and then making a call on splitting the rest of the pills.

Considering you're still going to be taking the Seroquel, you'll still have something in your system - I don't know specifics about how the two interact/neurotransmitters etc., but it's possible you won't specifically feel the mirtazapine withdrawal but you will notice the effect of not having it on mood/sleep/whatever you're taking it for.

Do you have anything you can use for anxiety as needed? It's also possible that your anxiety about this going badly could end up worse than the actual withdrawal itself. Really hard to say.

Good luck!
posted by terretu at 2:14 PM on May 10, 2015

Response by poster: I don't currently have a gp. Looking for one, but my last one was within the same hellacious program I've been having problems with. It's an "integrated care" system that can't seem to hold onto practitioners in any of their clinics (I have seen gps, gyns, psychiatric nurse practitioners and therapists through this system). My husband's insurance just kicked in, and I'm looking for physicians in all relevant areas.

I am currently only taking Seroquel and Remeron, so nothing else for anxiety except Sleepy Time tea.
posted by MuChao at 2:20 PM on May 10, 2015

Please call the clinic where the prescriber works who rejected the prescription. Tell them that you only have six pills left and need instructions for a taper.
posted by teamnap at 2:24 PM on May 10, 2015 [11 favorites]

Best answer: From an anonymous commenter:
I gave up mirtazapine cold turkey a couple of months ago and didn't experience any withdrawal effects at all. I had been on 45mg and have experienced withdrawal symptoms (mostly brain zaps) when coming off other antidepressants. In your situation I would probably take your 6 pills 1 every other night for the next 12 nights. That should take you to around your appointment on 22nd and you may be able to get a repeat prescription at that point.
posted by restless_nomad at 2:30 PM on May 10, 2015

Antidepressants' withdrawal, just like their effectiveness, varies by individual, and trust me, it can suck.

It sounds like you're being cut off more for bureaucratic reasons than medical ones. (Your doctor left and the clinic's shrugging.)

It's not as if Mirtazapine is a party drug or anything, so it shouldn't be too hard to get a refill from an emergency room if you just walk in and ask for it. Try that first.
posted by Sys Rq at 2:34 PM on May 10, 2015

Best answer: Sorry that you are going through such a crappy situation with your meds! Here's what I would do:
1) Call the clinic tomorrow, get the pharmacy to call the clinic (if you have a good pharmacist) and explain that you are facing cold turkey withdrawal symptoms and need a short term dose until you see them next (May 22). See what they say.
2) Call your new clinic tomorrow, explain what's going on and ask if you can get an earlier appt, advice etc. Sounds like your old doctor is much more reasonable.
3) How much would your copay be if you went to urgent care or emergency? I have gone to urgent care in the past with my prescription and had no problems getting what I needed (i.e. I need a 20 day refill, seeing a new doctor on the 29th, facing withdrawal).

Also, does your husband's insurance or state have a telehealth line you can call? I've done that before when I lost a bottle of meds on vacation over the weekend and chatted with a lovely pych nurse who suggested a tapering schedule with the pills I did have in my backup stash until I could get into urgent care. She also coordinated with my pharmacist to get me an emergency dose that day for another med that I could not miss without consequence.

Good luck!
posted by snowysoul at 2:54 PM on May 10, 2015

Best answer: It varies a lot. I personally stopped mirtazapine cold turkey with no problems, but had several weeks of hell when stopping trazadone, which most people don't seem to have a problem quitting. I strongly suspect however that the biggest problem you're likely to suffer is difficulty sleeping since you're used to using it. It might be worth asking your pharmacist if it's safe to use benadryl or another OTC sleep aid with the other meds you're on, so you can use that as backup if insomnia gets bad.
posted by metasarah at 3:54 PM on May 10, 2015

Have you reached out to the doc who rejected the refill request to see why they called it inappropriate and to make sure they have the details on your situation? Definitely push back on them before giving up.

If that doesn't work, ask your pharmacist for advice.

Good luck.
posted by bunderful at 4:04 PM on May 10, 2015

If you are seeing the doc who originally wrote the prescription later in the month, could you call and ask that she write a refill for you until you can get in to see her?
posted by goggie at 5:05 PM on May 10, 2015

Have you reached out to the doc who rejected the refill request to see why they called it inappropriate and to make sure they have the details on your situation? Definitely push back on them before giving up.

Yes. This. This JUST happened to me last week and I called and called and used the online messaging system until I could speak to the doctor (in this case either the new doctor who rejected you at your old clinic or the old doctor at her new clinic who you have a future appointment with, try both if one won't help) and it ended up just being a stupid mistake. They fixed it and I avoided withdrawal!
posted by easter queen at 8:23 PM on May 10, 2015

Response by poster: After a typical 45 minutes on hold yesterday, I left a message on the old clinic's nurse line voicemail. Tried again today and was told someone would call me.

In the meantime, I've left a voicemail with the private practice and expect her to call later this afternoon.

I started cutting the pills in half Sunday night and plan on doing that until 3 pills left (six halfs) and take half every other night until they run out. This is the slowest taper I can come up with, after a lot of reading. Does this sound reasonable?

So far, I feel ok. I'm waking up a bit earlier than I'd like, and waking up a little disoriented, but otherwise not noticing any adverse effects. It's only been two nights, though.

Thank you everyone for your patient and compassionate responses!
posted by MuChao at 8:35 AM on May 12, 2015

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