Mental Health Mirtazapine + gabapentin and no more clonazepam

[truenamebrand]

Hi, guys.
So, if you can't talk about this on BL, where can you? This will be a little lengthy so bear with me. I've suffered from depression to varying levels basically my whole life. I've tried countless antidepressants and am vehemently opposed to most classes of them. I'd been self-medicating for years mostly with kratom and occasionally other things as well. Not so much to get high but merely to keep depression away. I'd also had a benzo script for the better part of 14 years.

Anyhow, after not learning my lesson with phenibut the first time I tried supplementing the clonazepam with it once again (tolerance got to absurd levels) and in a matter of days it sent me off the deep end, magnifying my depression to the point of a legitimate suicide attempt. I took about 40 2mg clonazepam, about 30 grams of phenibut, a 750 of vodka, and hung myself with six feet of electrical cord I calmly purchased from Lowe's. The end tied to the tree evidently didn't hold and I spent 14 hours on the ground deep in the woods, eventually coming in and out of consciousness a few times shortly before the search team found me. I spent another 2-3 days trying to regain the ability to walk and talk and the next 10 in the psych ward.

Being totally opposed to most antidepressants I agreed to try mirtazapine. As they weaned me off clonazepam with tiny doses of diazepam and in the first few days lorazepam, I was also given gabapentin. Originally given the gabapentin as an anticonvulsant, the psychiatrist I saw after being discharged thought it would be useful to keep taking for depression and anxiety along with the mirtazapine. (Benzos are no longer an option. Even if a doctor agreed to write me a script after this, I would lose my family if I tried to get back on them.)

So I am now on mirtazapine 30mg and gabapentin 400mg 3x a day. My anxiety has been pretty bad but somewhat manageable thus far. However, I'm looking for input on how effective this combination of drugs might be in the long run when the initial fear of what I experienced, and joy of not being locked up in the psych ward, are both far in the rear view mirror. It would be even better if anyone has experience with this specific combo.

For someone on large benzo doses for almost my entire adult life, this seems like a very small gabapentin dose, but the psychiatrist said for now he doesn't wanna jump higher than that (though he may in the future). I get no recreational effects from gabapentin so that is not a concern. Has anyone gotten noticeable therapeutic benefit from it for anxiety and/or depression? And is it possible at such a low dose? As for the mirtazapine, I have gotten no negative side effects. I haven't even noticed an increase in appetite, which would be a positive for me as I'm 6' 3" tall and weigh about 150 pounds. The side effect element being squared away, what are your opinions/experiences with the drug? To me it sounded like a very benign AD in comparison to most of the other shit they're throwing around these days.

I guess seeing as I can no longer medicate with benzos and I've always had a negative view of antidepressants in general, I'm looking for some positive feedback if there's any to be had.

Thanks for reading.

 

[herbavore]

That sounds like a very horrendous experience and I'm glad you not only survived it but seem to have come through the benzo dependence pretty well. I have no direct experience with either of those drugs except using mirtazapine once for sleep while traveling (worked great for sleep but I still felt high the next day so discountinued).
Hopefully someone with more experience will come along to comment soon.

What non-medication things have you tried in dealing with depression and anxiety?

 

[truenamebrand]

That sounds like a very horrendous experience and I'm glad you not only survived it but seem to have come through the benzo dependence pretty well. I have no direct experience with either of those drugs except using mirtazapine once for sleep while traveling (worked great for sleep but I still felt high the next day so discountinued).
Hopefully someone with more experience will come along to comment soon.

What non-medication things have you tried in dealing with depression and anxiety?

To say it was a horrendous experience would be an understatement. When I briefly regained consciousness the next day, I had no idea what was going on or why I was laying in the woods with something wrapped so tight around my neck I couldn't breathe. I couldn't move or speak, I just tried desperately to yell for help. It was pure and utter terror and agony. Imagine my horror when the next thing I see is a German shepherd coming towards me. It was a search dog, obviously, but I thought for sure I was going to die but I didn't know why. Had I laid there another few hours I probably would have. It's pretty remarkable I survived the benzo/phenibut/alcohol combo I ingested, and didn't end up a vegetable.

People should know, suicide attempts without a gun involved are rarely successful. I wasn't playing games or pulling a cry for help stunt -- and yet here I am. I have some physical limitations that are slowly returning to normal, but otherwise came out of it perfectly fine. I also damn near lost my family as a result of this. This is something I never, ever want to go through again.

As far as non-medication ways to deal with my anxiety... I enjoy fishing and that has always been a sort of mini escape for me. It's something I definitely plan on doing before I go back to work in two weeks. I also used to play basketball with co-workers, but I enjoy doing that even by myself. I've admittedly been pretty lazy recently and that has no doubt contributed to my problems. A conscious effort to engage in some sort of physical activity is a must.

My have practically ruined my relationship with the mother of my child, who I love to death. Depression made me close myself off from her completely. So now as we try and fix our relationship, we're gonna go out and do things, just the two of us. Something we hadn't done in years, and hopefully this will help me individually as well. Breaking up the monotony of my life the past several years in any way will be helpful. That contributed to my problems in a major way.

Even when I've tried antidepressants I didn't view as straight up poison, I think on some level I just told myself it wouldn't help anyway -- and they didn't. Hopefully itll be different this time around.

 

[aihfl]

I take that exact cocktail as part of my bedtime routine, just lesser doses of both: 15mg mirtazapine and 900mg gabapentin. I've been on gabapentin so long I don't know if it's even doing anything anymore but I also know it's not doing any damage either. When I was in treatment the pdoc started me on 7.5mg mirtazapine, but that zombified me. Higher doses of mirtazapine are less sedating but they improve sleep architecture. I also have issues with sleep onset so the 15mg seems to work at both letting me fall asleep and keeping me asleep.

I don't know why antidepressants have such a bad reputation. I believe Celexa saved my life. I resisted going on it and kept telling the pdoc that I didn't think I was depressed and he just asked me to try it and asked if I had ever considered the possibility that I had felt bad for so long that I wasn't really aware of just how bad I felt. It's pretty easy not to drink or abuse drugs if I don't have a reason to self-medicate.

 

[truenamebrand]

^^ I started on 7.5 as well, but since they were also giving me trazadone in the hospital, I couldn't tell if the mirtazapine was actually knocking me out or if it was just the trazadone doing it. Either way I fell asleep no problem, even being weaned off benzos. Also had no problems waking up whatsoever. My internal body clock had me up around 5 every morning.

Now on 30mg, I don't think it's really sedating me much at all. But that's fine, if I have trouble falling asleep at any point, I was given plenty of clonidine.

Antidepressants get a bad reputation because cases such as yours, where one is credited with saving one's life, seem to be incredibly rare. I've discussed this a lot here and get a lot of agreement. SSRIs especially seem to do more harm than good more often than not, and typically if they "work," it's more a case of making one flatline emotionally, rather than truly reversing depression. I've seen it and experienced it plenty in my life. Sure, the depression may be alleviated, but it's only replaced with a profound case of numbness and apathy. This is why I refuse to take such medications and when I have agreed to antidepressants more recently, they have been Wellbutrin and now mirtazapine.

I'm glad Celexa worked for you, but you'd appear to be the exception to the rule.

 

[stiggy]

Thanks for this information. I recently had a severe bout of anxiety and depression (maybe resulting from the anxiety, or vice versa? Hard to tell as with all of these things it seems) that resulted in many sleepless nights that had me on the verge of a complete breakdown. A lot of my anxiety and depression was centered around my girlfriend, who I broke up with. A two week break for me to recover a bit and we're trying to ease back in to things as there was nothing objectively wrong with our relationship and I do adore her. She's a trooper.

ANYWAY! My psychiatrist started me on 7.5mg of mirtazapine and 300mg of gabapentin (as needed). I also take 200mg of lamotrigine, for what I think is misdiagnosed BP2, that I've taken for about 5 years with no side effects. I found that mirtazapine does little for getting me to sleep if I am truly anxious but the gabapentin in conjunction, usually taken after I discover I'm not going to go to sleep, seems to work for me. I did have an occasion a couple of nights ago and maybe right when I started gabapentin where I took them both at the same time and tried to go to bed immediately. I woke up out of half-sleep with weird thoughts of suicide/hopelessness/disorientation that subsided within a few minutes. I don't know if anyone has had that experience with gabapentin? It's certainly not that way any other time I take it, and honestly since I've been dealing with those kinds of thoughts and panic attacks anyway it's just hard for me to separate the ongoing effects of my anxiety and depression from drugs that I'm taking.

This is a new thing that I'm still trying to sort out. I wonder if upping my dose of mirtazapine might be more beneficial for my sleep as aihfl said that their sleep architecture has improved on a 15mg dose. That would be awesome because it seems that when I get really close to the edge it is often when I've been kept up for multiple nights in a row due to my anxiety.

Any more insight would be super welcome!

 

[aihfl]

^ I have not had the problem you describe with gabapentin. I was originally told to take 300mg 3x a day, but it made me weirdly dizzy and it was difficult to function at work, so I take the entire 900mg at night. If I have the luxury of sleeping in the following morning, I also take 75mg of doxepin (another sedating antidepressant), which does not help with sleep onset, but it helps me stay asleep. But taking all three drugs is lights out. If I have to be up early and/or function on a limited amount of sleep, I stick to the gabapentin and mirtazapine only. I have benzos for panic attacks, but use them for sleep only as a last resort because of tolerance/rebound insomnia issues.

 

[mp44god]

I've been taking Mirtazapine 45 mg nightly off-and-on for several years now. Never noticed any effect whatsoever on my anxiety, other than it allowed to sleep which probably helped in some minor indistinguishable way. Make sure you give at least 2 weeks bare minimum before you assess how you feel on it, it makes you feel very lethargic and hungry at first. Gabapentin, on the other hand, is a great anxiolytic imo, but will fuck up your memory/cognition after prolonged use.

 

[cheesenip]

Just checking in, how have you been doing?

About a year ago I completely lost my sanity. It was pure psychosis with racing thoughts, and I couldnt eat or drink anything without having a panic attack and throwing up. I ended up awake for 9 days straight and in a psych ward. At one point I became so psychotic i convinced myself that i was a psychopath who needed to kill myself before i hurt anyone else. Looking back on it now, it was completely ridiculous. At one point, I became familiar with light net research chemical markets and purchased diclazepam and clonazolam, both analogues of valium and klonopin, but 100 and 1000 times more potent respectively. At one point i took the entire bottle, after finishing a fifth of vodka, which would equate to half a thousand pills. I was unconscious for 3 days, but noone noticed. I remember waking up intermittantly, trying to walk and falling on the ground and knocking out. I kept this to myself, but a month later i was put on mirtazapine and low and behold, im on 30mg and I'm completely back to normal. 18 credit hours, a serving job. I still have trouble eating and sleeping often so I am scheduled to begin gabapentin tonight, but mirtazapine was a complete game changer in my life. I used to completely not believe in medicine, but now I genuinely have no intentions of discontinuing it. You would never know that I went through all of that if you met me now. How have your results been now that some time has passed?

 

[truenamebrand]

Just checking in, how have you been doing?

About a year ago I completely lost my sanity. It was pure psychosis with racing thoughts, and I couldnt eat or drink anything without having a panic attack and throwing up. I ended up awake for 9 days straight and in a psych ward. At one point I became so psychotic i convinced myself that i was a psychopath who needed to kill myself before i hurt anyone else. Looking back on it now, it was completely ridiculous. At one point, I became familiar with light net research chemical markets and purchased diclazepam and clonazolam, both analogues of valium and klonopin, but 100 and 1000 times more potent respectively. At one point i took the entire bottle, after finishing a fifth of vodka, which would equate to half a thousand pills. I was unconscious for 3 days, but noone noticed. I remember waking up intermittantly, trying to walk and falling on the ground and knocking out. I kept this to myself, but a month later i was put on mirtazapine and low and behold, im on 30mg and I'm completely back to normal. 18 credit hours, a serving job. I still have trouble eating and sleeping often so I am scheduled to begin gabapentin tonight, but mirtazapine was a complete game changer in my life. I used to completely not believe in medicine, but now I genuinely have no intentions of discontinuing it. You would never know that I went through all of that if you met me now. How have your results been now that some time has passed?

Wow, glad it?s worked so well for you.

I?m actually in the middle of tapering off of it. It just doesn?t seem to be doing anything anymore, and therefore I don?t see any reason to keep taking it. I tried just stopping, and after about 3 days I was a total mess. Horrific anxiety, dizziness, depersonalization... So a few weeks ago I started breaking my 45mg tablets in half. No discomfort thus far. Another week or so and I?m going to break them into quarters.

Also stopped taking the gabapentin, as it too just became useless.

Trying to find a new doctor (one who actually gives a shit what I have to say) so I can perhaps try something else.

 

[osmium]

I too am on a -- more or less -- parallel journey. After being on clonazepam(up to 4.5mg/day) in the late 1990s, I am down to 1mg/day at present.

I am at the cutting point again, and am going to 0.75mg/day starting Sunday(04.29.2018 ) The gabapentin works to alleviate the pain of benzo dose reduction/withdrawal. I was extremely skeptical before my trial of gabapentin, but now, I can tell the following day if I have taken even one less capsule. My mood is somber and I am internally agitated. This manifests itself in me being very curt when others ask even the most innocuous questions. I am downright snappish!

Getting off benzos after long-term therapy can be very difficult. I am hopeful that once my taper is complete that I don't suffer from post-acute-withdrawal syndrome(PAWS). This feeling of hope is new for me. I figured that after this protracted therapy I would be in for lots of symptom rebound that started me on this journey. Thus far, I have had only one issue: tinnitus.

I am certainly no Pollyanna on my best days, so having a positive mindset is a little alien, but quite welcome.

I should note that my overall cognitive levels are likely back to baseline after being dampened for years due to benzo use. These were, of course, prescribed meds.

Unlike you I so not have issues with taking antidepressants of two classes: SSRIs and the novel NaSSA - mirtazapine. I also found the SNRI venlaxafine to really work, but the cost was astronomical as I was precribed it when it was only available as Effexor; and I was between insurers.
I have been tried on many others, but for reasons unknown, they simply didn't work.

Re. Mirtazapine

Mirtazapine does not seems to have an effect on MY depression, but it has two key benefits. The first is that it works as a sleep aid without leaving me feeling sluggish the next day. The second is that it really helps with anxiety.

The thing one needs to watch while on mirtazapine therapy are carbohydrate cravings - which can surpass those of cannabis use. If you give in to the appetite stimulation mirtazapine is widely known for, expect to add weight - quickly.

My current cocktail consists of the following:

Clonazepam: 1mg/day Next week: 0.75mg/day
Mirtazpine: up to 30mg/day
Gabapentin: 300mg t.i.d.(total of 900mg/day)
Sertaline(Zoloft) 25mg/day

I do 1.5hrs./day of moderate cardio work. I find this to help with depression perhaps even more than meds.
A good diet also helps.

Hang in there!

Os

PS. I wrote this post on 04.28.2015, but when I tried posting earlier, the site was unreachable. I have been on 0.75mg/day of clonazepam for two days, and thus far, all is well. I am working with my P-doc and have a new gabapentin script for 300mg q.i.d.(4x daily) but as yet I have not had any issues with the 0.25mg cut; so I am still taking the gabapentin as before.

 

[osmium]

Quick update. All is going well on the clonazepam dropping front. In one week I'm going to try 0.5 b.i.d.(2x daily). I haven't resorted to additional gabapentin as my taper is still asymptomatic. If I can do it, anyone can. I had an extremely serious self-medicating issue(including one 14 day stretch where I drank a liter of 80 proof vodka per day..hospital detox ensued) until I was put on clonazepam.

I really think that in my instance - and it is a certainty for many others - that generalized anxiety with episodic panic are inextricably linked to depression. Once the AD meds kick in, my anxiety seems lower than that of the general population. The AD meds also block panic - which when it first 'worked' I was shocked and quite pleased.

 

[osmium]

Update:

Clonazepam down to 0.75mg/day(0.25mg in AM and 0.5mg PM) and no issues as yet. I have been having some depressive symptoms, but then I always seem to have something or other going on in that realm. My P-Doc upped my sertraline(Zoloft) to 50mg/day a week ago and things seem brighter.

Mirtazapine still gives me hunger pangs that I find(as noted above) to be far in excess of those received from cannabis, but my solution has been, and remains, fresh fruits and/or vegetables. Last night I ate a half a cantaloupe that was bigger than my head.

I'm still performing cardio work and have added some moderate weight training to my routine. Exercise and diet seem to be key factors in keeping the more intense WD symptoms at bay. I have only noticed three symptoms that are undeniably WD related. They are as follows:

1)Tinnitus
2)Parasthesia in my upper legs(it's really weird)
3)Sporadic inability to recall things like the names of plants, words, and ermmmm.. there it is again.

I am going to publish one update per mo. until the end of this thing. I will be certain to update after that time should I get the dreaded benzo PAWS(PABW for benzos).

Os

 

[osmium]

Since I loathe threads that aren't followed to completion, I'm updating again.

Update:

Clonazepam down to 0.25mg/day(0.25mg at bedtime)...feel pretty good.
Sertraline increased to 100mg/day about a month ago, and all is good save for tinnitus - which is sporadic now. That's a big improvement.

Parasthesis in legs is gone, recall seems back to where it was years ago. I am no longer searching for those pesky words that I noted in last update.

The reason for the 2+ mo. black hole of updates is that it took me a good long while to get comfortable at the 0.5mg/day dose.

Current meds recap:

Clonazepam: 0.25mg/day
Mirtazpine: up to 30mg/day(I have used mirtazapine sparingly of late. See exercise for likely lack of need)
Gabapentin: 300mg up to t.i.d.(total of 900mg/day..I am easing off the gabapentin. I no longer have any need for it. The sweats and intermittent morning fears are gone. My 30 days script is 22 days old and I have a huge bottle left.)
Sertaline(Zoloft) 100mg/day

Exercise has really made everything better.

Today's regimen was 1.5 hours of combined cardio/isometric work; and 3 hours of non-stop walking(4.0mph) for a lighter bit of calorie burning.
_________________________________________________

I see my P-doc in early Oct. My goal is to be free of benzos by the end of the year. It seems likely that I will get to this point early, but I prefer to under-promise.

Note: I am going to shave my 0.25mg clonazepam pills by a bit every 7 days. In the five weeks between today and my appt. I hope to be at no higher than 0.125mg/day. Given that I have been on high dose clonazepam therapy for 20 years this new clarity of thought is really quite remarkable; hence my remarks.

 

[osmium]

Another Sept. 2018 update:

Things have not gone according to plan - my plan, not the plan I agreed to with my P-doc.

I am stuck at 0.25mg/day. It's pretty difficult to cut by, say, 10% with anything like accuracy when pill cutting. With that out of the way, the reason that I haven't managed to cut further between my last post and this one is due to derealization...along with the pill cutting issue.. *ahem*

A little personal history may help any reader to better understand..

The reason I was prescribed clonazepam in the late 1990s was because the strong benzo stopped me from consuming body toxic levels of alcohol. I drank LOTS of ethanol to alleviate symptoms of panic; the main one being derealization. While some people might think that getting "free movie tickets" on a regular basis a great time, 'twas not the case with me. So, I drank to ease the freaking out, in lieu of something productive. Then, to save me from an early grave, clonazepam was introduced and I had been free from derealization and most other symptoms of panic/anxiety for the intervening years - as I developed much more effective coping strategies.

That brings one to the present - where, when I cut down from 0.25mg/day(0.5 of a 0.5mg pill) to anything less I am plagued by derealization. I am not nearly as freaked out about this as I once was, but it makes getting through a workday pretty difficult. Oh, I am also more snappish and less focused when I try to cut from this level, but it's the derealization that has me plateaued in my taper for the present.

As stated above, I see my P-doc in ~2 weeks, so we'll work out a new plan of attack. I am not disheartened by this one speed bump in my taper. One of those productive coping strategies I now possess is to not be so tough on myself.

The only changes to my meds protocol are that I am back to gabapentin 300mg t.i.d. and I have had to shutter the mirtazapine. The gabapentin seems to make a wee bit of difference in my baseline anxiety level as well as perhaps shortening the interval/intensity of the derealization spells. Perhaps. My mirtazapine use and the attendant carb craving just became too much. Even though I am still exercising at the previously noted level, my weight has increased by ~1 kg per week since my last report. I don't miss the mirtazapine at all; and the pantry stays better stocked at less cost

It's kind of weird. Since I really got serious with my taper, I have not had the desire to substitute another GABA_a agonist for the clonazepam my brain/mind/body is no longer receiving. At most any time in my past this would have not been the case. I feel that it's due to knowing that I am in the home stretch; and that anything worth doing is worth the work it takes to get it done. It certainly no sense throwing a spanner in the works at this late date.

 

[insert clever name]

Hi Osmium, I would love another update, as I can relate to your situation: I have also been on benzo's long term, well 6 years, and am anxious about getting off of them. I no longer have a Pdoc, and am looking for a new one, so I am anxious about finding a doc that will work with me. I'm on a pretty low dose (40 0.5 pills/every 30 days PRN), but recent changes in my life make me feel like I'll need more than that :/. I've tried different anti-depressants, including Mirtazapine, and have had no success with any. I am currently on gabapentin as well, and I think it helps
a tiny bit, very tiny bit with anxiety. I've also abused alcohol over the years due to anxiety (social and general), benzo use seems to have eliminated panic attacks, but with the cost of psychological and likely physical addiction. Had I never been prescribed benzo's, I likely would have developed more healthy ways of dealing with this, albeit, even if I suffered from panic attacks. But I can't really see a situation where I wouldn't have been prescribed them. Would love to hear how you're coping. ​

 

[fairnymph]

^Can you list all ADs you've tried & your responses to them?

 

[insert clever name]

^Can you list all ADs you've tried & your responses to them?

Hi fairnymph,

I just grabbed my bag of prior prescriptions--something I have regretted is not logging my response with each. The first one was Zoloft, which I took for about three months and got to apparently the highest dose. I remember that I felt quite tired on it, it seemed to demotivate me, and sexual dysfuntion.

I was prescribed Effexor long ago by a terrible doc, took one 150 mg ER pill and never took another--I felt completely bizarre that whole day, my vision was blurred, and I remember I just felt so weird, it made me pass out for hours as well. This was my first experience with AD and it left a mark for a while after.

I was prescribed Paxil and Lexapro, but I don't think I took a pill of either. Took Nardil back in 2012, and I think it might have helped, but the side effects were way too much: I was faint hours after waking, jerky motions, hypomania, and I think i experienced sexual dysfuntion as well.

Mirtazapine was the latest one, I don't remember any side effects, except for the common sexual dysfunction, and weight gain. I was always hungry, and it just didn't do shit, so DC'd.

I feel like there have been others, but I don't know where they are. I do not remember taking Lexapro, but I might have started it.

 

[insert clever name]

^Can you list all ADs you've tried & your responses to them?

Hi fairnymph,

I just grabbed my bag of prior prescriptions--something I have regretted is not logging my response with each. The first one was Zoloft, which I took for about three months and got to apparently the highest dose. I remember that I felt quite tired on it, it seemed to demotivate me, and sexual dysfuntion.

I was prescribed Effexor long ago by a terrible doc, took one 150 mg ER pill and never took another--I felt completely bizarre that whole day, my vision was blurred, and I remember I just felt so weird, it made me pass out for hours as well. This was my first experience with AD and it left a mark for a while after.

I was prescribed Paxil and Lexapro, but I don't think I took a pill of either. Took Nardil back in 2012, and I think it might have helped, but the side effects were way too much: I was faint hours after waking, jerky motions, hypomania, and I think i experienced sexual dysfuntion as well.

Mirtazapine was the latest one, I don't remember any side effects, except for the common sexual dysfunction, and weight gain. I was always hungry, and it just didn't do shit, so DC'd.

I feel like there have been others, but I don't know where they are. I do not remember taking Lexapro, but I might have started it.

 

[cj]

I went through a bunch of different anti depressants. Wellbutrin is the only common one I find worth a shit. It really helps my anxiety. I just recently got on lithium. It's pretty much a drug of last resort because it fucks your kidneys over time but so far it's working well for multiple depression. It also stabilized my mood. But that's a double edged sword because I feel extremely flat now