8 replies to this topic

[PabloHoney825]

Hi everyone, 

 

I take Propranolol to lessen the agitation, hypertension, heart rate, and physical symptoms of mirtazapine (anti-depressant) withdrawal. I feel like I'm jumping out of my skin and my BP and HR skyrocket without the beta blocker. Anyway, I was doing some research and came across this...

 

In addition to its effects on the adrenergic system, there is evidence that indicates that propranolol may act as a weak antagonist of certain serotonin receptors, namely the 5-HT_1A, 5-HT_1B, and 5-HT_2Breceptors.^[59][60][46] The latter may be involved in the effectiveness of propranolol in the treatment of migraine at high doses.^[46]

 

^{Does this potentially mean that while the Propranolol helps with much of the symptoms, if could be slowing or even impeding recovery of my serotonin receptors during this withdrawal? Perhaps a solution to this would be to switch to Atenolol which doesn't affect the serotonin receptors but is also prescribed for anxiety off label. I asked my cardiologist and he was clueless.} 

 

^Thanks!

 

 

[stewedsauerkraut]

Isn't it a good thing that propranalol's a seratonin antagonist? I thought the use of neurotransmitter antagonists was viewed favourably because that leads to your brain upregulating the receptors.

[PabloHoney825]

Thanks for your reply. Is this always the case? Do inverse agonists/antagonists always upregulate downregulated receptors? 

[DeGenisis]

Thanks for your reply. Is this always the case? Do inverse agonists/antagonists always upregulate downregulated receptors? 

 

Not always. 5-HT2A and 5-HT2C receptors are downregulated by both agonists and antagonists.

Edited by DeGenisis, 18 March 2018 - 06:58 PM.

[DeGenisis]

Propranolol is a pretty weak actor at 5-HT receptors. I wouldn't worry about it. I assume you are taking somewhere between 10 - 40 mg of propranolol?

 

What does of mirtazapine did you stop? Did you stop suddenly or taper?

 

Mirtazapine is such an absurdly potent H1-receptor antagonist, even at low doses. Those receptors extensively upregulate in response to mirtazapine and now histamine is taking your body for a ride. Histamine is a powerful vasodilator and I could totally see rebound tachycardia and hypertension in response to that vasodilation.

[PabloHoney825]

DeGenisis,

 

Thanks for sounding off. I'm glad you confirmed what I was thinking as I switched to Atenolol this morning since it has less affinity for the 5HT receptors than Propranolol. If I'm in anti-depressant withdrawal I don't want to mess around with these receptors any more than I need to. 

[PabloHoney825]

DeGenisis,

 

I didn’t see your previous reply before I replied. I want you to know how much I appreciate you taking the time to reply to me and share your knowledge.  I can handle a tough road ahead (such is life), but I’m stuck at a fork and don’t know which one to take.

 

I was only on about 15 mg propranolol. I can only handle 6.25-12.5 mg Atenolol or my HR goes down too low.

 

I was on Remeron for about a year. On the last month or two,  I took it sporadically (4-5 times a week) and reduced it from 7.5 to 3.25. On February 13th, I took a dose 3.25mg dose with 5 mg melatonin and some magnesium after I took Tryptophan 1000mg the previous night, and within minutes I started shivering and had muscle jerks. My BP went up to 170/110 and my heart rate was 130 with arrhythmias (PVC's). I ended up in the ER. That was the last night I took Remeron. Interestingly enough, I took Unisom (doxylamine) and melatonin a week later and the EXACT same thing happened so I'm assuming that since both Remeron (low dose) and Doxylamine act on the 5HT histamine/serotonin receptors, I developed an intolerance or sensitivity to these kinds of drugs. Perhaps it was because I was already in withdrawal from the sporadic and fast taper off the Remeron in the previous month or two before I took it for the last time and ended in the ER.

 

This all happened about the same time I'd been using Klonopin .125-.25 a few times a week for about 4 months. From what I understand they have similar symptoms of withdrawal. So just to make sure I’ve stabilized at a low dose Klonopin and I am micro-tapering off from .150. The symptoms have subsided between the Klonopin and the beta blockers but they are far from gone. I am afaid I’m just masking the Remeron Withdrawal which may clear up in a matter of months with Klonopin which I will develop a new dependency on. I’m hoping that daily nmicro-tapering off the Klonopin will help prevent that from happening. I should note that I was on Klonopin for 10 years daily and tapered off in 2014 successfully with minimal PAWS, but it took me two years to taper off. So I’m scared of kindling.

 

My symptoms right after ceasing Mirtazpaine and ER visits which lasted for weeks and come back if I stop the K or beta blocker: Panic, dread, derealization/ DP, tremors, shivering, muscle jerks, insomnia, burning skin (esp ears), brain zaps, hoarse throat, brain fog, tinnitus, itching, tightness in chest/abdomen (not heart pressure), agitation, hyperarousal, sensitivity to sound, intolerance to heat and esp, cold, tachycardia, jumpin out of skin, arrhythmia, elevated blood pressure, lack of appetite. I lost 20 lbs in a matter of 4 weeks.

 

Now, with a stable but low Klonopin daily dose and beta blocker, my symptoms consist of: insomnia, anxiety, burning skin (not as much), itching, brain zaps, brain fog, tinnitus, agitation, slightly elevated bp but much better. I’m starting to exercise and eat better.

 

I've considered reinstating a lower dose Remeron but am scared that the same thing will happen. I've read that after a certain point in withdrawal, reinstatement can be more harmful than good as your body can reject it and one could have an adverse reaction. I think that's what happened to me when I went to the ER (possibly already in withdrawal) but I'm not sure. Do you have any insight into this? Do you think this could be more AD or benzo related withdrawal?

 

 

 

 

 

 

 

[DeGenisis]

I was on Remeron for about a year. On the last month or two,  I took it sporadically (4-5 times a week) and reduced it from 7.5 to 3.25. On February 13th, I took a dose 3.25mg dose with 5 mg melatonin and some magnesium after I took Tryptophan 1000mg the previous night, and within minutes I started shivering and had muscle jerks. My BP went up to 170/110 and my heart rate was 130 with arrhythmias (PVC's). I ended up in the ER. That was the last night I took Remeron. Interestingly enough, I took Unisom (doxylamine) and melatonin a week later and the EXACT same thing happened so I'm assuming that since both Remeron (low dose) and Doxylamine act on the 5HT histamine/serotonin receptors, I developed an intolerance or sensitivity to these kinds of drugs. Perhaps it was because I was already in withdrawal from the sporadic and fast taper off the Remeron in the previous month or two before I took it for the last time and ended in the ER.

 

 

I take mirtazapine and diazepam, and have tried to taper both clonazepam and diazepam over the course of a decade, so I can relate. My personal experience is that mirtazapine can aggravate autonomic instability caused by benzodiazepine withdrawal. I developed POTS during a clonazepam taper. Adding mirtazapine made it 100x worse and landed me in the hospital. There are peripheral benzodiazepine receptors in the heart which influence autonomic function (https://www.ncbi.nlm...pubmed/21459278). Mirtazapine is fairly adrenergic and increases "cortical excitability" (https://www.ncbi.nlm...pubmed/15774440), both of which don't sound great during benzo withdrawal.

 

 

This all happened about the same time I'd been using Klonopin .125-.25 a few times a week for about 4 months. From what I understand they have similar symptoms of withdrawal. So just to make sure I’ve stabilized at a low dose Klonopin and I am micro-tapering off from .150. The symptoms have subsided between the Klonopin and the beta blockers but they are far from gone. I am afaid I’m just masking the Remeron Withdrawal which may clear up in a matter of months with Klonopin which I will develop a new dependency on. I’m hoping that daily nmicro-tapering off the Klonopin will help prevent that from happening. I should note that I was on Klonopin for 10 years daily and tapered off in 2014 successfully with minimal PAWS, but it took me two years to taper off. So I’m scared of kindling.

 

 

Unfortunately benzo withdrawal makes us sensitive to withdrawal from every medication as far as I can tell. Sometimes it can be hard to tell what's residual benzo withdrawal and what's withdrawal from another drug.

 

 

My symptoms right after ceasing Mirtazpaine and ER visits which lasted for weeks and come back if I stop the K or beta blocker: Panic, dread, derealization/ DP, tremors, shivering, muscle jerks, insomnia, burning skin (esp ears), brain zaps, hoarse throat, brain fog, tinnitus, itching, tightness in chest/abdomen (not heart pressure), agitation, hyperarousal, sensitivity to sound, intolerance to heat and esp, cold, tachycardia, jumpin out of skin, arrhythmia, elevated blood pressure, lack of appetite. I lost 20 lbs in a matter of 4 weeks.

 

Now, with a stable but low Klonopin daily dose and beta blocker, my symptoms consist of: insomnia, anxiety, burning skin (not as much), itching, brain zaps, brain fog, tinnitus, agitation, slightly elevated bp but much better. I’m starting to exercise and eat better.

 

 

Very complex multidrug withdrawal going on here. All of your symptoms which have ceased and all of them which are still present could be attritubuted to either mirtazapine or benzo withdrawal. It really does sound like withdrawal from the mirtazapine somehow triggered your benzo withdrawal, given some symptoms that are more specific to benzo withdrawal, like DP/DR and especially myoclonic jerks.

 

 

I've considered reinstating a lower dose Remeron but am scared that the same thing will happen. I've read that after a certain point in withdrawal, reinstatement can be more harmful than good as your body can reject it and one could have an adverse reaction. I think that's what happened to me when I went to the ER (possibly already in withdrawal) but I'm not sure. Do you have any insight into this? Do you think this could be more AD or benzo related withdrawal?

 

 

My unprofessional opinion is that your benzo withdrawal has come out to play. Both melatonin and tryptophan have effects on the autonomic nervous system so we have to be careful with them. You could try a low dose reinstatement. Even a crumb of mirtazapine is a significant antihistamine.

[PabloHoney825]

DeGenisis,

 

Thanks again. I was thinking of trying melatonin out in a few weeks but I'm also hesitant since I took it the same nights I ended up in the ER with the doxylamine and the mirtazapine. I know it may do some things to serotonin since serotonin produces it. It's all connected to the HPA Axis. What do you think about melatonin in this situation?