A complete guide to tapering off Mirtazapine - A letter to my younger self !
Lesson 1.
You were stressed out about a house move and had a few sleepiness nights. The Dr prescribed you Mirtazapine! Don't take it. Yes you're stressed, but it will pass, big deal try mindfulness (yes, i know you said it's a load of crap and wouldn't work), but when you tried it, it actually really helps doesn't it. The slow breathing exercises at night?, Amazed you managed to drop off when you swore you wouldn't be able to.
Q. Are you suicidal?
A. No. So don't start taking mirtazapine, the stress will pass, the event will pass. A few sleepiness nights will not kill you, coming off Mirtazapine the wrong way, nearly will.
Lesson 2.
Treat Mirtazapine with the utmost respect. It is a seriously powerful drug (even at tiny doses) and will seriously f& you up if you disrespect it. Do not take it on & off like a sleeping pill, if you must take it, use the smallest amount to get you through, consistently every evening and slowly come off it.
Lesson 3
Your Dr is a total prick and dangerous. His comments that taking a 1/4 of a tablet is so small it will have no effect and you might as well stop is the worst and most confusing advice you ever got from a quack. That will screw you up for a year.
The only Dr you should listen to is Dr Mark Horowitz. Watch his YouTube videos. Everything that ever happened to you will suddenly make sense and empower you to get off this horrific drug.
Lesson 4.
How to make the very, very small doses.
Equipment; 2x spoons, 1x child’s 5ml syringe from a Calpol medicine bottle, 1x electric weighing scales your wife uses for baking.
Crush 1/2 a 15mg tablet between the 2 spoons to get 7.5mg powder.
Using the scales pour 75g of water into a cup. This will be exactly 75ml
Add the powder to the water and stir very well which makes a 0.1mg/ml solution
Using the syringe, suck up the strength you need, eg if you want 0.2mg then suck up 2ml of solution, if you want 0.5mg suck up 5ml of solution, bin the rest.
Lesson 5,
All those horrific feelings of dread and anxiety over the last few years was not you being weak or too much stress at work. It was because a few week earlier you had stopped taking mirtazapine and never connected them together. You repeatedly went back on the mirtazapine because you thought you couldn't cope, but it was clearly severe withdrawal symptoms from stopping abruptly.
Lesson 5a
Start writing a journal to summarise your dose and symptoms.
Every time you stop you'll see you get awful anxiety and nausea at 8 days. In fact you could set your watch to it.
Without spotting that pattern, you'll never realise it's withdrawal and never come off them.
Lesson 6
The tinnitus. This started in December 2025 and really spooked you out and created a huge amount of anxiety. You couldn't work out why some days it was awful and other days it would fade away. You spent months seeing a physio and chiropractor convinced it's your neck. You started walking like a tit, head up, back straight. But it made no difference. There was no rhyme or reason and it depressed you so much you were back on mirtazapine and it started to ease away. You seriously considered suicide over 3 weeks because you thought that was simply the way life was always going to be.
Well, you've connected it all up now haven't you, that's 3 months of your life you'll never get back
Lesson 7
after taking 1/4 of mirtazapine for a month, you felt great and came off them.
Week 1 - Great.
Week 2 - Dreadful with the tinnitus as bad as ever.
Finally the penny drops and you realise this 'could' be withdrawal!!!
Lesson 8
April 2026 .You realise you need to slowly taper of this drug. So back on, but at 4mg
May to August you taper down via solution to 0.3mg and feel fine, it was easy, and you feel really pleased with yourself. In fact you had loads of days were the tinnitus almost disappeared. Happy days. What’s all the fuss.
Surely 0.3mg is so tiny, you might as well just lick the dam tablet. So you come off at 0.3mg.
Lesson 9
You fu&*** idiot.
Week 1 - Feel great,
Week 2 - Feeling dreadful, anxiety back, tinnitus is horrific, dreadful stomach pains, serious diarrhea 4x per day, no appetite, fried head feeling, trouble sleeping, bloated stomach. Horrific jaw ache like someone has smashed me in the face with a bat. But let's grin and bear this. your brain is healing.
Week 3 - Ditto but feel even worse. losing weight. Shattered all the time. Hell.
week 4 – ditto, just worse hell.
week 5 - signs that things are easing a tiny bit,
week 6 – Horrific again. Tinnitus is reaching new levels of hell, you've shat yourself inside out and lost loads of weight. You can't white knuckle this any longer. Jaw is almost locked up with pain and twitching all the time.
week 7 - Back on Mirtazapine but at 0.2mg.
week 8 - Today 25Sep2026 - feeling better. Tinnitus easing off nicely, appetite back, still got stomach ache but not as bad. Jaw ache almost gone. Thank God you didn’t kindle.
Lesson 10.
You've gone through the hardest 6 weeks of your life for no reason whatsoever except that you're a stubborn bastard who knows best. If you had tapered more slowly like Dr Horowitz advises and like your body was screaming out at you, you could have been at 0.1mg by now with far less issues and ready to stop. Now you've still got a few more months to go. Tit.
Mirtazapine — 0.2mg — 1 year — actively tapering
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