![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 366 to 390 of 488. Go back in thread:
Posted by jimbobwe64 on June 6, 2007, at 0:24:43
In reply to Re: Jim and Tired of Panic sugar cravings, posted by brazilnut on May 31, 2007, at 14:49:47
> > Hello Tired of Panic and Life. I just thought I'd say hi. I haven't been on here in an obviously incredibly long time. I'm still very much off the Remeron and it's been just over 10 months now. I've gone through some pretty rough times to get here and that's pretty much why I haven't been on here. At first it was mostly Depression and severe anxiety from the withdrawal. To tell you all, I've found from several really good and reputable sources that it really does take between 18 months to 2 years to get totally rid of the withdrawal symptoms. And I've learned that it really takes some great sacrifice and patience in order to alleviate these symptoms. I'm very glad to see that you two are still on this site and I'm very, very curious to hear how you've been doing. In addition if you or anyone else have any questions about what I've been through or what I've done to alleviate the bad thoughts, etc while I'm still "drying" out (lol), I'd be more than happy to embellish. I'm still having problems, but, finally my mind is 100 percent as sharp as it was before I went on AD's over 11 years ago. I'm hoping to hear from you soon.
> >
> > Jim
>
> Hi, Jim!
>
> I'm coming out from mirtazapine after almost 3 years on 45mg daily. It took 6 months to reach 50% of the original dosage and other 6 months to the point I'm now: one small fragment each 8 hours (the 3 taken in a day add up to about 2mg).
>
> I'm having a very hard time, sometimes I feel I'll not bear all this, mainly the anxiety. The docs say it's just anxiety (yes, I have been anxious all my life), nothing to do with withdraw, and that I have to take A/Ds or anxiolitcs. (The last one offered me a "harmless" drug, trazadone... I tried 20+ of these drugs for 8 years before discovering they were the main problem - never more!)
>
> So, could you please tell me more about the "several really good and reputable sources" you found? It would help me to convince the docs.
>
> Regards,
> Bob
>
Hey, Bob,Thanks for the question. Sorry to hear about the problems you've been having. No anxiety is a good thing, regardless of what the cause is.
First of all, I'm not a doctor, so anything I say should be scrutinized (until you get to know me, then it should be really scrutinized, lol). Anyhow, everyone's metabolism is different and only you can tell if you truly should get off a certain medication. However, if you've had anxiety before you went on any A/D med, then you really should get to the root of the anxiety, whether it be psychological or due to diet.
Second, as for sources, I have a friend whose wife is a very, very good psychiatrist who has given me a lot of sound ideas towards my recovery. I've always gone with her ideas to my doctors and have convinced them about what to do. I've just recently retired from the Canadian military and have not always had proper access to good quality psychological assistance, therefore having to rely upon, in almost all cases, general practitioners to do the job. Another source I've found in recent months and kind of helps to keep me going is as follows:
http://www.antidepressantsfacts.com/reaction.htmLike I said I don't know if your anxiety is something that can be managed without the assistance of meds or not. However, I do know one thing and that is that managing your diet can only do good things for you, if not only to relieve a few of the symptoms or the whole anxiety "kit and kaboodle".
All I can say is that I've made some major changes to my diet (because, quite frankly, mine was kinda poor) and it's helped my anxiety go way down to the point where I'm actually venturing without A/D's. something I would never have thought of about 3 or 4 years ago.
If you find that changing your diet's just not doing it to relieve the anxiety, then you should keep trying new A\D's until you find the right one for you. It is very important that I say that there are some people who simply should not be off those meds. And that alone is not a bad thing either, as well it doesn't make you a bad person because you're on A/D's, as it is definitely not your fault that you have a chemical deficiency.
The one question that I do have though, Bob, is: are the docs you're seeing qualified Psychiatrists or just General Practitioners??
Hopefully this helps a bit.
Jim
Posted by brazilnut on June 18, 2007, at 15:14:34
In reply to Re: Jim and Tired of Panic sugar cravings, posted by jimbobwe64 on June 6, 2007, at 0:24:43
> Hey, Bob,
>
> Thanks for the question. Sorry to hear about the problems you've been having. No anxiety is a good thing, regardless of what the cause is.
>
> First of all, I'm not a doctor, so anything I say should be scrutinized (until you get to know me, then it should be really scrutinized, lol). Anyhow, everyone's metabolism is different and only you can tell if you truly should get off a certain medication. However, if you've had anxiety before you went on any A/D med, then you really should get to the root of the anxiety, whether it be psychological or due to diet.
>
> Second, as for sources, I have a friend whose wife is a very, very good psychiatrist who has given me a lot of sound ideas towards my recovery. I've always gone with her ideas to my doctors and have convinced them about what to do. I've just recently retired from the Canadian military and have not always had proper access to good quality psychological assistance, therefore having to rely upon, in almost all cases, general practitioners to do the job. Another source I've found in recent months and kind of helps to keep me going is as follows:
> http://www.antidepressantsfacts.com/reaction.htm
>
> Like I said I don't know if your anxiety is something that can be managed without the assistance of meds or not. However, I do know one thing and that is that managing your diet can only do good things for you, if not only to relieve a few of the symptoms or the whole anxiety "kit and kaboodle".
>
> All I can say is that I've made some major changes to my diet (because, quite frankly, mine was kinda poor) and it's helped my anxiety go way down to the point where I'm actually venturing without A/D's. something I would never have thought of about 3 or 4 years ago.
>
> If you find that changing your diet's just not doing it to relieve the anxiety, then you should keep trying new A\D's until you find the right one for you. It is very important that I say that there are some people who simply should not be off those meds. And that alone is not a bad thing either, as well it doesn't make you a bad person because you're on A/D's, as it is definitely not your fault that you have a chemical deficiency.
>
> The one question that I do have though, Bob, is: are the docs you're seeing qualified Psychiatrists or just General Practitioners??
>
> Hopefully this helps a bit.
>
> JimHi Jim!
Thanks for your kind answer and information. So late to answer because life is hard down here.I asked for your sources on A/D withdrawal because I have a hard time trying to convince doctors that W/D from some medicines may last for months. They say that after a month of stopping the intake there is no more medicine in my body, so what I feel is not related to it. As if W/Ds were caused by the presence of the medicine, not the absence… I would like to find some scientific references on this, but the closest thing I came across were Prof. Ashton’s studies on benzodiazepines.
I started taking A/Ds in 1997 thanks to the ignorance of two docs. The first, an ENT with whom I would have a snoring operation, prescribed Frontal for sleeping during vacations, and told nothing about how to stop it – so I went cold turkey. The second, a psychiatrist, misdiagnosed the following severe W/D crisis as depression. Followed 10 miserable years in which I had 4 different diagnostics and tried 20+ of the strongest medicines available.
Only two years ago I discovered, reading this website, that the medicines were not solution but at least part of the problem. (Of course, I understand this happens to me and a small minority only, and many people benefit from such medicines.) I started then a very slow and difficult process of weaning off. Today morning I took the last particle of mirtazapine - I was taking 1 small fragment of about 0.5mg 3 times a day for 15 days. One year ago it was 45mg daily.
This situation – years of mixing and changing medicines – made me very anxious, and I know no medicine will help me. I am naturally anxious, but I am sure that the many W/Ds I went through magnified my anxiety. To counterbalance the absence of the mirtazapine I am taking Saint John wort and ginkgo biloba. For the anxiety I take valeriana officinalis (valerian root?) combined with humulus lupulus (sorry, don’t know the English names of these plants).
As for diet, I am a vegetarian for … 50 years! (since in the last 8 years I have been eating fish too, I am actually a “fishtarian”). I eat a lot of fruits and healthy vegetables and take supplements such as magnesium and B vitamin. I used to drink wine regularly, for many years, but decreased it naturally as my symptoms worsened - now I take half a glass weekly, or even less. Some doctors said I should take a little more to cope with the anxiety, but I prefer to be cautious.
About the qualification of my docs, I have been recently 11 months with one and 7 months with another of the best reputed psychiatrists in town, and consulted once with four others. The last one, also a nationally renowned pharmacologist, seeing my medicine list said there is nothing left to try. I have also a very good GP whom I visit regularly.
Bob
Posted by Brazilnut on June 30, 2007, at 21:27:49
In reply to Re: Jim and Tired of Panic sugar cravings, posted by jimbobwe64 on April 17, 2007, at 22:32:30
Hi everybody!Yesterday was my 10th day off mirtazapine, after almost 4 years taking it. Mirtazapine was just the last on a list of 20+ other strong medicines I have been taking the last 10 years, so these are the first 10 clean days of the past decade. I have been longing for these days for 2 years, but now they are just hell. Never worse than now.
Every morning I wake up between 4pm and 7pm with pressure in my chest, heat in my throat, difficulty to breath, occasionally palpitations. The thing in the throat slowly becomes an acute pain, which migrates also to the head. In a few hours the pain dissipates, giving place to heavy abdominal cramp, burning chest and throat and arms and legs, dizziness, depression, extreme anxiety... All the morning I am not able to work, due to the lack of concentration and anxiety. Usually I get a little better slowly, just to go to bed and wait for the next attack.
My question is whether anyone out there experienced something like this in relation to mirtazapine withdrawal. Or would it be rather a consequence of that long list (Klonopin, Stilnox, Efexor, Trileptal, Welbutrin, Tryptanol, Topamax, Risperdal…)?
Thanks for any information.
Bob
Posted by Maritza on July 1, 2007, at 23:30:46
In reply to Mirtazapine: 10 days, 10 years – a question, posted by Brazilnut on June 30, 2007, at 21:27:49
Hi Bob,
I have been on Remeron for about 6months. I have cut back from 30mg to 15mg, then to 7.5mg with 10mg of Celexa added in the am. My doctor added this to help me with the past reduction (down to 7.5mg) I tried to stop taking Remeron and still continued the Celexa about 3 weeks ago. After about 4 days I began feeling the symptoms you described. I became very tired and depressed. Then I developed abdominal cramps and the runs. This was followed by anxiety and heart palpitations along with chest pain. I took my 7.5mg dose after about 5hrs of this, and felt better within a half an hour. My doctor told me I need to stay on it for a year. He said that there are cycles to the medication and right now I am in the remission cycle. He said the next cycle is the recovery cycle where my brain should begin to manufacture its own seretonin in response to an increasing tolerance to the remeron. He said this takes time. The recovery phase should begin soon according to him. He said I could decrease my dose after being in this phase for a couple of months. I understand you were taking a very small dose for a while. I wish I could tell you what to do but I am very frustrated by this situation myself. I was satisfied with my doctors explanation but it came after months of insisting that I wanted to come off these meds. What has your doctor told you? How long have you been off of the other meds? How long were you on the last dose and what was it? I know it takes a while for your brain to adjust to each new dose. My doctor added the Celexa with my last reduction because he said it would be easier to come off of this. My pharmacist agreed with this. My doctor also said there isn't any withdrawl from Remeron.
Sometimes I feel there's a conspiracy and I'm not Schizophrenic (LOL)! Seriously, though, I worry about these withdrawl symptoms and fear they could be dangerous to my heart. I am seeing a Cardiologist this week because of the palpatations and the fact that this drug increased my cholesterol to 241 from 170 in 2months! I would also like to get the Cardiologist's opinion on withdrawing from Remeron. I read in one of these Blogs that a doctor prescribed a blood pressure med to protect the heart from increased adrenaline during withdrawl. My phsychiatrist told me Remeron is not dangerous to the heart, but he also said there aren't any withdrawl symptoms. Either he doesn't know what he's talking about or he's just plain lying to me! Anyway, I wish you the best of luck. Prayer has helped me through all of this greatly and I pray that my doctor can advice me properly. I'll pray for you. Let me know when you start feeling better. Maybe go to a medical doctor to discuss your symptoms and make sure your body is adjusting properly. I'll let you know what the Cardiologist tells me. I've also found that Magnesium supplements and potassium from juices like prune juice help to relax your nervous system. Remember that God gave you a sound mind and He is all powerful. When the symptoms come on release them to God and know that He can and will heal you. God Bless!
Maritza
Posted by Brazilnut on July 6, 2007, at 9:32:38
In reply to Re: Mirtazapine: 10 days, 10 years – a question, posted by Maritza on July 1, 2007, at 23:30:46
Maritza,
Thanks for your kind and comforting reply. It helps to know that others feel similar symptoms, so I am not crazy – or at least not crazy alone!
I´m glad to see that Celexa is helping you. As for me, I tried more than 20 of such meds in the last 10 years, and none was a solution, just another problem.
I quitted, perhaps too fast (3 months), klonopin and trileptal 2 years ago. A few months after I was feeling very bad and went for help to a psychiatrist, specialist on chemical addiction (later I learned his experience was on alcohol and street drugs). He just gave me other medicines that worsened my condition. It took me a whole year to wean off the last, risperidone. I changed to another doc, who denied any long term withdrawal – he said I had only anxiety. He gave me Inderal, a medicine prescribed for controlling blood pressure but also used for anxiety outside the US (perhaps the med you mentioned). I hoped that with time and observing what was happening to me he would believe me, but he just refused to see evidences against his beliefs. So I quitted him a month ago. Now I have only my GP, who also resists to believe in such long and painful withdrawals, but is more open to new evidences, and very competent on the other matters.
I never met a doc who believes in Remeron withdrawals; some concede there are a few cases of short and light symptoms after discontinuation. They just don´t know, because they didn´t learn it in school and never met it – luck people like ourselves are a tiny minority, I guess far less than 1%. And when they find one, they deny it, they don´t want to think about something that challenge their knowledge and their way of doing things. I don´t know how are things where you live, but here in Brazil docs have no time to pay attention to patients or to learn – unless from stuff released by pharm companies. If your case deserves special attention, specific care, forget it. You´ll be treated as the good average patient.
I took mirtazapine for 3 years, 45mg daily, and then started weaning off one year ago, very slowly, finishing it 16 days ago. The last dose was about 0,5mg thrice a day, for 15 days. The first days were not that bad, but in the last 10 days things are getting worse continually. I suspect that Inderal is part of the problem, because I am very sensitive to changes in its dose - any change will trigger a stronger attack next day. I tried to wean off it, just impossible.
Yesterday was the worst day in my life (each month I say this..) Now I don´t know what to do. Stop Inderal at any cost? Just wait until the recovery from mirtazapine starts?
Thanks again for your interest, suggestions and support. I wish your recovery starts soon. God bless you too!
Bob
Posted by 13243 on July 9, 2007, at 18:14:09
In reply to Re: Mirtazapine: 10 days, 10 years – a question, posted by Brazilnut on July 6, 2007, at 9:32:38
all. I have been on remeron/mirtazapine for the past 6 years. It was a "dream pill" for me when i first starting taking it. I had severe insomnia and tried many other meds to get it resolved but all failed. this stuff worked the first night i took it. That was great but a year later and ever since i've wanted to get off it but neve could. I felt i could "suck up" whatever withdrawals I would encounter but boy was i wrong. My symptoms were like any other time i missed A DAY of taking the stuff (15mg). I would wake up in the middle of the night figidity, headaches, nausea - you name it. I kept trying to get the courage to come off but 1 day of the above and i figured "why not stay on....." I just wanted to get off it. I had no real complaints but now that i'm almost done successfully weainging off I realized how much this thing was sedating me. I'd need 10 hours of sleep and another hour just to get my bearings straight but the rest of the day (what's left of it!) was fine. I'm like an earlier post "waiting for the right time" but like someone said above "when is the right time" so I'm giving it a shot now. I started weaing off a few weeks back. Started with 7.5 MGs a night for the first week and 3.75MG a night for the past week - should be done in a day or so. The only thing I've noticed now is that I've been a bit wiped out at times during the day but the other symptoms have seem to go away (figidity,nervous,nauseaus etc).
Good luck to whoever wants out! You'll need it. For years my only excuse for not trying more was the fear of feeling like garbage for the next day/s. I don't know why - maybe it's my time I'm feeling pretty lucky so there is hope. I have to say I had some personal issues during the past 6 years too which didn't help and I've squared them away so maybe that's the key - either way I'm excited to get off this stuff - it's a crappy feeling getting around every day making sure that "pill" is there for you - nothing worse than going away for a day or so and realizing you forgot the darn stuff knowing you're going to feel like crap!
Posted by Brazilnut on July 10, 2007, at 14:16:59
In reply to Re: Mirtazapine: 10 days, 10 years – a question, posted by 13243 on July 9, 2007, at 18:14:09
13243:
Each person is different, and I hope you aren't so sensitive as myself. One of the things I learned with great pain weaning off several meds is that at the beginning it looks like it will be easy. But after a few days on a lower dose problems start, and there’s no coming back. I spent 6 months to come from 22.5mg mirtazapine to zero, and now I think it was too fast. I finished it 21 days ago; the first 10 days were manageable, but then it started to get worse each day.
Another thing I learned is that splitting the dose along the day, instead of taking just one, helps a lot. I don’t know it will work for everybody, but it did for me with rivotril, trileptal and mirtazapine. My hypothesis is that W/d symptoms are more or less proportional to the variation of the concentration of the drug in the blood during the day. But even splitting the dose in 3 was a painful process for me.
I know what you mean by the feeling of that pill waiting for us every day. If you decided to stop it, go ahead!
Now that I finished mirtazapine, I learned that Inderal, that I started taking to lessen the mirtazapine W/D symptoms, is also very difficult to wean off… But this is subject for another board.
Good luck!
Posted by Maritza on July 11, 2007, at 13:05:16
In reply to Re: Mirtazapine: 10 days, 10 years – a question, posted by Brazilnut on July 6, 2007, at 9:32:38
Dear Bob,
I was wondering how you were coming along? I've been to see a Cardiologist about the chest pains and palpitations I've experienced, mostly when I try to stop Remeron. My Phsychiatrist just thinks it's anxiety but I would feel better being checked out. I have to take some tests and wear a halter monitor, these are comining up in the next month. My Cardiologist can't say whether I should stop the med or not. She did tell me to take magnesium supplements. I have been doing that for the past few months. It does have an effect that relaxes the nervous system. It should be taken with Calcium and Vitamine D. Calcium alone stimulates the nervous system but combined they provide a balance. I had been taking megadoses of Calcium when my symptoms started. I was recovering from cervical spine (neck) surgery where some of the bones in my neck were broken and hollowed out to remove discs and decompress the spine. They needed to grow back and fuse together to heal properly. The excess Calcium may have triggered my anxiety although I was worrying about the healing and many other things. My main question for you, at this point, is how to did divide the pills up into such small doses, (.5, etc)? also, are you only taking Inderal at this point? How does that make you feel? What is your blood pressure? Did it lower it? Do you plan on weening off of this? Did your Doctotr give this to you to help with withdrawl or did you have high blood pressure? Was it their suggestion or yours? I'm concerned with protecting my heart when I do withdraw completely. My Cardiologist told me that anxiety and depression are damaging to the heart and cardiovascular system. Thanks for your support, information and encouragement. Good luck and God Bless You!
Maritza
Posted by 13243 on July 11, 2007, at 18:14:49
In reply to Re: Mirtazapine: 10 days, 10 years – a question, posted by 13243 on July 9, 2007, at 18:14:09
Brazilnut,
thanks for the encouragement. Last night I did not take 3.75mg. I'm considering taking 3.75 tonight but not sure.....I feel ok. I'm sleeping well - a bit "quessy" at times and have had some bouts with tiredness (thank heavens i work from home so it helps if i need to take a nap which i have). It's weird - it just feels like it's my time..don't know why. Six years on this stuff and every time i even missed a day i was a mess. As I said I had some personal things going on (marital issues) that i got squared away a year or so ago so I'm in a better place. I'm just surprised (crossing my fingers too) that even though i may be moving on from the intial reasons i went on the stuff that the withdrawels have not been as bad as other times i tried to get off it.
Time will tell - I'll keep you posted!
Everyone be well
Posted by Brazilnut on July 16, 2007, at 21:51:27
In reply to Re: Mirtazapine: 10 days, 10 years – a question, posted by Maritza on July 11, 2007, at 13:05:16
Dear Maritza,
Thanks for your interest! Sorry for this so looong post.My heart and blood pressure were always OK, but I had palpitations and high blood pressure 3 years ago, when I was taking Stilnox (Ambien) and missed some doses. My GP gave me Ablok (Tenormin), a “beta blocker” such as Inderal. Ablok controlled both palpitations and pressure nicely and I took it for 2.5 years.
I’ll give magnesium a try. Was it effective for you? Are you completely recovered from the spine issue? How long did it last?
Now I answer, as much as I can, your interesting questions:
- My main question for you, at this point, is how to divide the pills up into such small doses, (.5, etc)?
I used scissors, after having tried sharp knives and a pill cutter (not good here in Brazil). I used to start with a 30mg pill and to divide it in twelve parts– of course they were not equal, but the important thing is to take each time equal or smaller amounts, as an average. To go below that size I scratched down those 1/12 pills, with the scissors or a nail, depending on the size. I prepared the necessary number for a week, all as much as possible alike (I used to take 3 a day, in order to keep the concentration in my blood as even as possible). For the next week I would prepare another batch slightly smaller. Of course at a certain point I was not able to assess the weight of the pills, but I was sure that, in the average, I was taking each week smaller or equivalent pills. So the 0.5mg was just a guess. I could buy mirtazapine in any dosage (I don’t know how small) in those pharmacies that prepare medicines to order (I don´t know the English term). It would be even much less expensive, but I tried it once and found the “power” of the drug lower than the manufactured one, what would require a painful adjustment.- also, are you only taking Inderal at this point?
I take also St. John´s Wort (in a concentrated form sold here as Iperisan), to compensate the antidepressant effect of mirtazapine; Ginkgo Biloba, as antidepressant also and brain stimulant; and valerian plus lupullus (sold here as Remilev) for sedative effect.- How does that make you feel?
Inderal was prescribed for anxiety. It looks like it is not officially indicated for this purpose in the US, but it is widely used by performers, such as musicians or speakers, to control stage fright. I stopped then the Ablok I was taking for the pressure, because they are equivalent for this purpose. That was in last December, when I was weaning off mirtazapine (45mg to 22.5mg) and risperidone (21mg to zero), and was having heavy anxiety attacks, always at wake-up time. At the beginning it worked, but with time not anymore. When I decided to quit it I discovered I couldn’t: I would have unbearable anxiety attacks with any change in doses. I made a search on the Internet and discovered that Inderal may have dozens of frightening side effects and withdrawal problems, for some persons – it seems that only for a very small minority, since it has been prescribed successfully for millions for many years (I read somewhere that at one point in time it was the most sold medicine in the US).- What is your blood pressure?
Now it is OK. At wake-up, when I have those attacks, only 13/8. The rest of the time about 11/7 (I think in the US it would be 130/80 and 110/70.)- Did it lower it?
It certainly helped to keep it down as a replacement for the other beta blocker, Ablok. Beta blockers usually lower the pressure and the heart rate.- Do you plan on weaning off of this?
Last week I took by accident two half pills (total 40mg) at bedtime, instead of the usual one. The next day was one of the worse days in my life. Similar things had happened before, with any change for plus or less. I decided then to quit it at any cost and switch back to Ablok, since I don’t recall any problem with this one. Today is the third day of the switch, and I’m having a very bad time, just for having substituted one of the three daily 20mg doses for 25mg of Ablock. Last night I was not able to sleep - each time I started I would wake-up with severe pains in the throat.- Did your Doctor give this to you to help with withdrawal or did you have high blood pressure?
In a certain sense, for the withdrawal symptoms, even considering that the doc, then a psychiatrist, believed it was only anxiety I had, not related to medicines.- Was it their suggestion or yours?
It was his suggestion.My final observation is: if you are sensitive to medicines, be cautious with Inderal. It’s a very strong medicine, acting on the brain. I can suggest you some places on the Internet where it is discussed.
Be strong and good luck!
Bob
Posted by Brazilnut on July 16, 2007, at 21:51:41
In reply to Re: Mirtazapine: 10 days, 10 years – a question, posted by Maritza on July 11, 2007, at 13:05:16
Dear Maritza,
Thanks for your interest! Sorry for this so looong post.My heart and blood pressure were always OK, but I had palpitations and high blood pressure 3 years ago, when I was taking Stilnox (Ambien) and missed some doses. My GP gave me Ablok (Tenormin), a “beta blocker” such as Inderal. Ablok controlled both palpitations and pressure nicely and I took it for 2.5 years.
I’ll give magnesium a try. Was it effective for you? Are you completely recovered from the spine issue? How long did it last?
Now I answer, as much as I can, your interesting questions:
- My main question for you, at this point, is how to divide the pills up into such small doses, (.5, etc)?
I used scissors, after having tried sharp knives and a pill cutter (not good here in Brazil). I used to start with a 30mg pill and to divide it in twelve parts– of course they were not equal, but the important thing is to take each time equal or smaller amounts, as an average. To go below that size I scratched down those 1/12 pills, with the scissors or a nail, depending on the size. I prepared the necessary number for a week, all as much as possible alike (I used to take 3 a day, in order to keep the concentration in my blood as even as possible). For the next week I would prepare another batch slightly smaller. Of course at a certain point I was not able to assess the weight of the pills, but I was sure that, in the average, I was taking each week smaller or equivalent pills. So the 0.5mg was just a guess. I could buy mirtazapine in any dosage (I don’t know how small) in those pharmacies that prepare medicines to order (I don´t know the English term). It would be even much less expensive, but I tried it once and found the “power” of the drug lower than the manufactured one, what would require a painful adjustment.- also, are you only taking Inderal at this point?
I take also St. John´s Wort (in a concentrated form sold here as Iperisan), to compensate the antidepressant effect of mirtazapine; Ginkgo Biloba, as antidepressant also and brain stimulant; and valerian plus lupullus (sold here as Remilev) for sedative effect.- How does that make you feel?
Inderal was prescribed for anxiety. It looks like it is not officially indicated for this purpose in the US, but it is widely used by performers, such as musicians or speakers, to control stage fright. I stopped then the Ablok I was taking for the pressure, because they are equivalent for this purpose. That was in last December, when I was weaning off mirtazapine (45mg to 22.5mg) and risperidone (21mg to zero), and was having heavy anxiety attacks, always at wake-up time. At the beginning it worked, but with time not anymore. When I decided to quit it I discovered I couldn’t: I would have unbearable anxiety attacks with any change in doses. I made a search on the Internet and discovered that Inderal may have dozens of frightening side effects and withdrawal problems, for some persons – it seems that only for a very small minority, since it has been prescribed successfully for millions for many years (I read somewhere that at one point in time it was the most sold medicine in the US).- What is your blood pressure?
Now it is OK. At wake-up, when I have those attacks, only 13/8. The rest of the time about 11/7 (I think in the US it would be 130/80 and 110/70.)- Did it lower it?
It certainly helped to keep it down as a replacement for the other beta blocker, Ablok. Beta blockers usually lower the pressure and the heart rate.- Do you plan on weaning off of this?
Last week I took by accident two half pills (total 40mg) at bedtime, instead of the usual one. The next day was one of the worse days in my life. Similar things had happened before, with any change for plus or less. I decided then to quit it at any cost and switch back to Ablok, since I don’t recall any problem with this one. Today is the third day of the switch, and I’m having a very bad time, just for having substituted one of the three daily 20mg doses for 25mg of Ablock. Last night I was not able to sleep - each time I started I would wake-up with severe pains in the throat.- Did your Doctor give this to you to help with withdrawal or did you have high blood pressure?
In a certain sense, for the withdrawal symptoms, even considering that the doc, then a psychiatrist, believed it was only anxiety I had, not related to medicines.- Was it their suggestion or yours?
It was his suggestion.My final observation is: if you are sensitive to medicines, be cautious with Inderal. It’s a very strong medicine, acting on the brain. I can suggest you some places on the Internet where it is discussed.
Be strong and good luck!
Bob
Posted by Maritza on July 16, 2007, at 23:16:13
In reply to Re: Mirtazapine: 10 days, 10 years – a question, posted by Brazilnut on July 16, 2007, at 21:51:41
Thank you for the very thorough response! I thought I'd tell you I am very impressed with your English, knowledge and patience ( especially in cutting the pills into 12 equal doses! LOL!)
I thought you'd find this interesting; today I took my mother (68 y/o) to a neurologist because she has alot of pain, also from herniated discs. Her doctor prescribed her Cymbalta for pain. She has never used antidepressants and is not depressed. I am completely against her use of this, for reasons which I'm sure you can imagine. She thinks it can help her because "the doctor said so". I can't decide whether these doctors are naive, ignorant or evil!
Yes, Magnesium does help calm the nervous system and I've stopped the morning dose of Celexa (10mg). I also started drinking Noni juice. There are claims of many benefits, particularly blood presure regulation and strengthening of the immune system. It is an adaptogen, so it responds to fluctuations in blood pressure by normalizing it. Many people claim they were able to stop taking BP meds just by drinking 1oz/day. I smoke so I take 3-4 oz/day. It calmed me immediately, making me feel overmedicated, so I stopped the am dose of Celexa. I plan to Quit smoking in the next few weeks. I need to be medically cleared to use the patch by my Cardiologist, who I consulted because of palpitations also. I then plan to cut back on Remeron, to about 3.5mg in about 1 month. I may restart the 10mg of Celexa at this time, if I need to, or maybe drink more Noni juice. I appreciate your correspondence so I thought you might like to know about the Noni, especially since you use supplements. I also take Ginko and have found alpha lipoic acid to be good for mental alertness. I used Valerian some years ago and found it to be addictive. It has a similar chemical makeup to valium and caused me to have tremendous mood swings. I also take some supplements that activate my metabolism, such as green tea concentrated, yerba mate and others. The list is very long. If your interested I'll list them for you. I was wondering if you had any weight gain on Remeron or loss since discontinuing it? I gained 10 lbs in 1 month and have lost it very slowly over the past three months as I changed dose from 30-7.5mg Remeron. This has been a very difficult struggle. I eat very low fat, low carb, and low calorie and include all of the necessary nutrients, etc. and excercise every day by alternating rollerblading, biking, raquetball and long walks on the beach. Thank God my neck has recovered completely and I am pain free! I need to lose 10 more lbs but I don't have three months left to be so agressive with the activity. I am a High School teacher and will begin two-jobs in September. I have been unemployed due to my injuries/surgery since last June. The doc keeps telling me that Remeron does not effect the metabolism but I disagree. Do you have an opinion on this? Thanks so much for your time, I apologize for the length of my posts. My God bless you with peace as He heals your body and mind!
Sincerey,
Maritza
Posted by Brazilnut on July 21, 2007, at 9:24:09
In reply to Re: Mirtazapine: 10 days, 10 years – a question, posted by Maritza on July 16, 2007, at 23:16:13
Dear Maritza,Thanks for your kind words. My English is not that good, I am just a perfectionist who tries hard. I lived two years in the US in the 80's, for professional reasons, and that helped – even if I was in Oklahoma… (ha ha) As for knowledge, I have only what resulted from my own long, unhappy experience, what I learned in forums like this one and from some Internet reading. Cutting those pills was really boring, but was the thing to do.
My mother, 87, was also offered an antidepressant a few months ago, for some circumstantial reason. Fortunately my sister, who takes care of her, didn’t agree. The problem with antidepressants and the like is that they are good for the majority of patients, and doctors tend to believe they are good and harmless for all. A few suffer mild side effects and withdrawal symptoms, and just a tiny minority like ourselves, which is out of the statistics, experience severe consequences. And there’s no way of knowing beforehand who will benefit and who will jump into a nightmare. Anyway, I believe that if one can avoid it, it’s better.
I had never heard of Nonin. A quick search on it with Google really impressed me. I even discovered the juice is being sold in Brazil, at US$ 80.00 per 1 liter bottle. It’s crazy, they just don’t want to sell. I’ll wait for better prices.
I have not found any previous reference to Valerian as addictive, but I’ll take care - usually what is addictive to someone is addictive to me.
I know green tea is rich in flavonoids, but I avoid it for the caffeine. Yerba mate is a traditional infusion, of Indian origin, in south Brazil. I tried it as a boy, but didn’t like - it’s hot like hell in the traditional way. What are its benefits? I would be interested in supplements for easing anxiety. Any suggestion? I am a vegetarian (actually a “fishtarian”) and have a reasonably healthy nutrition, plenty of salads, fruits and vegetables every day.
With Remeron I gained 4 kilos on top of 72, not much for 1.78m height. (Can you understand these figures?) Now I’m back to 72. My preferred exercising is ballroom dancing; it is really a therapy, for body and mind.
I am not prepared to give an opinion on Remeron and metabolism. But from a layman’s point of view, if it causes weight gain, changes sleeping, mood and sexual performance, isn’t it changing metabolism?
Thanks for praying for me. I need it.
All the best for you!
Bob
Posted by remerwrong on July 27, 2007, at 19:12:30
In reply to Re: Mirtazapine Withdrawal, posted by jules354 on May 24, 2006, at 10:58:32
I am tapering off of mertazpine and having spasms in my esophagus. Has anyone experienced this?
Posted by Maritza on July 27, 2007, at 22:47:10
In reply to Re: Mirtazapine: 10 days, 10 years – a question, posted by Brazilnut on July 21, 2007, at 9:24:09
Hi. How are you? Thanks for your reply. There are a couple of references I wanted to inform you of. The first is a nutrition company that sells supplements at discount prices. The web site is www.Puritan.com Customer Service at 1-800-645-9584 or E-Mail their customer service at custserv@puritan.com. The company is called Puritan's Pride. I order some of my many supplements through them. They have Noni juice and capsules at very good prices.
The second reference is PDRHealth.com. This is an online Physicians Desk Reference that includes info on medications and supplements. Lok up using the search tool, L-Theanine, (I found it under Theanine). Theanine is an amino acid found in Green Tea. One of its many benefits is that it promotes calmness and relaxation by increasing dopamine and seretonin levels in the brain. It also counteracts the effects of caffeine. Read the literature regarding this, when you can. You may find it interesting and useful in helping with withdrawl/ anxiety. The Japanese use it for this purpose. I recently tried it and found it too mellowing, but I am still on 7.5mg Remeron. I will definately use it when I decrease my dose. I also recently added L-Carnitine to my regimen. You may want to read about this also at PDRHealth.com. In combination with Co Q10 and Alpha Lipoic Acid it acts to improve neurological function by increasing mental clarity. In addition it protects brain cells and has numerous other benefits for the heart and cardiovascular system. L-Carnitine may be a little bit stimulating so I don't know if it would be good for you, but I am still trying to offset the mental haze associated with Remeron. You may also want to use this site to find out more info about Valerian root. I believe the L-Theanine would be very helpful,but, of course, discuss this with your doctor first.
I hope these references can be helpful to you.
May God Bless you with a complete recovery soon!
Maritza
Posted by Brazilnut on July 31, 2007, at 10:06:12
In reply to Re: Mirtazapine: 10 days, 10 years – a question » Brazilnut, posted by Maritza on July 27, 2007, at 22:47:10
Hello Maritza! Thanks for the excellent references. The material on theanine convinced me for the scientific support. I will try it, also my wife who has sleep problems. I will consider Carnitine later on. And Puritan has indeed very good prices – I compared for stuff I use to buy.
As for myself, very tough days. I’m done with Remeron for more than a month now and certainly part of my problems are related to its withdraw. But the major contribution is from Inderal, I am sure. Nothing affected me so much, not even klonopin or Efexor or Risperdal. If I take it, anxiety persists and I suffer horrible side effects. If I start weaning off, I experiment the worst withdrawal ever.
I wish you are better. A short recover for you too!
Bob
Posted by Brazilnut on August 9, 2007, at 14:56:05
In reply to Re: Mirtazapine: 10 days, 10 years – a question, posted by Brazilnut on July 31, 2007, at 10:06:12
Hi!
Now I’m really scared. I have been weaning off stuff the last 2 years – Efexor finished 2.5 years ago, Klonopin 2 years ago, Risperdal 7 months ago, mirtazapine 1.5 months ago. Everything has been done carefully, but painfully.
6 month ago I was given Inderal to help with the anxiety, as something harmless. Well, not to me. Now it is the only one left (around 47mg, divided in 4 doses) and I am struggling as never. A few days ago I decided to try Phenergan to alleviate symptoms, since it allowed me to quit Risperdal and many people mention it used in withdrawals. I took 25mg by bedtime 2 days, then reduced to 12.5mg, then zero, to see what would happen. Yesterday was the first day without it and it was better than the previous. But suddenly today is pure hell. I had never been like this before. Extreme anxiety and hot flashes, pain, dizziness… I was not able to leave home to work.
Does anyone believe could be Phenergan the culprit? Or the combination of it with Inderal? Or the mirtazapine finished less than 2 months ago? Or the summing up of everything I took?
Thanks,
Bob
Posted by Brazilnut on August 9, 2007, at 20:55:21
In reply to Re: Mirtazapine Withdrawal, posted by remerwrong on July 27, 2007, at 19:12:30
Hi Remerwrong!
It looks like nobody heard of that. I made a web search with "mirtazapine/remeron" and "esophagus", nothing related to withdrawal turned out. But many things are possible with mirtazapine...
I hope you are well now.
Regards,
BobP.S.: I loved your nickname...
Posted by Brazilnut on August 23, 2007, at 10:36:52
In reply to Re: Mirtazapine: 10 days, 10 years – a question, posted by Maritza on July 1, 2007, at 23:30:46
> Hi Bob,
> I have been on Remeron for about 6months. I have cut back from 30mg to 15mg, then to 7.5mg with 10mg of Celexa added in the am.
...
> MaritzaHi Maritza,
How are you now with your taper?I found a helpful site, www.benzo.org.uk, and became a member of its forum, because much of what I feel now is caused by my long use of benzodiazepines in the past.
What may be interesting for you is that they are totally against any supplement or additional psych drug during withdrawals. I think that rejecting supplements en bloc, without considering specific pros and cons, is quite a radical attitude. Perhaps they do so to prevent abuse.
They provide also reliable information on Valerian, showing that it acts as a benzo and may yield severe withdrawal symptoms (as you had told me). Other references say that St. John's Wort acts as an SSRI A/D and may also cause W/D symptoms. (I am on both...)
Perhaps it would be worth for you to take a look at their information, even you are not tapering benzos.
As for me, I am not well. I tried 2 times to start weaning off Inderal and things worsened quickly. I went back to the original dose, but things keep worsening. I don't know what to do next.
All the best for you!
Bob
Posted by Maritza on August 24, 2007, at 0:26:19
In reply to Re: Mirtazapine: 10 days, 10 years – a question, posted by Brazilnut on August 23, 2007, at 10:36:52
Have you been to your doctor? Do you have high blood pressure? Blood pressure medications are not meant to be weaned. What do you mean by "not doing well" and " getting worse?" Have you had a complete medical evaluation? It takes a while for blood pressure medications, such as Inderal, to stabilize your blood pressure. If you didn't need it and your doctor gave it to you this may result in you becoming dependent to maintain a normal blood pressure. With all of the fluctuations your body will take time to adjust and you may need to stay on this now. How did you feel on remeron, in terms of anxiety and depression? I have just quit smoking (5 days ago). I am feeling irritable and moody. I used the nicotine patch. I quit because I am starting a new teaching job in September and I want to be a good role model for my students (I teach High School Science. I feel that remeron has helped to control both my anxiety and depression and although it has some side effects I don't want (ie. weight gain, restless leg, tired, foggy, unfocused state of mind, and the need for alot of sleep)it has controlled the very serious problems that caused me start it in the first place. So, I'm not in a rush to stop taking it, right now. I need to be mentally sharp and emotionally stable to be a good teacher. Remeron treats my emotional state (which caused sever physical symptoms) but sacrifices some of my intellectual abilities. Withdrawing from nicotine is not helping this any. I'm not sure now is a good time to commit to quitting smoking but I want to have and maintain good physical and mental health. So, I feel conflicted and am lacking confidence because of these and other complicated reasons. I wish you good health and well being as well and hope that you continue to consult with experts until you are well again. Keep searching for Doctors that are familiar with your needs. Unfortunately, not all physicians are equal. Do not settle for hopelessness. Your body is in a state of unbalance and you need to make sure your doctors are properly assessing all of the factors and listening to you carefully. And that they are skilled in treating patients with the same problems as you. You may have some underlying deficiency or condition that is being overlooked because your doctors seem to only be treating symptoms. Also consider seeing a therapist or religious/spiritual counselor. There may be subconscious issues that are not being resolved which are expressing themselves physiologically. Being on Remeron has allowed me the ability to cope with many very serious and highly disturbing issues and learn ways to cope with future stress by allowing me to be at peace while I dealt with them. As I wean down, reality begins to creep back in and each day is a challenge of coping with past and present issues using the lessons I learned while on higher doses. My reality will increase drastacally with the start of my new job. This is why I feel the timing is not right to stop this medication but slowly learn to cope with these new challenges, then slowly wean down some more. I don't think I will reduce my dose again until November and if I am unsuccessful at quitting smoking, I will try again when I have met these next challenges. My point is you may have stopped the medication without learning how to deal with the challenges of life. Therapy is something we all can benefit from, but those of us that experience anxiety/ depression in particular need a source of guidance and perspective and we also greatly need to strengthen our faith. Imbalances in the mind, body or spirit can cause physical symptoms. For many of us, our imbalances are in all of the above because they are all connected together. Please seek further help and be persistant. In my church (I am Catholic) I have found great strength by being prayed over in healing masses. I have also increased my faith and spirituality by reading various spiritual books, including the Bible. I believe that I learned to build a strong personal relationship with Jesus Christ and He has guided me, healed me and strengthened me. He has also built a strong support system for me. Something which I never had. By surrendering myself to him and changing my heart He has renewed my life and provided me with many Blessings. Being at peace with the fact that I may need to stay on this medication a while longer is just one of them. I hope you find your source of peace, hope and strength. May God bless you.
Maritza
ps. with all that said, I still think SunTheanine might help you.
ps. sorry so long.
Posted by Brazilnut on August 26, 2007, at 14:38:43
In reply to Re: Mirtazapine: 10 days, 10 years – a question, posted by Maritza on August 24, 2007, at 0:26:19
Hello Maritza!
I’m happy to see you are on control of the situation and with a happy future ahead! But I hope someday soon you’ll quit Remeron. None of these drugs are made for long term use. Some people can benefit from their use for years, but many develop tolerance, addiction and get trapped.
Congratulations for having quit smoking! And with a so noble motivation as being a good model for your students. This is great!
I never had high BP, except for short periods quitting (legal) drugs. Anyway, Inderal has a second indication to control anxiety and that’s way it was prescribed. That was by the end of last year, when I was having withdrawal symptoms from dozens (yes, 25!) of different drugs I had the 9 years before.
My struggle with prescribed meds started in 1997. I had sleep apnea (snoring) and trouble to sleep, so I asked the doctor “something to sleep” during coming vacations. He gave me Xanax, without any information on what was it or how to stop it. I stopped cold turkey when the box finished and felt like crazy two days later. I went to a psychiatrist who didn’t recognize a withdrawal crisis and simply told me I had depression, and gave me an antidepressant. This started the familiar cycle of taking a new med, feeling bad, stopping it, feeling worse, starting a new one… changing docs and diagnostics (depression, bipolar, anxiety, apnea again, RLS, panic...)
In 2005 I hit that site on benzos, and finally understood what was going on. I didn’t need any of the drugs given to me, including Remeron and Inderal. They were given because doctors were trying to treat what they believed to be illnesses but were only withdrawals symptoms. But I didn’t grasp at the first moment how serious was the problem and how long the recovery could last, so I accepted some other “safe” drugs to cope with the withdrawals.
Initially Inderal helped to control the anxiety, but soon I developed tolerance. Now I have “interdose withdrawals”: when a dose wears off and the next is not in action, the body feels I have not enough and withdrawal symptoms start - in this case unbelievable anxiety attacks. If I look for a doctor now, I would be prescribed more of the same and I could end up trapped forever.
This is the problem I have: protracted withdrawal symptoms from so many drugs and tolerance to Inderal. The last long term (1 year) benzo I had was Klonopin, which I quit 27 months ago. But the protracted symptoms can stick to you for years.
Unfortunately, there is no expert to treat this. It is only patience, strength and a healthy life style. I strong recommend you to take a look at that site (www.benzo.org.uk) to understand what these drugs can do. The site is very well organized and documented. It is based on the feedback of hundreds of benzo sufferers and in the scientific work of Prof. Ashton. Their forum is very supportive, no post is unanswered, by users or moderators. I know you are not on benzos, but to protect your family and friends it’s better be informed.
My GP, after many years, believes now what I say on benzos, so I’m not alone. I’m doing CBT for 6 months, but there is not much help from there. I am a catholic too, or at least was, because I don’t practice any more.
Maritza, it is my pleasure to see you well and going ahead! God bless you too!
Bob
Posted by Brazilnut on August 26, 2007, at 19:13:57
In reply to Re: Mirtazapine: 10 days, 10 years – a question, posted by 13243 on July 9, 2007, at 18:14:09
13243:Congratulations for your decision!
But from my own experience and my readings on the Internet I would say a slower taper would be advisable. Many times withdrawal problems beguin days or weeks after the last pill. And then there is no coming back.
Good luck!
Bob
Posted by Maritza on August 26, 2007, at 23:09:53
In reply to Re: Mirtazapine: 10 days, 10 years – a question, posted by Brazilnut on August 26, 2007, at 14:38:43
Thank you for your encouragement but I could not have moved forward without reaffirming my faith and surrendering myself to God. I have made many mistakes and have failed in many important areas in my life over the past few years. I believe God spared my life in my car accident. While I was recovering from my neck surgery He made me aware of how much I had disappointed Him. This caused me tremendous guilt and I developed severe anxiety. I believe God was disciplining me so as to correct me and call me back to Him. He did this because of His great mercy and love. What father does not correct his child? Although I didn't realize this at the time, I did know that I had to change myself completely. I also knew I could not do it on my own. No one could change me. Only God. But He would not do so unless I surrendered myself to Him, completely. This I have done and will always do. I am eternally grateful to Him and want only tell others or show them by my example His great power, love and mercy, for all of us. Surviving my accident truly was a miracle! I lost control over my car in ice and was heading directly into a very large tree. I drove a convertible (very light weight) and the airbag did not deploy. My surgery was very risky and complicated. My doctor told me a number of times about the risks of dying or becoming comatose or permanently paralized, and the possibility of permanent severe pain. I was losing function in both my arms and needed to have the surgery done. Three discs were badly compressing my spinal cord. God's mercy spared me from these outcomes and I have been swimming, biking and going to the gym all summer! Additionally, due to factors that I caused myself, the likelihood of me finding employment in the career I love, teaching, was close to impossible. God's power opened doors for me and I now have two teaching jobs! The factors did not change, but with God, all things are possible. Many numerous sorrows from ruined relationships have been turned into peace and joy. I divorced my husband 2 years ago because of many reasons. Although I failed as a wife, I have asked God and my ex-husband for forgiveness and have been given a peace like I've never known before. I have learned that a parent can not help a child that has run away from home. The child has turned his back on their love, compassion and support because they want to have their own way. I have also learned that if that child returns home, apologizes sincerely, and allows his parents to take care of him, they will welcome him home and provide everything he needs, because it makes them happy and because they love him. It was that way with my parents. I moved home before my surgery and have been here since. I married young (24) to escape their control. I've learned much since then. Although I take responsiblity for my failings in my marriage, my ex-husband was an alcoholic who abused me mentally and eventually physically. We were married for 10 years. As a result, I lost my faith and nearly lost my soul. I began praying fervently before my surgery. God is our Father, and because He is perfect and Holy, His love is perfect and Holy. He is the Father I spoke of above. His love, power and mercy is beyond our understanding but we don't need to understand it to receive it. He is more powerful than abuse,addiction, anxiety, depression Klonpin, Remeron, Inderal or any physical or emotional distraction we are challenged with. These challenges are meant to turn us away. Without God we are trapped. In God there is Hope. I am blessed to experience so directly His awesome power and will always be grateful. I tell you this because I want my life to bring Glory to Him. His goodness has allowed me to help others and they will inturn glorify Him as well. Suffering does not come from God but He allows it in that it can motivate you to turn to Him. He's waiting for you. He will change your life, your heart, your mind, your body and your soul. I place my life on it. I am a living testimony of it. May God open your heart and mind to this message, for His Glory, because it makes Him happy to take care of you. May He guide you toward the help you need and may you have peace in your journey.
Maritza
ps. 8 days smoke-free! And zero withdrawal!!
I have been going to masses at a Catholic Church that prays over its members indiviually. They offer this service once a month and each time my faith is strengthened by the grace I receive. I've shared some of my miracles with you above, and those were just the smaller ones.
Posted by Brazilnut on August 29, 2007, at 13:00:00
In reply to Re: Mirtazapine: 10 days, 10 years – a question, posted by Maritza on August 26, 2007, at 23:09:53
Maritza,I could not imagine how much did you overcame. You are a survivor.
As for religion, I have been thinking of it my whole life, and currently I am satisfied with my view. Thanks for your genuine interest in helping me. You are a true Christian.
God bless you forever.
Bob
Posted by yataghan50 on December 7, 2007, at 5:28:00
In reply to Re: mirtazapine/remeron updates?, posted by caustin on July 1, 2006, at 5:14:58
Hi guys. Just wanted to add my experience and ask a few questions
I have been off mirtazapine for about 3 weeks after taking it quite consistently for about 6 months (15mg daily).
I am struggling. I have been suicidal, severe mood swings, some nights I feel so hot, anxious and sickly in my stomach I can't sleep.
I want to know, does it get better? I don't know how much longer I can hold out, but I have come this far I don't want to relapse now.
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