How do I taper off mirtazapine (mirtazapine) after taking 15 mg for 2 weeks and 22 mg for 2 weeks?

Tapering Off Mirtazapine After 4 Weeks of Use

After only 4 weeks of mirtazapine use (15 mg for 2 weeks, then 22 mg for 2 weeks), you should taper by reducing the dose by 10% of your current dose every 1-2 weeks, which means dropping from 22 mg to approximately 20 mg, then continuing this pattern until you reach very low doses before stopping completely. 1, 2

Specific Tapering Schedule for Your Situation

Given your short duration of use (4 weeks total), your taper can be relatively straightforward but should still be gradual:

• Week 1-2: Reduce from 22 mg to 20 mg (approximately 10% reduction) 1
• Week 3-4: Reduce to 18 mg (10% of 20 mg) 1
• Week 5-6: Reduce to 16 mg 1
• Week 7-8: Reduce to 15 mg (the standard starting dose) 1, 2
• Week 9-10: Reduce to 13-14 mg 1
• Continue reducing by 10% every 1-2 weeks until you reach the smallest manageable dose 1

Each new dose should be 90% of the previous dose, not a straight-line reduction from your starting dose, to prevent disproportionately large reductions at lower doses 1.

Critical Principle: The Taper Rate Must Match Your Tolerance

The taper rate must be determined by your ability to tolerate reductions, not by a rigid schedule 1. Pauses in the taper are acceptable and often necessary when withdrawal symptoms emerge 1.

• If withdrawal symptoms become severe at any point, temporarily return to the previous dose and then resume tapering at a slower rate 1
• The FDA label explicitly states to "gradually reduce the dosage of mirtazapine rather than stopping abruptly whenever possible" 2

Withdrawal Symptoms to Monitor

Watch for these specific withdrawal symptoms during your taper:

• Anxiety and panic symptoms 1, 3
• Insomnia and sleep disturbances 1
• Mood changes 1
• Panic attacks (can occur as early as 2 days after abrupt discontinuation and may recur every 1-2 hours) 3
• Palpitations, dyspnea, dizziness, nausea, and blurred vision 3

A case report documented severe, recurrent panic attacks occurring after abrupt discontinuation of mirtazapine following just 10 weeks of treatment, illustrating that even medium-duration therapy requires progressive tapering 3.

Follow-Up Requirements

• Follow up at least monthly during the taper, with more frequent contact needed during difficult phases 1
• Monitor specifically for withdrawal symptoms, mood changes, and any emergence of anxiety or panic 1

Important Considerations for Your Short Treatment Duration

Since you've only been on mirtazapine for 4 weeks (which is relatively short), you may tolerate a slightly faster taper than someone on long-term therapy. However:

• The FDA recommends dose changes should not be made in intervals of less than 1-2 weeks to allow sufficient time for evaluation 2
• Even after medium-duration therapy (10 weeks), progressive tapering is advisable to avoid withdrawal symptoms like panic attacks 3
• Your body has still developed some physiological adaptation to the medication, making gradual discontinuation important 1, 2

Reaching Very Low Doses

Once you reach the smallest available dose (typically 15 mg tablets can be split), the interval between doses can be extended before complete cessation 1. For example, you might take your final low dose every other day for a week or two before stopping entirely.

Common Pitfall to Avoid

Do not use rigid tapering schedules that ignore your symptom emergence—the taper must be individualized based on how you respond 1. The 10% reduction every 1-2 weeks is a starting framework, but you may need to slow down or pause if withdrawal symptoms appear.