I know people who had epic on-again, off-again romances. (Mostly in college.) I never had one of those romances, but I do have mirtazipane.

I’ve blogged about mirtazipane before, but here’s my personal timeline:

• I started taking mirtazipane in July 2013 when I was first diagnosed with postpartum depression. I took it at bedtime and it definitely helped me sleep. I wrote all about it in my memoir, Adventures with Postpartum Depression.
• My first psychiatrist yanked me off mirtazipane and Zoloft in February 2015 when I learned I was pregnant with my second child.
• When Julian was born in November 2015, I started taking Zoloft again. My new psychiatrist and I decided that I could wait on the mirtazipane.
• Three months after Julian was born, I started experiencing increased anxiety and insomnia. I tried to tough it out then realized I was being a martyr for no good reason. I called my psychiatrist and we decided to (1) bump my dose of Zoloft from 100 mg to 150 and (2) put me back on 15 mg of mirtazipane at bedtime.
• I took mirtazipane for a year or so and then my psychiatrist and I decided I was ready to wean off Zoloft and mirtazipane.
• I weaned off mirtazipane and was off it for several months but then, early 2017, when I made some dietary changes (quitting sugar, reducing carbs), I noticed a surge in anxiety at bedtime. Along with the anxiety came insomnia.
• I realized that I had been numbing some unaddressed anxiety with food, so I went back on mirtazipane for the rest of 2017. I did a lot of journaling to work through the anxiety and food issues.
• About six or seven months ago, in Fall 2018, I started weaning off mirtazipane for the third time. By the end of 2018, I was sleeping beautifully sans mirtazipane and assumed I did not need the drug anymore.

Whew. So that brings us through December 2018 and what I thought was the end of my relationship with mirtazipane. Then the insomnia returned in mid-January 2019 but it took me about two months to realize I had insomnia. Let me recap:

• First, my shoulder went out on January 13. I remember this because it was the day after I turned 40 and felt like a cosmic joke. Around that time, I started having trouble getting enough sleep. I blamed my sleep issues on my shoulder pain.
• Then, I had a cold. I took Tylenol PM and Nyquil and got enough sleep.
• Shoulder pain continued so when the cold was over, I blamed the shoulder again.
• Shoulder pain was brought under control, but I was still having trouble getting enough sleep. I would fall asleep easily enough but wake up and stay awake for hours and hours. Some nights, I’d be up from 2-5 a.m. Some nights, I was just up until it was time to start my day.
• I decided I needed to wean off caffeine. I always sleep better when I’m off caffeine.
• Another cold. More Nyquil.
• Finally, by mid-March 2019 I was fully off caffeine.
• But still, I was not getting enough sleep.

That’s when I took a deep breath and realized I needed to go back on mirtazipane. Which I did, and hot damn, I have been sleeping beautifully ever since. I’m only taking 7.5 mg, and that amount seems to work for me.

I did have a hiccup this past week. I’ve been off sugar since the beginning of 2019, but in honor of Pippa’s birthday party, I had a slice of red velvet cake and a scoop of ice cream. Then I slipped and started having chocolate every day. After about four days of this, I had a shitty night’s sleep. I slept six hours, woke up, and couldn’t get back to sleep. So later that day, when I had a tiny headache, I decided I “deserved” all the caffeine. Which I drank. And big shocker, I had another shitty night’s sleep. So the next day, I had even more caffeine to compensate. And total big shocker, I had a third consecutive night of shit sleep.

Yesterday, after three nights of crap sleep, I shunned caffeine and sugar, and lo and behold, last night I slept beautifully. I woke up to pee at some point during the night, but I got back to sleep within ten minutes. Bliss!

This is what I have deduced:

• I can splurge on sugar every now and then and still sleep fine. But if I eat sugar every day for several consecutive days, I will sleep like shit. (Fruit does not do this to me. I’m talking about refined sugar.)
• I can drink iced decaf coffee and still sleep beautifully, but I need to keep away from regular coffee and soda.
• I still need to take a small doze of mirtazipane at bedtime.

This leaves me with lots of questions:

• Why do I need mirtazipane to sleep?
• Is there some sort of PTSD lingering from the intense insomnia I experienced when I had postpartum depression?
• Or is there some other anxiety that I need to unravel?
• Or is this sleep issue related to some other health issue? I’ve been a light sleeper ever since adolescence. Is something going on?
• Are there additional dietary changes I can make to sleep better? I’ve quit sugar and caffeine, but what else can I quit? Or alter? Or add?

I don’t expect fast answers to these questions, but I want to pay attention, stay curious and figure this out. To that end:

• I’m seeing my doctor on Thursday morning to talk about my overall health.
• Then I’m seeing my psychiatrist on Thursday afternoon.
• I’ve emailed my therapist to set up an appointment. It’s been almost two years since I ended weekly therapy but now, I’d like to see my therapist every three or four weeks.
• I am planning on seeing a specialist to take about my thyroid. But this post is ridiculously long, so I’ll write more about that later. I need to read more about thyroid issues but sometimes, the thyroid can cause anxiety and insomnia. I am already taking a prescription for my thyroid, so I’ll be chatting with my doctor about that on Thursday.
• And I’m going to keep journaling because journaling helps me figure things out.

At the end of the day, I may just need to keep taking mirtazipane for the foreseeable future, and that’s okay. That’s better than okay. Sleep is the foundation of my health – physical, mental, intellectual and spiritual – and I’m not going to let any stigma about anti-depressants keep me from the sleep I need.