Posted by Sunnely on July 9, 2000, at 19:43:26
In reply to Re: What causes Remeron Weight gain, posted by allisonm on July 9, 2000, at 13:19:59
Hi Allison,
Here are the references:
Regarding sedation:
1. Psychopharmacology of Antidepressants by Stahl, SM, Martin Dunitz, LTD, 1997. Dr. Stephen M. Stahl, at the time of publication was Director of Clinical Neuroscience Research Center and Adjunct Professor of Psychiatry, University of California, San Diego. He is a well-known psychopharmacologist, U.S. and abroad. In his book, at page 79, he mentioned the "Clinical Pearls for Mirtazapine." He mentioned that "sedation may be INVERSELY related to dose. Lowering the dose may thus increase sedation."
2. Mirtazapine. In: Biological Therapies in Psychiatry Newsletter, January 1997, Gelenberg, AJ (editor). Dr. Alan J. Gelenberg is also a noted psychopharmacologist. I believe he is now the Chairman of the Department of Psychiatry at Arizona University. In his review of Mirtazapine (Remeron), he mentioned that "some clinicians believe higher initial doses of mirtazapine might produce less sedation."
I am not aware of any prospective study directly comparing the effect of low-dose vs. high-dose Remeron on sedation. Of course, each person is different as to response and side effects from psychotropic drugs.
Regarding weight gain:
1. Weight gain associated with antidepressant therapy. A Teaching Monograph. Rosenbaum, JF, Gadde KM, and Ginsberg DL, moderators. Dr. Rosenbaum is with the Dept. of Psychiatry at Massachusetts General Hospital, Boston, MA. Dr. Gadde is affiliated with Dept. of Psychiatry at Duke University Medical Center, Durham, NC. Dr. Ginsberg is affiliated with the New York University Medical Center, NY, NY. The following was mentioned in this article: "Weight gain with Remeron appears to be inversely related to dose, the European and US trials illustrated. When exceeding 15 mg, the H1 receptor becomes saturated and other receptor effects, such as increased release of serotonin and norepinephrine due to alpha2-adrenergic antagonism, predominate, and enhanced appetite and weight gain may be less of an issue."
2. Weight Gain Varies with Antidepressants. In: Clinical Psychiatry News, May 1999. The following was mentioned in this issue: "With mirtazapine, weight gain can occur as early as the first week of treatment, is usually associated with increased appetite, and is most likely due to the drug's antihistamine effects. Appetite diminishes after 4-12 weeks of therapy, however, and weight generally returns to baseline among patients who diet."
Again, different individuals respond differently to psychotropic pharmacological (therapeutic and adverse) effects.
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> Sunnely,
>
> I am curious where you got your information. I have found sleepiness did not decrease with a higher dose. Sleepiness always increased and did not level off over time -- ie, I was stumbling around on 45 mg. Always did. It never lessened. And I was in a thick fog every morning. I had to take the 45 at home so that I could go to bed quickly when it kicked in. I could never be out or drive on 45.
>
> I got sleepy and woozey on 30 mg, but it did not cause me to be unsteady on my feet as I was on 45. On 15 mg, the effect is less than 30. I get sleepy. I have taken Remeron for 2 years and 5 months -- at 45 for about a year and at 30 for about a year. Back down to 15, and I am just now finally losing weight.
>
> I have asked him more than once, and my psychiatrist insists that weight gain INCREASES with a higher dose. I found this to be true. Lithium exacerbates the weight gain. I could not get the weight off no matter what I did with the high Remeron dose and Li augmentation. I took Li for 6 months of the 2.5 years on Remeron.
>
> Thanks.
>
> Allison
poster:Sunnely
thread:39864
URL: http://www.dr-bob.org/babble/20000708/msgs/39915.html