Posted by JrBecker on May 5, 2003, at 23:58:07
In reply to Remeron for Atypical Dep » jrbecker, posted by Jack Smith on May 5, 2003, at 12:54:25
Jack,
yes, the sedation certainly does not help my atypical symptoms, however, Remeron can be quite stimulating at higher doses. With every drug there are side effects, and the big sacrifice with remeron is the sedation and a slight propensity toward weight gain. But the more you get up there in dosage the more these two effects diminish to a very low level. Both side effects are matter of degrees subject to dosage levels as well as an individual's ability to tolerate as well as adapt to it. OK, with the bad side out of the way, it's a great antidepressant. I mean this drug works like no other modern class antidepressant I've been on. It's sort of a jack-all-trades med: it antagonizes 5HT2(a&c), 5HT3 and noradrenergic alpha-2 receptors. To answer your question, it is not a reuptake inhibitor but causes a cascade of increased activity at dopaminergic and noradrengic sites because of its antagonism at those receptors. Also, it indirectly decreases cortisol output from the HPA. And don't discount the possible role that the antihistamine effect probably has as an AD. So, it's one dirty drug! And it works well. Are the side effects manageable? Yes. Will I still try other drugs as they come out (e.g., Duloxetine) to see if it has a better efficacy to side effect ratio? Sure. But right now it's working and that's the best I can hope for before having to think about trying out an MAOI.
Should you try it? Only doing a trial yourself will let you know if you can tolerate it. But I would definitely give yourself a period of at least 1-2 weeks where you know you wont have too many responsibilities for a while b/c it will zonk you out at first.
Sorry to hear the Effexor is working so-so. It's a rough ride. Perhaps when duloxetine comes out this summer, you can find a better match with an SNRI.
JB
poster:JrBecker
thread:223661
URL: http://www.dr-bob.org/babble/20030505/msgs/224611.html