Posted by bissie66 on June 10, 2008, at 10:04:28
In reply to Re: SNRI + Remeron question, posted by Molybdenum on June 8, 2008, at 18:45:57
Hi! I want to thank you SO much for your post! I devoured it. :) And am going to print it and show it to my pdoc if need be. This is really a different angle to view things. The common way of looking at Remeron is always 'less is more' and perhaps that's why I've only ever gone up to 60 mg in my dose. But maybe I've given up on rocket fuel too soon in the past. Wouldn't that be wonderful news! Because that stuff is good! It's the best mix I've ever had. My pdoc is big on it too. I'm going to talk to him about this. Would you recommend increasing the Remeron by 15mg or 30mg at a time?
What about the SNRI? Right now I'm on Pristiq which I'm not holiding out very high hopes for. For one thing the evidence so far is there's no point in increasing the dose. But I've gone an expensive 30-day supply I'll finish out - about 3 weeks left. After that I could go back on Cymbalta which I know worked in the rocket fuel. That has an adjustable dosing.
Thanks for the info on Essential Psychopharm. too. I've found that on the web and will def. check it out.
Finally, Modafinil sounds awesome! What do you take it for? I don't think my pdoc would prescribe it due to hospitalization last year for substance abuse. Sigh. There was a time he freely game me benzos and Adderall. I know what you mean about Ritalin though. Adderall was good for a time but in the end made me crazy. I appreciate how much you want to feel good though and how you always think more will feel better. :)
Thanks again for your post. You really gave me hope! Bissie
> Hi bissie66,
>
> About 5 years ago I was taking citalopram 20mg, adding another 20mg every 6 months up to 80mg. I was very busy at work & very tired (& depressed) and so I didn't realise that the citalopram had pooped out on me. I didn't know about the concept - that it could just stop working for me(!). What other drugs do that??? I sure didn't know. The state of exhaustion & covert-poop-out coincided with me losing my job. So I decided to quit the citalopram, the methylphenidate & any benzos I was on. I tapered down the citalopram by 20mg each week. So in 4 weeks I was off everything. I didn't get any withdrawal effects, even though I was expecting some - tapering down so quickly. In hindsight, maybe the poop-out helped free me from withdrawals?
>
> I felt REALLY DEPRESSED but I thought it was probably just rebound from taking them for so long. It just didn't get any better & so after 4 months of this hell I went back to the GP. He decided it wasn't rebound & put me on venlafaxine 75mg. Then I started doing a bit of research on the net. I'd felt so bad for at least the last year - even more so the last 4 months that I really wanted the biggest & strongest drugs to help me out. I had no more reserve of patience to draw upon. I wanted to feel OK again ASAP..!
>
> That's when I got hold of a copy of Stephen M. Stahl's "Essential Psychopharmacology". It's available at torrent sites as a PDF if you're interested. When I read about the rocket fuel, I convinced my GP to increase my venlafaxine & add mirtazapine too. I don't know how much was the mix & how much was my positive anticipation - either way, I started to feel incredibly less depressed. Then after a few months I wanted to increase the doses a bit but the GP wouldn't do it because he had no patients on more than I was taking. So he referred me to a pdoc. He increased me to 300mg ven + 90 mirt. That worked great for a while. Especially the way the mirt effected me: if I took it at 8pm, I would literally be stumbling on my way to bed within 45 mins. It was like a knock-out pill. So I ended up getting 10 hrs sleep - which I think helped a lot.
>
> Unfortunately every 6 months or so I'd start to lose the knock-out effect. Otherwise the mix was a fine AD. So each time the doc would bump up my mirt & again I'd get the great sleep. He said the sedative properties of mirt weren't supposed to work like that. They're only supposed to be so pronounced on very low doses. I didn't care 'cos it sure worked for me. BTW, I am one of those idiots that can't help thinking that "more is better", so I also told the pdoc occasionally that I was feeling depressed again (when I wasn't) just to get the ven increased.
>
> So 2.5 years after starting, I peaked at 600mg venlafaxine & 225mg mirtazapine. So it's never actually pooped out on me that I know of - or maybe coincidentally I have countered that with the increased doses? Either way, it's still working really well although at doses that are probably a bit high. BTW, the ONLY side effect I've had in the last couple of years (after we got the ven up to 300mg) was a bit of high blood pressure. So I take a pill for that too now. Other than that, "nothing". So my point....oooh look - here comes the point..!! : If you think it could help, don't worry about increasing both parts of the rocket fuel to my levels. It certainly won't kill you.
>
> I had planned on reducing the doses once my life got a little less stressed. I've actually already dropped my ven down to 450mg & the mirt to 180mg and other than one night feeling awful (maybe unrelated), I am fine & I feel no different. I've been on this new dose for a month, nearly 2 now. In another month or so I might cut it back to 300mg ven + 135mg mirt. That's the plan, assuming I feel no worse - which I was worried about but really haven't experienced so far (!).
>
> So that point again is to consider simply increasing the doses of the mix that worked well for you rather than changing it. Even apparently similar meds within the same class can have very different effects on diff people.
>
> BTW, I stopped taking methylphenidate (Ritalin) 6 months ago - really hated the speedy feeling, effected my judgement & made me feel like crap coming down. Now I take some modafinil instead. It is a WONDER DRUG for me. No speedy feeling, I don't feel that my judgement is impaired at all and it doesn't want to pay-out on you in the afternoon. It's very gentle. Just to keep my sensitivity going, I am taking every second weekend without it. I do feel very low on energy & mildly depressed for those 2 days, but nowhere like I'd feel after taking Ritalin for 5 days. I used to feel like HELL & sleep ALL weekend. Nowadays, on Monday I am all 100% fine again. So another HIGHLY recommended addition if you feel like it might help you.
> Take Care.
>
> "King of Rocketfuel".
>
> {"For I am Costanza, King of the Idiots." - Seinfeld}
poster:bissie66
thread:833453
URL: http://www.dr-bob.org/babble/20080606/msgs/833959.html