Posted by bissie66 on June 11, 2008, at 16:03:51
In reply to Re: SNRI + Remeron question » bissie66, posted by Molybdenum on June 10, 2008, at 20:32:46
Hi! Oh yes, I got A LOT out of your post. I printed it out and everything. And, in fact, based on your post, last night I took 60 mg of Remeron (I say Remeron bc I can never remember how to spell mirt.:) I didn't feel this was risky b.c. my prescription actually *says* 60 mg but I never took that bc of the old "less is more" theory when it comes to this drug. I feel hopeful knowing that I can increase higher than my thinking was telling me I could, and also that maybe I should go back on Effexor for the reasons you state, and with which I agree.
re: weight gain. I have been *very* fortunate. This time around, I haven't gained a pound. The first several times I took it, I gained a little bit of weight and that was part of the reason I stopped it. I definitely got the "Remeron munchies". (I think you need to make sure you hit the pillow *before* the drug hits *you*.) The main was reason I discontinued it was that I felt it had stopped working well and I gave up. But later, talking to my doc about the weight gain and he asked how much I gained and I told him between 5 - 10 lbs at the most he looked at me like I was crazy and said he had patients that gained upwards of FORTY.
Plus, this time around, I am on Topamax (for alcohol cravings) and I'm convinced that is keeping me from having any weight gain whatsoever. I am not wanting to eat anymore that usual at all. I'm VERY grateful for this turn of events bc I do NOT want to gain even 5 lbs!
Thanks for pointing me in the direction of wiki. and Modafinil. I've just taken a quick look and will head back after this to read more. It looks really, really good though (especially for someone like you who really needs it ;) -- seriously, though, much better than freakin' ritalin. I used to literally stay up ALL night on Aderall and go to work the next day feeling *fine* as if I had slept *all* night. Scary.
But yes, my mind is already working on how to tell my doc that this is worth a trial. I like your idea for an approach . . . thanks! But .. .Provigil . . that is ringing a bell . . and the bell is telling me that I mentioned it to my pdoc after reading about it here and I got "the look" from him. I think he said there wasn't enough evidence about its use as an a/d.
Oh, well, anyway . . I do live in the US. Do you not live in the US?
> Hi Bissie66,
>
> I'm so pleased you could get something useful from my little blurt. Sometimes I think I'm just writing my autobiography... ;)
>
> It certainly seems to be a common idea that you only need to augment with a small dose of Remeron. My doc had quite a few patients on higher doses & he
> believed it often was worthwhile increasing rather than changing it. I suppose you know that Remeron commonly causes weight gain - but it's not necessarily going to happen to you. And it doesn't make fat out of water & fresh air - you have to actually eat more too ;) So it's not an unmanageable side-effect is my point. Remeron can also cause some sedation into the next day, but that's supposed to be more prevalent on very low doses & from my experience & reading, it passes in a week or so. The "instant knock-out" effect I get doesn't take weeks to work. Like I said, 45 mins after taking it (8pm) I am "off to bed"..!
>
> Whether you go up by 15mg or 30mg would be something you could safely experiment with. If the doc writes you a script for 30mg tabs you could start by taking 1/2 & see how it goes. If it doesn't appear to be helping after x weeks (ask doc what x equals), then increase up to 30, 45, 60... Remember that
> every time I increased the Remeron it was to bring back the instant-sleep effect. And I would get that effect immediately I increased the dose. So I can't say how long the AD effects of it would take to kick in after an increase in dose, but your doc would have a good idea.
>
> I've been an avid googler of ADs for years now and still, every day at babble I see another few names I've never heard of and at least one interesting one. So I looked up your Pristiq. I think it would be fair to say that Wyeth is in business to make money. There's no shame in that. And they probably DO time the release of one drug to coincide with another coming off patent. So some people claim that Pristiq is no different to Effexor. In Wyeth's defence, from the little I have read & can understand, although Effexor (venlafaxine) gets broken down into several things - one of which is Pristiq (desvenlafaxine), that doesn't necessarily mean that taking Effexor or Pristiq will have the same effect in the same person. Apparently biochemistry is not that simple. So it's probably fair to call it "a different drug with similarities to Effexor".
>
> What I'm curious about is whether you need to be on Pristiq rather than Effexor. Particularly given Effexor will go off-patent this year & hence
> there'll be cheap generics available. So if money is an issue, it might be worthwhile switching back to Effexor, knowing that you'll be saving a bundle in a few months time.
>
> Effexor vs Cymbalta. Hmmm....Being ignorant of any other reasons, I would still probably want to have Effexor bundled with Remeron rather than Cymbalta & Remeron - simply because that's the combo Stahl suggested and so many people have tried it & gotten positive results. If it was me, I would be after the quickest / shortest / most likely path to feeling better. So unless you have a problem with Effexor, why be experimental?
>
> Modafinil - yes indeed. Well, reason I get prescribed it is because I have central sleep apnoea. I stop breathing lots of times, then breathe rapidly & it stuffs up my sleep. End result is chronic tiredness. However, your doc should be aware that modafinil IS commonly used to help with depression too. And of
> all the stimulants out there, it has a very low "abuse profile". Reason being you can't get high (well, most people can't anyway - I can't). You just feel "awake" & your "mood" is more positive. Taking double the effective dose has no increased effect in me & I have read that this is normal. I imagine that a very healthy, happy, young person after a good night's rest would probably not notice any effects at all from modafinil. Giving this person amphetamines for example - they'll DEFINITELY notice it. So there's a clear difference between modafinil & other stimulants. Have a read about it: http://en.wikipedia.org/wiki/Modafinil
>
> You might be able to convince your doc that your desire now is a long term return to normality, that you have no wish to get high for a few hours, that you know that's destructive, blah, blah, blah. I would approach the doc with the idea of simply trialling it. See how that goes. :)
>
> Cost - modafinil (brand name Provigil in the US) is not cheap. Good news is that there are very cheap sources of it from internet pharmacies. If you're in the US, you should make sure it's OK to import it though. I think that the FDA originally mis-classified it as a more dangerous drug than it really is. Not sure if they have fixed this. Point being that if you try to import it without a script & get busted, the DEA would get more upset than if it was classified as a "drug of less abuse potential". Read that link to Wiki. It mentions this issue. But here I am assuming you're in the US. Are you?
>
> Post or message me if you want any more info re it or any more babbling drool. ;)
>
> Take Care & good luck...!
>
> Mr. M.
poster:bissie66
thread:833453
URL: http://www.dr-bob.org/babble/20080606/msgs/834190.html