Posted by sowhysosad on April 21, 2009, at 19:49:33
In reply to Re: Remeron for treatment resistant depression..., posted by Enigma on April 19, 2009, at 22:48:05
Disappointingly, my friend who was on Remeron has decided not to try any more meds after her negative experience with it, and may never achieve full remission as a result.
I'm really angry with her pdoc. Some years ago she tried fluoxetine and imipramine, had no success and lots of side effects so gave up. So I was pleased to hear she'd decided, reluctantly, to give meds another shot.
Under the UK guidelines, docs are meant to try one of the tried-and-tested SSRI's first - fluoxetine, citalopram or sertraline. Then they can try mirtazapine (Remeron) or Effexor, then a TCA, reboxetine, moclobemide, dosulepin, AD combos, lithium augmentation or phenelzine for more stubborn cases.
With SSRI's all being very different, there was a good chance that citalopram or sertraline would have worked where fluoxetine failed. But for some reason he decided to start her off on Cymbalta.
Now I know a lot of people have a good response to it, but in the UK the national guidelines discourage docs from using it. Pooled data suggests it's less reliable than the older SSRI's and has a higher incidence of side effects. So the decision to start her on Cymbalta was unconventional to say the least. Lily must have bought him a really nice dinner. And gave him a free pen.
I think it was really unprofessional - given that my friend was VERY anti-meds to start off with - to start her off on a drug that guidelines say is less likely to work and may be more unpleasant to take! How did he expect to achieve compliance?
Then the Remeron was the final nail in the coffin - the heavy sedation, mental fog and binge eating were too much to bear. I just don't think its extreme side effects make it a good candidate for someone who's not comfortable with taking meds in the first place.
Docs are also meant to take into account Remeron's propensity for weight gain before prescribing it, so why give it to someone who already had a weight problem?
So there's another soul completely lost to psychiatry who'll probably never get well, all thanks to this idiot's irresponsible behaviour.
poster:sowhysosad
thread:891271
URL: http://www.dr-bob.org/babble/20090416/msgs/892007.html