Posted by tensor on October 31, 2009, at 7:22:16
In reply to Re: forgot email notification.. » tensor, posted by delna on October 31, 2009, at 7:06:06
> Hi,
> I really empathize with you about your tiredness issue, it can be so disabling.
>
> I'm sure you realize that Remeron is sedating, in itself but since you say you have tried many other drugs, I assume you are on it for a reason.
> Personally I have no experience with Remeron but I do with 'stimulating drugs'. So I can suggest an add on.
>
> I take Provigil(modafinil) and that is very effective. I have (many times in the past) combined it with 300mg Wellbutrin. This is a safe combination, as far as I know (with antidepressants). No pdoc of mine has ever objected to it. In fact when I start Effexor in several days I will be be adding this exact duo.
>
> Personally, I take up to 400mg of Provigil but the usual dose of 200mg makes a big difference for most people. Alternatively, you can try a conventional stimulant.
>
> I just double-checked in Stahls Prescribers guide to see what he recommends with Remeron and this is what I found.
>
> http://stahlonline.cambridge.org/prescribers_drug.jsf?page=0521683505c57_p325-330.html.therapeutics&name=Mirtazapine&title=Therapeutics
>
> Not sure you can the see the link without signing up so I am Cut/ pasting here:
>
>
> Mirtazapine
>
> 'Best Augmenting Combos for Partial Response or Treatment-Resistance
>
> * SSRIs, bupropion, reboxetine, atomoxetine (use combinations of antidepressants with caution as this may activate bipolar disorder and suicidal ideation)
> * Venlafaxine (California rocket fuel; a potentially powerful dual serotonin and norepinephrine combination, but observe for activation of bipolar disorder and suicidal ideation)
> * Modafinil, especially for fatigue, sleepiness, and lack of concentration
>
>
> As far as I know the really stimulating ones are:
> Wellbutrin (bupropion)
> Provigil (Modafinil)
> Reboxetine.
> He also mentions using conventional stimulants later on in the chapter (not available online).
>
> Maybe others can comment on the other suggested drugs and if they help with fatigue....
>
>
> So apparently both Wellbutrin and Provigil individually are safe with Remeron. You need to check with your pdoc if it is safe to take BOTH together with Remeron.(But I personally don't see why it should be a problem.)
>
> I have no experience with Remeron but as I have mentioned i have taken both Welllbutrin 300mg and Provigil (high doses) together with other antidepressants with no problems nor objections from my (various) pdocs.
>
> Hope that helps somewhat.
> Take care
> DHi and thanks for your reply!
Actually modafinil was one of the meds I was thinking about, I used to take it before with Remeron but that was before I started with bupropion. Modafinil worked great, I used to take 200mg in the morning and I have some pills left.
Neither bupropion nor modafinil is used here so my pdoc has really no experience with them so I'm not sure how accurately he could say if it's safe or not. I got these meds through a license from my pdoc. Although bupropion is available as Zyban for quitting smoking.I'm also thinking of adjusting the Remeron dosage, but I don't know if I should go up or down, i.e. 15mg or 45mg.
Thanks.
poster:tensor
thread:923606
URL: http://www.dr-bob.org/babble/20091029/msgs/923613.html