Posted by JohnBoy2000 on December 9, 2016, at 7:31:39
Gonna paste this from an old thread firstly:
Re: Mianserine-Any Experiences??? » BrainDamage
Posted by klein on April 26, 2014, at 12:02:13
In reply to Mianserine-Any Experiences???, posted by BrainDamage on April 26, 2014, at 8:15:20
> I've heard very little about this Old Tetracyclic
>
> What I have heard is generally positive
> But is really hard to get a feeling with so little information.......
> I imagine it must be similar to Mirtazapine
> I love Mirtazapine, but it doesn't help with Depression, just sleep
>
> So has anyone ever taken Mianserine?Yeah, I've taken mianserin for relatively extended periods (3 months maybe) several times. Good stuff. I'm a tetra fan.
Maybe the easiest way to describe mianserin is by comparing it to mirtazapine.
Mirtazapine and mianserin are both tetracyclics. At a glance they seem almost identical, mostly due to their similar side-effect profile (sedation from H1 antagonism and -usually- appetite increase, most likely caused by 5-HT2C and 5-HT2A blockade).
They're both classified as "NaSSas": "noradrenergic and specific serotonergic antidepressants", but that's a bit inaccurate.
They're actually very different.
They both block alpha 2 adrenergic presynaptic
receptors, which increases norepinephrine (noradrenaline) neurotransmission. Very, very strongly.But additionally, mirtazapine (but not mianserin) also blocks alpha 2 adrenergic presynaptic receptors on *serotonin neurons*, boosting serotoninergic neurotransmission. Mianserin's effect on these receptors is negligible.
So, basically, mianserin only pushes noradrenaline release and Remeron boosts both noradrenaline release AND serotonin release.
But that doesn't necessarily mean that Remeron is "better" than Tolvon (mianserin), they're just different. Mianserin inhibits norepinephrine reuptake, whereas Remeron has no known reuptake inhibition properties. Also, Tolvon has a much stronger / tighter binding affinity to most, if not all, of its targets compared mirtazapine, so you could say that it's more "powerful" in a way. It certainly acts faster (and mirtazapine itself is no slug).
There are lots of additional differences, I just mentioned the main ones.
They're definitely not interchangeable.
The beauty of these drugs is that they hit a whole bunch of "useful" receptors (and, even though they've been around for a while, the list of newly discovered pharmacological effects keeps growing) yet they are extremely clean.
Anyway, in practice:
Remeron might be underdosed in the US, which is probably why it's not all that popular. Maybe that's why it doesn't help your depression? In Europe and other areas, the max dose is 90mg versus 45mg in the US (and going up to 120mg is not unheard of). In most cases, the NE boosting action only just begins at 45mg, so chances are that you're not getting its dual action at 30mg (and certainly not at 15). Still, at 30mg the serotonin boost is very powerful, and that's why it can augment reuptake inhibitors very nicely. Whatever NE action that might be happening at the lower doses is usually drowned out by the flood of serotonin (soothing). I've gone up to 60mg Remeron and the only way I could tolerate it was with benzos onboard, starting at 45mg the amount of agitation and activation I got was downright scary. No sleepiness, no hunger.. It most definitely zapped my depression though, within days.
Mianserin is a whole different animal. I think that the max rec. dose is 90mg "worldwide". As mianserin doesn't push serotonin (kindof), all you get is raw NE action. I know that the following equivalence is totally incorrect, but the way it feels is 30mg mianserin = 45 mg remeron. 60mg mianserin (usual dose) = 60 mg Remeron. I have no idea how some people manage to tolerate the max dose of 90mg mianserin. BTW, IME mianserin's one big drawback is the soporific antihistaminic effect combined with the sheer NE activation at any dose, until I get used to this, I feel tired yet very energized at the same time, very uncomfortable.
I didn't even go into different 5-HT2C actions and the remaining boatload of additional targets and effects they have.
They're definitely very complex meds... and taking the proper dosage is everything, depending on how much you take you'll get totally different effects.
I'll keep rambling for a bit longer:
I use them sparingly because, unfortunately, they tend to poop out very quickly. I call them my safety net, they're my reliable last resort option.
- Whenever bad anxious depression strikes, it's Remeron 30mg. Helps a ton. Good sleep, mood brightening etc. I've only felt suicidal once during my screwy mental health career, and the 60mg dose pulled me out just in time... Might have just saved my life. But very hard to tolerate.
- Conversely, when bad anhergic depression strikes, just mianserin 15mg helps a lot. I usually start out at 30mg and quickly lower the dose to 15mg as soon as the most troublesome symptoms resolve as, despite the H1 sleepiness, I find it extremely activating.
As usual YMMV. Maybe the mianserin will glean no benefit for you... we all have different biochemical makeups of course so.. I hope this post is helpful, any questions just ask away.
Ok, enough with my Ode to Organon.
poster:JohnBoy2000
thread:1093476
URL: http://www.dr-bob.org/babble/20160928/msgs/1093476.html