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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Michael on March 7, 2000, at 22:24:12
Hello,
My agoraphobia started in 1989. I have seen shrinks off and on since then. I have gone to speciallty
courses and classes on understanding causes of panic attacks. Since 1989
I have expanded my boundries about 2hrs circumferance, anything
further creates alot of anxiety. I am no longer an agoraphobiac, I
am now a "panic disorder" case. I get anxious very easy,
but I will say that my anxiousness has improved dramatically
from therapy or desensitization. I have taken prozac for
one year, zolft for several months, zanax, and paxil. I always
stopped the medicinal treatment because I wanted to do it on
my own.
Well Im 29 years old now and I have a professional job now that I dont want
to loose. So my doctor has suggested that I take Remeron (I have
not started yet). I have never heard of this med before. My symptoms are
that I get extremely nervous when I think that I have to do something
like speak at our ssales meeting. I may have had panics before, but I have
never been known to be shy or scared of speaking or being the center of
attention. Well because of the thought of haveing to speak in front of 14
of my peers has caused my such anxiety every week, I have not shown up to our
weekly sales meetings. I may not even have to talk, but I cant seem to control
my physical reactions. It has now started to cause regression in all the
progress I have made over the past 11 years.
My question is: does Remeron help anxiety or just depression? Has it had
positive results in helping anxiety? Or should I consider another med?
I am a very active man. I train in the martial arts 5 nights a week, and
I train to compete. I train hard, in no holds bar style of fighting (Lions Den
for those who know). So will Remeron get in the way?
I dont want to loose my job...
Posted by medlib on March 8, 2000, at 2:08:29
In reply to Remeron for anxiety?, posted by Michael on March 7, 2000, at 22:24:12
Hi Michael-
I haven't taken Remeron, but wanted to call your attention to several sources of information on this site:
-Search on Remeron from the Dr. Bob's Tips page (midway down on right frame), but keep in mind that this is early info, not recent.
-Search the Babble archives on Remeron (top of this page.
-Do a search on Medline (select PubMed from Dr. Bob's links page) if you're comfortable with medical terminology. My search (from the Advanced Search page) was formulated (Remeron OR mirtazapine) AND (anxiety OR panic attacks) and brought up 25 articles. I can provide a "quick and dirty" one paragraph summary if medical database searching isn't your thing.
-Check out "The Phobia and Anxiety Workbook" on Dr. Bob's booklist if you're not already familiar with it--it's gotten good reviews from several posters on this board, also from my good friend who suffers from GAD (generalized anxiety disorder).Lots of us have long symptom histories; what struck me about yours was how hard you've worked to control or eradicate one expression of anxiety only to have it mutate or pop up someplace else. Sort of suggests an underlying mechanism at fault, doesn't it?
Good luck, and keep us posted on your progress.
medlib
> Hello,
> My agoraphobia started in 1989. I have seen shrinks off and on since then. I have gone to speciallty
> courses and classes on understanding causes of panic attacks. Since 1989
> I have expanded my boundries about 2hrs circumferance, anything
> further creates alot of anxiety. I am no longer an agoraphobiac, I
> am now a "panic disorder" case. I get anxious very easy,
> but I will say that my anxiousness has improved dramatically
> from therapy or desensitization. I have taken prozac for
> one year, zolft for several months, zanax, and paxil. I always
> stopped the medicinal treatment because I wanted to do it on
> my own.
> Well Im 29 years old now and I have a professional job now that I dont want
> to loose. So my doctor has suggested that I take Remeron (I have
> not started yet). I have never heard of this med before. My symptoms are
> that I get extremely nervous when I think that I have to do something
> like speak at our ssales meeting. I may have had panics before, but I have
> never been known to be shy or scared of speaking or being the center of
> attention. Well because of the thought of haveing to speak in front of 14
> of my peers has caused my such anxiety every week, I have not shown up to our
> weekly sales meetings. I may not even have to talk, but I cant seem to control
> my physical reactions. It has now started to cause regression in all the
> progress I have made over the past 11 years.
> My question is: does Remeron help anxiety or just depression? Has it had
> positive results in helping anxiety? Or should I consider another med?
> I am a very active man. I train in the martial arts 5 nights a week, and
> I train to compete. I train hard, in no holds bar style of fighting (Lions Den
> for those who know). So will Remeron get in the way?
> I dont want to loose my job...
Posted by medlib on March 8, 2000, at 2:13:52
In reply to Remeron for anxiety?, posted by Michael on March 7, 2000, at 22:24:12
Also check out the discussion on general Remeron questions at the top of this page!
medlib
Posted by Amanda S on March 8, 2000, at 20:58:32
In reply to Re: PS for previous post, posted by medlib on March 8, 2000, at 2:13:52
What's up with so few people on lamictal?? I and only a handful of people seem to be on lamictal. I would like to be able to see how they are doing on this med.
Posted by Cam W. on March 9, 2000, at 11:16:38
In reply to Not many people on lamictal, posted by Amanda S on March 8, 2000, at 20:58:32
Amanda - I would think the reason that not many people are taking Lamictal is because docs are afraid to prescribe it because 1/10 people get a rash from it and 1/1000 people gat a potentially life-threatening rash called Steven-Johnson Syndrome. This nasty side effect usually occurs if the dose is titrated too fast and is generally seen in the first couple months of therapy, if at all. It is seen more commonly in children. That being said, Lamital is a good ajunctive (add-on) mood stabilizer with antidepressant activity. I have seen it work well in bipolar depression. If you notice a rash develop (looks like sunburn and progresses to look like poison ivy) call your doctor ASAP. The rash is treatable and not life-threatening if caught early. I hope I don't scare anyone with this because a majority of people do not get a rash and the Lamictal is an effective drug. Cam W.
Posted by Chris A. on March 9, 2000, at 16:07:26
In reply to Not many people on lamictal, posted by Amanda S on March 8, 2000, at 20:58:32
Amanda,
I took Lamictal for a total of about two years and had no side effects. It didn't seem to help my tenacious bipolar depression much either. I kept taking the Lamictal because it is one of the few drugs that I have tolerated. Currently I'm doing ECT and it doesn't seem to be doing much for the depression either.
I hope it works for you. Just always remember to take dose increments slowly.Chris A.
Posted by Blue Cheer on March 9, 2000, at 22:05:35
In reply to Re: Not many people on lamictal, posted by Cam W. on March 9, 2000, at 11:16:38
>
> Amanda - I would think the reason that not many people are taking Lamictal is because docs are afraid to prescribe it because 1/10 people get a rash from it and 1/1000 people gat a potentially life-threatening rash called Steven-Johnson Syndrome. This nasty side effect usually occurs if the dose is titrated too fast and is generally seen in the first couple months of therapy, if at all. It is seen more commonly in children. That being said, Lamital is a good ajunctive (add-on) mood stabilizer with antidepressant activity. I have seen it work well in bipolar depression. If you notice a rash develop (looks like sunburn and progresses to look like poison ivy) call your doctor ASAP. The rash is treatable and not life-threatening if caught early. I hope I don't scare anyone with this because a majority of people do not get a rash and the Lamictal is an effective drug. Cam W.
An "effective drug," a "good adjunctive mood stabilizer with antidepressant activity (and more) that [you] have seen work well in bipolar depression," and it induces a benign rash in 10%. Jeez, did you have to scare me like that??Blue Cheer ~~~
Posted by JohnL on March 10, 2000, at 4:25:51
In reply to Not many people on lamictal, posted by Amanda S on March 8, 2000, at 20:58:32
>
> What's up with so few people on lamictal?? I and only a handful of people seem to be on lamictal. I would like to be able to see how they are doing on this med.I've taken Lamictal up to 125mg, increasing by 25mg a week to avoid the rash risk. It does stabilize me, and pleasantly diminishes my tinnitus.
I read in a research study that it didn't help many people for tinnitus, but it does with me. I read in another research that it has serotonin, NE, and dopamine reuptake inhibition all in one, which increases with dose. They aren't sure if that is why it has been promising in both unipolar and bipolar depression. But electrical smoothing and multiple reuptake inhibition all in one...sounds pretty good to me. Just have to go slow to avoid the rash.
My pdoc is getting ready next week to run me through the stimulant class. He wants me to stay on 50mg Lamictal pending results, if for no other reason just to help the tinnitus. If results on stimulants are disappointing, the next plan of action is to get me into the 200mg to 400mg range of Lamictal. Apparently the antidepressant qualities are more evident at these higher doses. We'll see. I have to admit it's kind of cool to have a pdoc with an organized strategy all mapped out in advance and customized for me.
I have nothing negative to say about Lamictal, except perhaps some insomnia. It is probably the most side-effect free drug I've ever tried. But I think its use in psychiatry is still fairly new. I was the first patient my pdoc tried it with, and my GP didn't even know what it was! lol :) JohnL
Posted by Scott L. Schofield on March 10, 2000, at 13:29:45
In reply to Re: Not many people on lamictal, posted by JohnL on March 10, 2000, at 4:25:51
> What's up with so few people on lamictal?? I and only a handful of people seem to be on lamictal. I would like to be able to see how they are doing on this med.
You have received a lot of good replies to your question.
I just wanted to add a few more comments.
I'm not sure to what degree clinicians are dissuaded from prescribing Lamictal by its potential to induce the rash-reaction. (By the way, is this an allergic reaction?) I have not heard of any occurrences of this when the prescribed titration schedule suggested by the PDR has been followed, although I imagine that they do exist. In fact, when this reaction appears as the result of too rapid a dose increase, the drug can be discontinued and successfully reintroduced using the more gradual schedule.
Lamictal has been used successfully alone as monotherapy for treating bipolar depression. Multicenter trials have demonstrated this consistently. These same trials have also established an average effective dose as being 187 mg/day. I think the range was between 50 and 300. For the small improvement it provides me, I need 300 mg/day. 200 didn't cut it.
Of course, it is also used in combination with other mood-stabilizing drugs. Depakote may be a good choice. As is very often the case with psychotropic drugs, there are people for whom Lamictal, as well as Depakote, produces negative reactions. They can feel worse for taking them, either as an exacerbation of depression or as a disturbance of cognition. Lamictal does seem to be pretty "clean" in most cases.
There is some support for its efficacy in treating rapid-cycling presentations.
I don't feel that there is enough reason to avoid trying Lamictal. It may be a necessary component to a treatment regime that can include antidepressants.
- Scott
Posted by Amanda S on March 14, 2000, at 17:51:32
In reply to Re: Not many people on lamictal, posted by Scott L. Schofield on March 10, 2000, at 13:29:45
I was happy about the response about lamictal. Many thanks. I do notice when I am in my manic mood, the lamictal really makes me feel good and when I am down the lamictal helps alot, but I feel I am still not at an effective dose. Was suppose to see my psychiatrist yesterday,but she canceled on me. Would like to know from her if I should increase it 25mg from 100mg a day. What can you do when they cancel and won't return your phone calls.
This is the end of the thread.
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