![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by caroline on April 3, 2000, at 16:00:50
Has anyone ever considered combining remeron with anafranil (low dose)? Does anyone have any thoughts on the subject? I have been on remeron (30mg) for a year now. I have found it profoundly beneficial in combatting a lifetime of insomnia but I feel it has done little to stabalise my anguished state of mind. I have previously found anafranil (200-250mg) to be rather helpful to this end. I have thought about dropping the remeron in favour of going back on straight anafranil but I don't think I could bear losing the sleep remeron has given me (and thus the break). N.B. Anafranil did improve my insomnia greatly last time I was on it, but I don't think it ever did the remarkable job that remeron is. Over the past fifteen years, I have been variously diagnosed as suffering anorexia nervosa, OCD, Bipola mood disorder, recurrent clinical depression, anxiety disorder and severe depression.
Any suggestions?
Posted by JohnL on April 5, 2000, at 2:36:02
In reply to remeron and anafranil combo?, posted by caroline on April 3, 2000, at 16:00:50
Caroline,
Remeron+Anafranil certainly sounds like a go-ahead combination to me. For most people the combo would be way too sedating. But for you it sounds like it could work very well. The Remeron will stimulate serotonin and norepinephrine, while the Anafranil will inhibit the reuptake of both of them (bias toward serotonin), resulting in an increase of serotonin and norepinephrine activity from two different and distinct modes of action. Try it and see. Remeron has few drug-drug interactions, so I don't see any problem at all other than the possibility of new side effects, which may or may not prove to be bothersome. No way to find out without trying. It does appear safe though, and makes sense based on your past responses to both of these meds.
Posted by caroline on April 5, 2000, at 14:54:43
In reply to Re: remeron and anafranil combo?, posted by JohnL on April 5, 2000, at 2:36:02
> Caroline,
>
> Remeron+Anafranil certainly sounds like a go-ahead combination to me. For most people the combo would be way too sedating. But for you it sounds like it could work very well. The Remeron will stimulate serotonin and norepinephrine, while the Anafranil will inhibit the reuptake of both of them (bias toward serotonin), resulting in an increase of serotonin and norepinephrine activity from two different and distinct modes of action. Try it and see. Remeron has few drug-drug interactions, so I don't see any problem at all other than the possibility of new side effects, which may or may not prove to be bothersome. No way to find out without trying. It does appear safe though, and makes sense based on your past responses to both of these meds.John, thanks for your prompt reply to my message. Another thought I've had - having read some of the other remeron-related messages on here - is of raising the dose of Remeron (I'm currently on 30mg). Do you have any thoughts on this?
Posted by JohnL on April 6, 2000, at 2:30:50
In reply to Re: remeron and anafranil combo?, posted by caroline on April 5, 2000, at 14:54:43
> > Caroline,
> >
> > Remeron+Anafranil certainly sounds like a go-ahead combination to me. For most people the combo would be way too sedating. But for you it sounds like it could work very well. The Remeron will stimulate serotonin and norepinephrine, while the Anafranil will inhibit the reuptake of both of them (bias toward serotonin), resulting in an increase of serotonin and norepinephrine activity from two different and distinct modes of action. Try it and see. Remeron has few drug-drug interactions, so I don't see any problem at all other than the possibility of new side effects, which may or may not prove to be bothersome. No way to find out without trying. It does appear safe though, and makes sense based on your past responses to both of these meds.
>
> John, thanks for your prompt reply to my message. Another thought I've had - having read some of the other remeron-related messages on here - is of raising the dose of Remeron (I'm currently on 30mg). Do you have any thoughts on this?Caroline,
You could certainly try raising the dose. Sometimes the Remeron is less sedating at higher doses, but sometimes it's too sedating. It affects everyone so differently. You would just have to try it and see. What you might do is increase dose perhaps 7.5mg at a time to feel it out. Use a knife to cut the pill into custom sizes.
Posted by caroline on April 8, 2000, at 15:27:42
In reply to Re: remeron and anafranil combo?, posted by JohnL on April 6, 2000, at 2:30:50
John
Sorry to bother you again. I found a lot of reassurance in your response to my earlier posting - i.e. that the idea of a Remeron/Anafranil augmentation was not totally stupid or wishful thinking. I have to admit, I am a little concerned that the sedation (particularly daytime) might be too much even for me, but what concerns me more right at this moment, is the fact I am having a really hard time getting my psychiatrist to so much as consider augmentation. He does not believe in messing around with meds, even when they are not working! He is even making very negative noises at the idea of raising my dose of Remeron (N.B. I am still not sure which of these two options I should go with). My Psychiatrist is a junior doctor doing a compulsary rotation and does not seem to know much at all about psychiatric meds - he had not heard of remeron until he met me in August of last year! Perhaps unfortunately, I live in the UK and so cannot request a transfer to another doctor or even a meeting with a consultant. The system says: take what we're offering or go without.
What I wondered, is whether you would know of any factual information I could hit him with in support of my either augmenting the remeron or increasing my current dosage - something on the net maybe? I am getting very desperate as I am due to meet with him again this Tuesday.I would be extremely grateful for any help or advice you or anyone else could offer.
Yours, Caroline.
Posted by caroline on April 11, 2000, at 16:06:08
In reply to Re: JOHN, posted by caroline on April 8, 2000, at 15:27:42
> John
>
> Sorry to bother you again. I found a lot of reassurance in your response to my earlier posting - i.e. that the idea of a Remeron/Anafranil augmentation was not totally stupid or wishful thinking. I have to admit, I am a little concerned that the sedation (particularly daytime) might be too much even for me, but what concerns me more right at this moment, is the fact I am having a really hard time getting my psychiatrist to so much as consider augmentation. He does not believe in messing around with meds, even when they are not working! He is even making very negative noises at the idea of raising my dose of Remeron (N.B. I am still not sure which of these two options I should go with). My Psychiatrist is a junior doctor doing a compulsary rotation and does not seem to know much at all about psychiatric meds - he had not heard of remeron until he met me in August of last year! Perhaps unfortunately, I live in the UK and so cannot request a transfer to another doctor or even a meeting with a consultant. The system says: take what we're offering or go without.
> What I wondered, is whether you would know of any factual information I could hit him with in support of my either augmenting the remeron or increasing my current dosage - something on the net maybe? I am getting very desperate as I am due to meet with him again this Tuesday.
>
> I would be extremely grateful for any help or advice you or anyone else could offer.
>
> Yours, Caroline.N.B Sorry if this got posted twice!
Posted by JohnL on April 12, 2000, at 4:32:03
In reply to Re: Question for JohnL/(RE:remeron/anafranil), posted by caroline on April 11, 2000, at 16:06:08
> > What I wondered, is whether you would know of any factual information I could hit him with in support of my either augmenting the remeron or increasing my current dosage - something on the net maybe? I am getting very desperate as I am due to meet with him again this Tuesday.
> >
> > I would be extremely grateful for any help or advice you or anyone else could offer.
> >
> > Yours, Caroline.
>Caroline,
Sorry to hear about the novice attitude of your doctor. He has a lot to learn.Bringing in research in writing has been a very helpful method for me, and others here, in convincing a doctor to allow trying something in particular. The best place I've seen overall to get information to print is right here at Dr Bob's site. I suggest clicking on 'Tips' at the top of the main page. Once you arrive at Tips, leave the search box blank and click on search. You will get a huge list of topics to explore. Each topic is a collection of feedback from doctors around the world discussing their opinions and experiences with the various topics. It can provide valuable real-life proof to show your doctor what other more expert doctors are doing in a routine manner every day.
For a more refined search, you could type in Remeron and/or Mirtazapine in the search box and then click on search. I think I've explored everything in there about Remeron, and I'm pretty sure you won't find anything about it being combined with Anafranil. But you will find comments about it being combined with other antidepressants as an augmenter, a sleep aid, a sexual dysfunction remedy, and as 'big guns therapy' when combined with effexor.
I sure wish you had access to more expert care. But in the absence of an expert, it's not hard to become our own best expert with the golden information Dr Bob has provided us. You'll find plenty of stuff to print out to make your case. It will be hard for your doctor to argue against what more qualified doctors are doing. Hope it helps. JohnL
Posted by Scott L. Schofield on April 14, 2000, at 12:50:04
In reply to Re: Question for JohnL/(RE:remeron/anafranil), posted by JohnL on April 12, 2000, at 4:32:03
>
> > > What I wondered, is whether you would know of any factual information I could hit him with in support of my either augmenting the remeron or increasing my current dosage - something on the net maybe? I am getting very desperate as I am due to meet with him again this Tuesday.
> > >
> > > I would be extremely grateful for any help or advice you or anyone else could offer.
> > >
> > > Yours, Caroline.
> >
>
> Caroline,
> Sorry to hear about the novice attitude of your doctor. He has a lot to learn.
>
> Bringing in research in writing has been a very helpful method for me, and others here, in convincing a doctor to allow trying something in particular. The best place I've seen overall to get information to print is right here at Dr Bob's site. I suggest clicking on 'Tips' at the top of the main page. Once you arrive at Tips, leave the search box blank and click on search. You will get a huge list of topics to explore. Each topic is a collection of feedback from doctors around the world discussing their opinions and experiences with the various topics. It can provide valuable real-life proof to show your doctor what other more expert doctors are doing in a routine manner every day.
>
> For a more refined search, you could type in Remeron and/or Mirtazapine in the search box and then click on search. I think I've explored everything in there about Remeron, and I'm pretty sure you won't find anything about it being combined with Anafranil. But you will find comments about it being combined with other antidepressants as an augmenter, a sleep aid, a sexual dysfunction remedy, and as 'big guns therapy' when combined with effexor.
>
> I sure wish you had access to more expert care. But in the absence of an expert, it's not hard to become our own best expert with the golden information Dr Bob has provided us. You'll find plenty of stuff to print out to make your case. It will be hard for your doctor to argue against what more qualified doctors are doing. Hope it helps. JohnL
Is there any need to be wary of serotonin syndrome?
- Scott
Posted by JohnL on April 14, 2000, at 15:45:16
In reply to Re: Question for JohnL/(RE:remeron/anafranil), posted by Scott L. Schofield on April 14, 2000, at 12:50:04
> Is there any need to be wary of serotonin syndrome?
>
>
> - ScottGood point Scott. I think anytime two serotonin medications are combined there should be an awareness of serotonin overload risk. Low starting doses and gradual increases is the best way I know of to keep the risks in check. Diarrhea accompanied with either unusual euphoria or unusual malaise is an early warning sign...a warning sign to back off. I think the risk is low, but nevertheless a risk worth monitoring. In my experience there is a lot of wisdom when people tell me "go low and slow". There have been times I think I got too aggressive too fast with dosing cocktails and I think I've experienced the outer edges of serotonin syndrome a couple of times. It would not have happened had I been a little more patient and conservative. I heard a saying once that I think has a lot of wisdom..."there are no safe drugs...only safe doses".
Posted by Scott L. Schofield on April 14, 2000, at 16:54:09
In reply to Re: Question for JohnL/(RE:remeron/anafranil), posted by JohnL on April 14, 2000, at 15:45:16
> I heard a saying once that I think has a lot of wisdom..."there are no safe drugs...only safe doses".
LOL
:-)
- Scott
Posted by caroline on April 17, 2000, at 16:00:50
In reply to Re: Question for JohnL/(RE:remeron/anafranil), posted by JohnL on April 14, 2000, at 15:45:16
John,
Thanks for the advice. I have started searching and will hopefully find enough info to convince the junior doctor of the stupidity of sticking with a drug at a dose that is only addressing my need to sleep and not helping on any other level.
By the way, I understand congratulations are in order. I read your posts. I am so pleased to hear you have finally found some drugs that work for you.
I am currently trying Remeron 45mg (my own experiment, Jnr doc wouldn't give me his blessing). To tell you the truth, the effect of such a small increase in dose has really shocked me. I'd always thought of Remeron as this wonderful sedative; a great sleeping drug. For me, at 45mg, the drug has turned into a stimulant! I have not had more than three hours sleep a night since last Wednesday. On the positive side, it is really helping with my anxiety, has increased my mental alertness, and is giving me loads of energy. With this positive side in mind, I plan to give this dose at least a few days longer to see whether there is anyway I can get sleep on it.
As I have suffered from crippling insomnia all of my life, I know I will have to abandon this dose soon if I can find no way to get sleep. I am now wondering; could I take Remeron (30mg) for sleep at night and a stimulating AD (like reboxatine/effexor/SSRI) each morning?
I would be grateful for any thoughts you have on the matter - including any doubts due to the possibility of seretonin syndrome.
Thanks again,
Caroline
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.