Psycho-Babble Medication Thread 39864

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What causes Remeron Weight gain

Posted by MB on July 9, 2000, at 0:43:09

I just started taking 15mg Remeron before bedtime. Does anyone know why Remeron is such a beast when it comes to causing weight gain? Is it the the way it stokes the appetite, or does it mess with metabolism? As long as I don't stay awake after taking the Remeron, I don't get appetite stimulation. I'm not particulary hungry the next morning after taking it. My eating and exercising habits haven't changed. Will I still gain weight? I guess my question is: If I take Remeron, but don't over eat on it, will I still gain weight?

MB

 

Re: What causes Remeron Weight gain

Posted by Sunnely on July 9, 2000, at 2:32:59

In reply to What causes Remeron Weight gain, posted by MB on July 9, 2000, at 0:43:09

Dear MB,

Weight gain from Remeron can occur as early as the first week of treatment, is usually associated with increased appetite, and is most likely due to the drug's antihistamine effects. Appetite diminishes after 4-12 weeks of treatment, however, and weight generally returns to baseline (with dietary regimen).

Another factor with weight gain (and sleepiness) with Remeron is the dose. It appears that when it comes to these side effects of Remeron, "more is less." What this means is, as you continue to take the medication and/or increase the dose, weight gain (and sleepiness) subsequently decreases or levels off.

In sum, with Remeron:

(1) Weight gain is due to increased in appetite which is in turn due to the antihistamine (H1 receptors) effect;

(2) Sleepiness is also due to the antihistamine effects and also to the blockade of the serotonin receptor subtype 2 or 5HT2 (also responsible for the lack of sexual disturbances);

(3) Sleepiness, appetite stimulation, and weight gain decrease as the dose is increased; and

(4) Blockade of the serotonin receptor subtype 3 or 5HT3 is responsible for the absence of gastrointestinal distress.

 

Re: What causes Remeron Weight gain

Posted by allisonm on July 9, 2000, at 13:19:59

In reply to Re: What causes Remeron Weight gain, posted by Sunnely on July 9, 2000, at 2:32:59

Sunnely,

I am curious where you got your information. I have found sleepiness did not decrease with a higher dose. Sleepiness always increased and did not level off over time -- ie, I was stumbling around on 45 mg. Always did. It never lessened. And I was in a thick fog every morning. I had to take the 45 at home so that I could go to bed quickly when it kicked in. I could never be out or drive on 45.

I got sleepy and woozey on 30 mg, but it did not cause me to be unsteady on my feet as I was on 45. On 15 mg, the effect is less than 30. I get sleepy. I have taken Remeron for 2 years and 5 months -- at 45 for about a year and at 30 for about a year. Back down to 15, and I am just now finally losing weight.

I have asked him more than once, and my psychiatrist insists that weight gain INCREASES with a higher dose. I found this to be true. Lithium exacerbates the weight gain. I could not get the weight off no matter what I did with the high Remeron dose and Li augmentation. I took Li for 6 months of the 2.5 years on Remeron.

Thanks.

Allison

 

Re: What causes Remeron Weight gain

Posted by MB on July 9, 2000, at 13:44:36

In reply to Re: What causes Remeron Weight gain, posted by allisonm on July 9, 2000, at 13:19:59


Allison,

This is very interesting. I told my doc that the Paxil was working fine (not depressed) but that I gained 20 lbs on it, and required 14 hrs of sleep/day. His recommendation was Remeron! He gave me a few samples. I guess he figured it was the only thing I hadn't tried yet. But still, why not just go back to the Paxil if the two main side effects of the *new* drug are going to be sleepiness and weight gain? I would of thought he'd try a combo before putting me on Remeron.

MB

 

Re: What causes Remeron Weight gain

Posted by allisonm on July 9, 2000, at 17:30:41

In reply to Re: What causes Remeron Weight gain, posted by MB on July 9, 2000, at 13:44:36

MB,

Hmmm.. that IS interesting. I first saw my psychiatrist because I couldn't sleep and the sleep lab I went to told me I had to get rid of my depression before I could get sleep again.

So that was my primary motive. Sleep. We tried Zoloft first, and then Effexor XR. Both were awful. So we moved on to Remeron, which was quite new at the time. I remember coming to this board with questions, and no one had had any experience with it. It's interesting to see so many posts about Remeron now.

Well, anyway, the Remeron finally gave me sleep. It was wonderful. He'd warned me about weight gain, but I was desperate and it didn't matter that much to me if it would get me out of the pit. It helped some, then my life kinda got blasted apart two years ago this month. I've been trying to recover ever since.

By the fall of 98, it became apparent that I was sliding, so he added lithium. I was on that till April of 99, but by June I started sliding again and it became apparent that I still needed something to augment. Enter Wellbutrin SR. Started at a low dose, 100 mg I think. That was a year ago. It helped, but then fall came around and with another backslide, so we upped it to 200 mg and lowered the Remeron from 45 to 30mg. Another backslide two months ago brought the Wellbutrin dose up to the max 400mg and we lowered the Remeron to 15mg.

I'm finding this combo works better for me. The Remeron still gives me sleep, and I notice a vast difference (not perfect, not a cure but a lot better) in mood now that the Wellbutrin is the primary AD and the Remeron the secondary.

I used to need coffee in the morning to clear the cobwebs from the Remeron, especially when I was at 45 mg. But the Wellbutrin is so activating that I have by necessity become caffeine-free.

Don't know if this helps.

Best wishes,
Allison

 

Re: What causes Remeron Weight gain ..}}Allison

Posted by janeS on July 9, 2000, at 18:50:48

In reply to Re: What causes Remeron Weight gain, posted by allisonm on July 9, 2000, at 13:19:59

>
> I got sleepy and woozey on 30 mg, but it did not cause me to be unsteady on my feet as I was on 45. On 15 mg, the effect is less than 30. I get sleepy. I have taken Remeron for 2 years and 5 months -- at 45 for about a year and at 30 for about a year. Back down to 15, and I am just now finally losing weight.
>
> I have asked him more than once, and my psychiatrist insists that weight gain INCREASES with a higher dose. I found this to be true. > Thanks.
>
> Allison

Allison:

Hi...just wondering how much weight you gained in total on Remeron(if you don't mind my asking.) I have now tipped the scales at 20 pounds in 14 weeks. Going to my pdoc this week and am going to inquire about the Wellbutrin, as you suggested in a prior post, but was wondering if Wellbutrin helped with weightloss at all or just going back to the lower dose of Rem.? I'm seeking help for the morning cob webs, etc., hence the Wellbutrin question...if you can figure this out, please reply!

Thanks!
Jane

 

Re: What causes Remeron Weight gain

Posted by Sunnely on July 9, 2000, at 19:43:26

In reply to Re: What causes Remeron Weight gain, posted by allisonm on July 9, 2000, at 13:19:59

Hi Allison,

Here are the references:

Regarding sedation:

1. Psychopharmacology of Antidepressants by Stahl, SM, Martin Dunitz, LTD, 1997. Dr. Stephen M. Stahl, at the time of publication was Director of Clinical Neuroscience Research Center and Adjunct Professor of Psychiatry, University of California, San Diego. He is a well-known psychopharmacologist, U.S. and abroad. In his book, at page 79, he mentioned the "Clinical Pearls for Mirtazapine." He mentioned that "sedation may be INVERSELY related to dose. Lowering the dose may thus increase sedation."

2. Mirtazapine. In: Biological Therapies in Psychiatry Newsletter, January 1997, Gelenberg, AJ (editor). Dr. Alan J. Gelenberg is also a noted psychopharmacologist. I believe he is now the Chairman of the Department of Psychiatry at Arizona University. In his review of Mirtazapine (Remeron), he mentioned that "some clinicians believe higher initial doses of mirtazapine might produce less sedation."

I am not aware of any prospective study directly comparing the effect of low-dose vs. high-dose Remeron on sedation. Of course, each person is different as to response and side effects from psychotropic drugs.

Regarding weight gain:

1. Weight gain associated with antidepressant therapy. A Teaching Monograph. Rosenbaum, JF, Gadde KM, and Ginsberg DL, moderators. Dr. Rosenbaum is with the Dept. of Psychiatry at Massachusetts General Hospital, Boston, MA. Dr. Gadde is affiliated with Dept. of Psychiatry at Duke University Medical Center, Durham, NC. Dr. Ginsberg is affiliated with the New York University Medical Center, NY, NY. The following was mentioned in this article: "Weight gain with Remeron appears to be inversely related to dose, the European and US trials illustrated. When exceeding 15 mg, the H1 receptor becomes saturated and other receptor effects, such as increased release of serotonin and norepinephrine due to alpha2-adrenergic antagonism, predominate, and enhanced appetite and weight gain may be less of an issue."

2. Weight Gain Varies with Antidepressants. In: Clinical Psychiatry News, May 1999. The following was mentioned in this issue: "With mirtazapine, weight gain can occur as early as the first week of treatment, is usually associated with increased appetite, and is most likely due to the drug's antihistamine effects. Appetite diminishes after 4-12 weeks of therapy, however, and weight generally returns to baseline among patients who diet."

Again, different individuals respond differently to psychotropic pharmacological (therapeutic and adverse) effects.

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

> Sunnely,
>
> I am curious where you got your information. I have found sleepiness did not decrease with a higher dose. Sleepiness always increased and did not level off over time -- ie, I was stumbling around on 45 mg. Always did. It never lessened. And I was in a thick fog every morning. I had to take the 45 at home so that I could go to bed quickly when it kicked in. I could never be out or drive on 45.
>
> I got sleepy and woozey on 30 mg, but it did not cause me to be unsteady on my feet as I was on 45. On 15 mg, the effect is less than 30. I get sleepy. I have taken Remeron for 2 years and 5 months -- at 45 for about a year and at 30 for about a year. Back down to 15, and I am just now finally losing weight.
>
> I have asked him more than once, and my psychiatrist insists that weight gain INCREASES with a higher dose. I found this to be true. Lithium exacerbates the weight gain. I could not get the weight off no matter what I did with the high Remeron dose and Li augmentation. I took Li for 6 months of the 2.5 years on Remeron.
>
> Thanks.
>
> Allison

 

Re: What causes Remeron Weight gain » Sunnely

Posted by Greg on July 10, 2000, at 8:05:27

In reply to Re: What causes Remeron Weight gain, posted by Sunnely on July 9, 2000, at 2:32:59

Sunnely,

I'm with you on the decreased sleepiness at higher doses. I was much sleepier at 15mgs than at 45. My doc told me this would happen, although I have unable to find much on the subject at any of the websites. I took Rem for about a year, initially for depression, but in the end for insomnia. The appetite problem never subsided for me which prompted me to stop it.

Greg

 

Re: What causes Remeron Weight gain ..}}Allison

Posted by allisonm on July 10, 2000, at 19:22:26

In reply to Re: What causes Remeron Weight gain ..}}Allison, posted by janeS on July 9, 2000, at 18:50:48

Jane,
One of the symptoms of my untreated depression was weight loss. I didn't bother to weigh myself, but I think I was under 180. I wore a size 16 skirt but it was too big. I had to hold my jeans up with a belt. The weight gain over a year (combined with the lithium) brought me up to and probably over 200 lbs. I stopped weighing myself after 200 because it was too depressing. I had moved up to size 18 jeans and even THOSE were tight, caused stomach aches because the waist was too tight, etc. I couldn't even get close to buttoning that old skirt anymore. Most of my clothes didn't fit. I had to get new ones. Exercise (swimming 3x/week for 45 min.) and diet did nothing -- especially when I was on lithium.

Yes, Wellbutrin helped me lose the weight and I think the lower dose of Remeron has helped. My appetite just isn't there anymore. I'm down to 185 without exercise. My size 18 jeans are baggy and I am continually hiking them up. My size 16 jeans fit nicely (I don't like 'em tight). I am hoping to lose more weight. I had gotten down to a size 14 in 1996. It would be nice to be there again. (BTW, I am 5'8".)

Hope this helps.

Allison

 

Re: What causes Remeron Weight gain

Posted by allisonm on July 10, 2000, at 19:47:41

In reply to Re: What causes Remeron Weight gain, posted by Sunnely on July 9, 2000, at 19:43:26

Sunnely,

Thanks for the information and for your thoroughness. I'll have to look those articles up.

I am curious to know in the article by Gelenberg where he says: "some clinicians believe higher initial doses of mirtazapine might produce less sedation" what he means by "initial." I know Remeron often knocks people off their feet for a couple of days when they first start taking it. I wonder if his observation about "higher initial doses" is in reference to this early effect or if he is talking about long-term use. I also am curious to know the average length of the various studies. I see that one was 4-12 weeks.

Thanks again.

Allison

 

Re: What causes Remeron Weight gain

Posted by allisonm on July 10, 2000, at 21:19:58

In reply to Re: What causes Remeron Weight gain, posted by allisonm on July 10, 2000, at 19:47:41

And then there's this from Organon... I guess I am in the 17% group of those with weight gain.
A.

PRECAUTIONS

General

Somnolence: In U. S. controlled studies, somnolence was reported in 54% of patients treated with REMERON® (mirtazapine)
Tablets, compared to 18% for placebo and 60% for amitriptyline. In these studies, somnolence resulted in discontinuation for
10.4% of REMERON® treated patients, compared to 2.2% for placebo. It is unclear whether or not tolerance develops to the
somnolent effects of REMERON®. Because of REMERON® ’s potentially significant effects on impairment of performance,
patients should be cautioned about engaging in activities requiring alertness until they have been able to assess the drug’s effect on
their own psychomotor performance (see PATIENT INFORMATION).

Dizziness: In U.S. controlled studies, dizziness was reported in 7% of patients treated with REMERON®, compared to 3% for
placebo and 14% for amitriptyline. It is unclear whether or not tolerance develops to the dizziness observed in association with the
use of REMERON®.

Increased Appetite/Weight Gain: In U. S. controlled studies, appetite increase was reported in 17% of patients treated with
REMERON®, compared to 2% for placebo and 6% for amitriptyline. In these same trials, weight gain of >7% of b.d. weight was
reported in 7.5% of patients treated with mirtazapine, compared to 0% for placebo and 5.9% for amitriptyline. In a p.o. of
premarketing U.S. studies, including many patients for long-term, open label treatment, 8% of patients receiving REMERON®
discontinued for weight gain.

Cholesterol/Triglycerides: In U.S. controlled studies, nonfasting cholesterol increases to 20% above the upper limits of normal
were observed in 15% of patients treated with REMERON®, compared to 7% for placebo and 8% for amitriptyline. In these same
studies, nonfasting triglyceride increases to 500 mg/dL were observed in 6% of patients treated with mirtazapine, compared to 3%
for placebo and 3% for amitriptyline.


 

Re: What causes Remeron Weight gain

Posted by MB on July 11, 2000, at 1:59:34

In reply to Re: What causes Remeron Weight gain, posted by allisonm on July 9, 2000, at 17:30:41

> Don't know if this helps.
>
> Best wishes,
> Allison

It helps a lot. Wellbutrin durring the day and Remeron at night to sleep is what is working for me also. On top of it, I take Buspar which doesn't seem to make me tired, but takes the edge off the anxiety.

MB

 

Remeron Weight gain

Posted by gene_error on January 9, 2003, at 14:43:20

In reply to What causes Remeron Weight gain, posted by MB on July 9, 2000, at 0:43:09

Having had horrendous side effects from Prozac and cipramil, I was recently put on zispin (mirtazipine). My appetite increased grossly and I have put on 12 pounds in 4 weeks (I'm 50, always been 8.5 stone, but now fat!). My partner is now also taking this drug and her weight gain is even more (undesirably) dramatic.

For me- it works as an AD and is great for panic attacks, but my partner is now depressed about increased weight and lives in chocolate heaven.

I can't exercise more as the weight increase is affecting my knees (They hurt - sympathy anyone?)

Bottom line is; I feel a lot more laid back, many fewer panic attacks, but my food bill is crippling me !!!!

Paul (UK)

 

Re: Remeron Weight gain

Posted by Madge on February 12, 2003, at 22:26:40

In reply to Remeron Weight gain, posted by gene_error on January 9, 2003, at 14:43:20

I gained 12 lbs just by looking at food initially on Remeron. I was put on Topamax as a first course of action to try to lose the weight, but that ended up not working for me. It does work for many people though - although the medical community doesn't understand why it works, it just does. The key to using it is titrating up very slowly 25mg at a time so that you don't have the cognitive dopyness side effects. I didn't suffer from that so much, but after I reached 100mg, trying to reach a max dosage of 150mg, I started getting chronic UTI's - eg every other week, and I lost no weight.
I am no titrating off the Topamax and m Pdoc has pput me on Phentermine which is the nonimplicated part of Phen fen. It releases dopamine/ and norepenephrine adn acts like an amphetimine. I am starting on 15mg in the am for a week then increasing the dosage to 30mg in the am. The major side effect is anxiety, but many people just feel a false sense of well being that supersedes the anxiety, which I can live with. One cannot take this drug if one has high blood pressure.
I hope this helps. There are solutions to the Remeron gains, but one has to take another drug to help.
Otherwise I think Remeron is a great drug. I went through so many to find one that didn't have all sorts of horrible side effects.I was on Paxil for 3 years without a problem, then grew intolerant of it.
Good luck

Madge


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