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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by cole on March 30, 2001, at 15:40:50
I have a question regarding cyclical depression (w/o mania-- just normal to low) and remeron dosing. I have been taking remeron regularly since this September.
When I saw my pdoc last wed I asked why despite a seemingly effective treatment I keep sliding into a depression every few months, usually around the end of my quarters in school. She explained that my depression is cyclic, and this is why I fall into a depression every few months. These depressions are usually lighter than what I had pre-remeron, but they are still upsetting, as they cause me problems with focusing on studying and self-esteem.
From September to December I took 45 mg/ night. I began getting depressed again in early December, and by the first week in January I was completely depressed (suicidal, anxious etc), and wasn't experiencing any of the side effects from the remeron anymore. During the 2nd week of Jan. I upped my dose to 60 mg, and remained relatively depression-free until late February, when I began sliding into depression again. I had been feeling mildly depressed since then (particularly bad during finals)-- less motivation, feeling anxious, low self esteem etc. A few days ago I decided to see if upping my dose would bring me out of the depression again, and I've been taking 75 mg/ night. I'm feeling great again.
So here's my question. Should I stay at this high dose, or should I drop back down to 60 after a week or so of the higher dose? I really don't like this pattern of depression leading to increased dosing, because I will be reaching unhealthy levels if this continues every couple of months. My doctor said that the remeron just keeps my lows higher when I go into depressions, but I'm seeing a pattern with a need to increase my doses to maintain the same level of AD response. Any ideas?
Thank you so much,
cole
Posted by stjames on March 30, 2001, at 16:02:33
In reply to cycling and remeron, posted by cole on March 30, 2001, at 15:40:50
My doctor said that the remeron just keeps my lows higher when I go into depressions, but I'm seeing a pattern with a need to increase my doses to maintain the same level of AD response. Any ideas?
> Thank you so much,
> coleJames here....
Stay at a high enough dose to remain well all the time. Depression is a progressive disease, each relapse makes the depression worse, more likely
to return stronger and with shorter cycles.James
Posted by SalArmy4me on March 30, 2001, at 16:39:48
In reply to cycling and remeron, posted by cole on March 30, 2001, at 15:40:50
I think adding Effexor would do you some good (Effexor and Remeron work on some of the same chemicals). Effexor + Remeron is the "power" combination spoke of in the Tips.
> I have a question regarding cyclical depression (w/o mania-- just normal to low) and remeron dosing. I have been taking remeron regularly since this September.
> When I saw my pdoc last wed I asked why despite a seemingly effective treatment I keep sliding into a depression every few months, usually around the end of my quarters in school. She explained that my depression is cyclic, and this is why I fall into a depression every few months. These depressions are usually lighter than what I had pre-remeron, but they are still upsetting, as they cause me problems with focusing on studying and self-esteem.
> From September to December I took 45 mg/ night. I began getting depressed again in early December, and by the first week in January I was completely depressed (suicidal, anxious etc), and wasn't experiencing any of the side effects from the remeron anymore. During the 2nd week of Jan. I upped my dose to 60 mg, and remained relatively depression-free until late February, when I began sliding into depression again. I had been feeling mildly depressed since then (particularly bad during finals)-- less motivation, feeling anxious, low self esteem etc. A few days ago I decided to see if upping my dose would bring me out of the depression again, and I've been taking 75 mg/ night. I'm feeling great again.
> So here's my question. Should I stay at this high dose, or should I drop back down to 60 after a week or so of the higher dose? I really don't like this pattern of depression leading to increased dosing, because I will be reaching unhealthy levels if this continues every couple of months. My doctor said that the remeron just keeps my lows higher when I go into depressions, but I'm seeing a pattern with a need to increase my doses to maintain the same level of AD response. Any ideas?
> Thank you so much,
> cole
Posted by cole on March 31, 2001, at 22:31:46
In reply to cycling and remeron, posted by cole on March 30, 2001, at 15:40:50
>I'm seeing a pattern with a need to increase my doses to maintain the same level of AD response.
http://www.biopsychiatry.com/mirtazap.html
I found this while surfing the tips section. It suggested that versus impramine (sp?) mirtazapine had a significant response to sleep, anxiety and agitation after 2 weeks of steady blood levels, then the effect began decreasing at 4 weeks. My depression has a significant anxiety component, so would it be fair to guess that one might also see a decrease in antidepressant effects at that 4 week mark, despite maintenance of dosing? And, if this is what is happening with me, how can this be avoided?
--cole
Posted by loosmrbls on April 2, 2001, at 8:55:47
In reply to does this answer my question?, posted by cole on March 31, 2001, at 22:31:46
Your story is SCREAMING bipolar II. Cyclic depression, ESPECIALLY "anxious" depression is CLASSIC for bipolar II.
Antidepressants are destabilizing in bipolar II, which is why you can crash on them, increase the dose, and continue cycling (trust me, I know).
I would strongly suggest talking over the diagnosis with your psychiatrist, see if he agrees, and start by adding a mood stabilizer like lithium or depakote.
Posted by cole on April 2, 2001, at 17:20:19
In reply to Re: does this answer my question?, posted by loosmrbls on April 2, 2001, at 8:55:47
> Your story is SCREAMING bipolar II. Cyclic depression, ESPECIALLY "anxious" depression is CLASSIC for bipolar II.
>
> Antidepressants are destabilizing in bipolar II, which is why you can crash on them, increase the dose, and continue cycling (trust me, I know).
>
> I would strongly suggest talking over the diagnosis with your psychiatrist, see if he agrees, and start by adding a mood stabilizer like lithium or depakote.Well, I mentioned such an idea to my doctor several months ago after reading something which tied anxiety and bipolar II into the same category. Her response was "No I don't think you are bipolar, that's why we have the diagnosis of mixed anxiety and depression (MAD). . . besides you don't want to be labeled bipolar."
I see the connections after looking through some of the articles on "soft bipolar" and such, but I don't know what to say. I'll give her a call and see if we can have a phone conference (I'm a few hours away) regarding this increased dosing issue. I'm not resistant to adding a mood stabilizer, so I'll talk it over and see what her ideas are.
cole
This is the end of the thread.
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