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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 Dinah on July 19, 2002, at 19:47:10
Originally posted by swingsnroundabouts
> Any comments or comparisons between venlafaxine and mirtazapine? I take venlafaxine but can't sleep on it and am interested in switching to mirtazapine but concerned that it could precipitate manic episode. I guess that it wouldn't if the venlafaxine doesn't but can't find much info on mirtazapine in bipolar disorder. Thanks in advance for any replies.
Posted by Shawn. T. on July 19, 2002, at 19:59:10
In reply to Re: venlafaxine vs. mirtazapine » swingsnroundabouts, posted by Dinah on July 19, 2002, at 19:47:10
Mirtazapine (Remeron) blocks serotonin 5-HT2a and 5-HT2c receptors, which are the ones implicated in mania. It is excellent for bipolar disorder IMHO. It's definitely a better drug that venlafaxine (Effexor).
Shawn
Posted by oracle on July 21, 2002, at 11:46:37
In reply to Re: venlafaxine vs. mirtazapine, posted by Shawn. T. on July 19, 2002, at 19:59:10
> Mirtazapine (Remeron) blocks serotonin 5-HT2a and 5-HT2c receptors, which are the ones implicated in mania. It is excellent for bipolar disorder IMHO. It's definitely a better drug that venlafaxine (Effexor).
>
> ShawnIntresting. How do you judge that one drug is better than
another ?
Posted by Shawn. T. on July 21, 2002, at 18:13:29
In reply to Re: venlafaxine vs. mirtazapine, posted by oracle on July 21, 2002, at 11:46:37
I base my decision process on a variety of things. I consider each of the following for all available drugs when recommending one: number of side effects, severity of side effects, dosage needed to bring about side effects, how they affects different receptors, on whether or not they have been shown to provide significant efficacy for similar and related mental health problems, on how they interacts with intracellular brain functions, and so on. I should mention that taking fish oils along with mirtazapine is a good idea for bipolars. At least I consider all of that, I'm guessing that a lot of psychiatrists take shots in the dark. My methods are not perfect, but they are definitely improving.
Shawn
Posted by oracle on July 21, 2002, at 22:20:17
In reply to Re: venlafaxine vs. mirtazapine » oracle, posted by Shawn. T. on July 21, 2002, at 18:13:29
> I base my decision process on a variety of things.
> ShawnI would keep in mind that this board is not a fair
sample of persons who take psyco meds. It is hard
to judge how a med effects the general population
by considering what those who do not do well on meds.People tend to be move motivated to seek help if things
are not going well.
Posted by Shawn. T. on July 22, 2002, at 15:11:07
In reply to Re: venlafaxine vs. mirtazapine, posted by oracle on July 21, 2002, at 22:20:17
I wasn't talking about what I have read on this board. I read clinical research studies on humans. I really don't even need to use that information; I pretty much understand how these drugs work in the brain judging by their receptor actions. I'll try to include more examples of large scale human studies in my posts from now on.
http://www.biopsychiatry.com/mirtazvvenlaf.html
Shawn
Posted by oracle on July 22, 2002, at 16:05:47
In reply to Re: venlafaxine vs. mirtazapine » oracle, posted by Shawn. T. on July 22, 2002, at 15:11:07
Abstracts are really not that useful for real study and understanding, at least for me, that is.
Posted by oracle on July 22, 2002, at 21:51:54
In reply to Re: venlafaxine vs. mirtazapine » oracle, posted by Shawn. T. on July 22, 2002, at 15:11:07
I pretty much understand how these drugs work
in the brain judging by their receptor actions.Ah. This assumes we have an amine theory that holds
true and describes mental illness. We don't. Any amine
theory is we have is very flawed. We cannot prove that amines
are the root cause of mental illness. They mey have
nothing at all to do with illness, but when adjusted by meds
cause other adjustments.I have always thought that regulation of amines
is in the middle of the chain of events that cause
mental illness. If they were the root cause, AD's would
be a cure, or at least much more sucessful.
Posted by cybercafe on July 24, 2002, at 20:31:01
In reply to Re: venlafaxine vs. mirtazapine, posted by oracle on July 22, 2002, at 21:51:54
> theory is we have is very flawed. We cannot prove that amines
> are the root cause of mental illness. They mey...depends what you mean by root cause no? i suppose DNA is the root cause.
have
> nothing at all to do with illness, but when adjusted by meds
> cause other adjustments.what are parts of the illness and what are symptoms? i'm sure we all have different ideas of the word "illness" and "symptom"
> I have always thought that regulation of amines
> is in the middle of the chain of events that cause
> mental illness. If they were the root cause,that sounds about right
>AD's would
> be a cure, or at least much more sucessful... true... of course different people have different causes of illness
basically what i'm saying is i totally agree with you -- this stuff is pretty complicated... but it seems to be beneficial to try and understand different levels of function ...
Posted by oracle on July 26, 2002, at 14:30:59
In reply to Re: venlafaxine vs. mirtazapine, posted by cybercafe on July 24, 2002, at 20:31:01
basically what i'm saying is i totally agree with you -- this stuff is pretty complicated... but it seems to be beneficial to try and understand different levels of function ...
I was thinking more along the lines of statements
like "selective meds are better' and "I can tell how a med will work based on how the receptors are effected" I felt the assumption here was that
neurochemistry functions in a vacuum.I see mental illness is a cascade of events. You cannot isolate one NT because if you effect one (with a med) you actually effect many of them.
We can say X effects Y, but the rest (Y effects D, which effects C, E and G, ect) is still not very clear.The med may be selective, the effects are not. This is why "dirty" meds tend to work better and why polymeds work. Also, we can qualify that X med
blocks Y uptake, but we cannot map the complex cascade of events the lead to AD's changing mood.
The chaotic and complex systems that opperate here
are beyond our ability to map at this point.I think many depressions are DNA based but some are caused by other events. So by root cause
I mean the very first biochemical/bioelectrical
event that starts this cascade effect that results in depression. I think this is where medication would be most sucessful. Till we can fix "bad" DNA.
This is the end of the thread.
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