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Dr. Bob is Robert Hsiung, MD,
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Posted by 4WD on August 19, 2005, at 14:53:14
My pdoc told me that Remeron blocks some SSRI side effects. I didn't think to ask which ones. I know it's an antagonist at 5HT2A, 5HT2c, 5HT3 and NE alpha 2 (from SLS's chart). But what does this mean in the real world?
Which side effects would be blocked by Remeron?
Marsha
Posted by linkadge on August 19, 2005, at 15:19:12
In reply to Remeron blocks SSRI side effects, posted by 4WD on August 19, 2005, at 14:53:14
Blocking the 5-ht2a receptor can block insomnia, physical and emotional anxiety, and cortisol release.
Blocking the 5-ht2c repceot can block agiation, akathesia, loss of appetite, and anorgazmia.
Blocking the 5-ht3 receptor can prevent nausia and GI upset. 5-ht3 receptor antagonists also seem to have a degree of anti-anxiety effect.Blocking the 5-ht2a/c receptors also increases frontal cortex norepinephrine and dopamine release, which could offset apathy produced by SSRI's.
The NE-Alpha-2 angatonist is more related to the clinical action of mirtazapine. This action increases serotonin and norepinephrine release.
This action might add AD efficacy but would not specifically reduce and SSRI side effects.
Linkadge
Posted by 4WD on August 19, 2005, at 15:22:51
In reply to Re: Remeron blocks SSRI side effects, posted by linkadge on August 19, 2005, at 15:19:12
> Blocking the 5-ht2a receptor can block insomnia, physical and emotional anxiety, and cortisol release.
>
> Blocking the 5-ht2c repceot can block agiation, akathesia, loss of appetite, and anorgazmia.
>
>
> Blocking the 5-ht3 receptor can prevent nausia and GI upset. 5-ht3 receptor antagonists also seem to have a degree of anti-anxiety effect.
>
> Blocking the 5-ht2a/c receptors also increases frontal cortex norepinephrine and dopamine release, which could offset apathy produced by SSRI's.
>
>
> The NE-Alpha-2 angatonist is more related to the clinical action of mirtazapine. This action increases serotonin and norepinephrine release.
> This action might add AD efficacy but would not specifically reduce and SSRI side effects.
>
>
> Linkadge
>
>
>
Linkadge, you are a gold mine of information. Thank you so much. (I know you understand the feeling you get when you get home from a 2 hour drive to a pdoc appointment and realize that you have not asked a question you needed to ask).How are you doing now? Is the Ritalin trial working out?
Thank you again,
Marsha
Posted by 4WD on August 19, 2005, at 15:51:09
In reply to Re: Remeron blocks SSRI side effects, posted by linkadge on August 19, 2005, at 15:19:12
> Blocking the 5-ht2a receptor can block insomnia, physical and emotional anxiety, and cortisol release.
>
> Blocking the 5-ht2c repceot can block agiation, akathesia, loss of appetite, and anorgazmia.
>
>
> Blocking the 5-ht3 receptor can prevent nausia and GI upset. 5-ht3 receptor antagonists also seem to have a degree of anti-anxiety effect.
>
> Blocking the 5-ht2a/c receptors also increases frontal cortex norepinephrine and dopamine release, which could offset apathy produced by SSRI's.
>
>
> The NE-Alpha-2 angatonist is more related to the clinical action of mirtazapine. This action increases serotonin and norepinephrine release.
> This action might add AD efficacy but would not specifically reduce and SSRI side effects.
>
>
> Linkadge
>
>If you weren't taking an SSRI, just the Remeron alone, what would be the effect of this antagonism at the different 5HT sites?
Just thought of that...
Marsha
>
Posted by Phillipa on August 19, 2005, at 18:28:42
In reply to Re: Remeron blocks SSRI side effects, posted by 4WD on August 19, 2005, at 15:51:09
I've never heard this one before. So they cancel each other out? Fondly, Phillipa
Posted by SandyWeb on August 19, 2005, at 18:59:22
In reply to Remeron blocks SSRI side effects, posted by 4WD on August 19, 2005, at 14:53:14
I use both Remeron (45 mg) and Celexa (80 mg).
I could not tolerate *any* of the SSRI's. I always had constant water-diarrhea (I know....more information than needed! Lol). But the point is that my diarrhea did not stop....weeks of it, then try another SSRI...weeks of diarrhea...try another SSRI...and on and on.
Remeron has allowed me to use Celexa without any GI upset at all this time. Remeron is my main antidepressant (my life saver), but I use Celexa to tie up the loose ends.
Hope this helps some.
Sandy
Posted by linkadge on August 19, 2005, at 20:23:30
In reply to Re: Remeron blocks SSRI side effects, posted by 4WD on August 19, 2005, at 15:22:51
No I am not continuing with the ritalin. I am stubborn. Although I am depressed, and suicidal most of the time, I'd rather die than have a short term solution. I don't want to taste happiness, unless it is sustainable. I've just got too many friends who started ritalin with good intentions, and for one reason or another ended up in the gutters.
Sorry for pessimism, feel free to ask anything.
Linkadge
Posted by linkadge on August 19, 2005, at 20:28:36
In reply to Re: Remeron blocks SSRI side effects, posted by 4WD on August 19, 2005, at 15:51:09
"If you weren't taking an SSRI, just the Remeron alone, what would be the effect of this antagonism at the different 5HT sites?"
I guess it depends on the baseline activation of the receptors. Since Remeron does increase serotonin release via alpha-2 antagonism, it may block some of that serotonin and prevent side effects.
If the 5-ht2a receptor is blocked excessivly, it can cause short term memory problems. If the 5-ht2c receptor is blocked excessivly you can experience obsessivness, and seizures. I don't know the side effects of excessive 5-ht3 receptor antagonism.
Personally, the magic dose of remeron for SSRI augmentation was 7.5 mg, which was 1/4 of a tablet.
Linkadge
Posted by linkadge on August 19, 2005, at 20:33:43
In reply to Re: Remeron blocks SSRI side effects » 4WD, posted by SandyWeb on August 19, 2005, at 18:59:22
It can be a good augmenting agent.
The theraputic action of SSRI's is thought to arise from activation of the 5-ht1a receptor, which seems to confer the antianxiety and antidepressant effect in animal studies at least.
Since remeron does not block this receptor, it would hopefully not compltetely cancel out the action of an SSRI.
Linkadge
Posted by 4WD on August 19, 2005, at 21:47:50
In reply to Re: Remeron blocks SSRI side effects, posted by linkadge on August 19, 2005, at 20:28:36
> "If you weren't taking an SSRI, just the Remeron alone, what would be the effect of this antagonism at the different 5HT sites?"
>
> I guess it depends on the baseline activation of the receptors. Since Remeron does increase serotonin release via alpha-2 antagonism, it may block some of that serotonin and prevent side effects.
>
> If the 5-ht2a receptor is blocked excessivly, it can cause short term memory problems. If the 5-ht2c receptor is blocked excessivly you can experience obsessivness, and seizures. I don't know the side effects of excessive 5-ht3 receptor antagonism.
>
> Personally, the magic dose of remeron for SSRI augmentation was 7.5 mg, which was 1/4 of a tablet.
>
>
> Linkadge
>
>
>Interestingly, that's just what my pdoc suggested. I had tried 15mg and 30mg. Got some sedation at 15 at night and big sedation at night at 30. Bad hunger pangs the next day and major dry mouth issues. Restless legs at both doses.
I've been on Celexa 10mg, not working great. Switched to Lexapro 5mg three weeks ago and got more anxious and more depressed. Cut it to 2.5mg and was still very anxious and depressed. Now I'm supposed to raise the Lex to 7.5 and if that doesn't work, then up to 10. If that doesn't work, then it's back to Celexa. Once I see what happens with the upped Lexapro dose, I will then add the Remeron if necessary. Same deal if I go back to Celexa.
Linkadge, have you ever been on imipramine? It really was more helpful to me than any SSRI has been. No mental or cognitive side effects at all. There was some pretty bad dry mouth but it got some better over time. Some nasal congestion but I have that anyway. Some postural hypotension but not bad at all. I was on 150mg. I only switched because my doctor put me on Prozac when it came out. The only reason I haven't gone back is the dry mouth issue. I've got so many crowns and bridges and general dental issues that I just can't risk more dental issues from dry mouth.
I just remember going on imipramine and feeling like the world had stopped being shades of gray and was suddenly in color again.
Marsha
>
>
Posted by linkadge on August 20, 2005, at 0:28:12
In reply to Re: Remeron blocks SSRI side effects » linkadge, posted by 4WD on August 19, 2005, at 21:47:50
I'd try it, but I really just don't care anymore.
Linkadge
Posted by SLS on August 20, 2005, at 7:45:17
In reply to Re: Remeron blocks SSRI side effects, posted by linkadge on August 20, 2005, at 0:28:12
> I'd try it, but I really just don't care anymore.
>
>
> Linkadge
I hope this is just a passing phase, Linkadge. I have been through it before. To be honest, I have grown weary of investigating psych stuff and don't much care about detail anymore. I just want to know enough to put me on the right track or in front of the right doctor. Just give me the right drugs and let me begin living a life enriched with things other than knowledge of biological psychiatry. I'd be very happy not to know anything about the differential roles that the various 5-HT receptors play in favor of watching Jethro Tull in concert.That being said, have you tried any of the neuroleptics that act as agonists at postsynaptic 5-HT1a receptors like ziprasidone or aripiprazole? Do you think gepirone might produce a therapeutic action as a partial agonist at these sites, or will it be as impotent as buspirone as an antidepressant? I wish flexinoxan were around. It is more potent than gepirone and lacks the NE alpha-2 receptor antagonist metabolite.
* Give yourself permission to be sick and tired of anything, but try to isolate which things are causing you feelings of helplessness or mental fatigue and put them away for awhile. You might find that you will find a renewal of energy and a more positive outlook. This might mean avoiding PB and psychiatric research for awhile. In the meantime, you will be able to deal with your true immediate priorities and perhaps gain a better insight into what things are acting as obstacles to your happiness.
- Scott
Posted by ed_uk on August 20, 2005, at 11:08:03
In reply to Re: Remeron blocks SSRI side effects, posted by linkadge on August 19, 2005, at 20:23:30
Hi Link,
Perhaps you could take Ritalin prn?
~Ed
Posted by ed_uk on August 20, 2005, at 11:09:41
In reply to Re: Remeron blocks SSRI side effects, posted by linkadge on August 19, 2005, at 20:28:36
>I don't know the side effects of excessive 5-ht3 receptor antagonism.
Headaches and constipation.
>If the 5-ht2a receptor is blocked excessivly, it can cause short term memory problems. If the 5-ht2c receptor is blocked excessivly you can experience obsessivness, and seizures. I don't know the side effects of excessive 5-ht3 receptor antagonism.
Where did you find this info?
Kind regards
~Ed
Posted by ed_uk on August 20, 2005, at 11:11:54
In reply to Re: Remeron blocks SSRI side effects » linkadge, posted by 4WD on August 19, 2005, at 21:47:50
Hi Marsha,
>The only reason I haven't gone back is the dry mouth issue.
Medication is available which should reverse the dry mouth.
~ed
Posted by 4WD on August 20, 2005, at 12:40:39
In reply to Re: Remeron blocks SSRI side effects » 4WD, posted by ed_uk on August 20, 2005, at 11:11:54
> Hi Marsha,
>
> >The only reason I haven't gone back is the dry mouth issue.
>
> Medication is available which should reverse the dry mouth.
>
> ~ed
What's it called? & why don't pdocs generally suggest it?marsha
Posted by ed_uk on August 20, 2005, at 14:11:14
In reply to Re: Remeron blocks SSRI side effects » ed_uk, posted by 4WD on August 20, 2005, at 12:40:39
Hi Marsha,
>What's it called?
Pilocarpine. It's a cholinergic agonist. Theoretically, it should reduce the dry mouth caused by anticholinergic drugs such as TCAs.
>why don't pdocs generally suggest it?
It's not approved for the relief of dry mouth caused by TCAs.
http://www.rxlist.com/cgi/generic3/salagen_ids.htm
Kind regards
~Ed
Posted by linkadge on August 20, 2005, at 16:01:19
In reply to Re: Remeron blocks SSRI side effects » linkadge, posted by SLS on August 20, 2005, at 7:45:17
>ziprasidone or aripiprazole,
I don't think are available in canada.
>? Do you think gepirone might produce a >therapeutic action as a partial agonist at these >sites,Buspar has some AD action. I think that its d2 antagonist properties reduce some of its AD effects. Some doctors have used it more sucessfully in much higher doses. As an adjunct it is perhaps better. Yes, a more potent, and selective 1a agonist might proove usefull.
----------------------------------------------I've just been thinking a lot about suicide lately.
Linkadge
Posted by linkadge on August 20, 2005, at 16:02:35
In reply to Re: Remeron blocks SSRI side effects » linkadge, posted by ed_uk on August 20, 2005, at 11:08:03
The crashing isn't worth it.
Linkadge
Posted by ed_uk on August 20, 2005, at 16:14:18
In reply to Re: Remeron blocks SSRI side effects, posted by linkadge on August 20, 2005, at 16:02:35
Link,
Do you crash after a single dose?
You might prefer Concerta, you could take it on bad days.
~Ed
Posted by linkadge on August 20, 2005, at 16:22:52
In reply to Re: Remeron blocks SSRI side effects, posted by ed_uk on August 20, 2005, at 11:09:41
From all over the place.
5-ht2c agonists as anticonvulsants:
-----------------------------------
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=15638778Seizure prone 5-ht2c knockout mice:
-----------------------------------
http://www.nature.com/nature/journal/v374/n6522/abs/374542a0.html;jsessionid=9BECE231CF19B4F2C9552C0A6DFFEAEE5-ht2c antagonists can produce seizures
----------------------------------------
http://www.columbia.edu/~rh95/constitutive.html"In addition, the mutant mice (5-ht2c knockout) displayed a lowered threshold for metrazol-induced seizures. Interstingly, this effect could be mimicked in wild-type animals with a non-selective 5-HT2C receptor antagonist"
5-ht2a and short term memory
----------------------------
http://www.nootropics.com/genes/index.htm
-----------------------------------------
"The neurotransmitter serotonin is better known for its involvement in depression, but drugs that block a particular serotonin receptor in the brain, 5HT2a, are known to also block short-term memory."
Linkadge
Posted by linkadge on August 20, 2005, at 16:30:33
In reply to Re: Remeron blocks SSRI side effects » linkadge, posted by ed_uk on August 20, 2005, at 16:14:18
I am taking a long acting version. Methylphenedate SR.
It lasts from the morning till about 5 pm.
Still, the crash then is just not worth it.
If you did a mood/time graph you'd see that the area above the baseline mood is eqal to the area beneith the baseline mood.
Linkadge
Posted by ed_uk on August 20, 2005, at 16:52:05
In reply to Re: Remeron blocks SSRI side effects, posted by linkadge on August 20, 2005, at 16:22:52
Perhaps you could try a smaller dose - the crash might be milder.....
~Ed
Posted by linkadge on August 20, 2005, at 17:01:21
In reply to Re: Remeron blocks SSRI side effects » linkadge, posted by ed_uk on August 20, 2005, at 16:52:05
Oh it will be milder, but then less effect.
I'd just rather not. Stimulants are dead ends for me. Extrordinarily helpfull, but dead ends none the less.
Linkadge
Posted by 4WD on August 20, 2005, at 22:16:53
In reply to Re: Remeron blocks SSRI side effects » 4WD, posted by ed_uk on August 20, 2005, at 14:11:14
> Hi Marsha,
>
> >What's it called?
>
> Pilocarpine. It's a cholinergic agonist. Theoretically, it should reduce the dry mouth caused by anticholinergic drugs such as TCAs.
>
> >why don't pdocs generally suggest it?
>
> It's not approved for the relief of dry mouth caused by TCAs.
>
> http://www.rxlist.com/cgi/generic3/salagen_ids.htm
>
> Kind regards
>
> ~EdThanks, Ed. I've always had in the back of my mind that imipramine would be there as a last resort but I could only resort to it as truly a last resort. I have a lot of dental issues (from former bulimia and a lifetime of dry mouth from medications) so the dry mouth thing wasn't just an annoyance - it was potentially a major problem.
Knowing that there is a potential solution to this issue somehow makes me feel safer. It gives me one more option, you know? So thank you.I think I might actually have Sjogren's disease since I also have also always had dry eyes and problems with dryness of other mucous membranes which I won't go into...
Marsha
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