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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by saturn on September 17, 2006, at 23:49:42
I'd be greatful for any feedback regarding Remeron. For simplicities sake I'll just list a few questions below. Question 5 is my most important one if you only want to read one. Thanks sincerely for any input.
1. How effective is it as an antidepressant( and is this effect only achieved when the NE kicks in at 30-45 mgs)? Can it stand up to anything like the ssris or tca's (or even stimulants)?
2. How pronounced is daytime sedation and cognition at the various doses. Is it possible to retain sedative effects for sleep while still having antidepressant qualities and full mental capacities during the daytime?
3. How likely and severe is "poop-out" and is it specificially difficult to withdraw from due to the remeron's unique propenisty for sedation at lower doses and stimulation at higher.
4. I've heard the prevalence of agranulocytosis to be around 1/1000. Is this underestimated/underreported?
5. Would Remeron be a reasonable medication for long term sleep maintenance that would allow me to be non-sedated/mentally focused and NOT DEPRESSED during the day?
6. Lipids and weight gain. I can fight off the munchies but how bad are the lipid effects?
Peace...Saturn
Posted by dbc on September 18, 2006, at 5:14:28
In reply to remeron questions for anyone, posted by saturn on September 17, 2006, at 23:49:42
1. On a scale of 1 to 10, 1 being paxil and 10 being stimulants i'd give it a 5 or 6.
2.The first two to three weeks will consist entirely of you sleeping or thinking about sleeping. Keep in mind this is one of those last line meds they give you before stronger stuff like MAOIs, its not meant for the feint of heart. For people with anxiety issues its sedating qualities are amazing but i wouldnt call them very consciously profound like say a benzo.
3. it seems totally subjective, some people claim it stopped working for them after two months while others take it for years.
4. I've only heard of this happening to one person.
5.Yes it works very well as a daily sleep aid. Theres no way to know before hand how something that hammers your histamine receptors so hard is going to effect you. It sounds like you're looking for the perfect drug (those dont exist).
6. Some people claim it causes them to crave sugar to the point of eating it raw. I didnt have this experiance and didnt notice weight gain but like every anti depressant people will claim it makes them fat. Literally every anti depressant on the market has been blamed for massive weight gain, theres no way to know whats true.
Posted by dbc on September 18, 2006, at 8:24:08
In reply to Re: remeron questions for anyone, posted by dbc on September 18, 2006, at 5:14:28
I recently saw a girl claim adderall was making her fat on a certain forum. (cough addforum)
Posted by Phillipa on September 18, 2006, at 10:48:20
In reply to Re: a followup to 6, posted by dbc on September 18, 2006, at 8:24:08
15mg with xanax didn't make me tired. Love Phillipa
Posted by joslynn on September 18, 2006, at 11:06:03
In reply to remeron questions for anyone, posted by saturn on September 17, 2006, at 23:49:42
>
> 1. How effective is it as an antidepressant( and is this effect only achieved when the NE kicks in at 30-45 mgs)? Can it stand up to anything like the ssris or tca's (or even stimulants)?I can't answer 1, as I take it at 15 mgs WITH an SSRI.
> 2. How pronounced is daytime sedation and cognition at the various doses. Is it possible to retain sedative effects for sleep while still having antidepressant qualities and full mental capacities during the daytime?
>
I can function at a high-pressure job during the day, and I have to be very detail-oriented and alert for a lot of my job. BUT I have to make sure to get at least 8 hrs sleep, 8 1/2 is better.> 3. How likely and severe is "poop-out" and is it specificially difficult to withdraw from due to the remeron's unique propenisty for sedation at lower doses and stimulation at higher.
Hmm, haven't had poop out.
I have gone off Remeron at various times, sometimes for over a year, because back then I couldn't figure out how to manage the munchies (see below for how I am doing that now). I didn't experience WD symptoms, just had to get used to sleeping without anything again. However, I do know that people on the WD board have had WD problems. My body didn't have this problem though. I went back on during a mini-relapse and stayed on because I just feel better and more emotionally strong on it. I do not have mini-episodes of depression when I am on Remeron and an SSRI. I did have some mini breakthrough depression episodes when I was just on an SSRI.
>
> 4. I've heard the prevalence of agranulocytosis to be around 1/1000. Is this underestimated/underreported?Er, dont' know what that is, so I guess I haven't had it. Do you mean the thing that starts out flu-like but is a rare, dangerous side effect? Haven't had that.
>
> 5. Would Remeron be a reasonable medication for long term sleep maintenance that would allow me to be non-sedated/mentally focused and NOT DEPRESSED during the day?
>
Yes, I don't feel depressed or sedated the next day.> 6. Lipids and weight gain. I can fight off the munchies but how bad are the lipid effects?
Ok, no idea what lipids are! The munchies are real, but, I have been able to manage them by avoiding white flour and sugar entirely. For me, on Remeron, it's easier to avoid these things altogether, or I just go crazy. I have gained a small amount of weight, which I am losing.
Posted by yxibow on September 18, 2006, at 13:15:59
In reply to remeron questions for anyone, posted by saturn on September 17, 2006, at 23:49:42
> I'd be greatful for any feedback regarding Remeron. For simplicities sake I'll just list a few questions below. Question 5 is my most important one if you only want to read one. Thanks sincerely for any input.
>
> 1. How effective is it as an antidepressant( and is this effect only achieved when the NE kicks in at 30-45 mgs)? Can it stand up to anything like the ssris or tca's (or even stimulants)?Its a very good antidepressant for some and can rival Cymbalta
> 2. How pronounced is daytime sedation and cognition at the various doses. Is it possible to retain sedative effects for sleep while still having antidepressant qualities and full mental capacities during the daytime?
Prounounced sedation. I took it in multiple parts during the day before consolidating a dose schedule. The sedation wears off a bit over time but yes, it still can affect mental capacities from just being tired.
> 3. How likely and severe is "poop-out" and is it specificially difficult to withdraw from due to the remeron's unique propenisty for sedation at lower doses and stimulation at higher.
I experienced the same sedation and side effects at lower and higher doses, some people apparently have what you describe about dose related comparedness. Poop-out is individualistic but I don't see that as a high factor. Withdrawal is mostly an insomniac effect I think.
> 4. I've heard the prevalence of agranulocytosis to be around 1/1000. Is this underestimated/underreported?Not that I'm aware of -- I had a test about a month after to be sure but its rather below Clozaril and other black box warnings.
> 5. Would Remeron be a reasonable medication for long term sleep maintenance that would allow me to be non-sedated/mentally focused and NOT DEPRESSED during the day?
Definately, its a great antidepressant and has REM sleep qualities and would allow you to continue your daily activities with the understanding that it is an individual nature as to when some (not all will) of the sedation wears off.
> 6. Lipids and weight gain. I can fight off the munchies but how bad are the lipid effects?
The lipid effects are there, possibly. But they're there in my opinion not because of the medication intrinsically, but because of munchies, which includes putting a padlock on your refrigerator. Its hard to say, the medication itself is sedating and may contribute some, but I think it has to do with massive weight gain.
It is really potentially among the best antidepressants for treatment resistant depression but the weight gain is real and there, rivaling Zyprexa. A calorie restricted diet is a must.
> Peace...Saturn
Posted by joslynn on September 18, 2006, at 13:40:13
In reply to Re: remeron questions for anyone, posted by joslynn on September 18, 2006, at 11:06:03
Posted by psychobot5000 on September 18, 2006, at 15:13:56
In reply to remeron questions for anyone, posted by saturn on September 17, 2006, at 23:49:42
1. On a meta-analysis rating, among other things, the force of antidepressant effect (by compiling self-ratings from dozens of studies), Remeron did very well against SSRIs and tricyclics--which is to say, there is not too much variation among various drugs, but it was rated among the highest. In my experience it is more powerful than SSRIs.
2. Effects are individual, but it is a powerful antihistamine/sedative, with a long half-life (over 30 hrs, perhaps). So, whatever effects help you with sleep are likely to hang around during the day. This was my experience, anyway. The sedative effects are worst in the first few days and weeks.
3. Never experienced poop-out, myself, despite taking it for many months.
5. I would guess it would help substantiall with sleep, especiall with doses 25mg or below, and help you be not-depressed during the day. Whether you will be sedated...who can say? Likely.
6. It increased my appetite somewhat--again, the antihistaminic effects. Never had a problem with weight gain, myself, but I imagine you'd have to keep on your guard.
>
>
> 4. I've heard the prevalence of agranulocytosis to be around 1/1000. Is this underestimated/underreported?
>
> 5. Would Remeron be a reasonable medication for long term sleep maintenance that would allow me to be non-sedated/mentally focused and NOT DEPRESSED during the day?
>
> 6. Lipids and weight gain. I can fight off the munchies but how bad are the lipid effects?
>
> Peace...Saturn
Posted by saturn on September 18, 2006, at 17:07:38
In reply to remeron questions for anyone, posted by saturn on September 17, 2006, at 23:49:42
Posted by dbc on September 19, 2006, at 8:41:53
In reply to P.S. I take mine at night (nm), posted by joslynn on September 18, 2006, at 13:40:13
I couldnt imagine taking it any other way. Within 45 minutes of taking mine i was asleep. This was at a 30mg dose.
Posted by Crazy Horse on September 19, 2006, at 10:10:07
In reply to remeron questions for anyone, posted by saturn on September 17, 2006, at 23:49:42
> I'd be greatful for any feedback regarding Remeron. For simplicities sake I'll just list a few questions below. Question 5 is my most important one if you only want to read one. Thanks sincerely for any input.
>
> 1. How effective is it as an antidepressant( and is this effect only achieved when the NE kicks in at 30-45 mgs)? Can it stand up to anything like the ssris or tca's (or even stimulants)?
>
> 2. How pronounced is daytime sedation and cognition at the various doses. Is it possible to retain sedative effects for sleep while still having antidepressant qualities and full mental capacities during the daytime?
>
> 3. How likely and severe is "poop-out" and is it specificially difficult to withdraw from due to the remeron's unique propenisty for sedation at lower doses and stimulation at higher.
>
> 4. I've heard the prevalence of agranulocytosis to be around 1/1000. Is this underestimated/underreported?
>
> 5. Would Remeron be a reasonable medication for long term sleep maintenance that would allow me to be non-sedated/mentally focused and NOT DEPRESSED during the day?
>
> 6. Lipids and weight gain. I can fight off the munchies but how bad are the lipid effects?
>
> Peace...SaturnHi Saturn,
I can only speak for myself, but for me Remeron was a great antidepressant for 5+ years. For me it was more powerful than any (and i've been on them all) ssri's,and TCA's. I took my dose at night and slept great, i had no daytime drowsiness from remeron. Towards the end of my treatment w/remeron we had to up the dose several times to get the same effect, but it did last 5+ years, and with these meds that's a long time. It did finally poop out on me.
The only drawbacks i had with Remeron was weight gain (evening munchies), and occasional sleep paralysis. Over-all i rate Remeron as a very effective antidepressant. I wish you good luck.
-Monte
Posted by yxibow on September 19, 2006, at 10:25:45
In reply to Re: remeron questions for anyone » saturn, posted by Crazy Horse on September 19, 2006, at 10:10:07
The only drawbacks i had with Remeron was weight gain (evening munchies), and occasional sleep paralysis. Over-all i rate Remeron as a very effective antidepressant. I wish you good luck.
>
> -Monte
I forgot to add the wonderful and sometimes scary effects of sleep paralysis.. If I fell asleep on a couch or some way that I couldn't get up, I would try to fight it and it was rather scary. Of course, if you don't fight it, you gradually wake up (or drop out to sleepland), but I have that fight or flight instinct.
But the ones that occurred in sleep to wake where I wasn't fighting it were the most interesting psychoactive response since I took Ambien (only one time, it said "come to sleep, its okay" as a feeling -- never again) -- as I woke up there was a brzzzzap! like a bee buzz and I saw the "last image" from my optic nerve placed above me as if it was a comic strip from a dream, as I awoke. And I've never done illicit substances but that was both minorly disturbing and yet powerfully fascinating. Sometimes it would happen multiple times in a row before I woke up completely, leading to multiple sub-dreams and these "comic strips" as a passing image. This persisted for weeks while I adjusted to the medication, in fact it never completely went away.-- tidings
Jay
Posted by tizza on September 21, 2006, at 15:29:16
In reply to Re: remeron and sleep paralysis » Crazy Horse, posted by yxibow on September 19, 2006, at 10:25:45
I suffer from sleep paralysis all the time too, with hypnogogic and hypnopompic hallucinations. I'm not on any ad's and it's been happening to me since I was a kid. I'm waiting to have a sleep assessment done (MSLT) It can be quite scary at times.
Posted by Crazy Horse on September 21, 2006, at 15:47:52
In reply to Re: remeron and sleep paralysis » yxibow, posted by tizza on September 21, 2006, at 15:29:16
> I suffer from sleep paralysis all the time too, with hypnogogic and hypnopompic hallucinations. I'm not on any ad's and it's been happening to me since I was a kid. I'm waiting to have a sleep assessment done (MSLT) It can be quite scary at times.
I feel for you! It is scary as HELL. When i was on remeron i had them frequently. It got so bad that i feared going to sleep.
-Monte
Posted by tizza on September 21, 2006, at 18:44:48
In reply to Re: remeron and sleep paralysis » tizza, posted by Crazy Horse on September 21, 2006, at 15:47:52
Posted by yxibow on September 21, 2006, at 19:58:50
In reply to Re: remeron and sleep paralysis » yxibow, posted by tizza on September 21, 2006, at 15:29:16
> I suffer from sleep paralysis all the time too, with hypnogogic and hypnopompic hallucinations. I'm not on any ad's and it's been happening to me since I was a kid. I'm waiting to have a sleep assessment done (MSLT) It can be quite scary at times.
I can understand the fear -- those hallucinations are a component of natural sleep in man and have been recorded for centuries. When I took remeron and had them first I feared them but then mostly I found it completely fascinating to literally see the last "frame" of my dream projected on the ceiling. The mind is a puzzle.
When one struggles with sleep paralysis however they become a more fearful element of the sleep to wake cycle then when one lets go and either awakens (most likely) or falls back to sleep. The position in which one sleeps affects them too, I believe sleep paralysis is more possible sleeping face down but I dont remember.
Posted by tizza on September 22, 2006, at 0:06:14
In reply to Re: remeron and sleep paralysis » tizza, posted by yxibow on September 21, 2006, at 19:58:50
I always sleep on my back, it can be ok sometimes when it happens but if it catches me off guard, I'm a goner. Having your dreams enter your bedroom are ok and can be quite interesting but unfortunatly for me I have alot of nightmares and when they mainfest into my bedroom it's a shocking experience including tactile (slapping,punching and smothering), visual and aural hallucinations. I just want it to stop, it can go on for 5-10mins sometimes or happen multiple times during the night, it leaves me so totally exhausted
Posted by tizza on September 22, 2006, at 0:16:04
In reply to Re: remeron and sleep paralysis » yxibow, posted by tizza on September 22, 2006, at 0:06:14
some of the things that have gone down in my bedroom at night are almost so obscure they are beyond words. If anyone else would like to discuss this further pls babble mail me. Paul
Posted by yxibow on September 22, 2006, at 2:44:19
In reply to Re: remeron and sleep paralysis » yxibow, posted by tizza on September 22, 2006, at 0:06:14
> I always sleep on my back, it can be ok sometimes when it happens but if it catches me off guard, I'm a goner. Having your dreams enter your bedroom are ok and can be quite interesting but unfortunatly for me I have alot of nightmares and when they mainfest into my bedroom it's a shocking experience including tactile (slapping,punching and smothering), visual and aural hallucinations. I just want it to stop, it can go on for 5-10mins sometimes or happen multiple times during the night, it leaves me so totally exhausted
I can see it is quite disturbing to you. If your insurance affords, you might want a sleep study if your doctor suggests it. This does go beyond an average bout of what I experienced on Remeron or in general. Undiagnosed narcolepsy is sometimes a cause, but I'm not suggesting that you have it. Treatment includes various psychological methods as well as medications like Xyrem and stimulants such as Modafinil as well as TCAs.
Posted by tizza on September 22, 2006, at 6:23:03
In reply to Re: remeron and sleep paralysis » tizza, posted by yxibow on September 22, 2006, at 2:44:19
Yes thanks, I'm booked in for one, MSLT, but they can't get me in until next year which I'm really pis*ed off about. The sleep specialist said I'm showing most symptoms of narcolepsy but no catalepsy. Apparently Xyrem is excellent for stopping the sleep paralysis but it's not legal here and not likely to be. He did mention stimulants to combat the EDS but what the hell do I do in the meantime!!!! It's so frustrating. He also told me that narcolepsy usually takes 10-15 years to diagnose and is usually treated as depression and anxiety disorders until the penny drops. I just want to know one way or the other, now!!! AAAARRRGGGGHHHHH. Sorry to rant but if you have anymore ideas let me know, thanks for the reply, PAul
Posted by zeugma on September 22, 2006, at 18:33:50
In reply to Re: sleep paralysis » yxibow, posted by tizza on September 22, 2006, at 6:23:03
Most srimulants (Ritalin, amphetamines) also have anticataplectic activity- albeit less than TCA's or Xyrem. Provigil has none. When I took a high dose of Ritalin with nortriptyline, I experienced no sleep paralysis whatsoever. I have to be very careful with Provigil, because it can exacerbate the cataplexy-related symptoms (whether it directly provokes them through a mixed antagonist/agonist action at alpha-1 receptors, or reduces the plasma levels of anticataplectic drugs through enzyme induction, or simply reduces sleep which itself causes increased cataplexy, is unclear. What is not unclear is that it is not helpful at all for cataplexy-related symptoms, such as sleep paralysis.)
Strattera is very effective at blocking sleep paralysis. If you are in the UK, reboxetine might be a good thing to try.
-z
Posted by yxibow on September 22, 2006, at 19:50:52
In reply to Re: sleep paralysis » tizza, posted by zeugma on September 22, 2006, at 18:33:50
> Most srimulants (Ritalin, amphetamines) also have anticataplectic activity- albeit less than TCA's or Xyrem. Provigil has none. When I took a high dose of Ritalin with nortriptyline, I experienced no sleep paralysis whatsoever. I have to be very careful with Provigil, because it can exacerbate the cataplexy-related symptoms (whether it directly provokes them through a mixed antagonist/agonist action at alpha-1 receptors, or reduces the plasma levels of anticataplectic drugs through enzyme induction, or simply reduces sleep which itself causes increased cataplexy, is unclear. What is not unclear is that it is not helpful at all for cataplexy-related symptoms, such as sleep paralysis.)
>
> Strattera is very effective at blocking sleep paralysis. If you are in the UK, reboxetine might be a good thing to try.
>
>
> -z
Actually Provigil has been used for narcolepsy but I was just listing it because its less harsh -- yes, phenylamines like amphetamines are used as well; SSRIs are used, a number of substances have been tested against various forms of this sleep disturbance.
Posted by tizza on September 22, 2006, at 22:32:37
In reply to Re: sleep paralysis » zeugma, posted by yxibow on September 22, 2006, at 19:50:52
This is the end of the thread.
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