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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by bleauberry on January 2, 2008, at 19:22:47
Whenever I just surf and study antidepressants, I tell you, remeron just always comes up shining. Speed of response, lack of ssri side effects, unique mechanisms boosting serotonin, norepinephrine, and dopamine, etc etc.
If I surf of lexapro, yeah it comes up top dog. Then effexor, yeah, it's way up there too. Then remeron, it blows both in the weeds. I mean, looking at clinical trials, not actual real world.
So when something looks so good in trials, universities, hospitals, and stuff, how come it doesn't seem that good to the rest of us? I would think remeron would be more popular. I do understand the sleepiness, and it usually goes away, and I understand the weight gain, but I mean, I don't know. It just puzzles me why something looks so good on paper and isn't more popular.
Posted by ClearSkies on January 2, 2008, at 19:44:28
In reply to I Wonder Why Remeron Isn't More Popular?, posted by bleauberry on January 2, 2008, at 19:22:47
I don't know, either. I tried so many SSRI's over the years, and the SNRI's (Effexor, Cymbalta), all of which either didn't work very well, or worked with really horrible side effects. I changed pdocs this summer after a ghastly experience and was finally put on Remeron, and I have to say that it really felt like somebody just handed me my life back, in so many ways.
The start up effects were really unpleasant - the incessant appetite and lethargy were truly horrible. But once I got up to my dosage of 30mg, the weight gain stopped, my energy returned, and my mood - my MOOD!!! - is pretty darn normal. I feel low, I feel high. I can FEEL. It's a real godsend for me.
High praise for this drug from me, and thanks to my pdoc for reevaluating my dx, which had been mild bipolar II, to major depressive. The dx fits me much better, and it's such a relief not to be on all those inappropriate medications that just wouldn't work, not matter how many I tried, or in how many different combinations.
ClearSkies
Posted by Phillipa on January 2, 2008, at 20:05:04
In reply to Re: I Wonder Why Remeron Isn't More Popular? » bleauberry, posted by ClearSkies on January 2, 2008, at 19:44:28
Just thinking my brain what brain that is could it be that the way we are diagnosed is wrong? I don't know my brain is wierd. Phillipa
Posted by Justherself54 on January 2, 2008, at 20:11:51
In reply to Re: I Wonder Why Remeron Isn't More Popular?, posted by Phillipa on January 2, 2008, at 20:05:04
I think weight gain is part of the reason it's not used as much..
Posted by Maxime on January 2, 2008, at 20:54:13
In reply to I Wonder Why Remeron Isn't More Popular?, posted by bleauberry on January 2, 2008, at 19:22:47
I think because of the weight gain and the sedation. Most people stop taking it for that reason ... I know I did. I was so sedated that I felt like I was floating. And I was also eating everything in sight.
Maxime
Posted by Phoenix1 on January 2, 2008, at 21:46:12
In reply to I Wonder Why Remeron Isn't More Popular?, posted by bleauberry on January 2, 2008, at 19:22:47
I thought the same as you when I first researched it. Yes, the literature certainly makes it look like a very effective AD and it is for some. Sedation is really only an issue on the lower doses, smart pdocs don't bother titrating up, they just atart at an effective, relatively high non-sedating dose.
I found it effective for at least 6 months. But the appetite increase and weight gain was a problem. And it made me feel very numb emotionally, and cognitively fuzzy. And then it pooped out, but the side effects didn't.
But certainly, some VERY depressed patients have imroved dramatically while under high-dose inpatient treatment with Remeron, so it's a valuable tool! And others find it useful in low doses as a sleep aid.
Phoenix1
> Whenever I just surf and study antidepressants, I tell you, remeron just always comes up shining. Speed of response, lack of ssri side effects, unique mechanisms boosting serotonin, norepinephrine, and dopamine, etc etc.
>
> If I surf of lexapro, yeah it comes up top dog. Then effexor, yeah, it's way up there too. Then remeron, it blows both in the weeds. I mean, looking at clinical trials, not actual real world.
>
> So when something looks so good in trials, universities, hospitals, and stuff, how come it doesn't seem that good to the rest of us? I would think remeron would be more popular. I do understand the sleepiness, and it usually goes away, and I understand the weight gain, but I mean, I don't know. It just puzzles me why something looks so good on paper and isn't more popular.
Posted by linkadge on January 2, 2008, at 22:26:14
In reply to Re: I Wonder Why Remeron Isn't More Popular? » bleauberry, posted by Phoenix1 on January 2, 2008, at 21:46:12
I didn't find it all that great for depression. It didn't seem to have the same type of kick that uptake inhibitors did.
I didn't mind the weight gain or sedation only that I was always so hungry I couldn't concentrate on anything else.
I have seen a few studies that showed that different individuals responded depending on their status of a certain (5-ht2a) receptor polymorphism.
The only think I liked about remeron is that it seemed to have some antipsychotic qualities. Especially when I was really stressed out, perhaps it was the cortisol lowering effect.
Linkadge
Posted by Phillipa on January 2, 2008, at 23:25:56
In reply to Re: I Wonder Why Remeron Isn't More Popular?, posted by linkadge on January 2, 2008, at 22:26:14
Well as usual I'm the one out as it didn't make me tired . I think I'm so used to benzos that drugs like remeron don't even touch me. No weight gain either or hunger????? Just I Phillipa
Posted by Darwin on January 3, 2008, at 17:40:29
In reply to I Wonder Why Remeron Isn't More Popular?, posted by bleauberry on January 2, 2008, at 19:22:47
I haven't heard any reports of long term effectiveness. Perhaps, as was the case with Phoenix, Remeron stops working after about 6 months for the majority of patients.
Posted by bleauberry on January 3, 2008, at 19:32:29
In reply to I Wonder Why Remeron Isn't More Popular?, posted by bleauberry on January 2, 2008, at 19:22:47
Yeah, I agree with everyone here. That is, the sedation and weight gain are the turn-offs with remeron. Poopout occurs, but that's nothing different than any other meds. At a forum where people rate their experiences with meds, I think weight gain and sedation were the big ones. Only one or two people felt worse taking it. A few didn't get any benefit. Most did get benefit but didn't like the side effects. Poopout victims found high doses effective and longlasting for years. 90mg was mentioned a couple times.
Posted by James_Glasgow_UK on January 4, 2008, at 8:24:39
In reply to Re: I Wonder Why Remeron Isn't More Popular?, posted by bleauberry on January 3, 2008, at 19:32:29
it made me sleep from 10pm to 3pm the next day and also made me very hungry when I was actually awake. So I gave in and went back on an SSRI.
James
Posted by Phoenix1 on January 4, 2008, at 8:51:03
In reply to Re: I Wonder Why Remeron Isn't More Popular?, posted by James_Glasgow_UK on January 4, 2008, at 8:24:39
> it made me sleep from 10pm to 3pm the next day and also made me very hungry when I was actually awake. So I gave in and went back on an SSRI.
>
> JamesWhat was your starting dose, and what was the highest dose you took?
I really believe a lot of the people who found that Remeron caused somnolence were either started on too low a dose or never raised to a high enough dose. (James, I'm not assuming this is the case with you) I know the manufacturer recommends starting at 15mg/day, but I think this sets people up for failure because of the drowsiness. It's hard for most people to understand that for Remeron, higher dose = less drowsiness. For most people it should be STARTED at 30mg/day. Any lower and you aren't getting the norepinephrine boost to counter the H1 blocking action that causes somnolence.
And the manufacturers recommended max dose of 45 is ignored by many pdocs. I was on 60mg for a while, and I know of patients who were taking 90mg. Somnolence is really not an issue at these doses. The appetite thing seems to be brutal at all doses though.
Phoenix1
Posted by ClearSkies on January 4, 2008, at 9:22:38
In reply to Re: I Wonder Why Remeron Isn't More Popular? » James_Glasgow_UK, posted by Phoenix1 on January 4, 2008, at 8:51:03
>
> The appetite thing seems to be brutal at all doses though.
>For me, the appetite went back to normal after being at 30mg for about 6 weeks. (I actually lost weight over Christmas, much to my delight.) "Your mileage may vary" certainly is true in my case - I couldn't be more pleased with this medication in every respect.
ClearSkies
Posted by Phoenix1 on January 4, 2008, at 9:30:17
In reply to Re: I Wonder Why Remeron Isn't More Popular?, posted by ClearSkies on January 4, 2008, at 9:22:38
Hi Clearskies,
Yes, Remeron seems to be a miracle for some people. It's a pretty powerful drug, but you're right, YMMV on this one.
I'm convinced that many patients just give up too soon, at too low a dose before the med has a chance to kick in. For me, it took about 4 weeks at 45mg to improve. The appetite side effect never disappeared, even after the med pooped out. Raising the dose to 60mg helped for a few weeks, but it just seemed determined to poop out on me. But otherwise, it is one of the very few AD's that has ever done anything for me.
Phoenix1
>
> >
> > The appetite thing seems to be brutal at all doses though.
> >
>
> For me, the appetite went back to normal after being at 30mg for about 6 weeks. (I actually lost weight over Christmas, much to my delight.) "Your mileage may vary" certainly is true in my case - I couldn't be more pleased with this medication in every respect.
>
> ClearSkies
Posted by elanor roosevelt on January 4, 2008, at 21:57:10
In reply to Re: I Wonder Why Remeron Isn't More Popular?, posted by Phoenix1 on January 4, 2008, at 9:30:17
my MD gave me remeron for sleep
it did awful things to my sleep structure
Posted by Racer on January 4, 2008, at 22:09:52
In reply to Re: I Wonder Why Remeron Isn't More Popular?, posted by bleauberry on January 3, 2008, at 19:32:29
> Yeah, I agree with everyone here. That is, the sedation and weight gain are the turn-offs with remeron. Only one or two people felt worse taking it. A few didn't get any benefit. Most did get benefit but didn't like the side effects.
I'm one of those who felt much worse on it. I only lasted about a week -- no sleep, rage, feeling out of control and violent. I virtually never raise my voice, and hardly ever lose my temper -- on Remeron, I told my husband to stay away from me, because I was afraid I would hit him. I also told him to keep the cats away, because I was afraid I'd hurt them. It was truly a nightmare period in my life -- and that was only about a week or so. Frightening for me, let me tell you.
And, of course, everything felt out of control, including my eating. At the time, there's no way I could have stayed on it any longer for that reason alone -- I couldn't decide to eat or not, I truly felt I had no control whatsoever.
It's too bad, since I've heard a lot of good things about it and almost wish I could try it. Oh, well...
Posted by linkadge on January 4, 2008, at 22:17:19
In reply to Re: I Wonder Why Remeron Isn't More Popular? » bleauberry, posted by Racer on January 4, 2008, at 22:09:52
I agree with above. Remeron helped my mood a little, but the rage was hard to deal with even when living on my own. I didn't really recognize myself while on it too.
Linkadge
Posted by johnj on January 5, 2008, at 10:34:53
In reply to Re: I Wonder Why Remeron Isn't More Popular? » bleauberry, posted by Racer on January 4, 2008, at 22:09:52
I have been on remeron twice, and both times it was a mistake. I stayed on it for sleep but it almost cost me my marriage and everything else. Anger, increased OCD, very very hard to let things go. I would repeat things in my mind. It may work for some but for me it was a nightmare and then the withdrawal is another story.
johnj
Posted by cubic_me on January 5, 2008, at 17:19:40
In reply to Re: I Wonder Why Remeron Isn't More Popular?, posted by johnj on January 5, 2008, at 10:34:53
At least in the UK, SSRIs tend to be used as a first line drug because they have fewer/better tolerated side effects. Usually only after one or two SSRIs have failed are things like Remeron considered.
For me it was magic for my mood, within 3 days I'd gone from acutely suicidal to functioning normally, however I also put on a rediculous amount of weight. I just couldn't stop eating, I estimated 5-6000 calories a day. Nothing I tried before had worked.
Luckily I'm managing med free at the moment, but on the advice of my doctor have a supply of remeron to take if things get really bad again. I'm willing to do this, since I'd rather be fat than dead.
Posted by oldschool305 on January 5, 2008, at 19:35:59
In reply to Re: I Wonder Why Remeron Isn't More Popular?, posted by cubic_me on January 5, 2008, at 17:19:40
Here's an interesting question for all Remeron users. I have the 30mg disolvable tabs. I never took the entire tablet, I would crush it and then lick a tiny tiny tiny piece...mmm, tastes like Orange. but I would take only about 2.5mg. They say that Remeron works best for sleep at lower doses, so would 2.5mg be stronger than an entire 15mg tab? Would 1mg be even stronger? You guys know what I mean? =O
I've taken remeron several times in the past to help me sleep or to take away panic/anxiety attacks. It works magic, everytime! Yah, I gained weight and had aggatation the next day but I love how it knocks me out at night.
Posted by bleauberry on January 5, 2008, at 20:13:59
In reply to Re: I Wonder Why Remeron Isn't More Popular???????, posted by oldschool305 on January 5, 2008, at 19:35:59
I have taken remeron purely for sleep. I would take a 15mg tab and break it into tiny pieces, yielding a dose of about 2mg to 5mg. That for me is plenty to knock me out and anti-anxiety too. Actually, a full 15mg dose would not knock me out as well, I would not sleep as well, and the next day was entirely stoned sluggish in a haze. Remeron's sedation truly is stronger at a lower dose because the antihistimine effect is proportionately stronger than the other effects at that dose. The tiny dose means a lot less carryover into the next day. I have tinnitus (ringing in the ears) and have noticed over the years that anything that stimulates norepinephrine worsens it. I noticed that at 7.5mg remeron the ear ringing picks up volume, but not below 7.5mg.
> Here's an interesting question for all Remeron users. I have the 30mg disolvable tabs. I never took the entire tablet, I would crush it and then lick a tiny tiny tiny piece...mmm, tastes like Orange. but I would take only about 2.5mg. They say that Remeron works best for sleep at lower doses, so would 2.5mg be stronger than an entire 15mg tab? Would 1mg be even stronger? You guys know what I mean? =O
>
> I've taken remeron several times in the past to help me sleep or to take away panic/anxiety attacks. It works magic, everytime! Yah, I gained weight and had aggatation the next day but I love how it knocks me out at night.
Posted by pstrait on January 8, 2008, at 1:35:47
In reply to I Wonder Why Remeron Isn't More Popular?, posted by bleauberry on January 2, 2008, at 19:22:47
I love remeron -- I take 30 mg a day along with 600 mg of trileptal, and it has been fantastic. Some people don't like the fact that it makes you hungrier -- I am underweight and have not really gained much while on it, although I have gained a couple of pounds in the last two months. My only complaint is that it doesn't make me even more hungry.
Posted by ExcellentCamper on January 10, 2008, at 5:40:50
In reply to Re: I Wonder Why Remeron Isn't More Popular?, posted by pstrait on January 8, 2008, at 1:35:47
My pdoc was talking to me about Remeron as a possibility. It was great for me when I first went on it, when sleep and agitation were the issues. But ultimately it was too sedating ... had a difficult time getting up for work in time. He was saying that at high doses, you avoid this effect. So it might be worth going back to. I've been on Emsam for five weeks now (just moved up to 12 mg) with absolutely NO effect and lots of frustration over patches coming off. Seems to be overrated and overpriced.
Posted by binarywoman on January 15, 2008, at 16:42:59
In reply to Re: I Wonder Why Remeron Isn't More Popular?, posted by James_Glasgow_UK on January 4, 2008, at 8:24:39
My mom sees a geriatric psychiatrist and says it's a good med for that population. She does well on it. She's also taking Lexapro.
My son, who is bipolar, took it when he was a teenager and it made him psychotic. It took months of AP's to get him back to normal.
Karen in NY
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