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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 5 to 29 of 45. Go back in thread:
Posted by ClearSkies on March 28, 2008, at 7:24:03
In reply to Medication adjustment - Remeron, posted by ClearSkies on March 27, 2008, at 20:07:52
> I finally admitted that my prolonged bout with depression was probably not situational, and called my pdoc for a phone consult. As I had been at 45mg of Remeron, we decided to increase it to 60mg and see if that makes an improvement.
>Oops - I meant to say that I'd been at 30mg and have gone up to 45mg.
CS
Posted by dbc on March 28, 2008, at 9:06:02
In reply to Re: Medication adjustment - Remeron » dbc, posted by ClearSkies on March 28, 2008, at 7:22:45
> Effexor has already pooped out on me, but while I was on it, it elevated my blood pressure, caused night sweats and hot flashes, and constipation. NOT my favorite antidepressant, as you might gather.
> CS
>Cymbalta would be just as effective. The point is that the combination is extremely potent and synergistic not the drugs themselves.
>
Posted by ClearSkies on March 28, 2008, at 10:26:28
In reply to Re: Medication adjustment - Remeron, posted by dbc on March 28, 2008, at 9:06:02
>
>
> Cymbalta would be just as effective. The point is that the combination is extremely potent and synergistic not the drugs themselves.
> >
>
>Cymbalta also pooped out on me (I've been on quite a few AD's by now). Remeron is the most suitable one in 12 years of tinkering. Can you explain how a medication that didn't suit me, caused uncomfortable side effects, and pooped out could be an effective synergistic aid, because I don't understand that bit.
Thanks for your input.
Posted by dbc on March 28, 2008, at 10:45:31
In reply to Re: Medication adjustment - Remeron » dbc, posted by ClearSkies on March 28, 2008, at 10:26:28
It was simply a suggestion its not important.
Theres plenty of science behind the combination of remeron and SNRIs being synergistic and extremely potent, some would say dangerously so. The cocktail is usually refered to as california rocket fuel or at least thats what stallman (the guy who writes the comprehensive text book on psychiatric pharmacology) called it when he created it.
Posted by Sigismund on March 28, 2008, at 23:38:30
In reply to Re: Medication adjustment - Remeron, posted by dbc on March 27, 2008, at 20:37:08
>Effexor with remeron produced some pretty interesting effects in me. Stallman is insane for coming up with that combo but its definetly effective at being an anti-depressant for most people.
You want to say what it felt like?Did it feel dangerous?
Did it feel good?
and anything else.
Posted by dbc on March 29, 2008, at 12:57:28
In reply to Re: Medication adjustment - Remeron » dbc, posted by Sigismund on March 28, 2008, at 23:38:30
> You want to say what it felt like?
>
> Did it feel dangerous?
>
> Did it feel good?
>
> and anything else.It basically felt like your brain was being slammed with neurotransmitters which left me in a sort of dream state. Im sure its by far the most potent SNRI/SSRI experience most people could. It was the only time i had any sort of anti-depressant reaction from these class of drugs which may have simply been drug induced hypomania but who can say. I've had this conversation with my psychiatrist before numerous times and she has no answer "what is the difference between not being depressed and hypomania", she doesnt know especially with people that have had long term depression.
Is it dangerous? Eh possibly, when you start mixing these seretonin promoting drugs theres always an off chance of serotonin syndrome.
If you're at that crossroad where you feel like all the typical SSRI/SNRI drugs are kind of not effective than give it a try.
Posted by Molybdenum on March 30, 2008, at 16:49:00
In reply to Re: Medication adjustment - Remeron, posted by dbc on March 29, 2008, at 12:57:28
Hi,
I'm taking 600mg Effexor & 225mg Remeron. So that'll give you an idea of how much you can take without causing death (!).
I started on 75mg Effexor & every few months the doc bumped it up as I still felt depressed. Then I read about the mix with Remeron & he agreed. At first it REALLY helped me get to sleep but the effect would wear off in a few months. Then we'd increase the dose again & I would again get to sleep really easily.
I never had any undesirable side effects by increasing the Remeron. I used to get anxiety when we increased the Effexor though. And BTW it DOES seem to be working for me as an anti-depressant although I still have bouts of feeling hopeless, etc. But overall, it's the best combo I've ever been on.
The doc said there's no justification for increasing it any more so here's where I say until either it poops out & I have to switch (maybe never - I hope) or else I succeed in slowly tapering down the Remeron (my plan for now).
Have a look at my other post on this, there's ref to the magic spell book of synergies. ;)
http://www.dr-bob.org/babble/neuro/20080114/msgs/809756.html
Good Luck
Posted by ClearSkies on April 1, 2008, at 12:49:05
In reply to Re: Medication adjustment - Remeron - correction, posted by ClearSkies on March 28, 2008, at 7:24:03
I have some semblance of motivation at this higher dosage. Have even cooked a couple of meals from scratch and done laundry - on the same day. Formerly have had to plan these activities throughout the week or else they would never get done. It's too soon to say I'm out of the woods but I'm getting glimpses of the sky. My greatest fear is that this medication will poop out on me as Effexor and Cymbalta both did. The memories of the depression I lived with during those times are still so very vivid.
CS
Posted by Phillipa on April 1, 2008, at 20:20:10
In reply to Feeling brighter at 45mg, posted by ClearSkies on April 1, 2008, at 12:49:05
Hey that's great good to hear good news!!!!! Phillipa
Posted by undopaminergic on April 2, 2008, at 3:18:59
In reply to Re: Medication adjustment - Remeron, posted by Molybdenum on March 30, 2008, at 16:49:00
In my experience mirtazapine (genergic Remeron) is more than dangerous enough on its own - no augmentation required. I was only taking 15 mg (or 7.5 mg? I don't remember), but I was having 24 h tachycardia and after meals it would get worse: my motor coordination would dissipate, my voice become dysarthric and there would be stiffening/cramping of neck and facial muscles. I don't think I've ever been so "drunken". I had to quit it in only a few days, which is sooner than for any other drug I've taken.
I suspect the problem was the blockade of alpha2-adrenergic receptors. These receptors should not be blocked; rather, they should be stimulated, for example with guanfacine, which has a soothing effect on the cardiovasclar system and enhances cognition.
Posted by ClearSkies on April 2, 2008, at 7:11:44
In reply to Re: Medication adjustment - Remeron, posted by undopaminergic on April 2, 2008, at 3:18:59
In my experience the drunkenness goes away rather quickly at higher doses. I haven't ever had any of the other side effects that you speak of.
thanks
CS
Posted by DuckDuckGoose on April 2, 2008, at 19:40:16
In reply to Re: Medication adjustment - Remeron - correction, posted by ClearSkies on March 28, 2008, at 7:24:03
I on my second week of taking Remeron (7.5mgs) to help sleep along with my zoloft and it is definitely brightening my mood even at this low dose. Even helping with ssri sexual problems. Hope it continues to work!
Posted by bissie66 on April 6, 2008, at 22:47:12
In reply to Re: Medication adjustment - Remeron » ClearSkies, posted by Phillipa on March 27, 2008, at 21:12:05
Just saw this thread and wanted to say this combo (Remeron and SNRI) is by far the best I have tried. I haven't even gained weight on Remeron this time around. I highly recommend it. (Also, absolutely no sexual side effects - in fact, it can improves things in that area.)
Posted by X-ray on April 7, 2008, at 10:34:35
In reply to Re: Medication adjustment - Remeron, posted by bissie66 on April 6, 2008, at 22:47:12
Hello bissie66,
Which SNRI drug do you take in combo with Remeron?
My doc has recommended Remeron and Effexor, but I have been afraid of Effexor.
Effexor is a medication people utterly loathe to have taken (from crazymeds.us).
Typical side effects: ...loss of libido and a host of other sexual dysfunctions (crazymeds.us).Keep smiling,
X-ray
Posted by bissie66 on April 7, 2008, at 13:49:06
In reply to Re: Medication adjustment - Remeron, posted by X-ray on April 7, 2008, at 10:34:35
Hi there! I am taking Cymbalta along with Remeron. I have taken both, and I think Cymbalta is a lot smoother, with fewer side effects, than Effexor. My pdoc said Cymbalta and Effexor should do the same thing when taken with Remeron, so I would think your pdoc would be willing to try Cymbalta instead of Effexor.
Having said that, I also had zero sexual side effects when I took Effexor + Remeron.
Feel free to ask me any questions you have about this combo. I am more than happy to help. Bissie
Posted by undopaminergic on April 9, 2008, at 22:07:33
In reply to Re: Medication adjustment - Remeron, posted by X-ray on April 7, 2008, at 10:34:35
> Hello bissie66,
>
> Which SNRI drug do you take in combo with Remeron?
>
> My doc has recommended Remeron and Effexor, but I have been afraid of Effexor.
>
> Effexor is a medication people utterly loathe to have taken (from crazymeds.us).
> Typical side effects: ...loss of libido and a host of other sexual dysfunctions (crazymeds.us).
>All serotonergic medications (and to a lesser extent noradrenergics), tend to have sexual side effects. However, I don't understand why they are mentioned so often, because they are no big deal. The diarrhoeas & loose stools are a lot worse, and so are the sleep disturbances, tremors, apathy and dry mouth. Of course, not everyone has all the side effects.
Posted by bissie66 on April 10, 2008, at 8:57:41
In reply to Re: Medication adjustment - Remeron, posted by undopaminergic on April 9, 2008, at 22:07:33
Remeron is different. I don't know what class it is. But it doesn't have sexual side effects that I'm aware of. Has anyone taking Remeron had sexual side effects from it? Is it even listed as a side effect? For some reason, for me (and others that I've read about) it negated the sexual side effects of Effexor.
Posted by undopaminergic on April 10, 2008, at 23:02:44
In reply to Re: Medication adjustment - Remeron, posted by bissie66 on April 10, 2008, at 8:57:41
> Remeron is different. I don't know what class it is. But it doesn't have sexual side effects that I'm aware of. Has anyone taking Remeron had sexual side effects from it? Is it even listed as a side effect? For some reason, for me (and others that I've read about) it negated the sexual side effects of Effexor.
>It's probably because Remeron is only weakly serotonergic, and because it's an alpha2-adrenergic antagonist much like yohimbine, which is used as an aphrodisiac.
Indeed, according to Wikipedia "Yohimbine hydrochloride has also been used for the treatment of sexual side effects caused by some antidepressants (SSRIs)".
Posted by bissie66 on April 11, 2008, at 6:35:36
In reply to Re: Medication adjustment - Remeron, posted by undopaminergic on April 10, 2008, at 23:02:44
Very interesting. That explains things. Thanks for the information!
Posted by pstrait on April 14, 2008, at 3:47:24
In reply to Re: Medication adjustment - Remeron, posted by bissie66 on April 11, 2008, at 6:35:36
I have been taking 30 mg of remeron for a few months now, and it has brought me completely out of depression. I had been taking zoloft, seroquel, and strattera, in addition to trileptal and lithium and adderall... now I take 30 mg of remeron, my trileptal, and adderall 3-4 days a week as needed.
Way less meds, and I haven't felt like this in almost a decade, when my bipolar disorder started to present. And I've been feeling great for the past several weeks -- but I've been sleeping 7-8 hours of sleep every night, so its not hypomania.
Remeron has really made the difference for me.
Posted by pstrait on April 14, 2008, at 3:50:15
In reply to I LOVE remeron, posted by pstrait on April 14, 2008, at 3:47:24
oh i was also taking around .5 mg of xanax every day, and when i started the remeron, my anxiety just went away. I can't remember the last time I took a xanax.
Posted by ClearSkies on April 14, 2008, at 7:20:16
In reply to I LOVE remeron, posted by pstrait on April 14, 2008, at 3:47:24
Me too. It's been by far the best medication for my depression that I've ever been on. And I'm encouraged that the increase to 45mg has been working. I did find it tough initially to adjust to, (when I first started taking Remeron) particularly at the lowest dosages - zzzz feeling so sedated! - but once I got up to a therapeutic range the fog lifted.
But the absence of side effects is the real godsend for me, and what has felt most that it gave my life back to me. I feel a full range of emotions, rather than a blunting of them as I have on other medications I've been on.
I'm still on a small daily dose of Xanax for residual anxiety (.5mg per day) but that hasn't changed in about 2 years.
CS
Posted by bissie66 on April 14, 2008, at 9:51:40
In reply to Re: I LOVE remeron, posted by pstrait on April 14, 2008, at 3:50:15
that's fantastic! that happened to me too, as far as anxiety. i was taking seroquel as needed for anxiety and i haven't taken it once since starting remeron. oh yeah, i was also taking it occasionally for sleep and i don't need help with anymore either.
Posted by bissie66 on April 14, 2008, at 9:54:56
In reply to Re: I LOVE remeron » pstrait, posted by ClearSkies on April 14, 2008, at 7:20:16
awesome! so, 45 mg. made a difference for you from 30 mg? less sleepy . . anything else? did you feel even better mood-wise too? i am considering upping my dose now from 30 mg to 45. thanks!
Posted by ClearSkies on April 14, 2008, at 11:25:53
In reply to Re: I LOVE remeron » ClearSkies, posted by bissie66 on April 14, 2008, at 9:54:56
> awesome! so, 45 mg. made a difference for you from 30 mg? less sleepy . . anything else? did you feel even better mood-wise too? i am considering upping my dose now from 30 mg to 45. thanks!
I needed the increase as an adjustment to my mood; my depression had deepened over the course of the last several months. While I had hoped it was going to resolve on its own, it didn't, and so I consulted with my doctor and he recommended the increase to 45mg. After 2 weeks I'm doing better and resuming more of my "normal" functions, as normal as I get, lol.
CS
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